12/3 Toulouse AMBG 160

Toulouse’s Mom

Toulouse’s Mom

Member
Good morning :)

I am still trying to work through what my dosing should be with Toulouse. Gave him .5 last night of Lantus at around 8:45 PM when his numbers were 356 and this morning he has been reading in the 100s so we skipped.

Is there a world in which Lantus can or should be given once a day? We are getting a new Libre 2 tomorrow and an at home reader on the way!

Thank you!
 
There really isn't an effective way to dose Lantus once a day. What you will likely see is wild swings in numbers -- a drop after you give insulin and then high numbers 24 hours later. However, if the response to dose it too aggressive, the better strategy is to lower the dose so you can give Lantus twice a day.

Personally, I would stick with the 0.5u dose. If you're nervous about that dose, you can shoot 0.25u. I think the 160 was likely shootable number but you need to be comfortable with the dose and shooting that number. Are you home during the day? If so, you're able to monitor and bump up Toulouse's numbers with food. It can help to remember is you have a pre-shot number that may be a bit below your comfort level, you are going to be feeding your cat and it's roughly 2 hours before the onset of the insulin.
 
Sienne and Gabby (GA) said:
There really isn't an effective way to dose Lantus once a day. What you will likely see is wild swings in numbers -- a drop after you give insulin and then high numbers 24 hours later. However, if the response to dose it too aggressive, the better strategy is to lower the dose so you can give Lantus twice a day.

Personally, I would stick with the 0.5u dose. If you're nervous about that dose, you can shoot 0.25u. I think the 160 was likely shootable number but you need to be comfortable with the dose and shooting that number. Are you home during the day? If so, you're able to monitor and bump up Toulouse's numbers with food. It can help to remember is you have a pre-shot number that may be a bit below your comfort level, you are going to be feeding your cat and it's roughly 2 hours before the onset of the insulin.
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Unfortunately, I am not home during the day which is what is giving me the most uncertainty about the shooting at 160. We have a vet appointment tomorrow morning, is there anything specific I should ask them to help me regulate our doses?

Thank you for your help! I don't know why this all feels so hard to me.
 
Toulouse’s Mom said:
Unfortunately, I am not home during the day which is what is giving me the most uncertainty about the shooting at 160. We have a vet appointment tomorrow morning, is there anything specific I should ask them to help me regulate our doses?

Thank you for your help! I don't know why this all feels so hard to me.
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Hi Joy, Welcome and we are all here to help.
It's not unique to you to be very worried. This is all very new to you and very overwhelming. We understand and have all been there.
It's very normal how you are feeling. I just wanted to reassure you of that!
You are doing the best thing for Toulouse by being here and asking questions!

Wishing you both the best of luck and success! :bighug:
 
If you're unsure, then reduce the dose to 0.25u. As long as Toulouse doesn't have a history of ketoacidosis, it may be fine to have numbers run a little higher and get the dose to a point where you can routinely shoot twice a day.

I'd also think about a timed feeder if you don't already have one. There were two things that helped me with Gabby since I was working. One, was a timed feeder. I knew that Gabby would eat if her numbers were dropping. The other was shot time. I moved my shot time to 5:00. That gave me a couple of hours to monitor her blood glucose before I left for work. If I needed to bump up her numbers I was able to. I could also be home by close to 5:00 -- I didn't live far from my office.
 
Sienne and Gabby (GA) said:
If you're unsure, then reduce the dose to 0.25u. As long as Toulouse doesn't have a history of ketoacidosis, it may be fine to have numbers run a little higher and get the dose to a point where you can routinely shoot twice a day.

I'd also think about a timed feeder if you don't already have one. There were two things that helped me with Gabby since I was working. One, was a timed feeder. I knew that Gabby would eat if her numbers were dropping. The other was shot time. I moved my shot time to 5:00. That gave me a couple of hours to monitor her blood glucose before I left for work. If I needed to bump up her numbers I was able to. I could also be home by close to 5:00 -- I didn't live far from my office.
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Hi there! Thank you so much for your help.

Can you shed some extra light on or tag someone who might know if it is best practice to always shoot the same amount AM & PM to get regulated? For instance, since I did not shoot this morning, it is now reading as "hi" so should I try to do .5 units tonight to be able to do .5 again tomorrow AM & hopefully PM too? I just don't know if I am supposed to be fluctuating between the amounts each time or if that is causing more crazy numbers (for example, 1 unit tonight since it is hi and then .25-.5 tomorrow if it's back in the 100s).

Thanks again!
 
It is much better to give the same dose am and pm if possible…
As Sienne said, if you are are concerned about giving the 0.5 dose when the preshot is a bit lower you could drop the dose to 0.25 unit and see if you can give that dose consistently (which is what is needed if you want to get Toulouse regulated).
You can see what is happening to the BG numbers when you skip doses…they go sky high.

Because you say he is now hi again after the skip, I would give the 0.5 dose tonight but in the morning try the 0.25 dose am and pm for a few days and see if you can shoot both cycles consistently.
And if you don’t have an automatic timed feeder I would definitely look into that suggestion.
 
One of the basic premises of Lantus is a need for consistency. Barring the need for a dose change (e.g., numbers drop below 50 with TR or 90 with SLGS or you've waited the requisite number of days to increase the dose), you want to shoot the same dose at AMPS and PMPS. The reason is the depot. Every time you alter the dose, it's like throwing a rock into a pond -- there's a ripple effect and in the case of the depot, it can take several cycles for the depot to catch up to the change in dose. If you are making back-to-back changes at each shot time over the course of several days, you're not going to get ripples. You'll get a tidal wave. (It's not a perfect analogy but you get the idea.)

Most other insulins are what we refer to as "in and out." They act quickly and don't last 12 hours. If you were to adjust the dose at each shot time, it wouldn't matter. That may sound appealing but the lack of duration is problematic. Lantus is longer acting and you get overlap between the cycles which contributes to it being gentler. That overlap is due to the depot and the basic pharmacology of Lantus. As a general rule, Lantus dosing is based on how low the dose brings your cat's numbers. Generally the low point (nadir), is around the middle of the cycle. You don't base the dose on the pre-shot numbers unless it is clearly a safety issue. I do have a caveat. As you're learning how to manage your cat's diabetes, you are also increasing your confidence when it comes to shooting progressively lower numbers. I followed TR. Once I was confident in what I was doing, I would shoot any pre-shot number above 50. Most new members would not be comfortable shooting that low of a number.

Also, keep in mind that when Toulouse drops into lower numbers, he tends to bounce. Bounces can also last several days. Right now, you're still getting accustomed to how Toulouse is responding to insulin. And, like most cats, I suspect Toulouse does not like being predictable.
 
@Sienne and Gabby (GA) + @Bron and Sheba (GA) thank you both so much.

Truly this group has given me so much more confidence and peace of mind. Two days ago I was crying every time I pulled out a syringe and now I can at least power through mostly without the tears. I am so grateful for kind folks like you for sharing your experiences and expertise! We went with .5 unit tonight and will watch the numbers over the next few hours. Hoping to be able to start consistently with .25 tomorrow *fingers crossed* thank you!
 
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