? Dosing advice,please

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Summers Mom

Summers Mom

Member Since 2017
Hi this is will be Summers 7th day on lantus when she receives her PM shot tonight. She has been getting .5 units 2 x a day. Her lowest point of her numbers seem to be around the +5 +6. I am using the TR but don't fully know when or if i need to increase. I feel helpless here. I don't know if i need to increase or when. I want this TR to work for Summer but i feel like i am not doing this protocol properly because i don't know what i am doing because of me being new to this. Please Help. I am thinking of increasing .25 unit starting in the morning. She is getting .5 units 2 x a day so that would bump her up to .75 units 2 x a day. What do you all think??
 
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From the TR protocol:

"
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."

You have held the initial dose for almost a full 7 days now and are not really seeing much movement. You have a good deal of data and it is unlikely that you are missing any low numbers which could cause bouncing.

With TR this is the guideline for increases:

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.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
  • 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.
http://www.felinediabetes.com/FDMB/threads/lantus-levemir-tight-regulation-protocol-tr.1581/


As you are feeding homemade raw the food should not have a bearing on the numbers. My thought is that it is time to do an increase and try to get some better movement with the glucose readings. Hopefully some others will weigh in shortly with their opinions/advice.
 
If you decide to go for the 0.75 unit dose this is what it would look like when you measure it. You would have to eye-ball it a bit so that it is between the 0.50 marking and the 1.0 unit marking.
5e86c3d4.jpg
 
Don't be afraid to keep asking what you should do with a dose. It took me ages with "dose increase?" in my subject line. Someone always helped me. You have been on the dose the 5-7 days needed for a starting dose. The nadirs are blue, so you should increase by 0.25 units. Good luck with the increase.
 
Kitty's numbers are not bad at all for start, you are probably very close to the target. Don't be afraid, follow the protocol and you'll be there in no time. Both TR and SLGS attached are pretty safe. 0.25 u increases when required will take you there. Fine tune-ups once you get into the holding phase will probably needed.
And don't forget, cats are very resilient and have 9 lives (at least) - no reason to panic. :).
Good luck !
 
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After a week with your kitty on Lantus, if you're feeling overwhelmed by all of the information, confused, and frightened that you're doing everything wrong, then you're exactly where you should be (unless this is not your first diabetic cat). We've all been in your shoes.

There are a couple of basics to think about. First, are Summer's numbers where you want them? With TR, if your goal is remission, ideally you want to see numbers in the normal (50 - 120) range. If nadirs are mostly above 200, you increase the dose after 3 days/6 cycles. If nadirs are largely below 200, you evaluate the dose after 5 days/10 cycle. It looks like you increased Summer's dose to 0.75u which was what TR indicates. In most cases, dose changes are in increments of 0.25u.

You decrease the dose if numbers drop below 50. You always want to be sure you have high carb (i.e. a "gravy" based food like Fancy Feast Gravy Lovers food or Karo or other syrup) food on hand. Likewise, most of us make sure we always have a stockpile of strips stored. If numbers drop, you end up testing a lot -- every 20 min or so.

Don''t hesitate to look at other kitties' spreadsheets. I have 6.5 years of data on Gabby's SS. She was a challenging cat to manage given an early nadir and a tendency to have her numbers drop low and fast. Looking at SSs, will give you a feel for how other people handle situations you may encounter.

No one expects you to know everything after a week. Please don't hesitate to ask questions. People ere are very generous with their time and information. Be aware that you may get conflicting recommendations, though. Everyone's experience is different and every cat is different (ECID). The people lending a hand also have differing levels of experience. Hopefully, when making a suggestion, the person making the suggestion will explain the rationale behind the suggestion so you better understand the thinking behind using Lantus.
 
Sienne and Gabby (GA) said:
After a week with your kitty on Lantus, if you're feeling overwhelmed by all of the information, confused, and frightened that you're doing everything wrong, then you're exactly where you should be (unless this is not your first diabetic cat). We've all been in your shoes.
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I absolutely feel overwhelmed, confused, frightened, and i feel like when i am reading, it is not soaking in!! lol Yes i am testing and i feel comfortable with that and Summer is so good about it too and i have Summer's spreadsheet up and updated but other than that, i feel like i am wearing blinders. When i look at her numbers that i am adding to her spreadsheet daily, i just can't understand what i am looking at and it makes me feel helpless. To me right now as i look at them, i see just numbers. I pray something will kick in and i will begin to understand what i am doing. I feel so very much overwhelmed with all the info.
 
Summers Mom said:
I absolutely feel overwhelmed, confused, frightened, and i feel like when i am reading, it is not soaking in!! lol Yes i am testing and i feel comfortable with that and Summer is so good about it too and i have Summer's spreadsheet up and updated but other than that, i feel like i am wearing blinders. When i look at her numbers that i am adding to her spreadsheet daily, i just can't understand what i am looking at and it makes me feel helpless. To me right now as i look at them, i see just numbers. I pray something will kick in and i will begin to understand what i am doing. I feel so very much overwhelmed with all the info.
Click to expand...

It's okay. I felt the exact same as you just a couple weeks ago, maybe less, you can search my threads and see for yourself. I said many of the things you are expressing. I'm still confused, I'm still reading and rereading things and wishing they would just stick for once and for all. But I feel a lot better too. It's a time game more than anything. Give yourself some time to connect the dots, Summer is doing okay. I also find such helpful people here, that somehow know just when to quote from a sticky (that I've read a dozen times already and have printed out) that it's so relavent and timely, things start to click.

I don't think you can do much more than you are doing right now. Even if you could make sense of the numbers, there's not much to make sense of just yet. It is so overwhelming, but everybody here has been patient and kind with me, and no doubt to you as well. You can ask questions, you can forget stuff in the sticky, you can be confused, it's okay and it will get better, probably sooner than you think it will (but probably not as instantly as you want it to). ;)

:bighug:
 
What you're outlining is how we all felt. The learning curve is very steep at the beginning. There was so much that was flying over my head when Gabby was first diagnosed. Now, I can answer pretty much what people throw at me without having to do research. It's permanently burned into my brain! As for the SS, it can take a while to begin to see the patterns and frankly, some people are better than others when it comes to making sense out of the data. FWIW, there's not much to interpret on Summer's SS. It's pretty flat.

You've been at this for about 2 months. Give yourself time to develop the knowledge and feel like you know what questions to ask. Gabby was diagnosed in May 2009 so I've been on the Board for over 8 years. Without question, finding out that Gabby had FD was one of the most difficult days of my life. The way I cope is to read (and read and read). I read websites, veterinary journal articles and books, medical texts and articles and got the best help here from people who had been living with FD and were paying it forward. Other than reading and re-reading the sticky notes at the top of the Board and looking through the innumerable links, looking at other kitty's SS can also help if you have a question about why someone is making a suggestion.
 
Thank you Toebeans, Sienne and Gabby and Gill and George for your advice and kind words. I am looking forward to understanding what i have been pounding into my head. And i am looking forward to feeling like i have a brain again instead of mushy spaghetti!!! Lol
 
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