8/8 Clare Vet says to increase just AM dose: OK?

Yesterday's Post: viewtopic.php?f=9&t=123137#p1279014

Dear LL Friends,
This morning at +5 we tested Clare's urine glucose and she had +++. We called our vet and she said to increase Clare's AM shot to .5 and leave her PM shot at .25.

Before we do this, because I respect your opinions very highly, I'd like to see if you would go along with the vet's recommendation. I don't see too many people doing a different AM dose than PM dose with Lantus; I understand that it's more long-acting and that the AM dose could be affecting the PM numbers.

It does seem like the new numbers that we're gathering for Clare are showing her high in the PM cycle, too, now. We've just received our timed feeder and we're ready to regulate her better at night. Should we go with the vet's recommendation for now, or is there something we should worry about? We are home all night tonight and could do a curve or test at various times you'd recommend.

Thanks for your help.

Except in very unusual cases it is best to shoot the same dose AM and PM. Since Lantus is a depot insulin every time you change the dose the shed needs to readjust. Changing it every other shot means constant readjustment. Often when a dose goes up numbers can go up too until the shed is filled to the new level. That can take up to 3 days. What the vet wants is to keep changing the dose and therefore constantly adjusting the shed. I think he is more used to other insulins which do not have a depot.

Hi Georgette

I agree with Ann. I think Clare needs a dose increase to 0.5u twice a day. The protocol here is tried and true and I'd stick with it. I would not vary the dose between a.m. and p.m.

Clare's bounce from the last green should have cleared by now so I think an increase isn't a bad idea, just do both AM and PM. Just keep testing (especially at the 3 day mark), you can always bring her back down.

Once a cat gets below the half unit dose you may want to think about shaving rather than .25U changes. See what the dosing experts say.

i'd go with the same dose am/pm as well.

the way Lantus works, it builds up in the body in a deposit, or depot, and sort of slow releases. there is a relationship between the size of the dose and the size of the depot. when you change the dose, the depot will adjust to "fit" the size of the dose. Giving the same dose helps to flatten out numbers. Changing the dose can result in wonky numbers for a day or so.

when we increase a dose and the numbers sometimes go higher, we call it "New Dose Wonkiness." We don't know why it happens, but it can last a day or so in some cats. Jill wrote a post on it here.

When you reduce a dose, we have seen that the previously larger dose can still be affecting the blood sugar as many as 6 cycles after the dose reduction.

In a high dose cat, like 10+ units per shot, there are times when a shot can be skipped and the numbers don't really show it - that's because the depot continues to "give" and can hold the blood sugar steady.

So you can imagine the consequence of giving a different dose of Lantus every 12 hrs. it's a bit like being in a boat and rocking it. Clare's going to feel best when her numbers become flatter and aren't going high/low in every cycle. Being consistent on the dose is one way to move towards flatter numbers.

Understanding the insulin depot that lantus has is pretty important to understanding its benefits and how it works best. There is a good post here about it. Your vet is likely thinking of the previous generations of insulins that have been more commonly used. Those are dosed more upon the preshot number and because they don't work in quite the same way, people might very well give a different dose am and pm.

Hi, Clare.

I agree with what everyone is saying. With Lantus and the way the insulin depot works, you'll get better results giving the same dose at AM and PM shot times.

Also, I would not base any dose decision on a urine glucose test. Urine glucose testing is unreliable. The strips do not register lower numbers so you can have a false sense of security. Also, they don't give you to the minute results. It takes hours for food to be processed and for waste to be collected. Then, enough urine has to form for your kitty's bladder to fill and for your cat to have the urge to use the litter box. The urine test reflects glucose levels that are hours old. You cat could be hypoglycemic and you'd never know it from a urine test.

Thanks, Everybody for your thoughts. It seems unanimous that the AM and PM doses should be the same.
I called our vet back this afternoon but she was gone for the day. I have an appointment to talk with her about this on Monday morning.

We were a little nervous about starting an increased dose over the weekend because of the usual decrease in the number of folks who are visiting this site then, and we also wouldn't be able to reach our vet. So we'll begin by increasing the morning dose on Monday and then hopefully our vet will have a chance to do her research before the PM dose and will be comfortable with the AM/PM increase.

In the meantime we'll continue to fill out the PM numbers on Clare's SS, introduce her to the automatic feeder for her +8 meal in the PM; and since we'll be out of strips tomorrow we'll also change over our meter to the ReliOn.