Glargine dosage question

[Zebib]

Hi,
I have restarted giving 1U of Lantus to Urru since last night because we had reached 5U with figures still in the high end. I really need some help confirming the following: based on Urru's weight and 5 units of Caninsulin, my vet recommended starting at 3 units of Lantus. Apparently, that was too high. What I would like to confirm is the following: when a cat was on another insulin, the tight protocol states that it should be taken into consideration. Is this right or not? Also, I have read on a thread here that someone in similar scenario as mine (i.e. switching to Lantus from another insulin + high units) that she regretted starting low because she lost time and ended up at the same dose of Lantus (I know every cat is different.). I would appreciate having a clarification on these two points from experienced people. I am on my own on this one as my vet does not prescribe Lantus often. Thank you very much.

 

[Bandit's Mom]

Hello and welcome to FDMB

I'm sorry I cannot help you with your query but let me tag a few people who might be able to.
@Wendy&Neko
@Sienne and Gabby (GA)
@Red & Rover (GA)
@Panic

What are you feeding Urru?

 

[Panic]

Okay, wait a sec. A few things for you to consider. You have virtually no mid-cycle data - you can't base insulin dose on pre-shots. You determine it by how low it brings your cat, not how high. Pre-shots are the LAST numbers to come down. Mid-cycles are where all the answers are.

Another thing is you're jumping the dose every day almost, (and in whole units - you want to stick to .25 increases, slow and steady) and haven't given the depot any time to fill properly. Lantus craves consistency for it to work ... you haven't given it a chance so you're essentially making the depot all wonky.

I don't know what the right dose is for Urru because we have no mid-cycle data... Are you able to start getting a couple tests in each cycle for us to see what's going on? I worry about the abrupt change from 1 to 5u. The dose wasn't upped properly but dropping back down can be dangerous. Are you checking for ketones?

These are some things to keep in mind. Very glad you posted, now let's get you some helpful experienced Lantus users to guide you.

@tiffmaxee @Sue and Luci

 

[Wendy&Neko]

We do base the Lantus dose on the previous insulin dose - but we have to know how low that previous insulin dose was taking the cat. In Urru's case, we don't know what 5.0 units of Caninsulin was doing because there were 3 different doses in the space of just 5 days of day time data.

Going completely back to 1.0 may or may not be a waste of time. It was to me. My girl got up to 5 units of Caninsulin with nadirs in the 100's. I switched to 1.0 unit of Lantus, again based on vet suggestion. Not long after that I started here. It took me over 3 months to get back to 5 units of Lantus, and ended up going higher.

my vet recommended starting at 3 units of Lantus. Apparently, that was too high.

There is no evidence that 3 units was too high a dose, or even too low. We don't have enough data to say what was happening on that dose. I suggest you pick one of the dosing methods described in the Dosing Methods Sticky Note at the top of this forum. It will show you what data you need to collect to determine how to change doses. In particular, we determine changes based on how low the dose is taking the cat. Those lows typically happen sometime between the preshots tests.

 

[Sue and Luci]

Welcome to the LB&L forum!

As others have mentioned above those mid-cycle tests are critical to determining the dose. Lantus works with a bit of a delay - so after about two hours, sometimes later in the 12 hour cycle the hormone has had time to take effect - although not always in the first day or three...there's a depot with Lantus and it tends to build up a bit over a few days and you can tell when it's kicked in because around 2+ all the way to 8 or 9+ in some kitties the numbers will drop, drop, drop. And guess what - same thing is going to happen at night - oh yes, the much dreaded night time tests. No one I know likes to stay up late with kitty or get up in the middle of the night - but it can be one of the most enlightening times of day to find out what impact the Lantus is having on your cat's blood glucose.

You may get a very pleasant (or in some cases, an unpleasant surprise by checking around 2+ before you go to bed, and then again a few hours later if it looks like you're getting some action (dropping numbers).

That's when the fun starts and you'll hear others talking about PJ (Pajama Parties)...and yes, some people do end up staying up very late or getting up very early in the morning - yes WAY before you're supposed to get up - and YES it does mean losing sleep...but it's crucial to finding out what's going on.

Here area couple of examples of spreadsheets where Kitty has made a decision to sail down to the lagoon (green numbers) .

@Butters & Lyla
https://docs.google.com/spreadsheet...R3-hgldFQg77eAqdlQOMNhVNiUVY0uGSHb2jB/pubhtml

@Sarah and Blaze
Currently in remission: https://docs.google.com/spreadsheet...3WHSjGkmNBWj-jI5rLdIy-k9OKTtKWlhfvZkN/pubhtml

This is the way to the Falls (another word for remission)
@JaxBenji
https://docs.google.com/spreadsheet...ukaCR2cCnZXfJKoTg42nwcVJiY/edit#gid=361360320

 

[Zebib]

Hello and welcome to FDMB

I'm sorry I cannot help you with your query but let me tag a few people who might be able to.
@Wendy&Neko
@Sienne and Gabby (GA)
@Red & Rover (GA)
@Panic

What are you feeding Urru?

Thank you. Urru eats Wellness no grain canned food and she was eating a tablespoon of Orijen, Red Meat but someone made me realize that it has peas, starch, etc. To be very honest, I was very strict with low carb, high meat protein food 9 years ago but loose track over the years. I know it's important, I will pay more attention to it.

 

[Zebib]

Okay, wait a sec. A few things for you to consider. You have virtually no mid-cycle data - you can't base insulin dose on pre-shots. You determine it by how low it brings your cat, not how high. Pre-shots are the LAST numbers to come down. Mid-cycles are where all the answers are.

Another thing is you're jumping the dose every day almost, (and in whole units - you want to stick to .25 increases, slow and steady) and haven't given the depot any time to fill properly. Lantus craves consistency for it to work ... you haven't given it a chance so you're essentially making the depot all wonky.

I don't know what the right dose is for Urru because we have no mid-cycle data... Are you able to start getting a couple tests in each cycle for us to see what's going on? I worry about the abrupt change from 1 to 5u. The dose wasn't upped properly but dropping back down can be dangerous. Are you checking for ketones?

These are some things to keep in mind. Very glad you posted, now let's get you some helpful experienced Lantus users to guide you.

@tiffmaxee @Sue and Luci

Hi, thank you for your kindness. You are right about the mid-cycle data and no, I am not checking for ketones. I know I should but I've had major issues with two other cats (gallbladder removal and severe anemia) lately so I haven't done many things properly. I am very worried about the 1 unit since yesterday and I can't do a curve (every two hours) until next Saturday. I will get at least two tests until the night shot. But I am guessing that it's better if I leave her at 5 units until next week. I feel so bad, she is such a cooperative sweet cat.

 

[Zebib]

Welcome to the LB&L forum!

As others have mentioned above those mid-cycle tests are critical to determining the dose. Lantus works with a bit of a delay - so after about two hours, sometimes later in the 12 hour cycle the hormone has had time to take effect - although not always in the first day or three...there's a depot with Lantus and it tends to build up a bit over a few days and you can tell when it's kicked in because around 2+ all the way to 8 or 9+ in some kitties the numbers will drop, drop, drop. And guess what - same thing is going to happen at night - oh yes, the much dreaded night time tests. No one I know likes to stay up late with kitty or get up in the middle of the night - but it can be one of the most enlightening times of day to find out what impact the Lantus is having on your cat's blood glucose.

You may get a very pleasant (or in some cases, an unpleasant surprise by checking around 2+ before you go to bed, and then again a few hours later if it looks like you're getting some action (dropping numbers).

That's when the fun starts and you'll hear others talking about PJ (Pajama Parties)...and yes, some people do end up staying up very late or getting up very early in the morning - yes WAY before you're supposed to get up - and YES it does mean losing sleep...but it's crucial to finding out what's going on.

Here area couple of examples of spreadsheets where Kitty has made a decision to sail down to the lagoon (green numbers) .

@Butters & Lyla
https://docs.google.com/spreadsheet...R3-hgldFQg77eAqdlQOMNhVNiUVY0uGSHb2jB/pubhtml

@Sarah and Blaze
Currently in remission: https://docs.google.com/spreadsheet...3WHSjGkmNBWj-jI5rLdIy-k9OKTtKWlhfvZkN/pubhtml

This is the way to the Falls (another word for remission)
@JaxBenji
https://docs.google.com/spreadsheet...ukaCR2cCnZXfJKoTg42nwcVJiY/edit#gid=361360320

Hi, thank you for your kindness. You are right about the mid-cycle data and no, I am not checking for ketones. I know I should but I've had major issues with two other cats (gallbladder removal and severe anemia) lately so I haven't done many things properly. I am very worried about the 1 unit since yesterday and I can't do a curve (every two hours) until next Saturday. I will get at least two tests until the night shot. But I am guessing that it's better if I leave her at 5 units until next week. I feel so bad, she is such a cooperative sweet cat.

Welcome to the LB&L forum!

As others have mentioned above those mid-cycle tests are critical to determining the dose. Lantus works with a bit of a delay - so after about two hours, sometimes later in the 12 hour cycle the hormone has had time to take effect - although not always in the first day or three...there's a depot with Lantus and it tends to build up a bit over a few days and you can tell when it's kicked in because around 2+ all the way to 8 or 9+ in some kitties the numbers will drop, drop, drop. And guess what - same thing is going to happen at night - oh yes, the much dreaded night time tests. No one I know likes to stay up late with kitty or get up in the middle of the night - but it can be one of the most enlightening times of day to find out what impact the Lantus is having on your cat's blood glucose.

You may get a very pleasant (or in some cases, an unpleasant surprise by checking around 2+ before you go to bed, and then again a few hours later if it looks like you're getting some action (dropping numbers).

That's when the fun starts and you'll hear others talking about PJ (Pajama Parties)...and yes, some people do end up staying up very late or getting up very early in the morning - yes WAY before you're supposed to get up - and YES it does mean losing sleep...but it's crucial to finding out what's going on.

Here area couple of examples of spreadsheets where Kitty has made a decision to sail down to the lagoon (green numbers) .

@Butters & Lyla
https://docs.google.com/spreadsheet...R3-hgldFQg77eAqdlQOMNhVNiUVY0uGSHb2jB/pubhtml

@Sarah and Blaze
Currently in remission: https://docs.google.com/spreadsheet...3WHSjGkmNBWj-jI5rLdIy-k9OKTtKWlhfvZkN/pubhtml

This is the way to the Falls (another word for remission)
@JaxBenji
https://docs.google.com/spreadsheet...ukaCR2cCnZXfJKoTg42nwcVJiY/edit#gid=361360320

Welcome to the LB&L forum!

As others have mentioned above those mid-cycle tests are critical to determining the dose. Lantus works with a bit of a delay - so after about two hours, sometimes later in the 12 hour cycle the hormone has had time to take effect - although not always in the first day or three...there's a depot with Lantus and it tends to build up a bit over a few days and you can tell when it's kicked in because around 2+ all the way to 8 or 9+ in some kitties the numbers will drop, drop, drop. And guess what - same thing is going to happen at night - oh yes, the much dreaded night time tests. No one I know likes to stay up late with kitty or get up in the middle of the night - but it can be one of the most enlightening times of day to find out what impact the Lantus is having on your cat's blood glucose.

You may get a very pleasant (or in some cases, an unpleasant surprise by checking around 2+ before you go to bed, and then again a few hours later if it looks like you're getting some action (dropping numbers).

That's when the fun starts and you'll hear others talking about PJ (Pajama Parties)...and yes, some people do end up staying up very late or getting up very early in the morning - yes WAY before you're supposed to get up - and YES it does mean losing sleep...but it's crucial to finding out what's going on.

Here area couple of examples of spreadsheets where Kitty has made a decision to sail down to the lagoon (green numbers) .

@Butters & Lyla
https://docs.google.com/spreadsheet...R3-hgldFQg77eAqdlQOMNhVNiUVY0uGSHb2jB/pubhtml

@Sarah and Blaze
Currently in remission: https://docs.google.com/spreadsheet...3WHSjGkmNBWj-jI5rLdIy-k9OKTtKWlhfvZkN/pubhtml

This is the way to the Falls (another word for remission)
@JaxBenji
https://docs.google.com/spreadsheet...ukaCR2cCnZXfJKoTg42nwcVJiY/edit#gid=361360320

 

[Zebib]

Thank you for the examples and the explanation.

 

[Panic]

Hi, thank you for your kindness. You are right about the mid-cycle data and no, I am not checking for ketones. I know I should but I've had major issues with two other cats (gallbladder removal and severe anemia) lately so I haven't done many things properly. I am very worried about the 1 unit since yesterday and I can't do a curve (every two hours) until next Saturday. I will get at least two tests until the night shot. But I am guessing that it's better if I leave her at 5 units until next week. I feel so bad, she is such a cooperative sweet cat.

I struggled with checking for ketones myself, my girl was indoor/outdoor and preferred going outdoor most of the time, meaning I rarely checked for ketones ... in hindsight I would have gotten a blood ketone meter. I think it's an easy thing to let slip through the cracks since it's not mandatory like BG checking.

Whatever the members here suggest you keep the dose at, that is what I would do. I'm not sure what they'll decide yet.

Would it be easier for you to get a couple tests in between pre-shots every day? If so you don't have to do a curve at all. We actually prefer the spot-checks each day to the curve. You never know if curve day gets ruined by cat getting into contraband or going through a bounce, then the whole day is ruined anyway.

 

[Zebib]

We do base the Lantus dose on the previous insulin dose - but we have to know how low that previous insulin dose was taking the cat. In Urru's case, we don't know what 5.0 units of Caninsulin was doing because there were 3 different doses in the space of just 5 days of day time data.

Going completely back to 1.0 may or may not be a waste of time. It was to me. My girl got up to 5 units of Caninsulin with nadirs in the 100's. I switched to 1.0 unit of Lantus, again based on vet suggestion. Not long after that I started here. It took me over 3 months to get back to 5 units of Lantus, and ended up going higher.

There is no evidence that 3 units was too high a dose, or even too low. We don't have enough data to say what was happening on that dose. I suggest you pick one of the dosing methods described in the Dosing Methods Sticky Note at the top of this forum. It will show you what data you need to collect to determine how to change doses. In particular, we determine changes based on how low the dose is taking the cat. Those lows typically happen sometime between the preshots tests.

Yes, I remember reading about your experience when switching from Caninsulin to Lantus. That is why I thought it didn't matter if I increased the Lantus units more quickly. I misunderstood what you meant, I guess. My question now is how much low do I start again, while following one of the dosing methods? 1 unit seems dangerous to me.

 

[Zebib]

I struggled with checking for ketones myself, my girl was indoor/outdoor and preferred going outdoor most of the time, meaning I rarely checked for ketones ... in hindsight I would have gotten a blood ketone meter. I think it's an easy thing to let slip through the cracks since it's not mandatory like BG checking.

Whatever the members here suggest you keep the dose at, that is what I would do. I'm not sure what they'll decide yet.

Would it be easier for you to get a couple tests in between pre-shots every day? If so you don't have to do a curve at all. We actually prefer the spot-checks each day to the curve. You never know if curve day gets ruined by cat getting into contraband or going through a bounce, then the whole day is ruined anyway.

Hi, yes, It's more easi to do tests here and there between pre-shots. I am going to do a test now and post the result in the spreadsheet. thank you.

 

[Panic]

That is why I thought it didn't matter if I increased the Lantus units more quickly. I misunderstood what you meant, I guess.

In Wendy's case, Neko was an acro cat that actually needed the higher dose, and the vet shouldn't have dropped him like they did.

Did you manage to get a reading today at the 1u? If you don't get advice about going back to 5u or staying at 1u I would make a new thread asking again, either here or on the Main Health forum. Sometimes threads have a hard time finding traction here, with all the other posts. Don't want you and Urru falling through the cracks!

You could also start posting here daily - the style is usually date - name - AMPS
so
9/20 Urru AMPS ###

And then if you need dosing advice include that in the title. People can follow along and help guide you two!

 

[Wendy&Neko]

The main concern I have is that we just don't know how low 5 units of Caninsulin, or 5 units of Lantus is taking your cat. It's possible he needs 5 units, or more or less. We need to see more mid cycle data to tell. When we were up at 5 units of Caninsulin, Neko did see mid blue nadirs. So if I knew then what I know now, I would have started at 5 units of Lantus instead of 1 unit. We do take the dose of the current insulin into consideration when switching, but that's only if we know how low it's taking the cat.

When you did curves on Caninsulin, it did look like 4-5 units was not enough. It wasn't a lot of days of data, but you had more mid cycle data than you have now. Going forward, could you try to get the preshot tests, plus one or two other tests per cycle for a few days?

In Wendy's case, Neko was an acro cat that actually needed the higher dose, and the vet shouldn't have dropped him like they did.

Her being a cat with acromegaly didn't matter, I've seen lots of vets suggest people started over at 1 unit when switching insulin. Whether it's 3 or 5 units, starting over is the wrong answer, provided you know how the old insulin was doing.

Here is the link to your previous post here, for continuity: https://felinediabetes.com/FDMB/threads/glargine-dosage-question.233195/

 

[Panic]

Her being a cat with acromegaly didn't matter, I've seen lots of vets suggest people started over at 1 unit when switching insulin.

Yes, I was referring to the part where the lowered dose set you back and wasted time, versus some kitties being overdosed by increasing too fast and needing to cut back.