Lantus dosing adjustments

[Brad Kowalski]

Hello, I just transistioned my cat from Vetsulin to Lantus this past Saturday. We will be at his 6th dose this evening. We are dosing every 12 hours and he is in an all wet food with low carbs and high protein. The Vetsulin was dropping his numbers into aa resonable range but after 6 hours they bounced right back to high 600 to low 700s. The Lantus so far using 1 1/2 units has been doing a great job bringing the numbers down and holding them longer at lower numbers. I am using a Aplhatrak2 meter and checking every 2-4 hours, keeping a log if bg numbers and units of insulin given. I have been reading about building an insulin depot with Lantus and not changing doses for a few days to allow it to work properly. The pre shot numbers are normally high 500 to low 600s. He does drop into low 400 to high 300s sobit appears to be working. With tonight being his 6th dose I am wondering if it has been long enough to create the "depot" and maybe I should increase his dose to 1 3/4 - 2 units to get the numbers down to a more stable reasonable range? This is all new for us but luckily my cat Sebastian is a great patient. He comes right to me and sits down when he needs his bgs tested and doesn't fuss when giving his shot. He has shown a huge improvement in his all around appearence and behavior since switching to Lantus. I work for myself and have taken off until he is stable. Any advice would be very appreciated!

 

[Juliet]

Hello, I just transistioned my cat from Vetsulin to Lantus this past Saturday. We will be at his 6th dose this evening. We are dosing every 12 hours and he is in an all wet food with low carbs and high protein. The Vetsulin was dropping his numbers into aa resonable range but after 6 hours they bounced right back to high 600 to low 700s. The Lantus so far using 1 1/2 units has been doing a great job bringing the numbers down and holding them longer at lower numbers. I am using a Aplhatrak2 meter and checking every 2-4 hours, keeping a log if bg numbers and units of insulin given. I have been reading about building an insulin depot with Lantus and not changing doses for a few days to allow it to work properly. The pre shot numbers are normally high 500 to low 600s. He does drop into low 400 to high 300s sobit appears to be working. With tonight being his 6th dose I am wondering if it has been long enough to create the "depot" and maybe I should increase his dose to 1 3/4 - 2 units to get the numbers down to a more stable reasonable range? This is all new for us but luckily my cat Sebastian is a great patient. He comes right to me and sits down when he needs his bgs tested and doesn't fuss when giving his shot. He has shown a huge improvement in his all around appearence and behavior since switching to Lantus. I work for myself and have taken off until he is stable. Any advice would be very appreciated!

Best thing to do would be to read the stickies at the top of this forum and pick a protocol. Either the TR protocol or the SLGS method and go from there.

 

[Kris & Teasel]

I agree. Read those yellow stickies. They are an excellent resource.

 

[Kris & Teasel]

Then ask a ton of questions!

 

[Brad Kowalski]

It seams I have been doing a tight regulation since the diabetes was detected and we started on Vetsulin which didn't do the trick. We are still following the tight regulation with the Lantus which we started 3 days ago. After checking tonights numbers which will be the 6th shot of 1 1 1/2 units I will increase tomorrows dose to 1 3/4 to see if the next few cycles get his numbers down below 300 and hold them there. Frustrating at best but much better having this forum to have experienced people to lend an ear and help.. Thank you all!

 

[Kris & Teasel]

It seams I have been doing a tight regulation since the diabetes was detected and we started on Vetsulin which didn't do the trick. We are still following the tight regulation with the Lantus which we started 3 days ago. After checking tonights numbers which will be the 6th shot of 1 1 1/2 units I will increase tomorrows dose to 1 3/4 to see if the next few cycles get his numbers down below 300 and hold them there. Frustrating at best but much better having this forum to have experienced people to lend an ear and help.. Thank you all!

Here's a new person's handout I made up:
____________________________________________________________________________________________

It would help us if you set up your signature (light grey text under a post). Here's how:

• click on your name in the upper right corner of this page
• click on "signature" in the men that drops down
• type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using /glucose meter you're using/what he eats/any other meds or health issues he has.

Another thing that will help us help you now that you've started BG testing at home is to set up a spreadsheet like the one we use here. We can all see it and look at it before offering advice: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

.................................................................................................................................................................................................................................

Here's the basic testing routine we recommend:

1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
3. do extra tests on days off to fill in the response picture
4. if indicated by consistently high numbers on your spreadsheet, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
5. post here for advice whenever you're confused or unsure of what to do.

This is useful: http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

.................................................................................................................................................................................................................................

Here's an explanation of what we call "bouncing". It explains why a kitty's BG can go from low to sky high:

1. BG goes low OR lower than usual OR drops too quickly.
2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.

.................................................................................................................................................................................................................................

Here are some tips on how to do urine ketone testing (VERY important if BG is high and kitty isn't eating well!):

• put the end of the test strip right in his urine stream as he's peeing
• slip a shallow, long handled spoon under his backside to catch a little pee - you don't need much
• put a double layer of plastic wrap over his favourite part of the litter box and poke some depressions in it too catch pee.

Most test strips have to be dipped and allowed to develop for 15 seconds before viewing the colour change in very good light.

 

[Juliet]

Here's a new person's handout I made up:
____________________________________________________________________________________________

It would help us if you set up your signature (light grey text under a post). Here's how:

• click on your name in the upper right corner of this page
• click on "signature" in the men that drops down
• type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using /glucose meter you're using/what he eats/any other meds or health issues he has.

Another thing that will help us help you now that you've started BG testing at home is to set up a spreadsheet like the one we use here. We can all see it and look at it before offering advice: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

.................................................................................................................................................................................................................................

Here's the basic testing routine we recommend:

1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
3. do extra tests on days off to fill in the response picture
4. if indicated by consistently high numbers on your spreadsheet, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
5. post here for advice whenever you're confused or unsure of what to do.

This is useful: http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

.................................................................................................................................................................................................................................

Here's an explanation of what we call "bouncing". It explains why a kitty's BG can go from low to sky high:

1. BG goes low OR lower than usual OR drops too quickly.
2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.

.................................................................................................................................................................................................................................

Here are some tips on how to do urine ketone testing (VERY important if BG is high and kitty isn't eating well!):

• put the end of the test strip right in his urine stream as he's peeing
• slip a shallow, long handled spoon under his backside to catch a little pee - you don't need much
• put a double layer of plastic wrap over his favourite part of the litter box and poke some depressions in it too catch pee.

Most test strips have to be dipped and allowed to develop for 15 seconds before viewing the colour change in very good light.

This is very useful. Would be great as a sticky

 

[Kris & Teasel]

Thanks, Juliet. I routinely give this to new members out on the other forums.

 

[Brad Kowalski]

I will figure out the spreadsheet after dinner. I was able to download it from google and now have to figure out how to add the info and share. Loks like a great tool!

 

[Juliet]

I will figure out the spreadsheet after dinner. I was able to download it from google and now have to figure out how to add the info and share. Loks like a great tool!

Re sharing - in the spreadsheet you can go to options then select "share and export" then select "copy link". Paste this link into your signature and it's a live link that will update as the spreadsheet updates.

 

[Bobbie And Bubba]

Hi Brad and welcome to Lantus and Levemir support group. I think you will like the results you get from Lantus, a depot insulin, rather an in/out one like Vetsulin. I originally was using ProZinc and we made the switch after 6 months and so glad we did.

There is a bit of a learning curb as you will be basing the dose on the nadir with consideration to the pre shot number unlike Vetsulin. Sounds like you are comfy with the TR protocol which is good because you will be able to get Sebastian in better numbers quicker .

Once you get the SS up and going it will really help us to help guide you with dosing.

Where are you located, generally, USA? Time Zone.

If you start a new thread each day with Sebastien's name, date and AMPS we will look out for you and help to guide you. Ask lots of questions as that is how we all learned. Also, read other's threads which will also help you.

Would love to see a pic of Sebastian, I'm a bit partial to Maine Coon kitties.

 

[Brad Kowalski]

Still figuring some of the toold out. I will post a picture later tonight as soon as I figure how to add one. And I did download the spreadsheet but just have to sit down afyer dinner to figure out how to add info to it. I am in Maine and on Eastern Time Zone. Thank you for all of this awesome info and help! Much appreciated!

 

[Bobbie And Bubba]

I am in Maine and on Eastern Time Zone

Can you add that to your signature? Let us know if we can help with any of the tech stuff.

 

[Wendy&Neko]

Hello and welcome. My Neko started on Caninsulin (same as Vetsulin which got rebranded in the US). Caninsulin was pooping out too early in the cycle for us too. I think you'll be pleased by the switch.

Looking forward to the spreadsheet. If you are following Tight Regulation, and the numbers are high enough, you might be able to increase by 0.5 units. But I'd like to see the SS first. Tight Regulation also suggests holding the initial dose 5-7 days, unless numbers are high.

One other difference with Lantus being gentler - you don't have to get all the food in at once. Spreading out the food to a few meals in the first part of the cycle is fine.

 

[Brad Kowalski]

I was able to download a spread sheet and put some info on it but I have to figure out how to link it to this site. I should have it on my page by the morning. Sebastians numbers are high, eating well and drinking normal amounts of water. I do think Lantus will be the answer for us getting him backnkn track. Looking forward to everyones input!

 

[Juliet]

I was able to download a spread sheet and put some info on it but I have to figure out how to link it to this site. I should have it on my page by the morning. Sebastians numbers are high, eating well and drinking normal amounts of water. I do think Lantus will be the answer for us getting him backnkn track. Looking forward to everyones input!

You linked it perfectly. It's in your signature. Somehow the color coding is not working tho. It has conditional formatting which changes color to the corresponding number you put in. @Marje and Gracie can help you fix that.

 

[Wendy&Neko]

Great job getting that spreadsheet up and running! I think you need to hold the dose for tomorrow's AM cycle so you have at least 6 cycles on this dose to start. But if you don't see anything below pink (300) by tomorrow night, feel free to increase to 2.0 units.

Love that picture of Sebastian. He's a really handsome cat.

 

[Brad Kowalski]

Thank you for looking at the spread sheet. And we will give the 1.5 unit dose for the a.m. shot. If the numbers do not come down then we will increase to 2 units for the p.m. dose. Just seeing the numbers not drastically jumping like they were on Vetsulin is promissing even though they are high. The drop is not as severe. Thank you for the info and help!

 

[Brad Kowalski]

Great job getting that spreadsheet up and running! I think you need to hold the dose for tomorrow's AM cycle so you have at least 6 cycles on this dose to start. But if you don't see anything below pink (300) by tomorrow night, feel free to increase to 2.0 units.

Love that picture of Sebastian. He's a really handsome cat.

Sebastian had great numbers today. We started off the day with a amps of 423, +4 was at 238, +7 was 95, +10 was 120. We are now waiting to do the pmps number to see where it is. Seeing the Lantus is now working and reducing the BG numbers we're not sure if we stay at the 1.5 U dose or will it crash his numbers since he dropped so well today down to 95?

 

[Juliet]

Sebastian had great numbers today. We started off the day with a amps of 423, +4 was at 238, +7 was 95, +10 was 120. We are now waiting to do the pmps number to see where it is. Seeing the Lantus is now working and reducing the BG numbers we're not sure if we stay at the 1.5 U dose or will it crash his numbers since he dropped so well today down to 95?

Which dosing protocol are you following? He doesn't earn a reduction until 90 on SLGS and 50 on TR. I'd hold the dose.

 

[Brad Kowalski]

Which dosing protocol are you following? He doesn't earn a reduction until 90 on SLGS and 50 on TR. I'd hold the dose.

Doing TR so we will hold the dose at 1.5U. If we are understanding Lantus properly once it finally works it should be fairly regular with numbers? This sure has been scary but feeling much more confident with all of the support here! Thank you!

 

[Sienne and Gabby (GA)]

Remember what I said above -- there's a very good possibility that Sebastion's numbers are going to shoot up. He's not yet used to seeing normal BG numbers.

 

[Brad Kowalski]

Just checked his pmps number and it's 159.

 

[Juliet]

Doing TR so we will hold the dose at 1.5U. If we are understanding Lantus properly once it finally works it should be fairly regular with numbers? This sure has been scary but feeling much more confident with all of the support here! Thank you!

The difficulty with that thinking is that this is a hormone. Things don't stay the same and I have been dosing Silver for 7 months and his numbers have never been regular.

 

[Brad Kowalski]

I increased the dose from 1.5 U to 1.75 U and it seamed to make a difference. It got us into the pink again but I am seeing now +4 into todays dose we went from a amps of 387 and expected to see a lower +4 number but instead we are seeing 556. Putting things together a little at a time. I am seeing the days we give Sebastian his soft chew vitamins that the Vet sent home are sending his numbers up we think? Every time we give just one of these his numbers shoot up into the black instead of dropping.. no more vitamins for my buddy. Will check in a few hours to see if the BG is dropping again hopefuly.

 

[Juliet]

I increased the dose from 1.5 U to 1.75 U and it seamed to make a difference. It got us into the pink again but I am seeing now +4 into todays dose we went from a amps of 387 and expected to see a lower +4 number but instead we are seeing 556. Putting things together a little at a time. I am seeing the days we give Sebastian his soft chew vitamins that the Vet sent home are sending his numbers up we think? Every time we give just one of these his numbers shoot up into the black instead of dropping.. no more vitamins for my buddy. Will check in a few hours to see if the BG is dropping again hopefuly.

My Silver always food spiked. He'd go right up til +8 and then come down again. What is the carb/sugar content of the vitamins?

 

[Brad Kowalski]

I'll have to look into the carb values. I asked the Vet about these but realizing that they really don't understand as much as you would think. Very fast to just raise and lower doses and state that all wet food is ok for our diabetic cats. I am learning so much and it is all very different from the information I left the Vet with when Sebastian was diagnosed. Going to check at +6 into this mornings dose to see if he is dropping back to satisfactory numbers. No more vitamins for him! I noticed this the other day but thought he was not liking the low numbers but now seeing the relation to tge numbers and vitamins.

 

[Juliet]

I'll have to look into the carb values. I asked the Vet about these but realizing that they really don't understand as much as you would think. Very fast to just raise and lower doses and state that all wet food is ok for our diabetic cats. I am learning so much and it is all very different from the information I left the Vet with when Sebastian was diagnosed. Going to check at +6 into this mornings dose to see if he is dropping back to satisfactory numbers. No more vitamins for him! I noticed this the other day but thought he was not liking the low numbers but now seeing the relation to tge numbers and vitamins.

It's good you've made the connection. I was giving Temptation treat with each test then realising on curve days he was high. Too many high carb treats!

 

[Kris & Teasel]

It's good you've made the connection. I was giving Temptation treat with each test then realising on curve days he was high. Too many high carb treats!

I use Temptations or similar added to a bit of low carb wet food when I have to prop up Teasel's BG - like last night and today!