Re: Ole and Rebekah AMPS 546 +2 444
Adding your last comment from the post on Health:
Hey!
I am happy to reduce down to 1 unit, but I am following my vet's recommendations in keeping his units at 5 for the curve.
I appreciate all of your experience, and the experience of this forum. I am trying to the right thing by Ole and my vet, who has really given Ole's care her all. She also appreciates that she is not a Lantus expert, and perhaps I didn't relay the information to her correctly, but I'm doing my best. Because he does not mind being tested, and I saw the gap in my data when compiling the spread sheet, I thought a curve, testing every 2 hours, was a good option. Sorry, I seem to have been wrong.
He will be reduced to a lower level tomorrow morning. One question I have is does the am shot and the pm shot have to be the same units?
Thank you for your support and understanding as we try to figure things out.
Rebekah
Don't get me wrong...doing a curve is FINE...it's just not something you need to do all the time, and it will give you some information on how Ole responds to the dose. We all occasionally do either curves (every 2 hours for one cycle) or mini-curves (every 3 hours for one cycle). There's no way to know for sure right now if (in the long run) doing it today will be a real help or not just because of the way you've been dosing.
We REALLY understand you've just been doing what your vet has recommended. Some of us came here just looking for more information after getting the diabetes diagnoses, while others (too many unfortunately) trusted everything their vet said and didn't find us until their kitty was in the middle of a hypoglycemic episode. It's really wonderful that your vet admits she doesn't know a lot about Lantus!! That's a very RARE thing that we find a vet who will admit they don't always know what they're talking about!!....and those kinds of vets are the most rewarding in the long run because they are willing to learn!! A lot of us who have taken the time to break through some of our vets ego's and gotten them to listen and consider they might not know everything are teaching them as we learn...and in the long run, future patients of those vets will benefit from what we've taught them....If they're willing to listen, that's the most important thing, and it sounds like you have a great vet!!
Lantus needs to be given consistently...so yes, it's very important that you give the same dose at every shot time during each dose period...so if you go down to 1 unit tonight, you'd want to hold that same dose for at LEAST 6 cycles, and get at least those 4 tests I talked about earlier (and more if you can, but they don't NEED to be every 2 or 3 hours)
It takes time for the depot to build (but Ole's already got a depot) so we're not treating him like a NEW Lantus user..for them, we hold the same dose for the first 5-7 days (10-14 cycles) before considering a dose change..UNLESS they drop below 50
Here's the protocol we use here:
"General" Guidelines:
Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
( But since Ole's already been on Lantus more than 5 days, we can skip this step)
Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.
Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Reducing the dose:
If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. See additional notes in the next paragraph about drops into the 20s and 30s. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.
Please do not let yourself become complacent or blasé about drops into the 20s or 30s.
If kitty drops into the 20s, a full reduction of 0.25u (or 0.5u if kitty is on a higher dose) is strongly recommended.
If your cat drops into the 30s, a full reduction of 0.25u is recommended. There are very few exceptions given for caregivers who have collected years of data and KNOW their cat's response to the combination of insulin and food backwards, forwards, and inside out.
Caregivers whose kitties have "High Dose" conditions may find the need to reduce in whole units or more.
Please ask for advice.
If anyone suggests otherwise, they are putting your cat at risk! Our kitties are not just numbers. They are living beings who trust us to look out for them. The TR Protocol is an aggressive method in itself. The modified version of the protocol is slightly more aggressive.
Keeping YOUR cat safe is the #1 priority of the FDMB.
Let's keep all our kitties in the Lantus Tight Regulation ISG safe by suggesting and taking appropriate reductions.
If an attempted reduction fails, go right back up to the last good dose as soon as you see kitty's numbers trending upwards. You don't have to hold the reduced dose for a certain number of cycles before taking the dose right back up. The guidelines listed under the topic "Increasing the dose" do not apply to a failed reduction.
Please use common sense in this situation. The "last good dose" is not the dose that just dropped kitty into the 20s or 30s. You want to resume momentum by finding a dose in-between the dose that dropped kitty too low and the reduced dose.
Try to go from 0.25u to 0.1u before stopping insulin completely.
Keep asking questions, and it's also a good idea to spend some time reading others condos...it will bring up questions you didn't even know you needed to ask, as well as add to your knowledge of how the protocol works.
Good luck! I don't have advice at the moment, but you are spreadsheet ready and hometesting so you're off to an awesome start ;-) Have a nice Friday!
