Newly switched to Lantus- question about increasing dose

[Ramon's mom]

I recently switched my cat from Prozinc to Lantus. The vet who suggested it had me start at 0.5 units despite Ramon having been at 3 units of the Prozinc. His numbers have gone up from in the blues to in the yellows as a result. I moved to 0.75 of the Lantus after one day but it has actually gotten worse. I was planning to the the Go-Slow approach which suggests I wait an entire week before increasing. I'm wondering if anyone can advise me on this. I'd like to increase now rather than have him be in the yellows for an entire week. I had him in the blues on Prozinc but he was kind of unregulated. And this vet hates Prozinc (its a vet new to me). I'd posted about this in the general health forum but was advised to post my questions here instead. Here's a link to the post in the general forum http://www.felinediabetes.com/FDMB/threads/switching-insulins.213989/#post-2371022

 

[Jill & Alex (GA)]

I agree with you. The starting dose was simply set too low.

I understand there's dry food in the picture and you intend to follow SLGS, but I think you need to fast track to get to an appropriate starting dose.

That said, I would suggest increasing in increments of 0.25 unit and revaluate after every six cycles provided you can continue monitoring closely . That would include getting at least a before bed test every night so you'd have an indication of where Ramon is headed. Once you start seeing numbers in the low 100s - high greens start holding doses for a week as suggested in the SLGS guidelines.

Tonight is the 5th cycle on 0.75 unit. If I were in your shoes (actually I have been ), I would shoot 0.75u tomorrow morning for a total of 6 cycles at 0.75 unit. With as much as you're testing and if nothing unusual happens between now and PMPS time tomorrow night, I would increase the dose to 1u bid, hold the dose for 6 cycles and reevaluate. Post for feedback. Posting daily will give everyone a chance to keep an eye on how things are going.

Make sense? Is close monitoring an option?
What do you think?

 

[Ramon's mom]

I agree with you. The starting dose was simply set too low.

I understand there's dry food in the picture and you intend to follow SLGS, but I think you need to fast track to get to an appropriate starting dose.

That said, I would suggest increasing in increments of 0.25 unit and revaluate after every six cycles provided you can continue monitoring closely . That would include getting at least a before bed test every night so you'd have an indication of where Ramon is headed. Once you start seeing numbers in the low 100s - high greens start holding doses for a week as suggested in the SLGS guidelines.

Tonight is the 5th cycle on 0.75 unit. If I were in your shoes (actually I have been ), I would shoot 0.75u tomorrow morning for a total of 6 cycles at 0.75 unit. With as much as you're testing and if nothing unusual happens between now and PMPS time tomorrow night, I would increase the dose to 1u bid, hold the dose for 6 cycles and reevaluate. Post for feedback. Posting daily will give everyone a chance to keep an eye on how things are going.

Make sense? Is close monitoring an option?
What do you think?

Your suggestions are good and I understand. With all these higher flat numbers I pull back on the monitoring because they worry me less than low numbers and he is getting tired of and reactive to the pokes and is starting to fight me on it. I am trying to give him breaks whenever I can. Generally I have been able to do a fair amount of monitoring. I have sleep problems so testing at night after the +4 is difficult for me. Daytimes vary for me. Over the last few months the excessive monitoring has made me very anxious and depressed, so I am loath to go back to that. But I'll try your suggestion to the best of my ability. Thanks!

BTW- there is no dry food in the picture now. In the past there was, but not in the last few weeks.

 

[Jill & Alex (GA)]

BTW- there is no dry food in the picture now. In the past there was, but not in the last few weeks.

I apologize. I caught my mistake, but obviously not before it had been read. I had crossed it out in my original post.

Your suggestions are good and I understand. With all these higher flat numbers I pull back on the monitoring because they worry me less than low numbers and he is getting tired of and reactive to the pokes and is starting to fight me on it. I am trying to give him breaks whenever I can. Generally I have been able to do a fair amount of monitoring. I have sleep problems so testing at night after the +4 is difficult for me.

I understand. Increase at your own pace if making dose adjustments every three days is too much.

Over the last few months the excessive monitoring has made me very anxious and depressed, so I am loath to go back to that. But I'll try your suggestion to the best of my ability.

I don't think you'll have to monitor more than you have been. I just think it will help to get that before bed test every night since cats often run lower at night. Doing the best as you're able is all any of us can do.

Hope to see you posting often... have a good day!

 

[Wendy&Neko]

Hello and welcome from me too. Good luck with the transition to Lantus and getting to a good dose. By the way a +4 test a night is a great one to get. You have a really good idea by then how that cycle is going.

I was reading with interest your thread in health where you mention feeding raw, in this case just rabbit. There are pitifully few rabbit options out there. I am dealing with a kitty who also has GI issues. If possible, it is better to find a couple proteins to rotate through. Have you found this website yet? http://www.rawfeedingforibdcats.org/

 

[Ramon's mom]

Hello and welcome from me too. Good luck with the transition to Lantus and getting to a good dose. By the way a +4 test a night is a great one to get. You have a really good idea by then how that cycle is going.

I was reading with interest your thread in health where you mention feeding raw, in this case just rabbit. There are pitifully few rabbit options out there. I am dealing with a kitty who also has GI issues. If possible, it is better to find a couple proteins to rotate through. Have you found this website yet? http://www.rawfeedingforibdcats.org/

Thanks for the link. I have access to a local pet food store that makes its own and sells a ton of different raw meats (chicken, turkey, pork, quail,venison, bison, lamb, duck, etc). The new vet has asked me to stick to rabbit right now so we can see if his skin condition(pemphigus) has a allergy component. Earlier I had him on pork, duck and rabbit plus low-carb canned foods. I will probably go back to that eventually.

 

[Ramon's mom]

"...Hope to see you posting often... have a good day!

Today went better numberwise, until PMPS. So I will up the dose to 1 unit and try that for a number of days. I decided to stop the pain med until the dose starts working better, then reintroduce it. I don't know if that also affected the BG numbers or not. We'll see, I guess. Thanks for the support.

 

[Wendy&Neko]

I wouldn’t stop the buprenorphine. You want to stay ahead of pain which can increase blood sugars. My Neko was on buprenorphine all the time for arthritis/acromegaly pain and her numbers improved when I started giving it. Plus she was just generally more happy and interactive and playing again.

 

[AmandaE]

Today went better numberwise, until PMPS. So I will up the dose to 1 unit and try that for a number of days. I decided to stop the pain med until the dose starts working better, then reintroduce it. I don't know if that also affected the BG numbers or not. We'll see, I guess. Thanks for the support.

Good luck with the new dose! I hope it goes well for Ramon!

 

[Ramon's mom]

...Hope to see you posting often... have a good day!

After 3 days at 0.75 I went up to 1 unit bid but his numbers are actually worse. I'm in the 6th cycle now at 1. Should I continue to increase? Should I wait more days to see if this improves? I added back in his buprenorphine (Pain killer) and since then his numbers have been in the 200's instead of the 100's. He seems "happier" but the BG is worse (and he's back to peeing a lot and everywhere). Any thoughts on the dose increase or whether to stop bupr again?

 

[Gill & George]

Have you read about the two dosing methods? What you do about the dose depends on which method you decide to follow.

Since the starting dose was probably a bit low for him (given that he was on 3u of prozinc), it's likely he will need to go up in dose.
Did you get a test before bed last night?

With him nadiring in blue and with no test on last nights cycle, on TR I might hold for 8 cycles and make sure to get those pm tests before taking him up to 1.25u

I added back in his buprenorphine (Pain killer) and since then his numbers have been in the 200's instead of the 100's.

I don't think bupe usually affects the numbers, guessing it's injectable?

 

[Ramon's mom]

Have you read about the two dosing methods? What you do about the dose depends on which method you decide to follow.

Since the starting dose was probably a bit low for him (given that he was on 3u of prozinc), it's likely he will need to go up in dose.
Did you get a test before bed last night?

With him nadiring in blue and with no test on last nights cycle, on TR I might hold for 8 cycles and make sure to get those pm tests before taking him up to 1.25u

I don't think bupe usually affects the numbers, guessing it's injectable?

I am not doing Tight Regulation because I cannot handle the intensity nor can he tolerate that much poking. I did not test last night because its all coming out the same numbers and I'm trying to give him a break from the pokes. He is also reactive to every insulin change so I am thinking he needs more cycles at the same insulin dose to see if things will settle down. Ironically he did better on 0.75 than he is doing on 1 unit. Its just that since changing to Lantus he hasn't got a single green number. I like the fact that Lantus doesn't swing as low as Prozinc, but I'd like to get it leveling out at the lower numbers. I don't know why his new vet insisted I start low on Lantus.

The buprenorphine is a compounded liquid and he is getting a very small dose. The vet wants it higher but anything higher makes him a sleeping zombie. Its for being declawed (not recently and not by me). The vet says he has pain and says this would ideally be longterm treatment. I can't tell if he has pain and/or can't tell if it helps. I'm just getting him off longterm drugs which probably caused his diabetes, so I am loathe to get him onto another longterm drug of questionable side effects.

 

[Jill & Alex (GA)]

He is also reactive to every insulin change so I am thinking he needs more cycles at the same insulin dose to see if things will settle down. Ironically he did better on 0.75 than he is doing on 1 unit.

It certainly won't hurt to hold the dose a couple more cycles if you think it would be better for him.

Its just that since changing to Lantus he hasn't got a single green number. I like the fact that Lantus doesn't swing as low as Prozinc, but I'd like to get it leveling out at the lower numbers.

It's likely it'll take a higher dose before you're seeing greens.

I don't know why his new vet insisted I start low on Lantus.

I didn't understand that either. That's why I suggested taking the dose up after every six cycles until you see high greens with low blues as long as you could monitor closely.

The buprenorphine is a compounded liquid and he is getting a very small dose. The vet wants it higher but anything higher makes him a sleeping zombie.

I also had to reduce Alex's bupe dose. I don't know why vets usually suggest a dose that zonks them out.

Hope you have a good day!

 

[Jill & Alex (GA)]

I added back in his buprenorphine (Pain killer) and since then his numbers have been in the 200's instead of the 100's. He seems "happier" but the BG is worse (and he's back to peeing a lot and everywhere). Any thoughts on the dose increase or whether to stop bupr again?

I don't think bupe usually affects the numbers, guessing it's injectable?

Bupe won't affect the numbers per say, but if he's uncomfortable or in pain without the bupe the discomfort could make the numbers rise.

Given the circumstances, I don't think I'd wait too long before increasing the dose as long as he'll tolerate being monitored, including a before bed check. The peeing may let up once his numbers are consistently below renal threshold.

Just my thoughts...