? Help with Lantus dosing

[paultxrn]

Hi everyone. I've had Jake on Lantus (started on 2 units - too high from what I have since learned) since 5/12 and have been increasing the dose very slowly. Jake has also been on Dr. Elsey's exclusively for about 2 weeks. Am I on the right track? The vet wanted to go from 2 units to 3 units but we decided to only go to 2.5 He's on been 2.5 for about 5 days. The other issue is that he has an infected tooth that needs to be extracted but vet won't do it until his sugars are stable. From what I've read here, the infection could cause the sugars to stay elevated. I want the tooth out ASAP but the vet wants to wait. It seems like it's time to go up to 3 units. Any advice would be appreciated.

 

[Shawna & Davidson (GA)]

Welcome.....Davidson came out of remission due to a tooth infection, and after 4 yrs of regular testing I knew there was a problem......his high blood levels were a direct result of the infection and he had to go back on insulin. I had dental surgery done and once the infections cleared up his blood levels dropped.....so don’t wait......his levels will be high until the dental is done.

As well, we increase in .25 increments and do regular testing. You’ve not done any testing after the evening shot so try to do at least 2 tests.

There will be others here that will reply, but my suggestion is to try to convince your vet to do the surgery or find another vet. Most have no clue about diabetes but there are a few who respect what we do here and are open to learning.

Good luck

 

[Wendy&Neko]

Any chance you have a dental specialist vet in your area. Some vet's seem nervous about doing dental before kitty is regulated, but that is often what prevents a cat from being regulated.

Here is your first post here for ease of following the history: http://www.felinediabetes.com/FDMB/threads/first-week-of-lantus-is-it-time-to-increase.195811/

OK, most important note. Please do NOT increase. On May 26th, Jake went below 68 which is too low on the AT meter. We determine how to dose the cat based on how low the dose takes the cat, not the preshots, which are typically the highest points of the cycle. Which means 2.5 units is too high a dose. Is there any way you can get some tests in between shots? Such as today on the weekend or before you go to bed at night? You need to at a minimum do a curve before increasing. Night time spot tests are very important. Many cats go lower at night and we need to catch those lows.

Based on the little data I do see, I would recommend going to 2.25 units, and getting more data in for a week, then deciding how the dose needs to be changed. Unless he goes below 90, in which case you'd lower the dose a further 0.25 units. The high preshot numbers you are seeing could be because he is going low mid cycle, and bouncing or dumping sugars into his blood stream to counteract those lows.

 

[paultxrn]

Any chance you have a dental specialist vet in your area. Some vet's seem nervous about doing dental before kitty is regulated, but that is often what prevents a cat from being regulated.

Here is your first post here for ease of following the history: http://www.felinediabetes.com/FDMB/threads/first-week-of-lantus-is-it-time-to-increase.195811/

OK, most important note. Please do NOT increase. On May 26th, Jake went below 68 which is too low on the AT meter. We determine how to dose the cat based on how low the dose takes the cat, not the preshots, which are typically the highest points of the cycle. Which means 2.5 units is too high a dose. Is there any way you can get some tests in between shots? Such as today on the weekend or before you go to bed at night? You need to at a minimum do a curve before increasing. Night time spot tests are very important. Many cats go lower at night and we need to catch those lows.

Based on the little data I do see, I would recommend going to 2.25 units, and getting more data in for a week, then deciding how the dose needs to be changed. Unless he goes below 90, in which case you'd lower the dose a further 0.25 units. The high preshot numbers you are seeing could be because he is going low mid cycle, and bouncing or dumping sugars into his blood stream to counteract those lows.

 

[paultxrn]

We can definitely test more often including afternoon and evening. I will get some 1/2 unit syringes today as well so I can do 0.25 unit adjustments. We’ll be talking to the vet again but a dental specialist might be a good solution to get his tooth pulled. Jake and I appreciate the advice very much.

 

[Wendy&Neko]

Dental specialists are used to driving dentals to older animals, or those with secondary issues. I started taking Neko to one once she got a heart murmur. I gave me peace of mind, but a little extra tug on the pocket book. However, the specialist also found an issue that my vet did not, so well worth it.

ETA, you will probably need a referral from your vet.

 

[Sienne and Gabby (GA)]

I had the same reaction as Wendy. It's great that you're testing. It will help to see more data from other than your pre-shot tests. One reason that we push spot checks is that it's entirely possible that Jake is dropping into lower ranges during the cycle. If a cat's numbers drop into a range that's lower than their body is used to, drops into low numbers, or there's a fast drop in numbers, it can trigger a "bounce." What this means is your cat's liver and pancreas panic in response to the change in BG and then release a stored form of glucose along with counterregulatory hormones. This response causes BG numbers to spike upward. Given that you're seeing "blue" numbers when you have gotten spot checks and the pre-shot numbers are in the 400s, it's likely that Jake is bouncing.

I'd also urge you to get at least a "before bed" test during the PM cycle. Many cats tend to experience lower numbers during the PM cycle. Getting some tests will insure that Jake is in safe numbers. In addition, without those numbers, you're missing half of your data.