? Lantus Dose Increased - Normal Range and AM Vomiting

Good evening,

Still new to diabetes and the message board. My boy was started on insulin 12 days ago. on day 6 was transitioned from 1u twice a day to 2u. His pcp didn't want me checking his bg but started today anyway. His numbers when he started on 1u were ranging around high 200 - mid 400. On 2 units now for 6 days and bg is hovering around 115-120. Vomiting in am last three days. Is the increased dose too much for him especially if he is not "snacking" during the evening? Difficult to get him to eat anyway, but wondering if this is what is causing vomiting in the am. He saw vet this afternoon and they are running fructosamine, says if comes back around the same lower numbers will decrease dose back, in the meantime, until I get results of that tomorrow, do I give insulin tonight knowing the vomiting has occurred the last three mornings? NOt sure if insulin related, but only correlation it seems, he has never been a vomiter even when really sick from panc etc

 

Hi there. We only increase doses in increments of .25 of a unit and that is so we do not go over the correct dose. If his BG are 11 5 -120, I feel he could be getting too much insulin. In the beginning we say do not shoot anything under 200 as you are following SLGS. Sometimes too much insulin will look like not enough. Since you kitty was just DX recently, I would scale back to 1 unit and monitor. Could you fill in the SS with any test that you do have as that helps us help you.

I think this will help you keep Pablo safe. Please update and continue to post and ask questions as that is how we all learned. If you start a new post every day with the date an Pablo's name, we can help guide you.


ETA: I am so glad that you are home testing. So important so you know whether it is safe to shoot or not. You are a good and conscientious bean to be testing. Take a bow!

 

Hi there, and welcome! If Pablo's not been eating well, and vomiting, he must be feeling pretty yucky! My vet recommended a jump from 1-2 u as well, but I chose to gradually increase.

I can't make any dose suggestions, being new myself , but hope he starts feeling better soon.

 

Thank you that's what I was thinking too regarding the insulin and why vomiting the last few days in the am. I'm supposed to get a fructose test back tomorrow but scared to give the insulin tonight until then because his numbers have went in complete opposite direction (glad they are coming down but from what vet said seems like they think maybe too much as well. When you say fill in the ss does that mean the spreadsheet? In still learning so appreciate input

 

Also when you say sometimemes too much insulin can look like not enough, what does that mean? So if he's 110-120 probably not give tonogiht until vet calls tom to confirm current dose or decrease?

 

I was just thinking back to one of my previous kitties, I wonder, you said Pablo vomits in the am? Is he vomiting food or liquid? It might be a bit of acid reflux, if it is liquid?

 

PS. Also, try separate his meals into mini meal through out the day to help him

Yes, SS is Spread sheet. That data filled in is helpful to you and to us. If it were my kitty, I would not shoot 2 units. Is it time for his PM shot? If so , get a test. If he is under 2oo, stall for 20 minutes and see if he comes up over 200 and then I would only shot 1 unit.

 

The 200 number is for newly diagnosed kitties. As you get more data on the SS to see how he is responding to the insulin, that number will lower.

 

Thank you. I do seoerate his meals into mini meals (sometimes have to syringe if not eating enough). It is time for his pm shot in an hour or so. Ok I will test again to see. Thank you so much.

 

To answer this question: If they are getting too much insulin, their numbers could fall lower fast and resulting in bouncing up higher and those high numbers are the ones we are catching. So, we think that they are too high needing more insulin and then we raise the insulin and the same thing happens. It is a vicious cycle. That is why we following methods/ protocol that instruct us to only increase in increments of .25 of a unit. Then we don't miss the correct dose.

 

Thank so much. All so very h confusing and feel like not getting much if any direction from vet

 

Hi Nicole, I am just now getting a good hang of this myself but we have a good example of why the smaller increases. When I switched insulins to Lantus, we started at 2u (had already been on another insulin for awhile, hence the higher starting dose). When it was time to do an increase going by the TR protocol that we follow, was supposed to be shooting 2.25u. Being a bean, I was having a couple days of brain fogs and though I was putting on the SS that I was shooting 2.25u, was actually shooting 2.5u. We just went ahead and stayed with that dosing since we were already there and even did an increase after that. Well, we are back down to the 2.25u and we are starting to see some good action happening! We could have been here a bit sooner if I hadn't had my brain farts and was doing his dosing correctly. It also made me more aware of how easily it would be to accidently shoot too much so I am triple checking the syringe now before I shoot to make sure I have the correct dose.

Our first vet was one of those who didn't want us testing at home, and actually tried to talk us out of it, so we go to a different one. I don't coordinate any of his diabetes treatment with the vet at this point, she is happy with the home monitoring and even says there is no need to keep bringing him in unless he gets sick. Will be going soon enough so we can get a script for his Lantus when it gets closer to time for that, but I have 4 full pens so that could be a bit. Not worried about going to the vet until it is either time for a checkup or Zeke starts showing signs of something else going on (crosses fingers).

 

Believe me, I understand! It can feel like a lot to process, I've re-read the sticky notes on lantus and SLGS, and still ask a lot of questions , vets do only what they can, thankfully with the help here, I like to think I have a broader, expanded view of feline diabetes and you'll get there too. Baby steps!

 

It's very common that vets don't give enough help. Increasing by a unit is risky especially without testing. He has CKD so tgat might explain the vomiting.

 

I didn't see the answer to what the vomit was. If it's just fluid, it could be stomach acid. Try to leave something out for him when you go to bed so he
can eat something if he feels like it..... even if it's just some freeze dried treats.

 

Rhiannon

he has other issues so eating for him is not great especially at night. One or two of the three times was bike looking and other one/two were fluid like

 

so he is getting pepcid ac original? not a substitute ?

imho, I would ask my vet for a prescription for ondansetron to see if it helps him. It's a nausea medication for humans that many of us here have
experience with greatly helping our cats. He might even be more willing to eat at night. You give it 30 minutes before giving cyproheptadine.

 

Thank you. His ckd is generally controlled but panc not so much.

 

He does get Pepcid. I do have/restated ondasteron since vomiting started (on my own to see if it helps yesterday he ate like a champ for him. Normally it never seemed to help him so not sure if was coincidence or not

 

put that in the comments section on your ss so you can track that he took it, ate willingly or not.... and you can look back and see if it's makes the difference.

 

Most of us did not get enough direction from our vets. Unfortuatley these vets get about 8 hours of instruction on Feline Diabetes. Sad but true. A lot of beans euthanize their kitties when getting the DX of Feline Diabetes because they thing they can't help of control the disease. WRONG. We are here to help you and Pablo. There is so much knowledge on this board. Just keep posting and asking questions so we can help you.

 

Is he vomiting food or clear? Sometimes they are better without pepcid or less often. Stomach acid doesn't mean the CKD is not controlled. For Max it actually didn't seem to tell at all and he did better without.

 

he has vomited both. Two tones mostly clear other small amounts of food

 

So it could be from the pancreatitis. I doubt it's the insulin.

 

I have no choice but to free feed Zeke. If I try to do just meals, he will vomit in the morning. So he gets 1/2 can of friskies 2 times a day, then free fed friskies the rest of the time. I pick up all food 2 hours before the meals/PS's

 

Nicole, are you giving something for nausea? If so it's not working. Maybe the dose isn't enough?

 

Yes just restarted ondasteron. I think it's the higher dose of insulin and that he doesn't eat much, and o have to prompt or syringe feed sometimes if not eating enough and because he's prob not eating during the evening: He's never ever really vomited in his life until the recent increased dose.

 

Hi Nicole. When you get a chance update the SS so that we can help you better. It very well could be that he does need more than 1 unit but until you get more data and especially during the nighttime as most kitties go lower at night, and he needs dose increases in increments of .25 unit and test around the nadir time of +4 - + 7 to see how low the dose is taking him.

 

Thank you very much, will do. And good to know regarding the hours as vet has not mentioned that at all. Thanks!

 

When you say +4 and 7 is that both at four goes and 7 hours after each dose?

 

Nicole, which set of labs is the most recent?

 

Yes that would be correct. And since cycles are only 12 hours, the PS is in place of +12 since you are starting a new 12 hour cycle.

 

What does does the ps mean in place of 12? Pre shot instead of doing insulin?

 

I should be receiving labs back today and going to update with those, but I'll fill in others too, most recent before yesterday's draw (with exception of bg checks) was beginning of August

 

Since we test before we shoot, the test at +12 is actually the beginning of the next cycle so it is listed as the AMPS/PMPS instead. It is the test before you shoot. I said it in a way that made it confusing, sorry.

 

Here is an explanation of interpreting the SS that helped me when I first arrived.

AMPS is the AM Pre-shot test (always test before shooting to make sure they're high enough to give insulin)...then the U column is for "Units" (how much you gave)

The +1, +2, +3, etc are for how many hours since shooting...so +2 is 2 hours after the AM shot, +9 is 9 hour after, etc.....Since we're all over the world here, saying "he was at 148 at 8pm" doesn't tell us anything...we need to know how long since his last shot

At the end of a 12 hour cycle, it's PMPS time! (PM Pre-shot) and the whole thing starts over

 

There are two sets of labs so far but without dates. Is the one closest to the ranges the older one?

 

I will look and update to make sure I have correct dates and info