4/15 Max 5 days on Lantus, AMPS 243, PMPS 196, dosing input please

Hi All,

So Max appears to be responding well to the switch to Lantus (expected, since he went into remission on it before). We're on cycle #11 tonight. Overall, his numbers are trending down, other than that one funny bounce.

I'm trying to stick to the 1U dose as well as I can so the numbers can be compared...but with his preshots going lower, it's making me nervous. We're also adjusting shot times this week to get them back to where they need to be--due to one wonky preshot number and a total brain fart on my part, we ended up on a 2-hours later than normal cycle time over the weekend. Shot times are being walked back by 15 minutes every dose (which is making dinner and soccer practice extra fun! ). I thought about skipping a shot to reset the time, but I don't want to mess up his progress.

Anyway...when Max was on insulin 9 years ago, he was on a steady 2U dose for a couple of weeks. When he moved to remission we went from 2U to the OTJ trial drop dosing in a week. It was a crazy slip-slide down the dose scale from what I remember. Of course I don't have his spreadsheet from back then for reference. I don't expect remission again (tho it sure would be nice!), but at what point do I need to consider an actual dose reduction? I can run a curve on Friday, but I work M-Th, and I can't come home to check him. He's still so new on Lantus I don't have a lot of data to know what his cycle could or should look like. I don't *think* he's had a nadir under 100 yet, but he might have today. I'm either gone or sleeping at that time right now, so I don't actually know. When we get him back on schedule I can get a +5 or +6 most nights before I go to bed.

I'd appreciate any insight you all can provide. I've had him longer than I've had my husband, he's my first baby, and while he's old and slowing down, I want to make sure I am not the cause of him feeling cruddy. My husband will be helpful when we get to a point where his numbers are somewhat predictable and on a stable dose, but until then, I'm the only one in this house processing all the numbers and insulin info.

 

Here is the link to your previous post here, which we include so people can see the previous history: http://www.felinediabetes.com/FDMB/threads/been-on-lantus-for-24-hours-pmps-179-do-i-shoot.213160/

We have two dosing methods we use here, described in the Sticky Note on Dosing Methods. The Tight Regulation (TR) protocol is from a paper published in a veterinary journal. The Start Low Go Slow Method was developed over time here. Take a read of the two dosing methods and see what might fit your lifestyle. The TR method says to reduce if they go below 50 for newly diagnosed kitties, but under 40 if a long term diabetic, which Max would be considered as he was first diagnosed over a year ago. The SLGS method says to reduce if they go below 90, and to keep the dose if nadirs are between 90 and 149, which is what you are seeing. As for "may have gone below 100", if we don't see it, it didn't happen. SLGS does give you lots of wiggle room with reductions at below 90. Tight Regulation does allow you to increase faster if numbers are high, but also comes with tighter testing requirements. Lots of people have followed TR with a full time job. This note will give you some tips how to do it. Many of the tips are equally helpful if following SLGS.

The dosing methods we use here find that it's better to shoot the same dose AM and PM. Skinnying a dose isn't very effective for the one cycle you skinny the dose, as the depot will often control what will happen in that cycle anyway. I would stick to 1.0 units. It takes 5-7 days for the initial depot to build, but unfortunately (life happens) you haven't had a chance to shoot consistently yet which could impact the depot.