? Started on Lantus How often do I test?

Discussion in 'Feline Health - (The Main Forum)' started by JanetMR, Jan 18, 2018.

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  1. JanetMR

    JanetMR Member

    Joined:
    Dec 29, 2017
    My cat Bella started on a low dose of Lantus two evenings ago ( .25 unit)
    I have held the morning doses because of blood glucose levels lower than 200. Last night I ended up testing every two hours just to make sure she wasn’t dropping too low. She got as low as 124 and then gradually came back up.
    What is the normal schedule for testing? I can’t do this every night... I’m exhausted. I want to keep her safe but not drop dead from lack of sleep. Thanks!
    Janet
     
  2. Lesliejm

    Lesliejm Member

    Joined:
    Dec 1, 2017
    From my experience of Lantus the ideal place you want your cat to be is in the greens keep with the dosage you are giving and do not skip a shot just test maybe an hour or two after the shot to make sure she is not dropping somebody else will chime in that knows more than I do but with Lantus you want it to be below a hundred and in the greens. We don't want them in the lime green because that is too low of a blood sugar other people will chime in and let you know what to.
     
  3. Lesliejm

    Lesliejm Member

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    Dec 1, 2017
    Look at my spreadsheet and you will be able to tell where you should be. I give .25 also just keep with the dosage and do not skip.
     
  4. Lesliejm

    Lesliejm Member

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    Dec 1, 2017
    I don't test all night long maybe one to two hours after he gets his shot and if I can swing it once or twice a day.
     
  5. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Great start last night! Negative ketones is also great! You'll get the best help with all matters Lantus over on the Lantus forum. There are a ton of very experienced people there. :)
     
  6. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi Janet,

    Just had a look at your spreadsheet and I was delighted to see "ketones negative" in today's remarks! Yay!!! :woot: Fingers and paws crossed for them to stay that way. :)

    It looks like Bella is responding well to her insulin so far.

    Per Leslie's posts above the overall goal to aim for with cats following the Tight Regulation Protocol is spending most of the day in 'green numbers' BUT that doesn't usually happen overnight. Instead, it's usual to see gradual improvement in BG levels as treatment progresses (and the dose may need to be adjusted in small increments in order to improve regulation).

    The idea is to start on a low dose, carry out appropriate BG tests to make sure the dose is safe and monitor response. Provided that it doesn't take a kitty too low, the starting dose is held for several days. With Lantus being a depot insulin it takes about 6 cycles before you get a real view of how the dose is working. After that period the BG data is reviewed to determine the kitty's response to the insulin. If necessary, the dose may be adjusted by a small increment (typically 0.25IU). This dose is then held for several cycles and response is reassessed again to see whether the dose needs further adjustment. Lather, rinse, repeat.

    As treatment progresses and the dose is fine-tuned then, all going well, a kitty will start seeing progressively better BG levels for longer periods in each cycle.

    The usual drill with Lantus is:

    1. Lift all food 2 hours prior to each PS BG check.

    2. Test BG, feed the kitty and then, provided BG is high enough to do so safely, give the Lantus dose.

    3. Check at +2 hours after the dose as often as possible. If the BG is approximately the same or lower than the PS BG level then this often signals that an 'active' cycle is ahead, in which case it is advisable to test later in the cycle as BG may very well go lower.

    4. Especially in the early days while you don't yet have a picture of Bella's individual response to Lantus, you'll need to do spot checks wherever possible between about +4 and +8 hours after each dose (the hours when nadir is more likely to occur in cats on Lantus) to try to establish when her most likely nadir time is and also to check that she's safe on the dose. It's important to do these spot checks on AM and PM cycles because some kitties tend run lower in one cycle than the other (frequently the night time cycle, but it varies from cat to cat) so it's important to make sure that the dose is safe on both the AM and PM cycles.

    5. In addition to the PS tests and mid-cycle spot checks you then run periodic curves on days when you've more time available to monitor.

    Gradually the test data will build up to give paint a picture of Bella's individual response to her insulin.

    In Bella's case, she's already seeing good numbers. The AMPS and PMPS BG checks are a given but, because she's responding well and the Lantus depot is still filling then for safety I'd recommend you do your best to get the +2 checks for each cycle as best your schedule allows (for the 'active cycle early warning' benefit!) and also try to get in at least one mid-cycle spot-check on AM and PM cycles somewhere between the hours of +4 to +8 after the insulin dose was administered. Once the depot has been established and you've got more data it will give you a better idea of good times to test Bella to see how low her nadir BG is getting.

    It is highly advisable to do a quick 'before bed', mid-cycle test to make sure Bella's in OK numbers before you retire for the night.

    Hope some of the above is helpful (and sorry it's so meandering but I'm not feeling very well at the moment and I'm having difficulty concentrating).

    As Kris advises above, there are many very experienced Lantus users who will be able to help you on the Lantus & Levemir board. Again because Bella's already seeing quite good numbers I'd recommend you post daily over there at the moment so that experienced members can keep an eye out for the two of you. (Lots of traffic on the Lantus board.)


    Mogs
    .
     
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