Dosing help requested

[billr]

[Some previous discussion here: viewtopic.php?f=28&t=103470]

We finally managed to get another curve on Gizmo yesterday and we're as confused as ever. Similar to what we've seen with spot checking in the past, his daytime readings are basically flat during the day. In the evening, he drops down a little, but generally still remains high. Is it unusual to not really have a noticeable nadir point?

We've been at 0.75U for quite while and it seems like a dosage change is required. What's confusing is that his readings are the same or higher now than they were on 0.5U. Should we step up to 1.0U and see how he does? I was just reading Sunday in a post by KPassa that giving too high a dose can also result in high BG numbers. What does this look like and how can you tell the difference between too little and too much?

At a guess, the high reading for today's AMPS was a bounce from last night.

 

[donaleen and Ozy]

Hi Bill,

Boy, you sound just like I did when Ozy's numbers were so unpredictable (and may be again, who knows). I am not experienced enough to give you dosing advice but I will say that it seemed to me that Ozy was mostly high and all over the place and I worried a lot about what it meant. I couldn't understand WHY his numbers would be higher when his dose went up.

Suddenly, it seemed, after about two months his numbers got lower and he stopped bouncing so much. I guess his liver stopped fighting the lower numbers.

In Ozy's case, I believe he was diabetic for quite a while before he was diagnosed. Therefore, his liver took some time to adjust and stop freaking out about the lower numbers.

It does seem like he has been on the same dose for a long time.

I see you are a fellow Oregonian. I am in Portland.

 

[BJM]

Yes, I would increase 0.25 units and take the dose up to 1 unit BID. Those nadir tests are the ones that guide the dose adjustment when pre-shots are high enough to shoot (Also, you may set your no shot level to 180 mg/dL now, since you've been doing this for a couple of weeks and aren't in any danger of going too low.)

There are 2 lantus forums - Tight Regulation protocol for Lantus and Relaxed. TR focuses on maintaining the glucose in near normal numbers with testing throughout the day when possible and always at pre-shot. Relaxed Lantus is for those whose cats or owners aren't able, for whatever reason, to do that (excessive bouncing, arthritis, helping a neighbor, etc).

In the lower right of the screen, is a down arrow which may be clicked, then a forum selected. Or, select the board index and navigate from there.

It might be worthwhile to take a look at each and see if either might be a good fit for you. You'll get more specific support.

 

[billr]

@donaleen, nice to see another Oregonian here! @BJM, thanks for the advice, we'll probably step of to 1.0U. I'll also post in the Lantus Relaxed Forum soon, as that method suits us better - at least now.

I'm still curious about the effect of too much insulin causing the BG readings to be higher. How do you detect this vs. not enough? I know that's why you start low and slow, so you hopefully don't get in that situation, but I'm still curious.

 

[BJM]

... How do you detect this vs. not enough? ...

If you do diligent testing and increment by small amounts (0.25 units for low doses; 0.5 unit increases for higher doses), you will notice color changes on your spreadsheet (using our template) that highlight higher vs lower levels ... or any glucose & glycogen reserves will get exhausted and the cat will crash in a hypo.

 

[Wendy&Tiggy(GA)]

Heres the tight regulation protocol and how to decide when and how to do dose changes: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

But in summary:

"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.

Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 (blue green) before increasing the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 (yellow) increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 (pink red black) increase the dose by 0.5 unit.

Reducing the dose:
If kitty drops below 50 reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further. If an attempted reduction fails, go right back up to the last good dose.