Lantus Dosing Questions - Bashful

COPY OF POST TO LANTUS SUPPORT GROUP -

AMPS 320 - PMPS 342 Bashful - Need Advice Dosing

Okay guys, I've posted a few questions on the main board, but not over here. I guess these are more lantus specific.

[FORGIVE MY VERBOSE NATURE...I'M SLEEP DEPRIVED AND CAN'T FIND MY HINEY WITH TWO HANDS AND A MAP AT THIS POINT. LOL]

Bashful just came back from the falls. Took Kitty to vet and had full blood workup to make sure nothing else was wrong and that this was just him needing to get back OTJ. All numbers ok, other than off pancreas numbers, which would make sense given that his BGs were high. Bash is about 17 years old, no major health concerns. He's on all wet gluten free diet with FF. He was diet controlled and OTJ for over 4 years.

The vet kept him 24 hours to start on Lantus (even thou I know how to do curves, I wanted to have a better average going in knowing the right dosage to use - given that this was a new insulin - I was on PZI lst time). They had him 1 unit every 12 hours. When he came home he had some much lovelier numbers, He went in there at 400 and came back out around 195 - and at BG shot +11 (1 hour before next shoot - and before I was due to give my first virgin (again) shot he was at 151. I waited a bit and he came up to 232 in an hour and a half and I shot a skinny 1 unit then.

RECAP UNTIL i CAN GET MY SPREADSHEET DONE TOMORROW:

1/17 - Vet return
PMPS - (+11 - 160), (+12 - 198), (+13 232), - shot skinny 1 unit

SUMMARY:

PMPS 232 - shot 1skinny unit lantus
+1 255
+2 181
+4 171
+5 173
(at this point it's 1:30 a.m. and I can hardly see and had to get back up early to do it all again...yeah...so went to snooze

1/18
AMPS - 320 - Shot 1 unit lantus, and apparently not very well - PROBABLY A FUR SHOT? (CAUSE I GUESS YOU CAN TELL BY THE NUMBERS HE WASN'T MOVING MUCH)

+1 - 327
+2 - 280
+3 - 305
+4 - 287
+5 - 346/338
+6 - 336
+8 - 375 - AT THIS POINT CAN I SAFELY GUESS I MUST HAVE SHOT A FUR SHOT???...GRRRR....

PMPS - 342- shot 1 unit Lantus (I and am pretty positive I did this one correctly and felt the plunger move and such (IT'S SUCH A SMALL AMOUNT TO CONTROL....DOES ANY ONE ELSE HAVE THESE STRUGGLES?).

1/18/10 -
PMPS - 342 - Shot 1 U lantus
+1 - 347
+4 - 287
+5 - 343
+6 - 393 (CRANKY VERY TIRED BEAN NOW JUMPS UP AND DOWN ON BED AND HAS A FULLY NINNY HISSY SNIT!)

SO what is the deal with all these high numbers???? I am totally un-used to the Lantus shed issue (used pzi before-which had a tendency to jump him low somewhat quickly).

I am not sure, but could have done a fur shot this a.m. that's going to screw these all up again shed wise. But I'm very very frustrated by the fact that at I started tonight PMPS at 342 and now at +6 I am back up to 393, with not much downswing in between.

Is this just shedding issues? Not doing my 12 hour at exactly 12 hours because of the lower number the first time? Maybe a fur shot? Am I not using enough insulin? Do I try this another 24-48 hours and then if they stay high like this do I then up the dose to 1.5 and then leave it for 2-4 days to then even out again? nailbite_smile nailbite_smile

Do I just have to be on Lantus for close to a week to see if the shed builds up and things even out (AT LOWER NUMBERS DARNIT!) - or do a smidchen increase somewhere along the way?

I'll create the spreadsheet tomorrow (with what little I know) while I am at work. I had limited access today to my computer.

Trying to remember to breathe, but go to freaked out land when his numbers stay too high because of fear of ketones...and then worry if the numbers go too low cause I'll freak out cause I think he might to hypo (not that the little skinker is going anywhere near that direction at the moment).

Going to get more test strips and ketone strips tomorrow on the way home from work.

Any advise would be so gratefully appreciated!

Very tired and frustrated Bean and sugarmom (Theresa)- to Bashful

Theresa & Bashful (age 17)

Theresa&Bashful

Joined: Fri Jan 15, 2010 4:11 pm

* Private message

 

Hi Theresa, (welcome back)

Yep your right, verra different to PZI in terms of dosing and protocol.

I know this is frustrating for you, but you do indeed hold initial dose for 5-7 days and then increase in increments of .25u because yes shed is building.
Consistent dosing is real important with Lantus and gives best outcomes (you saw how much he went up when you delayed, but can see why. Harder when you haven't got the data history to know how your kitty will react to an insulin)

The fur shot could have taken Bashful back a bit.Added with a delayed shot the night before may compound the numbers. I am surprised his +6 is higher, but could be several things (did he eat within 2hours of you getting that spotcheck? Have you definitely got the right measure on the syringe?)I think for now get spotchecks and see if anyone else who has used Lantus has had similar readings.

Make sure (if youhaven't already) you ask this in Lantus isg too. I haven't known beans be advised to increase initial dose before 5 days, but would say at the moment, increase at day 5 rather than 7 and be around to get spotchecks.

Your on day 3 already, so not long to wait.
And yep check for keytones. Elevated numbers for a short time shoudn't be a drama.
(some beans can't get their kitty's in lower numbers)

As someone in LL said, it's a marathon not a sprint (I think of the hare and the tortoise :smile: )


ps-we know how your feeling-how about bashful? ;-)

 

Hi Theresa,

Stay on 1 IE bid for 3 day's on Lantus (the first 3 day's).
After those 3 first day's (is that tomorrow?) you increase with 0.5. So as of day 4 you give 1.5 IE bid.

I do have the same issues with Spacey: on the first couple of shot's (2 I think) she went down, eummmm her numbers went down nicely but then came up again.
It's indeed the shed thing. At least what I think.

Here is the URL to the protocol on Lantus:
http://www.uq.edu.au/ccah/docs/diabetesinfo/link4.pdf

In there you can read that you hold the initial dose for 3 day's.

Well... that's what I'm doing

 

Hello, Theresa! I answered you in Lantus Land: viewtopic.php?f=9&t=3178

 

Ella and others, just to clarify a learning point:

Initial starting dose is held for 5-7 days.(Shed building and settling into using Lantus/Lev)

After that you can increase every 3 days(some beans hold a dose for longer for a variety of reasons). :smile:

 

Sorry Kate. It really doesn't say that. The protocol I mean. I have it right in front of me (printed it out for my hubby).
There its say's:
Phase 1: Initial dose and first 3 days on glargine or detemir.

3 days. Not 5.

And then, in phase 2, increasing every 2-3 or increasing every 5-7 days depends on the numbers.

I also checked the German forum. They advice the same.

I think things are different indeed when one reaches those lower numbers. But until then priority is, I guess, helping the cat to lower and therefore increase on a tighter schedule: every 3 day's.
At least, that's what I make of it all.

 

Re: Lantus Dosing Questions - Ella

Hi Ella,

you are indeed right about what it says in the protocol. I have searched everwhere including old board, but cannot find the reference other than the comment 'we use a slightly modified version of Tilly protocol'. I am positive at one time it was explicit.

If you look at Cassandras post from this morning:
viewtopic.php?f=9&t=3178
she says excatly the same as me in that you hold the starting dose for 5-7 days.

I'm making a huge assumption here because way before my time, the 5-7 days possibly came about because beans here could not tightly regulate/monitor like the German cat forum could (not sure even if that was just followed for the research study either)

I will pm Cassandra about it as it probably does need clarifying/making explicit somewhere so that it makes sense!

FWIW I tended to hold my subsequent doses longer than 3 days. It is only a guide because of the addage ECID and numbers and knowing your cat are the best guide,