Advice needed: Chart and dosage questions

Hello again,

It's been a month since I introduced myself and Blanco and things seem to be going really well. So well, in fact, that I'm at a little bit of a crossroads and not sure what to do next. Our vet has given us a couple of options and I wanted to get some opinions and some help understanding Blanco's chart.

Some background: Blanco is on 1u of Lantus, given twice a day. He's eating DM wet and has a great appetite. He's on a daily dose of 1mg of budesonide for IBD. Our plan is to get the diabetes regulated before attempting a reduction of budesonide.

I've read all the stickies on the Lantus board, but I'm not sure I understand them as they apply to Blanco. He doesn't seem to have the typical 12 hour cycle. It looks to me like Blanco's cycle is a little longer, but I don't know how the storage shed applies. His chart is here: https://spreadsheets.google.com/pub...b1ZONGFwTmpENGFGNUtuWWhfb3c&hl=en&output=html

As you can see on the chart, I've had to skip some shots because his BG numbers were low. I've been going by the guidelines found here and given by our vet. I don't give a shot if Blanco's PS number is way under 150. If it's around 150, I'll only shoot if I'm going to be home to watch him and do spot checks.

Anyway, one of the options presented to us is giving a 1u shot once a day. Does anyone here give a dose once a day and does that work for you? I wondered about reducing the dose to .5u and continuing on the twice a day schedule. Our vet is okay with whichever option we're comfortable with as long as we keep up the pre-shot testing and keep an eye on the numbers. Any feedback/advice would be appreciated...

Thank you!

 

Hi Shellie

Lantus does work the best on a 12/12 schedule.

On your spreadsheet, I would suggest a few more evening checks, some kitties do go lower in the evening cycle. You're missing a few evening checks in the past few days or so (unless you're at work there) We do suggest always get a before-bedtime check and an out the door check.

Using LC, MC, and HC (low, medium and high carbs) wet foods, instead of using dry kibble: dry can take longer to get in their system
plus a bit longer to clear (so you'll higher numbers at times after you give dry kibble)

I would suggest you stick with the wet foods, your using DM canned yes?
Do you have a supply of anything with any kind of gravy in it? That would be some of your MC to HC choices instead of kibble.

I'm including a few stickies from the Lantus forum for review:

Tilly's Protocol: Modified Version
Lantus & Levemir Insulin Depot AKA Storage Shed
Lantus & Levemir Data Ready To Shoot Low Numbers : eventually you will have to get comfortable shooting lower than usual numbers, this is part of data collecting. If you take a look at the Lantus forum, you'll see quiet a lot of kitties starting in the greens - have a look at those spreadsheets. It is completely nailbite_smile - I know, I was there too.

Example of a typical curve. Curves can be from every two - 3 hours when you're home to monitor:

+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number


I would suggest posting in the Lantus forum, you've got your spreadsheet set up, if you'd like there are experienced users in that forum who can guide you with the protocol we use.
In the meantime, I will see about sending some Lantus eyes over here to take a look.

 

I am getting ready to switch our foster kitty over to Lantus due to an insulin donation and have poored over those stickies! From what I can gather, you base your dosage off of the nadir and not the preshot value. It is very common for Lantus to have a longer than 12 hour duration (part of what makes the insulin great for kitties!) and it usually gives a gentle curve. If you are not seeing a nadir lower than 90 right now, I would try shooting, or maybe lower the dose a hair, but it is vitally important to stay shooting twice a day in order to keep the shed built up properly.

 

Thank you both for responding.

Ronnie, to answer your question, Blanco is on wet DM. The dry DM is given sparingly, but I'll put a stop to it completely for Blanco. We also have some high-carb wet food specifically in case of a hypo.

The part that is confusing me is that Blanco doesn't seem to hit his nadir at any predicable time, nor does he hit a consistent number. On days when we've done a curve, he hits it around +7 or +8 and he's still in the blue. However, if you look at 6/21, he was lower at +12 than he was at +6. He was also in the green both times. I've read the stickies and I still don't understand what's happening. Are those bounces or rebounds? Am I depleting the shed on days when he's at 79 and I don't give shot?

I feel like I need the dummy version of all this.

 

Yes, you are depleting the shed on the cycles that you do not give a shot. The body is having to use the shed during those times and then your next shot only goes toward filling the shed back up. From my reading, it is sometimes common for the numbers to drop again right at preshot time. If you are nervous about shooting the lower number - then I would lower the dose a bit and be consistent with it. Lantus likes consistency - which may also be the reason you are having wacky numbers.

 

Come over to Lantus and the beans there can answer this question and help to explain it for you.

Also, while you dump the dry, consider dumping the wet too. It's higher in carbs than necessary (7 carbs) and if your cat is carb sensitive at all, this could be too high for him, expensive and made with crappy ingredients. You can save your money and buy affordable commercial canned foods, like friskies and fancy feast.

Here take a read: Janet & Binky's Food Chart

 

Kelly: Thank you. It was the consistency that was worrying me, so it's really good to get that input.

Hillary: I'll post over on Lantus Land tomorrow morning. I've been hesitant to post there as I still very much consider myself a beginner at all this. But I would love to have someone else look at these numbers and tell me what they mean.
I've been hesitant to change the food again, but I think I will give Fancy Feast a try. Ironically, I consulted the food list to change my civvie's food because they eat together and I wanted to know that if Blanco got into it, it wouldn't be the end of the world for him. As we run out of DM, I'll try them both on Fancy Feast. Thank you!