Glucose level drop? 250

[Aito]

So basically after 5 days of 2u Lantus and Royal Canin diabetic food (I know it's not the best one and I've ordered better food) and levels averaging 400, Sica's bg finally dropped to 248.
As per her vet's request, we didn't give her an insulin shot at this level and we're taking her to the clinic later today for another bg test and maybe a shot of insulin, considering her bg.
The vet's treatment is the following:
BG level over 480, 3u of Lantus
BG level over 350, 2u of Lantus
BG level over 250, 1u of Lantus
BG level under 250, no insulin shot
What do you think of this? Also is it good that her bg level dropped? I was really happy about it but i'm wondering if maybe it is too sudden?

 

[Bron and Sheba (GA)]

The vet's treatment is the following:
BG level over 480, 3u of Lantus
BG level over 350, 2u of Lantus
BG level over 250, 1u of Lantus
BG level under 250, no insulin shot
What do you think of this? Also is it good that her bg level dropped? I was really happy about it but i'm wondering if maybe it is too sudden?

I have to disagree with your vets treatment schedule.
This is because Lantus is a depot insulin which means it leaves a little behind each time in the tissues, you give a dose and the depot needs to fill and settle. To do this the dose needs to stay the same, unless of course the BG drops too much and the dose needs to reduce. Chopping and changing the dose as the vet suggests will have the depot all over the place and the BGs will also be all over the place.
What you need to do is choose a dosing method…either the start Low go Slow method or the tight regulation method and follow that. It tells you when you need to increase, the dose, decrease the dose, when to decrease and increase the dose and by how much.
Dosing is based on the lowest point in the cycle (nadir) not the preshot BG. This is why it is so important to test during the cycles as well as before the dose.
So you stay on the same dose unless you drop under 90, for example on the SLGS method.

250 is a safe preshot to give a dose of insulin, as long as you have been testing during the cycles, can monitor the cycle and we can see how low the dose takes Sica.
I can’t see on the SS where Sica has dropped to 248.

what I would suggest you do is choose a dosing method, then post here daily so we can help you while you learn about it all. I honestly don’t think your vet knows much about how to use Lantus.
Here are the two LANTUS DOSING METHODS

 

[Aito]

I have to disagree with your vets treatment schedule.
This is because Lantus is a depot insulin which means it leaves a little behind each time in the tissues, you give a dose and the depot needs to fill and settle. To do this the dose needs to stay the same, unless of course the BG drops too much and the dose needs to reduce. Chopping and changing the dose as the vet suggests will have the depot all over the place and the BGs will also be all over the place.
What you need to do is choose a dosing method…either the start Low go Slow method or the tight regulation method and follow that. It tells you when you need to increase, the dose, decrease the dose, when to decrease and increase the dose and by how much.
Dosing is based on the lowest point in the cycle (nadir) not the preshot BG. This is why it is so important to test during the cycles as well as before the dose.
So you stay on the same dose unless you drop under 90, for example on the SLGS method.

250 is a safe preshot to give a dose of insulin, as long as you have been testing during the cycles, can monitor the cycle and we can see how low the dose takes Sica.
I can’t see on the SS where Sica has dropped to 248.

what I would suggest you do is choose a dosing method, then post here daily so we can help you while you learn about it all. I honestly don’t think your vet knows much about how to use Lantus.
Here are the two LANTUS DOSING METHODS

I understand and I updated her spreadsheet accordingly (I edited it since I realized I made a mistake in the beginning, sorry, I'm just now understanding how to use it).
And yes I will stop adjusting the dose of insulin weirdly. We'll be trying 2u of Lantus and keeping her on that unless the bg is too low. And we'll try to test her today after a few hrs of insulin

 

[Bron and Sheba (GA)]

Have you been giving 2 units of Lantus each 12 hours? There are several blank spots where the dose normally goes.
Also try and get some tests in during the pm cycles as well as that is just as important as the am cycle. Also cats often drop lower at night. So what we are looking for is how low the dose of Lantus is taking Sica each cycle. Then we can determine if she is getting the right amount of insulin or if it needs adjusting. Does that make sense?

 

[Sienne and Gabby (GA)]

You vet suggested you dose Lantus like a short acting insulin. Your vet is providing inaccurate information. Lantus needs to be dosed consistently (i.e., use the same dose at AMPS and PMPS) for 3 days if you're following TR or a week with SLGS unless a dose reduction is indicated. You do not change the dose based on the pre-shot number.

The "U" column on your spreadsheet is for the amount of the dose. Please indicate if you gave a shot by including the amount or enter "NS" if you skipped.

You also need to be testing a bit more. Since Lantus dosing is based on the lowest number in the cycle, you will need to get a minimum of 4 tests per day. You need to test at pre-shot times like you're already doing and get a spot check somewhere toward the middle of the cycle. We generally recommend a "before bed" test every day during the PM cycle. If you don't get those spot checks, you'll have no idea if you need a dose reduction. There's more information on how to use Lantus in the sticky notes at the top of the Lantus/Levemir/Biosimilar board.

 

[Aito]

Have you been giving 2 units of Lantus each 12 hours? There are several blank spots where the dose normally goes.
Also try and get some tests in during the pm cycles as well as that is just as important as the am cycle. Also cats often drop lower at night. So what we are looking for is how low the dose of Lantus is taking Sica each cycle. Then we can determine if she is getting the right amount of insulin or if it needs adjusting. Does that make sense?

It does yes thank you!
Edit: I updated the spreadsheet with the information.

 

[Aito]

You vet suggested you dose Lantus like a short acting insulin. Your vet is providing inaccurate information. Lantus needs to be dosed consistently (i.e., use the same dose at AMPS and PMPS) for 3 days if you're following TR or a week with SLGS unless a dose reduction is indicated. You do not change the dose based on the pre-shot number.

The "U" column on your spreadsheet is for the amount of the dose. Please indicate if you gave a shot by including the amount or enter "NS" if you skipped.

You also need to be testing a bit more. Since Lantus dosing is based on the lowest number in the cycle, you will need to get a minimum of 4 tests per day. You need to test at pre-shot times like you're already doing and get a spot check somewhere toward the middle of the cycle. We generally recommend a "before bed" test every day during the PM cycle. If you don't get those spot checks, you'll have no idea if you need a dose reduction. There's more information on how to use Lantus in the sticky notes at the top of the Lantus/Levemir/Biosimilar board.

I understand, I'll be trying to test more today

 

[Bron and Sheba (GA)]

I see you increased the dose to 3 units this pm. The PMPS was most likely higher because you skipped the dose in the am cycle.
Remember we do not increase the dose based on the preshot BG but the nadir.
By getting the tests in during the cycles you will be able to see how low the dose is taking Sica.
It is not a good idea to increase the dose in 1 unit increments. We recommend increasing the dose in 1/4 unit increments so you don’t go past the best dose and it is safer for Sica.
Are you using syringes or a pen to give the insulin?
Have a look at the two dosing methods….Sienne gave you a link above and see which one you want to follow. They both give very good directions and we can help you get sorted.