2/7, Vesper (3 DKA episodes), AMPS 289, PMPS 353, +3 398 - New to group and dosage question

[Kelly and Vesper]

Hi everyone!

This is our first post on the Lantus board. We are new to the FDMB and joined last week when Vesper had her 3rd DKA episode. We are so grateful for all of the support and assistance we received during that time and are happy to report that Vesper has improved a lot during the last week. She had her follow up at the vet today, and the vet said her clinical presentation was excellent. Vesper has now been on Lantus for 9 days.

We are still getting used to home testing, as Vesper can be an extremely aggressive cat and puts up quite the fight (she always has for anything like nail clippings, insulin shots, pills, etc), but we are starting to get the hang of it.

We will read through the materials on the forum to orient ourselves and find all the resources that have already been written, but we have a few time-sensitive questions in the meantime:

(1) Our vet recommended that we switch Vesper's dose from 1 unit to 2 units starting tomorrow morning. Is that a typical dosage increase? Do you think it makes sense for Vesper with her numbers?

(2) Knowing that Vesper is aggressive, what is the bare minimum # of home tests we should aim for, especially during a dosage change? And what times would be most helpful for us to test?

(3) Vesper vomited once today and we are on high alert. Is there anything we should be on the lookout for? She does also have chronic pancreatitis. We gave her an antinausea and she did eat again, but it was still concerning to see.

Here's a link to our prior post during her DKA episode in case it's helpful to have that here: https://www.felinediabetes.com/FDMB...ssible-euthanasia.297847/page-2?_params=Array

Thank you all so much!!

 

[Bron and Sheba (GA)]

Hi Kelly
I see you have not yet chosen a dosing method so I think that’s the first thing you need to do. Have a look at the top of the Lantus page and you will see the two dosing methods in one of the yellow stickies. TR and SLGS. With a past history of DKA it would be better if you did the TR method. But it would mean you would need to test 4 times a day…both preshot and once during each cycle as a minimum. And I know you have some trouble with testing but I really think this would be the better method for you. It allows you to do increase on dose more rapidly than the SLGS method. We can see how you go with it…

Our vet recommended that we switch Vesper's dose from 1 unit to 2 units starting tomorrow morning. Is that a typical dosage increase? Do you think it makes sense for Vesper with her numbers?

We recommend dose increases of 0.25 units with the BGs we care seeing with Vesper. 1 unit increase is too much and we don’t recommend that unless the cat is on a much larger dose…

Knowing that Vesper is aggressive, what is the bare minimum # of home tests we should aim for, especially during a dosage change? And what times would be most helpful for us to test?

As mentioned above 4 tests a day. Before both doses of insulin and sometimes during the cycle. Any time between +4 and +7 is good. If you see a big drop then you would need to test again an hour later. Always post and ask for help is unsure.

Vesper vomited once today and we are on high alert. Is there anything we should be on the lookout for? She does also have chronic pancreatitis. We gave her an antinausea and she did eat again, but it was still concerning to see.

You did the right thing giving her an antinausea med. I would also always check the ketones in a situation like that but I note the vet said there were none. But I’d check again tomorrow. You can never go wrong checking for ketones. Keep offering small frequent meals.

You are doing a great job with her and what a long way she has come from your first post here!

 

[Kelly and Vesper]

Hi Kelly
I see you have not yet chosen a dosing method so I think that’s the first thing you need to do. Have a look at the top of the Lantus page and you will see the two dosing methods in one of the yellow stickies. TR and SLGS. With a past history of DKA it would be better if you did the TR method. But it would mean you would need to test 4 times a day…both preshot and once during each cycle as a minimum. And I know you have some trouble with testing but I really think this would be the better method for you. It allows you to do increase on dose more rapidly than the SLGS method. We can see how you go with it…


We recommend dose increases of 0.25 units with the BGs we care seeing with Vesper. 1 unit increase is too much and we don’t recommend that unless the cat is on a much larger dose…

As mentioned above 4 tests a day. Before both doses of insulin and sometimes during the cycle. Any time between +4 and +7 is good. If you see a big drop then you would need to test again an hour later. Always post and ask for help is unsure.

You did the right thing giving her an antinausea med. I would also always check the ketones in a situation like that but I note the vet said there were none. But I’d check again tomorrow. You can never go wrong checking for ketones. Keep offering small frequent meals.

You are doing a great job with her and what a long way she has come from your first post here!

Thank you so much for your continued guidance! It's truly thanks to you all for helping us feel like we can make real progress managing her disease. My biggest fear was that I found this message board too late and wouldn't ever be able to give her the care I could have.

We will go with that approach! Any tips on how to ensure accuracy/precision with .25 measurements on these syringes? They are so small.

And how long will she likely be on 1.25 before we think about increasing further?

I'll check for ketones today, but she did not vomit at all last night and seems eager for breakfast, so fingers crossed.

 

[AYDA & PASHA]

Hello Kelly and Vesper, welcome aboard. You are at the right place and in very good hands here. I am also fairly new here and this community has been a life changer with their help, support and advice.

About your question on tiny measurement accuracy, I was given a caliper by a very kind member and friend here @DanaB. It really is a game changer when it comes to small doses such as 0.25 unit increase/decrease. I highly recommend investing in one. It needs to be adjusted accordingly to the syringe you are using and each time you change the brand of the syringe.

Wishing you and your sweet Vesper best of luck!

 

[cecile & bella]

Hello Kelly!
You can read the sticky here: Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)
There is a lot about how dosing works, when to increase, etc. You should also post here as you are doing, and you will get guidance from experienced members, which is so important, especially at first. I am glad you found the forum, it has been such a wonderful help for many of us.
Usually you aim to keep the dose for 5-6 days, unless you need to decrease. The numbers will tell you.
For .25 increases, look at the picture here:
https://felinediabetes.com/FDMB/thr...info-proper-handling-drawing-fine-dosing.151/

And calipers help a lot, too.
Testing will get easier. Does Vesper like treats? You can try to give her something special every time you test her, so she gets used to the idea. My cat would come and sit and wait for her tests, eventually. I always tested her just before a snack (small meal, she ate several small meals during the day). Not at first, far from it, it was such a struggle the first weeks! For insulin, I gave her her shot while she was eating and she did not even react to it. If I tried at any other time, she would act as if I was torturing her.
Good luck with the increase

 

[Helen + Noogi]

Hi Kelly,
Just wanted to say welcome. You will get a lot of info and help in this community. If you are like me you will need to read and re-read and read again the dosing guidelines! There is lot to learn and it will take time. You are doing the best you can for Vesper!
I've acquired a small tabletop magnifying glass with built-in light. It gives me a much better view of the syringe markings.
Good luck