Lantus Dose Help Again, Raise?

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I'm still a newbie, having had my cat diagnosed only a month ago, but I've read a lot and feel pretty confident about reading charts, but someone more experienced on this board should give a more definite opinion.

But I think (based on the data in your spreadsheet) that your cat was doing better on a lower dose (3.25) than now. 3 units twice daily is actually quite a high dose already. As you've got plenty of data for the 3.5u dose, which shows that it's not working right, I think you should be going down to 3u, not up. And I've been told it's fine to go down 0.5u at a time. I would try him out at that dose for at least a week to see how he's doing (something like 10 days would be perfect) and if it's improving his numbers, and reevaluate only then to see if you should lower even more or something else.

Just my 2 cents :)

p.s. I think you should use the Relion meter, which is known to be more reliable. I read in my research that Bayer's Contour is a pretty "meh" meter.
 
You held that dose increase for 10 days. For future reference, 10 days is too long to hold a dose. Our recommendation using the Tight Regulation Protocol is to hold the dose for a minimum of 6 cycles or 3 days. A cycle is a single 12 hour period.

Would you be willing to post over in the Tight Regulation or Relaxed Lantus forums? There are more eyes over there with lantus specific knowledge that would be able to help you better.

If you're like most of us, your life is hectic enough with work, family, volunteering, pets, children, and all the normal activities of life that you have a very full plate already. We understand that.

Having said that, it may take some additional effort to find a good dose for your cat. Are you willing? Then I would strongly encourage you to start posting, daily if possible, in one of the lantus specific forums I mentioned above.

I would recommend printing these documents out for reference. http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

http://www.tillydiabetes.net/en_6_protocol2.htm

This quote is from the lantus forum, only a small part of the post called "Sticky - Lantus & Levimir Tight Regulation Protocol"
"General" Guidelines:
•Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
•Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
•Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose:
•Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
•After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
•After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Reducing the dose:
•If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.
•If an attempted reduction fails, go right back up to the last good dose.
•Try to go from 0.25u to 0.1u before stopping insulin completely.

Random Notes:
•Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.
•A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.
•Sometimes a dose will need to be "fine tuned" by adding some "fat" or "skinny-ing up" the dose.

Using a weight based formula for determining a starting dose of Lantus or Levemir when following the Tight Regulation Protocol:
•the formula is 0.25 unit per kg of the cat's ideal weight
•if kitty is underweight, the formula frequently used is 0.25 unit per kg of kitty's actual weight
•if the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration
•Online Calculator for Converting Pounds to Kilograms
Click to expand...

Yes, you could increase the dose or the other possibilities are that you have bypassed the good dose for your cat. No way to tell. You may need to keep increasing due to insulin resistence. Your cats body has learned to live with these higher numbers and think they are normal.

Have you tested for Agromegaly or IAAA?
 
From here, it looks like he might either be on too high a dose and we're just not seeing the drops or he might still need another increase. The sporadic blues and greens, however, make me think something else might be going on.

What food is he eating? He might be needing a higher than average dose to counteract the carbs in his food. Does he have any other issues like infections or dental problems? Is he on any other medication like steroids?
 
Please go over to the lantus tight regulation board and have some experienced members have a look.. http://felinediabetes.com/FDMB/viewforum.php?f=9. Maybe post newbie with dose question in the subject line or some thing.

Although you saw a green on 3.25 I don't think that dose was working but I am not a dosing expert.

Since you are feeding low carb canned only I am still suspicious of that ear being infected .. Is it dirty if you look inside? Maybe stick a q-tip in and see what u get. How are his teeth?
 
He's eating Fancy Feast Classic.
The ear infection I referred to was 6 years ago when I first got him. It was checked again a couple weeks ago and there is no infection.
He only has a couple teeth and they are fine.
 
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