First day on Lantus - already a dilemma at 195. Advice?

Status
Not open for further replies.
RuthC

RuthC

Member Since 2012
George is on Lantus, 1.75u. Yesterday after his very first injections at 12:30pm he dropped from 312 to 53 in 2 hours - scaring me half to death. No pm injection per vet's direction.
This morning, I gave him the same amount and he was under 100 most of the day. At +12 my pretest for the PM shot had him at 195. I have read that anything under 200 = don't shoot but I'm really torn about whether to start making adjustments already to what the vet suggested.

My inclination is to NOT give him more insulin tonight and either check him later or else just wait until morning. I'm more concerned about him going too low than if he goes over 200 again overnight.

Would love to hear thoughts from you experienced caretakers.
 
Hello there Ruth, welcome to the board.. its fantastic that you are here and that you are testing. you are doing great for your kitty!

53 in the first day? Wow. What are you feeding him? Did you change his food after diagnosis? And what meter are you using?

Since you are new to this and aren't sure how he will behave, I think you should skip the shot too. But When you get a chance I would read this http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=147 for future reference. Plus pick up some high carb food, and karo syrup for emergencies.

Hoping an expert will chip in.
 
I use a Relion monitor which I've calibrated with our vet's. I've been testing and recording since Dec 19. I tried a few different kinds of low-carb wet foods but the only thing he eats with enthusiasm is classic Fancy Feast, so that's what we've settled upon. Four meals a day, one can each. Free choice Stella & Chewy freeze dried as a backup (he doesn't eat much of this, but some times will nibble). Food change-over was accomplished well before starting insulin.
I've done enough testing that I feel pretty secure with his pattern, and the 53 was def a shocker.
As recorded on my SS, this morning his AMPS was 214, which is below his average, and he dropped quickly in the first couple hours tho not all the way to 53.
Shouldn't the target be to keep them above 100 most of the day?
Karo is on hand.
 
Hello Ruth,
I just went and looked at your earlier posts and checked out George's profile so I could "catch up". It looks like he was diagnosed in mid-November, and you got good results from changing him to a proper diet, but not enough to completely avoid insulin. Your vet prescribed a good insulin, Lantus, and you started yesterday and saw immediate results! The only "problem" I see is that the vet might have prescribed too high a dose to start...
I know they used the weight-based formula and came up with "2 units". I'm wondering if that was too much too soon.

I'm going to ask some more experienced Lantus users from the TR forum to come over and take a look. There's no doubt that after only a couple of shots, George is responding to the insulin.
You asked some good questions in the thread you posted in the Relaxed Lantus forum earlier today.

started George on Lantus yesterday mid-day following a morning vet appointment. She advised just the one shot for the day and based his dose on .25 units for body weight totaling about 2 units a.m. and p.m.

First shot was at 12:30 yesterday and when I checked him 2 hours later he'd gone from a.m. 302 to 53. Whew! By 11pm he was back up to 120, and this morning I set up a SS and began posting for use in this forum (I've been tracking him on paper for the past month as we changed diet prior to beginning insulin). Today AMPS=214, +2=151, +4=61.

I assume there's some sort of "settling in" period initially while his system adjusts to the Lantus and I know I need to find his upper and lower limits.

My question: How low should I be concerned about? Should I make adjustments if numbers are low or will that screw up getting him started with the program?

I guess as we get farther into this I'll be more comfortable making "unauthorized" (i.e. without calling the vet) adjustments based on my own monitoring.
Click to expand...

That drop from 302 to 53 in the first couple of hours was really quick and pretty far. And the drop in 4 hours today was also evidence that he's responding to the Lantus well. Maybe a little bit "too well".

Yes, there is a "settling in" period with Lantus. Usually 3 days or more, until the "depot" builds up in his system. Some cats respond quickly, while others don't. George did.

As far as "how low should I be concerned". Well, it's not only how low, but how fast he goes from high to low. Usually, the insulin will begin to work 2-3 hours after the shot. And typically, the "low point" would be somewhere in the time frame of 5-7 hours after the shot. When you see an early onset and a rapid drop early in the cycle, that means it's likely to keep going down for a few hours. A nadir (the low point) of 53 or 61 is okay. Seeing low numbers like that early than nadir is the point where you would be "concerned".

I would skip the shot tonight if you got a 195, because you only have 36 hours of data, and that isn't enough to make a safe "guess" as to what a 2 unit dose will do.

Let me go get some other "eyes" on this...

Carl
 
Welcome, Ruth! George is beautiful. (I had a George and Gracie, as well.)

The 1.75u dose is an appropriate dose based on the initial dose formula for Lantus. (Initial dose = 0.25 x ideal weight in kilograms) However, if the dose is making you nervous or you're finding you're unable to give a shot twice a day, it makes sense to lower the dose. You might consider dropping George's dose to 1.5u or even less. You'll get the best results from Lantus if you can be consistent with both your dose and shot times.

FWIW, on the Lantus board, we use 150 as the "ask for help" number. You can always stall for a bit tonight (don't feed George) and retest after 30 min. to see if his numbers are going up. It takes roughly 2 hours for Lantus onset to begin and you will be feeding. It should give you a margin of comfort.

Also, some cats have an initially marked response to insulin. As their system gets used to being on insulin, the cycle may flatten out.

You may want to read the starred, sticky notes at the top of the Lantus board. They are a great source of information about Lantus. You are welcome to join us in "Lantus Land."
  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal version -- the “Tilly” Protocol developed by the counterpart of this group in Germany, which was also published by Kirsten Roomp & Jacqui Rand, DVM in one of the top vet journals.
  • New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
  • Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
  • Lantus depot: This is an important concept for understanding how Lantus works.
  • Lantus & Levemir: Shooting & Handling Low Numbers: What data you need in order to be able to work toward remission or tight regulation as well as information if you have a low pre-shot number or a drop into low numbers during the cycle.
 
While 53 on a human glucometer isn't a hypo, given that it is the 1st day, and Lantus builds up in the body, I think it would be prudent to drop the dose down to 0.5 unit if you shoot tonight. Keep that dose for 5 days unless below 200.

The objective is a dose which can be given safely every 12 hours which doesn't take the glucose below 50 on a human glucometer (80 on an pet-specific glucometer)
 
Thank you all for the advice, for looking at my available data, and for answering so quickly. I wasn't sure if I should go to the Relaxed Lantus board yet since I'm still a newby.

The upshot tonight: I withheld food, restested 2 hours later (AMshot +14) and got a 243. I decided to give a dose and feed, but reduce the amount to .5u since he seems so responsive to insulin. Even if he's a little high overnight I'll feel better with that than worrying I've hypo'd the poor cat on the very first day. Going forward I will look to keep his low point above 50.

If he starts the day again tomorrow at a fairly low point, I'll keep this lower dose and continue monitoring until either his ears wear out or I feel like understand the pattern :)
 
If I may, let me go over some basics.

I suspect that 0.5u will be too low of a dose. Most cats start on a dose of at least 1.0u. Since you've opted to start at 0.5u, I'd stick with that dose. Just so you have an appreciation of the bigger picture, when you stall, the net result is that stalling acts like a dose reduction. Stalling for 2 hours plus reducing the dose ends up doubling the effect.

Because you stalled, your shot time tomorrow is 12 hours from when you actually shot tonight. If you need to move the time back, you can do so in 15 min. increments at every shot or by 30 min. once a day.

Lantus dosing is based on the nadir -- the lowest point in the cycle -- not on your pre-shot values. This is one of the ways that Lantus is different than other types of insulin. The pre-shot is important only to the extent that you know it's safe to shoot.

If you need help, this forum or the Lantus Tight Regulation forum are the busiest places on the board to find assistance. The Relaxed board is not busy and you are not likely to get immediate help if you need it.
 
That'll work for tonight.
Next shot is 12 hours from previous shot.
You can adjust by 15 minutes per shot or 30 minutes per day to get back on schedule.
Shooting early is like a dose increase; shooting late is like a dose decrease.

Pop over to the Lantus forum and start reading the sticky posts on Lantus. Its really important to understand how it works. I tend to be cautious, hence the 0.5 for tonight. I suspect he'll run on a somewhat higher dose than that.
 
Status
Not open for further replies.
Back
Top