Lantus Dosage Concerns - Recently Diagnosed Cat

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Just wanted to give an update - I started him back on Lantus after a missed shot and his BG was 93 this morning. Instead of skipping a shot again, I decided to give him 0.25u (half the already reduced dose). Since we were both home and we had all the supplies we need (Karo and some FF with Gravy) we thought it would be okay. We tested him now, an hour before his next shot and his BG is 95. If I can keep it at this stable range I will be quite happy! We did not test him mid cycle because he got so aggravated yesterday after not getting any blood try after try when we tried to take it (check out my spreadsheet!) that I didn't want to do it and I was afraid to get another inaccurate reading bc of stress. Is it possible his numbers are so low because he's not eating a ton (just about 5oz per day)??? I hope this meter is still working properly! It just seems unusual to be this low so early in this regulation process. Maybe its the strict low carb wet food? He still doesn't have a ton of energy though, also because he's a little too thin. Will the energy pick up, and will he start putting on weight now that he's more stable???

We bought some treats for him, purebites and beefeaters that are low carb that seems to be helping after the ear prick so I'm hoping I can do it more often to get an accurate picture of the nadir.

I also noticed he definitely has some form of neuropathy...his front paw is kind of squished at the wrist. I think this may be causing discomfort when he walks? I ordered some Zobaline and going to try to crush it into his food. Anyone have experience with this?
 
eternalblue said:
I started him back on Lantus after a missed shot and his BG was 93 this morning. Instead of skipping a shot again, I decided to give him 0.25u (half the already reduced dose).....We tested him now, an hour before his next shot and his BG is 95. If I can keep it at this stable range I will be quite happy! We did not test him mid cycle because he got so aggravated yesterday after not getting any blood try after try when we tried to take it
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So his a.m. pre-shot was 93, and his p.m. pre-shot was 95?

These are likely to be the highest points over the 12 hour period. With readings that low, it is very important to know for sure how low he is dropping between shots. I know it seems like we're all repeating ourselves over and over, but those nadir readings as so important.

Please test him mid-cycle. Those numbers are rather low as it is, I'm concerned how much lower they are falling mid-cycle. A drop of only 30 or 40 points between pre-shot and the point when the insulin is having its greatest effect would in this case be enough to trigger a hypo. And that's really not a huge drop from insulin onset to point of greatest efficacy.

It sounds like your little kitty could have earned himself another dosage reduction, but only the nadir numbers will show this.

I know all too well how terrible it can feel to upset your cat by repeatedly poking their poor ears; but really, it doesn't hurt them that much at all, and compared to the alternative there is really no choice at all. Your cat will forgive you for one more poke during the day; you won't forgive yourself if you miss the warning signs for a hypo.

It sounds like you're really doing well with the food, the insulin and everything, kitty could need even less insulin than you think, and could be off the juice in no time.

But too high a dose not only risks a hypo, but also a rebound, causing a huge peak in BG levels, and screwing up the regulation you've managed to achieve so far.

Best of luck to you both!

H
 
Helene & Cleo said:
eternalblue said:
I started him back on Lantus after a missed shot and his BG was 93 this morning. Instead of skipping a shot again, I decided to give him 0.25u (half the already reduced dose).....We tested him now, an hour before his next shot and his BG is 95. If I can keep it at this stable range I will be quite happy! We did not test him mid cycle because he got so aggravated yesterday after not getting any blood try after try when we tried to take it
Click to expand...
So his a.m. pre-shot was 93, and his p.m. pre-shot was 95?

These are likely to be the highest points over the 12 hour period. With readings that low, it is very important to know for sure how low he is dropping between shots. I know it seems like we're all repeating ourselves over and over, but those nadir readings as so important.

Please test him mid-cycle. Those numbers are rather low as it is, I'm concerned how much lower they are falling mid-cycle. A drop of only 30 or 40 points between pre-shot and the point when the insulin is having its greatest effect would in this case be enough to trigger a hypo. And that's really not a huge drop from insulin onset to point of greatest efficacy.

It sounds like your little kitty could have earned himself another dosage reduction, but only the nadir numbers will show this.

I know all too well how terrible it can feel to upset your cat by repeatedly poking their poor ears; but really, it doesn't hurt them that much at all, and compared to the alternative there is really no choice at all. Your cat will forgive you for one more poke during the day; you won't forgive yourself if you miss the warning signs for a hypo.

It sounds like you're really doing well with the food, the insulin and everything, kitty could need even less insulin than you think, and could be off the juice in no time.

But too high a dose not only risks a hypo, but also a rebound, causing a huge peak in BG levels, and screwing up the regulation you've managed to achieve so far.

Best of luck to you both!
H
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My concern is if I skip the shot again, he will be put on a rollercoaster and I have to keep starting over. If I shave it down to about 0.1u would that be safer? I can get up in the middle of the night to test him. I completely understand your concern and I do agree, I will just have to suck it up and try to get the ear prick. I am less concerned about pricking his ears (even though I hate the bruises I've caused) and more about the frustration of him kicking and screaming while I try 10 times to get blood and come back with a big fat zero! :(
 
Hm. I'm hoping someone with lots of lantus experience will post a reply to your query about whether to skip tonight's dose, or not, and if so what to dose/ how much to reduce by. I don't know myself, I don't have experience of dosing with lantus other than what I've read here. I know enough to tell that with such low pre-shot numbers there is a concern about how low your kitty is dropping at nadir point. And I know that means you need to test mid-cycle. But I'm unsure as to how to respond to the situation immediately, i.e. what to dose tonight.

Do you mind if I post a link in the lantus forum to this thread, on your behalf? It's the busiest forum on this site, and is frequented by exactly the right people to provide an answer to this problem of yours. And it needs an immediate answer.

H
 
Do the kitty burrito! Wrap him up snugly in a towel or blanket until only his head is showing, and either kneel and place him between your legs or put him between your side and a couch arm, large pillow, etc. to secure him in place. It sucks, but it does get better. Scooter and I only had to do the burrito about 4 times until he decided that it was easier to be a good boy :lol: Make sure you're giving him lots of praise and treats, even if your tests are unsuccessful. Now Scooter sits in my lap and purrs the whole time... and he doesn't even shake his ear any more ;) You'll get there!
 
Helene & Cleo said:
Hm. I'm hoping someone with lots of lantus experience will post a reply to your query about whether to skip tonight's dose, or not, and if so what to dose/ how much to reduce by. I don't know myself, I don't have experience of dosing with lantus other than what I've read here. I know enough to tell that with such low pre-shot numbers there is a concern about how low your kitty is dropping at nadir point. And I know that means you need to test mid-cycle. But I'm unsure as to how to respond to the situation immediately, i.e. what to dose tonight.

Do you mind if I post a link in the lantus forum to this thread, on your behalf? It's the busiest forum on this site, and is frequented by exactly the right people to provide an answer to this problem of yours. And it needs an immediate answer.

H
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Yes, please post it for me, thank you! Haven't given his shot yet and I'm about 45 mins late on it.
 
Is it okay to hold off this long? I'm thinking it might be okay to give him 0.1u and try to monitor him? This would be even less than what I gave him this morning. I just don't want to keep skipping shots. :(
 
Hello there, can you get another measurement in now to see how he is going? Lets see how he is trending. I will ask to see if I can get an expert over here soon.
 
I responded to Helen's post on the Lantus board. Obviously, I've not been following Bubba so I'm at a bit of a disadvantage.

For someone who is new to testing and diabetes management, I'm not comfortable suggesting that you shoot a low number. While this is something we do routinely with Lantus, you need to be "data ready." In other words, you need to be able to reliably test your cat and get both pre-shot and spot checks during the cycle in order to know where the nadir typically is and know how low the numbers are ranging. Given how new you are to testing, there's not enough data to know where Lantus onset and nadir are. Without this information, I would encourage you to do one of two things. You can either skip the shot or continue to stall. If you stall, do NOT feed. You will need to test every 20 - 30 min. to see when numbers start to rise. The downside of stalling is that your shot tomorrow morning will be 12-hours from when you shoot tonight. You can safely move the shot time by back to your usual time by either 15 min. at each shot or 30 min. once a day. If your schedule can't accommodate the stall, it's best to skip the shot.

You might want to take a look at this post on handling low pre-shots and low numbers. You'll note that the first part of the post relates to becoming data ready.
 
Sienne and Gabby said:
I responded to Helen's post on the Lantus board. Obviously, I've not been following Bubba so I'm at a bit of a disadvantage.

For someone who is new to testing and diabetes management, I'm not comfortable suggesting that you shoot a low number. While this is something we do routinely with Lantus, you need to be "data ready." In other words, you need to be able to reliably test your cat and get both pre-shot and spot checks during the cycle in order to know where the nadir typically is and know how low the numbers are ranging. Given how new you are to testing, there's not enough data to know where Lantus onset and nadir are. Without this information, I would encourage you to do one of two things. You can either skip the shot or continue to stall. If you stall, do NOT feed. You will need to test every 20 - 30 min. to see when numbers start to rise. The downside of stalling is that your shot tomorrow morning will be 12-hours from when you shoot tonight. You can safely move the shot time by back to your usual time by either 15 min. at each shot or 30 min. once a day. If your schedule can't accommodate the stall, it's best to skip the shot.

You might want to take a look at this post on handling low pre-shots and low numbers. You'll note that the first part of the post relates to becoming data ready.
Click to expand...

Thank you so much for your help. Okay, I will skip the shot and tomorrow morning I will test at the usual time. Then should I go back to 0.25u (which I just decreased it to) and test 6 hours in? I really don't like stopping and starting but at the same time I really don't want him going hypo again (even though it was mild last time, it was very scary).
 
One of the other members mentioned that Bubba has had a positive test for ketones. When was the last test and is he still having a positive ketone readings. If so, skipping the shot is a bad idea.

You might be better off either stalling or shooting a slightly reduced dose.
 
Sienne and Gabby said:
One of the other members mentioned that Bubba has had a positive test for ketones. When was the last test and is he still having a positive ketone readings. If so, skipping the shot is a bad idea.

You might be better off either stalling or shooting a slightly reduced dose.
Click to expand...

The test was hard to tell, it continued to look like a cross between negative and trace. I haven't been able to take a test since late Wednesday which showed the same. He is urinating less frequently now that his numbers are lowering and going overnight so I haven't been able to get a sample. The vet said he wasn't very concerned especially with his numbers being lower and the negative/possible positive reading.
 
I agree with Sienne. For any kitty that has had ketones, we like you to get some insulin in them. You can stall and keep checking every 20 minutes and shoot on the rise.

You can also shoot the reduced dose. Either way, you need to be sure and get a +1 and +2 and post if the numbers are not rising.
 
Skipped the shot last night, this morning his BG was 200 on the nose. I am going to start him back on a lower dose of 0.25u and see how he fairs in 6 hours. Thanks for the help all! :)
 
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