Help with Lantus dosing please?

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emchic

emchic

Member Since 2012
I lowered Zoozey's dose of Lantus from 1.5u to 1u on Friday evening after his PMPS dropped to 48 (and after consulting some folks here in LL: viewtopic.php?f=9&t=86768 ). I did this hesitantly and without consulting my vet because money is super super tight right now. He seems to be doing well, and I've been getting decent readings from him, but I noticed that his +4 today was also low, 50. I'm going to do a curve on him in the next weekend or two once he's settled into this dose. (another question: how long should I wait with this dose to do the curve?). But I'm lost as to what to do after the curve. When will I know to change his dose? Should I call my vet and talk to her about changing Zoozey's dose? I'm just really confused as to what to do with him next or if I even need to change anything. He's doing fantastically well considering he was near death with dka two months ago and I don't want to jack with that. Please take a look at his spreadsheet. I need some advice.
 
Hang in there! No advice here as I'm too new....but there's some real pros here on board, please wait to hear their opinions before making any quick decisions....they're awesome and err on the side of caution to keep your kitty safe. Sending calming thoughts to help you get through this, it's nerve wracking at first until you get a feel for what works and when to change the doses!
 
I agree! I've gotten some great advice already! Everyone has been so helpful with Zoozey.
 
The protocol states:

Reducing the dose:
If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.
If an attempted reduction fails, go right back up to the last good dose.
Try to go from 0.25u to 0.1u before stopping insulin completely.
Click to expand...

The bold is mine. If you can continue to get spot checks particularly mid cycle checks to see where he is, when he goes below 50, reduce him. Looks like he came up nicely today. When he's ready for a reduction, he'll go below 50 and you might have to feed him a few times to get him back above it. Of course, if you have to work and will be away and you can't leave out food for him and are very concerned, you can reduce by .25u. But he's doing so great and he might earn it himself soon so if it's possible to leave the dose and monitor, I'd do that.

And I have to underscore "and monitor".
 
Would Zoozey count as a newly diabetic cat if he was diagnosed last January? He was diet controlled until Nov when he got a UTI and went into dka. He's been on insulin for about two months now. Would the 50 be at any point in his cycle? Or would it just be PS readings? The spring semester starts tomorrow and I'm teaching M-F this semester, so I'm not going to be home as much during the day and I'm not going to have off days this semester, so I might be able to get a +1 or +2 before I have to head off to school and I won't be home until after +8 or +9. I can certainly do the +4 +5 and +6 during the weekends. Is that going to be good enough? Just like anyone, I would love for Zoozey to be OTJ, and I'm hopeful that he's headed in that direction. I don't think his first round of diet control went so well, because he lost a ton of weight even before the dka and did not gain it back until after he had recovered from the dka. But I know so much more now!
Can you link the protocol for me? I can't seem to find the link anywhere.
 
Here's your link to your condo from yesterday: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=86809&p=929254#p929254
We link the threads together so it's easier to go back and find information if it's necessary.

I want to emphasize Marje's point about testing. You've been better about getting tests. It is imperative that you test at night, every night. At the minimum, you need to get a test before you go to bed and that will tell you if you need additional tests. It is doubly important that you test at night if you are gone during the day and can't test.
 
Also, I have no plans to change his dose right now because he is doing so well. I just want to know what to look for so that if I do need to lower or increase his dose, I know when to do it.
 
He's not newly diagnosed but because we don't know if he was possibly overdose at the 1.5u, I'd probably use 50 as the number to reduce him until we see what he does going forward. And it looks like your schedule might not allow you to monitor him as closely as he might need so it might not be a bad idea to reduce him now. You want to keep him safe.

Yes...the 50 is at any point in the cycle.

The Tight Regulation Protocol is in the Stickys at the top of this forum. One of the reasons he "might" be overdose is that you werent testing enough to see if he earned a reduction under the protocol.
 
I just did a +1.5 test because I'm about to go to bed, and he's already coming down, from 137 to 124. I was running a little late this evening, so I gave him his shot while he was eating to keep him on schedule. Because Zoozey has a tendency to run away and not finish his food if I give him his shot while eating, I don't usually do this. I just got lucky tonight. Most of the time I let him finish eating and settle down on the bed (that's where he like to be when I give him his shots and do his readings) so he gets his shots about 15-20 minutes after his PS reading. Would this make a difference? Usually I see a little spike between +1 and +2.
It's getting easier and easier to get readings, so I'm more willing to do mid cycle readings than I was when Zoozey began insulin. When I first started doing them he fought me A LOT, and that's saying a lot because he was still recovering from the dka. The first month I did hometesting my legs were covered in cat scratches, but we've both gotten used to things now. Now Zoozey only makes me chase him a couple of minutes now before he hops onto my bed and lets me do his reading or give him a shot.
 
Yeah, I got really sick with long lingering upper respiratory ilk not too long after we started the 1.5u, so I wasn't able to test as much as I would have liked, plus he was still fighting me a lot. Fortunately, I think we're (mostly) past the fighting now.
I can test him every day before I leave for school, so that should be around +1.5 or +2 on MWF and +1 on T/Th. Are those going to be helpful readings? If I can learn to get myself out of bed earlier, I can transition him back to 6:30 am/pm so that I can stay up until his +3 or +4 readings at night at least a few times a week. And of course I can regularly get readings at +8 or +9 during the week. If I do that and get +6 readings (and more of course) on the weekends, is that going to be enough to get an accurate picture of how he's reacting to this new dose?
 
What you outlined would be ideal!

The only point I'd make is that there are times, if numbers are dropping, you may need to sacrifice some sleep.

It's not unusual to see a spike in numbers at around +1 or so. This is due to the influence of food (i.e, a "food spike"). If your +2 is markedly lower than your pre-shot number, there's a good chance it will be an active cycle. This is a time when you would want to plan to get an additional test or two. If you have to leave to get to school, you would want to leave food out so Zoozy can feed herself if her numbers are dropping.

Since you need to be out of the house, you may want to think about getting a timed feeder. That way, you can set it up so there's food available during the day.
 
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