Need dosing advice on Lantus

Hi there, I am not an expert on dosing, but have a little experience. Looks from spreadsheet you were on .1 ( 1/10 of one unit) or a drop until last night and then increased just last night to one full unit?

We normally do not increase back up that much at once. If it were me I would get advice on what current dose should be.

I had initially tagged Amanda when she was online at shot time, but just missed her.

I later saw you had some advice yesterday on dosing. I am copying @Krystina & Nelli because she is familiar with situation from yesterday. I know it is probably past shot time now..
sorry
 
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I'd strongly encourage you to read the sticky note on the two dosing methods we use and pick one that you can follow. In looking over Spooky's spreadsheet, I'm having a very difficult time figuring out your dosing strategy. It looks like you're basing your dosing on the pre-shot numbers and Lantus dosing is based on the nadir. This is very different than with Vetsulin where you can adjust the dose based on the pre-shot number. Because Lantus is a long-acting insulin, you base dosing primarily on the nadir.

Please look over the dosing sticky and ask questions if you have any.
 
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Sienne and Gabby (GA) said:
I'd strongly encourage you to read the sticky note on the two dosing methods we use and pick one that you can follow. In looking over Spooky's spreadsheet, I'm having a very difficult time figuring out your dosing strategy. It looks like you're basing your dosing on the pre-shot numbers and Lantus dosing is based on the nadir. This is very different than with Vetsulin where you can adjust the dose based on the pre-shot number. Because Lantus is a long-acting insulin, you base dosing primarily on the nadir.

Please look over the dosing sticky and ask questions if you have any.
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I understand it now. I'm gonna upload a pic and can you tell me how much I gave Spooky this morning. The thing I'm really confused on is how much insulin I'm giving him.
 

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Take a look at the sticky on insulin care and syringes. There is a larger than life depiction of the markings on an insulin syringe. This may help you figure out what you're doing. From your photo, I'm guessing that you gave approx. 0.25u

There are several differences between Vetsulin and Lantus. With Lantus:
  • Dosing is based on the lowest number in the cycle (the nadir) and not on the pre-shot number;
  • You can test, feed, and shoot all within a few minutes since Lantus onset is at approximately +2 (vs Vetsulin which acts much more quickly);
  • Lantus is a long acting, depot type of insulin so it acts very differently than other types of insulin;
  • You hold the dose for a specified period of time, a minimum of 3-days, depending on the dosing method you choose.
  • With any change in dose, you need to let the depot stabilize for at least 3 days.
I'm probably forgetting something but those are the basics. You truly have to think differently about how you're treating Spooky's diabetes when you change from a shorter acting insulin to Lantus.
 
Welcome to FDMB!! You are in great hands with Sienne.

I’ve sent you a private message about issues with Spooky’s Spreadsheet. Just click on “inbox” in the upper right corner and you’ll see my message. :)
 
Also are those u-100 3/10 cc syringes? Can’t see the numbers, so not sure? Can you look on the wrapper for the syringe, just to make sure. Thanks.
 
Sienne and Gabby (GA) said:
Take a look at the sticky on insulin care and syringes. There is a larger than life depiction of the markings on an insulin syringe. This may help you figure out what you're doing. From your photo, I'm guessing that you gave approx. 0.25u

There are several differences between Vetsulin and Lantus. With Lantus:
  • Dosing is based on the lowest number in the cycle (the nadir) and not on the pre-shot number;
  • You can test, feed, and shoot all within a few minutes since Lantus onset is at approximately +2 (vs Vetsulin which acts much more quickly);
  • Lantus is a long acting, depot type of insulin so it acts very differently than other types of insulin;
  • You hold the dose for a specified period of time, a minimum of 3-days, depending on the dosing method you choose.
  • With any change in dose, you need to let the depot stabilize for at least 3 days.
I'm probably forgetting something but those are the basics. You truly have to think differently about how you're treating Spooky's diabetes when you change from a shorter acting insulin to Lantus.
Click to expand...

I'm sorry I didn't get back to right away. My phone card ran out, so I didn't have phone service for a bit. I have decided to give Spooky 0.3U, which is what I gave him yesterday morning. Now when I tested his bs at 8:05am, he was 146. What I'm scared about is giving him the 0.3U because of him going too low and then he goes hypo. Can you suggest what I should do when he's at a lower number at shot time? He should have his shot at 8:30, which is 5 minutes from now.
 
It looks like he is coming up from last night's greens and I would give the shot because of that, as long as you are going to be home to monitor and he is eating and you have supplies (lots of test strips and HC or syrup if needed).
If you haven't shot yet, and you already fed him, test him anyway now, and let us know where he's at. If you normally shoot at 8:30 and it is now 9:30, then you will need to be able to adjust his shot schedule to 12 hours after that.
 
Sorry I didn’t see sooner.

Thanks @Dyana

I also wanted to mention, usually if a lower number than usual at shot time and lower than you are comfortable shooting, you can stall for say 20-30 minutes (without feeding) and test again to see if they are on the way up, if so then go ahead and shoot.

I personally would not feel comfortable shooting much lower than 150.

Lantus normally starts to onset a few hours after shot, so maybe check +3 to see how things look and nadir (lowest point) is “usually” but not always around +6 after shot, so check then also.
 
I want to make sure we're using the same language when we talk about "hypo." There's a difference between low numbers and symptomatic hypoglycemia. The latter is a situation that all of us try to avoid. Typically, this involves numbers below 40 - 50, although a my kitty had seen lower numbers than that and never had a symptom (probably because I tested like a fiend). This is one of the posts that discusses hypoglycemia. On the other hand, low numbers (i.e., 50s -- or even 40s and above) should not be a cause for panic. In fact, for those of us who follow Tight Regulation, cats have to drop into that range for a dose reduction. If those numbers were dangerous, the TR Protocol would never have been published. This post will walk you through how to deal with low numbers should no one be around on the Board to answer a question.

I disagree with @Julie and Honey about not shooting below 150, unless her goal is regulation, not remission. With Lantus, the basic premise is "shoot low to stay low". A Lantus curve, once a cat is tightly regulated, is flat. Your cat would be in almost entirely green numbers which means, by definition, your shooting numbers that are below 100.

 
Sienne and Gabby (GA) said:
I want to make sure we're using the same language when we talk about "hypo." There's a difference between low numbers and symptomatic hypoglycemia. The latter is a situation that all of us try to avoid. Typically, this involves numbers below 40 - 50, although a my kitty had seen lower numbers than that and never had a symptom (probably because I tested like a fiend). This is one of the posts that discusses hypoglycemia. On the other hand, low numbers (i.e., 50s -- or even 40s and above) should not be a cause for panic. In fact, for those of us who follow Tight Regulation, cats have to drop into that range for a dose reduction. If those numbers were dangerous, the TR Protocol would never have been published. This post will walk you through how to deal with low numbers should no one be around on the Board to answer a question.

I disagree with @Julie and Honey about not shooting below 150, unless her goal is regulation, not remission. With Lantus, the basic premise is "shoot low to stay low". A Lantus curve, once a cat is tightly regulated, is flat. Your cat would be in almost entirely green numbers which means, by definition, your shooting numbers that are below 100.
Click to expand...
I did not say anything about not shooting under 150, I said I personally would not feel comfortable doing it. There are a lot of variables to be taken into consideration. There have been many times when no one was around to ask and in that case people that are new here should not assume it is okay to shoot any number. Sorry, I was stating my feelings, that should be clear.
 
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