Help with dosage

D

danowics

Member Since 2025
Hello FDMB community,
I'm new here and could really use some advice on my diabetic cat, Puffy. He's a 5.75 kg male, diagnosed with diabetes about 13 months ago. He's on Lantus insulin, injected every 12 hours at 9 AM and 9 PM. His diet is strict raw BARF low-carb: mostly raw meat, hearts, organs (heart, liver), taurine supplement, vitamin B12, inactive yeast, boiled egg yolk, kefir (minimal, about 1 tsp/day), and salmon oil. No carbs over 5-6%,
. He's been on Stress Control supplement (1/2 capsule/day) for anti-cortisol for about 10 days, and seems fine with it.
His blood glucose has been unstable lately with a yo-yo cycle: low mornings (even hipo like 61), skip dose, high evenings (400+), then back to 5U, and repeat. I use Accu-Chek Instant meter. Here's his recent spreadsheet with values, doses, and notes:
Google Sheets Link: Puffy's BG Spreadsheet. Hello everyone,
The idea is that I didn't know what else to do or who to ask for advice and help anymore, so I turned to AI for support — first ChatGPT, then Grok. I decided to follow the advice from Grok, which said it is based on many books and real examples from various groups, and it told me to increase the dose to 5 units, then to 6 units. But it’s not giving results. Honestly, I don't know where else to turn for help anymore. The veterinarians (no offense) are overwhelmed by the situation and don't really have much knowledge about insulin and blood glucose in cats. I heard about this group, and that's how I ended up asking you for help and advice too.
We're in Romania, I use Google Translate, and I have a 7-hour time difference, so my replies will be delayed.

P.S on spread sheet, the last approx. last 2 weeks, the dosage was 5 u
Thank you so much from the bottom of my heart.
Puffy (Daniel Pup) 's Sugar Sheet
 
Hello Romanian friend!

Could you please post this in the Main Forum? People will see it and be glad to give you a hand.

Don't ask AI, please. You've come to the right place. Here we have about 30 years of experience from real, live people.
 
Hello and welcome, tagging one of our members in Romania who may be able to offer support @diabetic_blue

Blue is in remission so not entirely sure how often Valentin visits the board but thought it would be worth a try.
 
diabetic_blue said:
Hi @danowics

What are you basing your dosing decisions on? Are you guided by a veterinarian or you decide yourself what to shoot? They seem a bit random to me. Are they all AI suggested? Lantus is a depot insulin, unlike caninsulin, so you won't see the effects after the shot but a few cycles later.

Have you checked this yet?
Sticky - The Basics: New to the Group? Start here!

And particularly this?
Sticky - Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)
Click to expand...
Hi
our vet has pretty little experience with diabetes on cats, so she can't help us. Not many vets can help, really. So I went on couple of groups on FB, but no good results, I tried AI, chatgpt, later grok, and actually grok suggested this forum. So here I am basically shooting in the dark, hoping for better results. Any good advise, would be much appreciated
 
Hi @danowics

So all your dosing decisions so far have been based on AI? I would stop doing that ASAP.
You did not answer my questions. Did you check those threads I linked previously?
Personally, if this was Blue, I would stop what you are doing currently and start with one of the two protocols linked. Which one to choose? I'd start with what fits your testing schedule best.
 
Welcome to FDMB.

I wouldn't use AI for medical advice for a human. AI has proved itself to be dangerous with medical decision making so I'd be very, very cautious with a cat. On the other hand, we have lots of experience guiding caregivers with managing their cat's diabetes. FDMB has been around for over 25 years.

Good job on the low carb diet and on getting your cat's spreadsheet set up. First observation on your spreadsheet -- please get at least one test every night. We suggest a "before bed" test so you know that Puffy is in safe numbers before you go to sleep.

There are a number of "sticky" notes at the top of the Lantus board. One of those notes is the dosing methods sticky that Valentin mentioned. If your vet has limited experience with feline diabetes, you will find those posts provide helpful background on how Lantus works, dosing, etc. You want to have a consistent approach to dosing. We make dose changes in 0.25u amounts. I've asked a few of our experienced members to take a look at Puffy's spreadsheet. Given that you didn't systematically get to a 5.0u dose, I think it will make sense to lower the dose and approach dosing in a more incremental way. I'm just not sure how much you need to lower the dose. (I'm thinking somewhere between 2 - 3u but I'd like to see some additional input.)

Please take a look at the stick notes. If you have questions, we're here to help.
 
Hello and welcome! To add to Sienne’s suggestions, and in looking at your spreadsheet, I agree that the increases were too large and too fast. You’ve likely gone past a good dose. I think going back to 3u would be what I would try, and as Sienne said getting regular before bed tests at night helps immensely to fill in some of the missing data. Also, don’t get too stuck on +6 testing during the day, try and move the tests around if you can. Those spot checks at different times on different days will help to see how the dose is working.
 
Christie & Maverick said:
Hello and welcome! To add to Sienne’s suggestions, and in looking at your spreadsheet, I agree that the increases were too large and too fast. You’ve likely gone past a good dose. I think going back to 3u would be what I would try, and as Sienne said getting regular before bed tests at night helps immensely to fill in some of the missing data. Also, don’t get too stuck on +6 testing during the day, try and move the tests around if you can. Those spot checks at different times on different days will help to see how the dose is working.
Click to expand...
So you are saying to change the nadir tests ? what would you suggest ? change from +6 to +4 or a +8, or just skip the nadir test sometimes? And what about the night test that you suggest ? he gets his night test and insulin at 21.00. you are saying to skip that + 12 test , and get a +14 , for example? or a +15 if i'm still awake ? :). Sorry about asking the baby steps, but I want to get it right. I've lost so much time already, and i feel like I am failing him :(
 
Hello! Christine is saying that you are always getting a test at +6. But cats don't always reach their nadir at that time.
For some it can be at +4, or 5, or 7 or 9.

So on different days, get a few tests in between the shot time and +6, so we can find out your cat's patterns, and when they are using insulin to its maximum effect.

And you're not failing your kitty. And you are very welcome to ask all the questions you like! Baby steps are wonderful, and we will help along the way. You're clearly doing a great job. You just didn't have a knowledgeable vet.

You are not alone in this any more :bighug:
 
diabetic_blue said:
Hi @danowics

So all your dosing decisions so far have been based on AI? I would stop doing that ASAP.
You did not answer my questions. Did you check those threads I linked previously?
Personally, if this was Blue, I would stop what you are doing currently and start with one of the two protocols linked. Which one to choose? I'd start with what fits your testing schedule best.
Click to expand...
it looks like the TR protocol would be best for me. I can do all the requirements. it;s just that it's been over a year, and BG still not regulated and not sure TR would still work . What do you think I should do? I can adapt to any of the two protocols
 
Lara & Luciole (Lu) said:
Hello! Christine is saying that you are always getting a test at +6. But cats don't always reach their nadir at that time.
For some it can be at +4, or 5, or 7 or 9.

So on different days, get a few tests in between the shot time and +6, so we can find out your cat's patterns, and when they are using insulin to its maximum effect.

And you're not failing your kitty. And you are very welcome to ask all the questions you like! Baby steps are wonderful, and we will help along the way. You're clearly doing a great job. You just didn't have a knowledgeable vet.

You are not alone in this any more :bighug:
Click to expand...
what about the night test? how long after the night insulin should I test ?
 
You can definitely do tight regulation! As long as you are at home to do tests, TR is great.

About your cat being diabetic for a year, for many cats, the protocol is key to getting regulated. You find out the actual, correct amount of insulin that your cat needs. This keeps them in a good zone (the blues and dark greens on the spreadsheet), which gives their pancreas the best opportunity to heal. That's when cats go into remission.

About the night, Lantus is on a 12 hour cycle for cats. Cats often like to go low in numbers during the night. So after you give your cat his PM shot, be sure to get a regular +2 test. If he is going low, you should get a +3 and +4, so make sure he does not go too low.

Give him small amounts of low carbohydrate food at +2, if you are not already doing this. Diabetic cats do better with smaller, more frequent feedings.
 
The nadir is not usually a fixed point -- well, part of the issue is that cats refuse to be predictable and they haven't read the dosing guidelines!! Not all cats have their nadir at +6. My cat routinely had an early nadir (around +3) except when she didn't. You're getting a fair amount of tests in during the AM cycle. However, it looks like it's been a while since you got a curve (testing every 2 hours for a full 12-hour cycle). You might want to think about getting a curve in the near future. In addition, some cats will have their nadir at different points during the AM and PM cycles.

With my kitty, I would routinely get a +2 or +3, especially at night. If the early tests are markedly lower than your pre-shot test, there's a good chance that the numbers may be dropping lower. A curve will also tell you when Lantus onset occurs (usually around +2).
 
Sienne and Gabby (GA) said:
The nadir is not usually a fixed point -- well, part of the issue is that cats refuse to be predictable and they haven't read the dosing guidelines!! Not all cats have their nadir at +6. My cat routinely had an early nadir (around +3) except when she didn't. You're getting a fair amount of tests in during the AM cycle. However, it looks like it's been a while since you got a curve (testing every 2 hours for a full 12-hour cycle). You might want to think about getting a curve in the near future. In addition, some cats will have their nadir at different points during the AM and PM cycles.

With my kitty, I would routinely get a +2 or +3, especially at night. If the early tests are markedly lower than your pre-shot test, there's a good chance that the numbers may be dropping lower. A curve will also tell you when Lantus onset occurs (usually around +2).
Click to expand...
But how do I find the right dose? I.ve tried a few methods, like to hold the dose ( 1, 1,5, 2) u for many days, but the numbers where high, over 300. i.ve tried with small dose, larger dose (5u), nothing seems to get constant number, only constant high numbers. I.ve been on a group on FB, they suggested to go lower, like 1u or even lower. I ve tried even calipers. no result. I tested him for acromegaly, he is negative, no infections, he eats good, drinks water. but bad numbers. the only thing it/s to find the right dose. but how?
 
But how do I find the right dose? I.ve tried a few methods, like to hold the dose ( 1, 1.5, 2) u for many days, but the numbers where high, over 300. i.ve tried with small dose, larger dose (5u), nothing seems to get constant number, only constant high numbers. I.ve been on a group on FB, they suggested to go lower, like 1u or even lower. I ve tried even calipers. no result. I tested him for acromegaly, he is negative, no infections, he eats good, drinks water. but bad numbers. the only thing it/s to find the right dose. but how?
 
We tend to start at a reasonable dose level and follow a dosing method that relies on a systematic increase in dose providing the numbers warrant a dose increase. We use two dosing methods for Lantus -- Tight Regulation (TR) or Start Low Go Slow (SLGS). TR requires that your cat is on a canned or raw low carb diet. In most cases, the dose is increased by 0.25u either every 3 days with TR or every week with SLGS. This is the link to the information on Lantus dosing methods.

Lantus works differently than most people expect. It is a depot type of medication. Every time you make a dose change, the depot needs to stabilize. It takes several days for that to happen. Every time you give a shot, the insulin forms microcrystals that are deposited in the fat tissue. The crystals mostly dissolve over the course of the 12-hour cycle. Not all dissolve, though. The process allows for a longer duration and overlap between cycles. If you make rapid changes in dose, the depot doesn't stabilize and you end up with wonky numbers.

In addition, there is a phenomenon that we refer to as a "bounce." If a cat drops into low numbers, if the drop is into numbers the cat is no longer used to, or if there's a fast drop, this can result in the numbers spiking upward. Given that there are no PM tests, you don't know if numbers have dropped -- you're missing half of your data. In addition, if you hold a dose that's not effective for an overly long time, it can result is glucose toxicity. The name sounds worse that what it is. Glucose toxicity means that a cat's body treats high numbers as the new normal.

I hope this provides some background and explanations.
 
You must log in or register to reply here.
Back
Top