9/13 Dosing Question

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Nancy&Pepper (GA)

Nancy&Pepper (GA)

Member Since 2012
My cat recently started on Lantus. The vet wants to increase his dose to 2 units twice a day. I have read about the "Start low, go slow" approach and i am concerned that a full unit increase might be too much. I am trying the relaxed method but it was suggested that I post here for advice. Any help would be greatly appreciated. Thanks.
 
You are right to be concerned, one unit - a doubling of the dose - is too much. You are missing a little bit of data but I think Pepper's numbers are high enough to warrant a 0.5 unit increase, others may be a little more conservative and suggest only a 0.25 increase.

Apart from risking hypoglycemia, if you increase too quickly you may go past the magic dose for Pepper.

If you can try to get a test every night before bed so you have some idea of what the night cycle is doing and please please please always get a test before you shoot :smile:

You do seem to be able to test frequently so may wish to consider the tight regulation approach as it has the highest rates of remissions when undertaken quickly after diagnosis but you are absolutely welcome to post here for advice anytime while following start low go slow too.
 
Good morning, Nancy. :smile:

I am in no way experienced with Lantus but must admit I really like the protocols. They are very easy to follow. Under the sticky for Tight Regulation, it says:

Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
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.

So, if it were me and my kitty, I'd only up the dose by .5 and even then only if I could monitor. I've been around long enough to have seen some kitty's react strongly to changes in dose. Adding .5 to your dose is a 50% raise, plenty to see a strong reaction...IF your kitty is sensitive to dose changes (not enough history to be able to guess). No way would I double the dose.

I'm sure more knowledgeable folks will be along later this morning to help you out.

Have a great day! :smile:
 
Welcome to Lantus Land!!

I agree that an increase by 1.0u is too much. I would not increase by more than 0.5u. However, if you are planning on increasing the dose, can you be sure to get at least one test every night? We encourage a "before bed" test at the minimum (that's before you go to bed, not Pepper).

As a matter of convenience, could you add a note to your signature line that you are following SLGS? That way, we won't assume you're following the Tight Regulation Protocol.
 
Thanks for the advice. What would you say would be the minimun amount of monitoring during the day to make sure Pepper is safe? I'll be home all day today, but not tomorrow - is it safe to increase the dose now?
 
I think Sienne may have left for work. She usually checks back some during the day but it may be a while.
You've only had the one number under 300 but since you are gone tomorrow, ( i'm guessing all day) I myself would play it conservatively.
Would you be able to get a +2 or +3 before you left?


"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...).
Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose:

Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
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.

Reducing the dose:

If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.
If an attempted reduction fails, go right back up to the last good dose.
Try to go from 0.25u to 0.1u before stopping insulin completely.
Click to expand...
 
I'm a big fan of a +2 or +3 test. In an ideal world, the +2 should be roughly the same as your pre-shot value. If it's markedly lower, you know you're likely to have an active cycle. Depending on what the numbers tell you, you'll have a better sense of when to test next and how to proceed with testing and feeding.
 
Welcome Nancy & Pepper! Good job on the testing - it's so hard to be patient sometimes...Keep up the good work! :RAHCAT
 
Welcome to the Lantus board, Nancy and Pepper! I agree with getting a before bed test to be sure, though. You'll do fine. Good luck with the new dose, and again, welcome! :-D Please wait for an experienced person comes along to answer your last question about increasing the dose.
 
Hi Nancy and Pepper

welcome to Lantus Land!!! You will find alot of warm and helpful people who are very generous with their time so please ask us any questions you have. It would be good for you to read the stickys and in the "new to the group" sticky, there is a link to the Start Low Go Slow protocol.

One thing I notice is you are missing some PS tests. We cannot overemphasize the importance of always getting the PS test. If I could not get a PS test, I would not shoot. I know some people look at the +11 and decide to not test again but this is not advisable. Cats can drop rapidly in a short amount of time and you need to be able to see if they are. We recommend that you test, feed, and shoot within about 15 minutes.

If you take Pepper up tonight, it might take a couple cycles for the insulin depot to catch up; however, some cats react quickly to a dose increase. We have a saying here "Every Cat is Different" (ECID) because they are. For some cats, a dose increase results in higher numbers for the first 24-36 hours. Others get to going quickly and then slow down. So it's not possible for us to know exactly what Pepper will do yet with an increase. But if you increase tonight, be sure you get a PS and a +2 in the morning as Sienne suggested.

Let us know how we can help.
 
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