Lantus dosing advice

B

Brittany B

Member Since 2022
Hi all,

Joey has had blood glucose in the last few weeks that are improved over previous weeks. He had loose stool for the past three days so we didn’t make any changes to his insulin dosing recently but he isn’t going with the nadir range that would cause us to hold. The past two days (which aren’t in the spreadsheet)have been higher on average and have larger ups and downs - any thoughts on why this would be?
 
It’s hard to say without any data from the last five days in the spreadsheet - no numbers and no notes to go by. I will tag in some of our experts @Bron and Sheba (GA) @Bandit's Mom , but on a general level I’m wondering if his numbers are higher due to physical stress - if he has loose stool, there’s likely a cause, and the cause (tummy upset? Infection?) may mean he’s not feeling good.
 
Based on numbers till 11/29 in the SS, he does need an increase. If his numbers have been higher since then you want to take that increase. With a history of DKA, you do not want him to hang around in higher numbers.

What is causing the loose stool? Any change in food? Does he still have loose stools? Is he eating and drinking okay? Do you check for ketones regularly?
I see a mention of pancreatitis in the comments from a few weeks back. Is he having another flare?
 
Spreadsheet is updated.
Loose stools from Thursday - Saturday (Dec 1-3), improved Sunday (Dec 4).
We’re not sure what’s caused the loose stool - no change in food and no other signs of pancreatitis.
 
She does need an increase. With SlGS you want to evaluate the dose every week. Holding doses too long when the numbers aren't where you want them to be can lead to glucose toxicity.

Good to know that she no longer has loose stools.
 
I agree Joey needs an increase in dose.
Brittany, have you thought about moving to TR? You are certainly testing enough and it would help get him into better numbers quicker. As Bhooma said, you don’t want to him hanging about in higher numbers with DKA in the history.
And the neuropathy while resolve more quickly when the BGs are in more normal numbers.
Do you test at all for ketones? If not, I would test at least a couple of times a week especially while he is in higher numbers and having loose stools. With a history of DKA, it is always a good idea when there is any issues with loose stools, nausea or vomiting or any infection/inflammation, to check more regularly for ketones.
Are you still giving him snacks during the cycles?
 
Spreadsheet is up to date - we increased to 2.5 units on Dec 6th. As you can see his numbers have been quite high since - any thoughts on why?

I occasionally test for ketones but will start to do so more frequently.

he doesn’t receive any snacks - fed once every 12 hours.
 
Brittany B said:
he doesn’t receive any snacks - fed once every 12 hours.
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With a history of DKA and because he is a diabetic, I would recommend you feed Joey a couple of snacks during both cycles as well as the main meals. If you are not there you could use an automatic timed feeder which a lot of us do.
I feed my non diabetic cats 4 times a day and they are much happier and content.
Brittany B said:
Spreadsheet is up to date - we increased to 2.5 units on Dec 6th. As you can see his numbers have been quite high since - any thoughts on why?
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Looking at the SS I see you have in the remarks column that he dropped to just above 8 (144) from 12mn to 6 am so I would say that he is bouncing from dropping into numbers he is no longer used to. Can you put that information about dropping to 8 into the SS please as it is important data. Also there is no data from the two nights before so he could have dropped low then too.
Here is an explanation about bouncing from the yellow stickies on the Lantus page called the Basics
  • Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
 
Bron and Sheba (GA) said:
I agree Joey needs an increase in dose.
Brittany, have you thought about moving to TR? You are certainly testing enough and it would help get him into better numbers quicker. As Bhooma said, you don’t want to him hanging about in higher numbers with DKA in the history.
And the neuropathy while resolve more quickly when the BGs are in more normal numbers.
Do you test at all for ketones? If not, I would test at least a couple of times a week especially while he is in higher numbers and having loose stools. With a history of DKA, it is always a good idea when there is any issues with loose stools, nausea or vomiting or any infection/inflammation, to check more regularly for ketones.
Are you still giving him snacks during the cycles?
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We have started TR a few days ago based on your response (will update the spreadsheet today). His numbers are improved.

Is there a pre shot blood glucose level where we wouldn’t give him insulin? I didn’t see any guidance on it. His blood glucose this morning upon us waking up is 8.2. This seems low to be giving him a full insulin dose. Any advice would be helpful!

UPDATE: we found some guidance on this. We have updated the spreadsheet and Joey is now at 7.2 so we are delaying his shot to see if he’s starting to come up a bit as we don’t have much background information on his numbers on TR or at this dose.

UPDATE: delayed his shot by 30min - blood glucose was 11.3.
 
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We didn’t know that we need to delay food with the delay for insulin. Will keep that in mind going forward.

We’ve updated his spreadsheet and the signature. He’s at 6.6 currently (about an hour away from his usual dinner time). I assume we delay again?

Should we decrease his insulin dosage?
 
Brittany B said:
We didn’t know that we need to delay food with the delay for insulin. Will keep that in mind going forward.

We’ve updated his spreadsheet and the signature. He’s at 6.6 currently (about an hour away from his usual dinner time). I assume we delay again?

Should we decrease his insulin dosage?
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I can tag a few members for you , @Bron and Sheba (GA) may not be around yet
Also on your spreadsheet can you make a blank line above Dec 10 and write Started TR, members don't always look at the remarks section, it needs to stand out :cat:
@tiffmaxee

@Suzanne & Darcy

@Wendy&Neko
 
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Your ss is not updated. Please update and also post the US numbers. When did you last test and did he eat?
 
It is updated - was solely missing the 5.5, there is a tab for the US numbers. We’re in Canada so use the other numbers.

we’re feeding him now because we delayed an hour from his usual feed and insulin time and he was 5.5.
We’re not sure what to do with his insulin as we’re not used to these pre shot numbers at all.
 
I see he was at 99. Test again. Can you monitor as long as necessary? Do you have enough test strips, high carb food and honey if needed? This is your first green preshot and I can not stay with you. I can check in from time to time. You could give a token dose which will probably just mean staying up for the first half of the cycle.

Test again to see if he is on the way up and let me know.
 
I see you have a libra so scan it and see the bg. I just saw the pmps. This new test would be your new pmps. So if you can test hourly and have supplies you can shoot a full dose but the first time we like to stay with you. I can not.

You can shoot but get a +1 and +2. I am in the middle of a remodel and can't necessarily respond quickly. Update your subject and ss. I will check in when I can.
 
Then give a token dose of 1.25 or 1.5 but you still might have an active cycle. Can you be off schedule? the morning shot can not be sore than a half hour early. You get back on schedule by shooting 15 minutes early each cycle or 20 minutes every 24 hours.
 
We shoot low to stay low. Usually a cat will have a flat cycle when shooting green. I would push you to do it but I can't guide you through each test this time.
Brittany B said:
Ok we fed him 15 min ago and he’s up to 9.7 - do you think we give him his full 2.75 unit dose now?
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Yes. Shoot the full dose if you can stay up as long as necessary. He could bounce from the low.
 
Libre is done as of today so don’t have today’s info but would like the group’s advice on dosing and why Joey doesn’t seem to be coming down as well in recent days. Is it because we messed up on delaying his food and insulin on the two days his preshot number was between 5and 6?

We’re wondering if his dose is too high and his body is over correcting?
 
He’s not on too much insulin. If that were the case you would see bg under 50 and you have not seen anything close. He needs an increase to 3.25.
 
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