Okay to give 2 to 2.5 units of lantus?

Hi everyone! My Angel was just switched to prednisolone (and metronidazole and cerenia) as he has bad IBD etc, and did not do well on budesonide (which is better for blood sugar levels). His BG levels have been through the roof for the past three days, all in the pinks now. I thought I remembered reading that one should not go above 1.5 units of lantus (so that's all I've been giving him), but I was relieved to see on some other SS's that folks do go to 2.5 units (even above?) when they see numbers in the pinks or reds. I'm doing a curve on him today, but wanted to ask: so it's okay to go to 2-3 units of lantus? Thank you. The vet is out till Tuesday, but I'll also be checking with her.

 

There is no limit on the number of units that can be used. I mean some cats here need 30+. You have to follow the TR protocol on your increases. You should do 6 cycles at 1.5. Sorry Angel has IBD.

 

Thank you. I should add: I'm not trying for remission any more; just trying to keep him relatively healthy.

 

AS MJW said some kitties need a very high dose. Your kitty needs what he needs and let the TR protocol be your guide.

 

Never give up! I guess we don't "try" for remission, since the goal doesn't change what we do. We hope for remission.

 

With the steroids in the picture, it's not surprising numbers are rising. The bottom line is that the prednisoline is necessary. You work the insulin dose around any other condition you have to treat. MJW's observation is correct -- the amount of the dose is whatever your cat needs. Some cats may need 0.5u whereas some cats may need 5u or a lot more.

All of that said, I want to strongly encourage you to get at least one additional test each cycle beyond your pre-shot tests, Lantus dosing is based on the nadir and not on the pre-shot number so it is important to get spot checks so you know what the low point in the cycle is and can adjust the dose accordingly. You have no way of knowing whether those high numbers are a result of the steroid or from numbers dropping very low at some time during the cycle and then bouncing into higher ranges. In addition, it looks like you are basing your dose on the pre-shot number and as a result, making back-to-back changes in dose. I'd encourage you to look over the two dosing strategies we use -- the Tight Regulation Protocol and Start Low Go Slow. There are sticky notes at the top of the board that describe each approach. Because Lantus is a depot insulin, any change in dose needs to be held for at least 3 days in order for the depot to stabilize (unless a reduction is indicated).

The Royal Canin Glycobalance is very high in carbohydrates. It may be considered a diabetic food but it's really not appropriate for a diabetic cat. I'm assuming you are aware of this. Have you thought of switching to a lower carb treat? Many of the kitties here like freeze dried chicken as a treat and it's zero carbs vs Whisker Lickens which is not low carb.

 

Thank you, Kris and Teasel. Will do. I have no idea why I'd got the idea that one should not go beyond 1.5 units of Lantus, and am relieved to hear otherwise.

 

Thanks, Sienne and Gabby. I did do an additional test in between today (hadn't added it to the SS), and will continue to try and do that. I actually worked on getting Angel into remission for a long while, so am familiar with the TR and SLGS protocols -- I was just confused as for some reason I'd thought that I'd read somewhere that one could not go above 1.5 units Lantus. Clearly, now that things have changed drastically with the pred., I need to alter my responses too. I actually need to change my info: I'm not feeding him glycobalance anymore. I had him on only low carb wet foods for over a year, but in the past month or two he's become extremely picky and is losing weight -- no wet food I try, or boiled or raw chicken, or liver (mind, I am a vegetarian, lol), or baby food or ANYTHING works, so I'm letting him eat the only two dry foods he's willing to eat, Blue Buffalo and Royal Canin for sensitive stomachs (or some such thing) as he really, really needs to eat right now. Hoping to stabilize him, and then get him slowly back to wet food, sigh. He's just under 8 lb now (was 12 lb at the height of his good health about 5 years ago). Thank you for your response. Much appreciated.

 

If you are feeding dry food, that means following the SLGS method - it's not a protocol, just a set of practises developed here that keep your cat safe. Good to hear you are getting some midcycle tests.

Dry food can increase insulin needs. I sat with one caregiver whose cat was on 5.5 units, until that day when she removed all dry food. Two days later he was off of insulin, scary times! I have seen pred alone cause a need for a couple extra units of insulin. A cat needs however much insulin they need. Neko peaked at 8.75 units. Focus on the blood sugar numbers, not the size of the dose.

 

Much appreciated, Wendy&Neko. This is all very useful. I'm going to review the SLGS protocol. At least Angel's diarrhea/bloody stools have stopped with the pred; once he's back to putting on a tiny bit of weight (even 8.2 lb) I'm going to go back to pushing the wet food. You're absolutely right about the wet/dry thing and how it affects bg. We had him on 100% wet except for treats for 6-12 months, and he was doing beautifully, just needing .5 units of lantus mostly. But at this point just getting him to eat is important. Thank you for your help.