Guinness the devil: Dosing advice

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Guinness's Mummy

Member Since 2014
Hi Everyone,
My name is Lucinda AKA the possessor of thumbs in the relationship, and this is my first post in this area, Marje and Gracie recommended that I come over for some additional assistance in monitoring Guinness's numbers. I'll try to be brief, but thorough.

Background. His numbers were very high at Dx, his starting does was 2.0 units BID. Vet used 0.5 units per kg on initial dose determination as the guidelines state that most cats are regulated at that dose. He remained high after an increase to 2.5 units BID of Lantus. He was on dry food hills m/d at this time. We then went up to 3 units BID right before converting to wet food. He's been on LC wet food from the magical list that's around for about 2 weeks now, often a member of the CP club, his numbers are dropping significantly, and we have been lowering his dose. Personality wise, we are good on all of the Ps, neg on ketones, and Guinness is engaging in all of his normal activities; attacking feet and string, biting, boxing matches with Mummy, being in the way, and dossing in his lair. Overall we are looking good. :smile: We finally got his numbers down!

Please note that I do use an ALPHA TRACK 2 Monitor.

-My questions.
-On an Alphatrack Monitor is there a number that I should definitely not shoot? I've been recently in the greens and blues preshot, and I skipped his insulin once. In the AM, I can’t be around to monitor for hypo kitty.
-We are now trying the 0.25 units per kg dose, but we haven’t quite determined how much he needs. I’m currently shooting between 1.0 – 1.5. Does this seam OK? Can I fluctuate a bit?
-How do I know if he needs less insulin? I'm planning on doing a curve on Sunday.

I have really appreciated all of the support from the Forum, any additional advice/insight you could provide would be greatly appreciated.
Cheers,
Lucinda
 
Re: Guinness the handsome devil: Dosing advice

Hi Lucinda! Welcome to Lantus/Lev Land!

Lantus works best if you give the same shot am/pm, fairly close to 12 hrs apart. Lantus dosing is based upon how LOW the dose will get the blood sugar to. To some extent, we place less importance on the high numbers, and a great deal of emphasis on the low numbers. As far as dosing goes, i mean.

thanks for raising the red flag that you're using an AT2. The numbers are higher than those on a human meter. Your normal numbers on an AT are roughly 68-160ish. When he hits 68, that's your signal to take action to raise his blood sugar up.

I'd suggest that for the next few days, you try to test mid-cycle so you can see how low the current dose is taking him. I'd probably just stick with the 1.0u for now. i'd try to get at least one test somewhere in the middle of each cycle, both am/pm cycles. Many, many cats have lower cycles at night - which is hard on getting a full night's sleep. As you learn what Guinness the Handsome Devil's patterns are, you likely won't need to test as much. For now, I'd just get a sprinkling of tests in here and there, as you can. You don't have to test every hour - some people become addicted to the data and test all the time! But to be able to see what's going on with Guinness, it's pretty important to get at least the preshots and one mid-cycle test in each cycle. That'll tell us what the dose is doing.

For now, you've shot in the 80's. It's pretty important to know where he goes after that. I'm not very comfortable with shooting a low number when you can't monitor. It might be that if you can't monitor, we should reduce the dose. Are you home now for the weekend and able to monitor?

We usually suggest that new people post and ask for advice on shooting if the preshot number is 150 or less on a human meter - that's roughly 200 on an AT. The goal is to work down to shooting everything over 50 (human meter) and 68 (AT), but that's for a person who is experienced and can monitor.

That's an incomplete answer, but i have to go and will get back to you. For now, I'd suggest looking through the "Shooting and Handling Low Numbers" sticky, particularly the part on becoming data ready.
 
Re: Guinness the handsome devil: Dosing advice

Hi Lucinda-

Welcome to Lantus Land! I have to admit, it's getting late for me and I'm starting to wind down for the night, but I do want to touch on some of your questions.

I took a look at Guinness's SS- great job getting that up and running...it will be a big help in figuring out how he's responding to insulin!

Lantus likes consistency. You will get the best results by shooting the same dose 12 hours apart each and every day. As an example, shooting a higher dose in the morning and a lower dose in the evening will result in all sorts of wonky numbers that make no sense. Likewise, shooting 11 hours apart one day, and 14 hours apart the next day will also result in wonky numbers. Additionally "dose hopping" and shooting at inconsistent times could potentially put Guinness at risk for hypoglycemia.

So, your first objective will be to find a dose that you can safely shoot 12 hours apart every day.

You will know he needs less insulin by testing his BGs at least once after shooting, preferably more. Lantus dosing is based on the nadir of the insulin cycle, not the preshot value of the cycle. This is a hard idea to get used to, because when we see high preshot numbers, we instinctively want to shoot more insulin. But, this is not necessarily the right or safe thing to do! So this is where mid-cycle testing become vital - not only to determine what dose works best, but also to keep a kitty safe from hypoglycemia. I know you do work during the day, but the evening tests are just as important; any and all data you gather will help determine what dose is appropriate.

Are you able to adjust your schedule so you can get in at least one test after shooting insulin in the mornings? We know that can be tough, but many of us adjusted our sleep schedules so that we can get this very important test in, as this test can give you an indication as to how Guinness is responding during a given cycle. Personally, I now get up at 5:00 so I can get at least 2 tests in before I head to work. It's exhausting at times, but it gives me peace of mind to know that Trix is safe before I leave for the day.

It sounds like Guinness is responding well to being on insulin and to the food switch; now it's time to make sure he stays safe and healthy!
 
Welcome to Lantus Land!

The weight based formula (initial dose = 0.25 x ideal weight in kg) is used only for calculating your starting dose. Once you've held the initial dose for 5 - 7 days, you begin adjusting that dose based on how your cat is responding. (The big "if" is if your cat's numbers drop below 80 on an AT meter then the dose has been set too high at the outset.) Dose adjustments are then made in 0.25u unless your kitty is at a high dose of insulin or numbers are quite high.

In addition, in order to follow any Lantus protocol, you must get at least one spot check per cycle. As Amy and Julie have pointed out, Lantus dosing is based on the lowest number in the cycle (i.e, the nadir). By not getting any spot checks, you have no idea whether Guinness is dropping into dose reduction territory. You also don't know if he's in dangerously low numbers. The TR protocol is safe ONLY if you are testing to make sure your kitty is safe.

It's likewise important to be data ready before you start shooting low. There is a section in the Shooting and Handling Low Numbers sticky that discusses becoming data ready. If you can't be around to monitor when you are shooting low, then you shouldn't be shooting low. It is far safer to have your cat in higher numbers than to shoot low and come home to find your cat in a hypoglycemic crisis or worse. You need to have an understanding of your cat's patterns before you attempt shooting lower numbers.
 
Thanks everyone! Guinness's dosing time I try for 8 AM and 8 PM. Unfortunately, it's the only time of day that even remotely works, as it's not uncommon for me to work 10-16 hour days. If I wake up early to push up his time for his shot, there is no way I'll be back home early enough for his PM shot. Getting BG tests post AM is only feasibly on the weekends, which I have scheduled this Sunday, but I definitely will try some evening tests, those are feasible. You will all be on his black list asking his Mummy to poke his poor little ears even more! (I feel so bad doing it, he doesn't like it, and I swear he thinks I'm being mean. I always get snubbed after BG curve day. What we do for love, huh?)

If you think 1.0 is a safe amount, I'll keep to that number. He was at 2.5 - 3.0 units pre-change to wet food and his numbers dropped so rapidly once on wet. I knew I shouldn't be shooting 2.5, but wasn't sure what is a dose that I could step down to safely.

Thanks again everyone. He'll be due for a poke soon.

Cheers,

Lucinda
 
Are you giving treats after ear pokes, even when you don't have a successful test? Treats make things much better :-D - and, they really do get used to the routine!!!
 
oh - and Neosporin ointment with pain relief in it can relieve the owie from the poke. you can slather it on at night, wipe off the excess in the morning, and his ear will be good to go for that day!
 
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