05/22/14 Kabaret : Dosing advice for 3rd day on Lantus

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kimouette

kimouette

Member Since 2012
Hi everyone,

Here's Kabaret's spreadsheet :
https://docs.google.com/spreadsheet/ccc ... _web#gid=0

We are currently going though Kabaret's 5th cycle on Lantus, but he obviously needs a dose increase.
Would it be too aggressive to increase to 3.0U tonight (keeping in mind that the cat's +3 will be tested, but nothing else during the night?) Or do we absolutely need to wait until tomorrow morning when we'll be able to test more often?
And should we increase to 2.75 insteadU of 3.0U?
The poor cat still has pretty high preshots even though he managed to go under 300 during his second and third cycle.

I'll wait for your advice! Thank you!
:)
 
Hi, I believe that you need to keep with the same dose of Lantus initially for about a week for Lantus. Then, you can change doses more frequently.

I know that seeing high numbers is frustrating, but if the cat goes below 300 a .5 increase might be too aggressive. What dose were you at on your last

insulin? Did you take that into account when starting the Lantus?
 
The depot of Lantus can take up to 5 days to build, so I would wait a bit longer.
 
What dose were you at on your last
Click to expand...
All the infos we know of are on the spreadsheet! He wasnt steady at all on Caninsulin. The only time we reached a green value was at 3.75U, but it kind of scared us!
As I am writing this, the last test just revealed that at +6 Kabaret is 290. So the nadir is definitely not at a fixed time of the day! This is going to be complicated!
I have never seen such instability, which is why I am writing to you guys!
And I'm starting to think that letting the numbers get so high might be what is causing the instability. So I'm really uncertain if waiting is a good idea!
The protocol mentions that if nadirs are above 200 but below 300 we can increase dosage after about 3 days... shouldn't this apply to Kabaret? Maybe by increasing to 2.75 instead of 3u?
 
I would hold it for another 2 days. Do you have a spreadsheet set up? It's hard to say for sure since we can't see the numbers, but if he dipped under 300 then I wouldn't say Kaberet is seeing high, flat curves which is what the protocol allows for increasing before the initial 5-7 day period. You don't want to increase him too fast, or by too much. Otherwise you could miss his optimal dose, and you could see high, uncontrolled numbers. Counterintuitive, I know.

~Suzanne
 
Ok, at first glance, those high numbers after the good ones are a bounce. Kabaret's body is used to higher numbers, so his body pumps out counter regulatory hormones when his blood sugar gets lower than he thinks is normal. You know those numbers are good, his body thinks they are too low. Julie, of Julie and Punkin(GA), has a good link that explains bouncing well.

The caninsulin isn't a depot insulin so you could adjust the dose more quickly. The Lantus builds up in he body so you want to give it time to work. You may have to increase it, but I'd give it a chance to build and see what he does with the dose he's on now.
 
Yes I know Caninsulin probably generated these bounces and I know about the depot.
But since he keeps going back to high numbers I thought a small increase might help just bring everything down a little.

Looking at his numbers, do you all agree that it is worth waiting another 5 cycles before increasing a little bit (a 0.25U increase)? Aren't we just letting his pancreas get worse everyday? Cuz I cant imagine that with such a small increase he would suddenly go into hypo! Now that I've said everything that's on my mind, I'll do as you guys say ...
 
Personally, I would. Just so I know I did things "by the book" and if I was still getting high numbers after that, I would know it wasn't my dosing. But that's just me.

This morning's preshot is substantially higher, which makes me think maybe he dipped lower overnight and bounced. He's recovering nicely from that though...down more than 200 points today. Cats often go lower at night so if it's possible to grab a +6 for a few nights, you can see where he's dipping to. I know getting up in the middle of the night to test is the last thing you want to do, but it could explain the high morning preshots. Lantus is dosed based on the nadir. It seems like you read the stickies, so you probably already know that. :smile: If you haven't, there's a lot of good info in them.

Ask lots of questions! There's a lot of experience on the board and you'll get some really helpful answers.

~Suzanne
 
Hi guys .. I don't think I've been to kabaret's condo before so welcome from us! No dosing advice from me but it looks like plenty of people have helped you out already .. have a great day guys!
 
I'll do as you guys suggest.. I'll wait until day 6!
I simply hope things dont get too ugly until then.
Poor kitty
cat_pet_icon
 
I agree on waiting a bit too. If there is any chance of getting a later PM test, that would be great. On the night of the 20th Kabaret went from 446 to 272 at +3. That's a big drop for Lantus, 175 points and a drop over 50 points an hour can cause bouncing. I would have set my alarm for a +5 or +6 test that night. But I see he also dropped a lot this morning.

The waiting for the depot to stabilize in Lantus is one of the toughest things to do.
 
I want to kill this forum. i just wrote this long post and now it's gone. second one tonight. ARGH!

ok, let me make it shorter. i'd give Kabaret another 2-3 cycles (total of 7-8) at the 2.5u and if you're not seeing greens by then and his spreadsheet hasn't changed significantly from the current numbers (high 200's and up) then I'd go ahead and increase. The guidelines say:

Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.
Click to expand...

That little caveat "unless the numbers tell you otherwise" . . . i think it was written for Kabaret. He didn't get to greens until 3.75 on Caninsulin and that told us that he might need more insulin than the 2.5u that we suggested for starting.

If you need to increase, based on the numbers you see in the next day or so, i'd decide on the amount of the increase by looking at these guidelines below. Right now he's having nadirs in the 200's, so i've highlighted the part that would apply to him - based on his numbers right now. If his numbers settle down and drop into low 100's or under, then let's reassess things. In the absence of that in the next couple of cycles, i would increase his dose.

Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Click to expand...
 
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