10/16 Vinnie amps 256 +4 311 +11 255 pmps 202 new to lantus

Vinnie Van Gogh's Mom

Member Since 2021
We switched from prozinc to lantus 5 days ago. Numbers were mostly in the 200s and 300s the first few days. Increased from .75u to 1u yesterday morning and he was significantly lower for pmps (156). Gave him .25u last night because of the lower preshot # and he dropped to 142 @ +3.5. He went back up to 256 for amps so gave him 1u this morning and he went up to 311 @ +4. Numbers are not making sense to me. Could he be having a delayed response to the insulin? (which would explain him dropping lower last night after the morning increase?) Should I stay the course with the 1u or make any changes?
 
Hi there,

When you get a chance can you update your signature please?

Please have a read through the dosing sticky here: https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

How you handle increases and reductions depends on the method you choose. Ideally you'd hold the starting dose for a week so the depot can build, but since you already changed it I'm thinking you should go back to 0.75U and hold that for a few days, but please wait for others to chime in @tiffmaxee @Christie & Maverick

What you're seeing is a bounce, it happens when BG drops lower or faster than they're used to, and it's different for every cat. Their body "panics" and dumps sugar into the bloodstream. It's normal, and will take a few cycles to clear. And it will take awhile over all for it to stop happening/swing as much.
 
Welcome to LLB. When did you make the switch? How much prozinc were you giving before the switch ? Usually you start with the same dose. It looks like from your spreadsheet you are going to follow SLGS. If that is correct please add that to your signature. It takes a week for the initial depot to build which is different from Prozinc which is not a depot insulin.

I think going back to .75 is a good idea since you already had to shoot a token dose.
 
You switched on 10/11? It would be helpful if you added the date you switched to your signature.

Lantus takes an entirely different mindset than Prozinc. With Prozinc, because it is not a depot insulin, you can adjust your pre-shot dose without the same effect on numbers that you will see with Lantus. Lantus dosing is largely based on the nadir. We typically recommend that if you get a lower than expected pre-shot number, that you post and ask for help.

The insulin depot is unique to Lantus and Levemir. When Lantus is injected, it forms microcrystals that are deposited in the fat tissue. Those crystals slowly dissolve. Not all of the crystals dissolve by the end of the 12-hour cycle. Instead, they overlap the next cycle which is what gives Lantus its long duration and ultimately, flat cycles. If you look at the spreadsheets of cats that are on OTJ trials, you'll see a lot of green numbers. It takes about 5 - 7 days for the depot to stabilize. It also means that with Lantus, you don't want to make back-to-back changes in the dose. Depending on which dosing method you choose to follow, doses are changed after 3 days/6 cycles with Tight Regulation or after a week with Start Low Go Slow (SLGS). Every time you make an alteration in the dose, it has an effect on the depot.

What you saw on 10/11 is fairly typical of an insulin switch. Your cat have a marked response to the new insulin. Numbers dropped and then you saw a bounce. It can take roughly 3 days for the bounce to clear.

So, at this point, I'm not sure exactly when you started Lantus and how long you need to hold the dose. I'd encourage you to read over the sticky notes at the top of the board. It will help you to wrap your head around the differences between Lantus and Prozinc. And please, ask questions! We're here to help.
 
Thank you so much everyone! @FrostD and @Sienne and Gabby (GA) I have udpated my signature.

@tiffmaxee I switched on 10/11 and was giving 0.8u of Prozinc. And yes, I am using the SLGS method for now.

Based on what I read in the sticky notes on Lantus dosing, I started him on approximately the same dose as the Prozinc (tough to do 0.8 on Lantus so I went with 0.75). I also saw in the Lantus dosing that if the pre-shot numbers were lower than normal but between 150 and 200 that one of the three options was to give a token dose which was why I went with the 0.25u. However, I admit I got impatient and did not hold the dose for a week as suggested in the sticky so I raised him to 1u. I must learn patience....

So it looks like the consensus recommendation is to go back to the 0.75u dose? Unfortunately, I gave him 1u again this morning before posting my questions. If he is low again tonight should I still give him the 0.75u? Or should I do another token dose tonight and do the 0.75u in the morning? Should I hold it for an entire week this time before making any changes?
 
You all may be out or in bed by now so I'm going to go with 0.75u since he dropped 50 points in an hour and is right on the 200 edge. Hope I'm making the right decision!
 
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