When to start OTJ experiment?

How do you know when it is possible to look at not giving insulin and trying OTJ to see how your cat responds?

Thanks!

Andy

 

You're not quite there yet.

And I see you're using Lantus which is long acting and does best with consistent, every 12 hour, dosing.

Ideally, you give twice a day dosing and gradually lower BOTH doses.

If you have to repeatedly skip 1 dose but not the other, you need to take both doses down lower. On the spreadsheet, when you have shot 0.75 doses, you repeatedly need to skip a dose. Thus, you would go to 0.5 twice a day. If that also results in needing to skip a dose, you would need to start "skinny" doses. You'll need U-100 needles with half-unit markings; that's as fine as they measure. This means you have to eyeball your measurement. It can help to fill a syringe with colored water for comparison.

You might start by lining up the plunger just below the 0.5 unit line, aka a skinny 0.5 units.

Then, if further decrease is needed, either due to skipping doses and/or nadirs below 50 on a human glucometer or on an AlphaTrak, you'd try to put the plunger halfway between 0 and 0.5. this is approximately 0.25 units.

If you continue to have nadirs that fall below the above, you'd go for a "fat 0", with the plunger just above the 0 mark. Some folks say they can measure drops by filling to a level, then carefully squeezing out the excess.

When you get to that last stage, and have a nadir below the criteria, you're ready to go for an off the juice trial.

 

Thanks for the guidelines to use on when and how to lower the dosage! I greatly appreciate it!

 

The folks in the Lantus forums can share a lot of their experiences and review the correct protocol with you. They may be on more than I am, and as you work to adjust the dose, can give you more prompt guidance.

It is looking quite promising, I think.

 

BJ is correct. If you aren't comfortable shooting the same dose twice a day, then it's best to lower the dose so you can, in fact, shoot twice a day.

One consideration, though is that you're not getting any tests other than at shot time. Lantus dosing is based on the nadir -- the lowest point in the cycle -- not your pre-shot numbers. The pre-shot is important in that it lets you know whether it's safe to shoot but it is not the basis for changing the dose. You could easily have missed numbers indicating a dose reduction was warranted.

If you look on the Lantus board, you'll see that people routinely shoot on numbers lower than where you're currently comfortable shooting. In order to move Lizzy closer to going OTJ, not only are you going to need to get at least one test per cycle in addition to your pre-test, you are going to need to increase your comfort with shooting lower numbers. FurBall spreadsheet is an example of what a kitty on the road to OTJ looks like. FurBall is currently on an OTJ trial.

 

Thank you for your help! I went with a 0.5 dose this AM and will recheck her numbers this PM. I think you are right when you say I need to be more comfortable with injecting at lower numbers. My vet feels she absorbs the insulin slower than other cats and I don't want to overdose. My schedule lately hasn't allowed me to do much extra testing, but I will try to test more to get more data.

 

There are a few posts on using Lantus you really need to read, to get optimal control - check out each of these:

STICKY: LANTUS & LEVEMIR - INFO, PROPER HANDLING, & STORAGE

STICKY: LANTUS & LEVEMIR - TIGHT REGULATION PROTOCOL

STICKY: LANTUS & LEVEMIR - SHOOTING & HANDLING LOW NUMBERS

10/16 TODAY'S LESSON--REDUCTIONS

I know its a lot of reading, but the better you understand your insulin, the better you'll be able to use it.