? Lantus dosing Chaz amps 381

[Kelly & Chaz]

Does Lantus or insulin in general act like some other meds where initially a dose seems to be working effectively, but then over a bit of time, requires gradual increases to continue to produce good results? I look back at our numbers since starting in early Dec, and long for those blues and greens of the lower doses. Chaz seems to be staying in the pinks for the most part now (other than that one weird low at amps a few days ago), and I just don’t know what to do to help him. I realize he technically earned a reduction with the amps low, and then since we had to skip, he has likely been bouncing. These consistent high numbers are scaring me. His activity has been pretty normal and he’s still eating watered down FF pates eagerly 4-5 times a day. Shot times and feeding schedule is consistent day to day. Help?

 

[Kelly & Chaz]

Bump

 

[Si am cat mom]

Hi there!
Just for reference:

Hold the dose for at least a week:

• Unless your cat won’t eat or you suspect hypoglycemia
• Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.

After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.

• If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
• If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
• If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

It does look like there were times you gave a different dose for the AM shot than the PM shot..
With Lantus being a depot insulin, any changes like that in dosing will disrupt the buildup and can give you wonky numbers. There have also been times there was a reduction due and it looks like you didn't take it or started to but changed back to the previous dose. On SLGS, under 90 earns a reduction and you hold it a week and do a curve to see how low it's taking Chaz.
I know it seems counterintuitive at first but - a week gives the new dose time to settle and taking the reduction usually means you will get more shootable PS numbers, so then you aren't having to skip or reduce as often.
Have you decided a shot number that you are comfortable with...like will you shot a full dose on anything over 150?
TR is different and you adjust doses more often.

This should bump your post again and maybe someone with more experience will be by.

 

[Christie & Maverick]

One important clarification to note is that insulin is a hormone, not a medication or drug. Because of this, the way kitties respond to the insulin can vary, and insulin absorption can also be a factor. Moving the shot location around helps, if you aren't doing that already. I've been struggling with this myself, since I'm finding my kitty is getting little fatty deposits in our usual spots, even though I try and move around.

Many of us have also found that the insulin syringes are very inaccurate. Doses do go up and down, so don't worry too much about the dose, you want to make sure you know how low the dose is taking Chaz before increasing, even though higher preshots are tough to see.

Your no shot has disrupted the depot, plus he's bouncing from that 74 as well. It looks to me that it may be that you missed a lower number sometime over pm cycle of Jan 16th, which led to a bounce. The bounce then cleared through pm cycle of Jan19th...he may actually have gone lower than the 74 you got at preshot. Bounces usually clear within 6 cycles, so I'd get a before bed tonight.

That's all I can think of at the moment; I'm a bit rushed as I have company coming for dinner

 

[Wendy&Neko]

In your last post here, I suggested you go back to 0.75 units, and hold the dose a week, as per SLGS. You held for four days, did not get a curve, then increased. Then got that 74 on the morning of the 20th, which told you yet again that 1 unit was too much insulin. It's time to go back to 0.75 units.

You'll find that Lantus teaches you patience. It was never my strong suit either.

 

[Kelly & Chaz]

Hi there!
Just for reference:

Hold the dose for at least a week:

• Unless your cat won’t eat or you suspect hypoglycemia
• Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.

After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.

• If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
• If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
• If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

It does look like there were times you gave a different dose for the AM shot than the PM shot..
With Lantus being a depot insulin, any changes like that in dosing will disrupt the buildup and can give you wonky numbers. There have also been times there was a reduction due and it looks like you didn't take it or started to but changed back to the previous dose. On SLGS, under 90 earns a reduction and you hold it a week and do a curve to see how low it's taking Chaz.
I know it seems counterintuitive at first but - a week gives the new dose time to settle and taking the reduction usually means you will get more shootable PS numbers, so then you aren't having to skip or reduce as often.
Have you decided a shot number that you are comfortable with...like will you shot a full dose on anything over 150?
TR is different and you adjust doses more often.

This should bump your post again and maybe someone with more experience will be by.

In your last post here, I suggested you go back to 0.75 units, and hold the dose a week, as per SLGS. You held for four days, did not get a curve, then increased. Then got that 74 on the morning of the 20th, which told you yet again that 1 unit was too much insulin. It's time to go back to 0.75 units.

You'll find that Lantus teaches you patience. It was never my strong suit either.

You are right, it is very hard to be patient when you’re trying so hard to do everything right and the numbers are far worse almost two months in than at the start. It just doesn’t seem like the dose is even bringing him to a lower nadir now - he’s staying right up in the upper 200s and 300s across the board, and he’s seeming to not feel great again, losing a bit more weight. I’m thinking I’ll try and get him in to see our vet early next week, just get him looked at for peace of mind if nothing else. Thank you for your reply and support. I’m not a fan of marathons . Have a great day.

 

[Kelly & Chaz]

One important clarification to note is that insulin is a hormone, not a medication or drug. Because of this, the way kitties respond to the insulin can vary, and insulin absorption can also be a factor. Moving the shot location around helps, if you aren't doing that already. I've been struggling with this myself, since I'm finding my kitty is getting little fatty deposits in our usual spots, even though I try and move around.

Many of us have also found that the insulin syringes are very inaccurate. Doses do go up and down, so don't worry too much about the dose, you want to make sure you know how low the dose is taking Chaz before increasing, even though higher preshots are tough to see.

Your no shot has disrupted the depot, plus he's bouncing from that 74 as well. It looks to me that it may be that you missed a lower number sometime over pm cycle of Jan 16th, which led to a bounce. The bounce then cleared through pm cycle of Jan19th...he may actually have gone lower than the 74 you got at preshot. Bounces usually clear within 6 cycles, so I'd get a before bed tonight.

That's all I can think of at the moment; I'm a bit rushed as I have company coming for dinner

Thank you for your reply. This is such a complicated and puzzling disease. I do try to switch up injection spots, but I can only get a hold of his fur to tent in certain areas while he’s eating and I’m injecting. I wonder about the syringe marking accuracy too, and then we’re trying to do half or one quarter, along with those darn air bubbles to deal with.
I just don’t understand how we were seeing much better numbers in December than we are now, but I will try harder to follow the protocol. Just want my sweet boy to feel better .

 

[Kelly & Chaz]

Hi there!
Just for reference:

Hold the dose for at least a week:

• Unless your cat won’t eat or you suspect hypoglycemia
• Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.

After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.

• If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
• If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
• If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

It does look like there were times you gave a different dose for the AM shot than the PM shot..
With Lantus being a depot insulin, any changes like that in dosing will disrupt the buildup and can give you wonky numbers. There have also been times there was a reduction due and it looks like you didn't take it or started to but changed back to the previous dose. On SLGS, under 90 earns a reduction and you hold it a week and do a curve to see how low it's taking Chaz.
I know it seems counterintuitive at first but - a week gives the new dose time to settle and taking the reduction usually means you will get more shootable PS numbers, so then you aren't having to skip or reduce as often.
Have you decided a shot number that you are comfortable with...like will you shot a full dose on anything over 150?
TR is different and you adjust doses more often.

This should bump your post again and maybe someone with more experience will be by.

Thanks for the reply, and reminder of the SLGS protocol. I guess maybe I haven’t been patient enough, I just get so worried when his number ps stay high through several cycles, not seeing much dip even at what should be peak time for insulin. I’ll try harder to be patient but a week straight with high numbers is hard to take.