Hi Bree,
Great job getting started with the treatment and the home testing!
I fully understand how tricky and confusing it can be when everything is so new and one gets conflicting advice from different sources.
I am glad that the kind lady in Seattle has been such a help to you with learning how to home test BG and getting you started with insulin treatment but I have treated my own cat with Lantus and I have some major concerns about the advice she is giving you about Lantus dosing; it is incorrect for this type of insulin - and potentially unsafe.
The lady is using a 'sliding scale' method for dosing based on the preshot BG.
A sliding scale method may be applicable for the in-out insulins Prozinc and PZI but it is NOT a suitable dosing method for depot insulins like Lantus. Trying to dose on a sliding scale with Lantus could very easily lead to highly unpredictable results for your cat. It is safer and more effective to have things as consistent as possible when treating a cat with Lantus.
As other members have already advised above, Lantus is a depot insulin which builds up a little 'tank' of insulin in the cat's body to help keep BG levels steady during the day. It takes holding a given dose 6-10 cycles to allow the depot to fill and stabilise before the efficacy and
safety of the dose can be properly assessed.
Lantus insulin works best when dosing is consistent. The method for safe and effective dose adjustment is slow and methodical. Dose adjustments need to be done in small increments (typically 0.25IU) and then held for several cycles to give time for the level of Lantus held in the depot to adjust.
Lantus dose adjustments need to be based on the nadir of the cycle (lowest BG level), NOT the preshot.
Lantus nadirs typically occur in the period between +4 and +7 hours after dose admin so I recommend you start doing BG spot checks between these times to better establish Kai's nadir BG.
You need to do mid-cycle tests for the PM cycle as well as the AM cycle. Many, many kitties have BG levels that run lower at night so for safety you need to see what is happening with Kai on the night time cycles. With the higher AMPS readings you've been seeing (the pinks) it is possible that Kai's BG may be bouncing back up from a fairly low number overnight. The sooner you start doing the PM mid-cycle tests the better: a dose which might be safe for a daytime cycle could well be too high for a nighttime cycle.
I am glad that you posted here for additional help. The advantage of posting here is that FDMB works on a peer review basis: when we post here with questions we are not reliant on just one person's advice or suggestions about treatment. When many people who have successfully used the insulin we're using give consistent advice and suggestions it helps to reassure us that the information they offer is sound. Also we can follow the stories of other kitties on the board using our insulin type and see how well they do following the dosing methods advocated here at FDMB (
SLGS - Start Low, Go Slow Method;
TRP - Tight Regulation Protocol).
For information there is a very strict rule on FDMB that all discussions about dosing must be done on the public board. The reason for this is to make sure that many eyes can review the discussion, validate correct information, offer more than one viewpoint, and - very importantly - raise a flag if any suggestions are offered which might be less than sound.
I echo the recommendations above for you to join FDMB's very active Lantus & Levemir ISG board. There are a number of highly experienced Lantus users participating in the group who will be able to offer you and Kai a wealth of help and support on your Lantus journey, including assistance with learning how to dose Lantus correctly. Here's a link to the board:
http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/
There are several very informative educational stickies at the top of the board to help you learn more about how Lantus insulin works. I've also attached below a journal article co-authored by vet Dr Jacquie Rand, a world authority on feline diabetes, about how to manage diabetic cats using long-acting insulins like Lantus (helps to see information from an independent, authoritative source so you may be able to better assess the validity of the advice and suggestions offered to you by others.)
I recommend you start a thread on the L&L board asking for help with correct dosing of Lantus. In the meantime I would recommend you do not give a dose higher than 1.0 IU Lantus BID and also always ask on L&L for advice before giving any insulin if preshot is less than 200. (You don't have much data yet and you have yet to establish how low Lantus is taking Kai at nadir. You need to get earlier mid-cycle tests - AM and PM - to ensure the start dose is safe before starting to increase.)
I hope this will clarify things for you. Kai is already showing a good response to his Lantus. When you get the correct dosing sorted out I think he will even out more and do really well (anti-jinx!). The experienced Lantus users at FDMB have helped many,
many caregivers get their kitties into remission!
Mogs
(PS: When you get a moment, Bree, it would be a great help if you could add the name of the meter you're using to your forum signature so that members replying to your posts will be able to properly interpret Kai's BG data and offer you better suggestions. Thank you!
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