Edith on Lantus - new dosing advice

albertresidence

albertresidence

Member Since 2019
Original post about increasing Lantus...

http://www.felinediabetes.com/FDMB/...iabetes-journey-thus-far.223709/#post-2502273

Hi all, ...Edith has been on an increased dose of Lantus (1.25 BID) since January 02nd, 2020. As you can see her numbers are still all over the place. I did another small BG curve on January 17th. She was in the 200 range until a chicken sausage disappeared from the stove while we were eating in the other room and her PMPS was 404. I also have remarks on her SS on days where we physically caught her getting into things. She holds a Masters Degree in Robbery. Nothing is save!

My question is, does she need more Lantus? Should I increase by 0.25 to 1.50 BID or is this not a save dosage for her?
 
There are a couple of basics that will help you manage Edith's diabetes.

First, the quick answer to your question is that Edith needs a dose increase to 1.5u, BID (we recommend BID dosing only).

Who would have thought a chicken sausage would be that high in carbs? (What's in that sausage?)

I know you mentioned feeling overwhelmed by the dosing method. I'll try to offer a summary. With SLGS, you want to evaluate the dose every week. You need to get a minimum of 4 tests per day -- your pre-shot tests and one test during both the AM and PM cycles. With the PM cycle, a test before you go to bed will let you know if it's safe for you to go to bed or if Edith's numbers are dropping During the day, once you establish where Edith's nadir is, you want to get a test somewhere in the vicinity of the nadir (lowest point in the cycle). At the end of the week, you do a curve which involves testing every 2 hours for a 12-hour period or every 3 hours for an 18-hour period. Based on the information on your spreadsheet, it looks like Edith's nadir is in the middle of the cycle (give or take). The curve gives you information about where onset and nadir. And just because cats refuse to be predictable, nadirs can and do change.

If nadirs are generally above 150, a dose increase of 0.25u is generally recommended.

If nadirs drop lower than 90, a dose reduction of 0.25u is indicated.

If nadirs are between 90 - 149, hold the dose for another week.

You do not want to stay at a dose for an overly long period. It looks like you increased Edith's dose on Jan. 1st and have been at the 1.25u dose for the past (almost) 3 weeks. With SLGS, you don't want to hold the dose more than a week if the nadirs are over 150. Allowing a cat to sit in higher numbers for a while can allow glucose toxicity to develop. (This sounds worse than it is -- the cat's body treats the higher blood glucose levels like her new "normal" which makes it harder to get the numbers to come down.)
 
@Sienne and Gabby (GA), Thank you so much for the detailed information. I really appreciate it. I think Edith is probably used to deal with higher BG numbers as her "normal". The reason I'm saying this is, that the Vet who had her as an office kitty, diagnosed her in November 2018, did a BG curve once and never again and kept her at 2U of Lantus SID until she came to me in December 2019. I put all the information I was able to collect about her BG levels collected by the Vet from 2018 in my original post (see above). I'm going to increase her dose to 1.50U BID as of tomorrow. Getting a BG curve done at the end of the week every week is going to be a challenge due to my schedule. We shall see.
 
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