When should I lower the dose?

[Laura Nels]

Haven't kept great track of BG testing when I've only done spot checks, but have recorded all curves.
With diet change, still a work in progress, and decreasing pred, Vivian's numbers are going down.
At one point she was at 81 before a shot so I decided to try her off insulin.
She was good for a day but went back up to 134 so I started on a reduced dose of .15U
She was good on that, daily highs 110-120 for a week, but then went up to a high of 139 so I increased to .2U
Her most recent curve was yesterday and can be viewed on her spreadsheet.
Numbers are nice and low, but she is drinking and urinating quite a bit, so I consulted the vet.
Vet said do a curve and check for glucose in urine, and when I said Vivian's numbers were too low for glucose in urine when I checked her BG a few times she
interrupted me and said, "What did I tell you about checking every day - don't do it! You (you in general not me specifically, this is her standard line to all diabetic cat pals) make yourself crazy, you check and it's low so you adjust by a tiny amount, you check and it's high so you adjust again. I told you, if you make an adjustment in dose, wait two weeks and do a curve, and do not test between times!"
That's pretty counter to the discussions on this forum. So there's one area of confusion.
So ok, beyond that, I tested her urine and there is no glucose, her #s yesterday were pretty low.
Beyond the fact that there is a worrisome increase in drinking and peeing to contend with, and her stool isn't good so she may not be tolerating the reduced pred, I am wondering at what point one would consider the cat is ready for a reduction in dose?

 

[Critter Mom]

Hi Laura

Vivian's your kitty. You get to decide when she needs testing. Your vet, of course, is entitled to her opinion on testing, but it's up to you. A doctor would not recommend blind dosing to a human patient, so why should we dose our kitties 'blind'? Much safer to do regular pre-shot and mid-cycle tests, especially when a kitty is giving such be-yoo-tiful numbers as Vivian is giving at the moment.

I've just had a look at Vivian's spreadsheet. Are you giving 0.2 units twice a day?

 

[Laura Nels]

Yes, she is getting .2U lantus twice a day, and truth be told, if I had waited for my vet's ok Vivian would still be at .5U
After she suggested Vivian was in remission, but she wasn't, the vet told me to reinstate at original .5U but I reinstated at .25 instead.
She hasn't said anything about that b/c frankly I don't think she always remembers what she tells me.
I was also the one who decreased her to .15U and back up to .2U using numbers I got from testing her every couple days a.m. +4 when she hits low and p.m. The vet would not like this at all if she knew that a) I was testing more often than bi-weekly curves and b) I was changing doses.
But I am, so I'm just wondering if her numbers warrant another dose decrease, back to .15U for example

 

[Laura Nels]

I should add that I am not at all comfortable with Vivian going below 50 for a low BG and make some decisions based on whether she has gone below 50 or is likely to go below 50 based on what I know about her reaction to glargine so far. The vet is perfectly comfortable with her going even into the 30's as long as she is "clinically normal" which I interpret as not in hypo crisis mode. I am not AT ALL comfortable cutting it that close. That's one of the reasons she doesn't want me to test, she isn't worried about those low #s and doesn't want me to panic and adjust her dose. We just disagree I guess

 

[Critter Mom]

I'd disagree with your vet's view: 30 is too low. On a human meter, and in line with the published Tight Regulation Protocol dosing guidelines, a drop below 50 triggers a dose reduction.

Also, just because a cat isn't showing symptoms it doesn't mean that the cat isn't at risk. From what I've learned here it's not at all unknown for Lantus kitties to have asymptomatic hypos; all the more reason for caution - and for home testing - in my book because there may be no warning signs like the cat becoming ravenous. Your meter is you and your kitty's best friend.

When it comes to lower dosing, I did Saoirse's first OTJ trial by going straight from 0.25 IU down to zero. She didn't hold it, so I reinstated insulin treatment. When it came time for her second OTJ trial, I followed some advice from the members here, namely to gradually titrate the dose down to 0.2 for several cycles, then 0.1 for several cycles. Saoirse was in normal numbers so I chose to just give her insulin during the morning cycle. She tended to run low at night so I leveraged that tendency to allow for a very gradual weaning off from the Lantus. The second taper worked and she passed the OTJ trial. You can see her data for October and November of last year to see some real-world numbers of how her levels went at that time. Because of the depot nature of Lantus, keeping a steady dosing schedule - even when microdosing - helps a lot. That said, I did shave microdoses here and there when tapering Saoirse off last year. The final stages were a real white knuckle ride. I found it very helpful to do BG checks a couple of hours after meals when tapering - sometimes food would lower the BG; definitely something to be careful of when a kitty's still on insulin and at low numbers.