Serious question about dosing

First off, I am going to work to update my testing spreadsheet, it doesn't consistently work for me, I don't have a computer at home so that leaves me to update from work in between seeing patients or staying late to do so, so my spreadsheet is sparse.

My question is, my cat is on Lantus, and we have steadily increased her dose from 1.5 units BID in October 2018, to 4.5 units on 5/21/19 due to curves and readings showing her consistently in the 300mg/dL readings on 1.5 to 4.0 units. She has also gained 4lb since October so that could account for the increase in dose over time. She has been doing well, peeing less, seems happier, etc. I have been testing on and off due to my schedule and her stress level at the ear pricks. Cue to yesterday morning when I was doing a curve to send to my vet, and got the living sh*t scared out of me, as these were her readings (had 4.5u lantus at 18:00 the previous evening):

6/16
06:00: 122mg/dL (gave no shot, freaked TF out as she has never been that low ever).
07:00: 140mg/dL (still no shot, thought it was a misreading earlier)
11:00: 219mg/dL
15:30: 220mg/dL
18:00: 278mg/dL - gave 3.0u lantus

6/17
AM pre shot 05:15: 283mg/dL - Gave 3.5u lantus this morning

Last night I shot her with 3.0 units of lantus, out of fear and not knowing how proceed with adjusting doses based off a reading. My question for you all is, is there any hard and fast rule as to backing off doses? Or am I going about this all wrong? She has consistently scored in the 300s since I started fostering her, no matter what dose, I have NEVER gotten a reading in the 100s ever, or even really low 200s. Do you continue the dose if she continuously tests in the 200s? Or do you back off? She wasn't being managed well for the past few months on her doses, consistently scoring in the 300s no matter the dose, so I am concerned at how to proceed. Of course my vet will weigh in later today or tomorrow as I am emailed my concerns to her after the curve. Her fructosamine at her 05/17/2019 visit was 392 which was high, and she had been on 4.0 units of lantus since mid february. Her BG at that visit, right before her evening shot, was 343mg/dL.

After this posting i am going to go through and fill in blanks of her curve history and testing history as I have records for. And yes from now on I will test her 30 minutes prior to each shot moving forward, I am just hoping to get some advice on how to adjust doses, if that is now what I need to do, based on her readings, or if you stay the course as long as she is in the 200s, of giving the large dose, and you don't back off unless she is under 200 or 150 or whatever magic number it is. Thanks everyone!

PS - I rush ordered a new meter and new strips, which arrived last night, because I was scared my meter had gone bad or something, so todays reading of 283 was in line with my other meter, so looks like a new meter wasn't necessary, that was actually her reading

 

There are two dosing methods normally followed with Lantus. Based on the fact that you said you cannot consistently test a lot, it sounds like Start Low, Go Slow (SLGS) would be the option for you though even it would require more testing than you have been doing. I suggest you read the information on the dosing method. That will guide you as to what to do as far as dose deductions/increases: http://www.felinediabetes.com/FDMB/...-low-go-slow-slgs-tight-regulation-tr.210110/ I will say that, normally, a dose change is not based on one pre-shot number. What's most important is how low the dose is taking the cat during mid-cycle. Often, it is fine to shoot at lower numbers, but without any data, it is hard to have anything to base dosing changes on.

The Lantus forum is the best place for you to ask for help. There are a lot of people with years of experience with that specific insulin who monitor that forum. So, I suggest you consider putting your post there: http://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/ (There are also 'sticky' posts at the top of the forum that provide valuable information.)

 

@TheReal_JD Have you had a chance to check out the Lantus Forum from the main forum page under "Insulin Support Groups"? Someone there might be able to give you insight specific to your insulin. Additionally you can learn a lot about Lantus and how it works Advice provided in that group depends on the dosing method that you follow, there are two for Lantus: Start Low Go Slow (SLGS) and Tight Regulation , You should check them out in the forum that I linked above and see if there is one that you think could work for your lifestyle.

The fact that you're testing BG levels yourself is great! and an important step to regulating BG levels in your cat. Also, it's awesome you're getting your spreadsheet set up! I'm not sure of your tech comfort level or if you have a phone or not, but I often use the app "google sheets" to update Mowgli's spreadsheet from my phone this helps when I don't have access to a computer, and helps me stay on top of my spreadsheet daily

Your reading of 122mg/dL is good news! it's a positive that you're seeing a downward trend in BG levels. While 122 is a number that is safe to shoot with experience, a half dose might have been wise in this situation. In the end, it is definitely always better safe than sorry, so if you're nervous, or can't monitor during the day it is better to be too high for a day than too low for a minute. Good Job

I will say, you will have to get used to giving a dose in lower numbers eventually or your cat will never be able to achieve regulation where their body can properly heal. That comfort level comes as you gather data along the way... BG levels in the 300's are still way too high. Typically, unless there are special circumstances we raise or decrease doses by 0.25u at a time.

Next time that you're in the same situation as yesterday morning I recommend creating a post in the Lantus, Basalglar, and Levemir Forum with a title along the lines of "HELP Dosing Advice needed!"

You're doing a great job! keep it up

 

First of all Welcome!! and congratulations on home testing,

Regarding the spreadsheet if you have an iphone or an android phone you can download the google sheets app and edit it from your phone wherever you are, is even more practical than having to turn on the computer

The normal blood glucose range is considered 80-120 on a human meter so that's our goal but getting there takes time and a lot of patience and it seems you are heading on the right direction with those numbers you are getting , at the beginning usually if you get a result under 200 we do recommend that you ask for advice here or stall and shoot a bit late if your schedule allows it and you can monitor him or skip the shoot, as you gain experience and data to know how he reacts we do shoot with numbers a lot lower than that.

To be shure is safe to give insulin you need to withdraw all food 2 hours before the preshot test just to be sure the result is not food influenced and is safe to shoot

With Lantus you will establish the dose based on his nadir ( the lowest value during the day if ) not on the preshoot test result I do recommend you take a look at the protocols and choose the one that suits you, although having to be out at work all day and not being able to do much testing probably the Start Low, Go Slow (SLGS) protocol would be the option but is up to you, the protocol will help you decide when to lower or raise the dose which with Lantus has to be consistent between the morning and evening shoot

 

The post is now on the Lantus forum: http://www.felinediabetes.com/FDMB/threads/advice-on-dosing.215775/

 

Thanks guys, I just posted on the requested lantus thread.

I have been testing blood glucose, I would say 5 out of 7 days, since October. I just track it in my meter and in a notebook, and also through the petdiabetes tracker app from Merck. I have the excel app on my phone and they don't link up so if I update it on my phone, I just have to go update it again here from a computer, so it's double work and annoying. I am just going to set a time on Monday morning after my morning rounds, to update my spreadsheet in between rounding and seeing patients.

Her readings have always been high 200 - low to mid 300 no matter the dose, that is why we have consistently gone up .5 units every month or so since October. She's also gained weight, she was 10 pounds and skeletal/sad when I started fostering her, she was 12 in October, and th vet stated she could stand to lose 2 pounds, as she is a bigger cat naturally, longer and taller than my 10 pound boy, so a good weight for her is probably 13 pounds.