Too small of dose increase

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Sean & Rufus, Feb 6, 2018.

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  1. Sean & Rufus

    Sean & Rufus Well-Known Member

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    Jan 10, 2018
    Hi all-

    I know recommended dose increases are .25 or .5, but I think in my case I need to get where we need to be sooner rather then later, and most cats are on a smaller regulating dose. I'm not seeing numbers really going down. I think I was on to something on Feb 4 where number where a "little" better, but he was on gabapentin on 4 day leading up to that. I have no doubt pain is inflating, or keeping BG numbers high. Just wondering if I should just go to 6units instead of the 5.5.

    I'm getting worried going on 10 or 11 weeks and still no numbers under 300.
     
  2. Carol in Chicago

    Carol in Chicago Member

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    Apr 5, 2017
    At higher doses (over 5U), you can increase in larger interval. I will look for a link and request other high dose guidance for you from @Wendy&Neko and @Bronx's dad.
     
  3. Sean & Rufus

    Sean & Rufus Well-Known Member

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    Jan 10, 2018
    Thanks. I asked for advice from my previous vet today, and she was saying that they like to see a cat hit at least a 300 in the first 12 weeks after diagnosis. I'm getting worried that his body is being over worked (?) from being so long in the higher numbers. I don't want to skip a "good" dose, but she seems to think he's just a big cat and bigger cats need more insulin.

    My main issue is everyone has different advice, and I understand that everyone will be different. I just don't know whose advice to follow anymore. I just want my dude to get better sooner rather then later :)
     
  4. Carol in Chicago

    Carol in Chicago Member

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    Understood. That is what we all! I'm asking others who have been successful working with high doses to guide you. The link I'm looking for is something more "official" than a cut an paste of guidance I have received. So... When I did a quick look at the high dose form, I found this. Please keep in mind this was for acro. I don't see that in Rufus' history, so not sure what is making him need higher amounts of insulin.

    Raise dose in increments of how far off numbers are. Really far, I've raised by 1 unit in acros when numbers way off (like nadir's in 300's or higher) , 0.5 units (like nadirs in 200's), or close (like nadirs in 100's) use 0.25 dose increases

    I am not finding anything "official" that says increase in half units when over 5, but I know that is guidance I have received. I hope others will have a reference handy for you.

    Most vets don't have a great deal of experience with FD in general or high dose conditions in particular, so this forum may be the best way to get the help you need to help Rufus. You are right, high numbers for an extended period of time can be very harmful. Let's see what others say about lowering them as fast as (safely) possible.
     
  5. Sean & Rufus

    Sean & Rufus Well-Known Member

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    Neither my previous vet or current vet know very much about acro, but I'm not sure if that matters right now, just need to get his numbers down. I did read that after increasing dose, that it can raise BG for a day, so maybe that's part of why he went up today.
     
  6. Bronx's dad

    Bronx's dad Well-Known Member

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    Nov 30, 2016
    After 5u, I did increase by 0.5 increments instead of 0.25. If you reach 10u (let's hope not!), you can increase by 1u increments.
     
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  7. Bronx's dad

    Bronx's dad Well-Known Member

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    Nov 30, 2016
    You may also want to consider using R in addition to the Lantus, but more frequent monitoring is needed since a little bit of R can cause a kitty, even a high-dose one, to drop too hard.
     
  8. Sean & Rufus

    Sean & Rufus Well-Known Member

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    Jan 10, 2018
    Right now I'm unemployed so more monitoring could be done, but when I get a job (hopefully asap), that'll be difficult :(

    Do you have any idea on when to/or when it's a good idea to switch insulins? Like to Levemir? When and why did you decide to change?
     
  9. Bronx's dad

    Bronx's dad Well-Known Member

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    Nov 30, 2016
    Lantus can sting in higher doses and I started to see Bronx flinch around 5 or 6u. Also Lev can offer a flatter curve and the nadirs are later in the cycle (for most kitties), which worked better for me so I could leave him alone when going to work in the am cycle and not worrying too much about going too low in the pm cycle while I was sleeping.
     
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  10. Sean & Rufus

    Sean & Rufus Well-Known Member

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    I see. I was wondering if people would switch because one insulin other might work a better than the other. I suppose every cat is different, though! thanks so much for the info!
     
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  11. Sandy and Black Kitty

    Sandy and Black Kitty Well-Known Member

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    I would be remiss to not point out that of the 44 shots you have given in the past 22 days, you have done exactly 6 preshot tests ( 5 AM cycles and 1 PM cycle) The remaining 38 shots were given without first testing or "blind". Of the 22 PM cycles on the ss I see only one that has any test data.

    So that's 86% of cycles were blind shots and half of the overall data picture missing by way of no testing on the overnights.

    There are 2 approaches used here, both require testing before every shot and some level of mid cycle testing - for safety sake.

    The best advice I can offer is that you hold the current dose, test before each an every shot, and sprinkle some overnight testing in.
    If you can manage that for a week that will fill in some of the picture and give us something to work with
    .
     
  12. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Feb 28, 2012
    I agree with Sandy. The numbers that Rufus are giving you can mean either his dose is too high, or his dose is too low. Without sufficient data, we cannot say which it is. For safety's sake, get more data for a week, then we can see which way you should go.
     
  13. Sean & Rufus

    Sean & Rufus Well-Known Member

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    Jan 10, 2018
    Oh my God you guys, I feel so bad. His numbers have been running so high, that I haven't been checking. The last check was in the 500's yesterday pm. Today I decided for the hell of it to check before his dose. 144! Wth! checked again and 162! Of course my vet is closed, I called emergency vet and they said to hold off on giving it to him. This is really strange, no? He's never been below 340!
     
  14. Sandy and Black Kitty

    Sandy and Black Kitty Well-Known Member

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    Dec 31, 2009
    I’d wager he’s seen plenty of numbers well below 340. I’m so glad you tested before shooting this morning. Well done.

    It’s time to start filling in the blanks so you can make safe decisions based on the full picture and get Rufus firmly on the road to regulation.

    Getting today s AMPS is a great start. Even though you are not shooting this morning please grab a couple tests during this cycle. It will be good data.

    How is Rufus? All Ps in place?
    (Playing, Pooping, Preening, Peeing, Purring) How is his appetite?



     
  15. Sean & Rufus

    Sean & Rufus Well-Known Member

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    Jan 10, 2018
    Well, vet just called and said I should shoot and test every couple hours. I guess that makes sense. We're working on a couple of the p's. It's really strange that with the way he was acting yesterday evening and early this morning that his numbers were at that. He seemed horrible. I've read that sometimes they feel or look worse once they get back into lower numbers though. They have to get used to the lower numbers.

    I guess the real question now is now that I gave him his insulin, I wonder what his numbers will be like today. Yuo'd think that pre-shot number normal range would go lower then after the shots.
     
  16. Sandy and Black Kitty

    Sandy and Black Kitty Well-Known Member

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    Dec 31, 2009
    please describe how he was acting.. describe ‘horrible ‘.

    if you shoot this morning, definitely test frequently.
    specifically...???

    I’ve gotta run but will check back this afternoon.
     
  17. Sean & Rufus

    Sean & Rufus Well-Known Member

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    Jan 10, 2018
    Horrible wasn't maybe the best word. Yesterdays bg @ 3 he was lip smacking a lot. He had a big dose of ondansetron, so I figured must be pain. He was sleeping almost all day. He came out to living room around 6:30. I made him food and took a couple licks. MAde different food. Couple licks. Lots of lip smacking and just general sense of not too "happy". But he has his good day and not so good days. Always wakes me up around 7am. Today he did last minute after my alarm went off he came into room. Usually hes ready to wake me up earlier.

    Playing isn't quite were it should be, but him playing is kind of rare even before all of this. Pooping in the box is a hit or miss. Sometimes in the box or else wherever he's feels like going. I assume outside of box he's just trying to tell me he's not feeling well. Preening is hard to say too, because of his allergies he's always licking himself.
     
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