I’d like to address some things which are not exactly correct. A lot of members read but don’t post and they should have the correct information.
Lantus works best when dosed consistently
There are other FD sites where they shoot sliding scales of Lantus and the cats seem to be doing fairly well. It’s just that the methods we use here, TR and SLGS, call for consistent dosing. This mantra around here that “Lantus loves consistency” isn’t true, There are other ways to use it; again, it’s just not how we use it here because we’ve found the methods we do use to be effective.
Stay at that dose for 6 cycles (3 days)
If she’s reducing the dose, there is no need to hold it for six cycles. I know you might think it’s not really a reduction because she’s not shot 1u every cycle but why stay at a dose that might not work for her when it’s less than what she was shooting?
. If you see that he's on an upswing, then you can go ahead and feed & shoot, knowing that by the time the insulin starts working, his food will start to hit his bloodstream and he'll be fine.
If his numbers are not coming up after stalling, you may decide to skip the shot (if, for example, you're not home to monitor). In that case, you should reduce the dose and stick with that reduced dose for 6 cycles. If his nadirs start to go above 200, then you can gradually increase the dose by 1/4 units. Remember that Lantus dosing is based on how low it takes him, and not what his BG is at pre-shot.
When stalling, we test every 20, not 30, minutes to catch the rise.
Theoretically, the food should hit the BG within 30-60 minutes and before onset. However, if numbers are still lower and she has to leave, she will have to decide whether she’s comfortable shooting or not. Example: PS is 60; she stalls 30 minutes without feeding and it comes up to 70. She shoots and feeds and at +1, it’s 80. At +2, he onsets and drops to 50. Yes....I’ve seen it happen a lot. So to tell her the food will hit the bloodstream and he will be fine when she’s not there to test and be sure....maybe, maybe not.
If she skips a shot for BG above 50 that she’s not comfortable shooting because she has to leave, why would she reduce the dose? She wouldn’t unless she was doing SLGS. If she was doing SLGS and didn’t feel comfortable shooting a 95 and leaving so she skips, she wouldn’t reduce the dose. Again, if she did get a number she couldn’t shoot because it was below 50 for TR or 90 for SLGS and she did have to reduce the dose, she wouldn’t hold it six cycles. For TR, if in three cycles, it was clear it’s a failed reduction, she would go back to the last good dose. If it’s SLGS, she’d wait seven days and do a curve and then adjust the dose, if necessary.
Amanda...if you read the stickys at the top of the forum, you’ll see we direct new members to the two methods to regulation we use here....Tight Regulation Protocol and Start Low Go Slow. Although it’s very possible to do TR and work, it does require a bit more testing than you are able to do, it appears.
No judgement here at all but we base dosing on the lowest number of the cycle and if you aren’t getting any tests at night, we have no idea how low a dose might be taking him. Cats often go lower at night. I usually suggest that members always, always get a preshot test both cycles. Always. For working members, in the morning after you’ve given insulin and fed, if you can grab an out the door test and then an in the door test, that helps. Then the PMPS, a +2, and a before bed test. That gives us plenty of data to have a better idea what’s going on.
Where to go from here? Normally, I’d tell a member that with this SS, they should reduce to 0.75u and try to get in more tests long enough for us to see how low the dose is taking him. However, what is more important right now is to get you shooting twice a day as much as we safely can. Therefore, I agree that dropping the dose to 0.5u and trying to collect more data will help us figure out where he needs to be.
Again, please read the stickys and let us know which method you want to follow by posting it in your signature. If you are doing TR, we dont shoot below 50. If you are doing SLGS, you’d skip if the BG is less than 90 at shot time and you can’t stall without feeding to see if it comes up.
