Need Advice. Increase, Decrease or Hold Dose?

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Tara and Scully

Tara and Scully

Member Since 2014
Scully is beginning her second week on Lantus. The first two days we were too uncomfortable maintaining her 1 unit dose in the PM due to her low PM preshot numbers. We reduced her dose to .5 units BID and have maintained that so far, but her numbers are all over the place. I know that during the week last week I hardly have any mid-cycle numbers, but we have been testing a lot the last few days. Her numbers are mostly high, but Sunday night she went as low as 64 before coming back up. Her AMPS and PMPS numbers were good on 5/22/14, but unfortunately I was unable to see how low she got during that cycle. I have read the dosing protocol several times, but am unsure whether to increase, decrease or hold her dose because one day her nadir is in the mid-200s, then another cycle she's in the green. Tonight her PMPS number was decent at 228, but at +2 her BG jumped up to 351! Could someone please recommend if we should change her dosage? I'm inclined to raise it .25, but I would appreciate some feedback from someone more knowledgeable than me.

One other thing... The last 3 weeks (at least), Scully has begun overgrooming and tearing tufts of fur out, leaving bald spots on her front and back legs. I believe the technical term is psychogenic alopecia, and it is a result of stress. I have read that cats will produce higher BG numbers at the vet's office due to stress, so perhaps her higher numbers recently may also be stress-related.

Thanks in advance for your advice!!

Tara & Scully
 
Hi Tara!

Welcome to Lantus Land! It takes a while to figure out what to do with the dosing - you aren't alone. we've all been through that.

I would hold your dose for now. I'm looking at the green numbers Scully had the night of 5/25. Very pretty! I suspect the numbers you've had since then are from bouncing. I've linked a post at the bottom here that describes what that is. It's really common. You might see high numbers even as long as tomorrow night (6 cycles after the green cycle on the 25th.) It could clear earlier, but my point is to not be alarmed if it lasts another full day, just in case it does.

The part of the protocol that I'm looking at in saying to hold the dose is highlighted in the quote below.

Tight Regulation Protocol
Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Click to expand...

Here's a post about 2 circumstances where you have higher numbers that don't mean that more insulin is needed: New Dose Wonkiness & Bouncing

Nice to see you and Scully - keep asking questions and we'll try to help!
 
Thank you! I also suspected that she has been bouncing, particularly after her nice numbers on 5/22/14 and then again after the evening of 5/25/14. What do I do if she continues to bounce after every green cycle? Will her body eventually adjust?
 
Hi Tara, welcome to you and Scully to Lantus Land. Scully will reduce the amount of bouncing she does as she gets used to spending more time in green. It's probably been a while so her liver is not used to those lovely numbers. Unfortunately there is no way to predict how long it will take to stop bouncing. It's something cats do at their own pace and very common for newly diagnosed cats.
 
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