New Member Advice Needed - Lantus Dosing

Boom64

Boom64

Member Since 2026
Hello everyone,
Thank you for taking the time to read. Long story short, Bumper was diagnosed in September and was prescribed 2 units of Lantus via the Solostar pen. After a couple instances of his BG dropping too low, my vet recommended I only give him 2 units if his BG was above 250 mg/DL and 1 unit if below. I thought this seemed a little contradictory to what I had read about Lantus online, but it seemed to work for a couple months. She also said I only needed to prime the needle with 1 unit before shooting, which I recently discovered is incorrect and should be 2 units. My observation was that 2 units would drop his nadir into an acceptable range, but by his next shot he would be in the 150 range. 1 unit would typically sustain this for a couple doses before he'd shoot back up again. I found myself repeating this for the months of November and December. All in all, he was very active, playful and had a healthy appetite.

In early January, his fructosamine test came back at 349, which concerned my vet. She was worried he may experience hypo episodes soon. This scared me and I became more conservative with giving him 1 unit, which significantly raised his nadir, but seemed to keep him in the 170 - 250 range (on a Relion meter which I believe is still high). After about of week of this, 2 units began to not lower his BG until sometimes 12 hours later, but 1 unit seemed to drop him quicker but not as low. I thought this was possible bouncing.

About this time, I began priming with 2 units, and noticed a significant increase in the efficacy of 1 unit which dropped his nadir into the 70-80 range for about a week. I thought this was great, and assumed perhaps the priming issue was the reason and that 1 unit would suffice. This morning, I tested him at 364 mg/DL, which was significantly higher than he has been recently. I really struggled to decide his dose, but I decided on 2 units. By his nadir, he was at 132 mg/DL, but again I was concerned about switching his dose around daily.

Basically, I've debated trying 1.5 units via syringe, or just sticking with the 1 unit while priming 2 units prior regardless of his preshot number. I've lost confidence in my vet for several reasons since his diagnosis, so I am hesistant to see what she has to say. She seems to think that both an Alphatrak and Relion give the same number (which has also caused confusion for me when determining his dose based on a 250 mg/DL reading.

Anyways, I am lost. Bumper's quality of life has incredibly improved since his treatment began, but I am not confident in what I am doing at the moment. My spreadsheet is in my signature. Any input would be greatly appreciated! Thank you!
 
Welcome to FDMB
You sound just as overwhelmed as we have been, and you are right, a lot of controversy from your vet, first, you should not take the BG value as correct at the vets office, cats get very stressed so the BG number will always be higher, I do not give dosing advice, but I can say that increasing or decreasing the dose according the BG reading is not a good idea, it takes 2-3 cycles to determine how the insulin is working in Bumper, I will tag a couple of members that can answer your medical concerns and help you with dosing, don't despair, you are in the right place, we are here for you ;) 🤗
@Sienne and Gabby (GA)
@Wendy&Neko
 
Welcome to FDMB.

We don't recommend using the pens to inject. You are stuck with dispensing insulin in full unit amounts which may be fine for a human but not so good for cats. You have much greater flexibility with dosing when using a syringe. We typically make dose adjustments in 0.25u amounts. If you test in 1.0u amounts, there's a good chance you'll sail past what may be an effective dose.

You've done a great job of testing at pre-shot times. However, you've only recently been getting tests toward mid-cycle, and mostly during the AM cycle. Lantus dosing is based on how low the dose brings your cat's blood glucose numbers. You need to routinely test around the nadir and test both during the AM and PM cycles. Many cats experience lower numbers at night.

We use two dosing methods. Where dose reductions occur differs with these methods. If you've not reviewed the sticky notes at the top of the Lantus forum, you may find the information helpful.
 
Thank you for the replies! When "cycles" are mentioned, is this typically considered several days worth of consistent dosing? I had read that the depot from long lasting insulin can take several days to become consistent. This is another reason I've had trouble regulating. In my experience, 2 units doses seem to carry an inertia for the following 2 days or so, which made me concerned to give another 2 units, or simply use 1 unit to sustain lower levels. This also had a significant impact on him having a consistent appetite.

I recently started testing near his nadir more often out of my fear that the 2 unit dose was dropping him too low. Unfortunately, his shot times are 6 AM/PM so testing at midnight hasn't been something I've considered, but will begin checking routinely. I had read that most cats test lower at night, but Bumper is usually higher in the morning, so I didn't really worry about it, but it is possible he is bouncing at night leading to higher numbers in the morning.

I just purchased 100 Unit/ml syringes with half unit markings to begin administering that way by pulling from the pen. My initial thought was to start at 1 unit for 5 days, routinely testing his nadir as well as pre-shot numbers, and then adjust accordingly. I am assuming increasing by .25 units is the best practice? And how exactly am I using his nadir and pre-shot readings to determine if that is the case? What is considered a safe zone for nadir testing that I should be aiming for? Because at the moment, anything between 80 - 140 (on a Relion human meter) has been good to me, but I know lower is possible and possibly preferred.

Edit: A lot of these questions have been answered as I am reading the Stickys from the Lantus group. Thank you!
 
Last edited:
I do not give dosing advice, but I do know that it takes at least 3 cycles (3days) with the same dose and every cat is different of course, to determine how the dose given is acting in Bumper, so it is very important to test during the day at least 2-3-4 times during the day. not just at AMPS/PMPS as well, this gives a more precise indication how the insulin is reacting during the day , so is important to keep the same dose, not changing it according to the BG at the time, but of course there are exceptions, if you feel you want to increase/decrease, post us, Sienne or Wendy can give you a more precise indication about that, I will tag her now so she can review my post in case there is a need to rectify, and your concern as well, I can tell you that I trust this forum and the members here to give the precise indications on dosing, I trust them blindly, you want to regulate Bumper, and if you allow yourself to be guided you will begin to see a pattern in Bumpers numbers, by seeing the every day consistency in BGs throughout the day, before you know it you'll be a pro, Bumper is lucky to have You Got This! ;) 🤗
@Sienne and Gabby (GA)
 
To correct the information above:
There are two, 12-hour cycles per day -- the AM and the PM cycle. The minimum number of tests per day is four. You want your AMPS and PMPS tests (the tests prior to shot time) and a minimum of one test during the AM and PM cycles.

Unfortunately, cats do not like to be predictable. I would encourage you to get a curve. A curve means that you test every 2 hours for one, 12-hour cycle. This will give you a reasonable idea when Bumper's nadir is. Not only do cats not like to be predictable, they don't read the rule book. While many cats typically have a nadir roughly at the mid-point in the cycle (i.e., +6), that's not true for every cat. My cat typically had an early nadir. She could hit a low point at +3. And, as I noted previously, it's important to get PM tests. Just as an example, Gabby tested in the 400s at pre-shot, dropped to the 40s at nadir and was back in the 400s by the next shot time. If I wasn't testing, I might have increased her dose whereas the numbers indicated she needed a dose reduction.

It's important to know which dosing method you intend to use. Please review the sticky note on dosing methods in the Lantus forum. The link to the Lantus board is in my post above. In order to provide input on dose, we need to know which method you will be using.
 
It has been very eye-opening looking at everyone else's charts as reference. As mentioned above, I have noticed an inertia with his dosing, typically following a 2 unit dose. How many cycles should I go through before I consider him clear of his 2 unit depot? If I am going to run a curve on 1 unit, I'd like to know that a prior 2 unit dose is not skewing him lower. I would prefer to start with SLGS, and I feel 1 unit would be a good starting point based on his prior numbers. I am mostly unsure if the 1 unit on the pen is entirely equivalent to 1 unit on the syringe, which is why I'd like to start there and then adjust upwards by .25 if necessary.

Today was also odd. His 2 unit dose in the morning didn't hit a low until almost the end of the cycle. This leads me to believe that this dose is way too high for him.
 
I would not draw a conclusion based on one cycle. If you look at the numbers for 2/3, the AM cycle is flat. The only time you want to base dosing on one number is if the number tells you a dose reduction is warranted. With SLGS, that would mean that Bumper's blood glucose is 90 or below. We suggest dose changes in 0.25u increments.

Also, since Lantus dose best with consistency, you want to be giving the same dose at both AM and PM shot times. If you give a different dose at each shot time, the insulin depot won't stabilize. With every dose change, you need to ensure that there's time for the depot to adjust. The different amounts of Lantus at AM and PM shot time will cause wonky numbers.
 
You must log in or register to reply here.
Back
Top