Insulin Dosage Based on BG Level?

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Maya_

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Hello, my cats BG level was 195 and was wondering would it be best to skip or give half the dose to avoid the BG going too low? Currently, I’m giving 0.5 units of lantus glargine twice a day.

But overall, depending on the BG levels, how should we adjust the dosage? For example, between 150-200, do we give the full dosage still or only do half?

Thanks!
 
Bron and Sheba (GA) said:
Here is your first post for continuity https://www.felinediabetes.com/FDMB...-cat-recently-diagnosed-with-diabetes.292341/
For us to give you dosing advice we need to see data on a spreadsheet. Here is a link HELP US HELP YOU which will give you the instructions on how to set up the spreadsheet, also the signature. We need both those to help you please.

what type of meter are you using? A pet or a human meter?
Are you going to be able to monitor the cycle by testing the blood glucose?
Click to expand...

Hello - Sorry didn't get to create it before but below is the link with the latest results. Just as a background, we were initially doing 1 unit twice day but it seems a bit strong. So then we did 1 unit only once a day but that was really throwing off her BG levels since majority of the day the BG level would be in an acceptable range but spike back up the next day, which is why we're currently doing 0.5 units twice a day.
https://docs.google.com/spreadsheets/d/1HtPfnRq4uNP2J6Pih435jPRPFe9j1au6VBd_tkj_tKw/edit?usp=sharing

I'm using the Alpha Trak 3 meter

Lulu, diagnosed June 2024
Lantus Glargine, 0.5 units twice a day, Alpha Trak 3, Fancy Feast Classic Pate
 
Hello again Dosing is mostly based upon how low a dose takes your cat so you need to find out what that is. That often occurs midway through the cycle but it can vary cat to cat and even cycle to cycle. I can see your spreadsheet and that the only tests on it are preshots. It sounds like you have more tests that that. Is that correct? Would it be possible to add the tests for the last week or two?

Did you get a chance to look at the stickies we mentioned in your prior post? The methods sticky explains about how we determine dosing.

https://www.felinediabetes.com/FDMB...-cat-recently-diagnosed-with-diabetes.292341/
 
tiffmaxee said:
Hello again Dosing is mostly based upon how low a dose takes your cat so you need to find out what that is. That often occurs midway through the cycle but it can vary cat to cat and even cycle to cycle. I can see your spreadsheet and that the only tests on it are preshots. It sounds like you have more tests that that. Is that correct? Would it be possible to add the tests for the last week or two?

Did you get a chance to look at the stickies we mentioned in your prior post? The methods sticky explains about how we determine dosing.

https://www.felinediabetes.com/FDMB...-cat-recently-diagnosed-with-diabetes.292341/
Click to expand...

Link: https://docs.google.com/spreadsheets/d/1HtPfnRq4uNP2J6Pih435jPRPFe9j1au6VBd_tkj_tKw/edit?usp=sharing

Yes I have more testing results and updated them in the spreadsheet (link above) but from before we were doing 1 unit instead of 0.5. When doing 1 unit, the BG level was great throughout the day and when I would test again at night it would be low for me to give another dose so I would end up skipping just to be safe. But the next morning it would spike back up. That's why we shifted to 0.5 units twice a day.

Unfortunately, I haven't had the chance to really review the dosing methods but will look through it. I'm still new to this, not sure how I can increase the chances of remission but trying to learn as much as I can. So far right now, I've been doing 0.5 units twice a day since its been a bit more consistent.
 
You need to give insulin every 12 hours. Until you decide upon a method start with .50 and hold the dose for 7 days. Try and get a second test every cycle if at all possible. Dosing fur both methods is based upon how low a dose takes your cat. That usually is between +4-+7. You have very little data during the day and none other than pmps at night. A curve testing every 2 hours for 12 hours or every 3 hours testing fur 18 hours would help.

I suggest you start with SLGS.
 
You need to give insulin every 12 hours. Until you decide upon a method start with .50 and hold the dose for 7 days. Try and get a second test every cycle if at all possible. Dosing fur both methods is based upon how low a dose takes your cat. That usually is between +4-+7. I suggest you start by following SLGS.


Requisites when following the Start Low, Go Slow Method:
  • Learn the signs of and how to treat Hypoglycemia and prepare a Hypo Toolbox.
  • Test regularly for ketones and know about Diabetic Ketoacidosis (DKA).
  • Use a meter calibrated for humans, not a pet-specific meter. Reference numbers given are for measuring blood glucose with a human meter.
  • Use U-100 3/10cc syringes with half units marked on the barrel for fine dosing.
  • Most kitties are easier to regulate when fed small meals throughout each cycle. Others adapt well to free feeding.

Starting Dose:
  • 1u BID if kitty is not on a wet/canned low carb diet
  • 0.5u BID if kitty has been switched to a wet/canned low carb diet
  • If the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration
  • Generally, shots are to be given 12 hours apart.
Hold the dose for at least a week:
  • Unless your cat won’t eat or you suspect hypoglycemia
  • Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.
After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases. If you decide to change another factor (e.g., diet or other medications), don't increase the insulin dose until the other change is complete (but decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change).

Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments-- no matter how high your cat's blood glucose is! Rushing towards regulation will cost you time in the long run, because you may shoot past the right dose.
 
Just as an FYI --

Numbers in the 200s and above are safe for giving insulin. However, you need to get at least one test during both the AM and PM cycles. Lantus dosing is based on how low the dose takes your cat's blood glucose level. The lowest point in the cycle, the nadir, is generally at about +6 but this varies for each cat. That said, we don't expect you're going to wake up in the middle of the night to test your cat. You don't adjust the dose based on the pre-shot numbers unless the pre-shot test indicates that it's not safe to shoot. That number will become progressively lower as you get more experienced with managing your cat's diabetes.

If you're unsure whether it's safe to give insulin, please post and ask for help. Put the request in your subject line. There is usually someone around who can guide you through the process.
 
Yes it’s working! Well done. Are you able to get a test in sometime during all the pm cycles so we can see what is happening there please?
 
Bron and Sheba (GA) said:
Yes it’s working! Well done. Are you able to get a test in sometime during all the pm cycles so we can see what is happening there please?
Click to expand...

Great! Yes, I will try. I just took her BG test and it’s at 205, just gave her morning meal and will give insulin after but thinking of doing half the dose just in case to see how low it will go to get a better understanding. I will test again in 6 hours to see what her BG level is
 
205 is high enough to give the full dose. Best to keep staying at the same dose if possible unless she earns a reduction or the Preshot is too low. dint forget to look at the 2 dosing methods and choose one. It is far better to follow a dosing method than not.
 
Bron and Sheba (GA) said:
205 is high enough to give the full dose. Best to keep staying at the same dose if possible unless she earns a reduction or the Preshot is too low. dint forget to look at the 2 dosing methods and choose one. It is far better to follow a dosing method than not.
Click to expand...


I gave 0.25 prior to reading your post but thank you for letting me know! What is usually considered too low to give a dose? Also, I'm currently following the SLGS method
 
Maya_ said:
I gave 0.25 prior to reading your post but thank you for letting me know
Click to expand...
That’s ok. It’s all a learning curve.
Maya_ said:
What is usually considered too low to give a dose
Click to expand...
At the moment until we get more BG data don’t shoot under 200 . If that happens you stall, don’t feed and test again in 20 minutes to see if the BG is rising. And post and ask for help. As you get more data, you can lower when to shoot.
Do you think you could get a test in each pm cycle? Otherwise you are missing half the data. Even a before bed test is helpful. If that test is much lower than the preshot BG, that is a little red flag for you to say…hey this is going to be an active cycle….and you might need to get up again later and check that the BG has not dropped too low.
I think you can start posting over on the Lantus page now. There are a lot more people over there and you will get more help quicker. And everyone uses glargine or equivalent.
Here is the page https://www.felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/

and here are the posting guidelines for posting on the Lantus page.
https://www.felinediabetes.com/FDMB/threads/posting-guidelines-please-read.231511/
 
Bron and Sheba (GA) said:
That’s ok. It’s all a learning curve.

At the moment until we get more BG data don’t shoot under 200 . If that happens you stall, don’t feed and test again in 20 minutes to see if the BG is rising. And post and ask for help. As you get more data, you can lower when to shoot.
Do you think you could get a test in each pm cycle? Otherwise you are missing half the data. Even a before bed test is helpful. If that test is much lower than the preshot BG, that is a little red flag for you to say…hey this is going to be an active cycle….and you might need to get up again later and check that the BG has not dropped too low.
I think you can start posting over on the Lantus page now. There are a lot more people over there and you will get more help quicker. And everyone uses glargine or equivalent.
Here is the page https://www.felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/

and here are the posting guidelines for posting on the Lantus page.
https://www.felinediabetes.com/FDMB/threads/posting-guidelines-please-read.231511/
Click to expand...

Thank you for the information! Yes, I will try to get the testing results for the pm cycle. I posted on the Lantus page about how my cats bg levels the last few days has not gone down. Not sure if my cat may be becoming resistant or its time to change the vial? I've had the vial now for about a month and it's been in the fridge.

Post from Lantus page:
https://www.felinediabetes.com/FDMB/threads/lantus-losing-effect.292827/
 
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