3/6 Kiwi needs dosing help

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Kiwi F

Kiwi F

Member Since 2012
Hi everyone.

We're new to the Lantus board. Kiwi was recently diagnosed, and prescribed 1.0u of Lantus, twice a day. As you'll see on my spreadsheet, we reduced to .5u because I was sick and couldn't watch him closely. But today I was feeling better, and his bg was up (AMPS today was 439), so we went back to his 1.0u dose, and his +6 was 124. With this big of a drop, I'm worried about tonight's dose (and whether 1.0u is too high in general, for him). Any advice would be appreciated.

Kim and Kiwi

If this link doesn't work, I'll have someone add it (and I'll get it in my signature soon):
https://docs.google.com/spreadsheet/ccc?key=0As065lxTAGXLdFpKVFhLRndiUDFuRUxQRExDaWloVUE#gid=0
 
Basically, going from 0.5 units to 1.00 is doubling the dose, and I think that's a lot.
We usually advise going up in 1/4 unit increments, so if we thought 0.5 units was too little, most times, we would recommend trying 0.75, and holding that dose for at least 3 days to see how it settles in.
Also, we usually recommend sticking with the same dose every twelve hours for the first 5 to 7 days.
And getting a test before every shot, and at least one mid cycle test (around +6) every cycle, especially in the beginning.
There will be others that will come by to give you more advice and probably say it better than I do.
There is a lot to learn. Please ready the stickies at the top of the page when you can, and ask all the questions you have.
That 439 could be a bounce (liver overreacting to a low number) from Kiwi going lower at night (which a lot of cats like to do), so, please set an alarm, and start getting those mid cycle tests at nighttime, too.
 
Hi Kim! You're doing a great job. I know it's been hard feeling sick and not being able to care for Kiwi yourself. Just to clarify what I think I understand, the vet originally prescribed 1.0u. You reduced because you were worried about not being able to test because you were ill. Now you went back up to the vet's original dose.

You're doing great, and some more dosing advice and help will be here soon!
 
Welcome, Kim.

Let me make sure I have the facts straight. It looks like Kiwi was diagnosed on 2/21 but you didn't start Lantus until 3/3. (I think I remember reading your story on Health.) You started at a dose of 1.0u but you were giving a shot once a day. You got sick on 3/4 and reduced the dose to 0.5u. You then started shooting 0.5u twice a day on 3/5. This morning, you increased the dose back to 1.0u.

There are a couple of considerations. First, Lantus likes consistency. The more you tinker with the dose or the shot time, the more likely it will be that you get what amounts to weird numbers. In the beginning when using Lantus, it takes approximately 5 - 7 days to establish the insulin depot (or "shed" -- there's a sticky note on this topic). So, at this point, given all of the dose changes, you're pretty much back to square one. What I would suggest is picking a dose and sticking with it. You can start at 0.5, 0.75, or 1.0u. It sounds like you're worried about giving 1.0u. If you want to drop the dose back, that's fine. But, unless Kiwi's numbers drop below 50, it will help if you stick with the dose you choose.

In addition, it is very important that you not only test before you give Kiwi a shot, but that you get spot checks both during the day AND the evening cycles. Many cats experience lower numbers at night. If you don't test, it's very likely that you will miss a dose reduction. In addition, if you don't test at night, you are missing half of your data. At the minimum, it would be help if could get a test before you go to bed every night.

You may want to take a look at all of the starred sticky notes at the top of the Board. They will help you to understand how to best use Lantus as well as how this Board operates so you can get the most out of your experience and give your best help to Kiwi. Below is a description of what's contained in the sticky notes.
  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal versions -- the Tilly Protocol developed by the counterpart of this group in Germany and the Queensland/Rand protocol developed by Jacqui Rand, DVM and published in one of the top vet journals.
  • New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
  • Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
  • Lantus depot/shed: This is an important concept for understanding how Lantus works.
  • Lantus & Levemir: Shooting & Handling Low Numbers: What data you need in order to be able to work toward remission or tight regulation as well as information if you have a low pre-shot number or a drop into low numbers during the cycle.
Please ask questions. There's a huge amount to learn. The people here are very generous with their time and information and we will help in whatever way we can.
 
Yes, Kiwi has only been on insulin for a few days. In retrospect, I see a few things I should have done differently. He was prescribed 1.0u, but I was told to wait. Then I was told not to wait. So I gave him 1.0u the first dose, and his bg dropped so much that I got scared and skipped his next dose (I never intended to inject only once a day). Then, because I was unable to watch him closely (due to being sick) and I had been alarmed by his unexpectedly fast drop, I reduced to .5u. When I was feeling better and saw how high his bg was, I thought it was safe to go back to his original prescribed amount. I didn't expect it to drop so much.

But can anyone tell me what I should do now? If I were to stick with the 1.0u, how far might he drop? Does anyone think he was progressing okay on the .5u? At the numbers I got (I know it was only a couple days), is it worth trying to stick it out at .5u? Or does it make more sense to try .75u?

Thanks for your help,
Kim and Kiwi
 
Update: His PMPS was 129. Should I assume 1.0u is just too much? Does anyone have a recommendation of a dose to stick with? He weighs 9.2 lbs.
 
Hi Kim and Kiwi and welcome to Lantus Land,

You have gotten a lot of good advice so far. Initial dosing usually takes the ideal weight of the cat into account. How much does Kiwi weigh? Most cats on the board here start off with a dose of 1 unit every 12 hours (like your vet prescribed). If Kiwi is a small cat, he may need to start with less. The important thing is consistency: a shot every 12 hours. It will take about a week to build the Lantus "shed" (the depot of Lantus in the cat's body that allows the insulin to maintain it's long, gentle action). Until the shed is full, much of the insulin you are giving is going into building the shed and therefore is not working on Kiwi's blood glucose levels.
If you are uncomfortable with giving 1 unit, you might try a starting dose of 1/2 unit. Hold the initial dose for 5-7 days to give the shed a chance to build. Try to get at least one mid-cycle test each cycle. Keep your spreadsheet up to date so that the experienced people can see what is happening and will be able to give you guidance.

Read the "Stickies" that Sienne recommends as essential reading and don't worry if it doesn't all make sense at first. Feline Diabetes has a steep learning curve and everyone here is still learning! We help each other.

Sounds like a lot to do, doesn't it?! You can do it! Welcome again,

Ella & Rusty
 
Hi again, Our posts crossed. His weight being 9.5 lbs., I think you could safely start with a dose of 1/2 unit. It looks like he is reacting well to the insulin. I hope others with more experience will be along to guide you.

Ella
 
You've gotten some great advice so far, so I'm just stopping by to say "Welcome"! We all know how overwhelming FD can be, so please ask as many questions as you need to - everyone here is very generous with their knowledge and support!
 
Sandy and Black Kitty said:
Hi there!

Sorry I'm coming in late here - did you shoot?
Click to expand...


Since his PMPS was 129, I didn't shoot. I'm debating going back to .5u and giving it more time so this doesn't happen again. I should have waited a few more days. He just finished eating. Is it better to give him a tiny amount? Or is it better to skip this time?
 
Welcome Kim and Kiwi! You've gotten a lot of great advice but I wanted to stop by and welcome you. You are doing great and asking a lot of good questions. I agree that the .5 U is a good starting point. Consistently is more important right now while the shed builds up. Start low and go slow approach is probably a good approach for you. Read the stickies the others mentioned. Ask questions. There are absolutely no stupid questions so don't be shy about that. We have all been there and want to help you and Kiwi. It is very overwhelming at first.
 
Thanks to all of you for your advice, suggestions, links, and support. And thank you for being patient with someone new, like me. We do have a lot to learn.

Kim and Kiwi
 
If you fed him, you should skip this shot. Generally, when we stall to see if numbers are rising, we do not feed, because food will influence the blood glucose number. In any event, in my opinion this number is too low for you to shoot, since you don't have enough data to know how Kiwi will respond.
Tomorrow morning, give 1/2 unit and then stick with 1/2 unit for 7 days so that you can get an idea how he is reacting. If at any time his preshot number is below 150, do not shoot. Post and ask for advice. Make sure to put your question or the question-mark symbol in your subject line to get experienced eyes on your situation.

You are doing fine. Keep asking questions!

Ella & Rusty
 
I do have another question. Our vet told us to 'roll' the bottle of Lantus. Something I read made me think that might be wrong. The instructions that came with the vial only said 'do not shake'.

Also, are there any specific times I should test tonight, since I didn't shoot, that will tell me how long his dose lasts for him?
 
I think going to .5u is a good idea. It's important that you find a dose you can shoot consistently, every 12 hours.

Are there any ketones or history of ketones in the picture?

If not, being that you are just starting to collect data and the data you have is based on a variety of doses with some skipped shots sprinkled in, I'm not comfortable with you shooting this number tonight.

How about a fresh start in the morning - .5u and stick with it for at least 6 cycles ?
 
Hi again, Kim,

Do not roll, shake or do anything with the vial of Lantus except to treat it very gently. It' doesn't like to be shook up. Rolling the insulin is for older types of insulin that need to be "mixed" each time before use. Lantus does not need to be mixed. For more information, read the "Sticky" on how to handle Lantus. (Many vets are not familiar with Lantus and how it works.)

If you can get a test or two tonight that would be good. It will provide you with data on how Kiwi reacts to a skipped shot.

Carry on!!

Ella
 
Your vet is incorrect. You do not want to shake, rattle, or roll your Lantus. And above all, do not let Kiwi treat it like it's a hockey puck!! Seriously, though, Lantus is a solution. As such, it requires no mixing. (Other types of insulin, like Humulin N are a suspension and you need to roll the vial to get the precipitant into solution.)

I wouldn't worry about shooting a lesser amount. Sometimes, a cat is started on too high of a dose. The caregiver ends up skipping shots. What we typically suggest is to reduce the dose so you can shoot the same dose twice a day.

How far from your usual shot time are you? I'd hate to have you skip.
 
hi kim!

i want to say welcome too! don't worry about what's happened in the past, let's help you get started for tomorrow morning's dose. it's ok to skip a shot when you've got a BG number that's too low to shoot. with a person who is new, we generally say if you get a test under 200 at shot time, please don't feed Kiwi anything, post here and ask for help on whether or not to shoot.

there's someone on here almost all the time and we can usually give you a hand pretty quick.

there's so much to learn - and we all understand that. don't worry about asking about anything. we'll be watching for you and will give you a hand as you learn how to help kiwi.
 
We've been testing for ketones often. All the tests have been negative (vet's test as well). Good news on that front.

His shot time was one hour ago.
 
Like Julie said, skipping is fine. If you're able to get another test and want to shoot late, that's a possibility. However, can your schedule accommodate shooting 12 hours from when you shoot tonight? Not everyone has flexibility with their shot schedule.
 
i would agree with the suggestion to drop the dose to .5u (one half of one unit) for tomorrow morning. then you'll want to try to keep her shots at 12 hr intervals as much as possible.

you already fed tonight, right?
 
Hi Kim

I wanted to come past and say welcome too. Agree that it's probably best to start fresh tomorrow on half a unit. With a big drop like that Kiwi will probably bounce into higher numbers tomorrow so don't be too concerned about that when you see the number tomorrow.

So glad you found your way here, everyone will help you get Kiwi sorted and back into tip top shape. You just need to remember to ask as many questions as you need to and to breathe, many deep breaths :smile:

Serryn
 
Hi Kim, I just wanted to come in and say hi, too. You've gotten great advice so far. Remember to stick with this dose for 5-7 days and get as much data as you can with the tests. I'm still fairly new-ish, compared to most folks, but we started Lantus on this past New Year's Eve and Atticus is already heading towards coming off it! I know it's a pretty steep learning curve at first, but you'll learn fast. Once you start doing regular testing, you can see how it affects him and learn his particular cycles. Every cat is different. Welcome to Lantus Land, and good luck!
 
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