My Diabetic Foster Cat, formerly BooBoo -- what to do?

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stefani&toonces

stefani&toonces

Member Since 2009
Hey all!

I wanted to get some feedback from the other lantus users on what my next move should be with my new diabetic foster cat. For those who don't know me, I've been on the board since 2004 and am pretty experienced with lantus, but I am a little rusty with this particular type of lantus response. My own cat Toonces was on lantus for a year and a half, but he had a history of severe hypo that complicated his regulation and he was very inconsistent in his response. After he passed, I fostered 3 diabetic cats of the next few years, and was able to get each of my 3 fosters either off insulin entirely or needing only occasional insulin by doing tight control. They made it easy -- they were consistent responders and good responders.

"Boo boo" however had been on 4 u BID of Novolin N when he came to me on June 13. I switched him to lantus and within a couple of days realized that he needed to having a starting dose of 1.5 units, which seems like a lot to me with lantus, but his preshots were in the 400s, and he was not getting much below 300 on 1 unit.

Now, what I am used to seeing with my prior fosters is preshots getting lower in the first few days of therapy, leading to a need for a decreased dose, and thereafter more dose reductions needed. At least one of my other lantus fosters thought, didn't get a full 12 hours out of lantus.

My challenge is this:

Since raising his dose to 1.5 units, he has gone as low as the 50s with a preshot in the low 300s. At the same time, he's only getting about 11 hours out of that. And in other cycles where his preshot has been higher than that, he doesn't usually make it below the mid 200s (although once he did).

My next move could be:

1. Stand pat waiting for a more reliable response. Keep the dose at 1.5u and either do or do not reduce the dose with a preshot below 250.

2. Get some R and start a basal bolus routine, giving his PS a downward nudge with R if it is over a certain number (say, 350), and concurrently give him either 1 or 1.5 u of lantus. This is the option that sounds best to me.

3. Try starting TR using lantus alone, by checking where he is at +6 and giving a small booster (.25u) if his numbers are above a certain line (say 250) at midcycle. This has the downside of putting me in a round the clock cycle but it's kind of how I got the others
off the juice, except the difference is they were more consistent. This would be hard to maintain during the workweek as I would definitely need to run home on lunch if not more often.

4. Try levimir instead. This would be premature at this point I think.

Thoughts?

Also the entire question may be premature, since I don't have a nice full curve to share with you, but I do have lots of spot checks. See below.



6-23

PM
PS 447 1.5u
+3 339

AM
PS 477 1.5u
+3 298

6-22

PS 428 1.5u
+4.5 255


AM

PS 184 (reduced dose of 1u)
+ 2.5 90
+4 59
+8 86

6-21

PM
PS 219 (reduced dose of 1u)
+3 205
+6 128

AM

PS 407 1.5u

6-20

PM

PS 443 1.5u
+3 139

AM

PS 388 1.5u
+ 4.5 254

6-19

PM

PS 320 1.5u
+3 117
+6 52

AM

PS 361 1.5u
+4 298

6-18

PM

PS 338 1.5u

AM 405 1.5u
+4 321
 
Hi Stefani!

BooBoo is actually doing very well. It's great at this point to see nadirs in the 50's. The high preshots aren't uncommon, most Lantus cats bounce around for a while once they start getting good numbers. Some get through that phase quickly, others keep bouncing for a long time. Some keep bouncing until right before they go OTJ. Today I think BooBoo is bouncing from yesterday's nice numbers. Those bounces can last up to 72 hours, though it looks like BooBoo is typically clearing his faster than that.

In this group, we typically dose by nadir, with little consideration to the preshots. What I'm saying is that I would hold the dose at 1.5, ignore the preshots (keep getting them, of course, but don't worry if they're high), and keep testing mid-cycle when you can. Here, cats earn dose reductions by going below 50 at any part of the cycle. I'm thinking that BooBoo will probably be asking for a dose reduction in the next couple of days. When you catch that dose reduction earning number, reduce by 0.25 and see if he can maintain the good numbers on that dose.

I personally don't think R is a good option for most cats, unless they are high dose cats. As you have seen, he can get from 300's to 50's without any R, and I think he went below 100 on 6/20 even starting in the 400's. In my opinion, adding R on top of that could be risky.

*If* you decide to go the booster route, which I don't think is necessary at this point, you don't want to do a booster of Lantus (I'm not clear from your question if that's what you are thinking). Doing an additional shot of Lantus could lead to weird/unpredictable overlap issues.

I really think BooBoo is on a good path the way he is, and that he'll be starting on the dose reduction path soon, hopefully. I hope this helps...
 
I am not very good at reading numbers but I think you should stick with the 1u. do not respond to those pre shots so much. as you know. lantus likes consistency, not only in dosing but dosage. he could have been bouncy cause of the lower numbers and he needs liver training school. but wait for someone who is good with reading into these things
 
My thoughts are listen to Libby :-D

Get a spreadsheet up and get some more mid-cycle checks if possible. The knowledge is in the numbers.
 
Stefani!

So nice to see you in LL!
Looking forward to seeing pics of BooBoo and a spiffy spreadsheet to match hee hee :razz:

have a good day and hope to see posting often!
 
Thank you for your replies. Yes, sorry no spreadsheet or full curves yet. I will do both this weekend.

I think for now I am going to stick with 1.5u and try to muster the intestinal fortitude to give this dose at lower preshots until I see a <50. However, I am not going to shoot below 200 for now. I have hyponoia. I'm not afraid of low numbers in a consistent cat, but until I see the clear pattern I am still scared.

Libby, re: lantus. Your counseling is wise re: lantus boosters. Here is a little confession or interesting tidbit, depending on how you look at it! -- I realize its "not done" but believe it or not I have used lantus boosters successfully in the past -- only with consistent cats, though. It has worked to help me get the fosters into remission but it's not a protocol I'm shopping around. However, I'm not sure I could do this with him because I'm not confident of his patterns yet. It worked with others but they were consistent, i.e, I knew if they were 300+ at +6, they were not going to have a late drop, so it was safe to nudge them with a tiny dose and then use that overlap for the next round. So far he's not showing me that. I had it easy with his predecessors.

Like I said, I know it's "not done" and of course you are right that lantus likes a consistent dose. I like a consistent dose too -- makes my life MUCHO easier!

So I think that based on the advice I've gotten and my observations of his responses to 1u I am going to stick with 1.5u and try to stand pat until I see a sub 50 number. I am concerned about his duration if/when he needs the dose reduction, but we will cross that bridge when we get there.

Thank you!
 
what have you decided to name him? If you told, I haven't seen it and am anxiously waiting!!!!

and I agree - listen to Libby - she knoweth what she speaks!
 
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