Updated Spreadsheet - need some advice

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Lkldcatlady

Lkldcatlady

Member Since 2013
I've updated Bob's spreadsheet. As you can see, my vet felt it was fine to increase Bob to 3 units from 2 units. The numbers last night look good, but he went down really fast and obviously, we had the symogi (sp?) effect this morning. My vet AND my diabetes specialist do not increase by smaller than one unit . HOWEVER, I'm thinking going slower is probably a good idea. I'm going to pick up the 3/10cc needles today and just want to hear some thoughts. I respect both the vets (so please don't tell me they are idiots ;-) ), but I'm seeing with my own eyes that I need to do this slower. I sent a couple of the articles I found here to them and hopefully they will read them. I'm a little worried because I can BARELY see the markings on the regular u-100 needle. I'm a little worried about trying to measure out the .25 units. I'm only 41 and still can see pretty good, but it's just soooooo smalllllll.....Anyway, I gave Bob two units this morning, but he was not in a good mood and basically walked away from the needle ohmygod_smile so pretty sure we had a partial fur shot. Should I go back to the two units for a little longer? The vet advised increasing based on the fact that bob's numbers were staying pretty high and he was still drinking alot. Otherwise, on the 2 units he seemed to be acting like his old self - beating up his brother Hector, playing, cleaning himself, sharpening his claws, jumping up on the furniture, etc.
 
Pick up a syringe magnifier at your drugstore when you pick up the syringes. I can send you pictures of the small doses if you are interested. Those 3/10cc syringes with 1/2 unit markings will make it easier to measure 0.25 or even 0.5U changes.

Ok, on Lantus we need to give the depot time to fill up. Initially, that is 5-7 days.

Here are the general guidelines for the initial dose and then changes.
"General" Guidelines:
•Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive 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 consecutive cycles).
•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.
Click to expand...

You held the initial dose for 4.5 days and then raised 1U based on your vet's advice. I would have liked to see a few nadir tests around +5 to +7 on day 3 and day 4 on that 2U dose before making that decision.

If your vet is not as familiar with Lantus, he may have based the changes on the pre-shot values. It should be based on the nadir or lowest point in the cycle. Some insulins like Humulin and PZI are dosed on the pre-shot values, but not Lantus and Levimir, because of their duration and depot effect.

You are seeing some of those low numbers since you have increased the dose from 2U to 3U. The depot has not filled yet and will continue to fill for a couple more days if you had stayed at that 3U dose.

I see that you have dropped the dose back to 2U as of this morning, 6/13. Would you please get a test or 2 around that +5 to +7 timeframe? If you are working, that may mean setting your alarm to get those tests. Bob may need a dose increase but we can't really tell without those nadir numbers.

Your vet's are not idiots, they simply follow different guidelines to raise the dose by 1U increments. Since we use the only vet journal published protocol, we do things according to that protocol for Lantus. Through years of study with many cats here, we even have made a few modifications to that protocol and have 2 different versions, TR (tight regulation) and SLGS (start low go slow).

Rant on: I hate it when I see vet bashing. We do not know the entire circumstances for the decisions. Nice link on DCIN Facebook page last night on how this is not productive. Written by Venita Wood, DCIN and posted here: http://catonmysleeve.blogspot.com/2013/06/vet-bashing.html Rant off.

Going slower and with smaller dose increases is more conservative. We tend to be conservative here. That is the big difference I think between us and your vets. Once you give the dose, you can't take it back out.

Since Lantus builds up a depot or storage area over several days, a dose change you do today may not be seen for several days.
 
Deb & Wink said:
I see that you have dropped the dose back to 2U as of this morning, 6/13. Would you please get a test or 2 around that +5 to +7 timeframe? If you are working, that may mean setting your alarm to get those tests. Bob may need a dose increase but we can't really tell without those nadir numbers.
Click to expand...

Thanks Deb - the first two days I got what I thought were "high flat curves" and that's why I called the vet, but I guess I really didn't get enough numbers. Maybe I misunderstood somewhere, but I thought I read that you should check at +3, +6 and +9 when starting a new dosage on Lantus. That's what I was trying to do the first two days.I will get those numbers tonight and post tomorrow. I pick up the 3/10cc needles tomorrow but I can do a couple more days on the 2U.
 
but I thought I read that you should check at +3, +6 and +9 when starting a new dosage on Lantus. That's what I was trying to do the first two days.
Click to expand...
Yes, you did read that somewhere. The reason for doing this, is to make sure the dose is not too high and dropping your cat too low. Safety.

It takes the depot 5-7 days to fill. After that, we are seeing the full effect of the insulin action for your cat. Until the depot fills, only part of the shot is going to work. The rest of the shot is going into storage, the depot.

You are new with the Lantus, so we don't know yet when nadir is. Yes, the first couple of days, getting the +3, +6, +9 is good. We just need a few more tests in that +5 to +7 timeframe to find Bob's nadir.

Testing for 2 days at the beginning was not enough to give us info on when the nadir is because the depot was not full yet. Now that the depot is full, finding the nadir is the next step and goal with testing.

Thanks for trying to get more mid-cycle tests in the next day or two.
 
If you are willing to do it, a test at +4, +5, +6 and +7 would be good. Some cats nadir early, especially at the beginning of using an insulin. So I added a +4. (My Wink always nadired around +3.5 +4.5)

Think Bob will let you do all those tests?
 
he will let me but last night he was getting extremely grumpy because he's used to sleeping all night. I think I'll wait until saturday and do it during the day. I really don't mind getting up and doing it, I just hate to stress him out. He's usually very agreeable to me getting his blood, but like I said - he was getting very moody last night because I was doing it every 30 minutes or so until I was sure he wasn't going down anymore. I'll post on saturday if you don't mind checking back then to see what you think. Thanks for your help!
 
Then only do one or two of those tests each day. You don't have to get them all in one day.

If your PMPS is early enough, maybe get a +4 before you go to bed.
If you are home early one day, take a +7.

Get a +4 and a +6 one day.
Get a +5 and a +7 another day.

It's all about filling in the holes on the SS around those mid-cycle times.
 
I agree with Deb.. I would like to see you hold the 2units for 3 whole days and get some more tests in (unless he drops under 50 in which case you immediately reduce the dose by 1/4 unit).

After three days, the depot will be full and we re-evaluate and if the dose isnt working we move him up by only 1/4 unit since we dont want to skip past the good dose. he might end up on 3 anyway but lets take it slow.

Wendy
 
Hi guys - I got the numbers you asked for - I got a couple of +4's the last two nights and today I did the +5, +6 & +7. What do you think? It look like he's staying pretty high and almost straight with the 2 units. My vet advised increasing 1/2 unit but I think I'll stick with the .25 increase. I ordered some needles with 1/2 unit markings (could not find them ANYWHERE in my area) and they should be here Monday. I would really like to increase his dose tomorrow if possible so I can keep an eye on him. Guess I can just "eyeball" the dosage. I'm looking at the needle now and wondering how the HECK I'm going to manage to measure out .25 of a unit. Any suggestions? It's a 3/10cc needle with 1 unit markings.
 
Hi Dara,

Got your PM to take a look at your SS. Thanks for the tests you have been getting.

Looks to me like Bob is still bouncing from the lows on PM of 6/12. Some cats take 72 hours to clear the bounce so we need to be a litle patient for one more cycle to see what is going on. If tonight's PMPS and +4 test are still high, I would consider raising the dose to 2.25U on 6/16 providing the AMPS is high as well (over 300).

If tomorrow's AMPS is lower, <300, Bob has probably cleared the bounce. Let's wait until tomorrow AM before deciding on a dosecrease.

It can be tricky to determine of the bounce has cleared if if the insulin dose is jsut not enough.
 
so you don't think he's back to where he was before that increase to 3 units (and subsequent low number)? I will check him in the am and post his number. I don't mind waiting until Monday to increase - I'm sure I'll have an easier time using the new needles!
 
His BG does look like it might be dropping today so we might see a lower PMPS too (lower than current +7) .. And if you do I would definately get some night tests in too to see how low he drops.

So let's see how it goes like deb says.
 
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