Lantus users

[Simba1]

Hi..I'm hoping I can get guidance with regulating my cat's glucose levels and Insulin injections., I have had little to no help from my vet, yet they are encouraging and have said I shouldn't go to a specialist. I've called a few clinics and they said any internist came help me..does not give me confidence. My cats name is Simba. He is 13, maine coon mix.
Simba started Lantus 10/8. I haven't done the spread sheet yet..looks complicated. I do keep a daily journal for his BG, Insulin, appetite, etc. Lately, he has had real lows 40s and highs, over 400. His appetite is iffy but I have lots to tempt him with. He is suppose to get Lantus every 12 hours, +/- 2 hours. No in-between feeding, but sometimes I give him cooked chicken breast. The vet started with 1 unit (my insistence), went to 2, 3 and 4 and thats when the problems started. For example:
12/16 - 9a.m. bc before insulin was 140. I gave him 1-1/2 units. . I took his bc every couple hours, bc was 57, 48, 58 and at 7p.m. 114. I didn't give him evening insulin.
12/17 - 8:30a.m.bc 461 before insulin. I gave him 2-1/2 units. His bc dropped down to 65 at 5p.m., 8:15p.m. was 169. Again, I didn't give him evening insulin.
12/18 7:45a.m. bc 423 before insulin. I gave him 2 units. At 4:24p.m. his bc was 46, fed him 1 small can, hungry. At 8:30p.m. bc before insulin was 235. I gave him 2 units.
12/19 today, 8:45 bc 127 before insulin. I had read that its bad to skip Lantus injection so I gave him only one unit of Lantus. At 4:09p.m. his bc was up to 365. I'll give him 2 units at 6p.m.
I am stressed that I'm doing something wrong and basically hurting Simba.
I am committed that by Friday I will tackle and complete your spreadsheet. Until then, any advice that will be helpful is appreciated. Thank you.

 

[Juliet]

You’re doing amazing! Just managing to convince your vet with the 1u starting dose is great! The spreadsheet really is easy. You just type in your reading and it automatically changes color. All the formatting has been done for you.

You’re in the best place you can be to get all the help you need. I’m a Lantus user too. The Lantus forum has many people ready and willing to help. There’s a few posts at the top of the forum which make really useful reading. There are two methods of dosing you can use for Lantus and both are listed in those “stickies”. I’m doing Start Low Go Slow (SLGS) but many are doing TR (Tight Regulation). Following one or other of these is very useful for knowing how to dose when not to dose etc.

Welcome to the best place you hoped you’d never be.

Read as much as you can. Other posts, stickies etc. it’s the best and fastest way to learn.

 

[Chris & China (GA)]

I haven't done the spread sheet yet..looks complicated

it's really not....it's already set up...you just have to download it and start plugging numbers in! Here are instructions, but if you have any problems, I'd be happy to set it up for you. Just click my name and choose "Start Conversation" to send me a private message.

He is suppose to get Lantus every 12 hours, +/- 2 hours.

Every 12 hours is right, but it really should be as close to exact as possible....early can act like an increase in dose.... late can act like a decrease. We know it's not always possible, but it's what you should strive for.

No in-between feeding, but sometimes I give him cooked chicken breast

The chicken breast is fine, but it's really not necessary to only feed twice a day. Most cats do better with smaller, more frequent feedings. The only time it's really important for them not to eat is the 2 hours immediately before testing before shots. (the "Pre-Shot" test)

The vet started with 1 unit (my insistence), went to 2, 3 and 4 and thats when the problems started.

Not surprising....Your vet has gone up in dose way too quickly and by too much. We only increase in .25 unit increments. A little bit can make a huge difference in how your cat responds.

Lately, he has had real lows 40s and highs, over 400

What's going on here is called "bouncing".....When his glucose drops too low (or lower than his body is used to), his liver releases stored sugars and hormones to bring him back up quickly. Dropping below 50 (on a human meter) means the dose is too high and he needs a reduction in dose

 

[Tracey&Jones (GA)]

Chris gave you some great advice so I am only going to say Hi!

 

[tiffmaxee]

Hi. Just want to add if using a pet meter under 68 calls for a reduction. What kind of meter are you using?

 

[MyTitan (GA)]

Reading your notes, you are increasing/decreasing dosages based on current BG readings. That is bad for Simba. Read the stickys over and over. Once a dose is started i.e. (1 unit ) hold that for at least 6 cycles (3days) then make a decision to increase or decrease as dictated. Dose is based on his nadir ( lowest reading thru the day) not on AMPS or PMPS. Most vets are not as proactive in treating FD, they are "old school". We have found the info and SUPPORT here on the FDMB to be invaluable in getting Titan semi regulated. He is an Acro cat so we are dealing with a tumor on his pituitary gland. Good luck and welcome .

 

[Sienne and Gabby (GA)]

Reading your notes, you are increasing/decreasing dosages based on current BG readings

That's not exactly correct. Let me restate what I think Paula, @MyTitan, meant. Your note suggested that you are basing your dose on your pre-shot blood glucose (BG) test number. With Lantus, the dose is based on the nadir (lowest point in the cycle) and not on the pre-shot number. While the pre-shot information is important from the standpoint of whether it's safe to shoot, overall, doses are increased or reduced based on how low a particular dose brings the numbers. It also sounds like your vet was raising the dose a lot more aggressively than we encourage or what the research literature would encourage. The Tight Regulation Protocol is based on published research. Dose changes are typically made in 0.25u amounts so you don't increase past what could be a good dose for your cat.

Like everyone else, I'd encourage you to transfer all of the information you've been collecting in a notebook onto a spreadsheet. The best way we can help you is to have your kitty's numbers in front of us. (I have 6.5 years of data in the SS in my signature if you want to see what the SS of a testaholic caregiver looks like. You do not have to emulate me!)