Just switched to Lantus, advice for expected late shot?

[Leslie and Jasper]

Hi!
I would appreciate some advice for planning ahead. We have been shooting Jasper 2x per day at 8:30 am/pm to fit around work schedule, that has been working OK so far. This Saturday night we will be out 6:30 - 11:00 for close friends retirement party, what to do about shooting Jasper? Do we start shifting shot time now? Test and shoot him when we get home then work back to our preferred time? Yesterday morning we switched Jasper to Lantus 1u twice per day. We are following the protocol and already seeing quite a difference from the Humulin N. Yesterday he was high and didnt vary much. Overnight he dropped a lot and with some trepidation I decided to give his am shot this morning despite low number. Numbers dropped lower faster than expected which spooked me so I am testing him frequently but fairly stable green so far, whew. Jasper has just 3 shots on Lantus so far and I dont know we can expect by Saturday. I still feel new at this, the shock of diagnosis has worn off and board input and info has already helped us a lot, but we are still very much novices finding our way. Would it be better to start shifting his regular shot time now or plan to give him his Saturday night shot 3 or 4 hours late? Other ideas? Any advice appreciated, thanks!

 

[Julia & Bandit (GA)]

I would suggest one of two things--ideally, you would want to move the shot forward and then back again in 15 minute increments (30 minutes a day). If you started today, you could get to 11 by Sat. because it will take 5 days to get up there and 5 more to get back down to 8:30 again.

That said, life happens, and I don't think anything terrible is going to happen if you just skip your Sat. PM shot and keep to your current schedule. You don't want to skip shots frequently, but once in a great while isn't going to set you back too much. I would probably skip the shot if it were me, rather than attempting to move it that far ahead.

And that 47 today means that Jasper has earned a dose reduction! So you should be shooting .75u and holding for his next shot. You're getting some good action from it already, which is fantastic.

 

[Leslie and Jasper]

Thanks, good thoughts. I will plan to keep Jasper on our current schedule, we can test him after the party Saturday to make final decision then about skip or late shot. It was quite a surprise to see his numbers dropped so much since yesterday, we have not been testing during the night. I just did his +9 which is 91, I can see the Lantus curve flatness vs. his Humulin curve. I am a bit uneasy about reducing dose before we have 3 full days of Lantus, changing too soon. However if his numbers are remain steady and fairly low at shot time tonight, will go down to 0.75 and see how he does. Giving too little insulin is better than giving too much.

 

[Julia & Bandit (GA)]

Lantus dose adjustments are based of the nadir (lowest number of the cycle), not preshots. You'll likely have a high preshot for his PM shot tonight--cats' livers dump glucose into their bloodstream when they hit a low or normal number. You don't base dosing decisions of those numbers.

According to thedosing protocol for Lantus, you should reduce the dose by .25u when you get a number below 50, regardless of how long you've been at that dose.

If you do decide to shoot late, make sure that you're moving the dose back by a half hour each day. You do not want to shoot at your regular 8:30am time if you shoot at 11pm. That would create crossover for the duration of action with the insulin and be potentially dangerous.

For more information about how to dose Lantus, check out this sticky: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581.

 

[Leslie and Jasper]

Thanks! As you predicted, tonight we did get a somewhat higher preshot 127 though that much lower we were usually getting with Humulin. We reduced Jasper to 0.75u tonight. We reread the instructions again, steadily undoing our Humulin thinking. I think Jasper had a pretty good day today, even took frequent testing in stride. He has been eating lightly but steadily and no puking today so far, yay! Our transition to wet food may have been complicated by degraded food. We noticed a can on the bottom of the case was very puffed up and didnt trust the rest. After extended power outages here with recordbreaking heat, who knows, maybe it got too hot in transit or storage. We returned the cans we had left and got new food from a different lot. Since we restocked, Jasper and our other cats are more receptive to the wet food. They graze throughout the day, eating less than we expected but no longer crying and pestering for food and not throwing up much. Now we keep an eye on how Jasper does with the lower dose and continue our journey to get him regulated. Thanks for your help and support!

 

[rhiannon and shadow (GA)]

I think lowering the dose was the right thing to do.

 

[Julia & Bandit (GA)]

Wow, what great numbers Jasper had yesterday!

Like I said, don't panic and raise the dose if you see some higher numbers today. That's normal. You want to hold the .75u for 3-5 days, and maybe longer if you keep seeing such great numbers! You would reduce to .5u if you see any numbers below 50 again. Here's a link that explains how to handle low preshot numbers, if you get some: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=147.

Lantus is dosed very differently from Humulin N, because it works very differently. It needs to build a "shed" under the skin (an insulin depot) before it goes to work on lowering BG, it usually takes about 24 hours for a dose adjustment to show up in the numbers. That's why dosing decisions are based off nadirs (mid-cycle numbers) rather than preshots. Humulin starts lowering BG immediately, and wears off quickly, unlike Lantus and Levemir that work for 12+ hours.

But Jasper seems to be doing fantastic on the Lantus! He may only need it for a short time before he goes into remission.

 

[Leslie and Jasper]

Thanks, this coaching is really helpful! Your "dont panic" reminder in your post was quite timely. I was very optimistic about Jasper's good numbers yesterday, now we know its possible. Then this morning Jasper's am number was much higher at 277, I gave him same 0.75u dose as last night anyway for consistency. He moved at the wrong moment so it might have been a fur shot, though I didn't detect any liquid on his fur. I just tested his +3 which is up to 357, higher than I hoped but we will see what his +6 shows. I am testing him less frequently today since his ears got quite tender from my overanxious hourly testing yesterday, poor baby. Jasper's Lantus curves thus far vary by day and seem fairly flat within the day, so I decided testing every 3 hrs should be enough tracking for first few days while he is adjusting to Lantus. He is also eating less today, so I am encouraging him to eat.

Leslie

 

[Julia & Bandit (GA)]

Jasper's doing what we call "bouncing"-that effect I mentioned where you see higher numbers after lower numbers because his liver has dumped glucose into his bloodstream because of the low number. A bounce can last up to 72 hours, but usually clears a bit sooner. So you want to hold the dose until we see what numbers Jasper drops back down to after that excess glucose clears from his blood. Hopefully you'll see some good numbers again tomorrow, or maybe even later in his PM cycle.

Don't get discouraged by these higher numbers--they are perfectly normal when you're just starting out, because Jasper's body hasn't adjusted to extended periods of normal blood sugar yet. Most cats need a several weeks/months on insulin before this effect stops happening, but every cat is different so you just have to be patient and see what his numbers tell you. :smile: