9/25 first few days on lantus for Lovey?

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lovey11

Member Since 2013
Good morning.

Just wanted to give a few numbers for Lovey on 1 unit of Lantus. I In light of the fact that Lovey was on PZI dose of 1.75 and these numbers. Could I just bypass 1.25 and go to 1.5. I think 1.5 could of have been a reasonable starting dose but I was scared.


1st shot
Preshot 275
+6 316


2nd shot

preshot 428
+6 302

3rd shot

Preshot mid 300's

4th shot preshot mid 300's
(possible fur shot, lovey moved)

5th shot today Preshot 386.

6th shot

Preshot 361
+ 6 309
+9 267
AM Preshot 287
 
Re: 9/24 first few days on lantus for Lovey?

It's 5-7 days on the Lantus, to let the insulin depot build up, before you increase the dose. Any dose change, is based on those mid-cycle tests, not the pre-shot tests, so we'll really be looking for those. Any increases/decreases are recommended to be in 0.25U increments, so you don't bypass a good dose.

Automatic decrease if Lovey drops below 50 BG.
 
Re: 9/24 first few days on lantus for Lovey?

Would you please edit your signature to show you are now on Lantus.

And the bolding isn't working in your signature, for some reason.
 
Re: 9/24 first few days on lantus for Lovey?

Thank you! I see it much better and folks can tailor any advice to the correct insulin and meter information.
 
Re: 9/24 first few days on lantus for Lovey?

If midcycle numbers are really high (300 or above) or cat prone to keytones, I read to move up by .5 on the stickies that I copied. I don't think .25 more of insulin would do it if the mid cycle numbers are that high.
 
Re: 9/24 first few days on lantus for Lovey?

You wouldn't want to go up at all until Lovey has been on the same dose for at least 5 days (10 cycles) since you're just starting on Lantus. It takes time for the depot to fill.

If Lovey goes below 80 (since you're using the Alphatrak) you'd reduce by .25 unit

Let's see the numbers after you've been on Lantus for awhile before deciding on a dose increase...and even then, we usually only go up in .25 unit increments for safety
 
Re: 9/24 first few days on lantus for Lovey?

Chris, is it oK for a cat to be that high for a week? Was China high in the beginning on Lantus?
 
Re: 9/24 first few days on lantus for Lovey?

Many cats can tolerate higher glucose levels for short periods. If he never had diabetic ketaoacidosis (DKA), he should be OK.
Prudence, however, suggests testing for ketones. There are some tips in my Secondary Monitoring Tools signature link.

If you have a cat that has had DKA, you may need to use a supplemental, short acting insulin such as R.

Patience must be used with depot insulins. If you go too fast with the Lantus, you run the risk of getting too high due to the cummulative effect. Its like filling a funnel too full, too fast - it spills over, rather than making a pool that is continuously filling and continuously flowing out. Or like you've gone up a down escalator too fast and reached the top, when the objective was to be in the middle, trudging along.
 
Re: 9/24 first few days on lantus for Lovey?

She was probably that high (and higher) for quite some time before you ever got the diagnosis. Of course we always want them to be lower, but not at the expense of safety.

Lantus works totally different than Pro Zinc...it takes time to "fill the depot". The Tight Regulation Protocol says:

"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.

As long as Lovey isn't prone to ketones, it'd be best to just stay with the 1 unit and see how she does. IF she drops below 80, you'd reduce it down to .75 twice/day
 
Re: 9/24 first few days on lantus for Lovey?

Thanks China and BJM. Great analogy BJM to help me understand. I was looking at your spreadsheet China to get an idea of how you adjust the dose. You do a lot of home testing. I don't have the ear testing down yet.

The ear bled yesterday but not enough. I use the paw right now which Lovey doesn't like, but she gets over it. You had to intervene to give high carb food and repetitive tests. DId China every have symptoms? I haven't had green numbers much only a few times with Pro ZInc.

Do you think Lantus requires more testing than Pro ZInc because of the depot effect? With ProZInc, it is in and out.
 
Re: 9/24 first few days on lantus for Lovey?

DId China every have symptoms?
Click to expand...

No she didn't. At the beginning, I don't know how I knew exactly, but several times "something" just told me to do a test, and I'd get a really low number. This is what we mean by "Know Thy Cat" I guess.

Now, with the data on her spreadsheet, I can usually tell if it's going to be a cycle where I need to test more, or one where I can get away with leaving her for the day. When my mom was in the hospital, and I was spending a lot of time over there, I was REALLY happy to have China in the 200's at Pre-shot times. If you test at +2 or +3, you can get a good idea of if the cycle is going to be "active" or quiet too.

If the +2 number is about the same as the pre-shot, it's probably going to be a quiet cycle
If the +2 is much lower, you should expect an "active" cycle...and will want to do more testing.

The problem with hypo's, is they don't generally show any symptoms until it's too late and you have to get them to a vet as an emergency to get a glucose drip....or worse. It's important to know How to handle hypo's and maybe have it printed out somewhere in case the website is down

Do you think Lantus requires more testing than Pro ZInc because of the depot effect?
Click to expand...

The minimum number of tests per day is 4..same for all insulins. The 2 pre-shot tests, as well as 1 during the AM cycle and 1 "before bed" test on the PM cycle. That being said, there's no such thing as too much data, so the more tests you get in, at different times in the cycles, the more information you'll have about how YOUR cat reacts.
If you can only get those main 4 during the week (due to work or something), I'd suggest doing a curve on the weekends. A full curve is every 2 hours through one entire cycle...a mini-curve is every 3 hours through an entire cycle.
 
Re: 9/24 first few days on lantus for Lovey?

i'd like to offer a slightly different opinion based on the fact that lovey has been switched from pzi to lantus and the guidelines quoted throughout this thread so far apply to a newly diagnosed kitty... new to insulin use.

lovey has been on pzi since june. when switching to lantus from another insulin, ample consideration should be given to the dose on the prior insulin when determining a starting dose with lantus. the prior pzi dose of 1.75u only resulted in drops to the high 100s (AT meter). imho, lovey's initial starting dose of lantus was set too low.

"If the cat received another kind of insulin previously, the starting dose should be raised or lowered by taking this information into account. When selecting a starting dose, it is important to know that while Lantus and Levemir have a longer duration than other insulins, they also have a lower potency in most cats." [emphasis mine]
http://www.tillydiabetes.net/en_6_protocol2.htm


catherine, if you can get a few mid-cycle spot checks today and tonight and you find lovey's numbers remaining high and flat, i wouldn't hesitate to increase the dose after 6 cycles on lantus. increasing by 0.25u is a cautious approach. increasing by 0.5u if nadirs are greater than 300 is a little more aggressive approach... one that requires frequent monitoring.

"The cat should be monitored closely on the first 3 days on Lantus/Levemir: do curves between the AM and PM-doses, e.g. AM pre-shot, +3 hours, +6 hours, +9 hours, PM pre-shot. Generally the starting dose is kept for 3 days. Test for ketones daily. Cats that have a tendency to get ketones and/or who are getting relatively high flat curves after the switch should have their dose raised earlier (after 24-48 hours). It is extremely rare that a cat will need to have its dose reduced in the first 3 days, *but if the cat falls below 50 mg/dl, reduce the dose." [emphasis mine]
http://www.tillydiabetes.net/en_6_protocol2.htm
*note: but if the cat falls below 50 mg/dl or 80 mg/dl on the AT meter, reduce the dose




fwiw, just my thoughts...
 
Re: 9/24 first few days on lantus for Lovey?

Jill or other Lantus helpers, what starting dose what you have selected? My vet first suggested 2.5 based on .5 units for every kilogram of body weight and glucose over 350 at preshot. I am not sure if these are old guidelines are just the vet' s approach. Many helpers on this site thought that was too high too start especially since I work during the day.

After, I called her and said that I wasn't comfortable with that dose due to the fact that I work during day and can't test midcyce until the evening cycles. She then suggested I try 1.5 for 3 days and then moving up if needed. Do you think that is reasonable to go up to 1.5
Now that I started with 1 unit. I am locked into only .25 increments because of the depot that's building? Is that why .5 would be may be too aggressive? If I started with the 1.5 units would it have been OK.

I appreciate any input.
 
Re: 9/24 first few days on lantus for Lovey?

I think the 1.5 makes really good sense...get tests when you can and see how she does. I agree with Jill that since she's already been on Pro Zinc, it's probably fine to go to a higher dose that you'd normally start at for Lantus (If you decide to give it at PMPS tonight, at least you can get some testing in since you'll be home)

No matter what, it's still going to take a little time to see how each dose effects Lovey, so you'd want to hold the 1.5 for at least 3 days (6 cycles) and then we'd see what the numbers look like then before deciding to go up any more.

The other option is to continue at the 1 unit dose awhile longer and see if you get any better results...or maybe even just go up to 1.25 unit instead of the 1.5

However, IF she goes below 80, that's an automatic decrease of .25
 
Re: 9/24 first few days on lantus for Lovey?

Thank you Chris. I gave the 1 unit again tonight and I will get a midcycle. I think this was the 6th cycle, but I may have given a fur shot cycle 4 so .. Maybe, tomorrow evening I can give 1.25 or 1.5 and monitor.
 
Re: 9/24 first few days on lantus for Lovey?

I'd like to invite you to the Lantus Group too!

Each day, we start a new topic (we call them condo's) with the date, cats name and the AMPS reading in the subject line. As you get other tests in, you just add those into the subject line...for example, yours could say 9/22 Lovey AMPS 275,+6 316,PMPS 428

In the body you'd give the WCR (Whole cat report)..how she's acting..good appetite? The 5 "P's" (peeing, pooping, playing, preening, purring)? Any little thing you'd like to share...and if you have a question you'd add the ? icon to the subject line.
 
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