You can gradually shoot lower and lower with Lantus as you collect data to show it is safe. The key thing is collecting that data and to understand it. So here are some tips on understanding glucometer results.
An important note about glucometers: The FDA allows glucometers to be sold which read within 20% of what a lab test might get. This means that any test represents a range of possible values.
For any 2 tests, they may be considered equal if they overlap, ie. 1.2 * low value is greater than 0.8 times the high value.
In general, a pet-specific glucometer will read higher than a human glucometer. At the low end of values, that difference is approximately 30 points. At the high end of the scale, it doesn't matter. If the test is high, its high and you take the appropriate action based on the insulin you are using.
If there is another medical condition affecting the glucose levels, you treat that condition and adjust the insulin.
Here are some glucose reference ranges used for decision making
using a human glucometer:
< 40 mg/dL
- Treat as if
HYPO
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.
< 50 mg/dL
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50.
- At nadir, often indicates dose reduction is earned.
50 - 130 mg/dL
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s; if
not on insulin, this can be safe.
> 150 mg/dL
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.
180 - 280 mg/dL
- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.
>= 280 mg/dL,
if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones;
if more than a trace level of ketones, go to vet ASAP.
