? Lantus differential AM and PM dosing: any views?

Vanda Kay

Vanda Kay

Member
I'm reposting this question in a new thread, because I haven't been able to find anything about it in the forum. My vet looked at Landa's numbers and discussed them with an internist friend of hers. The internist suggested lowering the dose from 1u to 0.75u in the AM, because of a couple of nadirs that went below 90 and raising the dose to 1.25u in the PM, because the numbers seldom go below 250 at night. Has anyone followed such a dosing protocol?

PS How do I tag someone in this thread?
 
Vanda Kay said:
Thank you! I am still learning how to use this forum!
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No problem at all :bighug::cat:


To link your previous posts
Your previous days post will always be in the URL all the way up top ignore where it says insert or cancel I'm just trying to show you where your previous days post will be
Just ignore where it says insert and cancel
Just copy your previous days post and then paste it when you do your new post new thread





Like I said
your previous days post it will be the one all the way up top, above the pic of that cat and the picture of a bottle of insulin there, let me know if you understand it, only way I can explain it :cat:

If you can I would post everyday
Can you update your spreadsheet for last night (3-25)
 
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To answer your question, lantus being a depot insulin does not work as it’s designed by shooting different doses day and night. What you are seeing is bouncing at night from the lower bg reached during the day. It’s quite common especially in cats new to insulin but since cats all the way to remission. Most cats stop bouncing as much when they get used to normal bg.

Here’s some info on the depot.
https://felinediabetes.com/FDMB/threads/what-is-the-insulin-depot.150/
 
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Different dosing AM and PM is not recommended for depot style insulins like Lantus and Levemir, and especially not with the dosing methods we use here. Different dosing AM and PM is more common with the older style in and out insulins.

We dose based on how low the dose is taking the cat, not on the preshot value. You've been shooting all different doses the last few days. The earned dose per SLGS is 0.5 units now. Landa has been below 90 several times now, which earned reductions down to 0.75 units per SLGS. Yesterday she went below 90 while on 0.75 units dose, meaning that earned another reduction down to 0.5 units. Please don't increase to 1.25 units - that will take her way too low. She's already shown that 1.0 units is too much insulin.
 
tiffmaxee said:
To answer your question, lantus being a depot insulin does not work as it’s designed by shooting different doses day and night. What you are seeing is bouncing at night from the lower bg reached during the day. It’s quite common especially in cats new to insulin but since cats all the way to remission. Most cats stop bouncing as much when they get used to normal bg.

Here’s some info on the depot.
https://felinediabetes.com/FDMB/threads/what-is-the-insulin-depot.150/
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Thank you. Does that mean I need to give Landa a lower dose both times to stop the bouncing or just wait for the bouncing to resolve itself? I have read the stickies about Lantus and have lowered the dose a couple of times as per the SLGS protocol, because of nadirs below 90. I'm still not clear on how the bouncing resolves itself: by lowering the dose and starting from scratch or by just continuing.
 
I'm still really confused, folks! I've updated Landa's ss. We're doing SLGS and I had to reduce her dose to 0.75 due to a couple of nadirs below 90. But now she's not even going into the blue or green zone at all. Does that mean I have to increase the dose back to 1u which is what she started on 3 weeks ago?

@Wendy&Neko
 
Cats bounce from being in lower bg than they are used to and only when they get used to better bg does bouncing get less frequent. Some cats are bouncier than others. Try .50 both dishes first 7 days unless there’s a drop under 90 which would mean another reduction.

Bounces can last 6 cycles and sometimes longer. That’s why the bg is high now. With SLGS once you decrease you hold the dose for 7 days.

Bouncing, as we use the term in the FDMB, is the increase in the BG due to a fast drop of the BG (this does not have to be a fast drop from high to low numbers) or a drop to a lower BG than the cat’s body is accustomed. This also does not have to be a drop to a hypoglycemic BG. Many cats will bounce, initially, when the BG drops, for example, from 300 to 150 over the course of a cycle. The cat’s body has become accustomed to higher BGs and the BG of 150, in this example, causes the liver to release counterregulatory hormones and glucagon to raise the BG back to what it deems a “safer” BG.
 
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Wendy&Neko said:
Different dosing AM and PM is not recommended for depot style insulins like Lantus and Levemir, and especially not with the dosing methods we use here. Different dosing AM and PM is more common with the older style in and out insulins.

We dose based on how low the dose is taking the cat, not on the preshot value. You've been shooting all different doses the last few days. The earned dose per SLGS is 0.5 units now. Landa has been below 90 several times now, which earned reductions down to 0.75 units per SLGS. Yesterday she went below 90 while on 0.75 units dose, meaning that earned another reduction down to 0.5 units. Please don't increase to 1.25 units - that will take her way too low. She's already shown that 1.0 units is too much insulin.
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Thanks, Wendy. I must have missed this. We had a big scare this morning with her numbers going down to 58. I am going to go back to 0.5. How long do I hold that dose for and what happens if her numbers go up over 400 again? Does that earn an increase?
 
58 is safe, but you don't want Landa going any lower, so good thing you were able to monitor and respond! She spent a lot of time in good pancreas healing numbers today, which is nicer when she's in those higher greens.

We do reductions by 0.25 units at a time. I recommend going to 0.75 units AM and PM as her new dose. Lately you've been shooting a mix of 0.75 units and 1 unit, which makes it really hard to say what her new dose should be, and why we suggest shooting the same dose AM and PM.

A reduction is earned when they go below 90, and you reduce by 0.25 units when they do so. You hold the dose for 7 days, unless she goes below 90 again. The 7 days gives her time to get over any bounce and for us to see how low the new dose gets her. Ignore those numbers over 400, that is just her bouncing, it is temporary.
 
Wendy&Neko said:
58 is safe, but you don't want Landa going any lower, so good thing you were able to monitor and respond! She spent a lot of time in good pancreas healing numbers today, which is nicer when she's in those higher greens.

We do reductions by 0.25 units at a time. I recommend going to 0.75 units AM and PM as her new dose. Lately you've been shooting a mix of 0.75 units and 1 unit, which makes it really hard to say what her new dose should be, and why we suggest shooting the same dose AM and PM.

A reduction is earned when they go below 90, and you reduce by 0.25 units when they do so. You hold the dose for 7 days, unless she goes below 90 again. The 7 days gives her time to get over any bounce and for us to see how low the new dose gets her. Ignore those numbers over 400, that is just her bouncing, it is temporary.
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Thanks, Wendy. I thought I was supposed to go down to 0.5 because on March 25th she went down to 85 after an AM dose of 0.75. Yesterday, after the 58, I dropped down to 0.5, but the nadir last night was above 350 and the nadir this morning was about 225. Should I take her back up to 0.75?
 
Vanda Kay said:
Thanks, Wendy. I thought I was supposed to go down to 0.5 because on March 25th she went down to 85 after an AM dose of 0.75. Yesterday, after the 58, I dropped down to 0.5, but the nadir last night was above 350 and the nadir this morning was about 225. Should I take her back up to 0.75?
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@Wendy&Neko
 
March 25th is a week ago. You didn't stick with the 0.5 unit dose but increased shortly thereafter. My recommendation to go to 0.75 units was based on best guess of what the Lantus depot looked like yesterday. Now that you have 3 cycles of 0.5 units under your belt, stick to this dose for the full week, unless she starts to show ketones.

Next day that you post, could you start a new thread please: POSTING GUIDELINES PLEASE READ This is a busy forum, so we have some guidelines that help us monitor progress and help those that need it.
 
@Vanda Kay, As you can see in the forum threads/lists, many of us post daily here in the LLB forum, following the title-line guidelines which state we should list the date and our sugar baby's name, and then we add our AMPS values and update with other daily test values (alternatively, some folks do this all at once at the end of the day, and that's fine too). When you post, you'll want to also post the link to your previous day's condo (or post). If you can post daily, it's helpful in a couple of ways. Posting daily and linking the previous day's condo keeps the information current for anyone needing to help you, and it ensures that you have one thread running, and not multiple threads, which can become confusing. Also, posting daily allows members of the forum to see what is happening with Landa as you're working to get her regulated--members often weigh in with advice and encouragement on a daily basis. If you have questions that come up during that day, post them in that day's post and then adjust your title with a brief summary of the question you're asking (leaving the other data intact in the title). You can also use the question mark or other prefixes (which you've done on this post). But the most important thing is that you create a new post every day that you post on the forum, and that you include the previous day's post in your daily post.
 
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