Need some dosage advice

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Bandubh

Member Since 2010
Hi. My cat - Baby - is getting Lantus insulin and I monitor her blood am and pm. Her BG is quite low in the AM usually 3-6 (64 - 108) and my vet has told me not to inject her if she is under 10 (180). I am not real comfortable with that - I live in a rural area and the vet here is mostly used to large animals and he does not have too much experience with diabetic cats. The PMBG is usually high 16-19 ( 288 - 343 ). I am giving her 3.5 i.u of Lantus in the evening and it seems to work fine according to AMBG. But with such a low BG how much should I be giving her. I gave her 1.5 yesterday in the AM and in the evening her BG was 17 (306) so that is obviously not a high enough dose. I would greatly appreciate any advice on dosing. Thank you
Dan
 
I am by no means an expert. Someone with more experience will be around to offer dose advice.
There usually isn't too many people online at this hour, but they do come on early in the morning.
I do know that Lantus likes consistency. Same dose AM & PM 12 hours apart.
Also, the more spot checks you can get between shots the better.
You could set up a spreadsheet to keep track of the BG's and dose amount. It also helps anyone who is going to help you.
This is the link for the spreadsheet:
http://felinediabetes.com/FDMB/viewtopi ... 07&start=0
There is one for the US and one for Canada (world)
If you use the world one it automatically calculates the BG to the US number for you.
Looking at your numbers I'm guessing you are somewhere in Canada.
I would also suggest reading the stickies at the top of the Lantus page. You will find lots of good information there.
The people on this board are very helpful and wonderful.
 
Thanks Noreen. I do not live in north America but in Europe. Unfortunately my work schedule does not allow me to test as often as the spreadsheet suggests. Can only do it morning and evening. I just would like to know if I should inject her with a lower dose when she has a low BG. I have decided to BG test 6 hours after her AMBG and see if she needs a shot then. I am also not sure why it is necessary to monitor the BG so often as the spreadsheet suggests. If the cat is only receiving twice daily shots what is the point of testing 6 or 7 times throughout the day. My cat is obviously discomfitted and when I take blood and she appears to be in pain when it pricks her - therefore I am leaning towards less BG monitoring. Therre may be something about the frequent tests that I do not understand and am open to a convincing explanation.
 
I am definitely not an expert since my cat was just diagnosed a few months ago, but the advice I have been given here has been so beneficial. I'm sure someone will come on and answer your questions, but I do know that you should use Lantus consistently 2x/day, 12 hours apart for it to really work well. The units shouldn't change around based on the bg. The 3.5 units may be too much to be giving your cat. My vet started Simon on 4 units and if I did not check his bg, he would have hypo'd. Once I moved him down to 1 unit, his numbers were very high for a short period of time (something about the shed -- others can explain this better), but then he settled down and his numbers have been very consistent until recently when I had to put him on steroid drops (which raises bg). The reason you need to test more than AM and PM, is that your cat's lowest bg can occur sometime between the AM and PM. For instance, often Simon's lowest number is at +5 or +6. I also work full time and it has been hard to monitor during the day. If you are off on the weekends or on your days off, do a curve throughout the day checking numerous times. This will give you an idea if your kitty drops dramatically at a certain point. The more data the better. I know others will chime in and give you a more knowledgeable answer, but I just wanted to say hi -- I know this is all so confusing, but it will get better.
 
Welcome to Lantus Land, Dan.

Let me see if I can convince you! First, you don't need to test every hour or even every couple of hours. Many of the people here work or are in school and not available to test as often as you may think. We do try to arrange our shot times to maximize testing, though. Most of us will get a test at shot times, before we leave for the day, when we walk in the door, and as often as is feasible during the cycles where we're home and over the weekends or holidays. The importance of these spot checks is due to Lantus dosing being based on the nadir, or lowest point, of the 12-hour insulin cycle. The nadir is usually somewhere near the middle of the cycle. Since the pre-shot tests are often the highest points of the cycle, if you try to base your dose on these numbers, you could easily overdose your cat.

Lantus also likes consistency. It is what's technically called a "depot" type of drug. What this means is that it builds a reservoir (we refer to this as a "shed") under the skin which gives Lantus is long duration and makes it a gentle quality. Every time you adjust a dose, it effects the shed. The more you alter doses or don't shoot a consistent dose at AM and PM, the more impact it has on the depot and numbers may suffer. The dosing protocol that we use, which is based on the research of Jacqui Rand, DVM and has been published in a top tier veterinary journal, clearly indicates that you need to administer a consistent dose at AM and PM.

If you are outside of the US, we do have a spreadsheet template that will automatically convert your BG numbers (mmol/L) to the numbers we use in the US (mg/dL). The instructions on setting up the World spreadsheet template are in the Tech Center.

As the others have suggested, please read over the starred, sticky notes at the top of the Board, They will provide you with a great deal of information about Lantus, its dosing and the protocol we use, key concepts, and using this Board.
  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal versions -- the Tilly Protocol developed by the counterpart of this group in German and the Queensland/Rand protocol developed by Jacqui Rand, DVM and published in one of the top vet journals.
  • New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
  • Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
  • Lantus depot/shed: This is an important concept for understanding how Lantus works.
  • Becoming Data Ready: What data you need in order to be able to work toward remission or tight regulation.

Please let us know how we can help.
 
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