Looking for advice with Martin's dose

[jakes]

Hey everyone,

It's been about 3 weeks since we switched Martin off of PZI and onto Lantus. Overall his BGs have been better on Lantus, but we're still seeing some pretty big swings and aren't sure what to do. Our vet thinks he might be bouncing and suggested we try giving him 0.5u only once a day to see how that works, but everything I've read here has said that Lantus should always be given twice a day and as consistently as possible.

Would anyone mind looking at this chart and giving us feedback? He started Lantus on 5/18 and we've just seen some really weird cycles. For example, 6/1 PM looked really good, but then 6/2 AM it almost seemed like the Lantus didn't do anything. Other cycles are also strange and aren't making a lot of sense to us.

Our vet also thinks that Martin may have some underlying condition causing some insulin resistance, but we don't really have the money to pursue all the tests that would be necessary for figuring that out.

Thanks! :smile:

 

[Libby and Lucy]

welcome to Lantus!

I wouldn't go down the road of insulin resistance yet, not by a long shot. Martin is actually doing very well. With Lantus, you have to get used to looking at action in "waves" of a few days at a time, rather than just one cycle at a time. Looking at Martin's spreadsheet, he is a bit bouncy but that is nothing to be worried about at this point. He hits a good number, bounces for a couple of cycles, then goes back to the good numbers again. Most cats bounce quite a bit at first, but usually they settle down on their own. Click on the spreadsheets of Lantus users who have been here a while, and you'll see that you are not alone. :smile:

Martin appears to be a low-dose cat, and is probably sensitive to very small changes in dose. What we need to do is to figure out how low he is going in the middle of the cycle so we can see if he needs a dose change or not. On 6/1 he hit the 60s and bounced straight up to 494, but came back down quickly to land in the 90s. On 6/4 he was either bouncing from the 90s the day before, or maybe he went low on the morning of 6/4 and bounced from that. Then he probably went green on either the night of 6/5 or morning of 6/6 and bounced (this was a high bounce, so was his nadir lower than the 60s that sent him to 494 on the 2nd? Maybe). Again, the bounce cleared very quickly and left him in green last night. The skipped shot and green number caused him to end up in the 600s today. It looks like he cleared that quickly too.

Based on his patterns, I would like to see you get some spot checks tonight and tomorrow, at whatever times you can. He is probably heading to green again and I would like to see how low he is going and at what point in the cycle he goes there. It is possible that 0.4u is too much, but the tests will tell us.

FYI, on this forum we tend to not worry much about the bounces. Dose so the nadirs are where you want them, and usually the other numbers will eventually come down and everything will flatten out. If he doesn't flatten out, we have strategies for that, but I always prefer to start with what is simple and works for most cats, then go from there.

 

[Sienne and Gabby (GA)]

The test for insulin resistance (insulin auto-antibodies) isn't that expensive. The shipping is a bit pricey but not prohibitive. However, we don't generally suggest testing until your cat is on a much larger dose (usually over 6.0u). There's an awful lot that can happen between your current dose and 6.0u.

With Lantus, the dose isn't reduced unless BG falls below 50 in a cat that's within the first year of diagnosis. In other words, I'm not sure why you reduced Martin's dose. I also agree with you in that I wouldn't try once a day dosing. On 6/7 when you skipped the PM shot, Martin's AMPS was very high which suggests that if you go to shooting only once a day, the swings in numbers will be substantially worse.

If this were my cat, I'd be thinking about bringing the dose back up to 0.5u (which will be easier for you to consistently measure). However, with Lantus, you do need to get at least one test during both the AM and PM cycles. It's particularly important to get spot checks during the PM cycle since many cats run lower at night and, if you can't test during the day due to work, it makes it even more important to get tests in the evening. I would wait until you can get some additional tests and then consider raising the dose.

 

[jakes]

Thanks - we'll move back to 0.5u twice a day and stay steady at that to see how he does. How should we handle low pre-shot numbers though? We've seen pre-shot BGs as low as 67, and we're scared of him going hypo if we shoot when he's that low. It's made worse by the fact that our schedules are hectic and we often have to leave him alone in the house for 8-10 hours at a time. I've seen some places like Tilly's site suggest that it's okay to shoot Lantus when pre-shot BGs are as low as 50, but the last thing we want is to send him into a hypo episode.

 

[Sienne and Gabby (GA)]

I would wait before changing the dose until you get some additional data -- especially data from the PM cycle.

As for shooting low, in the beginning, we don't suggest shooting under 150 unless you can post and we can lend a hand. You've shot as low as 99, so I would suggest using that as your guide. Most of us work our way down to shooting numbers in the 50s and above. Issues of where your comfort level is, whether you can monitor, etc. all need to be factored in to a decision of whether to shoot a low number. If you're unsure what to do, there are usually people here pretty much 24/7 who can lend a hand.

This is a post that Libby wrote on dealing with low pre-shot numbers. You may find it useful.