Need help with correct Insulin Lantus dosage

[Anastasia]

http://www.felinediabetes.com/FDMB/threads/moving-post-to-here-for-anatasia.159062/#post-1696830

 

[Sienne and Gabby (GA)]

I don't see anything in the labs that's indicative of an infection of any kind or any abnormal kidney values. The SDMA is a recent addition to lab panels and is predictive of kidney disease -- it's in normal range. BUN and creatinine are also within normal limits -- this wouldn't be the case if a cat has kidney disease. If there's a kidney infection, chances you would be seeing Daisy making frequent trips to the litter box, she may have blood in her urine, pain, fever, and Daisy just not being herself. However, some cats exhibit no symptoms which is why this is hard to diagnose. I'm curious as to what your vet based the kidney/UTI diagnosis on. The urine samples didn't grow any bacteria.

I would consider increasing Daisy's dose to 3.25u.

 

[Tuxedo Mom]

I don't see anything in the labs that's indicative of an infection of any kind or any abnormal kidney values. The SDMA is a recent addition to lab panels and is predictive of kidney disease -- it's in normal range. BUN and creatinine are also within normal limits -- this wouldn't be the case if a cat has kidney disease. If there's a kidney infection, chances you would be seeing Daisy making frequent trips to the litter box, she may have blood in her urine, pain, fever, and Daisy just not being herself. However, some cats exhibit no symptoms which is why this is hard to diagnose. I'm curious as to what your vet based the kidney/UTI diagnosis on. The urine samples didn't grow any bacteria.

I would consider increasing Daisy's dose to 3.25u.

Sienne

With the fact that Daisy was started at 2 units only 1 week ago and raised to 3 units less than 3 days later, I questioned whether the dose might be too high. The glucose reading at the vet on May 17 was 354 and there was no sign of ketones. The starting dose seems high and there was no time to settle into the dose before a 1 unit increase was done

 

[Jill & Alex (GA)]

Copy of my response on Health:

Advice to Suggestion Givers: Know the principles; know the exceptions. "Every cat is different" is not just a slogan. There are general guidelines that work for most cats, and then there are the cats that didn't read the manual. You need to know about both in order to help with the complicated cases.

I would still like to get more feedback on this from the Lantus forum;

Fedback has already been given in the Lantus/Levemir forum:
Lantus Insulin/ Need help regulating /choosing correct dosage for a cat who just started insulin

If Daisy hadn't been throwing ketones, lowering the dose might be the way to go. However, a kitty who has been throwing ketones within the past week make this a complicated situation... an "exception" to the rule. @Marje and Gracie and I recognized that the other day and gave the reasoning behind our suggestion to increase the dose to 3.25 units bid in the link above (posts #10 thru 19).

Over and over again we see recommendations to lower the dose when it *appears* to be too high in ketone prone kitties (having recently thrown ketones). It rarely, if ever, works. All that usually happens is the advice to significantly lower the dose ends up setting the caregiver back weeks, if not months, AND kitty almost always begins to throw ketones once again.

ok what should I do now? reduce her dose? Or just start with 0.5?

Anastasia: Since you've already given 3 consecutive cycles at 3u bid, you could continue that same 3u dose for a total of 6 consecutive cycles (unless the numbers tell you otherwise), but I would test for ketones at least once a day AND I would try to get another BG test or two in the PM cycle as Marje mentioned the other day.

If Daisy begins to throw ketones again, I would immediately take the dose up to 3.25u bid and post for help. Like I mentioned the other day, if I were you I would have already increased the dose to 3.25 units bid when you originally asked.

The advice given is what I would do if Daisy were my cat, but all decisions are yours to make. Daisy is yours and you hold the syringe. Gather opinions and do what makes the most sense to you.

Going forward, you'll find those with the most Lantus/Levemir experience in this group:
Lantus (Glargine) / Levemir (Detemir). Many will post there everyday until they get the hang of things.

 

[Sienne and Gabby (GA)]

@Tuxedo Mom
Mary Ann - see Jill's note above. I would not rely on information from May 27 when it comes to BG numbers. Those numbers can change. With nadirs being over 300 coupled with a history of ketones, I would not be thinking about anything except increasing the dose. The starting dose of 2u was not too terribly off the mark especially if there was a concern about ketones.

 

[Tuxedo Mom]

@Tuxedo Mom
Mary Ann - see Jill's note above. I would not rely on information from May 27 when it comes to BG numbers. Those numbers can change. With nadirs being over 300 coupled with a history of ketones, I would not be thinking about anything except increasing the dose. The starting dose of 2u was not too terribly off the mark especially if there was a concern about ketones.

Thanks Sienne. I had not seen the discussion that Jill and you had yesterday discussing all this.

 

[Anastasia]

Yes Daisy had keystones at 5 trace when i took her to veterinarian last Wednesday so she was put on 2 units asap by vet, she was not eating and I had to syringe feed her. But two days later she recovered, No more keytones and eating like crazy.

 

[Anastasia]

Hello everyone, Daisy has been on 3 units for couple days now and her BG numbers are still high (please see her spread sheet). How long does it usually take to regulate a cat? Thank you