Am I panicking and lowering doses too quickly?

I need some advice on dosing with Lantus. We're basically on a tight regulation protocol with Hoss, although we've been slowly weaning him off of higher carb dry food so he's not yet 100% on strict low carb. He's currently eating about 95% canned low carb (under 10% carbs) and the rest is a 50/50 mix of Glycobalance dry and Dr Elsey's Clean Protein dry. I have 2 other cats, they all have to eat the same thing - there's really no way to separate these cats to feed them and they've free-fed their whole lives. So I'm never going to be able to not have some dry food available because I have one cat who WILL NOT eat enough wet to keep himself from starving. So I'm trying to do the next best thing and get everyone switched over to Dr. Elsey's Clean Protein. They can't eat Young Again - I tried it and it gave all three cats explosive diarrhea.

Hoss has been on Lantus for 2 weeks. At his original starting dose of 2 units BID, we were still consistently getting BG's in the 300's and 400's by early this week so we upped his dose a half unit to 2.5 BID. That dose started to drop his BG pretty well and pretty quickly and last night, pre-shot, he was at 145! Yay! We were in the blue! But then I kind of panicked. I didn't know what to do with that dose. Give him the full 2.5? Drop him? I talked to my vet and she suggested we drop him back to 2 units and see what happened. So I did that and this morning, pre-shot he was back to 339. Sigh.

So in reading everything I have now about Lantus, I'm wondering if I'm panicking too quickly when I get those lower pre-shot readings. This happened a couple of days after we first started Lantus - he responded to it really quickly, I got one pre-dose reading in the mid 100's and we dropped the dose a half unit to 1.5 and boom - he jumped way back up again. So we put him back at the 2 units and left him there, but he rebounded way up to the 300-400's for several days till we raised him to 2.5 this week. Now, after he started to respond really well to THAT dose, I feel like I may have panicked too quickly again in lowering his dose again. I'm just SO scared of making him hypoglycemic that I don't know what to do when I finally see a pre-shot number that "low".

Is all this bouncing around "normal" in the first few weeks of using Lantus? Or is it truly just a case of every cat is totally different? Or is it all my fault because I'm being too much of a scaredy-cat wuss in the dosing? If I get a pre-shot reading of 145 or 150 and he eats well, because Lantus doesn't "kick in" for about 2-3 hours after injection, is it still safe to give him his full current dose? Would the Lantus not kick in until he's naturally starting to rise in his BG cycle and thus not take him too low? Help. I'm totally confused. All this bouncing around can't be good for him.

 

Yes, it is completely normal

What we recommend is if he's over 150, shoot the scheduled dose.....if under 150, Stall, don't feed and post for help. Retest in 20-30 minutes to see if the number is coming up on it's own without the influence of food. If it is, it's usually going to be safe to go ahead and shoot the scheduled dose.

Look at China's spreadsheet …..I'll shoot anything over 50 (but of course I didn't start out that way!) It's a matter of Knowing Thy Cat and being data ready to shoot those low numbers.

 

My problem is, I can’t stall him very long because I can’t get off the injection schedule I’m on. I can’t shoot Hoss any later than 5:30 am during the week because that’s when I leave for work. So because shooting earlier than 12 hours can act as a dose increase, if I have to stall to re-test at night and end up 1/2 hour or an hour later on his shot, then I’m screwed in the morning because I’ll be giving him an “early” dose and then leaving the house for 12 hours unable to watch or check him.

 

Leaving that early in the AM does present a problem. Is it possible for you to get a PM +11 every weekday morning? Then if the AMPS is lower then you would know you would be shooting a falling number. If the AMPS is higher that the +11 and a safe number to shoot you would have some more confidence to shoot.

As far as taking him up and down in dose, Lantus needs consistency and the depot can take 4-6 cycles to stabilize. Going up and down without holding the dose for the required amount of time can really confuse the depot. Of course if he goes 50 you would reduce.

 

I could definitely do a PM +11. That's a good idea. So if his numbers are between 100 & 200 and he's falling between the +11 & AMPS, then what? It's the gray areas of like 130, 140, 150... I don't know what to do. Hypothetically, if he's on a 2.5 Unit dose and I get a +11 of 140 and then an AMPS of 135 or 130... do I go ahead and shoot 2.5 as long as he eats a good meal? Or do I lower the dose? And if so, by how much?

 

First of all, it's completely normal for us beans to panic when our kitties start seeing good numbers.

Second thing, with some dry food in the picture, you should be following SLGS for dosing, not TR which requires an all low carb wet or raw diet. The processing of dry in their systems is just too unpredictable to follow TR safely. The guidelines for shooting low with SLGS are different than from TR, though some of the ideas like stalling or getting a +11 are common. As per SLGS, or Tr for that matter, if you get a lower number than you are used to and will be away all day and don't have data on how Big Hiss handles those types of cycles, caution is key. Do you have an autofeeder or way of giving him food mid cycle?

 

I don't have an autofeeder. It's been recommended by several others as well. I have a very, very small house, three cats and a dog and really no place to be able to close Hoss off from the others except our tiny bathroom and I hate to do that to him. If I leave cat food where our lab can get to it, he'll eat it. Every bit of it. So we have the cats' bowls in our bedroom and just put a chair in front of the door which keeps our lab out but the cats can come and go at will. We free feed at home and I always leave PLENTY of food in the morning before I leave - especially now after his diagnosis - and there's nearly always some food left when I get home. So he does have access to food all day every day.