new to lantus; help with bouncing

Yuki has been on 1 unit lantus since 1st June and she seemed to be stabilising, getting back to her old self. Over the last few days I have taken BG readings and it seems her nadir BG drops quite low. Even pre shot was very low. However, reducing or skipping her next dose seems to make her BG high.

She is a grazer, but typically is sleeping during the day; hence, doesn't eat much then. I cannot understand what is going on with her BG; it's like one step forward, two steps back.

Could this be bouncing?

I wonder if varying the AM and PM dose would be better? Does anyone have experience with different AM and PM doses on lantus? Any advice/suggestions?
Please let me know if I can provide any other information, which I may be forgetting.

I'll be discussing with my vet, but she has never handled any patients with lantus.

Other info: Yuki was on AB (synulox) for a UTI between 26thMay to 2nd June.

Thanks!
Arathi

 

Hello Arathi!
Those lime green numbers (and the lethargy) indicate Yuki went hypo on the 8th and 9th. Although I'm still new at the Lantus (Glargine) game, this tells me your dose is too high. Are you following TR or SLGS protocol? I think you would decrease your dose by at least 0.25. Unfortunately, I'm not an expert on dosing, so perhaps someone will be by to confirm that aspect.

As far as varying doses goes, I've heard it's best not to do it. The lower doses are basically like a decrease and drain the depot, giving your kitty an erratic response to the Lantus.

 

Thanks for your reply, Amanda. I want to follow the SLGS method, but since Yuki had started on vetsulin, vet recommended 1.5 units to begin with, which was later brought down to 1unit. It does seem from what you said that it is better to reduce the dose. I will be going off to take a reading, hopefully that will provide some guidance as to whether I need to skip today or not.
All this so confusing and overwhelming at times. Thanks to this board , for reducing my stress!

 

I think the high numbers are both from the lack of insulin and some bit of bouncing. Another reduction is definitely in order. I wouldn't give more than 0.75u after those lime greens. Although I'm not sure if 0.5u might be better until Yuki gets her bearings. You might want to update your thread title with a ? and Requesting dose advise ASAP if you would like to draw some more eyes. I'm a poor substitute for our more experienced members, ha.

 

Updated:

have done that, but it is close to her dose time, hope someone replies soon. i am thinking about 0.75U

 

is that a <1.1 today at +7?

If it is, that's WAY too low

But no matter what, she needs to be reduced to a dose she can get twice a day without skipping.

I'd like to suggest .5

We can always go up to .75 if we need to, but first we need to find a dose she can get every 12 hours without hitting those lime greens

 

Hi thanks for responding. sorry, i panicked and gave 0.75u this pm. but will start with 0.5 tomorrow am. I read that one should continue with one dose for 3 days at least, before considering a change, is that true?

 

It depends if following SLGS or TR. I suggest that you read the yellow sticky for each protocol. Even with TR a test of under 50 calls for a reduction.

 

right now i am not strictly following either. My vet (not regular) had recommended to be on 1 unit for a week before taking any readings. My regular vet is back now, and I will discuss with her the option of SLGS with 0.5 U. I know it says to be patient with this method, but sometimes it is so hard! for today i did reduce by 0.25U, but tomorrow am planning to go with @Chris & China 's recco of 0.5 U.

 

Interesting language.….LOL

 

yes, if you're doing TR.....On SLGS, you'd hold the dose for a week.

Of course if Yuki drops below 50 (on TR) or below 90 (on SLGS) it means another reduction

 

First and foremost, if your vet tells you not to test, please, please, please ignore the vet. Testing is the only way to make sure our cat is safe. You are not testing enough to know that Yuki's numbers are not in a hypoglycemic range. This is especially the case with a cat that is prone to bouncing. My cat could start a cycle with an AMPS in the 400s, drop to the 40s, and bounce back to the 400s by PMPS. If I hadn't been testing, I would not have known to reduce the dose. You need to be getting test during both the AM and PM cycles and always getting tests before giving a shot.

Bounces are annoying buy a normal phenomenon. Yuki's body is not used to being in lower numbers and as s result, her liver and pancreas overreact to the low numbers and dump a stored form of glucose and counterregulatory hormones into her system. This causes numbers to spike upward.

I agree with Chris. I would drop the dose back to 0.5u.

 

sorry if i am making you repeat the same thing again; but i want to make sure i understand correctly. so lets say i start her off on 0.5 u tomorrow, 11th june, then if on 12th itself the bg drops below 90, i should reduce? and from then on stick with the reduced dose or continue back with 0.5U? i am not sure how frequently i can test her, as she is not very co-operative with this, and honestly i am struggling. i will try my best to get as many readings as i can.

 

yes, i do agree with you that the greater the bg readings the better the understanding of what is going on. My vet has encouraged me to do readings at home, as taking yuki to vet just for bg readings is not an option. Like i mentioned to @Chris & China yuki is not very cooperative for the bg readings, and i am not making it very easy. i have gotten better as compared to before, but sometimes it is such a miss. poor yuki also has almost a half chopped off of one ear, when she was in a shelter. so i am now mainly doing the testing on one ear. i do hope i get better with time, though at this point i am not sure if i can take readings everyday.

 

We don't usually do "back to back" reductions, so in this case, we may suggest you hold the .5 dose.....it depends on the circumstances so I can't really give you an exact answer.

Here's something I wrote up for others for testing...maybe it'll help you too!



It can be really helpful to establish a routine with testing.Pick one spot that you want your "testing spot" to be (I like the kitchen counter because it's got good light and it's at a good height....it also already blocked 2 escape routes due to the wall and the backsplash) It can be anywhere though...a rug on the floor, a table, a particular spot on the couch...wherever is good for you.



Take him there as many times a day as you can and just give his ears a quick rub and then he gets a yummy (low carb) treat.Most cats aren't objecting so much with the poking..it's the fooling with their ears they don't like, but once they're desensitized to it and learn to associate a certain place with the treats, they usually start to come when they're called! Or even when they hear us opening the test kit!



You also have to remember...you're not poking him to hurt him...you're testing him to keep him safe and understand what's going on inside his body. There's just nothing better than truly understanding what's going on inside your kitty's body and with this disease, the more knowledge you have, the more power you have against it. The edges of the ears have very few pain receptors, so it really doesn't hurt them. Also, if you're nervous and tense, it's going to make your kitty nervous and tense too.As silly as it might seem, try singing! It forces you to use a different part of your brain!



It's also important to make sure his ear is warm.A small sock filled with a little rice and microwaved or a small pill bottle filled with warm water (check temp against your wrist like you would a baby bottle) works well



For new kitties, using a heavier gauge lancet is also really helpful.A 25-28 gauge lancet pokes a bigger "hole" than a 31-33 gauge lancet does, so look for "Alternate Site testing" lancets that are usually a lower number



Finding the right "treat" will be a great help too!Freeze dried chicken, bonito flakes, little pieces of baked chicken...whatever low carb treat you can find that he really enjoys will help him to associate the testing with the treat! China's Achilles heel was baked chicken, so I'd bake a piece, chop it into bite sized pieces, put some in the refrigerator and freeze the rest to use as needed. It didn't take long for her to come any time I picked up the meter!

 

hi thanks, i think i get it now about the dose. i do most of the things u suggest for the bg reading. i think i need to work on making the ear warm. that has been the major problem, as sometimes even when i prick her i never get enough blood to test. also wanted to ask, she has one ear with a major chunk cut off, so i have been using just one ear for testing. is that ok?

thanks for all your advice today, it has been a major help.

 

Yes!! China's ears are fine, but I'd have better luck getting blood out of a rock than her right ear, so she only gets poked in the left!

 

that is good to know, what a relief!

 

It was the same for me -- I tested Gabby on only one ear.

Also, it can take a little while for an ear to bleed well. The more you poke, the ore the capillary bed in that area becomes built up making it easier for the ear to bleed. It also helps if you are using a larger gauge lancet in the beginning. If you're not already using a 28 or 29 gauge lancet, you may want to try that out. It may hurt a little bit more, but it's likely you'll be more successful than if you're using a lancet that's 30 gauge or more. (The higher numbers are thinner in width.) If you can't find a wider gauge lancet, poke twice right next to the first poke. That may help to get more blood.

 

Yeah, Chris also said the same thing, so that has made me feel better. i am using 28Gauge ones.

 

Thanks everyone for responding and helping me out, especially for your tips for BG testing. It has really helped me. Yuki had stabilised on 0.5 U so much so that my vet thought she could be on remission (due to readings and negative glucose in urine). Well it didn't last, and I had to give her the 0.5 U today morning. But hopefully she will be ok on the 0.5 U.

 

The same thing happened to me when Max was first diagnosed. If you follow the protocol here you have a good shot at remission. I wish I had been able to be more aggressive at the beginning and never stopped insulin or was testing at home at the time. Stopping before he was ready instead of decreasing to .25 was a big mistake for Max.

 

Thanks for sharing. I wanted so bad for Yuki to be on remission, but somehow I felt it was too good to be true.