Need advice PLEASE...

I ran Tigger's curve this past Sunday. From the results, it seemed like his lowest reading was his AM PS (306). I sent his vet the curve results and she is recommending that he now receive 3 units of lantus in the AM and keep the regular dose of 2 units in the PM. She then wants me to do another curve in 3-4 weeks. Tigger's diabetes symptoms have definitely resurfaced where he's drinking more water and urinating large quantities. He is also hungry all the time although honestly at times I wonder if he is just being a greedy little one. At his last doctor's visit he was tested for keytones and that was negative. I have not checked for that at home because having two other non-diabetic kitties, it is difficult to do. My question is - does raising the dose a full unit in the AM and then keeping the PM at current dose sound right? From everything that I've read here on the forum it seems like the insulin should be raised in increments of .25 or .50 -- am I to listen to what the vet says and go for the 3 anyway in the AM? Since I work FT, I"m terrified of my boy going hypo on me when no one is home. Can someone please offer me some advice? Aside from my SS, I am also uploading an excel file that shows ALL of his curves done since his diagnosis late last year. Thank you so much in advance for any input you can provide. I really do appreciate it.

 

Lantus is best given with same amounts in AM and PM. I agree you do need to increase, but I would do 2.25 units AM and PM and monitor. It would be a good idea to get some nighttime tests as most cats go lower at night.

If you want to test for ketones, you can wait until he goes to the litter box and sneak the strip underneath his urine stream. I have done it before. Once they start, they can't stop.

It would be a good idea if you do a curve weekly and increase the dose in 0.25 unit increments as needed to get Tigger into the blues and maybe greens. It's easier on their kidneys if they are kept in lower numbers.

 

We generally recommend increases of 0.25 u both AM and PM unless the dose is a large one. You might have more success if you follow one of the Lantus dosing guidelines that are described in the yellow stickies on this forum's main page. The SLGS version might suit you better because it's less aggressive. We all understand the reluctance to stray from the vet's advice but I'm fairly sure most of us here had to in order to get our kitty feeling and doing better. I certainly did.

 

@Mandy & Rex and @Kris & Teasel thank you for responding. My gut is also telling me to go slowly also, starting at .25 increase both AM and PM. I just need to now figure out how to figure out where the .25 is on the syringe as I had just recently purchased the syringes that are marked for whole units and I still have a good amount left.

 

Here's what you can try: take one of those syringes and draw up some coloured water to what you think is closest to 2.25 u. Use it as a guide for all your doses at this level. Being consistent dose to dose is more important than absolute accuracy. Repeat later on for other fractional doses.

 

Bad thing about using a single day's curve to assign a proper dose is that anything could affect that particular day's numbers. If kitty is bouncing from a lower than usual run, that day's numbers are very inflated. Just having tests done every 2 hours can cause excitement or confusion affecting numbers. If kitty isn't feeling well that day, numbers can be inflated. Being able to vary test times over a few days usually gives you the real clues to dosing needs.

I too think you should stay with the .25 unit changes - 1 unit change is a huge amount for a kitty! Yep, you get to eyeball it - doesn't really matter if it's exactly .25, just keep it consistent

HUGS!!

 

If this was in response to what I said earlier, I just meant with SLGS, they recommend doing a curve weekly before doing an increase in addition to daily testing. However, if one is testing frequently, then a curve isn't necessary.

 

Good idea! Thank you!

 

So many things play a role in these numbers that it gets so confusing. But I now see that I have to start testing more often when I am able to. Especially at night. Thanks for taking time to respond. Wish us luck.

 

Wishing you luck and I totally agree with all the suggestions you have received today.

 

Thank you!

 

No Mandy, your info was good! This was really in response to the vet (or anyone) looking at a single day's curve to base a dose change on like upping a whole unit. If you don't know what the day to day looks like, the single day's curve isn't really telling you a lot. If it's a bounce that day, that cycle's insulin won't look like it's bringing the numbers down into a good range. If you vary testing times over a week then combine them into a single glimpse of the numbers, you have a better idea of how the insulin is actually working.

Tigger's such a cutie...

 

I just wanted to be clear with my information. What you said is spot on about a curve not giving the whole picture.

 

I got home today and his PS number was 295 so I was happy to see that although not a great number. He then ate so I'm going to do a test or two before I go to bed tonight. I'm sure his next reading will be a lot higher since he ate. I also bought some keystone test strips so I'm going to try and get creative when trying to check that. I read somewhere on the forum that someone used a plastic bag over the litter box and I'm going to try that. I just have to pay attention to when he goes. He already went before I noticed but I'm going to watch him closely again and follow him to the bathroom each time he goes. He's my baby so I will do anything for him.