New to Board - Lantus dosing questions

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kryskat

kryskat

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Hi - I'm reposting this, hopefully in the right place this time: My 18 yr old kitty, Kasha, was diagnosed approx 4 weeks ago. I was initially giving 2 units Lantus twice daily. I've gradually lowered dosage as she's had some pretty low numbers in between shots (using my one touch mini glucometer). Monday night she hit an all-time low of 41 at 2 hours after a dose of 1 unit Lantus (her pre-shot was 208). She stayed low for a few hours even after I gave her some low-carb snacks (and then I went to sleep). Her AMPS was in the 400s - so I was guessing rebound maybe? I only gave her 1/2 unit yesterday morning because of her low numbers the previous night. I cannot always be home to check her nadir, since I work. Even when I can stop home at lunch, I find I may have missed the nadir, because some days it's at 4-5 hours and the earliest I can check on her is 6 or 7 hours after her last shot. Her PMPS last night was 266 and I gave about .75 units Lantus.

I feel like I'm doing a constant science experiment and I'd like some advice on what I should be doing to even out her numbers and hopefully stabilize her and maybe get her into remission - the ultimate goal, of course. I added her numbers to the template (need to update for the last day or so still), but it's a little wonky since on some days she's been so low I wasn't comfortable giving insulin so I waited several hours (up to 5 or 6) and gave insulin when her numbers were higher. Then I had to adjust by giving late doses for the next few shots to get back to my work schedule.

Yesterday (4/13) her morning nadir seemed to be 78 at 11:30 am (she got approx 1/2 unit Lantus at 7:05 am) and her evening nadir around 89 at +4 hours (after between 1/2 - 3/4 units Lantus).

Also, my syringes only have whole unit markings, so I'm approximating. I know there are some syringes available with 1/2 unit markings, but how do you measure the smaller quantities?
 

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Hi and welcome. I'm willing to bet some very experienced people will be along soon to give you more concrete advice. I just wanted to say a couple of things.

One is that Lantus works best for cats when given--whenever possible--at those 12 hour intervals. It isn't an insulin given WHEN the BG is high, but rather one that is dosed regularly to achieve a steady state. Adjustments in dosage are made to keep happy numbers throughout the whole cycle.

The second is it does sound at least to me as if you were looking at rebound with that 400 something.

Did I miss it or did you mention diet? Is Kasha eating only low carb wet food? Because that is very important to contorl diabetes.

Finally, about low insulin dosages. Hocks (there's a link to them at the top of the page) sells syringes with half unit markings. You CAN'T be sure you are giving precisely half a unit or precisely a quarter or a tenth of a unit. BUT you can be reasonably sure you are dosing the SAME small dose all the time and that's what really matters. There are lots of techniques people will share for getting your dose to be as reliable as possible.

Best of luck and hope to see more of you here in this wonderful and supportive community.
 
Yes, Kasha and the other 2 cats she lives with are eating only low carb canned food or cooked meat (turkey or chicken). Only low carb, freeze-dried chicken treats.
 
I had posted to your question on the Health board. This is the link to Health thread.

To cut to the chase and not be completely redundant, I'd suggested that we look for a dose that you can comfortably shoot twice a day.
 
Hi and welcome to Lantus Land. If you haven't read the stickies at the top of the page, may I suggest that you do so. You will learn a lot of good information there.

I noticed that you have been doing a lot of dose hopping. Lantus actually works better with one consistent dose for a period of time so that the dose can "settle in". Dosing is also based on Nadar, not preshot values. Like Sienna said, what you need to do is find a dose you can feel comfortable with and get as much data on that dose as you possibly can to see if it is the "right one".

As far as measuring those micro-doses...well, let's say, it's not easy at times, lol. What I did was find a spot on my syringe that I perceived to be the .3u or the .2u or the .1u and stick to that spot. It may not have been that exact dose, but it was consistent. It can be tricky, but it can be done.
 
So what can you do if 5 or more days a week you are at work for at least one nadir and I can't always be awake to check at night? I work > 8 hour days and since she was diagnosed, I haven't been sleeping much so I can check on her and my other cats who also developed health issues at the same time. It's wearing on me in a big way. I want to do what's best for her, but I already had to change my entire schedule to be home every 11 or 12 hours - I can't do every 6 hours and I've got no support from friends or family near me to help out.
 
Most of us work or are in school and some folks here have very demanding schedules. We work with/around your schedule since most of us can't run home to do spot checks. You do your best to get the nadir data on days off or on weekends. I've arranged my schedule so I'm able to get a +2 before I leave the house. This is usually when Gabby's Lantus onset is. (You get that kind of data from doing a 2-hour curve.) So I get an "out the door" check, I try to get an "when I get home" check if it's not on top of PMPS, and I get several checks in the evening -- definitely a before bed check. I doubt that the majority of people here could test every 6 hours. And, just to complicate things, the nadir can change -- it's not always at +6. Some cats have early or late nadirs. (And they are cats and do what they want despite our schedules or our needs.) Don't torture yourself over this. You get as much data as you can when you are able so you feel confident of the dosing decisions you will be making. We'll help you work it out.
 
Hi kryscat! I'm the one who posted to you last nite on health & told you to come here!!
Glad you did!! You have gotten many suggestions already & yes, many of us work & are out many hours a day--
I really suggest getting a timed feeder-catmate makkes a good one, and that way you can have Kasha being fed at those times when the numbers start to drop, like +3, and then at +6, which is the usual nadir...Then when you come home, you can take the PMPS & do spot checks then...
I'm sure you will get dosing help sometime today, definitely tonite, just please post any tests you get today & tonite, if your ss isnt up yet.
You are already feeding good foods, & are bg testing--So you are doing well already..
Will be back to check on you later-- :mrgreen:
 
I had timed feeders (both for dry before I switched and ones I can put canned food in with an icepack) - but unless I supervise her eating, I cannot assume she eats. I have 3 cats, including one who is a little pig and steals food from other bowls, etc. while Kasha is not a big eater. It seems like she quickly gets tired of eating and then goes to lie down. Usually very little food has been consumed at that point. If I put her food in front of her (lying in her bed like a princess), she may finish it. If I keep after her, she will almost definitely finish (that's our morning ritual now). Otherwise, it will sit for hours and I usually end up throwing it away. Somehow she knows that I want her to eat so she won't, you know? Instead of a feeder, what I usually do is put a bowl of roasted turkey (torn in little pieces by me) out before I leave the house in the morning. She's the only cat that will eat real food so she'll have something to nibble on throughout the day and no one will steal it.

And even the times I checked and found her BG reading in the 40s (at least on my meter -I've heard that low numbers aren't as accurate), she hasn't shown any hypo signs, but I've given her a little snack or meal just to reassure myself.

Can someone direct me to instructions on how to attach my spreadsheet from google docs? I saw instructions somewhere but can't find them now...
 
Hi and welcome to Lantus
Here is the link for your ss and how to attach it to your signature.
It is in the "tech form" so if youhave any other issues that you are not sure of,
you can go on ver there too.
You have receieved a lot of great advice and I know how overwelming it can be.
Just take a deep breath, relax, be good to yourself and
everything will be fine.

SS Link viewtopic.php?f=6&t=16
 
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