? Lantus dosing for my post SRT girl - UPDATE

Stacy Alicia

Stacy Alicia

Member Since 2024
Hello - My cat Misty has SRT in August - she has been mostly in the 300-400 range since on 8 to 9 units of Lantus. I have switched to a new internist who put her up to 11 u and she immediately is in the blues today. 140 at +6, 168 at +9, 159 at +10. I have never shot her at less than 300 because she is usually ALWAYS at 400 plus both AMPS and PMPS. I am panicking about what to do in 2 hours when it is time for her shot! Other acro moms have said to shoot as long as she is over 100 - I am feeling a little squeamish about shooting 11u if she is not over 200. Any thoughts/advice?

https://docs.google.com/spreadsheets/d/1Nssv-XXTUKAIGMbYPLhI2kr4CxJU_tMFFXJoTQRiGMk/edit?usp=sharing
 
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Nice to see that run of blues (100's) today. :cool: But she isn't used to it, and there's a chance she might bounce before PMPS. I have seen acro caregivers shoot much higher doses on much lower preshots (including below 100), but you may wish to work up to it. The lowest I ever shot was 51, but after I had more experience. Typically people have the data to shoot lower numbers before doing so. You have shot full dose on a preshot of 260, so that's a big jump to shoot if close to 100. 200 might make more sense.

Can you monitor tonight? Do you have higher carb food/syrup/honey in case she were to go low?

You might want to test again, an hour before PMPS, to see if she's going up yet, and making it easier to shoot lower numbers.

Since you are feeding high carb food (spreadsheet says RC glyco), that means following our SLGS dosing method and being a bit more conservative at first. You have a couple options. One is to delay a bit after PMPS until she goes over 200 and you feel more comfy shooting that number. However, you have to not feed while you delay or the numbers will be influenced by food. If you do the delay, then the shot for AMPS will be delayed by the same amount. If you delay too much, her numbers may go down without food, so this option is a delicate balance.

Option 2 is to shoot a reduced dose. However, the depot of the 11 unit dose so far may influence the first part of the cycle, meaning it could look like you shot the full dose.

Option 3, if over 200, is shooting the full dose.
 
Thank you so much, Wendy. We tried to transition Misty to Tiki and she had terrible yellow diarrhea. Of course, I was NOT smart and started her on Cabergoline at the SAME TIME, so we were not sure what was the culprit. So the vet suggested going back on RC Glyco and stopping Cab until the stomach resolves itself (it has since we stopped the Tiki). Not sure if I will restart Cab. Have a hard time finding a good low carb option for her that has enough fiber w her IBD issues?

Today I fed her in at the AMPS (6 oz) and then at +6 (3 oz) and +9 (3 oz). Food does not seem to influence her numbers very much. She is ravenous so am trying to feed her more often - find that it keeps the DKA away. I will get some higher carb food (I have Nutri cal paste?) and will plan to delay a bit after the PMPS - maybe 30 mins and then feed? And then if over 200 still give full. If under, I will reduce to half? Does that sound like a good plan? She is at 158 with 1.5 hrs to go til PMPS.
 
Delay 30 minutes and test again to see if she's come up. Then decide if you have to feed. The plan sounds good. When you shoot your lowest number yet, do try to get some early tests in to see where she's going. It can give you good data for the next time you see a lower number.

She might have an allergy to fish or poultry if the Tiki bothered her. There are lots of other options such as lamb, rabbit, venison to name a few. What country do you live in? Might help with food suggestions. I have an IBD kitty at home. You can add psyllium husk fiber to add addition fiber if you need to.
 
She eats cooked chicken as a treat without a problem but I think maybe having just pure cooked chicken (I was giving her the chicken w quail egg) was too much for her? I am in the US (Los Angeles). I have heard about adding psyllium husk - had planned on this prior to her diagnosis but then was not sure if I still could use it? Thanks so much for your help, Wendy!
 
Stacy Alicia said:
She eats cooked chicken as a treat without a problem but I think maybe having just pure cooked chicken (I was giving her the chicken w quail egg) was too much for her? I am in the US (Los Angeles). I have heard about adding psyllium husk - had planned on this prior to her diagnosis but then was not sure if I still could use it? Thanks so much for your help, Wendy!
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If your cat doesn’t like psyllium husk added to her food, you can try adding freeze dried pumpkin (Amazon) to the food. My cats don’t particularly like the psyllium husk powder as it seems to change the texture of the food into something I describe as “gummy.” Some cats don’t mind it though so you can start there.
 
So I waited it out last night for 30 mins and shot the 11u at 240. Now it seems like she has had a bounce? She climbed steadily all nigh into the 300s and is now at 400 after her morning 11u and is not budging. Sigh. Is this a sign of too much insulin or just her body adjusting? She is still on the hi carb food as her stomach is healing from her IBD bout. I do think a switch to even an 8 percent will help. But I do not want to start the diarrhea back up again. I guess I will celebrate the one good day and hope for more? Thanks everyone for the advice!!
 
Yes, she is bouncing. Those high numbers can last up to six cycles. 11 units got her down to 128, and may do so again once both the bounce is over, and the depot is full. It can take 6 cycles/three days for the depot to fill. In the mean time - do something for you.

Out of curiosity, where did you get the SRT done? There are so many more places offering it now than back in the day when I got it done for Neko.
 
Wendy&Neko said:
Out of curiosity, where did you get the SRT done? There are so many more places offering it now than back in the day when I got it done for Neko.
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Thank you, Wendy - I am not sure I remember HOW to do something for me!! I need to get on that!! :)
Misty had her SRT done in Studio City, CA at TrueCare by Dr Lauren Quarterman. We know another cat who also had her SRT there as well. Your sweet Neko was one of the pioneers for sure ❤️❤️
 
Wendy&Neko said:
Yes, she is bouncing. Those high numbers can last up to six cycles. 11 units got her down to 128, and may do so again once both the bounce is over, and the depot is full. It can take 6 cycles/three days for the depot to fill. In the mean time - do something for you.

Out of curiosity, where did you get the SRT done? There are so many more places offering it now than back in the day when I got it done for Neko.
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Well, we are entering the end of the 6 cycles and she has continued to post increased numbers. My question is if the internist recommends going UP instead of going down - what is the thought? I feel like maybe going up 1.5 units we could have missed the "sweet spot" - somewhere between 9.5 and 11? She has not had a BM today which is also a red flag as it usually precedes a bout of stomach upset/pancreatitis. She will get blocked up and then we have a big mess on our hands. I am thinking I need to stop the probiotics? Do some people give them every day or is it usually just an occasional thing?

Also, do you think that manipulating food times would work for Misty? I do feed her every few hours but have not been taking into account the nadir. I bought a timed feeder. Could this be helpful?

Thank you so much for sharing all of your wisdom!
 
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Some cat go high before they break the bounce and go low. Today was cycle six after the blues. Curious to see what she does tonight.

Constipation can also cause the numbers to go up, as does pancreatitis. Sometimes our older cats go every two days, so one day without not as worrying. How is her appetite?

With probiotics, it can become an every day thing, depending why you are giving probiotics. Just start with a lower dose and work your way up to the every day dose.

As far as dosing goes, the dosing at 9.0 units was jumbled in with some 9.5 unit doses. Our dosing methods say to hold the same dose, at least six cycles, to build the depot and see what a dose can do.

At 10 units dose, we typically suggest going up by 1.0 units at a time unless just tweaking an already pretty good dose. 9.0 units was not that. I wouldn't worry about the 0.5 unit difference with a 1.5 unit increase. If 11 was too much insulin, you should have seen her dive low by now.

You've also been changing around her food, a lot of which is high carb food compared to the Tiki. That will also impact the numbers.
 
Wendy&Neko said:
Some cat go high before they break the bounce and go low. Today was cycle six after the blues. Curious to see what she does tonight.

Constipation can also cause the numbers to go up, as does pancreatitis. Sometimes our older cats go every two days, so one day without not as worrying. How is her appetite?

With probiotics, it can become an every day thing, depending why you are giving probiotics. Just start with a lower dose and work your way up to the every day dose.

As far as dosing goes, the dosing at 9.0 units was jumbled in with some 9.5 unit doses. Our dosing methods say to hold the same dose, at least six cycles, to build the depot and see what a dose can do.

At 10 units dose, we typically suggest going up by 1.0 units at a time unless just tweaking an already pretty good dose. 9.0 units was not that. I wouldn't worry about the 0.5 unit difference with a 1.5 unit increase. If 11 was too much insulin, you should have seen her dive low by now.

You've also been changing around her food, a lot of which is high carb food compared to the Tiki. That will also impact the numbers.
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Well, after her 6 cycles of being elevated, Misty did indeed go back to blues. She then stayed in yellow and pink yesterday but has been in pink today. An improvement for sure but not holding in the sweet spot yet.
Her internists want her to try the Cabergoline again before changing to a lower carb diet. I want to switch the diet first. I am considering never reintroducing the Cab - it feels like very few SRT kitties have used it (they have never had a cat on it) and I would rather work on getting the diet in check. Any thoughts? Thanks as always!
https://docs.google.com/spreadsheets/d/1Nssv-XXTUKAIGMbYPLhI2kr4CxJU_tMFFXJoTQRiGMk/edit
 
I agree with your ideas. I would switch to lower carb food first, if you can find one that agrees with her. It's too early to jump onto Cabergoline - some SRT kitties take a while (3 months), before starting to see some SRT action. In the mean time, the dose just might have to keep increasing. Though a diet change will also help.

In my time here, I have seen a few people with cats on cabergoline decide to undergo SRT. Cabergoline doesn't work for all cats. I have seen exactly one person with a cat who had SRT decide to add Cabergoline after SRT. It was even more complicated cause he had the surgery first, but it didn't get all the tumour so he had to have SRT on the remaining part of the tumour. Anyway, not sure the Cabergoline did much in that case.

I'm not saying don't every consider Cabergoline, just that I'd wait to see what SRT does first. When SRT starts working, the impacts can be dramatic on amount of insulin needed. When Carbergoline starts working, I've seen even more dramatic changes. Add the two together at the same time and it could be very risky.
 
Wendy&Neko said:
I agree with your ideas. I would switch to lower carb food first, if you can find one that agrees with her. It's too early to jump onto Cabergoline - some SRT kitties take a while (3 months), before starting to see some SRT action. In the mean time, the dose just might have to keep increasing. Though a diet change will also help.

In my time here, I have seen a few people with cats on cabergoline decide to undergo SRT. Cabergoline doesn't work for all cats. I have seen exactly one person with a cat who had SRT decide to add Cabergoline after SRT. It was even more complicated cause he had the surgery first, but it didn't get all the tumour so he had to have SRT on the remaining part of the tumour. Anyway, not sure the Cabergoline did much in that case.

I'm not saying don't every consider Cabergoline, just that I'd wait to see what SRT does first. When SRT starts working, the impacts can be dramatic on amount of insulin needed. When Carbergoline starts working, I've seen even more dramatic changes. Add the two together at the same time and it could be very risky.
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I agree about the risk factor. I am going to try the diet change first. I am thinking of trying the Feline Natural Lamb Feast to try and introduce a novel protein. She was
Back in the 300s today so it feels like a pattern is starting to form. Never had a pattern before so happy for that lol.
 
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