Day 4 of lantus. Flat high curves. Can I increase his dose?

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phlika29

phlika29

Member Since 2014
Hi everyone I need some advice.

Remi started on lantus on Saturday morning. I have been trying to monitor his BG as much as possible and from the figures I am getting I wonder if I should increase the dose now rather than wait a whole week. I know it has to build up in his system but the curves as so high and flat that going on the guidance in the tight regulation sticky he would benefit from an increase as his preshot and nadirs are still up in the 300/400's

I would love to hear what others think. My only problem is that he spreadsheet isn't working properly for me at the moment. You can view his mmol figures but the US figures stopped populating a couple of days ago and I only just realised. I have posted a message in the main forum asking for help with that and should hopefully get it fixed.

If I do increase would you go up to .75? And how do you measure that on a u100 syringe?

Many thanks :smile:

Sarah
 
Re: Day 4 of lantus. Flat high curves. Can I increase his do

Yes Ma'am take him up to .75u At this point unless you see wide swings or he drops below 50 at any point in a cycle you can take him up every 4 days. Ideally you want to keep the cycle as flat as possible with each dose increase just the overall numbers getting lower and lower.

Mel and The Fur Gang
 
Re: Day 4 of lantus. Flat high curves. Can I increase his do

Cheers Mel. I will increase tonight to 0.75 unit. I love the way you tell it straight. Very clear and with confidence. As a newbie I really appreciate that. :-D

Is there a way to gauge that dose on the syringe? Do you put the base of the plunger on the 1 unit? Am sure I saw a picture somewhere. Will go and hunt for the thread again.

Many thanks

Sarah
 
Re: Day 4 of lantus. Flat high curves. Can I increase his do

That I've found kind of depends on the brand of syringes you are using. Some are better for eyeballing a dose than others. But with the ones I use because the lines are thick I line up the top of the plunger with the top of the line above that I'm shooting instead of the bottom of the plunger on the bottom of the dose line for a true dose. If that makes any sense at all. (Still not on the top of my game just yet).

But in general you just try to eye ball half way inbetween the .5 and the 1u. It isn't so much what you call it or even if that is what the true dose is as long as it is consistent. So a cleave trick is to once you've drawn your first .75 or what you'll be calling .75u is to take a piece of masking tape, and mark that syringe before you inject, then save that syringe, fill with colored water to the tape making, cap it and stick it with your insulin or other syringes to use as a template with all future .75u doses.

Mel and The Fur Gang
 
Re: Day 4 of lantus. Flat high curves. Can I increase his do

Got it. Be consistent. Ive had a look at the syringes and there doesn't appear to be an easy way of lining the 0.75 dose up. By the look of it you have to pull the plunger so the middle of it is on the next mark. I will do as you suggest and mark it off with some masking tape.

If anyone in the UK has used the BD micro +demi U100 syringes and tried to find 0.75 I would be grateful if you could tell me how you went about getting it.

Hope you are finally feeling better. Coconut water is meant to be very good if you have had an upset tummy (also good for hangovers ;-) )
 
Re: Day 4 of lantus. Flat high curves. Can I increase his do

Thanks for the tip on the coconut water, unfortunately while I love the taste of coconut it isn't as fond of me...lol Its about the only food out there besides cow's milk that will make me horribly sick, not as bad as milk (lactose intolerant) but I will be red and itchy for weeks, even if I just lick the back of a spoon when making German Chocolate frosting.. :sad:

However, the next time DH decides to go drinking with the boys that might come in handy although I prefer my grandmother's trick for dealing with a hungover spouse. Run the vacuum, the dish washer and the laundry machines at full volume for as long as the hangover lasts also be sure to drop lots of pan lids and rearrange the entire house with their help. :lol: ohmygod_smile :cool: Granny never raised her voice but she could make you wish that she would just yell at you already...Her big punishment for us kids when I was little was she would make you churn butter on the front porch with an old fashion paddle churn, seasons will change while you churning butter.ROFLMAO

Mel and The Fur Gang
 
Re: Day 4 of lantus. Flat high curves. Can I increase his do

LMAO haha_smiley haha_smiley haha_smiley
 
Re: Day 4 of lantus. Flat high curves. Can I increase his do

LMAO haha_smiley haha_smiley haha_smiley
 
Re: Day 4 of lantus. Flat high curves. Can I increase his do

MommaOfMuse said:
Thanks for the tip on the coconut water, unfortunately while I love the taste of coconut it isn't as fond of me...lol Its about the only food out there besides cow's milk that will make me horribly sick, not as bad as milk (lactose intolerant) but I will be red and itchy for weeks, even if I just lick the back of a spoon when making German Chocolate frosting.. :sad:

However, the next time DH decides to go drinking with the boys that might come in handy although I prefer my grandmother's trick for dealing with a hungover spouse. Run the vacuum, the dish washer and the laundry machines at full volume for as long as the hangover lasts also be sure to drop lots of pan lids and rearrange the entire house with their help. :lol: ohmygod_smile :cool: Granny never raised her voice but she could make you wish that she would just yell at you already...Her big punishment for us kids when I was little was she would make you churn butter on the front porch with an old fashion paddle churn, seasons will change while you churning butter.ROFLMAO

Mel and The Fur Gang
Click to expand...

:lol: :lol: :lol: :lol:
 
Re: Day 4 of lantus. Flat high curves. Can I increase his do

phlika29 said:
If anyone in the UK has used the BD micro +demi U100 syringes and tried to find 0.75 I would be grateful if you could tell me how you went about getting it.
Click to expand...

Hi Sarah,

Those are the syringes I use. I bought a jeweller's loupe (with LED) from Ebay to help with setting the doses.

To measure a 0.75 IU dose, I draw up 2-3 units of insulin, flick to centralise the bubble then express some of the excess insulin. Then holding the syringe horizontally with the needle pointing away from me and viewing it against a bright white background I gently and slowly squeeze out insulin until I can just see the barest crack of daylight between the base of the 0.5 graduation mark and the leading edge of the plunger. I then always view the syringe vertically at eye level using the loupe to make sure that I can still see a sliver of light between the graduation mark and the plunger. If I can't see the light, I draw up more insulin and repeat the above until I'm confident I've measured the dose as consistently as I can manage. I find it helps to do this prior to the PS BG test and feed, since the process is fiddly and it can a fair bit of time to measure the dose properly.

Hope that helps.
 
Re: Day 4 of lantus. Flat high curves. Can I increase his do

You can also twist the plunger with the needle pointing skyward and slowly twist out the insulin in drops until you get the dose you want.

Mel and The Fur Gang
 
Re: Day 4 of lantus. Flat high curves. Can I increase his do

wow! i love ur granny. wish i was aggressive enuf to do those things to ppl. hmm guess if i had a drunk husband, i would. haha but i would feel so mean.i think? and churning butter? wow. very cool!
 
Re: Day 4 of lantus. Flat high curves. Can I increase his do

Some nice mid-cycle numbers today, Sarah! :smile:
 
Re: Day 4 of lantus. Flat high curves. Can I increase his do

I really wish I could say the same for today. It's been high all the way. I've started a thread in the main asking if I missed the shot. If anyone would care to comment on his spreadsheet that would be great.

I also asked about minimum amount a cat has to eat to give the shot. Remi only ate a little and I still went ahead and gave it. He ate okay earlier but just wasn't bothered about his dinner.
 
Re: Day 4 of lantus. Flat high curves. Can I increase his do

Replied on other thread but neglected to ask if you have any cyproheptadine at home? If he doesn't eat soon, it might be worth considering giving him a dose to make sure he eats throughout the cycle.
 
Re: Day 4 of lantus. Flat high curves. Can I increase his do

No but he has ondanestron. I will give him his usual dose in abit and hopefully that will help although I didn't get the impression he was nauseous no lip licking, etc.
 
Re: Day 4 of lantus. Flat high curves. Can I increase his do

Saoirse's nausea symptoms have lessened markedly, too. I'm only giving her the single 2mg dose of ondansetron each day to ensure that Saoirse is well stabilised before I try to taper her off it.

I don't know where I'd be without cyproheptadine to help Saoirse to eat regularly. If not for the medication I think I'd have difficulty giving her insulin with anything approaching consistency and she would not be as well-regulated without it. Pancreatitis/nausea isn't her problem any more. Indeed, it wasn't the problem in the first place. The inappetence Saoirse developed once her numbers returned to the healthy range after switching to wet low carb food and the attempts to get her to eat something are the things triggered her pancreatitis flare up. She stopped eating properly so I thought that it might be that she didn't like the new wet food so I tried to transition her to Lily's Kitchen food because she seemed to like the taste of it but it made her really sick. (BTW my civvie, Lúnasa, also threw up a couple of times after eating LK food.)

I wish there was more info on this board or elsewhere on the net to throw light on why so many diabetic cats seem to develop problems with inappetence/nausea and how to tackle it for the long term. :YMSIGH:
 
Re: Day 4 of lantus. Flat high curves. Can I increase his do

We'll remi's numbers are still high again. They have a slight curve in them but nothing all that much. I am wondering if the effect of a new dose wears off all a few days as it just doesn't appear to be doing what it was.

He still hasn't eaten all the much tonight either. Just not bothered. I think I will start with some nice fresh food and see what he thinks. It does worry me because of the whole ketone thing. If nothing else I will just have to give him some more treats and hopes he wants food in the morning.

So the question now is should I keep him on this dose of increase to 1unit?

Any suggestions gratefully received.

Sarah
 
Re: Day 4 of lantus. Flat high curves. Can I increase his do

He just are a small bowl of food so think the ondanestron does still help him.
 
Re: Day 4 of lantus. Flat high curves. Can I increase his do

Just a note - if his glucose is high and he hasn't eaten, you may want to give a token dose of insulin. It will let the body use what is in the blood stream and by dropping the glucose level, may actually trigger some appetite. By token dose, I mean 1/4 to 1/2 of the regular dose, based on how comfortable you are with giving him some.

Also, at 2 or more days of not eating, the risk of hepatic lipidosis is increased. The fat breakdown for energy goes to the liver. Too much fat congests the liver and blocks bile release into the digestion. This completely deranges digestion and can be fatal. If you have to assist feed using a syringe, do it. It may save your cat's life.
 
Re: Day 4 of lantus. Flat high curves. Can I increase his do

hi Sarah
hope your baby starts to eat and feels better.
 
Re: Day 4 of lantus. Flat high curves. Can I increase his do

BJM said:
Just a note - if his glucose is high and he hasn't eaten, you may want to give a token dose of insulin. It will let the body use what is in the blood stream and by dropping the glucose level, may actually trigger some appetite. By token dose, I mean 1/4 to 1/2 of the regular dose, based on how comfortable you are with giving him some.

Also, at 2 or more days of not eating, the risk of hepatic lipidosis is increased. The fat breakdown for energy goes to the liver. Too much fat congests the liver and blocks bile release into the digestion. This completely deranges digestion and can be fatal. If you have to assist feed using a syringe, do it. It may save your cat's life.
Click to expand...

BJM

I will remember about the token dose as it does seem a shame to not give any insulin. I was lucky as he ate much more an hour or so later. I think I may have given him too much during the day and he just wasn't bothered. He has never been a food orientated cat (until he became diabetic!).

We thought remi had HL a couple of years ago when he had a big pancreatitis flair and and became jaundiced. That was a horrible time. It turned out he had a cholangihepatitis.
 
Re: Day 4 of lantus. Flat high curves. Can I increase his do

Hey Aine and Nadine

Remi's appetite picked up again and yesterday he ate fine. I am trying to only put a little bit of food down at each meal so he eats the whole thing but it is difficult to assess how much remi will eat in one go having only had dry food all his life. I had been giving 30g in the am followed by two snacks of 20g but I think that is almost too much. Today I gave 25g for breakfast and will give 15 g as a snack and 20g for lunch. Then repeat in the evening.

This is the second day that remi is on 1 unit of lantus. So far he is back to being more vocal and I think drinking/peeing less and BG reducing slightly. Fingers crossed we are getting close to a god dose :-D
 
Re: Day 4 of lantus. Flat high curves. Can I increase his do

Hey Aine and Nadine

Remi's appetite picked up again and yesterday he ate fine. I am trying to only put a little bit of food down at each meal so he eats the whole thing but it is difficult to assess how much remi will eat in one go having only had dry food all his life. I had been giving 30g in the am followed by two snacks of 20g but I think that is almost too much. Today I gave 25g for breakfast and will give 15 g as a snack and 20g for lunch. Then repeat in the evening.

This is the second day that remi is on 1 unit of lantus. So far he is back to being more vocal and I think drinking/peeing less and BG reducing slightly. Fingers crossed we are getting close to a god dose :-D
 
Re: Day 4 of lantus. Flat high curves. Can I increase his do

phlika29 said:
I was lucky as he ate much more an hour or so later.
Click to expand...
That appetite uptick may well have been due to the insulin starting to kick in, as BJM mentioned above.

Glad Remi is eating better today. :smile:
 
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