? Anyone give different units am vs pm?

one vet had told me when it was time to increase lantus, to keep standing dose am and increase the pm dose by 1 unit. So if the dose was 2u in am and pm, then when we do increase, it would be 2u in am and 3u in pm. Isnt that a little weird?

Does anyone give a different dose am vs pm?

 

I'm very new to feline diabetes myself & am def still learning, but I looked at Mr. Biddles SS and noticed that you use a pretty high dose of Lantus. My vet also had me at 4 units, but most people on here say that that's an extreme amount. How did you arrive at that amount & how do you think it works for you? Just curious cause I cut my kitty's in half when I started on here a few days ago & am not sure of its effect...

 

I'm new here too, but it's my understanding that you only increase by 0.25 units at a time. So a jump from 2 to 3 would be a big difference in the cycle. Someone more knowledgeable will be along shortly, I hope.

 

we're not on 4u now - you must've been looking at the top of the ss? scroll down and you'll see after increasing we ran into trouble and had to go back down. we've been on 3u for about 4 weeks now, with an increase just today to 3.5.

we started on 2u back in november 2015 when first diagnosed, and have yet to achieve good regulation. started increasing this spring, but did it too fast. you'll see my chagrined post here: http://www.felinediabetes.com/FDMB/threads/how-not-to-increase-lantus-psa.159784/#post-1705039

 

Your last post on LL forum http://www.felinediabetes.com/FDMB/threads/drawing-from-lantus-pen.159757/

Lantus does much better with consistent dosing, you need to have the same dose evening and morning, usually we take the dose up in 0.25u steps. The dosing strategy your vet is suggesting is not the best idea, plus he is taking him up too quickly

Have you looked at the stickies for the dosing methods we use?
Have you decided which you would like to follow? Tight regulation or Start low and go slow?
Personally I followed TR as that is based on a veterinary study and it had the better stats to get George well regulated, safely and quickly thus giving him the best chance to get OTJ (which he did 2 months ago)

I see you got a curve done on June 16, looks like that was a bounce cycle, so although he was high it doesn't really give you much useful data.
It's very difficult to give you any advice because of the lack of any midcycle tests in the last 4 days. Mr B may well need more insulin, but without the midcycle data we just can't say for sure. Taking his dose up could well prove risky.

Just because a preshot is high/red doesn't mean that Kitty cant drop, there have been kitties on this board that go from red to green and back to red by next preshot.

Lantus dosing is based on how low a particular dose takes kitty, and for this you need to be getting some midcyle tests in, it doesn't mean that you have to run a curve every day but rather get 3 or 4 tests in per cycle (am and pm) try to spread them about as much as possible and get them done at different times on different days, this will help you build up a picture.

I see you shot 3.25 last night and then 3.5 this morning, flip flopping with the dose is not recommended as this can result in wonky numbers. Lantus doses need time to settle, this is because it is a depot insulin as opposed to an in out insulin (like some of the older insulins) The depot takes time to build and the size of the depot is directly dependent on the size of the dose, so every time you change the depot has to readjust up or down and that can result in wonky numbers, we generally consider the depot taking 6 cycles to fill.

Sticky on Depot
sticky on Tight regulatin (TR)
Sticky on Start Low Go Slow (SLGS)

 

My vet suggested different doses at one point because he thought it would be hard to measure very small increases. I told him about calipers but it never came up again. Since many drop at night it would make it really confusing to figure out if giving too much or too little. JMHO.

 

My vet also suggested this and wasn't too excited about small dose increases as she thought it would be too hard to measure. So at one point we were doing 2u am and 3pm instead of doing a 2.5 at both. Based on what I've learned here, consistent dosing is really important and we haven't used a dosing strategy like that in a long time. I suggest reading all the stickies, learn about the depot and then re-engage with your vet

 

thanks i'm trying to figure out what best approach to use. i've read the stickies
i find .25u dosing extremely tricky to manage. i started a related post on air bubbles and difficulty with dosing accurately at .25u . just placed order for monoject syringes which may be better than ulticare.

 

The monojects that you ordered - do they have half-unit markings? Half unit markings do make measuring the .25u doses much easier - and it does get easier with practice, too.

I agree with the others about dosing consistently...it does make a big difference because of how Lantus works.

Welcome to the group!

 

yes they have 1/2 unit mkngs
wish they made syringes with 1/4 unit markings!

 

I'm interested in the syringes that your referring to too!

I thought all syringes have half unit markings...they don't?

 

Yeah, there are a lot of syringes that only have whole-unit markings. Since the syringes are really made for humans, and humans usually don't need the teeny tiny dose adjustments our kitties need, there isn't always a call for half-unit markings in the human world.

 

Ahhh, I didn't know that. I guess I got lucky with my first box of syringes. I'm learning something new ever day

 

That's the idea. The longer you're here, the more you learn. It's amazing what you can pick up, reading other people's condos!

Jen, Cinco's vet had us try the two different doses when he was first diagnosed, and it did nothing but make his numbers more confusing! I would stick with the same dose twice a day, as the others have said. Yes, measuring .25 is hard, but once you figure out where it is on your syringe, the important thing is not to get it right every time, but to get it the same every time. Consistency is more important than accuracy in this case. You can also get a set of calipers and set them to the dose, then use them to get it the same every time.

Don't we all?!!! There would be a run on those, for sure!

From the Sticky on dosing:

 

My vet also suggested a different dose in the AM vs. PM. But that's because she was used to the older in and out insulins and not the depot insulins like Lantus and Levemir. For the in and out insulins, shooting a lower dose at night means the people don't have to worry as much about monitoring the cat. With the depot insulins, you'll often get the opposite effect. I often find that Neko's cycle is heavily influenced by what dose she got the cycle before hand.

 

Jeeperz i am so sick of vets who dont know how to treat diabetes!! Thank you i will stick to .25 increase am and pm!