Need help getting started (again) with Lantus

[Debra and Jill (the cat)]

Hello, sort of new here! My cat Jill was diagnosed mid-March and we started her on Lantus immediately. I'm hoping to get some thoughts on Jill's BGs and insulin dosing. We have her on Lantus, but just once a day based on her BGs per my vet, who said:
-- any BG below 200 to skip insulin
-- 200-250 to give 1/2 unit
-- over 250 to give 1 unit

She's usually in the low/mid 200s in the mornings and mid 100s at night, so we've been shooting in the am only. Jill's spreadsheet:
https://docs.google.com/spreadsheet...jCQm4U8sRny4nrIcD3oNBg-H5c/edit#gid=361360320

I know once-a-day dosing isn't typical, so I'm looking for some help for how to get a better approach started. I'm not sure where to look here for a step-by-step on how to get started with Lantus - dosing, testing, curves, etc. I would truly appreciate any feedback, thoughts, or direct links to pages where I can find info on how to do this!

Jill's a pretty good patient and we are home all the time and willing to do what we can to help her.

Background: Jill's 10(ish), I switched her immediately on Dx to only canned food (Merrick grain-free salmon, sometimes Tikicat chicken or salmon). She has eosinophilic granuloma in her mouth - years ago the vets thought it was cancer, but she was misdiagnosed. She probably either has asthma or a polyp since her breathing has always been noisy. No other serious medical issues. She takes Welactin Omega 3 every day for itchy skin.

Thank you in advance!!

 

[Chris & China (GA)]

We have her on Lantus, but just once a day based on her BGs per my vet, who said:
-- any BG below 200 to skip insulin
-- 200-250 to give 1/2 unit
-- over 250 to give 1 unit

Your vet doesn't understand how to use Lantus and is using it like the older, harsher insulins. Lantus craves consistency so needs to be given at the same dose both AM and PM.

At first, if you get a PS less than 200 you should stall, don't feed and test again in 20-30 minutes but you've been testing enough that you could drop that "stall point" to 150 though.

If this were my cat, I'd try .5 both AM and PM. If you get a PS less than 150, stall, don't feed and retest in 20-30. If the number goes up, it's usually OK to go ahead and shoot but the first few times you should post here with a clear subject line like "STALLING! NEED HELP!" to get somebody's attention. Once you have somebody helping you, you can go back and edit the subject line and just keep it updated with your latest test numbers.

We have a tradition here. If somebody encourages you to shoot a lower PS than you're used to, they also agree to stay online to watch for updates, even if it means staying up most of the night with you. We won't tell you to shoot and then disappear!

You also need to be getting at least 1 mid-cycle test on the AM cycle (if at all possible) and at least a "before bed" test on the PM cycle. Lantus dosing is based on how low it takes them so it's important to get those tests in. Also, most cats go lower at night so that "before bed" test is important to get so you have an idea if you should set an alarm to get more tests later or can sleep the rest of the night.

As you gain more experience and get more testing data, that "stall point" will continue to go down. Depending on the dosing method you choose, it will go down to where you're shooting the scheduled dose if Jill's PS is above 90 (for Start Low, Go Slow) or above 50 (for Tight Regulation).

Jill's great response to treatment this soon makes me think she's a good candidate to get back into remission too!

 

[Debra and Jill (the cat)]

Thank you so much for responding! Let me know if I got this right: In theory, I should be giving the same dose of insulin the am and the pm. But I'm a little confused about the BGs. If she's less than 150 in am or pm, should I not give insulin at all, even after waiting and retesting? The stalling is to make sure the BGs are going up, right?

Here's the tough part for me regarding stalling, maybe you have some advice. We have 8 cats and a VERY strict eating schedule. These cats know how to tell time! Everyone knows at 9 am they should be getting fed and we can't feed the other cats and not Jill or she will lose her mind. She's already been freaking out about mealtime, which is one of the symptoms we noticed first. My cats are very sensitive so if one cat gets upset, it sets off a chain reaction. We have a lot of behavior issues here with the cats so I want to try to avoid that if possible.

So this means I have to always plan to test 20-30 mins before mealtime in case I need to stall and test again, right?

Maybe I need some help putting together a daily timeline so I know what I should be doing throughout the day?

 

[Chris & China (GA)]

If she's less than 150 in am or pm, should I not give insulin at all, even after waiting and retesting? The stalling is to make sure the BGs are going up, right?

If under 150, you stall, don't feed and test again in 20-30 minutes. If it goes up without the influence of food, it's a pretty good sign that the last shot is wearing off.

These cats know how to tell time!

Of course they do! Cat's stomachs are better than the finish Swiss timepieces! And when we change times in Spring and Fall, it's always fun...NOT

So this means I have to always plan to test 20-30 mins before mealtime in case I need to stall and test again, right?

No, not really. It shouldn't happen all that often to begin with and the cats may just have to wait along with Jill. You could test at +11.5 and then test again at Pre-shot so you know which direction the blood glucose is going, but that's not a guarantee you won't still need to stall when it's actually shot time (but it helps)

 

[Debra and Jill (the cat)]

Here is what I'm thinking for my daily plan. Hopefully this makes sense:

• 9 am: AMPS
• 9:30 am: Insulin 0.5, if 150+ (after eating)
• 10:30 am: Breakfast #2
• 3:30 pm: (+6) Test BG
• 6:30 pm: Dinner
• 9 pm: PMPS
• 9:30 pm: Insulin 0.5, if 150+
• 10 pm: Bedtime snack
• 11 pm: (+1.5) Test BG

Is it OK to shoot before her bedtime snack? She's always hungry so I wouldn't be worried about her not eating.
Is 1.5 hours after her PM shot long enough to do a BG? What should I expect the reading to be, and when should I be concerned/not go to sleep?
If her BG is below 150 and I stall, but it doesn't rise to 150, do I skip a dose?

Thank you!!!!