Jack was started on Lantus on 2/3. I started him out at .5 unit twice a day. My original plan was to "start low, go slow" but his BG numbers were so high I decided to follow the tight regulation protocol. After 2.5 cycles I upped him to 1 unit and after 3 more full cycles I upped him to 1.5 units. His BG was over 300 at nadir so I have been doing .5 unit increases
I am finally in the blue today which makes me happy but also a little nervous. Due to a class that I have a test in I probably won't be able to test him until +3 this evening. If his numbers are still in the blue once it's time for his shot do I go ahead and give him his normal dose?
Oh and I do plan on bringing him to school with me.
Hello and Welcome to Lantus/Levemir Land. Both the Tight Regulation and SLGS protocols would have had you hold the initial dose a little longer, at least one more cycle for TR, longer for SLGS. From the protocol:
"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...).
It's hard to say where he'll be at shot time. You could get a +11 test to give you a hint where he's going and ask again what you should do. On this forum, we use 150 as the point where you post and ask for help before shooting. And do NOT feed. One of the options when shooting lower than you are used to, is to wait without feeding and test 1/2 hour later to see if he's coming up. Since Jack is not used to blues, he could also bounce by preshot time, in which case you can go ahead with his 1.5 unit dose.
What I read was in the beginning increases can be made every three days if BG numbers are high. I misused the term cycles. Based on the protocol that you just posted the part beneath states the starting dose can increase after 3 days. Admittedly I jumped the gun a little at 2.5 days (I misused the term cycles before).
I will be getting his +11 in about 20 minutes and post the results here.
He's pretty much surfing along on the same number, but unless he jumps up in the next hour, I'm worried that you can't test until +3. Normally we ask that you get earlier tests (at least a +2) when you are shooting your lowest number to date in the blues and greens. Your options are (1) delay an extra half hour if you can, and see if he's coming up more before shooting. (2) shoot a one time reduced dose for tonight. (3) give him some higher carb food than you normally would and makes sure he has access to food early in the cycle. What is Jack eating now? (4) skip. I'd hate to see the skip as he's made a lot of progress today.
Nice surfing from Jack - looking good the drop at PMPS (or was it PMBG (blood glucose rather than pre shot) - his spreadsheet's not showing that you shot) was just a little double dip which is quite common. Looks like he's responding really well to the lantus
What kind of doses did Jack have when you were using Vetsulin? Usually we would take into account what dose you needed on Vetsulin when suggesting a starting dose for Jack - 0.5u is pretty low, although some folks do start with it because they feel better with it. How much does Jack weigh?
Great cycle for him today! Typically when you reduce the dose because of circumstances, instead of because the cat's blood sugar went below 40 (for a more-than-1-year diabetic cat) you return to the "regular" dose with the next shot. That would mean you'd go back to 1.5u in the morning.
Jack's dose on Vetsulin was 3 units twice a day. This amount got him to a good BG at nadir however the effects wore off by the time he was due for his next shot. One reason I started so low with Lantus is because last year when he was first diagnosed the vet had tried 1 unit of Lantus and it brought his BG from the high 600s to under 100 just with the first shot. I decided to err on the extreme side of caution in case he reacted like that again.
That said, last night was definitely a lesson for me to trust how Lantus works. I know I've read on here that +1 and +2 can be higher than pre-shot and that we're shooting based on the nadir. I'm still so used to how the Vetsulin worked so I need to just get over that mindset. Next time he is in the blue at pre-shot I am going to give him his regular dose and just check a lot. It is interesting to see though the impact of the lower dose last night had on his BG levels during the day today.
I think some of this morning's ugly numbers were also due to Jack "bouncing" as well as the reduced shot last night
It may have been quite some time since Jack's body has seen blue numbers and it's gotten used to living in those higher ones. When he dropped down (even though not TOO low) his body still reacted by releasing stored sugars and hormones to bring him back up to where he's gotten used to being.
Bounces can take up to 6 cycles to clear, but as he spends more and more time in those "good" numbers, his body will get used to them again and he won't bounce as high, and the bounces will clear faster
Take a look at Rooh's condo (thread) today. This evening Mel shot the full dose into normal numbers and notice that Rooh has surfed along in green numbers for hours. Lantus works best like this. It's not great with 400s but it's fantastic when you give it a 75 to work with.
the drop at PMPS (or was it PMBG (blood glucose rather than pre shot) - his spreadsheet's not showing that you shot) was just a little double dip which is quite common. Looks like he's responding really well to the lantus 
