Should I increase Lantus after one week with no drop in BG?

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Christianna

Member Since 2014
Noodle started Lantus and tomorrow will be day 6. While he seems better each day, more alert and friendly and eating, drinking and peeing like a normal cat there has been no real drop at all in his BG numbers. I know from other forum members that Lantus has to build up slowly and that I might not see change right away but after one week shouldn't I see some trend downward? Is it too early to increase the dose slightly and what do you recommend? Thank you.

Christianna
 
Re: Should I increase Lantus after one week with no drop in

how low does he go between shots? Those are the numbers that determine dose adjustment. (Sorry - my phone seldom sees the spreadsheets).

If mid-cycle shots are above 150 mg/dL, you may increase at least 0.25 units. Have you decided if you are following the Tight Regulation protocol or the Start Slow, Go Slow protocol? Those provide guidance on when and how much to increase. Both are described in the Lautus Tight Regulation forum.
 
Re: Should I increase Lantus after one week with no drop in

Hi BJM,
Thanks for the response. So far, he has only gone to around 275 or so mid-cycle. Given that most mornings, pre-shot, he's at about 300-325, that's not much of a drop. The vet wanted me to do a start low, go slow trial and to report back to him after Noodle has been on Lantus 10 days. But I'm very interested in getting opinions here on the forum from people who are using or have used Lantus, so I appreciate your help.

Christi
 
Re: Should I increase Lantus after one week with no drop in

Here is the Tight Regulation protocol, which includes a link to a Start Low, Go Slow protocol.

You probably could raise it 0.5 units safely, just keep checking mid-cycle to see what the lowest value/nadir is.

Also, see my signature link Secondary Monitoring Tools for some tips on urine ketone monitoring. With glucose levels that high, it is important to be on the alert for these as more than a trace may indicate diabetic ketoacidosis (DKA).
 
Re: Should I increase Lantus after one week with no drop in

Hi Christianna and extra sweet Noodle!!

What's really important for you to do for the next couple of days is to start getting some tests in on the PM cycle. Most cats go lower at night, so it's possible Noodle is going low at night, and "bouncing" back higher the next day.

If you can at least get a "before bed" test in on the PM cycle, it will help to see what's going on overnight.

Also, if you can get a few more tests in during the AM cycle it will help too (although if you can just get one somewhere mid-cycle like you have been, that's fine!)

It might be ok to increase, but I'd only go to .75...at least until you have a few nighttime tests in
 
Re: Should I increase Lantus after one week with no drop in

Hi Chris and China,
Thanks so much for your suggestions. I know I haven't been testing quite enough, especially in the PM cycle. Had a crazy work schedule this week, DH did too, so getting our tests has been spotty :sad: I have been able to get in 3 tests so far today (day off) and will try to get in at least 2 more, one of them before bed. One problem we're having is that Noodle gets his shot around 8 a.m. (due to the crazy work schedule) and at 8 p.m. so getting in a test around 11 p.m. is the best we can do right now. I'm thinking of setting the alarm clock for maybe 2 a.m. and seeing what Noodle's BG is. The vet told me to test before each shot and at +4, +6 and +8. He never mentioned Noodle maybe going low at night so I really appreciate that tip! He also said to keep Noodle on the same dose for 10 days then do a curve but my gut tells me maybe Noodle needs a slightly higher dose, especially with the trace ketones. Otherwise Noodle is acting great, better than in ages. So hopefully the Lantus is having some slight positive effects somewhere, though not enough certainly. It's hard to be patient! I am so grateful for your help. I've felt overwhelmed with the newness of it this week but this forum has really helped.

Christi
 
Re: Should I increase Lantus after one week with no drop in

Hi BJM,
Thanks so much for the Lantus protocol with the Start Low, Go Slow link. I went and read, then re-read it to make sure I'm doing things right. Seems like things are taking awhile to sink in for me. Chris and China recommended more tests at night which my vet never mentioned so I'm very glad to know that too. I did not know so much that is in the Lantus protocol. Did I understand it correctly, that dose is based on mid-cycle number not on AMPS number or have I got that confused?Thanks so much for your help.

Christi
 
Re: Should I increase Lantus after one week with no drop in

Yes, the dose is based on the nadir, not the pre-shot number

The question we ask is "How low is this dose taking the cat?"

I hate to sound like a broken record, but without knowing how low he's going at night, I'm not sure I'd recommend increasing his dose...If you can get that test in at 11pm (so +3 if he gets his shot at 8pm) for the next few nights, that will help a LOT in knowing what might be going on, and if he needs an increase

Remember..high numbers take time to do their damage and Noodle has been diabetic for awhile before you ever knew...Low numbers can kill quickly, so we're always really careful about increasing...especially when we don't have the data necessary to make a decision to increase or not.

What does worry me is you are now saying he has trace ketones??
 
Re: Should I increase Lantus after one week with no drop in

Ketones are a by-product of fat breakdown for calories. Too many ketones may indicate diabeti ketoacidosis, a potentially fatal, expensive to treat complication of diabetes.

Please keep monitoring for ketones. If you get more than a trace, go to the ER immediately.
 
Re: Should I increase Lantus after one week with no drop in

Hi Chris and China,
Noodle didn't show any ketones today, thank goodness. But I am monitoring his urine every day, sometimes twice a day and it worries me too. The vet said there was a very small amount of ketones in the UA they did and wasn't very concerned as long as Noodle was eating and drinking fine and acting good, all of which he is. BUT he had hepatic lipidosis in May and barely made it through so we sure don't want to have that happen again. I think I'm more worried than the vet. What concerns me too is obviously the Lantus is taking awhile to start helping so what else can I do to help him until the insulin really starts doing its job? I'm going to test tonight at 11 and every night for a while in order to get a more complete picture of what's happening at night. If a kitty is going to go hypo, does it usually happen at nadir time or shortly after a shot?
Also I was so upset tonight. Noodle squirmed away after I gave him his shot and I saw a drop of blood. I'm so worried I punctured something. Has this ever happened to you before? It just made me sick. I will post all numbers as I get them and thank you so much for your help. I'm a nervous wreck these days :sad:

Christi
 
Re: Should I increase Lantus after one week with no drop in

You might have hit a small capillary. It should be fine - just like pricking an ear.
 
Re: Should I increase Lantus after one week with no drop in

Hi BJM,
I am testing once or twice every day and Noodle showed no ketones today. But he had them twice last week, trace, with no other symptoms. My vet knows this and I'm wondering why he didn't seem more concerned, because I sure am. I'm going to call him in the morning if Noodle shows any ketones at all. I don't know what to do to help Noodle, as the Lantus must be taking awhile to get into his system and that would fix the ketones, right? Thanks so much.

Christi

P.S. Thanks for responding about the blood. I hope that's all it was but it sure upset me. I'm so NOT GOOD at this.
 
Re: Should I increase Lantus after one week with no drop in

We recommend you always test before you shoot.

Things happen, like fur balls, food batch changes (watch the can codes), occasional GI upsets, etc., which can substantially affect the glucose levels. If you shoot and he's too low for safety, he could hypo on you.

Dose adjustments are made primarily based on how low he goes between shots, aka the nadir. That usually happens between +5 to +7 hours after a shot of Lantus. Whenever you can, snag at least 1 test during that period. Using a human glucometer, you want him no lower than 50 mg/dL when on insulin.
 
Re: Should I increase Lantus after one week with no drop in

Getting his blood glucose under better control should help prevent ketone production....in the meantime, as long as you're testing for them and not getting more than a "trace", just keep monitoring him.

Adding water to his canned food to make it more "soupy" will help too...the more water you can get into him, the better it is for his kidneys.

Lantus usually nadirs somewhere mid-cycle (Nadir is the lowest point in the cycle), so usually around +5 to +7, but some cats nadir earlier and some later in the cycle....it's very much one of those ECID things (Every Cat Is Different)....and just because he nadirs at +6 today doesn't mean he won't nadir at +4 (or +8 or +5) tomorrow. The nadir can change from cycle to cycle, but the reason we suggest all the testing is to narrow it down to when you can kind of expect it with your cat.

I really like getting a +2 because it can kind of act like a crystal ball....If the +2 is about the same as the Pre-shot number, you can expect a fairly normal cycle with the numbers gradually going down and then gradually going back up ....Kind of like the bottom line on a smile :smile:

If the +2 is lower than the pre-shot, it's a good indication that you should try to get some more testing in because they might be going too low later in the cycle (below 50 is too low)...and if you absolutely can't get a test in, you can leave food down so kitty can eat if his blood glucose does drop. Most cats will go looking for food if their BG goes low

If it's higher than the pre-shot, it could be indicating that kitty is starting a bounce. Bounces happen when their BG goes lower than their body has become used to, so their liver releases stored sugar and hormones to bring it back up quickly. The more time you can keep them in "normal numbers", the more used to them the liver will become and (hopefully) will stop bouncing so high.

As long as he's eating well, you really don't have to worry so much about the hepatic lipidosis...that happens when they aren't eating enough for over 24 hours.

There's really no "set" time that a cat may hypo...it depends on where they start, the dose their on and if it's too much. Again, that's why we're so big on testing so you can learn how YOUR cat responds to both insulin and food.

If you can get some tests in during the PM cycle for the next couple of nights and it doesn't look like he's going too low at night, we'll probably have you increase his dose to .75 in a couple of days. We don't like seeing him in those icky numbers any more than you do, but our first concern is to keep him safe...and without knowing for sure what's going on at night, we can't know that he needs more insulin.

Think of your spreadsheet as a puzzle....if the only pieces you have in the puzzle are on the edges (pre-shots) or only on half the picture (only AM readings), it's impossible to know what the picture really is!
 
Re: Should I increase Lantus after one week with no drop in

Hi Chris and China,
Wow, thank you so much for all that information! Those were some of the best explanations I've ever read and much of it was new to me. Thank you so much.
I talked to the vet today about the trace ketones that come and go and he said what everyone on here has said--keep monitoring, which I'm doing and as long as Noodle is acting fine, which he is, just keep a close eye on him as we try to bring those BG numbers down. Trouble is, Noodle is showing no real movement in his BG which I told the vet. He wants me to increase Noodle's dose to 1 unit twice a day starting tomorrow. Do you think that's too fast an increase? It scares me. I will be testing Noodle after the pm shot again but am a little nervous about essentially doubling his dose. Everyone keeps telling me to be patient and I'm trying to be but it does seem like Noodle's BG should be coming down at least a little. At this point, I assume you'd advise against 1U until I have further test data? Thanks for your help!

Christi
 
Re: Should I increase Lantus after one week with no drop in

If you increase, make it small. We do most increases in 0.25 unit amounts, 0.5 if the nadirs are over 300 mg/dL.
 
Re: Should I increase Lantus after one week with no drop in

Hi Christi!!

I agree with BJ...I'd increase to .75 and just continue getting those tests in

You don't want to try to do .1unit increases (like to .6) since right now, we need to get his numbers down some. You will want to do increases and decreases in full .25 increments

Once we find a "good dose" for Noodle, we might want you to try to get a "fat" or "skinny" dose in, but for now, just stick with the protocol and do your changes in .25

Once you go to .75, you'll want to hold that dose for at least 3 days (unless it drops him below 50) and keep getting those tests in...especially on the PM dose....at least a test right before you go to bed

You'll soon learn that sleep deprivation comes right along with the insulin, the food change and the poking....lol
 
Re: Should I increase Lantus after one week with no drop in

Hi Chris and China and BJM,
Thanks for the good advice. The .6 dose was nothing but a chicken attempt to increase it slightly because I was too scared to go higher. But I took your advice and gave .75 today and tonight because either I or my husband could monitor Noodle closely. Unfortunately the numbers haven't budged except for a higher number this evening--going in the wrong direction! I still don't believe I've pinned down Noodle's nadir and if I read it right the nadir can change somewhat from day to day? But I was very relieved to get 2 urine samples from Noodle today, both negative for ketones. Such a relief, as that was one of my biggest worries. I still don't understand absolutely NO movement on her BG after 1 week. Am I being too impatient? Noodle acts great otherwise and I'm so happy for that, just worried about those darn numbers :-( Thoughts?
Thanks!

Christi
 
Re: Should I increase Lantus after one week with no drop in

Oh, yes, how do I measure .75? I really felt like I was just wingin' it the two times I did it. Made me nervous. What's the best way? Thanks.

Christi
 
Re: Should I increase Lantus after one week with no drop in

Those "in between the lines" doses are hard on everyone! The important part is that you keep it consistent though...decide where you think .75 is and try to keep giving that same amount for at least 3 days

You can take a used syringe and some colored water of some kind and pull up what you think .75 is and then when you do the insulin, compare back to your "sample" to make sure it's the same.

You can try using calipers.....Here's Marje's Dosing with Calipers thread to look at.

Each time you change the dose you have to wait 3 days to see how they do. I know it's frustrating, but it's the only way to make sure you don't skip over a "best dose"
 
Re: Should I increase Lantus after one week with no drop in

Thank you Chris and China. I'll practice with the colored water. I searched around on the internet to see if anyone sells syringes with .25 markings and haven't found any yet. You'd think someone would make them. You're right--it's hard to be patient and adds some extra stress when I'm not sure I'm getting the exact same .75 each time. I've sprouted quite a few gray hairs in the past few weeks :shock: Thanks for talking me through some of these issues!

Christi
 
Re: Should I increase Lantus after one week with no drop in

Larry and Kitties said:
They do not make an syringes with 1/4 unit markings
Click to expand...


Thanks Larry. Guess I can stop my fruitless search!

Christi
 
Re: Should I increase Lantus after one week with no drop in

Actually, if you were an experimental laboratory, they do make such tiny syringes ... of glass, and they are autoclaved between uses. They are very pricey syringes and require very pricey cleaning equipment.

(Because I searched too, found them, and discovered they really weren't feasible for us.)

Ex: http://www.microsyringes.com/hplc-syringes
 
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