Newbie Question

Discussion in 'Lantus (Glargine) / Levemir (Detemir)' started by Thepbjs, Feb 25, 2018.

  1. Thepbjs

    Thepbjs New Member

    Joined:
    Feb 13, 2018
    Good morning! I posted this in the main forum and it was suggested I posted here on the lantus board. I'm hoping I can get some suggestions or opinions. : )

    Harley, 9 yr old male dx on 2/10/18. First vet was not a fit for us. Did not approve of home testing and no guidance or support. Went to new vet 2/17/18. BG at both vets was 598. Both times very stressed. First shot of lantus given at vet on 2/17, I believe it was 1 U. The next morning I read the prescription was written at 2 U bid. Called and left message for vet. Gave him 1 U and vet confirmed later in the day that she wanted him on 2 U. Continued doing 2 U bid until we received our glucometer on the 21st. Tested that evening and bg was 37. Did a control test on meter and it came out within appropriate range. Retested 2 hours later after food and was only at 74. Did not give him his insulin. Called the vet the next morning. Bg was 323. Vet said to decrease to 1.5 U bid. Tested again in evening and his bg was 48. Called the vet again and they said no insulin and decrease to 1 U the next morning and do glucose curve. Tested next morning and bg was was 387. Gave 1 U and started glucose curve. Numbers were AMPS 387, 364, 269, 181, 147, 95. Called the vet before they closed and she told me to go ahead and feed (don't worry about last testing) and decrease to .5 bid. Tested next morning and bg was 249. Gave him .5 U. PMPS was 123. Did not give him pm shot. This morning I tested him....not an easy task as he's mad as nails about being poked!!!...bg at 193. I just fed him and will retest before I go to work in about an hour.

    I'm unsure now if I should give him his .5 U this morning or just wait and test him when I get home this evening and see where his numbers are since I won't be home to monitor him.

    His water intake is no longer crazy and his urine output is more towards the normal range. Before insulin he was running to the faucet any time you walked near it. He was also flooding the litter box.

    Any suggestions???

    TIA
     
  2. Thepbjs

    Thepbjs New Member

    Joined:
    Feb 13, 2018
    Update....tested his bg and he was at 278. Gave .5 U and will check again tonight :)
     
  3. Nan & Amber

    Nan & Amber Well-Known Member

    Joined:
    Mar 19, 2016
    Welcome!

    Wow! So glad you didn't listen to the 1st vet and home tested! 37 on an AT is a wake-up call for sure.

    Couple of questions for you: did you just change foods to the FF and DM when you started insulin? And second, just to make sure: Harley was not diagnosed with ketones or diabetic ketoacidosis at the diabetes diagnosis, correct?

    I think the 0.5U is a good "re-set" starting point for Harley right now. Going forward, generally speaking we use two dosing methods on this board-- Start Low, Go Slow (SLGS), and Tight Regulation (TR). They're both described in yellow stickies at the top of the forum. Read through the stickies to see if one or the other seems like a better fit for you and Harley.

    Just saw this, I'm a little confused... Did you give the 0.5 at the usual shot time, or 2hrs late after the 278?
     
  4. Thepbjs

    Thepbjs New Member

    Joined:
    Feb 13, 2018
    No ketones showed.

    I had switches him to FF in January along with Acana dry. Took away dry on 2/10 and started dm on the 21st.

    I gave the .5 U 2 hours after food and normal shot time.
     
  5. Nan & Amber

    Nan & Amber Well-Known Member

    Joined:
    Mar 19, 2016
    OK, good! The food change likely has been part of the decreasing insulin needs. It can take some time for the dry to work its way out of the system, but once it does the removal can have a big impact. :)

    Something to keep in mind about shot times: Lantus is an insulin that tends to work best on a regular 12-hr schedule, because of the "depot". When you shoot late, it can act like a dose decrease (more than usual of the insulin goes to re-fill the depot used up during the delay), and when you shoot early, it can act like a dose increase. "Late" doesn't mean much this morning because of the no-shot last night, just something to consider in general, and something that will influence the shot decision tonight. Even if he's high enough, I wouldn't recommend shooting at your normal time (10hrs after this morning's shot), you'd want to shift the times back more gradually (15min increments).

    But since you've been no-shotting the past several nights, let's cross that bridge when we come to it, see where Harley is tonight. Ideally we'd like to find a dose that you can shoot safely every 12hrs, I'm hopeful that the 0.5U will be a good one, but it's really up to Harley!
     
  6. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Well, Harley has certainly been keeping you on your toes!

    Just to be sure, when you were getting those rather low "green" numbers, were you giving Harley any high carb food or syrup to bump up his numbers? If you look at any of our spreadsheets, you'll see we keep pretty careful records of what we're doing especially if our kitty hands us low numbers. (On my spreadsheet, I'd put info in the comments section as to whether I was giving Gabby high carb food to steer her numbers.)

    Are you able to adjust Harley's shot time given that it sounds like you shot 2 hours later than your usual shot time? Generally, if you change the shot time, you can move the time either by 30 min. once a day or by 15 min at each shot time.

    Not being sure what information you've gotten from either of the vets you've used or how far you've gotten in reading through the sticky notes at the top of the board, I'm going to run through some basics.

    Lantus likes consistency both with regard to shooting as close to 12-hours like Nan mentioned and in terms of dose. It is a long-acting, depot insulin that has an impressive record for getting cats into remission or tightly regulated. However, it requires patience and monitoring to get your kitty into good numbers (unless, like Harley, they want to get there in a hurry). Once you find a dose that doesn't keep putting Harley into way low numbers, you'll see that doses are held for anywhere from 3 days to a week (depending on which approach to dosing you're using) in order to give you time to evaluate how effective that dose is.

    When giving your cat Lantus, you test, feed, and shoot within a short window. (Most of us do this within 5 - 10 min.) Because Lantus is long acting, you do not have to have food on board for at least an hour prior to giving a shot. Lantus doesn't begin to work (i.e., onset) for about 2 hours after you shoot. Dosing is based on the lowest number in the cycle -- the "nadir" -- which for most cats is somewhere in the middle of the 12-hour cycle. You need to get several tests every day. You need to test at pre-shot times. It's also very helpful if you can get at minimum, one additional test during each cycle.That said, some of us are testaholics (look at Gabby's spreadsheet -- I tested a lot because she would have steep dives early in the cycle).

    To be honest, I'm not a big fan of DM. It's low in carbs but it's not a particularly high quality food. Take a look at the label -- the largest portion of the ingredients are liver and various by-products. Liver is cheap and cat's don't need that much of it. By-products are not a good quality source of protein. It's not muscle meat. It's also terribly expensive for a food that is that poor in quality. You could be feeding Harley a very high quality, human grade food for what your spending on DM.

    Please let us know if you have questions. The people here are very generous with their time and knowledge. We're here to help.
     
  7. Thepbjs

    Thepbjs New Member

    Joined:
    Feb 13, 2018
    We were doing every 12 hours until Harley started throwing the low numbers. We keep a calendar with all the shot times since my daughter or hubby do the even shots if I work late. Tonight's shot will be 12 hours from the shot this morning. If we need to adjust time we will do it in the increments you said :)

    I have emergency high carb foods and Karo syrup out for low numbers times.

    I am not a fan of the dm food either....neither is Harley. The vet would not budge on the food so I purchased some from them and got a written prescription to "buy online". I compared the ingredients with ff and wasn't impressed with the dm.

    Thank you all for the help and encouragement.
     
  8. Thepbjs

    Thepbjs New Member

    Joined:
    Feb 13, 2018
    So I just tested Harley again tonight and I'm hoping someone is able to answer.
    His bg is at 84 and my huge question is should I still give him his .5 u tonight?? He's eating now so my window is about 15 mins
     
  9. Chris & China

    Chris & China Well-Known Member

    Joined:
    May 10, 2013
    Sorry you didn't get an answer sooner

    If it's not too late, I think I'd skip tonight and let his depot drain, especially since you're already 2 hours off schedule

    By skipping tonight, you'll be able to shoot at your normal time in the morning
     
  10. Tricia Cinco(GA) & Harvey

    Tricia Cinco(GA) & Harvey Well-Known Member

    Joined:
    Jul 18, 2011
    If you have cut out the dry completely and are feeding only FF classics, that could have had a huge effect on Harley's BGs the past few days. Not sure if you shot tonight or not, as there are no numbers in the PMPS column. Because you have shot a variety of doses over the past several days, the depot is completely confused. It is very difficult to tell you what you should be shooting from here on. Assuming you skipped tonight, I'd say check the BG in the morning, and unless the BG is under 200, shoot .5. If it's under that, OR no one will be able to monitor through the day, DON'T FEED and post for advice.
     
  11. Thepbjs

    Thepbjs New Member

    Joined:
    Feb 13, 2018
    I did not shoot last night. The vet opens before shot time this morning so I am going to call them. I will test his bg in a few hours and post them here as well. I do work today so I wouldn't be able to monitor him.
     
  12. Thepbjs

    Thepbjs New Member

    Joined:
    Feb 13, 2018
    I tested bg and he is at 213 this morning. I have not fed yet. I have a call in to the vet and they will hopefully get back to me soon.
     
  13. Thepbjs

    Thepbjs New Member

    Joined:
    Feb 13, 2018
    Vet called back. They told me to feed and go ahead and give .5 U bid UNLESS he is under 100. They are going to check back with me in 2 days unless I have other concerns before then.
     
    Chris & China likes this.

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