? Vet says lower Lantus, but 1x/day instead of every 12 hours...inclined to do the latter

Hello all,

Just writing to see what other thoughts are on this. Brief background: Gas Runkey is newly diagnosed, diabetes was discovered when she got blood work done as part of her annual exam, which coincided with dental extractions and major infection. This was about 3 weeks ago. Her numbers were 387 at that time.

We started her on Lantus 1unit twice a day. All has gone well. Today is day 19 since treatment started. I was initially monitoring with urine, but did my first glucose curve this week (she's too fractious to take into the vet without being anesthetized every single time). I didn't want to keep treating her without checking her glucose levels, etc. It just took us a while to get that down. All that to say, she's been doing great, her health is already much better, and the curve I did this week showed some nice numbers. I am attaching it here. Don't judge me for the fact that it doesn't look like the spreadsheet you all have--this is what works best for me along with writing by hand in a notebook and I am posting as a reference.

I shared the curve with my vet, and he was excited by the numbers and suggested that after another week, we do a curve again and that maybe we go to 1x a week.

Since I did the curve and discovered that my cat WILL let me prick her ears (it took me a few days of trying), I have been checking her numbers before shots. Yesterday morning, her pre-shot numbers were only 144 (keep in mind this is with Alphatrack, so it would be a lower number on a human glucometer). I called the vet and he agreed to hold the shot. He was in surgery, so he was passing on the message through the receptionist. She said he wanted me to not give GR any shots for two days, then check her morning sugar on Sunday and if it was "getting high" again then to start again, but only do 1 unit once a day.

This was a bit vague, but since he was in surgery, I didn't get to ask many questions... I did go all day yesterday without a shot like he said. In the evening, however, I checked her numbers, and it was up to 244. I didn't give the shot thinking he might have some kind of plan. But I checked again this morning, and it was at 242. At that point, I went ahead and gave her the 1 unit this morning, emailed the vet, he agreed she hadn't resolved, and then told me to start on the 1x/day cycle and plan to do a new glucose curve in 7 days.

I have been doing a ton of reading--both here and elsewhere. On the AAHA site and other official vet sites that give protocols as well as pubmed, etc., the guidelines all give 2x a day. I know once a day will work for regulation, but I am wanting to get things as controlled as possible with the hopes she'll go into remission. She IS improving, and I don't want to do anything that will get in the way of that.

Tonight, at the 12-hour mark I took her glucose to see where she was at. She was only at 141. So, again, too low for an injection at 12 hours.

So here's the question. Obviously, the 1 unit of Lantus is working in a way that she isn't ready for another dose at 12 hours, so lowering the dose makes sense. But I am inclined to just divide the dose so she's got that steady stream of insulin without disruption. I am about 90 percent in favor of just doing this starting tomorrow--0.5 2 times a day--without consulting the vet. It's the weekend, and I won't get the chance to talk to him until Monday anyway ...

Thoughts? I am not expecting specific dosing advice, but where do ya'll lean when it comes to the 1/day or 2/day question?

Thanks in advance. Excuse the length here!
Lori Anne (and Gas Runkey)

 

P.S. I've got her on all wet, low carb (~2 percent), high protein food.

 

If you are finding you have to skip often because the preshot test number is lower than you want to give insulin, I would lower the dose. On this forum, we change by 0.25 units at a time so the new dose would be 0.75 units. Yes, that is eyeballling.

Infections/bad teeth can indeed raise the blood sugar. Was she on low carb food before she was diagnosed with diabetes?

 

In my opinion, the numbers on your spreadsheet are not low enough to reduce the dose. Also, Lantus really does need to be given twice a day.
This is my two cents. I have been out of the “loop” for a while. I was fortunate to have my sugar kitty go into remission within 4-5 months following the tight regulation protocol. I would read as many of the stickies at the top of the tread to gain as much knowledge as you can before you decide to reduce

 

Once a day dosing doesn’t work for cats from what I’ve seen. Lantus usually lasts for 12 hours. As Wendy suggested it’s far better to drop the dose to .75 and give every 12 hours. I suggest you read the yellow stickies which explain how lantus works. It’s based on research.

 

Hey Wendy&Neko,

Thanks for the reply! I did notice that on the start low, go slow guide lines (the .25). I am not opposed to doing that and eyeballing. It seems easy enough, as long as I'm wearing my glasses. But 2 times a day, right? not doing it all in one dose?

I knew that the bad teeth could be part of what led to the blood sugar increase. The vet was not convinced when I suggested that as he thought it was too high for that to be a reason, but I also think she'd been having tooth trouble for a while. They are so stoic and she's had intermittent ear trouble off and on, so I now suspect some head shakes were actually TEETH and not ear.

Before tooth surgery, she wasn't on low carb, but dastardly dry food (good, expensive food but high in carbs!). Because of surgery, she was over to all wet before shots started, and it happened to be Koha and very low carb. So she was wet, low-carb for about a week before we started the insulin. I realize both the healed mouth and the diet have helped her numbers already ...

la

 

thanks. I have already read them all and understand how it works. Just getting some extra thoughts. Thanks!

 

I agree with Wendy and Elise (Tiffmaxee). Go down to 0.75 units and give it twice a day.

 

Thank you. We weren't reducing based on that curve alone--actually, the vet was suggesting it, but I said let's hold off for another week and then reassess. But in the following days the numbers were too low at 12 hours for me to even give a shot. I have read all the stickies; i was just getting some more ideas. In any case, I wouldn't decide this on my own willy-nilly or without being informed and do want to work with my vet, who has a lot more knowledge than I do. I was just basically wondering about the once a day versus twice and day thing. He's obviously had success with that protocol, and perhaps others have as well, but I really want to do everything I can to get her in remission.

Thank you so much for your reply!

 

Grazie!!

 

Thanks all. Even though I have been reading and researching like mad, it just helps to get some feedback. I LOVE this idea of lowering by only .25 as it makes me not worry about giving too little if I just start splitting it in half. I'll just do this and let my vet know what I am doing. I definitely don't think I am interested in once a day. Again, this is appreciated. Just needed to bounce this stuff around...

 

Just an update--this morning, even at 24 hours since the last shot, my furry one was down to 217. Her numbers are steadily getting better. The last time there was the 24 hour span (yesterday morning), she was at 243.

I gave her the a.m. shot at .75. Getting to that in-between spot was a wee bit tricky pre-coffee, but I managed!

Thanks again!
Lori Anne

 

I posted this as a new question, but following up here too. So her numbers ARE getting better. Not sure though if I should give shot or not. Here's new info:

Hey all,
Following up on last night's post, but with new question so wanted to bump it up. Reduced to 0.75 this a.m. Twelve hours later, the numbers are higher than they have been at the 12-hour mark, but just at 157. Should I give a shot or not? The numbers for the start low, go slow method have 150, but all those guidelines are human meter.

Thank you!
Lori Anne

 

Good to hear the numbers are getting better. Without seeing blood sugar data in a spreadsheet, it's going to be very difficult to help advise you on dosing. We are rather data oriented here.

As far as AT vs. human meters, we use the same numbers in the start low go slow method. The only difference is is that the "take action" number, or number where we give high carb food, is 68 on the AT vs. 50 on the human meter.

One last thing, due to the volume here, we suggest starting one new post a day, with a link to the old one.

 

Well, you answered my question (about the take action number) exactly, which is appreciated, so my question really didn't need another spreadsheet with it. I don't plan on being on the board enough to do one of the spreadsheets you have, which isn't the way I have mine set up with my vet anyway. I have my own at home. Thank you so much.