? Dosing questions on Lantus:Charlie-cat & Sarah

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Sarah & Charlie-cat

Sarah & Charlie-cat

Member Since 2022
Howdy! I am Sarah and one of my six cats, Charlie (about 5yrs), was diagnosed with diabetes on 12.1.22. He'd been dragging for a while and my husband brought him into the vet while I was traveling for work. He stayed in the vet hospital through the weekend getting stabilized (also diagnosed with pancreatitis). He lost about 4 lbs recently. He has also been on steroids for a year and a half, for a blood clotting disorder he apparently developed after his last vaccination.

He started on 1 u Lantus on 12.3.22. and we kept him on the canned food he was eating at the vet (Hills I/D). His steroid dose was reduced from .15 ml transdermal to .1 ml.

On his check-up on 12.9.22 his preshot, prebreakfast BG was 408. We went to 2 u. This past week, on 12.15.22, his BG was 402 on the vet's meter and 372 on mine (I tested myself with my meter a few hours after dinner and got 100. So maybe my meter is a bit on the low side).

Vet and I discussed upping his insulin dose, lowering his steroid or changing his food. I wanted to get him off the Hills after looking through the carb spreadsheet and onto the Fancy Feast pate. She calculated his intake to be 2.5 cans to maintain his weight.

He certainly seems like he's gotten his spark back. He's been climbing the high cat tree, which he hasn't done in years, giving chase to his wrestling buddy, and hasn't been drinking as much water. He's still more clingy than normal, sleeping in my bed during the day.


I tested him this morning and got 210. And then about 4 hrs post shot it was 79. I gave him his .5 can and retested 2 hrs later, 111. He was back up to 361 beforehand. At the suggestion of a member of the FB group, I tried to trim .25 off his dose tonight due to that 79 number earlier in the day. That was challenging to judge. Might have been more. He was big mad about his fourth ear poke by his apparently hapless mom. So, might not get another test tonight but try again tomorrow and pick up more lancets.

It's all very anxiety producing at the moment because, well, I'm rather prone to anxiety and having ADHD makes any sort of attention to detail and keeping track of things stuff hard.

Our spreadsheet is below.
https://docs.google.com/spreadsheet...WDunDbVvf5f-iEjgHchCTpzfkQw/edit?usp=drivesdk
 
Hi, Sarah and welcome to FDMB!

It looks like you figured out how to set up your signature and Charlie's spreadsheet. Thank you! There's some additional information that you may find helpful. This is a link to the Lantus board. At the top of the board are what we refer to as "sticky notes." These are permanent posts that contain a lot of great information about Lantus, dosing, methods, etc. I'd encourage you to read them over and pay particular attention to the dosing methods sticky.

It really sounds like you are on track. You did a great job of bumping up Charlie's numbers. What you're seeing at PMPS is what we call a "bounce." Charlie isn't used to being back in normal numbers. As a result, his liver and pancreas panicked and dumped a stored form of glucose along with counterregulatory hormones into his system. In response, his numbers shot back up. It can take several days for the bounce to clear.

I'd encourage you to try to get a test before you go to bed tonight just to be sure Charlie stays in good numbers.

Please let us know if you have questions. We're here to help.
 
Thanks. I will try. I was unsuccessful trying at 3pm and 4pm today. He was mad enough that he tried to bite me and he's usually very sweet. The later attempts, the first one didn't get enough blood and the second one he shook his head. Hopefully, I'll get my husband to help. He's much more squeamish and can't handle things like when they sing the song of their people on the way to the vet.

I'm glad I lowered his dose a bit. I think changing his food made a difference.

Although, he definitely got into someone else's breakfast this morning. I forgot to pick it up before I let him roam the house. At least it wasn't kibbles.
 
Hi and welcome Sarah and Charlie cat.you have done a great job getting set up and organised.
Where is says current insulin on the spreadsheet, could you remove the dose please as we can see the dose given in the SS and put Lantus, so we can see what insulin when we look a the SS…thanks.
When you are testing him, are you giving him a treat as you test or straight after?
If he has lost a lot of weight, he is probably starving. And unregulated diabetic cats can’t absorb all the nutrients in the food so will be hungry. I would give him snacks during the cycles …day and night…so he doesn’t get into other cats food. Don’t feed for the 2 hours preshot though as we don’t want that BG food influenced.
A snack is a teaspoon or two of low carb food.
asl as many questions as you need to , we are happy to answer them all.
 
Checking back in... I'm just generally a Facebook person and have been posting more over there. Here is his spreadsheet again: https://docs.google.com/spreadsheets/d/1Rm-EkOfJ9tugvljDWDunDbVvf5f-iEjgHchCTpzfkQw/edit?usp=sharing

We got a Freestyle Libre yesterday because ear sticks were not happening, even with two adults sometimes. And because yesterday at his pre-shot vet check he was at 91 and I was like um, hi, I think his dose is too high and I thought it was too high when I was told to go to 2 U, and I lowered it to 1.75 almost immediately after on the day I managed to get four tests in and one of them was 76. Also, here is my copy of the 2018 AAHA report on managing diabetes, I have highlighted sections and taken notes.

Vet was annoyed I lowered his dose but conceded yesterday, still annoyed, that I should lower it again. So, yesterday morning he got .75u am and 1.5 pm, and this morning 1.5 u. He's been curled up in my bed all day. He seemed sleepy yesterday and the day before, as opposed to chasing the lady cats around, which he had been doing more of... oh, the old Charlie is back! (both vets we normally see at this practice are out or under rweight restrictions)

He's clearly been chewing on it, but I hope we get a few days of data out of it (neither the inflatable donut situation or the dog jersey I got at Petco yesterday worked, might need to see if I can find something on Chewy).

So far today:
6:53 am (this is an hour and a half prebreakfast/shot for us): 165
8:45 am (preshot/prebreakfast): 165
9:45 am (+1): 165
10:45 am (+2): 147
11:45 am (+3): 108

I'm going to wave my magic wand over him again before I run out to lunch with friends at 12:45. Seems like his numbers will keep going down this afternoon, so I'm going to keep an eye on him with my magic wand (seriously, technology is magic, I want to cry for joy over getting a reading without having to torture either of us).

These are priceless and I wish I felt like my vet's office was following them.
https://www.aaha.org/aaha-guidelines/diabetes-management/diabetes-algorithms/monitoring/
https://www.aaha.org/aaha-guidelines/diabetes-management/diabetes-algorithms/hypoglycemia/

I did call the call cat practice in town, All Feline, and they couldn't get us in until the end of January!

Anyway, I for sure know he was having clinical signs to go with the blood and urine tests they ran at the beginning of the month. Crying that he was hungry all the time, drinking water like it was going out of style, huge pees, including one very stinky one I had to clean up, and right before he went in, he was a sad, sad lump of a cat. But is it possible that it was just pancreatitis without diabetes? I switched his food to FF and the vet lowered his steroid dose. Or is this just because the vet that looks like she's 12 went nuts doubling his dose from 1u to 2u based on pre-shot numbers at their office and he should have gone from 1 to 1.25 and now we're just on our way back down to 1.25 rather quickly?
 
He was 88 when I was running out of the house. I gave him one of his 1/4 can FF snacks early. Will watch him like a hawk when I get home. Cat mom anxiety at 11!
 
Did the vet happen to run a fructosamine test when Charlie was diagnosed? If so, that would be the definitive test to tell you if Charlie has been in diabetic numbers for a period of several weeks. Without the fructosamine test, it's certainly possible that the inflammation from the pancreatititis coupled with being at the vet's office caused Charlie's numbers to be higher than desirable. Of course, the steroids may also be contributing.

From the data on your spreadsheet, Charlie's numbers are outside of normal range (50 - 120). It's hard to know if his being on steroids is elevating his numbers. There are cats who must be on steroids. It's easy enough to work insulin around steroids. It may, however, mean that Charlie has a less good chance of remission. The bottom line is whether Charlie feels good and you're seeing the "old Charlie's" personality shine through.
 
He is a whole new cat. He's back to his shenanigans of chasing the female cats around, rying to beat up the other male (who is now twice his size), humping the fuzzy blankets.

We thought the Feliway was contributing to the calm recently, but no, he was just sick ‍♀️
 
Up, being anxious about one of my other cats who is chewing his fur off again and snagged a reading of 70 from Charlie's Freestyle Libre. He had his Lantus at 8:20 with his whole can of FF. I was pretty sure I got about half his 1.5u dose on him not in him. He has his pre-bedtime snack of 1/4 can of FF at 10:40ish.

That earns him another .25u reduction? I gave him a little extra FF just now. His spreadsheet below. I have been struggling with getting an ear poke off him, hence the libre and the patchy data.


https://docs.google.com/spreadsheet...unDbVvf5f-iEjgHchCTpzfkQw/edit?usp=drivesdkis
 
Sarah -

Have you had a chance to read about the two different dosing methods for Lantus? I'm asking because the dose reduction points are different for Tight Regulation (TR) vs Start Low Go Slow (SLGS). The reduction points are 50 vs 90, respectively. If you have decided on a method, could you include the information in your signature and on the top of your spreadsheet (there's a space for the info)?

Given that you don't have a lot of test data yet, I'd err on the side of safety and reduce the dose to 1.25u.
 
The SLGS method seems more in line with the AAHA recommendations and the decision trees they have published. I am not able to get any ear sticks from Charlie so the idea of testing every three hours seems quite impossible.
 
Just a couple of FYIs...

With either method, the minimum number of tests is 4 -- your two pre-shot tests and at least one test during both the AM and PM cycles. It would be next to impossible for anyone who works to test every 3 hours. With both methods, you will need to get a curve. That involves testing every 2-hours. The curve will help you figure out when onset starts, where the nadir (lowest point in the cycle) falls, and how much duration you're getting.

Tight Regulation is a dosing method that is based on published research. The original article was published in one of the leading veterinary journals. SLGS was developed here. Both methods are solid. I'm someone who likes to see methods that are based on science so I'm a fan of TR and it was largely what was being used when I joined FDMB. However, we have plenty of people who use SLGS and their cats have done well.
 
I have a PhD in a social science, I love science. I love that TR was developed by real people in the real world because I know that if something is impractical in practice, people won't do it (that is like the entire history of education change research).

Having read through both, SLGS seems like it fits our current constraints better, including my tendency to be more risk averse and TR seems more aggressive. The other constraint is that I haven't been able to get a test on him at home in weeks. It takes two people at the vet. I am able to work from home a lot of days but there will also be times I'm gone for a few days so this is going to have to work for my husband who is fairly squeamish as well.

But given the two dosing options, it's not especially clear as to what the goal is for either the highest or lowest numbers. I feel like it's not even clear as to what number should I be watching for to worry about hypoglycemia since one method is like 50 is fine and the other is like back off under 90.

We are currently doing a curve with a freestyle libre since I'm not feeling especially great about our vet office at the moment (and the two we usually see are on maternity leave or under weight restrictions and Charlie is no wee cat). Having more data is great! But not being sure about what to do with it, less great
 
On a human meter, 50 is your “take action” number meaning it's time to intervene with food to bring the BG up , always ask if you're not sure about somethingsomething
Edit meant to mention 50 is the take action if following T R
Thanks Sienne
 
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With regard to numbers, we aim to have your cat get back into normal blood glucose (BG) numbers (50 - 120). That is the ideal range for keeping a cat regulated or getting into remission. We encourage members to do their best to get their cat below renal threshold as best they can. Renal threshold varies for each cat. It's the point where there is no glucose in the urine. It's roughly around 220 so aiming for under 200 will help to preserve your cat's kidneys since diabetes is hard on renal function.

As Diane mentioned, the "take action" number is 50 if you're following TR. Essentially, that means you want to intervene with food if numbers are dropping. Whether it's high, medium, or low carb food depends on where the numbers are, how fast they're dropping, where you are in the cycle, what you know about your cat, etc. As an example, my kitty was a diving diva -- her numbers could drop like a rock early in the cycle. As a result, I tested early and often and based my intervention strategy on what her numbers were doing. With SLGS, 90 is the point where you give a dose reduction. In terms of safety, it's a very safe number. The reduction point for TR, for a newly diagnosed cat, is 50. As you correctly surmised, TR is more aggressive -- the reduction point is lower and doses are changed more often.

It's hard to give a fixed "rule" about hypoglycemia. We also differentiate between low numbers and symptomatic hypoglycemia. To a degree, one of our favorite slang sayings applies -- ECID (every cat is different). Gabby had times when she dropped into the 30s and the only sort of symptom I saw was she was a bit glassy-eyed. Other members would describe more significant symptoms (e.g., ataxia, disorientation) if numbers were in the 60s. Just like humans, some cats are more sensitive to low BG numbers than others. The best suggestion I can offer is to be a good observer of Charlie's behavior. What did you see when he dropped to 70? If I'd been online, I would have suggested giving him some low carb food and re-testing in 30 min. This post on How to Handle Low Numbers will walk you through what to do. It's a post we suggest you print out especially if you travel so whoever is caring for Charlie will know what to do. In the absence of truly low numbers, we encourage "feeding the curve." What this means is that if you're seeing numbers progressively dropping, intervening first with low carb to see if numbers level off and if not, increase the carb level. The idea is to not overdo the carbs and instead, try to flatten out the numbers so your cat is "surfing" in a normal BG range.

The good news for your squeamish husband is that getting a test reading from a Libre is easy (unless it stops working or Charlie decides to remove it). If you're traveling, we're here to walk your husband through or answer questions. Hopefully, his learning how to give a shot will be a very short learning curve.
 
Thanks Gabby. That's a good point about making sure Charlie had a libre on him when I know I'll be done for a few days. It was 40 bucks. I've easily spent that on strips and trying to get the right sized lancets and freeze dried fish. He is now wearing a very rakish bright pink polka dotted recovery color with a frilly edge to keep him from chewing on it. If we do this more regularly, I'll have to get him the lions mane one, you know for his ego ;)

Yes, that's exactly what I did, low carb food, retest. He came back up last night to the mid 80s and then back to 70 and then back up to the mid 80s and I went to bed. I did that with the first under 80 number as well. Fed, retested, though a few hours later, and he was back up in the mid -80s. He appeared to have dipped under 70 while we were out just now but by the time we came back he was in the low 100s. Maybe he was busy burning up his glucose giving chase to his sister.

I have seen him go glassy eyed and seen him sleep more than normal in the middle of the day. There have even been a few times where he seems extra cold. He's a very particular kind of cuddler, so it was weird when he took a nap around noon under the covers with me. His numbers from today and yesterday suggest he hits his nadir at +4. And then last night when I finally turned in he was like, hello, I would like to be under the covers and it's like 50 degrees warmer this week than it was last week.
 
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