? Newly Switched from Vetsulin to Lantus, Dosing advice-BG lower after meals

Dee Dee has been on Vetsulin since Jun, his PS BG stubbornly hovers around borderline 150 (8.3), though strangely his BG after meals often drops to below 120 or even 100.

i have tried following Vet instructions was to give only if above 150, his normal dose 1.2 units, I have tried giving small doses even if bet 120 - 150.

Last week (12 Oct), Vet suggested to switch to Lantus, start dose 1.0.
Tried but had a hypo scare as his BG dropped to 1.9 - 2.2 range but he looked ok, so i just monitor him for signs of Hypo which he did not have.

I then lowered his dose to 0.5 but only dose if above 150 (8.0). And since his PS BG did not dip below 150, i did not give him his shots for the last 3 days.

Looking at his BG, even without Shots, his BG would still trend low about 2-3 hours after meals, and hit peak every 12 hours. I want to give him his shots so that he can have a strong remission but right now am scared to give coz his mid cycle BG is low around 80-110. Insulin may push it down even further.

Advice, suggestions ?

 

With Lantus, we shoot lower Pre-shot numbers

At first, if you get a PS under 150, we suggest you stall, don't feed and post for guidance. Test again in 20-30 minutes to see if the number is going up without the influence of food

As you gather more data, you gradually reduce the number you're willing to shoot. Those of us doing Tight Regulation that have enough data and experience will shoot the scheduled dose if our cats are above 50

You might want to try a dose like .25 to see if you can get two shots per day in without him dropping below 50 (the "time to act")

 

Welcome. What type of meter are you using?

 

Overall he is looking good, however, if you are using a human meter then I do think he looks like he needs some continued insulin support.

Usually lantus is best dosed twice a day, it doesn't last long enough in cats. So finding a dose that will allow you to do that comfortably is important.
On a human meter you would be wanting to see him in a normal range is 50-80 most of the time.

How are you feeding? Folks I've come across who swap from vetsulin to lantus often feed just two meals a day.

 

I m using accu Chek instant. Human meter,
Pmps was 99 so I dare not shoot

 

George relapsed this may as well due to bad teeth take a look at his ss for may 2018, you can see that I dosed 0,25u in not dissimilar numbers.

I do think that the 1u was too much, given that 0.8 or even 0.6u of vetsulin had been getting her into the 60's.
We would usually suggest starting on a lower dose of Lantus when swapping from Vetsulin. Chris's suggestion of 0.25u twice a day may not be a bad place to start.

What's your availability like for monitoring?
You may want to make sure you are available to monitor and steer with food should you need to, the first time you are going to shoot a lower number.

 

Thanks!, yes very similar BG profile. Agree, he still needs insulin support, he is at the Pre-diabetic range, any small issue, stress may push him to yellow or even red again.

Btw the vet prescribed Steriods for his ear infection, think that caused his relapse. Now i check all his prescriptions.
I will try the 0.25 dose this weekend when i can monitor closely. He is feed twice a day 1.3 can wet food only.

He is also on twice a day Hepavite supplements for his liver.
he just had his pm meal at 730pm and now 1030pm, his BG is 98.

 

The steroids in the ear drops have been known to affect other kitties BG so yes it is a possibility.
Seems like a good plan, for starting the insulin support at the weekend, if he's high enough, since lantus dosing is cumulative, because of the depot, it will take few cycles (up to 6) for you to see the full effect of the dose, if you are able to maybe starting friday night would give you with a little more time on the dose to establish numbers.

With Lantus, most of us feed several meals during the course of the day, rather than just a big meal at shot time, it usually works better at flattening out their BG.
When I started, I used to do PS and +5, but eventually what worked best was
PS 3 ounces
+2 1 ounce
+4 1 ounce
+6 1 ounce
I used an auto feeder, so I could feed when I was out or in bed. I still maintain the above feeding schedule, in remission, with the exception that he also gets a +9, small regular meals are easier on the pancreas and helps stabilise his bloodsugars. Interestingly, I found that if he missed a +9 snack in the night his ambg was often higher.

 

Sounds like you have a plan. Please add the meter you use to your signature.

 

? What needles do you use, i find real difficulty measuring 0.25 units.
Also do we need to refrigerate the lantus insulin pen ?
Thanks

 

Yes, refrigeration will make it last a really long long time. Far past the manufacturers expiration date.

 

If treated carefully and refrigerated a pen will last to the last drop.

 

These are the syringes I use. They have 1/2 unit markings that help with the .25.

 

Thanks everyone!