Murphy - Lowered Lantus Dosage

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missmurphy2010

missmurphy2010

Member Since 2011
Hello all. We have successfully lowered Murphy's Lantus dosage -- her fructosamine was down to 241, when I believe her critical hospitalization she was almost 500, so major, major improvement.

Upon switching her food over to Wellness grain free wet turkey, we had a bit of a scare though. I had a sick feeling in my stomach about 2 weeks ago that something was awry. I came home and Murphy was really hypo. For her, being hypoglycemic, a number in the low 60s is not good. She looked like she had been out partying for weeks on end. So, we dropped her Lantus to 1.5 units twice per day. Her numbers became irregular and have been for the last couple of weeks. She's finished pussy-footing around eating her old food - Evo cat and kitten, and is now eating the Wellness wet all in one sitting at dindin time! Happy about that. So, she's shooting on the low 200s now. I think it was just a fluke and the fact that we had just switched the food. I really really want her vet to revert back to the 2 units twice per day, in my opinion, otherwise we are looking at uncontrolled diabetic kitty.

Thoughts? Also, we decided to run ultrasounds on her little abdomen. Her pancreas looked terrific, kidneys, gall bladder, bowels! Yippee! Could the straight physlium husk powder I have been using as her fiber be elevating the carbohydrate level in her food?
 
do you have your recent numbers somewhere that we can see? Your spreadsheet stops on 2/13. High numbers can mean either too much insulin or too little insulin, but the spot checks done in mid-cycle can help tell the story.

Sorry you had a hypo scare. :sad: If things are changing quickly for Murphy then you probably need to get serious about testing a LOT.
 
Murphy's SS is now updated if someone can take a look. She's still in the blue, but her number are pretty high -- much higher than they were before, and it concerns me because my meter is higher than the Alpha Trak at the vets, almost 25 points.
 
Spreadsheet says you increased to 2 units this morning, is that right?

Here's the thing: 2 units gave Murphy a symptomatic hypo. That means you cannot give 2 units anymore. Symptomatic hypos are actually pretty rare on Lantus, so I'm thinking that Murphy must have been much lower than you realize before you came home and tested her, and I think she may have been pretty far over dose for that to happen.

Where does that leave us? You can't shoot 2 units. You reduced to 1.5 units, which is fine. Now before deciding whether to hold that dose, or increase, or maybe decrease, you need to get spot checks on a variety of different cycles to find out how low this dose is taking her. High preshots can be the result of too little insulin, but they can also be the result of too much insulin. What if she is going to 40 every night and the AMPS readings are little bounces off of going too low at night? It's possible, and even likely. Please read this post for more information: viewtopic.php?f=9&t=33863

My recommendation is to hold the 1.5 unit dose and do as much testing as you can for the next few days. You need to find out when Murphy nadirs (how many hours after the shot) and how low she is going at nadir. Get both preshots and whatever mid-cycle tests you can get - maybe a +1 or +2 before you leave for work, a +10 when you get home, a +3 or +4 before you go to bed every night, anything you can get. Without spot checks, nobody here will be able to recommend a dose for Murphy. We can only advise based on data.

If it turns out that she does have room for a dose increase, then we typically only increase doses by increments of 0.25 units when nadirs are in blue or green. When their numbers are this good, dose changes are more like fine-tuning than a major adjustment. Increasing by 0.5 units (which is 33% of her current dose) is too large an adjustment and is likely to send her too low again. Details on how we arrive at dosing recommendations are in the same post linked above, and they are also linked in this sticky: viewtopic.php?f=9&t=1581 (incidentally, this sticky is a great resource to give your vet, especially because there is a link to our protocol as published by Dr. Rand in Queensland). If your vet is at all unsure about how to handle Lantus dosing, this should give him/her confidence because it is published by a respected feline diabetes veterinarian.

Be careful - safety ALWAYS comes first. Her numbers are not too high, they are well under renal threshhold, but if you send her too low then that can be deadly in a hurry.

I hope this helps!
 
hi there

I just read Libby's post to you, lots of good info there, to share with your vet.
check it out ok?
best of luck to you both!
 
Can you explain the symptomatic hypo state to me a little more? B/C in my opinion, it was the 2nd day of her diet change, and it could have been a fluke, although I agree, always go with the safest route as possible. She's doing very well on her new diet and is eating regularly and not pussy-footing around like she was before. See, that was part of it too, she didn't want to eat the Evo any longer.

How long do you all keep your Lantus 10 ML vials? I've had mine since December 14, 2010. She's just about 1/2 way through that vial.
 
Murphy is now at 114 2 hours after dindin. She was at 147 at 6:00. What I did start to see at the higher numbers she has shot this past week is that she started to drink more water. Not sure if there is anything in that or if it's just me thinking too much. So, am I being too nervous about her being close to or over 200? I have to watch b/c my meter is about 25 numbers off, closer to her BG on the meter at numbers closest to 200. This is what we tested at her last curve, by using both meters. When she gets low-mid 100s, then I'm reading a number that is actually lower than her BG is -- say 115 - she would actually be around 135-140. Although this is risky business - I have considered purchasing the Alpha Trak. I don't trust the One Touch Ultra.

Thoughts?
 
If you look at the protocol written by Jacqui Rand, DVM, which is the formal version of the protocol that we use here, she has 2 sets of guidelines. One set is for use with a glucometer that is calibrated for humans use (e.g., the One Touch or others) and the 2nd version is for a meter calibrated for feline use. The numbers are different. Typically, the AlphaTrack or a meter used in your vet's office, is calibrated about 30 points higher than the cut offs used based on a human meter. (For example, to earn a dose reduction when using a human meter, a newly diagnosed cat's BG has to fall below 50 and when using an AlphaTrack, numbers have to fall below 80.) Many people here use a One Touch meter. It's generally a reliable meter.

How long people use their Lantus is variable. The manufacturer recommends discarding after 28 days. There are quite a few people here, myself included, who follow this guideline. Others will wait until they see that their cat's numbers are becoming weird. Members of the German Lantus forum indicated that they get 6 months from their Lantus. I don't think anyone here has gotten that kind of duration. I think people will often get 2 mos. from their Lantus. I would be considering starting new Lantus at this point. Also, most of us use the pens rather than the vials.
 
Okay, so now we're at 96. She ate at 6:00 p.m. Also, generally during a 12-hour period, what times would be considered nadir. I may set my alarm for midnight to see how she's doing.
 
First, I haven't a clue what 6:00 is in relation to what time it is now. This is why we use +hours. Everyone is in different time zones and depending on what time it is that someone is peeking into your condo vs. what time you posted, it could be way off. Using time since shot (i.e., +3), is a much better way to communicate about time.

In an ideal world, nadir is at +6. The nadir usually falls somewhere between +4 and +8. However, the nadir is not a fixed point. It can change from cycle to cycle. In the last few days, Gabby's nadir has been at +2, +3, and at +5 and her nadir has been as late as +7.
 
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