Need dosage advice

Discussion in 'Lantus (Glargine) / Levemir (Detemir)' started by Marcia-n-Chinker, Feb 24, 2018.

  1. Marcia-n-Chinker

    Marcia-n-Chinker Member

    Joined:
    Jan 3, 2018
    Chinker has been switched to Lantus on Feb 8 & I noticed improvements within 2-3 days after using Lantus, less drinking, less urine, not as hungry and more active. Getting to my concern is his dosage, I'm seeing green bgs in the 70s (Feb 21) after about two wks. I called the vet to inform her of what had happen & was told to reduce dosage to .50 because his bg shouldn't go below 100 & that Chinker was rebounding. I'm not convinced what the vet told me is the correct info. Should I lower or stay at the previous dosage. Is he rebounding, on to much insulin?
     
  2. Stacy & Asia

    Stacy & Asia Well-Known Member

    Joined:
    Oct 2, 2017
    Haven’t seen you before, welcome to you and Chinker! :bighug:

    Looks like the numbers were starting to improve on 1.5 and got worse when you lowered the dose per your vets instructions in early January. Somogyi phenomenon has been debunked with the invention of continuous glucose monitors but a lot of vets hold fast to it still. I would not lower the dose. I would, however, try to get some overnight tests in. Try to get a different hour once a night until you fill in some blanks there and make sure Chinker isn’t going low because you are missing half of the puzzle. Many cats go lower at night.

    Read the stickies for SLGS and TR at the top of the forum here and see what you think. We have different dosing strategies depending on which one you choose to follow. :cat:
     
  3. Juliet

    Juliet Well-Known Member

    Joined:
    Sep 8, 2017
    It sounded like @Marcia-n-Chinker was talking of bouncing not Somogyi phenomenon. Not sure there’s much difference between the two. Both mean going high after having gone too low. So if the one has been debunked - the other hasn’t?
     
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  4. Stacy & Asia

    Stacy & Asia Well-Known Member

    Joined:
    Oct 2, 2017
    They are different, actually, and bouncing is not going high after going too low. Somogyi aka rebound hyperglycemia, is something that was observed in the 1930s and for whatever reason has become pervasive to doctors and vets in regards to diabetes even though it has been disproven. The theory was that people waking up with high blood glucose were having silent hypoglycemia event when sleeping. The fix is to reduce the dose because the problem is too much insulin causing hypoglycemia. If we sung the praises of somogyi around here, we’d have lots of cats with too little insulin, and probably several DKA incidents to show for it. It has also been studied and debunked in cats specifically.

    What we call bouncing is a response to having dropped lower than the body is used to or too quickly, including but not limited to low “lime green” numbers. Dropping from 400 to 200 in one hour could trigger a bounce, 200 is not a hypo inducing number, nor is it a number we would want to reduce insulin on, but to a cat that has been diabetic for awhile and is used to numbers in the 400s, it’s a shock to the system. Bouncing is the body freaking out to a sudden change and dumping all this glucose as a protection mechanism because the body thinks it could be in trouble, not because it actually is. Reducing the dose in response to a bounce depends only if the number went below an action number, otherwise, you keep on keeping on and you ignore the bounce. Many cats bounce and are far from having enough insulin on board. You can see this in many of the acro cats on the board, they will bounce from numbers in the 300s, the solution is not less insulin in that case, the solution is more insulin.
     
  5. Juliet

    Juliet Well-Known Member

    Joined:
    Sep 8, 2017
    Yes I knew that. When I meant bouncing is going high from having been low I meant “than cat is used to”.
     
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  6. Sandy and Black Kitty

    Sandy and Black Kitty Well-Known Member

    Joined:
    Dec 31, 2009
    Hi there :cool:

    Here is the link for SLGS
    Here is the link for the TR Protocol
    Lots of good info there.

    Some very important differences between Lantus and Prozinc are that Lantus is slow acting and longer lasting and it forms a depot.
    Also, dosing decisions are based on nadir rather than PS numbers.

    So how did you find out Chinker was diabetic?
     
  7. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Hello and welcome.

    A favour to ask, could you put an blank line after Feb 7th in the spreadsheet. Then put Start Lantus, or something like that, in that line. That'll make it easier at a glance for us to see the change.

    Did the vet say why Chinker shouldn't go below 100? The normal range for a cat is mostly in the green (below 100) range. If you are home testing and can steer numbers with food, it's OK if your kitty goes below 100. Vets get nervous at lower numbers, because the majority of their clients are not home testing. We take action by feeding high carb food, when kitty goes below 50. People here follow one of two dosing methods (TR or SLGS that Sandy linked above). Each dosing method has a reduction number, different one for the two methods. If kitty goes below that reduction number, the dose is reduced.

    Finally, one last thing. If you can, it's a great idea get some tests in the PM cycle. Many cats go lower then. A test before bed is a good one.
     
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  8. Marcia-n-Chinker

    Marcia-n-Chinker Member

    Joined:
    Jan 3, 2018
    Hi,
    I noticed Chinker had an increased hunger level, I fed him more (Friskies gravy), I know now gravy is bad, anyways, he didn't gain any weight (quite thin). My instincts told me something isn't right, so took him to vet, did some blood tests and here I am (bummer). Been on this forum for a few months, reading mostly when I have time. I find all these bg numbers that I need to be aware of, very confusing and not knowing what to do next. Thanks you for the info.
     
  9. Marcia-n-Chinker

    Marcia-n-Chinker Member

    Joined:
    Jan 3, 2018
    What is a reduction number? I made copies of the TR and SLGS so I could have them on hand to read over several times, I still find some of the info confusing. What does a person do when I get a bg of 147 at +12, this happen last night & I assumed I needed to reduce dosage, which I did, now today his bgs are in the 300s. Anyways, I tried making a blank line on the spreadsheet to high light the change to Lantus, without success. Are there instructions on how to insert a blank row?
     
  10. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    If you see a kitty with a number below the reduction number (50 for TR, 90 for SLGS), you reduce the dose. It's called earning a reduction. We determine what dose to give a cat based on the nadir, or lowest number in the cycle, not so much the preshots. For people who are new, we suggest that if you get a preshot number below 150, you do not feed, and post here for help. Take a look around the other posts here. You will see that with data and experience, people will shoot lower numbers. Often the cycles are much flatter when you shoot lower numbers.

    To insert a line, open your spreadsheet, highlight the line either before or after you want to put in the line by selecting the left most cell. Then go to the Insert Menu and select either Row Above or Row Below, depending on which makes sense.
     

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