help please dose adjustment needed?????

[Knotty dee and Jaxon]

Hello,

I am still very new to the diabetes world and am seeking some direction. please see Jaxon's SS in my link. I think that his dose may be too high and increased too quickly from 2u to 3u twice daily. I feed wet food for main meals at 8am and 8pm prior to injecting. I also have just started giving Jaxon a snack around the time of his lowest bgl.

In the last couple of days i have held the evening dose on one occasion, the next am he was very high. two days after that i gave 1u rather then his 3 and had a similar effect although the numbers were better.

tonight i am considering to give 2 u even though his bgl is in the normal range.

any thoughts would be great.

 

[Hillary & Maui (GA)]

Have you visited the lantus forum yet? They have people there who can help you fine tune your dose and guide you.

Generally speaking, yes you are increasing your dose too much. We recommend the start low and go slow approach - meaning starting at a low dose such as 1 unit or 1/2 unit and slowly adjusting that dose by 1/4 - 1/2 unit increments. NEVER would we recommend adjusting 1 full unit at a time.

Why - because once the insulin is in, you can't take it out. And by skipping the small increments, you don't know if you skipped over the ideal dose.

Also, when you stall giving the shot by more than 15-30 minutes, then this too can be considered a dose change. Giving the shot early or late is considered a dose change too.

My recommendation is to visit the lantus forum and post there and get specific assistance.

 

[Sienne and Gabby (GA)]

Welcome to FDMB!

I think your instincts about dose are good. With Lantus, we typically increase doses in much smaller increments. That insures that doses are raised safely and systematically and you don't miss what could be a good dose for your cat. As Hillary noted, usually doses are changed in 0.25u increments. In addition to dose increases, if your cat's numbers drop below 50, you want to decrease the dose.

It looks like you Jaxon was started on a reasonable dose. It looks like the increases were in a larger amount than what is recommended in the research. It's fine if you want to reduce the dose and see what happens.

Lantus dosing is based on the lowest point in the cycle -- the nadir. As a result, you want to test before you give a shot and you want to get at least one test during both the AM and PM cycle. That's my not so subtle way of encouraging you to test during the PM cycle. Even if you skip a shot, testing to see when numbers start to rise can be important data.

There is a great deal of information about Lantus and it's use at the top of the Lantus board. The starred, sticky notes contain information as noted below:

• Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal versions -- the Tilly Protocol developed by the counterpart of this group in Germany and the Queensland/Rand protocol developed by Roomp & Rand and published 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.

Please let us know how we can help. If you want to post on the Lantus board, you'll find that it's busy place where people are around almost 24/7. The people there are very generous with their time and information.