Opinions on Sam's curves please

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Aerya

Member Since 2013
Hi all,

This is my first time posting Sam's spreadsheet, so let me know if it doesn't work. It's in my signature. I don't have Excel, so the color codes were lost... :(

Long story short, Sam is 8-9 years old, grey tabby, very thin and used to pee like he didn't know how to hold it in (he's gained weight and stopped peeing as much). We changed his food right away in early March to low carb wet food (3 weeks on Purina DM to gain weight, then Friskies and Special Kitty to change it up a bit). We've started Sam on Lantus insulin on March 16 and gradually went up .5u every week (as per the vet). The vet only asks us to do a curve every weekend to check how the new dose is doing (start low, go slow approach, I believe), so we don't have random testing during the week, as Sam is still adjusting to the dosage.

Starting on Tuesday, April 2nd (PM shot), we started giving him 2units, twice a day as his nadir was not going low enough on 1.5u according to the vet. On Saturday, April 6th, we had a very low reading of 2.7 mmo/L pre-shot, so we didn't give him any shot, gave him food with gravy (more carbs) for breakfast, and got his BG higher throughout the day. Called the vet and she said to give go back to 1.5u starting that evening, since it looks like 2 units were too much.

Now he's been back on 1.5 units since that day and today (April 14) we were planning on doing another curve and his pre-shot reading was 1.7. So we gave him higher carb wet food again, and we've been taking his BG level every 2 hours. He's barely going up, but I think we may be able to give him 1.5u tonight (at 7pm) at mealtime.

Last week, I spoke to the vet and she mentioned that she thinks some cats need different dosages morning and night. He may need 1.5 in the morning and 1 at night or something else. I also read that Lantus can linger and which would explain low AMPS numbers.

Based on the fact that two weeks in a row he's been very low, do you think he could be slowly going into remission? Or the vet is right and we should be giving different dosage morning and night?

Do you think we should be doing tests during the week to get AMPS and PMPS readings to see if it's giving us similar numbers mid-week as during the weekend?

Thanks for your help/opinions!
 
hmmm, having a number as low as 1.7 at any time is definitely an indication that the dose is too much. I would reduce the dose immediately.

It does look like things are changing for Sam. If he was mine, I would start testing during the week (at preshot times and other random times when you are able) to get an idea of what the dose is doing for him. Sometimes once they start getting low numbers and start needing dose reductions, things can move pretty quickly. If his pancreas is healing, it can happen fast. Once a week curves might not be often enough to catch the low numbers, and you don't want a hypo.

Lantus works best if you give the same dose AM and PM. Rather than giving 1.5 in AM and 1 in PM, I would reduce to 1 or 1.25 and give the same dose all the time. Since he hit 1.7 (30.6 in US scale) I'm inclined to suggest 1 unit twice a day.
 
Thanks!

I'll speak with the vet today and will let her know I'll be doing AMPS and PMPS readings every day this week to see how it's going. We may be going down in dosage, we'll see. Will keep the chart updated.
 
So I just spoke to the vet and she said he may be going into remission soon. She said to give him 1.5u of Lantus only once a day (in the morning). We will still test him before his shot to make sure he's high enough for a shot, but it shouldn't be a problem.

Has anyone heard about giving Lantus only once a day? I thought it wasn't a 24h drug. On the other hand, Sam seems to hold on to his insulin longer lately, so his reading in the morning is lower than expected. I guess we'll see how it goes.
 
Yes, I have read about once daily dosing of lantus(glargine). It is not as common as bid dosing.


From this old 2005 article http://www.uq.edu.au/ccah/index.html?page=43599&pid=0
From this article on U of Queensland :

Some cats may have a preinsulin glucose concentration less than 12 mmol/L within 2 weeks, but it is suggested that insulin therapy be maintained for a minimum of 2 weeks to give the β cells more time to recover fully from glucose toxicity. The dose can be reduced to 0.5 to 1 U once or twice daily.
Click to expand...
 
Hello and welcome to the board

You really want to find a dose you can safely give twice a day.

It looks to me that 1.5 is also too high given he dropped so low last night - every time he drops below 2.8 you want to reduce by 1/4unit. I am going to ask some experienced dosers to come across but they might want you to drop the dose even further.

Wendy
 
Again he looks like he got a low number (2.5). I really think you should reduce his dose to 1unit - 1.5 is too high!

With any dose you want to hold the dose consistently for a few days to see how it does before changing it. Unless he drops again below 2.8 and then you reduce the dose by 1/4 unit immediately! After a low you will see high numbers for up to 72 hours which is why you want to keep the dose consistent until that reaction "bounce" has passed.

General" Guidelines:
Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Reducing the dose:
If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.
If an attempted reduction fails, go right back up to the last good dose..
Click to expand...
Wendy
 
Thanks for your post. I've sent all my results to the vet and am waiting for a call from her regarding the new dosage. I'm thinking of going back to twice daily shots, of maybe 0.5u each, to see how it's doing for a few days. He's been getting 0.75u and 0.5u this weekend because he was low, and it seems to have been ok. I'm just not sure if it's going to work if his BG AMPS is around 20, since it would take more to bring him down. I'll post an update once I hear back from the vet.
 
So I just spoke to the vet. She wants us to do 0.75u once a day (morning). We'll keep taking note of his AMPS to make sure it's normal and do a curve next Sunday. Wendy, do you have those pictures of the syringes with 0.75u? My husband is the one giving the shots so I'd like to show them to him to make sure it's constantly the right dosage. We're using the BD u-100 half-markings syringes. Thanks!
 
Here you go! You can see the black line of the plunger between the 0.5 and 1 unit mark.

5e86c3d4.jpg
 
Thanks for the pic! Very useful.

We used to do twice a day and don't mind it at all, but we've had him on one shot daily (1.5u) for the last week and it's been fine. The vet wants us to keep doing that, but with a lower dose. We'll see by next weekend if he should be going back to twice daily.
 
Hey there - can you let me know how things are doing? With that 3.3 the other day you might want to reduce the dose to 0.5 if you cant get more tests in.
 
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