Django 18/10 AMPS=274, +4=365, +7=385, +10=418 dosing help!

[Amy and Django]

We switched to Lantus on Sept 25 and I feel like it was the biggest mistake ever. After 9 days on 1.5 units of Lantus 2x a day, Django's numbers are still horrible and he's peeing on the floor again. His preshot numbers are sometimes better than at any other time in the cycle - I have yet to even see Nadir type lows. What do I do? Raise the dose? Maintain? Go lower? Give up and go back to caninsulin? I'm feeling really panicky and guilty, like I can't get any of this right.

https://felinediabetes.com/FDMB/threads/django-15-10-amps-362-5-338-dosing-advice.236936/

 

[Chris & China (GA)]

You're holding the dose longer than you need to which can allow glucose toxicity to set in. I know it was suggested that because he got into blue that he might be bouncing, but I have to wonder if that was just a bad test. Anytime you get a number that just doesn't make sense with the other tests you've gotten, it's a good idea to grab another test to make sure.

Have you decided which dosing method you want to use? Start Low, Go Slow or Tight Regulation? If there's no dry food in the picture (which it looks like there isn't) you can do TR which allows you to increase the dose every 3 days if it's not getting him where you want him.

I'd take him up to 2U and see how he does.

 

[Amy and Django]

Thank you! No, no dry food. Seeing as I'm back to work I won't be able to test as regularly so I don't think I will be able to do TR - SLGS seems preferable if I can only do consistent mid cycle testing on weekends. I just don't want to leave him at high numbers for too long, though. I will go to 2u tonight and do at least 2 tests post shot. What kind of numbers should I be seeing if things are going well, and when more or less?

 

[THH & Snowcrash (GA)]

I'm not as familiar with the dosing methods as Chris is, but I second the recommendation to increase to 2 units. Even without the bg numbers, he's having hyperglycemic symptoms, which also supports an insulin increase.

It can take Lantus a week or two to really start working. So hopefully he'll be feeling better and hitting lower bgs soon.

 

[Chris & China (GA)]

Seeing as I'm back to work I won't be able to test as regularly so I don't think I will be able to do TR

Have you read the idea's in the "Is TR possible with a full time job?" thread?

What kind of numbers should I be seeing if things are going well, and when more or less?

There's no pat answer for that. I wish there was!! But I also think you don't understand the difference between Caninsulin and Lantus. With Caninsulin, yes, you can force those numbers down but then it wears off and they go right back up. You can get stuck in a continuous bounce cycle too by dropping too fast. With Lantus being a gentle insulin, you shouldn't get the big fast drops (although they can still happen occasionally) but the dose lasts through the next cycle. It can look like you're not getting the "better" numbers, but in the long run, the Lantus will work longer and produce a more gentle curve.

 

[Sue and Luci]

Hang in there Amy...this Lantus stuff takes time. Lantus is a depot insulin and it takes time to build the depot up...at that point you may see some better numbers. If not, you can increase again.

Chris has given you great advice about Caninsulin and Lantus - they're just very different acting insulins.

Have a great evening Amy!

 

[Wendy&Neko]

I'm not as familiar with the dosing methods as Chris is, but I second the recommendation to increase to 2 units.

As someone a little more familiar with the dosing methods, I have to say a 0.5 unit increase is too much at this point in time. With either of our dosing methods, you would only increase by 0.25 units if you are seeing numbers under 300. That blue on the 14th does look possible, as he kept going straight up and bounced after that. It's a lesson all of us have had to learn, but Lantus really does teach patience.

If you could swing TR, you could increase faster. You don't have to get mid cycle tests per say. If you shoot two hours before you head out the door in the morning, you can get a +2 as you leave, and that's good enough to give us a good clue what happened that cycle. Bonus, it'll tell you if you need to leave higher carb food out to keep him safe while you are away for the day. If a +2 isn't possible, is an in-the-door at +10 possible? Then get that before bed test at night, hopefully +2 or later. And that's enough data to do TR and safely increase faster.

 

[Amy and Django]

Have you read the idea's in the "Is TR possible with a full time job?" thread?

I just did a bit more reading about tight regulation and it may work with my schedule. I just have to get handle on his cycle - right now with his numbers constantly high I have no idea when his nadir will be etc. I'm going to track him as much as I can on the new dose and see what the numbers say over the next few days.

There's no pat answer for that. I wish there was!! But I also think you don't understand the difference between Caninsulin and Lantus. With Caninsulin, yes, you can force those numbers down but then it wears off and they go right back up. You can get stuck in a continuous bounce cycle too by dropping too fast. With Lantus being a gentle insulin, you shouldn't get the big fast drops (although they can still happen occasionally) but the dose lasts through the next cycle. It can look like you're not getting the "better" numbers, but in the long run, the Lantus will work longer and produce a more gentle curve.