Re: BGs haven't budged - need advice from Lantus users
Hi. I'm not able to tell you whether to change the dose at this time as I leave that sort of specific advice to people with more experience or people who have been following your condo and know all the details. Nonetheless, I can give you some general advice based on my experience with Lantus.
RE: Checking with the Vet. The official answer you will always get if you ask that vet question is "Always talk to your vet before you change the dose." There's certainly no reason not to, in a perfect world. However, a lot people who use this board don't. Aside from the costs, it seems to depend on whether the vet is knowledgeable about Lantus.
My vet charges about $65 just to see my cat. I really can't expect him to make a decision like that without seeing the cat, taking some tests (more $), and reviewing the spreadsheet. A few people have a vet who is experienced and knowledgeable about Lantus. The vet will take a copy of the spreadsheet and agree to a dose change without a full exam, tests, etc. Some will even give you a break on the cost. You could talk to your vet about whether he or she will do this, but if your vet doesn't know much about Lantus dosing, that won't help you very much.
I found that the experienced people on this board knew far more about dosing Lantus than my vet. I almost always posted for advice before I changed the dose regardless of what the protocol said. Feel free to do this even if your questions seem silly and the answer seems obvious. Part of the beauty of this board is the moral support for something that is worrisome, nerve racking, and tends to make even the most confident people nervous -- dosing insulin.
My cat bounced a lot (when the liver dumps glucose in response to a lower BG than the cat's body is used to experiencing). This made it really hard to tell when I was seeing "real" numbers or bounces. That made me feel uncomfortable using the protocol alone. I found out later that it didn't matter a whole lot whether I was seeing a bounce or not, but I was a Nervous Nelly who couldn't get that concept. There is sooooo much to learn and so many little things you can do this way or that. That's why it's great to have this board to help you while you are on the steep Lantus learning curve.
Of course, there is the money issue. I changed Max's dose over 20 times. I spent all that money (more than $1500 just for vet visits, for sure) on supplies, insulin, pet sitters, etc. instead of on the vet visits. Also, in my opinion, it is not always practical to see the vet every time. You might end up changing the dose every three days in some cases.
Ultimately, it's your decision because you hold the syringe. If you do talk to your vet, and his/her advice conflicts with what the protocol says, I suggest that you seriously consider following the protocol instead whether its TR or SLGS. There are always exceptions or medical conditions that have bearing on this decision, but generally the protocol is the way to go. However, you can skip a shot if you don't feel comfortable shooting a low number, can't be home, can't stay up half the night, etc. Some people using TR will shoot very low numbers and go "as fast" as possible -- changing the dose every 72 hours. They are usually people who have been dealing with FD a long time or this is their second FD cat, or something similar. I would not have been comfortable with that.
That said, when the cat is getting high numbers, one problem with NOT raising the dose if the protocol calls for it, is the possibility that the cat will take a lot longer to get to regulation and require a higher dose in the end before you start to see the need for decreases. For this reason, you don't want to hold a dose too long if you are getting nadir numbers after 6 to 10 cycles (3 to 5 days) of that dose that indicate an increase is necessary. Another problem is the possibility for ketones. It has probably been suggested that you get Ketosticks, and use them to test fresh urine. There are other issues, too, but these are two. If you are getting numbers up in the 250 and higher range at shot time, you want use the protocol or consider posting for dosing advice unless you feel ok with using the protocol alone.
RE: Tight Regulation. As far as TR vs. SLGS is concerned, anyone who has had success getting her cat regulated on TR will tell you it is the way to go. However, unless you can keep your cat safe while using it, you should stay with SLGS. Keeping the cat safe may require you to stay up half the night, stay home all day, etc. If you don't have to go to work, and don't need to sleep every night, you can probably use TR, no problem. Some people even use it although they have jobs away from home.
You can always take it a bit slower than what the protocol would suggest. If you are getting low numbers, such as under 150-200 at shot time, you can skip doses every now and then when you, as the caregiver, are not feeling well or are too tired. (You would only do this when you see numbers below 200 at shot time. If you are getting numbers up in the 250 and higher range at shot time, you want to keep shooting every 12 hours.) Even people very experienced with TR take it slower sometimes. An important part of deciding whether to give a shot when the BG is under 150 at shot time is "caregiver condition" at night or the ability to stay home with the cat in the day.
I'm sure there are more experienced members who can elaborate on what I've said or clarify anything you have questions about. All in all, I'm impressed with how much you are testing, and I think it's a good sign that you saw a Yellow number at test time recently. You will want to set your alarm and get some +6 tests in the night. It's important to have this information. Also, BG can be different at night due to the circadian rhythm.
Best of Luck!
