Help need dosing sliding scale for,Lantus

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Cbiscuit

Cat is currently on Lantus will be home Friday from shelter will do detox and then need a dosing scale using human Glucometer. ty
 
Per my post in the introduction section, it would probably help if you filled in a few blanks.

Lantus is not dosed on a sliding scale - The initial dose will depend on what you are feeding, how much the cat weighs, if the cat is at ideal weight or over/underweight. What is the current dose and do you know how long the cat has been diabetic or on that dose?

Keep in mind that Lantus dose adjustments are not based on pre-shot glucose readings - my understanding is the most important consideration is how low the cats blood sugar goes during the 12 hour cycle. This insulin works best with a consistent dose 12 hours apart. I suggest that you go to the sticky section of this forum and read about Lantus it will help you a lot.
 
We don't use a sliding scale for lantus. Lantus is best given with consistent dosing at 12 hour intervals.

We follow either tight regulation (TR) or start low go slow (SLGS) the details of each can be found in the posts at the top of this forum.
 
Lantus is actually best when given at the same dose both morning and evening, not using a sliding scale

There are other insulins that use the sliding scale but we know of another group that advocates the use of a sliding scale with Lantus that they just extrapolated from their experience with ProZinc. We don't consider their way of doing things correct though

The only protocol that's been published in a veterinary journal is the Tight Regulation Protocol that's explained in the Sticky's at the top of the Forum. It's a very successful protocol that gives cats the best chance at remission
 
I know everyone is saying Lantus is not dosed based on a sliding scale. Let me explain why.

Unlike many of the earlier generations of insulin, not only is Lantus a long-acting insulin, from a pharmacological standpoint, it is a "depot" type of medication. This means there is what amounts to a "storage bin" of insulin that forms which is what contributes to it gentle and long-duration mechanism of action. This is different than other insulin (e.g., Humulin N/Novolin, Vetulin, Prozinc). Insulin other than Levemir, are shorter-acting -- some people will refer to this as "in and out" where as the effects of Lantus and Lev are cumulative. With a shorter-acting insulin, you base your dose on the pre-shot number since the theory is that all of the insulin has been metabolized in the 12 hours between shots. With Lantus and Lev, the depot contributes to carryover between doses and because of this, dosing is based on the lowest point in the cycle, usually around the middle of the cycle (i.e., the nadir).

In addition, the depot needs to stabilize between doses. Every time you change a dose, it has an effect on the depot and it can take several cycles for the depot to level off after a dose change. If you are dosing based on the pre-shot number, you could be changing the dose twice a day. The end result of this kind of frequent change in dose is wonky numbers.

Please let us know if you have questions. I'm guessing the vet you're working with is talking about a sliding scale dose or you're more familiar with shorter-acitng types of insulin. Using Lantus takes a very different mindset about dosing.

 
My vet provided me with a sliding scale for Lantus. If you look at Doodles SS sheet from 9/17 - 10/11 you'll see it was pretty much all over the place. After finally joining FDMB on 10/11/15 we started dosing correctly and have seen significant progress. I literally tossed the sliding scale in the trash and no longer communicate with that particular vet. She also told me home testing wasn't needed except for an occasional preshot and a curve once a month. All the sticky's and information received here has proved invaluable!
 
Brashworks said:
Per my post in the introduction section, it would probably help if you filled in a few blanks.

Lantus is not dosed on a sliding scale - The initial dose will depend on what you are feeding, how much the cat weighs, if the cat is at ideal weight or over/underweight. What is the current dose and do you know how long the cat has been diabetic or on that dose?

Keep in mind that Lantus dose adjustments are not based on pre-shot glucose readings - my understanding is the most important consideration is how low the cats blood sugar goes during the 12 hour cycle. This insulin works best with a consistent dose 12 hours apart. I suggest that you go to the sticky section of this forum and read about Lantus it will help you a lot.
Click to expand...
 
hE is currently being fed Hills metabolic diet wet and dry. About 12 pounds. bEen on Lantus since June and dose is current .25. wAs going to do a detox and hope his numbers come down and thus Lantus dose comes down? nO? Will go read but many posts not sure which to focus on? ty
i planned on changing his food to Daves 95% zero carbs as soon as he is home
 
Doodles & Sour Pea said:
My vet provided me with a sliding scale for Lantus. If you look at Doodles SS sheet from 9/17 - 10/11 you'll see it was pretty much all over the place. After finally joining FDMB on 10/11/15 we started dosing correctly and have seen significant progress. I literally tossed the sliding scale in the trash and no longer communicate with that particular vet. She also told me home testing wasn't needed except for an occasional preshot and a curve once a month. All the sticky's and information received here has proved invaluable!
Click to expand...
ok sO if you don't use a sliding scale how do you determine the amount of insulin if the BG changes ? aM I missing something? iN other words if the cat is on .25 units 2 times a day and I detox him and feed low carb food and his BG drops wouldn't I need to use a sliding scale to match the amount of BG? aNd your saying at 12 hr not pre Shot?
 
Grayson & Lu said:
@Cbiscuit - what are you detoxing him for? If numbers are high, and you're remaining with the same insulin, I wouldn't think stopping would be necessary.
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wAnt to get him off the high carb food he is on at shelter and feed him lower carb food. rEad a detox is good to kickstart the liver.
 
Gotcha! It may be, with that low of a dose, that the food change is all you need. If you shift food, you can do it gradually (better for them) or cold-turkey (as I did). A little harder on their system, but then you may find that you don't need insulin. My diet-controlled Herb was on insulin for a week. My (failed) foster Chloe never had insulin at my house. Spartacus dropped from either 11 or 13u of N insulin (and dry kibble) to .5 Levemir. He's never been at more than 1.25 in the 1.5 yrs I've had him.
 
...be sure to keep an eye on BGs if you change food and continue to dose. Food may be the only thing he needs to get his numbers down...
 
Grayson & Lu said:
...be sure to keep an eye on BGs if you change food and continue to dose. Food may be the only thing he needs to get his numbers down...
Click to expand...
Yes no dosing for 24 hours when on detox. But will check to make sure he's ok during TY
 
As the others have said, Lantus is not dosed on a sliding scale, and it is dosed based primarily on the nadir with only a some consideration given to the preshot values (such as, for example, a preshot that is too low to safely shoot).

You are correct, though, that as a cat adjust to lower carb foods and other changes that may affect BGs, the dose does need to be adjusted. These two stickies do the best job of explaining the two approaches most members of this group follow when it comes to adjusting dose:

Start Low, Go Slow

Tight Regulation (TR)

Note that Start Low, Go Slow is "technically" a method, whereas "Tight Regulation" is a protocol based on scientific data. Over time, as you learn how your kitty responds, you may find yourself working with a "customized" version of one of these concepts.

Please keep asking questions...we love to help as much as we can!
 
You said you plan to switch to Dave's? Canned or dry? Canned food is best for all cats, especially diabetic cats. Dave's canned foods are very good but the As Fed for the dry is 29% carbs (sorry I don't have all the data to calculate the ME (% calories from carbs) for it.) If he has to have dry (won't eat canned!) Young Again would be a better choice, 0% carbs ME.
 
Cbiscuit said:
ok sO if you don't use a sliding scale how do you determine the amount of insulin if the BG changes ? aM I missing something? iN other words if the cat is on .25 units 2 times a day and I detox him and feed low carb food and his BG drops wouldn't I need to use a sliding scale to match the amount of BG? aNd your saying at 12 hr not pre Shot?
Click to expand...

I follow the SLGS method described in the sticky. Since he's only on .25 and you'll be getting him on low carb food I agree he may just need to be diet controlled. Also with coming home with you and out of the shelter that is also a factor. If they have any BG reading information..ask for it and put into the FDMB spreadsheet so someone can help further. Without seeing the data we are all speculating.
 
You've had lots of good info, so I'll just add a welcome to the Lantus/Lev Insulin support group.

Do you know how to home-test his blood sugar? That's the best first step you can take to help protect him. We also use a spreadsheet here. The best place for you to start reading is probably the "New to the Group?" sticky.

Glad you're here - keep asking questions and we'll do our best to help you help your new kitter.
 
julie & punkin (ga) said:
You've had lots of good info, so I'll just add a welcome to the Lantus/Lev Insulin support group.

Do you know how to home-test his blood sugar? That's the best first step you can take to help protect him. We also use a spreadsheet here. The best place for you to start reading is probably the "New to the Group?" sticky.

Glad you're here - keep asking questions and we'll do our best to help you help your new kitter.
Click to expand...
TY and yes we are ready to home test. DAves 95% is zero carbs so we are going to use a 6.8 food to move hime for the 34% Hills weight management he has currently been on wet and dry for three months. Not sure if a zero carb food is actually good?
 
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