08/31 Benjamin AMPS 159, +5 40, +10 114, +11 115

Status
Not open for further replies.
cindyh

cindyh

Member Since 2012
Hello!

I've been getting help on the general health board, but it's been suggested I start using this board for help with Benjamin's lantus dose. His numbers are low today, and he is about 30 minutes away from his PMPS and getting fed. I need help with a plan for this evening and tomorrow morning. I'm still pretty new to this and appreciate all the help.
 
The quick answer is that I think you should reduce Benjamin's dose to 1.0u.

Now for the long answer. What I suspect you're seeing is the result of the 1.5u dose and an insulin depot that's a bit full. I'm not entirely sure why you reduced Benjamin's dose from 1.5u to 1.25u last night. With Lantus, if you're following the Tight Regulation Protocol, doses are reduced when a cat who's within a year from diagnosis, BG numbers fall below 50. Maybe you're intuition is very much in tune with Benjamin! There are times when you reduce the dose but the insulin depot hasn't quite caught up with the dose reduction and numbers continue to run low for a few cycles. Ordinarily, you would hold the dose. However, we don't know Benjamin. I'd sooner err on the side of safety and have you take the reduction. If the numbers don't hold, you can always increase the dose.

Also, could you clarify how his numbers dropped so low on 8/16? It looks like there wasn't any insulin given (i.e., there's no dose amount noted).
 
Thanks, Sienne. First the quick question, should he get 1u tonight? And if so, should I wait till a little later when his number is higher?

The dose reduction last night was from advice I got on the general health forum. No, I don't know Benjamin that well. I'm only his foster mom and he came to live with me at the beginning of July. And that ties into the story of how his number got so low on 8/16. I started out testing only a few times per week on the advice of his vet (my boss! yikes!) and he was getting 3u twice a day. His numbers had been looking ok, and he looked fine that evening, his normal self. But I guess it was intuition that told me to test him that night before I shot him, and thank goodness I did. I have been here ever since figuring out what I really need to do for him.
 
Hi Cindy, welcome to Lantus Land! You are doing a great job with Benjamin. :-D Sienne is a dosing expert and gives excellent advice. Be sure and post all of your questions. The collective knowledge and expertise of this place is amazing.
Liz
 
I think you're find to shoot the 1.0u. It looks like he's bouncing given the big jump between the +11 and PMPS.

Thank goodness you tested Benjamin when you did on 8/16. I'm not sure why more vets don't encourage home testing. I know there are a lot of people who are afraid to test but it's the best possible way to keep a cat safe. If this were a child, I have no doubt that caregivers would be testing!!
 
Thanks so much. I will give him the 1.0u. Should I plan on sticking with the 1.0u for a few cycles?

I don't know how people manage without home testing.
 
Unless the numbers dictate otherwise, any dose change is held for 3 days/6 cycles. Don't overreact to the bounce. It can take a bounce 72 hours to clear. It's going to be hard to tell if the reduction isn't holding vs. a bounce.

Tight Regulation Protocol sticky said:
Many Lantus and Levemir users in this forum have been successful following a somewhat modified version of this Tight Regulation Protocol for the last few years. These "general" guidelines are based on anecdotal evidence and personal experiences of laypersons frequenting the forum.

"General" Guidelines:
  • 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.

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.
  • 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.

Reducing the dose:
  • If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.
  • If an attempted reduction fails, go right back up to the last good dose.
  • Try to go from 0.25u to 0.1u before stopping insulin completely.
Click to expand...
 
Thanks, Sienne. Just so I can hopefully get a better understanding of this, when I reduced the dose to 1.25u, according to the protocol, it looks like it should have actually been increased by .25 since his nadirs were over 200. Is that correct or am I misinterpreting? It's so hard sometimes to stick with the data and not overreact to an individual number.
 
Status
Not open for further replies.
Back
Top