Newbie requesting feedback :) Lantus, time to increase?

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Good afternoon,
Jack's first dosage increase was 2 weeks ago. We went from 1IU 2x daily, to 1.5IU in the morning and 1IU at night. Since he has started insulin, he has been bouncing hard. from 150 range to over 600 overnight. The past few days, he has stayed between 329- 478. If you look at his Libre graph, he is now just going up and down all day instead of the long declines and long inclines that take hours.

Although his numbers are still extremely high, Is this what "normal" is supposed to look like? Does this mean his body has adjusted to the increased dose?

The vet would like to reassess every 2 weeks, so I will be reaching out to her today. Would now be the time to increase his dose again? I think we should increase his PM dose to 1.5 as well, since his numbers always seem to be high in the morning.
 

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@Jack & Jamie
Welcome to the best group you could have joined
I'm going to tag some experienced members for you on what to do about the doses but first can you set up what we call our signature
It's in gray letters at the end of everyone's post
Tap on your name up top then tap on signature and add the information
Shooting different does of Lantus is not suggested it messes with the depot
  • Add info we need to help you:
    • Caregiver & kitty's name
    • DX: Date
    • Name of Insulin (do not include dose or frequency)
    • Name of your meter
    • Diet: "LC wet" or "dry food" or "combo"
    • Dosing: TR or SLGS or Custom (if applicable)
    • DKA or other recent health issue (if applicable)
    • Bexacat or Senvelgo (if applicable) and dates
    • Acro, IAA, or Cushings (if applicable)
    • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
    • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.
Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.

Thank you!


By the way on your spreadsheet you have the Relion
Meter and the Freestyle Libre 2

Are you using the Relion as a back up ?

Did you read the dosing methods for Lantus
I see you are following SLGS
We base the dose on how low the BG is dropping not the pre shots

https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/
 
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Good afternoon,
Jack's first dosage increase was 2 weeks ago. We went from 1IU 2x daily, to 1.5IU in the morning and 1IU at night. Since he has started insulin, he has been bouncing hard. from 150 range to over 600 overnight. The past few days, he has stayed between 329- 478. If you look at his Libre graph, he is now just going up and down all day instead of the long declines and long inclines that take hours.

Although his numbers are still extremely high, Is this what "normal" is supposed to look like? Does this mean his body has adjusted to the increased dose?

The vet would like to reassess every 2 weeks, so I will be reaching out to her today. Would now be the time to increase his dose again? I think we should increase his PM dose to 1.5 as well, since his numbers always seem to be high in the morning.
@Wendy&Neko
@Sienne and Gabby (GA)
@Bron and Sheba (GA)
 
Hello and welcome. On this forum and with the dosing methods we use, we find it's best to use the same dose AM and PM. As you've discovered, he's higher in the AM with the lower dose at night. I think you've be fine going to 1.5 units for the next dose. Just so you know, with our dosing methods, we typically increase by 0.25 units at a time. And yes, that means eyeballing those dosing between the syringe lines.

Bouncing is completely normal for a newly diagnosed cat.

Here is the link to your previous post here, for some background: https://felinediabetes.com/FDMB/thr...review-starting-dose-freeze-dried-cbd.296785/. It's be helpful to us if you could fill in that signature, especially letting us know what type of food you are feeding now. Food is the second thing besides insulin, that can impact blood sugar numbers.
 
@Jack & Jamie
Welcome to the best group you could have joined
I'm going to tag some experienced members for you on what to do about the doses but first can you set up what we call our signature
It's in gray letters at the end of everyone's post
Tap on your name up top then tap on signature and add the information
Shooting different does of Lantus is not suggested it messes with the depot
  • Add info we need to help you:
    • Caregiver & kitty's name
    • DX: Date
    • Name of Insulin (do not include dose or frequency)
    • Name of your meter
    • Diet: "LC wet" or "dry food" or "combo"
    • Dosing: TR or SLGS or Custom (if applicable)
    • DKA or other recent health issue (if applicable)
    • Bexacat or Senvelgo (if applicable) and dates
    • Acro, IAA, or Cushings (if applicable)
    • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
    • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.
Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.

Thank you!


By the way on your spreadsheet you have the Relion
Meter and the Freestyle Libre 2

Are you using the Relion as a back up ?

Did you read the dosing methods for Lantus
I see you are following SLGS
We base the dose on how low the BG is dropping not the pre shots

https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/
Good morning!
I've updated my signature per your feedback. Please let me know if anything should be added or modified.

Let me clarify what I meant by increasing his dose for Lantus. I wouldn't increase for just that shot or day, I would increase every day while monitoring, just as we did 2 1/2 weeks ago, by increasing the morning dose to 1.5IU. Does that make sense? "Basing the dose on how low the BG is dropping" The lowest it drops in a 12 hour period is generally in the 200-350 range. The lowest it has gone in the past month is 139.

My question was the photo I had attached from the Libre, where his numbers stayed in a much tighter range in comparison to how it's been. He didn't have the long slow drop and the long slow climb that he usually has. Instead, it went up and down throughout the 12 hours, from 329-478, which I'm not used to seeing. Does this mean his body is adjusting to the current dose?

Yes, I have been trying to use the Libre as our main meter, but it tends to read higher and because he is often over 350, Libre only gives a "HI" reading, so I check it with ReliOn. I've also had issues with keeping the Libre on him and error issues that it stopped working after a week. I'm thinking of only using the Libre when I want to do a curve, so I don't need to pick him all day and making ReliOn my main reader. Any advice? What I don't like is the two meters can be very far off from each other.
 
Hello and welcome. On this forum and with the dosing methods we use, we find it's best to use the same dose AM and PM. As you've discovered, he's higher in the AM with the lower dose at night. I think you've be fine going to 1.5 units for the next dose. Just so you know, with our dosing methods, we typically increase by 0.25 units at a time. And yes, that means eyeballing those dosing between the syringe lines.

Bouncing is completely normal for a newly diagnosed cat.

Here is the link to your previous post here, for some background: https://felinediabetes.com/FDMB/thr...review-starting-dose-freeze-dried-cbd.296785/. It's be helpful to us if you could fill in that signature, especially letting us know what type of food you are feeding now. Food is the second thing besides insulin, that can impact blood sugar numbers.
Thank you for the feedback. I thought the dosing should be the same, but this is what my vet recommended. Once I get more comfortable, I'll have more of a backbone to do what I think is right haha. And yes, I was thinking this morning that he would probably adjust better if I did only increase .25 at a time. That's what I'm going to do for the night dose.

The photo that I attached to the original post, of the Libre graph, is that what normal should look like? (except in a lower number range)

Appreciate your feedback!
 
Let me tag a few members about the doses. I'm sure they are going to tell you to give the same dose in the AM and the PM. I'm not experienced enough to give advice about doses .
@Wendy&Neko
@Bandit's Mom
@Bron and Sheba (GA)
@Suzanne & Darcy
Hi ladies can you please read her introduction post and post # 5 and 6.
Please look at her spreadsheet she now gave 1.5 units in the AM and 1.25 units last night

Before that she was giving 1.5 in the AM and 1 unit in the PM
 
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There's an inherent problem with how your vet is thinking about dosing. Lantus is a long acting insulin and it forms what is called a "depot." Pharmacologically, when you give an injection, Lantus forms microcrystals that are deposited in the fat tissue. These crystals largely dissolve over the course of the 12-hour cycle. However, not all of them dissolve. Thus, there's a bit of insulin in "storage." Because of the way the depot functions, this is what gives Lantus its longer duration than most insulin and there's overlap between the cycles. Every time you adjust the dose, there's an effect on the depot since you are administering different amounts of insulin. The first research on using Lantus with diabetic cats was conducted by Rand and her colleagues in 2009 and they authored the Tight Regulation Protocol. This dosing method stipulates the same dose at AM and PM and there's a minimum of 6 cycles/3 days (or a week if you're following SLGS which is not a researched approach) when you hold the dose in order to allow the dose to stabilize. By alternating your AM and PM dose, there's a very good chance you'll see wonky numbers.
 
I thought the dosing should be the same, but this is what my vet recommended.
My vet (who self admitted was not familiar with Lantus) suggested lower doses at night and higher during the day. She was used to the faster in and out insulins like Caninsulin (called Vetsulin in the US). I never did the different doses AM and PM - a locum vet had told me to follow what FDMB told me to do. :) Sienne gave you a great explanation above about what is happening inside the cat's body and why we find the same dose AM and PM is the best.

I see that 92 in there today. Nice! Was that with the Libre or the hand held meter? We do recommend that people test lower Libre numbers with the hand held as they can read high in lower numbers.
 
My vet (who self admitted was not familiar with Lantus) suggested lower doses at night and higher during the day. She was used to the faster in and out insulins like Caninsulin (called Vetsulin in the US). I never did the different doses AM and PM - a locum vet had told me to follow what FDMB told me to do. :) Sienne gave you a great explanation above about what is happening inside the cat's body and why we find the same dose AM and PM is the best.

I see that 92 in there today. Nice! Was that with the Libre or the hand held meter? We do recommend that people test lower Libre numbers with the hand held as they can read high in lower numbers.
92 was on the hand meter, lowest it has ever been. That was the day after increasing the night dose to 1.25. You will notice it bounced back up and has been going high and low ever since.

How would you recommend balancing out his AM/PM dose? I could increase PM dose to 1.5 so that AM/PM are the same? Or maybe give him a few more days on the 1.25 PM shot to continue to adjusting it up to 1.5/1.5?

The only other thing I have changed is feeding more frequently. The vet wanted me to feed 2x daily, but I am currently feeding 2 meals and 2 'snacks' daily. I just break out a small portion of each meal and feed a few hours after eating.

@Sienne and Gabby (GA) Your opinion on adjusting his dose?
 
Maybe start with 1.25 units both AM and PM and see what that does. With SLGS, you don't want to go lower than 90.

Today he is bouncing in reaction to that 92. Don't worry about it, perfectly normal though annoying to us. Focus on how low the dose is taking him instead.
Here is the definition:
Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
 
Maybe start with 1.25 units both AM and PM and see what that does. With SLGS, you don't want to go lower than 90.

Today he is bouncing in reaction to that 92. Don't worry about it, perfectly normal though annoying to us. Focus on how low the dose is taking him instead.
Here is the definition:
Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
So I would do 1.25 AM & PM, until he starts to balance out hopefully in a week or two? Then adjust both AM/PM to 1.5 if he is still trending high?
 
Yes, that is correct. The same dose both times will give us a good idea how the 1.25 unit dose is doing, and if nadirs (low points) are still too high, the dose would go up.
 
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