? Any Suggestions on Dosing?

[Really Riley (GA)]

Riley would bounce every time his dose was increased by more than .5 units. That happened a lot while trying to follow the vet's instruction. I decided to back him down to a low dose and try to go very slowly. Guess I shouldn't have gone from 2.5 to 3, but rather 2.5 to 2.75. However, it seemed that his average was staying way too high. Where would you suggest we go from here? Stay at 2.75 for about one week and then move to 3? And then hold 3 for a week before 3.25? Sometimes I wonder if I'm doing the right thing when I look at other spreadsheets and see high doses bringing the patient's glucose to a good level. I'm afraid Riley will never see remission at this pace.

 

[MyTitan (GA)]

Hi Riley and beans, I'm no spread sheet guru and hopefully others with more knowledge will chime in. There are a few questions that need answering. Our experience with Titan was similar, vet wanted to start at 1 unit and do checks once a week at vet office, we did start right out on Lantus. Our first break thru came when we had Titan Dx for acromegaly which he was positive for so that told us he would be a high dose kitty. We did not have him checked for IAA (insulin auto antibodies). Wish we would have. Have you had Riley checked for either? If not I would have your vet do this, it's a blood draw that gets sent to Michigan State University. Looking at Riley's SS he's not responding to lower doses of insulin. Knowledge is power. We assumed Titan was positive for IAA and went on a very aggressive increase regimen to find his dose. ( do not try that on your own) IAA if he is positive can be broken, the antibodies will eventually give up fighting the insulin. Titan broke thru at 12 units 2X a day and we have been actually working back down as he earns reductions. There is lots more to know but just wanted to give you a bit of hope and that finding Riley's correct dise can be done and the knowledgable folks here can help. Also I would change your post thread headline to include a blue question mark that is available and advise you are looking for dosing help, your line doesn't let anyone know what you need help with. Good luck! Ed

 

[Tracey&Jones (GA)]

I am not an expert!! Hopefully someone with more experience comes along.

Insulin is a hormone not a drug. So a dose for Riley may not have the same reaction as that same dose does for another kitty. Riley is unique and he has his own story to tell. Time and testing will guide you to what Riley needs.

Looking at his spreadsheet. Those blues on the 12th look like they set off a bounce which can last up to 6 six cycles. That said, is there any way for you to get some mid-cycle night tests in? Even a test before you head to bed?

Have you read the stinky notes in the Lantus forum? There is two protocols that we use here. TR and SLGS. The protocols tell you the method for when to increase and decrease. You have 4 cycles on 2.75u, if it was me, I would hold that dose and get some more mid cycle tests in to see how low Riley is going. That is the key with Lantus - it is not so much about the pre-shot numbers but how low is the dose taking him. Read those stickies and decide which protocol you would like to follow.

Was Riley on Lantus before when he went into remission?

 

[Really Riley (GA)]

I am not an expert!! Hopefully someone with more experience comes along.

Insulin is a hormone not a drug. So a dose for Riley may not have the same reaction as that same dose does for another kitty. Riley is unique and he has his own story to tell. Time and testing will guide you to what Riley needs.

Looking at his spreadsheet. Those blues on the 12th look like they set off a bounce which can last up to 6 six cycles. That said, is there any way for you to get some mid-cycle night tests in? Even a test before you head to bed?

Have you read the stinky notes in the Lantus forum? There is two protocols that we use here. TR and SLGS. The protocols tell you the method for when to increase and decrease. You have 4 cycles on 2.75u, if it was me, I would hold that dose and get some more mid cycle tests in to see how low Riley is going. That is the key with Lantus - it is not so much about the pre-shot numbers but how low is the dose taking him. Read those stickies and decide which protocol you would like to follow.

Was Riley on Lantus before when he went into remission?

I would love to do a 24-hour on him to see where the peaks and valleys are, but with my luck it would end up being the 24-hour period that Riley's system is "behaving". I agree that I've got to start getting up around 3 am to see what's happening. Will have to speak with my "assistant" (husband) . Riley's previous remission was weird (to me). The vet I was seeing at that time had initially put Riley on 3 units of Lantus once a day. I know now that isn't right, but I didn't know then. The vet had me leave him in his office for a couple of days and said that he had reduced Riley's glucose so that he was on maintenance. A couple of weeks later the vet reduced the dose to 1.5 units once a day after he had Riley in his office for a day. I thought the vet knew what he was doing and all seemed to be going well until I couldn't give Riley his insulin for a couple of days because of being hospitalized myself. When I returned home Riley was lethargic, drinking water so often that he had decided to sleep with the water bowl, and urinating all over the place. The vet said to bring him in right away and expect him to be there a few days. After that few days, the vet said he was going to have to euthanize Riley because "nothing was working". I couldn't do that without a second opinion so I went to the vet's office and picked Riley up. Riley was dehydrated, emaciated and barely able to stand. He'd walk a couple of steps and fall over. He was extremely constipated and would crawl into the litter box and fall over trying. I felt like I'd made a huge mistake in not allowing the vet to follow through, but I had to wait until the next day to do anything. Somehow, Riley seemed better. I started feeding him zero-carb Tiki and nothing else. It took a couple of days, but every day he seemed to improve. He slowly regained his strength and started to look like himself. I threw away the needles and Lantus figuring that was the problem. He stayed on a Tiki only diet. A couple of months later I took him to another vet for a checkup and he was pronounced in excellent health. His glucose reading at the vet's office was a little over 200 but the vet said it was because of stress.

 

[Really Riley (GA)]

Hi Riley and beans, I'm no spread sheet guru and hopefully others with more knowledge will chime in. There are a few questions that need answering. Our experience with Titan was similar, vet wanted to start at 1 unit and do checks once a week at vet office, we did start right out on Lantus. Our first break thru came when we had Titan Dx for acromegaly which he was positive for so that told us he would be a high dose kitty. We did not have him checked for IAA (insulin auto antibodies). Wish we would have. Have you had Riley checked for either? If not I would have your vet do this, it's a blood draw that gets sent to Michigan State University. Looking at Riley's SS he's not responding to lower doses of insulin. Knowledge is power. We assumed Titan was positive for IAA and went on a very aggressive increase regimen to find his dose. ( do not try that on your own) IAA if he is positive can be broken, the antibodies will eventually give up fighting the insulin. Titan broke thru at 12 units 2X a day and we have been actually working back down as he earns reductions. There is lots more to know but just wanted to give you a bit of hope and that finding Riley's correct dise can be done and the knowledgable folks here can help. Also I would change your post thread headline to include a blue question mark that is available and advise you are looking for dosing help, your line doesn't let anyone know what you need help with. Good luck! Ed

Thanks for the info on IAA. I've often wondered if there was something going on with Riley wherein his body was fighting the insulin.

 

[Tracey&Jones (GA)]

He stayed on a Tiki only diet

Low carbs is good and that alone can have a kitty go into remission.

I think your previous vet didn't know what he was doing. Lantus is usually given in even doses every 12 hours.

I totally advocate home testing vs. in clinic testing. 1) it is cheaper to do at home 2) it is less stress for kitty and provides more realistic numbers 3) this is the big one - keeps your kitty safe!

It will be interesting to see where Riley goes when he clears that bounce. You saw some nice blues there, not sure what dose got him there but I am thinking you may see some blues on that 2.75u does. I am going to assume the bad teeth knocked him out of remission.

I would love to do a 24-hour on him to see where the peaks and valleys are, but with my luck it would end up being the 24-hour period that Riley's system is "behaving".

All data is good data. Patterns start to emerge and that helps with deciding what to do.

agree that I've got to start getting up around 3 am to see what's happening

I usually grab at test before heading to bed. Jones gets his shot @ 645- so I can get a +3 or +4 most nights before going to bed. On the weekend I will stay up later to get those +5 - +6 tests. I am bad in that my PM cycle is not really that full of data.

 

[Gill & George]

I don't necessarily think that you need to be thinking in terms of IAA/acro just yet. There's not enough data to be able to asses whether it would be worthwhile, we usually suggest it when kitties are experiencing high flat cycles and have got up to over 5u.

Before getting those tests I would take at least the next week or so of gathering a bit more data and see if you can figure out how low this current dose is taking him (I'd hold the dose for now while you gather a bit more data)
He is getting high preshots, but those blues of a couple of days ago have me wondering if you are missing some lows. The 512 this morning makes me question whether he dropped low (for him) last night and has bounced up. You don't need to go mad with tests, however, the numbers may prompt you to up the frequency of testing eg if you find his BG is dropping like a stone in the early part of the cycle.
Just a couple of tests in every cycle in addition to the amps and pmps will allow a pattern to emerge.

I usually grab at test before heading to bed. Jones gets his shot @ 645- so I can get a +3 or +4 most nights before going to bed. On the weekend I will stay up later to get those +5 - +6 tests. I am bad in that my PM cycle is not really that full of data.

As Tracey explains getting a test just before bed is a useful way of always gathering some pm data. Many cats have their lowest cycles at night, so it's really important to get a feel for those pm numbers, otherwise you are only looking at half the picture making dosing decisions more difficult.

 

[Sienne and Gabby (GA)]

I agree with Gil. Based on what's on Riley's SS, it's hard to pinpoint what may be going on. I'd encourage you to try to get at least one test, in addition to the pre-shot tests, each cycle. If you're working and not home during the day, do what you can to get data during the cycle when you are home as well as on weekends, holidays, etc.

I work full time. I had some flexibility with my schedule and I didn't live too far from work. I ended up moving my shot time so I was shooting at 5:00. Since Gabby had an an early nadir, this allowed me to get in a few tests before I left for the office. Gabby was also quite capable of diving into low numbers. Just because you're seeing a high pre-shot doesn't mean the entire cycle is equally high. My kitty could start out in the 400s, drop to the 40s and bounce back into the 400s.

 

[Really Riley (GA)]

I agree with Gil. Based on what's on Riley's SS, it's hard to pinpoint what may be going on. I'd encourage you to try to get at least one test, in addition to the pre-shot tests, each cycle. If you're working and not home during the day, do what you can to get data during the cycle when you are home as well as on weekends, holidays, etc.

I work full time. I had some flexibility with my schedule and I didn't live too far from work. I ended up moving my shot time so I was shooting at 5:00. Since Gabby had an an early nadir, this allowed me to get in a few tests before I left for the office. Gabby was also quite capable of diving into low numbers. Just because you're seeing a high pre-shot doesn't mean the entire cycle is equally high. My kitty could start out in the 400s, drop to the 40s and bounce back into the 400s.

You have confirmed my worst fear - that the high numbers represent the result of a bounce in reaction to a low. So high in the morning could mean low during the night. I really do need to get some tests after the PM shot - and that will mean moving the shot times - and enlisting my husband's assistance since Riley isn't really excited about all the ear pricks.

 

[Really Riley (GA)]

I agree with Gil. Based on what's on Riley's SS, it's hard to pinpoint what may be going on. I'd encourage you to try to get at least one test, in addition to the pre-shot tests, each cycle. If you're working and not home during the day, do what you can to get data during the cycle when you are home as well as on weekends, holidays, etc.

I work full time. I had some flexibility with my schedule and I didn't live too far from work. I ended up moving my shot time so I was shooting at 5:00. Since Gabby had an an early nadir, this allowed me to get in a few tests before I left for the office. Gabby was also quite capable of diving into low numbers. Just because you're seeing a high pre-shot doesn't mean the entire cycle is equally high. My kitty could start out in the 400s, drop to the 40s and bounce back into the 400s.

Can I ask a question regarding those bounces? If Gabby did start in the 400s, dropped low and then went back up, did you change the dose? Or did you keep on with the same dose until the bouncing stopped?

 

[Sienne and Gabby (GA)]

It largely depends on how low the low is. Since I was following TR, a drop below 50 signaled a dose reduction.