New and Need Help with Lantus Dosing

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J

Jan and Topper

Member Since 2013
[http://felinediabetes.com/FDMB/viewtopic.php?f=28&t=93164]
http://felinediabetes.com/FDMB/viewtopic.php?f=28&t=93164
I have the Spreadsheet up with what few numbers I have. As I stated in my original post (I hope I did the link correctly) I just recently started testing even though Topper has been having insulin for 9 months.

I really need help. I don't know if he is having too much or not enough insulin.
 
Yes, that is a rather high Lantus dose.

Some questions.

What does you cat weight?
How much should your cat weigh?
- a calculation for starting dose is the lower of current or ideal weight, in kilograms (divide pounds by 2.2), times 0.25.

Do you check for urine ketones?

How much insulin did you start on?

When you made an increase, how big was the increase?

Have you been in our Lantus forum and started reading how to use Lantus?
 
He was started on .25 Lantus twice a day.
Vets curved every 10-14 days. If dose was increased it was by .25u
He weighs 11 pounds, should weigh 9 - 9.5 pounds.
I check for Ketones.
His bg at diagnosis was 340. Had eaten Fancy Feast Classic, no dry for several years prior to diagnosis.
 
You are doing a wonderful job of getting test data!

I would encourage you to take a look at the starred sticky notes at the top of the Lantus Board. To be honest, it sounds like you're already familiar with the dosing protocol we use given that you ignored the vet who told you to increase Topper's dose by some huge amount and instead, you increased by 0.25u.
  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal version -- the “Tilly” Protocol developed by the counterpart of this group in Germany, which was also published by Kirsten Roomp & Jacqui Rand, DVM 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: This is an important concept for understanding how Lantus works.
  • Lantus & Levemir: Shooting & Handling Low Numbers: What data you need in order to be able to work toward remission or tight regulation as well as information if you have a low pre-shot number or a drop into low numbers during the cycle.
It sounds like you systematically increased Topper's dose. If that is, in fact, the case, then it's entirely possible that you have not yet gotten to what is a good dose for your kitty. I would encourage you to increase the dose to 3.5u. If you take a look at the information in the Tight Regulation Protocol sticky, we evaluate the effectiveness of a dose every 3 days. If a cat's numbers aren't in a good range at the end of 3 days, the dose is increased.

Please let us know how we can help.
 
Seems like you're doing the right things.

I'll note that doing the curves at the vets may not have been optimal due to vet stress, unless you have an exceptional cat who loves to visit. You could do the curves yourself and save the money. Its just testing every 2 hours from pre-shot to pre-shot.

Has he ever experienced a hypoglycemic attack and if yes, under what conditions?
What is your cutoff limit for not giving insulin? Have you ever skipped shots because he was too low to give insulin safely?
 
Thank you for the replies.
I was not testing regularly, so he could, at any time over the months hypoed and if he did not have symptoms, I didn't know. When he had his UTI last fall, a couple times he was acting odd and I tested and he was 45 -60. Lowered the dose by .25u. Because of that, I did test at shot time for awhile and spot checks and he kept going low and dose kept reducing. Then infection cleared and bg started coming up. Curves at vet and dose increasing again. This has never made sense to me. Why would he drop down, then come back up?

I'm wondering if he may have started getting too much insulin at some point in this time.

And again, because of not testing, I don't know if I ever shot when he was too low.

There were some bg numbers I got when I was shooting 3.50, I think it was, where he would drop to 122 or around there, then PS would pop up to 400. His bg seemed to me to be jumping up and down, vet said he needed an increase in dose. I'm trying to find my notes on these numbers... I'm suspecting the vets have been basing increases on high numbers rather than low numbers in the cycle, or as was said, his overall curves were high from stress at the vets.

I really don't know what has happened. All I know is that his numbers keep going up and up.
Is there any way to tell if he is getting too much insulin?
 
Dosing increases or decreases with Lantus should be based on the nadir, or low point in the cycle.

If a cat is getting too much insulin, the numbers can vary quite a bit, doing what we call bouncing.

That low of 122 is a good number.
 
I'm a little confused on your spreadsheet. Did you skip on the evening of the 12th, and your dates are in the wrong column, or do you have 2 lines of data for the 12th?
 
Never mind.
I see in your Remarks column that you were testing two diffent meters, and the two lines of data are correct.

You're doing a good job of testing. I think you have room for an increase.
 
I raised the dose to 3.50u last night. His PS was 303, then his +7 was 387, I forgot to test him at +6 but did feed.

His new found friends here donated towards his going to the vet to get his ears checked, there is no infection. I don't know why he is fussing with them.
His PS today was 321.

That Spreadsheet is such a great idea! I love it. It really puts the numbers into perspective.

I'm trying to figure out how to put up a photo of Topper.

Just thought I'd add that they checked Topper's bg at the vets, it was 397 on their meter, 393 on my Bayer Contour and 284 on my Relion Prime.
 
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