Advice on dosage adjustments ?

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ecurie

ecurie

Member Since 2012
We (mark,mary and oliver) are one week into Lantus. We go back to the vet on Tuesday for dosage adjustment. I'm hoping to get your opinion on his numbers. You people have more experience than most vets and i would like to hear what you have to say. I apologize for not getting more test numbers, but it's just been today that Ollie isn't having a major fit when it's testing time. He seems to be getting into the routine of test and treats. He still growls some, but only when we're waiting for the drop to form and he gets tired of the ear futzing. Mark has been wonderful and has done all but one of the tests.
WE are going to test every 4 hours for the next couple of days and see what his numbers are.
thanks in advance for any advice.

feeding only wet fancy feast. about 2 and 1/4 cans/day. assorted shrimp and bits of pork tenderloin for treats during tests and shots

Ollie's spreadsheet should be attached....
xoxo
m/m/o
https://docs.google.com/spr
 
Hello Mark, Mary and Oliver,
I think that the persons here who give dosing advice are going to want those tests you are talking about doing. A curve is every 2 hrs and a mini curve is every 3.
I would suggest you do the preshots and the +2, +4, +6, +8, +10 tomorrow. Sorry sugarbaby, pin cushion day. :sad:
But also even tonite, try to get a +3 and maybe another later on like +10.
This is a sleep deprived place around here as we all set alarm clocks to get those tests.

Now someone may come along and want different tests. I"m just trying to help you get some data as you said your cat wasn't so thrilled.
I would use kitty's favorite treat for testing and make that the only time he gets it. That will help create that positve association. I also add praise for being good myself.
And then after you get those tests in tomorrow's daytime cycle, come back and ask about the dose.

Since you are going to the vet , my crystal ball says they will tell you to go up in whole unit increments.
But here, you will most likely be advised to go up by either 0.25 u or 0.50 u.
It will depend on your numbers, dosing is decided by your nadir ( the lowest number in the cycle) . It is not chosen by your preshot number.

Your ss looks a lot like my beginning days here so even though we want out of those pinks, it doesn't take big dose changes to get there.
So if you don't return, please consider that , if your vet wants you to increase in a whole unit upward. In my humble opinion, that will be too much.
 
Welcome to Lantus Land! We're happy to lend a hand.

The intro to the Tight Regulation Protocol states the following:
REQUISITES WHEN FOLLOWING A TIGHT REGULATION PROTOCOL WITH LANTUS OR LEVEMIR:

  • Kitty should be monitored closely the first three days when starting Lantus or Levemir. Blood glucose levels should at least be checked at pre-shot, +3, +6, and +9. More monitoring may be needed.
  • It will be necessary to test kitty's blood glucose levels multiple times per day.
  • Learn the signs of and how to treat HYPOGLYCEMIA and prepare a HYPO TOOLBOX.
  • Test regularly for ketones and know about DIABETIC KETOACIDOSIS (DKA).
  • Use U-100 3/10cc syringes with half units marked on the barrel for fine dosing.
  • Feed a high quality low carb canned or raw food diet.
  • Feed small meals throughout the day. Some kitties adapt well to free feeding.
Click to expand...

It would be helpful if you could test every 3-hours (a mini-curve). If every 4 hours is what you think Ollie will tolerate, that's fine. In fact, if you want to get spot checks at random times, that's fine, too. The point is that you want to get sufficient tests to try to determine when Lantus onset begins and where Ollie's nadir falls.

With Lantus, you want to hold your initial dose for 5 - 7 days. This allows the insulin depot to form and stabilize. Beyond that first week, if your cat isn't spending the majority of his time in numbers under 200, you increase the dose after 3 days. Thus, I would suggest increasing Ollie's dose to 1.25u.

I'd strongly encourage you to read the starred, sticky notes at the top of the board. The information contained in those notes are as follows:
  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal version -- the “Tilly” Protocol developed by the counterpart of this group in Germany, which was also published by Kirsten Roomp & Jacqui Rand, DVM 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: 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 let us know how we can help. The people here are generous with both their information and their time and very dedicated to the well-being of your cat.
 
Welcome to LL. Definitely the best place you never wanted to be.
I can't offer much advice on dosing, etc but just wanted to say HI and encourage you to read the information Sienne posted to you.
We were diagnosed one month ago and found this website about 1.5 weeks later. We sooo were not told about how lantus worked or the importance of testing. The protocal feels pretty overwhelming at first but there is so much wisdom to it.
Everyone here has been so supportive, encouraging and amazingy helpful. Feel free to ask as many questions as you need. Read up on other peoples posts and get familiar with the process.
You are in a great place!!!
Karen
 
Welcome to Lantus Land Mary, Mark, and Oliver!

Sienne has given you some good info and onto that I want to add a couple things.

First, I see you are trying to move your shot time. That's fine as long SS you move it by 15 mins each cycle or 30 mins once cycle a day. Be careful about changing your shot time by more than that because a late shot is like a dose reductions and an early shot is like a dose increase. But doing it as I stated above won't affect him.

Second, cats can go lower at night and if you don't get tests at night, you are missing half your data. I've seen cats go from 300 to 40 to 300 in one cycle. We understand people work and have to sleep so the best thing to do is to get at least a +2 test and a before bed test. If the +2 test is much less than the preshot, it's likely he's going to come down in BG early and quick. If the +2 is close to the preshot, he will likely have a normal, active lantus cycle (see below for a typical lantus curve). If his +2 is much higher than his PS, you can go to bed and not worry.

+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.
Click to expand...

We are here to help as much as we can. I'd highly recommend you check in with us after your vet visit. For some reason, vets often want to dose on the preshot instead of the nadir and/or raise the dose in too high of an increment thereby missing the best dose for the kitty and resulting in an overdose.
 
Advice on dosage adjustments and shot time

Thank you so very much.
We will be testing Oliver all day and night today if he doesn't hide under the dresser/bed and refuse to come out. I can block his favorite hiding places with blankets. I'll post his numbers as we get them. Then i'll let our vet say whatever she wants and come right back here. (she didn't even want us to test at home)
We are trying to move his shot time. We'd like to get to 7am/7pm. We thought we'd move it 15min am and 15 pm, then wait 2 days and move it again by 15min am and pm. I don't want to move too far too fast. It's a long way from 10 to 7 and if you think our schedule is too fast, we'll slow it down.

thank you VERY MUCH.
m/m/o
 
Morning. ~O)

As long as it's 15 minutes each shot time (or 30 minutes for each 24 hr period), you can do it each day. You don't have to skip every other day.
 
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