With Lantus we often don't see hypo symptoms until the cat is severely low - which is one more reason why we're so pro-home-testing here.
It looks like you're just on day 6 of Lantus - is that right? You might want to insert a row in the ss showing "Starting Lantus" or something like that so it's obvious.
One of the biggest things that people have to get used to in switching from one of the other insulins to Lantus or Levemir is that you're now using an entirely different insulin and the dosing decisions are made differently. Take a look here at the sticky on the
Tight Regulation Protocol.
"General" Guidelines:
- Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
- Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
- Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.
The reason the the initial starting dose is held for a week, which is what we'd have suggested for you, especially given that he was seeing blood sugar tests under 100 on the 1.5u that you started with, is that it takes that long to build up the Lantus depot in the body. It then slow-releases back into the body. Think of it as being somewhat like timed released drugs. Here's the link to info about the
Lantus Depot and how it works.
After you inject it into your subcutaneous tissue, the acidic solution is neutralized by your body to a neutral pH. Because glargine is not soluble at a neutral pH, it precipitates out into a form that's not soluble in subcutaneous fat, and there forms a relatively insoluble depot. From that pool, or depot, of precipitated glargine in the tissues, small amounts slowly move back into solution over time and then to the bloodstream.
Because you are still within the first week of using Lantus, I'd actually suggest you drop back to the 1.5u. Getting into the 30's when you are just starting out suggests the dose is definitely too large, and I'd be concerned that reducing only by 0.25u isn't enough. I'd go back to 1.5u and hold that dose for a few more days unless he goes below 50 again. Because he was getting under 100 on 1.5u right from the beginning, I think that's another indicator that 1.5u would be a better dose than 1.75u.
In the General Guidelines above, the other important switch in thinking for people who have become experienced at using other insulins is that with the long-lasting insulins (Lantus and Levemir) the dosing decisions are made by how LOW the dose takes the cat. You don't adjust the dose based upon the preshot tests. That's a hard transition for many people to make, but it's really important to wrap your head around. We look at the previous 3-5 days worth of cycles and look at how low that dose has caused the blood sugar to go, then decide if the dose should be held a little longer or increased.
The other important thing to learn about Lantus is that when you change the dose, the insulin depot will change as well. The depot change lags behind the dose change. For example, tonight's 2.0u shot will affect as many as 6 more cycles - more at the beginning than 6 cycles later, but let's say you reduce to 1.5u in the morning. The depot from the 2u that you've been shooting will continue to release at a higher level and will continue to "help" with blood sugar control for the next several cycles. So you may see lower numbers in the next day or two from it. Or he may also bounce from getting into the 30's. That was pretty low and most cats will bounce from that. Or if he's been seeing numbers in the 30's recently he may not bounce. We'll know tomorrow.
If you're following Tight Reg you don't need to do a curve tomorrow. Since you're low on strips, I'd get a preshot and a +2 and decide from there when to test next.
We encourage new people to post before increasing the dose until you've learned what to look for and how to see if he needs more or not. Just post and put something like "dose advice?" in your subject line. This board is busy, but not everyone feels comfortable helping with dosing decisions, so it helps if you give a few hours of notice before you need to shoot. Like maybe post in the morning for help deciding on what to shoot that evening.
There's lots to learn but just keep posting and keep asking questions. We'll try to help you learn how Lantus works and how to help Mr. Sluggo.
And welcome to the group! It's the best place you never wanted to be.
