Vet's dosage increase instructions versus SLGS

Tahirah & Fidget

Tahirah & Fidget

Member Since 2019
Hello!

I posted last night in my state of daily panic and doubt around this whole thing and had a bit of a follow up. My vet got back to me this morning telling me to increase Fidget to 2u twice daily from our current 1u twice daily. She wants me to start that tonight, and to do another curve test and send her the results next weekend. I agreed, but now looking over more information I feel a bit torn from what I've read about doing such big increases. Despite the conflicting information, I know there are several diabetic cats that she treats and she is highly praised in the community--her practice is the highest ranking vet in my area--so there is a level of trust on my end.

I have looked at a couple of pet's spreadsheets from users on here and seen full unit dose increases, which is reassuring. But if the risks are that serious, is there a way to meet somewhere in the middle? I don't feel comfortable challenging my vet, but I also don't want to risk Fidget's health. I was wondering exactly how unsafe it is to do such a large increase. Despite SLGS suggesting a dose increase of 0.25u, would increasing from 1u to 1.5u would be an acceptable compromise?

As always, thanks ahead to those that take the time to respond and help me understand this better, it means the world to me and Fidgey!
 
Some people give higher increase because kiity has a high dose condition and have been doing this a long time and know their cat and how they respond. That being said.

You are very new to this. The depot has just filled. You gave 1.25 last night, SLGS you raise by 0.25 units and you should msintain the 1.25 units for 7 more days. The reason for small increases is that you do not want to by pass what could be the optimal dose needed. If given higher increase it could put Fidget in a precarious situation.

My Olive is a high dose condition kitty, so we have to go out of the box. Do not copy what we do.

You should stay with the 0.25 increases and maybe speak with vet snd let her know you are uncomfortable with such a large one.
 
Getting conflicting information from your vet and what you read here can be so conflicting, it definitely isn't easy to make decisions on what to do, especially if you have a vet you know and trust. We’ve all been there.

1u is a very large increase. I know where you're coming from, if you look at Mowgli's spreadsheet on March 30, I decided to increase Mowgli's dosage by 0.5u because he was high so often. He dove down all the way to green, and even though he was safe in the end it scared me enough to believe in the 0.25u at a time is the safest way to change dosage. I was lucky that I had thought to do another test before bed, it could have been another story if I wasn’t there to feed him and boost his numbers.

May 5th/6th is also a good example of how much of a difference even 0.25u can make. Of course Fidget and Mowgli aren’t the same cat but these are just a couple of examples where I forgot to put on my patience pants and got pretty close to a dangerous situation.

I like to share the advice that was given to me when I first started here (just mentioned it to someone yesterday!): This is a marathon, not a sprint. Fidget is just getting used to Insulin, he will get there as his body builds his depot and learns to properly use the insulin :)

In the end Fidget is your cat so you can give the dose you feel is best whether it’s advice from this board or from your vet. My personal experience with dose changes for Mowgli is that over 0.25 is too much for him. I would encourage you though, if you do decide to go for the full 2u to make sure you can be home to monitor for the full day in case anything goes wrong, read over what to do in case of a hypo event and what to keep in the house for your hypo treatment kit.

Welcome to the Lantus Basaglar and Levemir Board, you’ll get a lot of support here, don’t be afraid to ask questions and if someone knows the answer they will offer it to you.

Looking forward to seeing your updates on the forum :):)
 
Here is your post from the main board. We link them so we can look back easily:)
http://www.felinediabetes.com/FDMB/...-dosage-and-bg-that-just-wont-go-down.215640/
I agree with others. I know it is hard to go against vet advice. A lot of vets go up in 1 unit increments and it is too much unless the kitty has another problem which needs faster increases. Your kitty is only very new to FD and by increasing in 1/4 increments you will be doing the best for your kitty. 1/4 unit can make a huge difference to the BSLs. 1 unit is doubling the dose.
If you explain to the vet, you will be teaching her something new and hopefully she will take it onboard.
I agree with everything Paula has said.
A dose takes several days to get the full effect because it is a depot insulin so you will need to be monitoring closely all the time if you go with the full 1 unit.
 
Hello and welcome from a fellow Torontonian. Fidget is adorable!

0.25u increases are optimal. Insulin is a hormone not a medication. It's not like one aspirin vs. two for a headache. Hormones affect the body differently and doubling the dose could just hold up getting Fidget regulated rather than speeding up the process. If you bypass the optimal dose, it's a lot harder to back up and figure out what works than to move forward slowly and methodically. Take it from a kitty Mom who learned the hard way.

Ultimately, the decision is yours and taking the advice of a pile of strangers on the internet over your vet's counsel is a tough decision. A half unit increase would be a reasonable compromise but I definitely wouldn't skip all the way to 2u.
 
Amanda - Thank you so much for such a thoughtful response. I've been scared of hypo since the start, so I've been reading up on it as much as possible and have a little kit sorted already! I do have the advantage of starting this on a Friday, as I'll be home with Fidget all weekend. I'm still not terribly comfortable with leaving him unmonitored until I get more comfortable with all of the changes. It's definitely a lot to think about. I'm checking his numbers in 30, so that will maybe give me better insight as well.

Bron - Thank you for sharing the link that way! I'll keep that in mind going forward :-)

Linda - Nice to see another Torontonian! And thank you, your kitty is adorable also!! That's a great way to put it--that it's not like an aspirin. It is a tough decision, and I feel bad for wanting to follow the advice of my vet because this is a great community, and I don't want to feel like I'm going against people that have a different kind of experience. I still have some time to make a decision. I think I'm leaning toward a compromise in the middle, and call my vet tomorrow to follow up about not feeling comfortable jumping straight to 2u. I'll be home all weekend to monitor Fidge anyway, and absolute worst case there is also a vet clinic directly outside of my apartment, albeit not a great one.
 
If you happen to be in the west end, I have a great vet who works with you as a partner not a dictator I think you'd like. She was quite impressed with the information I got from here and I managed to get my high dose girl with a secondary confounding condition that my vet had no experience with into remission thanks to the experience and knowledge here.
 
AmandaE said:
Getting conflicting information from your vet and what you read here can be so conflicting, it definitely isn't easy to make decisions on what to do, especially if you have a vet you know and trust. We’ve all been there.
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It is conflicting, but I went through the same dilemma as @Tahirah & Fidget.
I know that this board recommends SLGS, but my vet started Sophie on 2 units twice daily. I trust my vet - who has treated many diabetic cats over the past 25 years and who is currently treating four. My Sophie's numbers were high enough, and we have to get her regulated before mid-August, so I decided to follow my vet's advice.

Sophie is now on 3 units twice daily and she will be staying on that dose. Her numbers are usually in the yellow range with the occasional blue, which isn't ideal, but which will be safer while she is in a cattery, where it won't be possible to watch her as closely as we do.

Tahirah, you know Fidget better than anyone else does. I'm not telling you what to do, but Fidget's numbers still look high enough for not running a great risk of a hypo if you increase the dose to 2 units - and you will be checking his blood sugars carefully.
 
MrWorfMen's Mom said:
If you happen to be in the west end, I have a great vet who works with you as a partner not a dictator I think you'd like. She was quite impressed with the information I got from here and I managed to get my high dose girl with a secondary confounding condition that my vet had no experience with into remission thanks to the experience and knowledge here.
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Unfortunately I'm in the east, but I sought out the highest rated vet in my neighbourhood and switched from the closer one I had been using with my previous two cats, and I've been happy so far. She was really happy with how much knowledge I had coming into the diagnosis (I had been using FDMB as a reference while we were waiting for the blood test results pre-diagnosis just so I knew something going in), and has made me feel the most at-ease than any vet I've been to in my 20+ years of owning cats. If the west end was more accessible to me I would always be happy to meet another vet, so thank you!

Celle said:
It is conflicting, but I went through the same dilemma as @Tahirah & Fidget.
I know that this board recommends SLGS, but my vet started Sophie on 2 units twice daily. I trust my vet - who has treated many diabetic cats over the past 25 years and who is currently treating four. My Sophie's numbers were high enough, and we have to get her regulated before mid-August, so I decided to follow my vet's advice.

Sophie is now on 3 units twice daily and she will be staying on that dose. Her numbers are usually in the yellow range with the occasional blue, which isn't ideal, but which will be safer while she is in a cattery, where it won't be possible to watch her as closely as we do.

Tahirah, you know Fidget better than anyone else does. I'm not telling you what to do, but Fidget's numbers still look high enough for not running a great risk of a hypo if you increase the dose to 2 units - and you will be checking his blood sugars carefully.
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Thank you so much for this. I had reached out to another user here who went from 1u to 2u, with no issues. My vet also advised that for now if I get a reading of 15 or lower on my Alphatrak to hold off on the shot to minimize the chances of hypo until we nail the dose. I also have no problem doing a before-bed check tonight and some extra ones throughout the day tomorrow. I've only been a bit more conservative in testing after last weekend when I had to buy new strips, which ran me $100 for 50! Expensive little cat, haha.
 
Hi There and welcome to L, B, & L forum. Fidget is adorable, but then I am partial to orange cats. :)

I agree with the others with the dosing increases. By raising in increments of .25 unit you will be doing it methodically and safely. Another thing to consider is that sometimes too much insulin can look like not enough so all the tests that you can get in a cycle is good data to know what that dose is doing for Fidget.

It appears that you are working during the daytime by your SS and unable to test during the daytime, another reason to raise slowly to keep him safe. Are you able to get in a +2 in the AM cycle before you leave for work? That would give you an indicator of how the cycle could play out. If the +2 is the same of lower than the pre shot number, then the cycle could be active and then you might want to leave him some food if you don't all ready do that to help bolster him.

Keep asking questions as there is big learning curve with Feline Diabetes for sure. We are here to help.
 
Bobbie And Bubba said:
Hi There and welcome to L, B, & L forum. Fidget is adorable, but then I am partial to orange cats. :)

I agree with the others with the dosing increases. By raising in increments of .25 unit you will be doing it methodically and safely. Another thing to consider is that sometimes too much insulin can look like not enough so all the tests that you can get in a cycle is good data to know what that dose is doing for Fidget.

It appears that you are working during the daytime by your SS and unable to test during the daytime, another reason to raise slowly to keep him safe. Are you able to get in a +2 in the AM cycle before you leave for work? That would give you an indicator of how the cycle could play out. If the +2 is the same of lower than the pre shot number, then the cycle could be active and then you might want to leave him some food if you don't all ready do that to help bolster him.

Keep asking questions as there is big learning curve with Feline Diabetes for sure. We are here to help.
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Thank you so much for your response! Unfortunately the earliest I would be able to get before work is +1, which I don't think would be as effective as I think I remember reading that the numbers don't really start changing until +2. Changing his time wouldn't be convenient either, as I work slightly extended hours. I'm happy to do as much extra needed over weekends though! Thank you again :)
 
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Unfortunately the earliest I could get before work is +1, which I don't think would be as effective as I think I remember reading that the numbers don't really start changing until +2.
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Not necessarily. Onset varies depending on the cat. (A very popular term here is ECID - every cat is different.) Gabby's onset was typically around +2 but sometimes her numbers were dropping by +1. Likewise, nadirs are not always at +6. Some cats have either early or late nadirs. Gabby's nadir was at around +3 -- except when it wasn't. Nadirs can shift around. In other words, the more data you collect on Fidget, the more information you'll have and know when your cat's onset and nadir fall.

There is a dilemma with regard to the dose advice you were given. I agree that a 1.0u dose is way too large. However, if you were following Tight Regulation and based upon the majority of your nadirs being above 300, you could increase by 0.5u. The difficulty, though, is that you have very limited data reflecting the nadir. It's just as important to get PM cycle data as AM cycle and it's especially important to get PM tests if you aren't home to test during the day. I'd urge you to get at the very minimum, a before bed test every night.

Please keep in mind that Lantus dosing is based on the nadir, not on the pre-shot value. Without having a better idea of where the lowest numbers in the cycle fall, it's hard to make a good decision about increasing the dose.
 
Sienne and Gabby (GA) said:
Not necessarily. Onset varies depending on the cat. (A very popular term here is ECID - every cat is different.) Gabby's onset was typically around +2 but sometimes her numbers were dropping by +1. Likewise, nadirs are not always at +6. Some cats have either early or late nadirs. Gabby's nadir was at around +3 -- except when it wasn't. Nadirs can shift around. In other words, the more data you collect on Fidget, the more information you'll have and know when your cat's onset and nadir fall.

There is a dilemma with regard to the dose advice you were given. I agree that a 1.0u dose is way too large. However, if you were following Tight Regulation and based upon the majority of your nadirs being above 300, you could increase by 0.5u. The difficulty, though, is that you have very limited data reflecting the nadir. It's just as important to get PM cycle data as AM cycle and it's especially important to get PM tests if you aren't home to test during the day. I'd urge you to get at the very minimum, a before bed test every night.

Please keep in mind that Lantus dosing is based on the nadir, not on the pre-shot value. Without having a better idea of where the lowest numbers in the cycle fall, it's hard to make a good decision about increasing the dose.
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I keep forgetting ECID! Thank you--this is absolutely great advice and something I'll keep in mind. I'm going to definitely be doing a before bed test going forward, as well as +1/+2 when I can, which in the evening will almost always be possible. I've settled on a 0.5u increase for now, and will be keeping a close eye on Fidget for tonight. I'm planning to call my vet first thing in the morning to have a more in-depth discussion about her recommendation as well. Thank you.
 
Tahirah & Fidget said:
Thank you so much for your response! Unfortunately the earliest I would be able to get before work is +1, which I don't think would be as effective as I think I remember reading that the numbers don't really start changing until +2. Changing his time wouldn't be convenient either, as I work slightly extended hours. I'm happy to do as much extra needed over weekends though! Thank you again :)
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Welcome to the forum! I'm also pretty new & everyone here is SO helpful! My cat just started on Lantus yesterday-switched after unsuccessful with Vetsulin. Thank you for sharing your challenge because dosing does seem to be a bit tough & like you, I trust my team. With that being said, I also check out others' experience/thoughts & then try to pull it all together to make a decision. As Amanda said, this is definitely a marathon & she reminded me of that this morning--THANK YOU Amanda & also others who provided their much needed insight & support!!

I also definitely noticed what people have been saying about the +2 at night. Yesterday was 300s during the day (which kind of freaked me out) but then I got a nice 257 +2 after evening insulin & today the lower number came at +8. Obviously its super early for us with the depot, but still interesting to see how the random checks are important. Learning day by day! I'm happy to hear you have a vet that is open to a discussion--thats key!
 
Amy47 said:
Welcome to the forum! I'm also pretty new & everyone here is SO helpful! My cat just started on Lantus yesterday-switched after unsuccessful with Vetsulin. Thank you for sharing your challenge because dosing does seem to be a bit tough & like you, I trust my team. With that being said, I also check out others' experience/thoughts & then try to pull it all together to make a decision. As Amanda said, this is definitely a marathon & she reminded me of that this morning--THANK YOU Amanda & also others who provided their much needed insight & support!!

I also definitely noticed what people have been saying about the +2 at night. Yesterday was 300s during the day (which kind of freaked me out) but then I got a nice 257 +2 after evening insulin & today the lower number came at +8. Obviously its super early for us with the depot, but still interesting to see how the random checks are important. Learning day by day! I'm happy to hear you have a vet that is open to a discussion--thats key!
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Welcome as well! I'm happy with my compromise for now and plan on doing lots of extra checks this weekend as it's a bit harder during the week for me. Absolutely just taking it one day at a time. I imagine if I didn't have FDMB and was just following my vet's instructions that I still wouldn't be too terribly off, and if I were I have the proper resources to help him. So it's just nice having a second opinion from a great group of people! I hope everything goes well for you and Mr T :-D
 
L
Tahirah & Fidget said:
Welcome as well! I'm happy with my compromise for now and plan on doing lots of extra checks this weekend as it's a bit harder during the week for me. Absolutely just taking it one day at a time. I imagine if I didn't have FDMB and was just following my vet's instructions that I still wouldn't be too terribly off, and if I were I have the proper resources to help him. So it's just nice having a second opinion from a great group of people! I hope everything goes well for you and Mr T :D
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Looking forward to traveling the Lantus road with you & Fidget :)! Heres to better numbers SOON!!
 
One thought when you speak with your vet... To let your vet know that you're uncomfortable with a large increase is truly OK. I'd let your vet know that given your work schedule, you're gone much of the day and you don't want to put your kitty in danger of numbers dropping if you're not home. Taking it slowly so you have a better understanding of how Fidget is responding is not unreasonable. I would, however, be worried if your vet could not provide you with a cogent explanation for why to increase by 1.0u. (It's also a very subtle way of reminding your vet that s/he is liable if you follow the 1.0u increase and something happens to Fidget.)

A question -- those spreadsheets you noted where there were 1.0u increases, are you sure these weren't high dose kitties (e.g., acromegaly)? Once a cat is at a large dose, the size of the increase is larger.
 
Sienne and Gabby (GA) said:
One thought when you speak with your vet... To let your vet know that you're uncomfortable with a large increase is truly OK. I'd let your vet know that given your work schedule, you're gone much of the day and you don't want to put your kitty in danger of numbers dropping if you're not home. Taking it slowly so you have a better understanding of how Fidget is responding is not unreasonable. I would, however, be worried if your vet could not provide you with a cogent explanation for why to increase by 1.0u. (It's also a very subtle way of reminding your vet that s/he is liable if you follow the 1.0u increase and something happens to Fidget.)

A question -- those spreadsheets you noted where there were 1.0u increases, are you sure these weren't high dose kitties (e.g., acromegaly)? Once a cat is at a large dose, the size of the increase is larger.
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Great point, thank you! I'm hoping to swing by the vet today so hopefully will be able to have a more in depth discussion with my vet. The person I reached out to was not a high dose kitty, it looked like they followed a similar pattern to what Fidget has been advised, increasing by 1u until getting it right and bringing it back down as the numbers look better. We've been good since last night and I have a close eye on him but I definitely want to bring up my concerns of comfort moving forward, especially as I'm not always home during the day to check +2 or +5/+6, etc.
 
Tahirah & Fidget said:
Welcome as well! I'm happy with my compromise for now and plan on doing lots of extra checks this weekend as it's a bit harder during the week for me. Absolutely just taking it one day at a time.
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I think that’s the perfect idea! A compromise between the vet and what you’ve read here while monitoring closely! The important piece is that you’re monitoring with a larger increase! Good luck with the increase today :)
 
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