New Member - dosing advice

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Emma Stanley

Member Since 2022
Hi!

I have been reading the advice on here since my Boo was diagnosed with diabetes in January 2022, and it has been incredibly helpful. I feel my vet doesn't know a whole lot about diabetes and luckily I think I may have avoided some hypo episodes thanks to reading all the information on here!

I now have a few questions of my own and after asking my vet, it seems she doesn't even really know what to do.

Currently, Boo is on 2.5 units of Lantus 2 times a day and only eats wet food (Fancy Feast Pates, super picky eater!!). Originally started at 1 unit in January, to 1.5 units in February, moved up to 2 units in March and this past week my vet recommended going up to 3 units. After reading all the info on here it seems going up an entire unit was unsafe, so I made the choice to put him to 2.5 units. (He has been at 2.5 units for about 3.5 weeks now) The reason for the increases was Boo was remaining between 360-475 all day. I have done 4 curves for him now ( testing preshot, then every 2 hours) and this past weekend his curve was alot better, between 260-288 for majority for the day. I have been checking him about 6-8 hours after his shot when his glucose is supposed to be the lowest and it has usually been around 270.

Yesterday, I checked him 7 hours after his shot and he was at was 72, I then checked him right after I fed him his dinner (12 hours) when he would normally get his shot and he was only 90. I figured giving insulin was a big no no as he might go hypo, so i didn't give him his shot. I checked him 2 more times after that and he was around 100-108. This morning when I went to check him before his breakfast he was around 200 and i was really hesitant to give him his insulin as i worried he could go hypo and I wouldn't be home to monitor him, so I didn't give him his shot. I am headed home and will check him shortly to see where his glucose is at now.

After discussing with my vet, she thinks maybe he can go down to 1 shot a day and stay at 2.5 units but after reading everything on here it seems that 1 shot a day doesn't really work in cats.

I was wondering if anyone here does 1 shot a day? I worry that maybe he is getting to much insulin now for him to drop that low and remain that low. I am still trying to learn all about feline diabetes but from my understanding if he was getting to much insulin wouldn't he would drop really low and then bounce really high, but it seems he didn't really do that, so is it possible it could be a sign of remission?

Any advice would be greatly appreciated
Thanks!
 
Emma Stanley said:
Currently, Boo is on 2.5 units of Lantus 2 times a day and only eats wet food (Fancy Feast Pates, super picky eater!!). Originally started at 1 unit in January, to 1.5 units in February, moved up to 2 units in March and this past week my vet recommended going up to 3 units. After reading all the info on here it seems going up an entire unit was unsafe, so I made the choice to put him to 2.5 units. (He has been at 2.5 units for about 3.5 weeks now) The reason for the increases was Boo was remaining between 360-475 all day. I have done 4 curves for him now ( testing preshot, then every 2 hours) and this past weekend his curve was alot better, between 260-288 for majority for the day. I have been checking him about 6-8 hours after his shot when his glucose is supposed to be the lowest and it has usually been around 270.
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Hi Emma
We can increase by 0.25 units at a time
With lantus there are 2 dosings to choose from, what is best for you to choose from
Here they are
https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/
Please read about them
We usually start with 0.5 units
You were correct in not shooting with those low numbers
Shooting once a day will not work
I haven't seen anyone shoot once a day
I will tag a few more experienced members for you about dosing
Do you work ? How often can you test him both day and night

I will give you a link to set up your signature ,information about Boo that we need to know ,also you need to set up our spreadsheet so you can enter Boo's numbers so we can see how the insulin is working and how low he's dropping
If you need help setting up the spreadsheet just ask we have a member who will set it up for you
I don't think your vet knows too much about diabetes
You have come to the right place for advice
If it wasn't for the members here Tyler wouldn't be in remission since 1-24-21
I'll give you the links and then tag some members for you


Here is a link helping us to help you link. If you noticed, our members have some basic information about their cat's in their signature. This helps us to not pester you by asking the same questions (your cat's name, insulin type, date of diagnosis, etc.) repeatedly. We also have a link to our spreadsheet in our signature. We are very numbers driven. The spreadsheet is a record of your cat's progress. By linking it in your signature, we can follow along and provide feedback should you need the help.
 
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What I suspect happened is the days you did curves were bounce days - when their BG drops lower and/or faster than they're used to, the liver panics and dumps stored glycogen into the system to spike BG back up. It can last for 4-6 cycles. So very possible he was going lower on days you weren't testing. It does NOT necessarily mean dangerously low, but we just don't know. It takes time for them to get used to lower numbers.

And you are correct - twice a day, 12 hours apart.
We do usually only increases by 0.25 units at a time.

I suspect Diane is fixing her post, but we do have two dosing methods. Per the more aggressive one (Tight Regulation, or TR) those numbers were ok, we reduce under 50 on a human meter (68 on pet meter) with that method for cats within one year of diagnosis. Now the flipside is it sounds like you aren't testing enough to follow that method, as the testing is required to keep them safe in the lower numbers. There's more to it, but that's just a quick summary so as not to overwhelm you too much at first.

The other method is Start Low Go Slow (SLGS). We reduce by 0.25U any time they go under 90 regardless of type of meter, and hold each dose for a week. A curve is done weekly and dose adjustments are decided upon based on the curve and other test data you have.

Regardless of which method someone follows, we do recommend testing before every shot to see if it's safe to shoot. The cat should fast for 2 hours before every shot, so you have a consistent number to base decisions on at shot time. Ideally, each cycle (so each day and each night) should have at least one extra test at various times - this way, over the course of a week, you get a pretty good picture of what's going on.

The dose is too high to call it near remission, but generally speaking the best chances at remission are within the first year of diagnosis and following the TR method. You would continue to step down the dose in 0.25U increments as reductions are earned, then it goes 0.25U to 0.1U to a drop doses and only then do we start an OTJ (off the juice) trial. Remission is never guaranteed though.

You do need to reduce your dose by at least 0.25U. if you can get a spreadsheet set up with whatever data you have we can take a look and see if a larger reduction might be needed.
 
I would just add that if you are skipping doses, you need to be testing for ketones in the urine. To do that you need a bottle of Ketostix from Walmart or a pharmacy and follow the directions on the bottle. Thee should be no ketones in the urine. If there is more than a trace, tell the vet.
Once you get the SS and signature set up, we will be able to help you a lot more.
As Melissa said, to keep your kitty safe, you need to be testing before every dose to see it is safe to give it. And I would get another test in around the +5 to +7 mark to see how low the dose is taking Boo.
Do you have a hypo kit set up? I formation is in the link Diane gave you….help us help you.
 
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