I think increase is too much

josette

josette

Member Since 2022
Hi Oscar went for his check up at the internal medicine doctor today. Originally he was 2 units of prozinc twice a day with old vet. Then went to internal medicine vet who changed him to lantus at 1 unit. She had me do a curve on 9/2 and based on that changed him to 2 units on 9/7..

Yesterday I did a curve as she requested and is sooo happy I test and do a curve, but she wants me to increase his dose to 3 units twice a day. I told her I was not comfortable with a whole unit of increase and my group recommends .25 or .50 at a time. Her comment was that if his nadir was in the 200’s she would say .50 but since it was in the 300’s he could take it. And it was also based on weight which it is not….right?

Well, I do not feel at all comfortable with 3 units so I am going to go with 2.5 and do a curve after 10 days and see what I get. She doesn’t want to see him for 6 months anyway.

anyway just wanted your take on this. And she found fleas which he never had and gave him a Capstar pill and didn’t tell me (I saw it on my bill while in the car and ran back in to question it.).
 
Hi Josette , I notice on your SS you are not testing after the AM dose or the PM dose
Also most cats drop lower at night, at least get anither test in before you go to bed, if the BG is much lower than the PMPS number that means it may Bevan active cycle and you will need to test further
Doing curves really isn't the way to determine the dose.
You need to be getting at least a test in @+2, @+4, @+6
Then the next day switch the testing times up like @+3, @+5, @+7
It's like filling in the pieces of a puzzle
You will never know when Oscar's nadir is ( lowest point in the cycle)
We adjust the does by how low the nadir is.
We don't adjust by full units , we adjust the dose by 0.25 units
You need to pick a dosing method when using Lantus
They will let you know when you need to increase or decrease the dose
I'll give you the link , when you decide please add it to your signature and your spreadsheet

https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

On your spreadsheet can you please highlight ( any color you want to ) where you have switching to Lantus ,it's easy to skip over it. Thanks
 
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josette said:
Hi Oscar went for his check up at the internal medicine doctor today. Originally he was 2 units of prozinc twice a day with old vet. Then went to internal medicine vet who changed him to lantus at 1 unit. She had me do a curve on 9/2 and based on that changed him to 2 units on 9/7..

Yesterday I did a curve as she requested and is sooo happy I test and do a curve, but she wants me to increase his dose to 3 units twice a day. I told her I was not comfortable with a whole unit of increase and my group recommends .25 or .50 at a time. Her comment was that if his nadir was in the 200’s she would say .50 but since it was in the 300’s he could take it. And it was also based on weight which it is not….right?

Well, I do not feel at all comfortable with 3 units so I am going to go with 2.5 and do a curve after 10 days and see what I get. She doesn’t want to see him for 6 months anyway.

anyway just wanted your take on this. And she found fleas which he never had and gave him a Capstar pill and didn’t tell me (I saw it on my bill while in the car and ran back in to question it.).
Click to expand...
@Wendy&Neko

@Sienne and Gabby (GA)

@Bron and Sheba (GA)

@tiffmaxee

Please look at her SS there is not enough data , I gave her some info above
 
Diane Tyler's Mom said:
Hi Josette , I notice on your SS you ate not testing after the AM dose or the PM dose
Doing curves really isn't the way to determine the dose.
You need to be getting at least a test in @+2, @+4, @+6
Then the next day switch the testing times up like @+3, @+5, @+7
It's like filling in the pieces of a puzzle
You will never know when Oscar's nadir is ( lowest point in the cycle)
We adjust the does by how low the nadir is.
We don't adjust by full units , we adjust the dose by 0.25 units
You need to pick a dosing method when using Lantus
They will let you know when you need to increase or decrease the dose
I'll give you the link , when you decide please add it to your signature and your spreadsheet

https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

On your spreadsheet can you please highlight ( any color you want to ) where you have switching to Lantus ,it's easy to skip over it. Thanks
Click to expand...
Diane Tyler's Mom said:
Hi Josette , I notice on your SS you ate not testing after the AM dose or the PM dose
Doing curves really isn't the way to determine the dose.
You need to be getting at least a test in @+2, @+4, @+6
Then the next day switch the testing times up like @+3, @+5, @+7
It's like filling in the pieces of a puzzle
You will never know when Oscar's nadir is ( lowest point in the cycle)
We adjust the does by how low the nadir is.
We don't adjust by full units , we adjust the dose by 0.25 units
You need to pick a dosing method when using Lantus
They will let you know when you need to increase or decrease the dose
I'll give you the link , when you decide please add it to your signature and your spreadsheet

https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

On your spreadsheet can you please highlight ( any color you want to ) where you have switching to Lantus ,it's easy to skip over it. Thanks
Click to expand...


I don’t understand the two dosing types. There is so much to read and I got lost.
 
Hi Josette.
A couple of things first before I comment on the dose.
Are you able to get at least one test in during the PM cycle? A before bed test is a good one to get and if that is lower than the preshot……that is a good indication that Oscar might drop lower, so I would test again a bit later. Is that doable?

Also I would recommend you look at the two dosing methods DOSING METHODS and choose one of those. We can help you decide to choose one if you are having trouble with them

Because the nadirs are in the 200s I would only increase to 2.25 units.
 
josette said:
I don’t understand the two dosing types. There is so much to read and I got lost.
Click to expand...
Posted by a member see if this helps you
SLGS: You hold a dose for 7 days (unless a reduction is earned). You decrease the dose when the BG falls below 90. The aim of this protocol is to keep the cat in the 90-150 range. This is more suited for caregivers who can't test as much as TR requires. You do a weekly curve with SLGS.

TR is a more aggressive protocol with increases as often as every 3-5 days. Reductions are earned when the BG falls below 50. The aim is to keep the cat in the range of 50-100 (which is the normal BG range for cats). To follow TR, you would need to get at least one more test per cycle in addition to the pre-shot one i.e. 2 tests per cycle or 4 tests per day. You would also need to be feeding only LC canned food and no dry food.
 
Diane Tyler's Mom said:
Posted by a member see if this helps you
SLGS: You hold a dose for 7 days (unless a reduction is earned). You decrease the dose when the BG falls below 90. The aim of this protocol is to keep the cat in the 90-150 range. This is more suited for caregivers who can't test as much as TR requires. You do a weekly curve with SLGS.

TR is a more aggressive protocol with increases as often as every 3-5 days. Reductions are earned when the BG falls below 50. The aim is to keep the cat in the range of 50-100 (which is the normal BG range for cats). To follow TR, you would need to get at least one more test per cycle in addition to the pre-shot one i.e. 2 tests per cycle or 4 tests per day. You would also need to be feeding only LC canned food and no dry food.
Click to expand...

Well I can do more than 2 tests per day and feed only canned food which I do already but I am not comfortable increasing every 3-5 days if necessary. I feel like I am somewhere inbetween.
 
josette said:
Well I can do more than 2 tests per day and feed only canned food which I do already but I am not comfortable increasing every 3-5 days if necessary. I feel like I am somewhere inbetween.
Click to expand...
@Bron and Sheba (GA)

Then I would follow the SLGS method ,
Bron do you agree ?

I would suggest you do a new post everyday so the members here can follow along in order to give you advice on doses if you need help or have a question

Do you know how to add SLGS to your signature?
If not tap in your name up top, then tap on signature, add SLGS to it and then tap Save
You can also add it to the top of your spreadsheet where it asks you

Please add SLGS to your signature and spreadsheet
@josette
 
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Bron and Sheba (GA) said:
Hi Josette.
A couple of things first before I comment on the dose.
Are you able to get at least one test in during the PM cycle? A before bed test is a good one to get and if that is lower than the preshot……that is a good indication that Oscar might drop lower, so I would test again a bit later. Is that doable?

Also I would recommend you look at the two dosing methods DOSING METHODS and choose one of those. We can help you decide to choose one if you are having trouble with them

Because the nadirs are in the 200s I would only increase to 2.25 units.[/QUOT

Yes I can test more times a day and before I go to bed. And will try to find the 2.25 unit mark on that syringe. I can barely see the 2 mark now.
Click to expand...
 
josette said:
A completely new post or just continue this post each day ?
Click to expand...
A new post each day
I'll tell you how to do it
Everyday you start a new post on the Lantus forum
You will put
Date, Oscar, AMPS# and any other tests after that
To add those tests look to the right you will see the word Thread Tools
Tap on that , then tap on the word Edit Title go ahead and add those test and tap Save. You can go back when you test him at PMPS and add additional tests
Bookmark this page so you can remember what to do ,or write it down
Here is an EXAMPLE ONLY of what it will look like
9-22 OSCAR AMPS-220 , +2-200, +4-180 PMPS-200 and so it


Also when you do a new post every day we link the previous days post to the new one ,in case we need to go back and look at it
You will post a new post on the Lantus board which you are doing
https://felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/
To the right it says Post New Thread


The best way that I can explain it to you about linking your previous days post to the new day is
The best that I can explain how to do it is to look up top where that picture is of that cat on the left hand side , above it will be this post in that long line where it sayshttps://feline diabetes.com/FDMB/threads/i-think- increase is too much
You copy it and then paste it on your new post tomorrow where you would begin to write something

Do you see it up top now it's your post from today

A favor when you read when a members replies back to you can you please tap in the work like that's to the right of someone's reply just so we know you have read it
Did you read Bron suggested to only give 2.25 units tomorrow morning ,it's post #6
 
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josette said:
Well I can do more than 2 tests per day and feed only canned food which I do already but I am not comfortable increasing every 3-5 days if necessary. I feel like I am somewhere inbetween.
Click to expand...
Diane Tyler's Mom said:
Then I would follow the SLGS method ,
Bron do you agree ?
Click to expand...
If you are more comfortable doing the SLGS, that is fine. You can always swap to TR later if you want.
So you will need to hold the dose for 7 days unless the BG drops under 90 in which case you will reduce the dose.
Then you do a curve before deciding on the dose. The dose may stay the same or it might go up or it might go down….so I would always post and ask advice in the beginning until you get more informed.
I would also try and get at least 1 test in every cycle if that is doable, as that will give you a much better picture of things than just a curve once a week.
Posting daily if you can, will let everyone get to know you and Oscar and we will be able to help and support you. You will find it will all get easier as time goes by.
 
Let me provide a bit of explanation. Lantus (and the glargine biosimilars) and Levemir have a different method of action than other types of insulin. As a result, dose changes are based on the nadir -- the lowest point in the cycle. The pre-shot tests are important as a means of determining whether it's safe to shoot but in order to know if the insulin is working, you need to know how low the dose brings your cat's blood glucose (BG) numbers. By way of an example, my cat was notorious for fast, hard drops. I was also a testaholic! Relatively early on, Gabby began her day with numbers in the 400s. Her BG dropped into the 40s and by PMPS, she was back in the 400s. If I hadn't gotten the in-between tests, I would have missed the drop into the 40s which meant a dose reduction. If I'd only had the AMPS/PMPS numbers to guide my thinking, I might have been considering a dose increase.

That said, with the two dosing methods we use, the typical dose increase or decrease is 0.25u. Unless numbers are consistently higher than 300, you would be increasing by 0.25u. The rationale is that you don't want to increase by too much and as a result, miss what would be a good dose for your cat.
 
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