Newly Diagnosed Dosing Advice

[Pam and Tango]

Hi everyone,

We are 6 days in to our start on Lantus. It has been a good adjustment and I have noticed higher than normal numbers, but recognize that may be normal in the beginning. In the weeks prior to starting Lantus we did try Senvelgo for 2 days but ketones quickly got out of control (up to 6) and that was stopped immediately. His BG readings then were are consistent average of 16.5, now we are up around 20-21. Is this of concern? Tango's starting dose is 1 unit twice a day. I plan to do a curve tomorrow so will have additional data to see how it is working.

Another question I have is how to dose on days you cannot be consistent with the 12 hour interval. That should be only once a week for me, but as I work that evening, his shot may be delayed by approximately 2 hours. He receives his dose at 6-6:30am and pm. On Tuesday evenings I will not be able to dose him until around 9pm. Any thoughts or suggestions for this?

Thanks!

 

[Bron and Sheba (GA)]

Hi and welcome to the forum.
We normally get you to post first over on the main health page until things are all set up, but you look as if you are pretty organised with the spreadsheet and the signature.
I'm very glad you were testing for ketones and you stopped the Senvelgo quickly. That is one of the drawbacks of the oral medications.
Would you mind putting ketones present up the top of the SS where it asks if there were ketones or DKA please? Also the type of insulin at the top of the SS please?
We like to know if there is a history of ketones as it can change how we give advice on dosing.

I see you have chosen SLGS dosing method.

Are you giving a good meal before the dose and then giving 2 or 3 snacks during all the cycles? With ketones in the picture I would be giving extra food as it is food and insulin which will keep the ketones at bay. We normally say to give 1 and a half times the normal amount of calories if ketones (or DKA) have been present. If you work and can’t be home to do this you might like to look at buying an automatic timed feeder to dispense the food. A lot of us use them and they are invaluable.
Are you testing the BG before you feed Tango? The routine is test/feed / give the insulin if the BG is high enough. I would recommend you try and get at least 1 test in during every cycle as Lantus dosing is based on how low the insulin takes the BG. Don’t forget about the pm cycle as that is just as important as the am cycle for testing.
With SLGS you will need to hold the starting dose for 7 days, unless the BG drops under 90, in which case you would reduce the dose by 0.25 units.
It takes time for the cat to adjust to the hormone insulin, so don’t expect results immediately. Some cats settle down quickly but most can take up to a few months or longer to start getting better numbers.
After you do the curve tomorrow, that will be 7 days and we can see about a dose increase.

Another question I have is how to dose on days you cannot be consistent with the 12 hour interval. That should be only once a week for me, but as I work that evening, his shot may be delayed by approximately 2 hours. He receives his dose at 6-6:30am and pm. On Tuesday evenings I will not be able to dose him until around 9pm. Any thoughts or suggestions for this?

There is not a lot you can do if you can’t get home until 2 hours after the dose. Just give the dose as soon as you can after testing and feeding.The main issue will be the following dose when it will be 2 hours earlier than normal and that can act like a dose increase. Are you at home on Wednesday mornings?
I’ll tag @tiffmaxee and @Bandit's Mom to watch out for you.
@Wendy&Neko lives in Canada so I will also tag her.

 

[Pam and Tango]

Hi and welcome to the forum.
We normally get you to post first over on the main health page until things are all set up, but you look as if you are pretty organised with the spreadsheet and the signature.
I'm very glad you were testing for ketones and you stopped the Senvelgo quickly. That is one of the drawbacks of the oral medications.
Would you mind putting ketones present up the top of the SS where it asks if there were ketones or DKA please? Also the type of insulin at the top of the SS please?
We like to know if there is a history of ketones as it can change how we give advice on dosing.

I see you have chosen SLGS dosing method.

Are you giving a good meal before the dose and then giving 2 or 3 snacks during all the cycles? With ketones in the picture I would be giving extra food as it is food and insulin which will keep the ketones at bay. We normally say to give 1 and a half times the normal amount of calories if ketones (or DKA) have been present. If you work and can’t be home to do this you might like to look at buying an automatic timed feeder to dispense the food. A lot of us use them and they are invaluable.
Are you testing the BG before you feed Tango? The routine is test/feed / give the insulin if the BG is high enough. I would recommend you try and get at least 1 test in during every cycle as Lantus dosing is based on how low the insulin takes the BG. Don’t forget about the pm cycle as that is just as important as the am cycle for testing.
With SLGS you will need to hold the starting dose for 7 days, unless the BG drops under 90, in which case you would reduce the dose by 0.25 units.
It takes time for the cat to adjust to the hormone insulin, so don’t expect results immediately. Some cats settle down quickly but most can take up to a few months or longer to start getting better numbers.
After you do the curve tomorrow, that will be 7 days and we can see about a dose increase.


There is not a lot you can do if you can’t get home until 2 hours after the dose. Just give the dose as soon as you can after testing and feeding.The main issue will be the following dose when it will be 2 hours earlier than normal and that can act like a dose increase. Are you at home on Wednesday mornings?
I’ll tag @tiffmaxee and @Bandit's Mom to watch out for you.
@Wendy&Neko lives in Canada so I will also tag her.

Thank you! Most of the time I will be home on Wednesday mornings and could dose later that day to give a bit of time and gradually work it back. Alternatively, I could give it 2 hours early? Is there a better approach?

 

[Pam and Tango]

I will add that information to the spreadsheet, I did have some on the world page but realized it doesn't copy over the US which appears when it is opened!

Yes, I test Tango before feeding, then feed along with the insulin administration. He receives a lunchtime meal as well, he did get quite skinny and is putting weight back on nicely. With your advice I will break that down into more frequent feeding and continue to add further calories. I am fortunate to be home at least half of the week during the day, so can monitor and test more frequently to see how he is adjusting.

I really appreciate the advice and will continue to be patient

 

[tiffmaxee]

Welcome! Giving insulin 30 minutes early every 24 hours usually has little if any impact on the bg. Would giving it at 7 instead of 6-6:30 help?