Finishing first 3 days on Lantus - feedback?

[Lisa & Leo]

Leo started 1.5 units of Lantus on Thursday night (newly diagnosed) and we're finishing his third day. I'm monitoring every three hours. He gets 1.5 cans of Fancy Feast with each injection, and, on average .5 can at +6. For each reading, he gets a little handful of chicken for a treat.

The first 2 cycles jumped a little, but the last couple have been fairly smooth. It seems suspiciously smooth, but I have no experience to say. I thought the BG values would usually fall after the injections, but it's not consistent. Can anyone shed light on why the first 3 cycles were jumpy and the last three are more smooth? Is the isulin working? I'm wondering if it *isn't* doing anything, and this is just random. Is it a good thing that his values aren't jumping all over? We don't have enough experience to know what we are seeing here.

Also, if I look at the protocol, it would seem that he should go up 0.5 units tomorrow. I wouldn't do that without taking to the vet first, but there doesn't seem to be a risk to do so.

Thoughts? His spreadsheet is in my sig.

Thanks! Lisa and Leo

 

[Carl & Polly & Bob (GA)]

I don't have the experience to tell you what you are seeing either, but I'll ask some folks who are to drop by.
I'm thinking this is the part of the protocol you are referring to?

"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 before increasing the dose by 0.25 unit.
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.

I did want to say great job on the testing though! Every 3 hours around the clock for 3 days isn't easy to do.

Carl

 

[Lisa & Leo]

Yes, that was the part of the protocol I was looking at. He has a high curve that the experts may call "flat" and his nadirs are above 300 because *everything* is above 300 :smile: However, I can't tell where his nadir time is. Sometimes what I would think would be nadir time, the BG is high!

Thanks for the feedback - I've been groaning each time the alarm goes off!

Leo has clearly linked Pleasure and Pain, and finds Pleasure wins. He gets about 6 little pieces of chicken as his treat. He finds me and mills around my legs as I warm up the chicken. Then he runs to his room and sits there while I prepare the meter. He fidgets the whole time, but he's a good boy. Only once, at around 4am, did I hit a capilary and he shook his head, spraying little drops of blood everywhere. Murder scene!

 

[Julia & Bandit (GA)]

I would hold the initial dose for at least days instead of three. Lantus has to build up a "shed", or insulin depot, under the skin before it goes to work lowering blood glucose. So you may not see any action first 24-72 hours for this reason.

If you start seeing some numbers in the 200 range before then, then you'll want to raise by .25u instead of .5u.

 

[Just-As-Appy]

Not quite sure what was left out of Julia and Bandit's first sentence (would hold the initial dose for at least days instead of three), but if you are testing for ketones then I think that holding for another day or two would not hurt. You might get a clearer picture of the nadir timing which would help you to reduce testing frequency.

 

[Sienne and Gabby (GA)]

OMG!! You were testing around the clock? I'm incredibly impressed but you really didn't need to lose that much sleep!! You must be exhausted. Generally, people interpret the instructions to mean to get a mini-curve (testing every 3 hours) during the day and grabbing what tests they can at night.

With Lantus, as others have noted, you give the initial dose some extra time in order for the insulin depot time to form. As a result, you want to hold that initial dose for 5 - 7 days. There can be some exceptions to this "rule."

Does Leo have any significant medical history? I'm particularly interested in whether he has a history of ketones (or diabetic ketoacidosis). If so, we would be a bit more aggressive with regard to when to increase his dose.

 

[Lisa & Leo]

Leo's history was very unremarkable until he was bitten on the tail in January and got FIV. No Ketoacidosis during the vet testing but I don't test for that. I just got the strips for that.

Yes, I got up every three hours ... (lol) ... I don't want him to deal with injections his whole life if we can get him into remission with only some short-term pain for us! That's one reason I wanted to be aggressive with his dose if that would help. I am home from work for a week to be with him 24/7 and would like to take advantage of my availability to make dosages changes most effectively, since I will be here to watch him and test him every 3 hours. Afterwards, he won't be getting testing during the day at all due to my and my husband's travel schedules.

I'll get a little more sleep tonight and keep him on the same dose (1.5) - that's a good suggestion to try filling in some of the other points on the curve to find the nadir.

Thanks everyone for your suggestions! Now we have a plan for the next couple days.

 

[Julia & Bandit (GA)]

Arrghh, sorry. and of course I then logged off. Meant to say 5-7, but Sienne filled that part in.

 

[nwnews]

HI Lisa, I agree with the others and would hold the dose for 5 days before increasing. When my cat first went on lantus her numbers were all over the place the first two weeks - then she finally settled down into stable numbers. Each cat is different but Lantus is well known for building a shed or reserve up. Good job on the testing!!! Jan

 

[Sienne and Gabby (GA)]

I agree with the input you got from your vet -- I'd increase Leo's dose to 2.0u. Here are the guidelines for the next couple of days:

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.
• 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.

If you want to get more input regarding dosing or regarding Lantus use, you're welcome to post on the Lantus Tight Regulation forum. It is a busy forum and there are lots of people with a great deal of expertise who can answer your questions and offer support almost 24/7. The dosing protocol we use has a very high success rate of getting newly diagnosed cats into remission. I hope you will join us there.

 

[Ry & Scooter]

Yes, I got up every three hours ... (lol) ... I don't want him to deal with injections his whole life if we can get him into remission with only some short-term pain for us! That's one reason I wanted to be aggressive with his dose if that would help. I am home from work for a week to be with him 24/7 and would like to take advantage of my availability to make dosages changes most effectively, since I will be here to watch him and test him every 3 hours. Afterwards, he won't be getting testing during the day at all due to my and my husband's travel schedules.

Aggressive dosing is OK, but don't get impatient... you can't rush it. This is a marathon, not a race. It doesn't happen overnight (though some do get lucky like that!) and it is probably not going to happen in a week either. My Scooter was on insulin for 7 months before going OTJ in July. Some cats have been on insulin for years with no remission. While remission isn't a bad goal to aim for, I would aim for regulation first. What really matters most is that Leo is on the road to feeling better, shots temporarily or indefinitely. I felt like you did - just wanted to get it over with ASAP. But I took it slow and did it properly and now Scooter is OTJ.

The shots really aren't painful at all, and they give you something to bond over. Even in remission Scooter still wants to be tested all the time. :lol: Even my non FD civvie Charli likes being poked... as long as she's in my lap she's happy. It's only a matter of time until Leo is seeking you out for testing and shots (and the treats that come afterwards!)