Dosing suggestion for 100-200 BG

[aleahmora]

Hello! Luna recently started insulin last month, and started with a libre, and now work has been busy so I apologize for my messy spreadsheet.

I am trying to figure out how to dose Luna, I am interested in the SLGS method but I worry 1u might be too much to start with -- note the huge change when she switched too 100% wet food on 10/05!
Currently my syringes do not have 1/2u marks (I am very low on the syringes that do have them) so I have been skipping when she is under 200 (suggestion from my vet). I do have access to a 3D printer so I might see about printing some of those dosage helpers.

I know my recent data is not super helpful since I have been skipping very many doses and don't have as much data. I am thinking that tomorrow I can get a curve done, but ideally I'd like to do a curve after shooting too. However, her diet has also been pretty inconsistent because she is taking chlorambucil, she is very very picky. I have beef, turkey, and chicken Fancy Feast and Friskies and I have to offer her several cans every morning to see what she likes today Next week I am going to the vet to discuss different options for the chlorambucil; she gets 1.75mg every other day but we talked about doing twice a week, or 4mg every 2 weeks instead. And add Zofran.

So, I am not so sure. Do I make any changes to what I am doing? Or should I wait for her appetite to improve / updated chlorambucil dose?

 

[Wendy&Neko]

I am on my third cat with SCL. I strongly recommend the every two weeks dosing. It is much better at reducing nausea from chlorambucil. It is a lower chlorambucil dose overall too. And get ondansetron (Zofran is the name of the much more expensive brand) as soon as possible.

I would try to get more 1/2 unit marked syringes, or use whatever tools you can to be able to dose 1/2 unit instead of 1 unit. Another common tool people here use is digital calipers. Dosing with calipers An old fashioned way is to count drops in your one unit. Load a used syringe with a coloured liquid (tea, juice, pop). Try twisting the plunger to get out a drop. Practice until you get consistent sized drops. Then count the number of drops in your 1 unit. Now load a syringe with 1 unit, and twist out half those drops.

Glargine is a depot style insulin and we find it does much better with consistent dosing every 12 hours. No use doing a curve unless you are shooting insulin.

 

[aleahmora]

@Wendy&Neko Thank you Wendy Both the specialist and my regular vet are pushing back on the 4mg every 2 week dose, specialist says the bigger dose just might make her feel even worse, regular vet is worried about the smaller dose overall not being as effective. I think I will try and push back on them, everything I read from cat owners says their cats did better on the 2 week dosing.

Thank you for the feedback - going to try to start getting in consistent 1/2u doses and get a curve this weekend and next weekend to see how she is doing at this dose.

 

[Wendy&Neko]

Two of my previous SCL kitties I switched from every other day to every two weeks. The last one started on every two weeks. Neko was one of those on EOD who was nauseous every day. Nausea after chlorambucil can last for days. Going to every two weeks gave Neko 7-8 days of no nausea. Unfortunately, as I found out later, I was underdosing her ondansetron. Not all vets believe cats can get nauseous from chlorambucil. They are wrong. As Luna has shown you. Like you, I had to start on the EOD version, then convince the internal medicine vet that the every two weeks would be better. It made a huge difference. As you have read elsewhere.

1.75 mg every other day for 2 weeks = 12.25 mg. Which is over three times larger than 4 mg every two weeks. There is a groups.io group on feline small cell lymphoma. It has some good files and literature that can help you make your case with vets. Apparently the last two versions of the standard oncology textbook suggest the every 2 weeks version. Good luck.

 

[aleahmora]

@Wendy&Neko Would you give Neko ondansetron every day, or just on chlorambucil days?

 

[Wendy&Neko]

Every day when on EOD dosing. When I went to every two weeks, for about 5 days in a row. Cats differ in when the worst impact of chlorambucil is, so you have to find out what works for Luna. Some cats are good for just a few days worth in the two week method, some need a week. Ondansetron should also be given at least 3 times a day.