Please help with dosing & regulation

[tarams]

Thank you for any help or advice you can give. We started with Lantus Fri eve & have been giving 1u morning & night. Here's what our #'s look like:
Fri PM 426
Sat AM 391 (after 1 dose of Lantus here I was thinking great, our #'s are going down!)
Sat PM 476
Sun AM 433
Sun (eve/3 hrs before due for test/shot & only because he was crying to eat) 463

Is it too soon to really start seeing a real difference? Do I need to up to 1.5 or 2u? Or just keep going at 1u & hope to see a change soon?
Thank you....

 

[MommaOfMuse]

Sorry I haven't really been following everything on the boards right now so I don't really know the back story on Paws..I have a very sick little girl right now that has been taking most of my time, so please forgive me if you have answered this somewhere else...

Are you only getting preshot test? If you are then it is really hard to say, hold or go up or go down...see Lantus dosing is based off the lowest part of the cycle (the twelve hours between shots is a cycle) or what you will see referred to as the Nadir. Now usually the nadir is right around +6, but some cats it can be earlier and some cats it can be later, but you can get a general idea of how low they are going by testing around +6. But without those mid-cycle tests we can't tell you if she is staying high, going low and bouncing.

With Lantus if you are using the start low go slow protocol you want to hold a dose for a week and then on a day off when you can be with Paws all day, run a curve (testing every 2 hours between shots) to give you not only an idea of where Paws' nadir is, but how low she is going. Because the lowest point is what decides the dose not the preshot values..The preshots are to make sure they are high enough to give insulin in the first place.

Mel, Maxwell, Musette, Autumn & The Fur Gang

 

[Sienne and Gabby (GA)]

It doesn't look like many people are responding to your inquiry. There is a great deal of information on the Lantus Tight Regulation board. This is an outline with links to that information. Hopefully this will help to answer many of your questions and get you started.

• Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal versions -- the Tilly Protocol developed by the counterpart of this group in Germany and the Queensland/Rand protocol developed by Jacqui Rand, DVM and published in one of the top vet journals.
• New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
• Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
• Lantus depot/shed: This is an important concept for understanding how Lantus works.
• Lantus & Levemir: Shooting & Handling Low Numbers: What data you need in order to be able to work toward remission or tight regulation as well as information if you have a low pre-shot number or a drop into low numbers during the cycle.

The cats on the Relaxed forum typically use the Start Low Go Slow (SLGS) protocol. You are welcome to post here or on the Tight Regulation forum as there are several people who use the SLGS approach and post on the TR forum.

 

[Blue]

You had asked for a link to making a spreadsheet; you can try this one:
Create your Spreadsheet

I am glad you have your numbers from pre-shots; now you need to see about testing in mid-cycle because your dosing for Lantus is based on what's happening in the middle of the 12hours....

if you test after about 6hours (at +6) and you get a number that's in the 200s or so, you know that the Lantus is working a bit and the dose may be not too bad.

If you test around +6 and get a number that has not dropped all that much, you may need a bit higher dose.

Now, after 3 days, you may start to see some improvement in how the cat is acting, even if the numbers don't look that great yet. We don't know how long our cats have been diabetic, so it sometimes takes a bit of time to convince the cat's body that those lower numbers are the good ones!

For Lantus, when first started out, it's advised to hold the dose for 5 to 7 days.... build up the shed and let the cat settle in, and then think about changing the dose.

I know people give links, but it's more convenient to see some of the stuff right here, in addition to be given the links.

here is the gist of the protocol that many people giving Lantus are following:


"General" Guidelines:
--- Hold the initial starting dose for 5 - 7 days (10 - 14 cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 cycles).
--- Each subsequent dose is held for a minimum of 3 days (6 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 cycles) if nadirs are less than 200 before increasing the dose.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
--- After 3 consecutive days (6 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.
--- Try to go from 0.25u to 0.1u before stopping insulin completely.

Random Notes...
Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.

A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.

Sometimes a dose will need to be "fine tuned" by adding some "fat" or "skinny-ing up" the dose.


Now, see if you can get some mid cycle tests... it does not have to be every cycle, but when you can, and then maybe around Tuesday or Wednesday, you will have an idea how this dose is working.
If you want to know sooner how it's going, you can see if you can get a couple tests mid-cycle today.... test at +3, +6, +9, if possible, and if you are still getting pretty flat and high numbers, you don't have to wait the full 5days, especially since you were already giving some insulin before and you feel you are seeing some improvements.

If the mid-cycle test numbers are 300 or higher, then you can increase the dose from 1u to 1.5u.
If the mid-cycle test numbers are sometimes between 200 and 300, then make your increase only up to 1.25u.

Be sure you have syringes with the 1/2 unit markings because there will be many times that you need to give doses that are between full and half units.

Keep in mind that you WILL see changes in the cat before you see them in the numbers.
Also, you want to be testing urine when you get a chance for ketones with KETOSTIX from the pharmacy. Some cats are prone to ketones, while others can have high numbers for long stretches and never get ketones. If you test and get anything other than negative, post the result you get so people can help you with what to do.

I was quite fortunate that both my cats never registered any ketones, despite their high BG numbers, but other cats who are prone to ketones will register some even if they have lower BG numbers.... it's not just with higher BG, so it's something to know about your cat.