Lantus Dosing Question

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Scott Walker

Member Since 2017
Hi All,

I have a dosing question. We are now ~7-8 weeks into diagnosis (9/25), and finally making progress this week after withdrawing Purina DM dry and utilizing only wet food (which Mittens likes, so this wasn't a huge deal). And the wet is now varied selections from a low-carb menu that Veronica & Babu-Chiri were kind enough to provide a link to.

I have a longer anecdotal history of Mittens first 6-7weeks of diagnosis here. Unfortunately, we only began using the spreadsheet this week after we upped her dosage to 3u 2x/d. Between the food and higher dosage, she's clearly making progress (97 at AMPS+6 today was the first healthy BG reading I've had with her since diagnosis).

After an earlier post, I'm editing here after I found the dosing guidelines at the top of the board. I see the guidelines on PS readings and what to do given a range of possible scores. I think i will follow the advice given (sub 200, cut back on dose level), but given her relatively fast progress over the last few days (i.e. first time she's been in healthy range), any extra considerations to keep in mind? Thanks all.
 
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First a couple of questions. What dose was she on before going to 3.0 units? ie. what was the size of increase? And what data was used to decide on an increase? via home testing/vet testing? Any data you have saved from before hand could be entered into the spreadsheet. It'll really help us help you. I would also include info in the Remarks column if you change food. A change from dry to wet can make a dramatic difference in the amount of insulin needed. If Mittens only ate dry and switched to wet, then you will need less insulin, not more. You may need to step up your monitoring. And yet another question, what type of meter are you using?
 
Hi - the link in the above thread, as well as here, gives a history of our pre-spreadsheet days (first 6-7 weeks). Basically, we started at 1u 2x/d without getting levels below 300 during weekly vet visits, then went to 2u 2x/d, during which Mittens became sick and had one 56 reading that the vet thought was too low (along with Mittens being depressed/lethargic), so we had a stop/restart thing and worked on stabilizing her appetite. She bounced back quickly, so we started at 1u and made our way to 2u. After a period of appetite stability and dosing stability at 2 units, she still wasn't getting sub 300 during the doctor visits or during home testing (which we weren't recording at the time, but doing PS). Generally, she was consistently >400 PS and would trough between 300 and 400 when we were home to do PS+6. Using this information, the vet advised going to 3u 2x/d, which was about the same time I started recording data in the spreadsheet. I'm using a Lantus pen, so haven't had the functionality for partial doses which I have since learned about. I'll try to switch to syringe method after my vet visit tomorrow.

Commensurate with the increase to 3u (which also corresponded with increased frustration on my part over our lack of success to date), I delved into the boards here and decided to ditch the vet's rec to keep dry Purina DM kibble available to Mittens (in combination with varied wet). This happened this past weekend - Mittens has been on all-wet since. I'm using Soulistic and FF varieties with >50% protein (occasionally some like FF Classic Salmon Savory with high fat), but now all are <10% carb. So my concern on tonight's shot is that I've made 2 changes at once this past weekend (#1 change elimination of dry + #2 change increase from 2u to 3u). She's had some pretty dramatic improvements over the last few days, and I was super-pleased to see 97 at AMPS+6 today. I see the dosing guidelines on the Lantus page, but presume these are for cats that haven't had 2 changes simultaneously. My concern was just on whether a high reading followed by 3u might be aggressive given her general trendline this week.

The glucometer is a human glucometer - CVS store brand.
 
Hi, I comment only here because I see you are confused and not too many members around to help. :)
If Mittens had been mine I'd switch to syringe method, go back to 2.5u and see what's going on - and taking from there in increments of 0.25u.
2 changes simultaneously may have drastic effects on BG and better be safe than sorry - if the reduction doesn't pay off you can be back to 3u in few weeks.
Hopefully more experienced members will have the time to comment before PMPS.
Cheers.
 
Most glucometers have at least a two week memory, so you can go back and recall previous readings which could be entered into the spreadsheet. Any additional data can help complete the spreadsheet picture. We are a rather data focussed group here.

Time will if 3 units is too much insulin. It was a big jump in dose. Keep trying to get preshot tests and one other each cycle to help fill in the details on what is happening. Good job today spotting that green. And I also strongly encourage you to switch to syringes for dosing. Most cats are sensitive to 0.25 unit changes. Sometimes my Neko responded to even smaller changes.

The reason for caution is removing dry food. High carb and dry food can make a major difference in how much insulin is needed. I have seen a cat go from 5.5 units to zero units in a very intense day and a half after dry food was removed from the house. I sat up with the caregiver, so I know how much hard work it was. Most cats don't respond that much, but most see a need for less insulin, not more.
 
Great tip on the glucometer memory! Thank you! I didn't realize they were that sophisticated. I uploaded the history to the spreadsheet.

Overall, we are seeing better #s with the increase to 3u and change to wet. I'm at least encouraged we have a pathway to getting this under control.
 
Hi Scott and welcome to the best place you never wanted to be! Good job in testing and filling in the SS with past data. I too would add to be cautious with the jump up to 3 units. Usually we increase in increments of .25 unit. And with changing Mittens to low carb wet food along with a one unit increase, he could really start dropping into lower numbers so, be vigilant. He is all ready started to hit the green numbers which is wonderful.


Keep asking questions as that is how we all learned.
 
Thanks again to everyone. Mittens was in the high 60s/low 70s today at AMPS+3-5, so the vet agreed with everyone's recommendations above to pull back from 3u. We're going to try 2u, but of course if she tests low @ PS, we'll adjust down or skip altogether using the recommendations under the SLGS thread. She's also back to 11.4lb from her trough 10.2lb at diagnosis, so this is also a good sign. She had been ~13lb for many years, but the vet thinks something in the 11-12lb range is more appropriate for her age (~15ish) and activity level (not very).
 
60's and 70's are still safe numbers, but do earn a reduction to 2.75 units if following SLGS. Did you discuss using syringes with the vet today? One more thing, could you put SLGS in your signature, so we know what dosing method you are following, at a glance.

Great news on the weight gain! Well done.
 
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