8/24 Help- Smokey new to Lantus

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SmokeyD

SmokeyD

Member Since 2011
Hi All,

This is my first post in this site (I know I'm supposed to post in the other forum first, but this is about Lantus numbers and dosing!). Smokey, (12yr old male tripod) was diagnosed with diabetes on Aug 3 of this year (like 3 weeks ago). He was a dry food junky- I didn't know any better. I had noticed increased thirst and urination, took him to a vet (the first visit since moving to Minneapolis) and all of his labs were great except for the glucose (485!!!). I wasn't sure I wanted to do insulin (really wasn't sure he would let me and unsure if I could afford it). I transitioned him off of dry food and onto Fancy Feast classics and, for about 2 weeks, his numbers went into the 100s (but not below 150). Then, all of the sudden, we spiked. I had a horrible experience with the first vet I chose but found a new one and started Smokey on Lantus 8 days ago. We started at 1U and I have increased to 1.5U at day 6 after observing no reduction in numbers. This is the third day at 1.5U (6 cycles) and I've started dosing at 10hr intervals instead of 12 hoping to overlap a bit but I'm not having luck. I'm getting better at the glucose testing (almost always get blood on first or second stick) and injecting (I'm pretty sure I'm not getting fur shots). I had been posting at YourDiabeticCat but most people there use Bovine PZI and I'll be using Lantus. It seems like there are people more knowledgeable about that tight regulation protocol here. I've started a Google Doc with Smokey's testing numbers and really need some advice and encouragement. I'm thinking of upping the dose to 1.75 starting tomorrow (well at 2am tonight really as I'm trying to go with the 10 hr thing).
 
Re: Smokey

Hello. You've come to the right place for help. But I'm not the person. Please edit your Smokey subject line:
Help..New to Lantus.
Or something like that. You'll get great advice. And like they tell me always...Breathe, relax and read everything you can here. But do change your subject line so it grabs someone's attention. Good Luck!
 
Re: Smokey

First, until you have a great deal more data, please stop shooting every 10 hours. You have no idea how well Lantus is working at this point in the process. Shooting repeatedly at 10 hours could do way more than just take advantage of the overlap. This is not an approach for a newbie. The YDC site has had cats' numbers seriously tank. I would not like to see that happen to Smokey. It is more likely that Smokey needs a higher dose of insulin than risking an overdose due to shooting for greater overlap.

Please stick with a 12 hour cycle. You will be able to systematically work up to a dose that brings Smokey's numbers down. Lantus is gentle and will not "yank" numbers down. It takes patience and perseverance.

Also, could you please check the color coding on your spreadsheet? Sometimes numbers in the 200s are orange (which is supposed to be numbers in the 300s).

Please read the starred sticky notes at the top of the Board. It will provide you with a great deal of information about Lantus as well as our dosing protocol and other important information.
 
Re: Help- Smokey new to Lantus

hi and welcome! good for you for being so proactive and doing so much already to help smokey!

you want to stay with the 12 hour dosing - don't move it early - that's like a dose increase. we try really hard to stay as close to 12/12 shots as we can - like a 15 minute or so window whenever possible.

beyond that, sounds like you're doing everything right. glad you're here! you're invited to post every day and we'll help you through all the questions!
 
Re: Help- Smokey new to Lantus

Hi. Have you searched this site for hints on testing? It does take practice.
Are you warming the ear or rubbing it for a while first?
Can I assume the "vacation" on Smokey's SS means he did not receive insulin during that time?
Can you fill in some of the blanks before on the SS before that?

As far as I know, very very few people stray from the 12/12 shot schedule, so I can't recommend that you try shooting every 10 hours. While it looks like a dose increase may be warranted, there really isn't enough data from the past 6 cycles to say for sure. But try not to change more than one variable at a time. I'm a research scientist - it makes data analysis very difficult (and as my boss would say, "that's bad science!")

MJ&Donovan
 
Re: Help- Smokey new to Lantus

Thanks for the fast reply everyone. I went back and looked at the posting stickies- thanks for the advice about title subjects!

Also, thanks for the advice about stopping the 10hr dosing- that may be more appropriate with the PZI even though YDC suggests it for Lantus as well. I'll start fresh tomorrow morning at 7am/7pm which works best with my schedule (and what I had been doing). Advice- should I shoot 1.5 or 1.75 (an increase) tomorrow? Thoughts??

To clarify, I didn't start insulin (Lantus) until I returned from out of town (changed text on Smokey's sheet from "vacation" to "out of town").

I saw the mistake in my glucose number color coding and corrected it- thanks for pointing it out!

As for BG testing, I filled a sock with rice that I microwave for 20 sec and hold against Smokey's ear- he seems to like it! We are certainly making progress in my ability to test and Smokey gets a treat (dried shrimp) after testing so he's not horrible about it. I'm trying to have him come to me when I test. He is a pretty skittish cat and I don't want to chase him and make this into something horrible. I'm going to get an nose hair trimmer next time I'm at Target so hopefully that will make things even easier.
 
Re: Help- Smokey new to Lantus

Welcome!

It's great that you are home testing. I'm a bit concerned that you are missing a bunch of pre-shot numbers. While we dose based on the minimum (nadir) between each dose, getting the pre-shot is a check to make sure that the cat is not doing something unexpected. Every once in a while, you'll get some very low, very unexpected number, and whether you shoot or not, you'll need to keep a close eye on the cat!

The jump from 1u to 1.5u was a big step. One of the few edits this board has made to the Rand protocol is that we try to keep the steps to 0.25u here (at least until you are up to 6u or so). We've found that those 0.5u steps are too often too big. You will probably want to wait a couple more cycles to see what happens before making more changes. Lantus takes patience, but it pays off. You'll make small changes and see nothing, and then suddenly he'll drop into the greens. You don't want to raise the dose so fast that you shoot right past that sweet spot.
 
For now, I'd suggest sticking with the 1.5u dose and switching back to a 12-hour cycle. Once we see how the numbers look, it will be easier to make a recommendation about dose.

Actually, the info Sam posted is not entirely accurate.
Tight Regulation sticky said:
Increasing the dose:

Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose.

After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.

After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Click to expand...
Smokey's nadirs were varying between the 200+ and 300+ range. If you note above, when nadirs are over 300, the increase can be 0.5u.
 
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