Lantus dosing- different dose am and pm?

[Kirsten ACG]

My cat was in for an exam, labs, check up and the vet said her fructosamine, 285, indicates that she is having periods of prolonged hypoglycemia. My cat has GI lymphoma and takes dexamethasone in the am and pm- she takes a bit more in the morning than in the evening. Vet suggested that I continue with 3 units in the am and drop her to 2.5 units in the evening because I give her a lower dose of steroid in the evening, thus possibly keeping her BG numbers lower over night since the steroids drive them up. She also suggested I leave food out for her over night in case she drops low. I usually leave out food for her during the day (but remove at least 2 hours before PMPS) but not overnight. Does this plan sound good, as I have learned here that dosing should be consistent with Lantus. If not, what do you suggest? Thank you!

 

[Katherine&Ruby]

Hi Kirsten,

My Ruby is on pred for SCL, and I give her 5 mgs of pred each day, with the dose split to 2.5 mgs evenly between AM and PM. I still find that she drops lower at night. See our spreadsheet for an idea. I have thought about different dosing, but it's a lot to remember and coordinate because I work a lot and my partner does dosing at night sometimes when I am out late. Still, her lows at night have been manageable. I found the right dose of insulin that keeps her from dropping too low. I also test her a lot and can see if her numbers are dropping quickly and intercede with a medium or high carb food to prevent too much bouncing into high numbers.

I suspect from looking at your spreadsheet that you might not have found the right dose yet to combat the effects of the dexamethasone, but hard to know because you're not testing much at night. I don't see low numbers to say whether or not the dose is causing hypoglycemia. Any chance you can get at least two or three tests in the AM and PM? Then we can help you better to figure out what's going on.

 

[Kirsten ACG]

Hi Kirsten,

My Ruby is on pred for SCL, and I give her 5 mgs of pred each day, with the dose split to 2.5 mgs evenly between AM and PM. I still find that she drops lower at night. See our spreadsheet for an idea. I have thought about different dosing, but it's a lot to remember and coordinate because I work a lot and my partner does dosing at night sometimes when I am out late. Still, her lows at night have been manageable. I found the right dose of insulin that keeps her from dropping too low. I also test her a lot and can see if her numbers are dropping quickly and intercede with a medium or high carb food to prevent too much bouncing into high numbers.

I suspect from looking at your spreadsheet that you might not have found the right dose yet to combat the effects of the dexamethasone, but hard to know because you're not testing much at night. I don't see low numbers to say whether or not the dose is causing hypoglycemia. Any chance you can get at least two or three tests in the AM and PM? Then we can help you better to figure out what's going on.

Thank you so much for the response. It’s perplexing to me how her numbers could drop so much at night given how they aren’t very close to normal ranges during the day. Her steroid dose isn’t that much different in the am vs pm. I wonder if it’s that she doesn’t have access to food all night but she does during the day? What interval or overnight testing would be most helpful do you think?

 

[Katherine&Ruby]

I would try to test at least once or twice at night to see where the numbers go. You've been following SLGS well, holding doses when nadirs drop below 150. But if the fructosamine test is 285, Bea might be getting into some low numbers you're not catching.

Lantus acts in waves. It's not an in and out insulin. There's overlap and carryover, and its effects can last anywhere from 12-18 hours. Because it's a depot insulin, giving different doses will muddy the picture and make it harder to figure out how low it's taking the kitty.

 

[Wendy&Neko]

It is very common for cats to go lower at night. My girl once went three months dropping low at night and bouncing during the day. If I had dosed her based on day time numbers, I would have increased her dose. Instead, she needed dose reductions. This was without any steroids in the mix at the time. Adding steroids does make it even more complicated, but kitties seem to react differently to them. Any reason you are splitting the dose into two doses a day instead of just one? Again, it differs by cat, but I have seen people give steroids in the cycle they can't test much cause they know the steroid will bring them up that cycle.

Why does you kitty not have access to food all night? Can you put it in an autofeeder so she gets some regular feeds? Start with a test 2-3 hours after PMPS. If it's quite a bit lower, test again a couple hours later.

 

[Kirsten ACG]

It is very common for cats to go lower at night. My girl once went three months dropping low at night and bouncing during the day. If I had dosed her based on day time numbers, I would have increased her dose. Instead, she needed dose reductions. This was without any steroids in the mix at the time. Adding steroids does make it even more complicated, but kitties seem to react differently to them. Any reason you are splitting the dose into two doses a day instead of just one? Again, it differs by cat, but I have seen people give steroids in the cycle they can't test much cause they know the steroid will bring them up that cycle.

Why does you kitty not have access to food all night? Can you put it in an autofeeder so she gets some regular feeds? Start with a test 2-3 hours after PMPS. If it's quite a bit lower, test again a couple hours later.

We’ve experimented with the steroid dose and times of administration and she seems to do best taking it twice per day. I’ve never left food out a night so as not to interfere with the AMPS test and have just given her a snack before bedtime. I could get a timed feeder. Thanks for the response!