Handsome & Momma Need Some Lantus Dosing Help

Discussion in 'Feline Health - (Welcome & Main Forum)' started by MeowMomma, Feb 6, 2020.

  1. MeowMomma

    MeowMomma New Member

    Joined:
    Oct 4, 2019
    Hi all!

    We have been doing the sugar dance since September 2019 and I feel like we are going backwards instead of forward. I'll share a bit of our back story below.

    My Handsome baby was diagnosed on 9/12/19. We went thru all the mess of being given the wrong food, given no direction on home testing etc. For the first month my fear took hold and I didn't test before shooting. Let me just say in big capital letters - HOME TESTING CAN SAVE A LIFE! We've been home testing (AlphaTrak) since October and I'm grateful to have gotten past my fear. It took a near hypo event for me to get my head straight and realize I simply have no choice.

    He was put on Lantus 1u every 12 hours to start. Numbers were still high, vet increased to 2u on 10/26. Numbers were still bouncing within 300, 400, 500's with a few dips into the 200's. Vet increased to 3u on 11/29. I wasnt comfortable with that increase but didnt listen to my gut and did it. I did a curve the day the increase started to keep a check, but now realize it prb wouldnt show up that fast. Tested that night at 5:30 and he was at 62 (dangerously low). Had I not been doing home testing, I would have fed him and then given the 3u, with a potentially deadly outcome. He ate 6 oz of Fancy Feast chicken pate and I tested again at 8pm, was 104. Tested again at 10pm, was 303. Too scared to guess what to do so NO SHOT! A sleepless night let me tell y'all! I felt totally lost on what to do from there. I emailed my vet directly and did call in that night, but just to relay information. When they decided to get back to me, it was over 24 hours later and the advice was - under 100 give 1U, over 100 give the 3U. From reading the FB group (which I love), I knew that was VERY wrong. I had his records transferred to a new vet three days later. Sadly the new vet may be just as lost, but we have a decent relationship in that he knows I won't follow his advice blindly. He doesn't use Lantus but agreed to give me scripts as that's what we are using. Handsome did have a touch of diarrhea for about a week and I started using Fortiflora and it cleared right up so I am continuing to give that once daily. Handsome had a fructosomine test on 1/10/20 and it was 342. Vet's advice? Hold the dose! That simply can't be the correct advice as that's just an average and he is still having numbers in the 300's, 400's and 500's.

    So - from the beginning of January we have basically been on our own with all this. On the advice of an admin from the FB group, I started over with 1U for a week, then curve. Then bumped it up .25 each week, holding the dose for a week and then doing a curve. I've been trying to get random checks in as well other than the test/feed/shoot times, as my work schedule allows. As you can see from his spreadsheet - he is all over the place, and currently on 2U.

    We need dosing advice in the worst way!! And please be kind. I have been very fearful to post here for fear of looking stupid and having someone say as much, lol. I am a FB girl and much prefer that format - but here we are!

    My apologies if this should be posted elsewhere or the title isn't correct. I wasn't sure to post this here OR the Lantus area.

    Thanks for reading and for any advice anyone may have.

    https://docs.google.com/spreadsheets/d/1n7Tt4VXKQb987y-JO3FGMJYKgyTC4nZBNpB61UHpv1w/edit?usp=sharing
     
  2. Ann & Scatcats

    Ann & Scatcats Well-Known Member

    Joined:
    Dec 31, 2009
    I just want to bump this for you since I am not an Alphatrak user. But others are.
     
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  3. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Beth, Please remove your last name from your signature. Beth C would be ok. Trying to keep your privacy on a public forum.

    The only stupid question is the one you "dont' ask."

    Back in a bit after I've had a look at Handsome's SS. (and taken a break for a bite of lunch for me and my kitty)
     
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  4. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Not so much a FB girl myself, but I can deal with it when I need to. I've just asked to join a French language diabetic facebook group and don't understand much French myself.:blackeye::(;) Ack! What did I just do to myself?!?!?

    No worries, we'll try to treat you kindly. We may overwhelm you at first. Tell us to stop and give you time to digest what we have said and we will. Let us know what works for your work/life/responsibilities and we'll see what suggestions we have to make things work better.

    If something we suggest does not work for you, speak up, let us know, tell us to "go fly a kite." Whatever it takes.
     
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  5. MeowMomma

    MeowMomma New Member

    Joined:
    Oct 4, 2019
    Thank you!

    I'll do another increase by .25 again over the weekend after our curve. His numbers are terrible and I just dont know what to do.

    I feel like I'm failing my kitty. I'm desperate for dosing advice.
     
  6. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    SLGS and using an Alphatrak meter. See you are on CST here in the US. I'll be making some comments that are going to be based on hind sight, or looking back at your SS and seeing where things could have been done differently. That is in the past and "water under the bridge" as the saying goes but it is what it is. It may give you a bit of insight into what is going on with Handsome and his BG readings.

    General notes first.
    1. Lantus dosing changes are based on the nadir or lowest point the insulin takes your cat.
    2. If you are not testing in the PM cycle much, you are missing half your data. Please try to get a test at +3 in the PM and another before you go to sleep. IF you are up that late and available to do that. Or if you wake up in the night to do something else. More data in the PM 12 hour cycle is good. Cats often drop lower at night. And bounce, and bounce, and bounce.
    3. Curve once a week. Without fail. Looks like you started to do that around 1/18/20.
    4. Handsome is what we would call a newly diagnosed diabetic. Diabetes < 1 year.
    5. Spreadsheet numbers are entered in the dosing cycle you are on. AMPS is your pre-shot test, +1 is 1 hour later, +2 is 2 hours later. (Just had another facebook member that thought the times on the SS corresponded to her local clock time)
    6. Are the numbers on your SS entered in the correct places? Unless you shoot at midnight and noon, your clock time will be different. you need to think in blocks of 12 hours when giving insulin, with your pre-shot tests anchoring either end of those blocks of time.

    p.s Saw the signature change. Writing more for you. Review what I have written and look for more.
     
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  7. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    More specific to Handsome and using SLGS with an Alphatrak meter.
    1. On 1/12/20, Handsome got an 86 at +6 AM cycle. That was an automatic dose reduction.
    2. Using an Alphatrak, I think you should take an immediate 0.25U dose reduction whenever the BG drops below 110 mg/dL
    Some of these numbers I'm giving you on when and how to adjust are my best guess when using a pet meter. All our documentation is written for human meters. Nadir or lowest of 110 is my best guess for SLGS with an Alphatrak.
    3. Lantus dosing changes are like steering a huge cruise ship. It takes time to see the effects of the change in the dose because of that "depot" storage area. It can take time to see what is going on.
    4. On 1/27/20, Handsome got down into the yellow range at pre-shot. AMPS of 282. He probably dropped lower that morning and/or at night and you did not catch that low. Likely bouncing like crazy since then.

    Doing a bit of brainstorming here to try and figure out why the Fructosamine looks good but Handsome still has high BG readings.

    Checking your drawing/measuring insulin technique.
    1. How accurately and consistent do you think you are with those quarter unit in between the lines doses?
    2. Have you seen the pictures of the fine dosing for plunger placement?
    3. Getting all the air bubbles out of the syringe after you have drawn the dose up? You may want to draw up a tiny bit extra and squirt out excess.
    4. Tapping the syringe, needle pointed up to get the air bubbles to float to the top?
    5. Using the "plunger twisting" technique to slowly twist out the last of the air bubbles?
    Checking your meter use/technique.
    1. Have you calibrated your Alphatrak meter lately? or ever? with the control solution?
    2. Is your meter coded to correspond to the number on the test strip vial? Each vial of test strips can have a different code. Don't use a generic code.
    3. Do you use only the Alphatrak strips or are you trying to use a less expensive substitute strip?
    4. Have you ever tested yourself? Fresh lancet and strip.
    Checking your shooting technique
    1. Are you sure you are not giving more fur shots?
    2. Lantus smells like bandaids.
    3. Checking for wet fur?
    4. Trimmed a bit of fur or shaved a small spot on the flanks? To see where you are shooting?
    5. Shooting in the scruff or elsewhere?
    6. Roll technique for shooting?
    7. Angling the insulin syringe to get under the skin, into the fat layer underneath?
    8. Needle not sticking out the other side of pinched up bit of skin?
    Do you work during the week? Daytime or at night? Anyone else around to help you test Handsome or are you it?
     
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  8. Juls and Billy

    Juls and Billy Member

    Joined:
    Dec 28, 2019
    Hello Handsome and Beth! I popped in for moral support. First off, you are awesome for taking such good care of Handsome. We all feel like we messed up at first. The problem is that most vets don't understand feline diabetes well, and they don't give you the best direction or instructions. That's not your fault. I just had an argument with my Billy's vet office today. "Nope. I am not giving my cat who had a BGL under 100 today two units of insulin. K. Thanks."

    The good thing is that you are here now. There is so much good information here. Keep reading, keep learning. Read all the sticky posts. The more you know, the better off Handsome will be. It doesn't matter what happened before. It's not too late. Handsome will do so much better because of it.

    I won't give you any dosing advice. Deb & Wink has way more experience than me, and knows Lantus. I just wanted to tell you that you're awesome and that Handsome is a beautiful cat.
     
    Last edited: Feb 6, 2020
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  9. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    If I had a nickle for every time I messed up I would be rich. lol like Deb says the only stupid question is the one or two ORRR three that arent asked. You have found the right place! WELCOME TO FDMB
     
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  10. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    I'm a good generalist with most of the insulins. There are people that live and breath lantus and 2 of them posted over on Beth C.'s post over on our sister facebook page, inviting her to come over here to the FDMB message board for help.

    Hope they see this and post replies here to her. Never sure how much detail all those new members/folks posting over on the facebook page get. It doesn't hurt to ask Beth the most basic of questions. Especially after Crystal and her SS snafu.

    Latest time I posted there was a couple of days ago, when someone else said the Friskies Shreds and Meaty Bits canned foods were low carb. NOT. Try medium carb. Good for your hypo kit.

    I do think that Beth needs to go to the Lantus forum. Soon. Very soon.
     
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  11. MeowMomma

    MeowMomma New Member

    Joined:
    Oct 4, 2019

    Thank you so much for going into such detail! I will try to be as thorough with my replies.

    The issue with the PM cycle is that I am typically asleep by 8pm - which is the +3. I can def get more of those, but later times I could only "attempt" on the weekends. I am up anywhere from 3am til my alarm goes off at 4:30. His poke/feed/shot time is 5am/5pm and I do my best not to let that fluctuate by more than 15/20 minutes. I am OCD so trust me when I say we can keep a tight schedule, lol. Typically I am testing him around 4:50am/pm, he gets his treat, then feed (Fancy Feast pate) and while he is eating I shoot. I wait til 3/4 of his meal has been eaten before shooting. I had a major syringe phobia for a hot second so I feel like this is the only way I can confidently shoot him. So we had been using pen needles with the Lantus pen up until you see the .25 doses on the ss. Since then it's been ALL syringe.

    Yes, I do know what the +3, + 6 etc means. Bless her heart it's an honest mistake, lolol! Yes the numbers are entered correctly. There were some wonky doses in less than 12 hour places when he was bumped to 3 by the vet and started getting low no shoot numbers at shot time. Ugh, I didn't know any better.

    Thanks for the heads up on the last name. I guess my thought was that I wanted to be sure the people that told me to get over here could find me since my name here is different.

    I'll post this and then reply to the next post you made.

    THANK YOU - THANK YOU - THANK YOU
     
  12. MeowMomma

    MeowMomma New Member

    Joined:
    Oct 4, 2019

    Oh boy, I'm gonna try to keep up with you! LOL!!

    So you are saying the no shoot number for him would be the 110 and not the 200? Or the no shoot number is till 200 but if he goes lower than 110, reduce? Also wanted to mention that I have ketone strips and check his urine about once a week and he has never had any. The only other notable thing would be when he started with the diarrhea, he did a tube of pectalin and I started him on the Fortiflora and have kept him on it. I try to make comments on the ss of anything I think might be important.

    I think I am pretty consistent with the dosing. I printed out the photo that gets posted by everyone and keep it right next to the syringes so if I have any doubt, it's right there for me to verify with. I feel like I have seen the photo with plunger placement but I would't mind if you wanted to post it so I can make sure. I draw up extra, and I flick for air bubbles, needle pointed up.

    Now the calibration and the control solution would be a no. I honestly didn't even think to do that. How often is that necessary? Yes, I know each vial could have a diff code. I use the real alpha track strips and I have poked myself accidentally but never use a strip to check the blood.

    I am pretty confidant I am not doing a lot of fur shots. I try to note every time I think that may have happened, and there have been one or two. And I know since it's not a sure thing not to try to give a second shot. I can feel the pressure on the syringe when he goes into his skin if that makes sense, and sometimes he jumps but not often. One thing I am doing differently is refrigerating the insulin. I was told not to refrigerate it by the vet, saying it would cause discomfort. So up until 2 weeks ago, it was never refrigerated. I actually love the smell of it, how weird!! Yes, I always check for wet fur as I try to give a gentle rub to the area after. Now I haven't shaven him. Since he is totally white I feel like I can see what I am doing pretty good. Roll as in the place I'm shooting? Yes. I typically get him on the side in the area from the photo that gets posted often. I am not sure what you mean by angling. And no, I have never had the needle stick out the other side.

    Yes I work. Monday thru Thursday 8am til 4pm Fridays are always random, and I am typically home 24/7 Saturdays and Sundays. I We keep our 12 hour schedule pretty religiously, basically I have no life. LOL! I've cancelled many planned vacations. I refuse to board my Handsome boy because he doesn't do well with the vets, etc. And I have no one else willing. I live alone, the BF visits but I do 100% of the testing/shooting.

    So we are currently doing 2U - curve on Saturday and then the increase on Sunday. I am very anxious to hear your thoughts on what you think the plan should be for this weekend.

    THANK YOU!!!!!
     
    Last edited: Feb 7, 2020
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  13. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    No, the no-shoot number is still 200. For now.
    If Handsome drops below 110, then you would reduce the dose for the next shot.

    Don't rub the skin after you have given the shot. Can't remember why, but someone said recently they did that. I think you do not want to rub the injection site as it can cause some of the insulin to leak back out? Can't remember who said it either. Within the last week, but I read too many threads to remember everything. Old age you know.
    Each batch of test strips? Don't remember the answer to that question either. The Alphatrak manual should say how often to test with the control solution. It's been 7 years since I used the Alphatrak.

    Refrigeration can make the insulin vial or pen last longer. Beyond the 28 days after opening that the manufacturer tested. It's the time period the FDA required them to test.

    The photo is in this Sticky from over in the Lantus forum.
    Insulin Care & Syringe Info: Proper Handling, Drawing, Fine Dosing
    Pictorial guide using a U-100 syringe marked with half units:

    [​IMG] [​IMG]
    [​IMG]

    Lots more information in the Lantus forum. Look at the "Sticky" or pinned posts at the top of that forum. Don't let yourself get too overwhelmed by all that info.

    Insulin syringe is more parallel with the body, not perpendicular. That is what I meant by angled.

    Thank you for confirming all those questions I had. Sounds like you are doing just about everything right.

    I'm up pretty early myself. And to bed very early too. Not on the message board that early. I have to get stuff done for myself and my cat first.

    Bron and Sheba (GA) (aka Bron O.) and Sienne and Gabby (GA) (aka Cheryl C)were the 2 people I recognized from here.
     
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  14. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    You don't rub the injection site because once Lantus is injected, it forms microcrystals that are deposited in the fat tissue. These crystals dissolve over the course of the cycle which is in part, what gives Lantus its duration. Not all of the crystals completely dissolve in one cycle and this is how the depot forms. If you rub the shot site, you break. up the crystals.

    If you've not done so already, you will want to look at the sticky notes at the top of the Lantus board. They contain a great deal of information about Lantus and its use.

    Just out of curiosity, if you are shooting at 5:00, what time do you leave for work? If you're able to get a test in before you leave for work, you may want to consider using Tight Regulation rather than SLGS. TR will allow you to raise the dose more quickly and, frankly, getting Handsome's numbers into a better range would be a good thing.

    I'd also encourage you to post over on the Lantus board. It's all Lantus all the time. There are a great number of experienced Lantus users there and people are around pretty much 24/7.
     
    Last edited: Feb 7, 2020
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  15. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    I just want to add that for SLGS, the BGs referenced in the method apply to human and AT numbers. That means the reduction point is below 90 for both meters. We do not use different numbers if you are using a pet meter because there are no equivalents. A 90 on a human meter one time might be a 98 on a pet meter and next time it might be 130. You can look at my Gracie’s SS tab where I did a comparison and the numbers are all over the place.

    So...to summarize, SLGS was designed to use human meters. If you use a pet meter, you would follow the BGs mentioned in SLGS as written. :)
     
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  16. MeowMomma

    MeowMomma New Member

    Joined:
    Oct 4, 2019
    First, thank you to everyone that has posted to this thread with advice or otherwise. I appreciate the replies so much, it means the world to me!

    So let me recap and see if I have this all right.

    No shoot number is still 200 but the dose reduction number is 90. I calibrated the meter last night - solution had NOT expired and the meter tested within the correct range. I will now calibrate with EACH set of strips that I open. No more rubbing the shot area so as to leave the crystals alone. Thank you for the photo of the plunger placement! I will print that out as well. I had only done the .25 and by the photo I did it correctly.

    Once I get work out of the way today I will be right back here to read all the stickys in the Lantus area. I admit I don't know a thing about TR. I typically leave for work between 7/7:30am - would checking again so soon after eating be ok?

    I can certainly post in the Lantus area as well. Should I just copy/paste my original post from here or just start a thread there with a link to this post?

    I keep his ss current with each number/shot so I am really hoping someone can advise on what to do after the curve tmrw. I don't want to keep increasing if it's something I shouldn't be doing.

    I will also mention that I have been feeding him a bit extra because with his higher numbers he has been starved to death. He is prb getting an extra can (split) up that he typically doesn't get. Normally he gets 1&1/2 cans at 5a, 1/2 can at 11a, 1&1/2 cans at 5p and 1/2 can at 10p. For the last 2 days I have given him a full can at the 11a and 10p spots.

    THANK YOU!
     
    Last edited: Feb 8, 2020
  17. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Good recap!

    Yes. I think that would either be a +2 or a +2.5 for you? Pre-shot test is at 5 AM for you? First test of the cycle should be uninfluenced by food, for 2 hours if possible. Any tests after that, we expect your cat to eat normally and see some food influence.
    One exception being if you are stalling at pre-shot, because the BG number is not high enough to shoot. Test, BG <"shoot/no-shoot" limit, do not feed, retest in 20-30 minutes. Repeat as necessary. Options are reduced dose, or skip if BG's not high enough.

    Lantus dosing schedule is best on a 12/12 hour basis. If you stall, you need to adjust the next dosing cycle. 15 minutes per cycle or 30 minutes per day, until you are back on schedule.

    Simply start a new thread over in the Lantus ISG. At the very top of your new thread, include a link to this post. That way, people have some history to refer to.

    Unregulated diabetic cats are very hungry!! May need almost twice as much food as normal. That is because their bodies can not process the food correctly.
     
  18. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Actually, the “no shoot” number for SLGS with Lantus and Levemir is below 150 when you are starting out. Between 150 and 200, you have options:
    • Stall, without feeding, for 20 minutes to see if the BG increases and if it does, you can shoot.
    • Shoot a little less insulin
    • Skip
    It’s usually very worthwhile to stall and see what happens when you are first starting out. Eventually, you learn, even with SLGS, to shoot between 90 and 150.

    And just to clarify, in Main Health, we do use a “no shoot” number of below 200 because members are generally new and getting their feet on the ground. However, in the Lantus/Levemir forum, we assume you have learned the basics on hometesting and feeding which enables you to shoot those numbers between 150-200. You can always post for help if you are unsure.
     
  19. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    She is one of the facebook members that has only started posting here this week.

    Assumptions are not always "accurate" shall we say.
    Plenty of members have been coming over from our sister facebook group, and we have no idea how much they do or don't know.
    One member over in the facebook group "complained" because she waited for 30 whole minutes without a response here.
     
  20. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    If one reads the SLGS sticky, it states exactly what I wrote. It’s just been for some time that we use a ”no shoot number” of 200 on Main Health, not only because members are just getting their feet wet, but also because other insulin users (Normalin/Humulin, PZ, Caninsulin, Vetsulin) shouldn’t shoot below 200 until they get a lot more experience and data.

    Once you suggest a member move to the L/L ISG, then they should start considering a shift to shooting between 150-200 unless they are not able to monitor. So, perhaps, they need to spend a little more time in Main Health instead of jumping right to L/L ISG.
     
  21. MeowMomma

    MeowMomma New Member

    Joined:
    Oct 4, 2019
    Yes, preshot time is 5am, so I can start getting another before I leave between 7/7:30. In fact I have gotten some extra numbers just in the last few days and have to say I am now freaking out over the yellows! I set my alarm to wake me up last night so I could get 9p and 11p numbers and now I see what you mean about going lower at night. And I will pretty much check in if I get a number below 200, but I do get what you are saying by using the 200 on the forum that other insulin users may apply to themselves.

    Are we finally getting somewhere since he has had a few yellows? Should I hold the dose a few more days or increase tmrw?

    I am headed over right now to post in the Lantus area and read the stickies.
     
  22. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Yellows are not scary. Low bright greens are scary. Or the first time you see low blue numbers, or your first green number <99. Scary but wonderful, because those lower numbers means what you are doing is working. :)
     

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