Newbie Lantus Dose Question - Jessica and Callie

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Jessica A

Jessica A

Member Since 2021
Hello - I am so glad to have found these boards! My partner and I have been lurking and reading and learning tons of info for the last week+ but now I have my first question about the dose that I am hoping you can help me with.

First, by way of intro: my name is Jessica and my 10-year-old cat Callie was diagnosed with diabetes on 7/21/21 and started on 1U Lantus on 7/23/21 in the evening. We also had a freestyle libre 2 implanted while we started learning how to take BG ourselves at home. (We changed her food to mostly low carb upon diagnosis - she has allergies so that is a bit of a challenge but we're making it work so far.)

We got about 5 days of good readings on the freestyle libre before Callie dislodged it this past Thurs am and we had it replaced yesterday afternoon. We were able to get ear BG readings in between before each insulin dose but we didn't try to test every two hours knowing that we were going to have another freestyle libre placed and Callie has been so stressed with all of the changes and vet visits (she also has asthma and had a full blown asthma attack last night for the first time in years.)

We have been working with the vet to tweak Callie's dose and since her BG readings remained quite high with 1U and even 1.5 U, we started giving her a "light" 2U on 7/28. With the vet visit yesterday, Callie's BG was still pretty high most of the time but today she has actually been in the blue range much of the day, even dipping as far down as 92 at 5pm today. She is back up a little now - last reading 152 at 7pm. Callie's appetite is very good and she has been eating well today. We have not given her any higher-carb food because we have been able to watch her very closely and scan the libre often.

So now to the questions: we have been doing an 8a/ 8p insulin schedule (we're in NYC.) If Callie remains in the low -mid 100s, should we give her the full 1.75ish U? Just worried because although we have been able to monitor her closely over the day, that is a little more challenging overinght. Also, should we give her some higher-carb food with her insulin tonight? I think you should be able to see the link to Callie's spreadsheet with additional details in my signature. Please let me know if not though.

Thanks so much for any guidance you can provide. This is all still so new to us and has been extremely overwhelming (not to mention heartbreaking...)

Jessica and Callie
 
If you're using the SLGS dosing method, she hasn't earned a reduction yet. (if you think her dose is 1.75 instead of 2, you should put that in the U column. If you think it's between 1.75 and 2, that could be either a "fat" 1.75 or a "skinny" 2 and would be either 1.75F or 2.00S)

All that being said, I'm concerned your vet raised the dose a little too fast. On SLGS, you should hold each dose for at least 7 days unless she drops below 90 and earns a reduction. You only did the 1.5 for 3 cycles instead of 14.

With her going up so much between +10 and +11, I'm going to bet she's going to be higher at PMPS. If she's above 200, how would you feel about dropping back to the 1.5 and give her a little time to let that dose settle in and see what it can really do?
 
I will change the U column to skinny 2. It has been between 1.75 and 2 as best as we could get it.

Thanks for responding -- the vet didn't specifically say that she was doing SLGS. I just assumed that based on her initial instructions ... but I will speak with her about that and the 14-day question.

We did get a PMPS reading of 211 and also heard back from the vet just before 8 pm here (we had put a call into her earlier but just heard back now.) She advised doing 1.75 so that's what we just did. Unfortunately, I only read your reply when I came back to update this thread after I get info from the vet and gave the shot. My fault - sorry to have so many crossed wires and to have given so little time for anyone to respond. I will definitely try to post with more time before we actually have to give the dose in the future. We were actually just taken by surprise that Callie's numbers hadn't risen more and kept thinking that they would so when we got the 7pm reading, we got nervous.

We are supposed to speak with the vet again on Monday. Do you think we should ask about putting Callie back to 1.5 or do you think it is better to leave at 1.75 assuming Callie stays in the same range as today? I feel like her numbers were surprisingly good today but I am generally concerned about bounce and also hypo and based on what you replied, am also worried that we jumped the gun and Callie might actually do well on 1.5....

Thanks again. It is such an incredible relief to have so many kind, experienced people here ready to help.
 
Ah, got it. I may well have assumed wrong that the vet had us doing SLGS... I had read about both when I first joined these boards but to be honest, my brain is completely overloaded at this point and we also haven't gotten much sleep in the past week worrying about Callie so everything is a little jumbled. I will read everything at the link you sent me above with clear and hopefully more rested eyes tomorrow and then speak with the vet on Monday. And of course, I'll continue to update Callie's ss and post here about our progress. Thanks again. Have a good rest of weekend.
 
Welcome to FDMB!

You are doing a great job for being so new to managing Callie's diabetes! You've crossed off a lot of the initial boxes -- signature and spreadsheet (SS) and home testing being the big boxes. Feeling completely overwhelmed is absolutely normal.

As Chris alluded to, with Lantus there are two dosing methods that we use. Your vet will not know the term, "Start Low Go Slow." It's a method that was developed here a long time ago and it's used for most types of insulin. The Tight Regulation Protocol is a term your vet will be familiar with since it was published over 10 years ago in one of the leading veterinary journals and it's specific to Lantus and Levemir. Both methods work. TR is more aggressive and has a strong track record for getting newly diagnosed cats into remission. SLGS can get cats into remission -- we just don't have the facts and figures to know how well it works.

I want to back things up a bit. With Lantus, it takes 5 - 7 days for the depot to stabilize. You want to hold the initial dose for at least 5 days. If nadirs (lowest number in the cycle) are above 300, if you're following TR, you can raise the dose by 0.5u. (On SLGS doses re raised by 0.25u only.) So, the increase to 1.0 to 1.5u was fine. Again, with TR, doses are evaluated after 3 days/6 cycles. If the numbers are not in normal range, you want to increase generally by 0.25u. Thus, the increase from 1.5u to the skinny 2.0u was premature. The reason that it was too quick is because Lantus is a depot insulin. The depot needs 6 cycles to stabilize after any increase or decrease in dose. Given the changes in dose the past few days, I'd suggest that you stick with the 1.75u dose for 6 cycles.

It's also not surprising to see the high numbers this morning. Callie isn't used to seeing those blues and green. As a result, her liver and pancreas released a stored form of glucose along with counterregulatory hormones which caused her BG levels to spike back up. We refer to this as a "bounce." It's normal albeit very annoying to us.

Please let us know if you have questions. The members here are very generous with their time and knowledge. If you feel like you're ready, since you are feeding Callie a low carb diet, are home testing, and have a spreadsheet set up, you are welcome to start posting on the Lantus board. There is even more expertise available there and like on this board, we have members around close to 24/7.
 
Thanks so much for the warm welcome. Chris was incredibly helpful last night and it definitely made us feel much less alone with this whole thing when we got such quick and thoughtful replies on a Saturday evening.

You must have been reading our minds when you posted today -- we were just inputting updated numbers into Callie's SS and talking about how frustrated, confused and saddened we are by how high they are today. I had read about the bounce and thought that could be at least some of what is going on but I am glad to have you confirm my assumptions. ( It IS extremely annoying. It feels a little like we are on a terrible rollercoaster that we would very much like to get off of.... and we are desperate to help Callie feel and be better as much as possible as quickly as possible ...but we also realize that's not exactly how this works.) We will hang tough and continue on w/ the 1.75 U for at least the full 6 cycles to see where we are at then.

We'll definitely continue posting here or on the Lantus board as questions come up. And they will for sure.

Thanks again - you all are a godsend.
 
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