Reduce Lantus? 2nd day

Not sure if this is the right place but Honey's stats are improving after 2 days on 1 shot per day as prescribed by vet and 1 day on 2 shots as prescribed by me.
But is it too early to reduce?

Should I reduce the lantus am shot, ie. the next one ?
Just took her BG +11 252 - she's down almost 150 from yesterday AMPS

Previous Condo


Her shot isn't due for another hour - do I need to retest?
When I get up at 6am, my cats who were used to kibble out all night, are ravenous and want feeding.
I assume its best to get the BG before she eats but that makes it an hour earlier than shot time - is that ok?

 

No you don't reduce in the first 3 days unless she drops below 50. Actually that is good that you are seeing some yellow now because that means you want to hold this dose for 5-7 days and keep getting plenty of spot checks. You would only reduce if she drops below 50.

Off to a great start but keep testing regularly because she may drop lower in the next few days as the depot fills.

You want to test as close to the shot as possible, within 15 minutes. As soon as you get the routine down perhaps you can get them closer, and you always want to test before she eats.

 

I did give her the same unit this morning - figured it would be ok and I'm trying to hold out to test her at +4.

Thanks for responding on the timing. This is where I am now:

6am - I get up and cats all want feeding - Test Honey before feeding
7:30am - shot due

so, should I retest at 7:30am or not test at 6am? (Testing isn't easy and she's starting to figure out when I'm going to do it and tries to hide).
Also, should I move the shot earlier to be closer to the feeding?

1 of the problems I have is self-inflicted. The cats are indoor/outdoor - all ex-ferals who love to sit in the (very safe) yard all day.
If I give her the shot later, then by 7:30pm she's ready to come in from her sunbathing and eat - so I can test and then give next shot.
I know its easier to keep her in but she loves going out so much and generally, she just sits under a bush all day - but she won't come to me when she's outside unless its feeding time.

 

Hi Denise,
Part of the issue might go away in a couple of weeks when we set the clocks back, since it'll be getting darker an hour earlier, so her sunbathing time will run out earlier.

Most people test, then feed, then shoot, all within just a few minutes. Couple of reasons for that. One of course is that it makes your life easier and that 10 or 15 minute period just becomes your routine, which Honey will adjust to pretty quickly. The other is because of the relationship to how food and insulin work together (or more correctly, how they oppose each other).

Insulin has a timeline, and typically what you will see with Lantus is a curve that looks something like this:
Example of a typical Lantus curve:

You'll notice that usually (and keep in mind that every cat is different, and this is just a typical timeline), there will be an increase in BG from feeding, and that by three hours after feeding and giving the shot, the insulin "onsets", starting to push the BG lower. Sometime around 5-7 hours after the shot, it is most effective, and that when you would expect to see the "low number" (nadir) for that 12 hour cycle.

The way you are doing the morning routine, you are testing before feeding which is just what you want to do. That test is important, and it is important that it be a "fasting" number. Then you are waiting about an hour and a half or so before giving the shot, right? The effect of that might be to make her BG curve "atypical". You might see an earlier onset than normal because the food will be mostly digested earlier in the shot cycle. You might not see an increase an hour or two after giving the shot that you would see if she ate just before the shot (does that make sense?)

The other thing, I am thinking that for the PM routine, you are doing the test/feed/shot thing all right around 7:30, right? If so, then you will probable see a more typical curve at night, but it won't be the same as the AM cycle, just due to the timing of food and insulin being different.

I think what is really important, no matter what your routine, is that you find one that works best for you and your schedule. One that lets you test/feed/shoot close together, and allows you to give the shots 12 hours apart. Honey will adapt to your schedule, because it will become "routine". Once we set the clocks back at the beginning of November, you may find a time that works both AM and PM and lets you do that.

Two basic principles to this "dance". Food makes BG go up, and insulin makes BG go down. That is important because you will find that by adjusting the timing and the amounts of food given, you can affect Honey's BG curves during the day or night. You will find what works best for her and it could be different than what works for me or anyone else, because every cat is different. What we try to advise newer members is what is "typical" based on what we have seen in our cats and lots of other cats.

Hope that helps some,
Carl

 

wow! A lot to think about.

I'll try to get the am shot closer to the food.
Part of my problem is the kids - the cats don't like them so I try to do testing in particular when the kids aren't around. So that works best early am - before the kids are up. But, that makes it worse in the evenings as the kids are around for dinner and so the cats won't come in.

The kids will have to go... :lol: