lantus question

[Tobby]

Most of the cats on lantus are only at 2 units the most. Do you also see other cats higher than that dose? Are cats ok to have more than 2 units of lantus? Tobby is now on 5.5 units 2x/day. So far his preshots are still high but not as HI as before. He cannot walk well as he is having diabetic neuropathy. I give him b12 tablets daily. Pretty much he eats, use the litterbox and goes to bed. At times, he will lay still after using the litter to rest then get up to go to his bed. It still worries me if I need to stay on lantus or switch to another? Not sure if lantus is going to work for him. If cat is on high dose condition, will the dose lower later?

Heidi

 

[Diane Tyler's Mom GA]

Your previous post
https://felinediabetes.com/FDMB/threads/questions.298949/#post-3252012

 

[Diane Tyler's Mom GA]

Most of the cats on lantus are only at 2 units the most. Do you also see other cats higher than that dose? Are cats ok to have more than 2 units of lantus? Tobby is now on 5.5 units 2x/day. So far his preshots are still high but not as HI as before. He cannot walk well as he is having diabetic neuropathy. I give him b12 tablets daily. Pretty much he eats, use the litterbox and goes to bed. At times, he will lay still after using the litter to rest then get up to go to his bed. It still worries me if I need to stay on lantus or switch to another? Not sure if lantus is going to work for him. If cat is on high dose condition, will the dose lower later?

Heidi

@Bron and Sheba (GA)
@Sienne and Gabby (GA)
@Bandit's Mom
@Angela & Cleo
@tiffmaxee
@Suzanne & Darcy

She's following TR but looking at her Spreadsheet it doesn't look like she's following it correctly.
Can you please take a look ladies
Thank you

 

[squeem3]

My diabetic is currently on 2.25 units. He's been on as much as 2.75 units before. My previous diabetic cat needed 4 units of insulin at one point. I know there have been cats on higher doses of Lantus and they don't have acromegaly or anything. How much insulin a cat needs varies and depends on a variety of things. Sometimes a higher dose is needed before dose decreases can be made.

Are you using methylcobalamin to treat the neuropathy? Regular B12 does not work.

Are you using U100 insulin syringes? Prozinc is a U40 insulin and you were likely using U40 insulin syringes. U40 insulin syringes doesn't work for Lantus.

Do you test before giving every insulin shot? There are missing PS numbers in your spreadsheet.

 

[Diane Tyler's Mom GA]

This is what you should use for diabetic neuropathy
the Vitacost brand another member told me about
Vitamin B-12 Methylcobalamin -- 5000 mcg - 100 Capsules

Same as Zobaline , but the Zobaline is so expensive as you know
This is the same thing
The only difference is the Zobaline has 200 mcgs of folic acid
So I bought the folic acid at the supermarket and crush it up and added it to the Vitacost brand
If you can't find the 200 mcg get the 400 mcg and cut it in half and crush it up and add it, some members didn't even add the folic acid and the neuropathy improved
The Vitacost brand is a capsule so just open it and pour the powder on the wet food
Has no taste, no need to crush it up, I still give it to Tyler every now and then and he has never tasted it in his food , I always add water to his food and just stir up the methyl B-12 good
I switched to the vitacost brand because the zobaline was too expensive,
Even though the vitacost brand is 5000 mcgs and the zobaline is 3000 mcgs
What they don't need they will pee out because it's water soluble.

The Zobaline is expensive for 60 pills, 30.00 some other places want 33.00
I used to use the Zobaline when I joined, then a member told me about the Vitacost brand .

It took about 2 months for Tyler to get back to walking normal, jumping on to the couch, running around
But every few weeks I did see a slight improvement
Some members didn't even add the folic acid to the vitacost brand and it still helped and the neuropathy was gone

https://www.vitacost.com/vitacost-vitamin-b-12-methylcobalamin-5000-mcg-100-capsules-6

14.49 for 100 capsules

 

[Diane Tyler's Mom GA]

If you are using Lantus which I think you are
Using syringes with a pen, cartridge, or vial:

• U-100 3/10cc syringes with half unit markings are the best to use for drawing Lantus, Levemir, or the Biosimilars from vials, cartridges, and pens.
• BD Ultra-Fine, CarePoint Vet, Monoject, GNP, UltiCare Vet Rx, Sure Comfort, and ReliOn are just some of the brands available with half unit markings.
• Syringes come in 5/64 inch (6mm), ½ inch (8mm) or 5/16 inch (12.7mm) needle lengths. Needle gauges are 29, 30 or 31 (31 being the thinnest)
• You can order the U-100 syringes with half unit markings from Amazon without a doctors script
  https://www.amazon.com/UltiCare-31-Gauge-Veterinary-Insulin-Syringes/dp/B009LTE0DO

• Full and half-unit syringe scales:

You want the ones with half unit markings

• Full and half-unit syringe scales:

 

[Bron and Sheba (GA)]

Hi Heidi
There are some conditions where the cat needs more insulin such as Acro.
I’m going to ask @Wendy&Neko to have a look at Tobby’s chart for you.

 

[Tobby]

My diabetic is currently on 2.25 units. He's been on as much as 2.75 units before. My previous diabetic cat needed 4 units of insulin at one point. I know there have been cats on higher doses of Lantus and they don't have acromegaly or anything. How much insulin a cat needs varies and depends on a variety of things. Sometimes a higher dose is needed before dose decreases can be made.

Are you using methylcobalamin to treat the neuropathy? Regular B12 does not work.

Are you using U100 insulin syringes? Prozinc is a U40 insulin and you were likely using U40 insulin syringes. U40 insulin syringes doesn't work for Lantus.

Do you test before giving every insulin shot? There are missing PS numbers in your spreadsheet.

I give zobaline every day , use u100 syringes. But I looked at the syringe and compare u40 to u100, looks u40 is bigger to me than u100. I use the veticare insulin syringes. I do test before giving insulin shot most of the time. Some are missing because I do late at +14 when I come home from work. Correct if I am wrong, Tobby was on prozinc at 3.5units using u40 and to convert u40 to u100, it should be 8.5 units of u100 I think.

 

[Tobby]

Hi Heidi
There are some conditions where the cat needs more insulin such as Acro.
I’m going to ask @Wendy&Neko to have a look at Tobby’s chart for you.

thanks.

 

[Tobby]

This is what you should use for diabetic neuropathy
the Vitacost brand another member told me about
Vitamin B-12 Methylcobalamin -- 5000 mcg - 100 Capsules

Same as Zobaline , but the Zobaline is so expensive as you know
This is the same thing
The only difference is the Zobaline has 200 mcgs of folic acid
So I bought the folic acid at the supermarket and crush it up and added it to the Vitacost brand
If you can't find the 200 mcg get the 400 mcg and cut it in half and crush it up and add it, some members didn't even add the folic acid and the neuropathy improved
The Vitacost brand is a capsule so just open it and pour the powder on the wet food
Has no taste, no need to crush it up, I still give it to Tyler every now and then and he has never tasted it in his food , I always add water to his food and just stir up the methyl B-12 good
I switched to the vitacost brand because the zobaline was too expensive,
Even though the vitacost brand is 5000 mcgs and the zobaline is 3000 mcgs
What they don't need they will pee out because it's water soluble.

The Zobaline is expensive for 60 pills, 30.00 some other places want 33.00
I used to use the Zobaline when I joined, then a member told me about the Vitacost brand .

It took about 2 months for Tyler to get back to walking normal, jumping on to the couch, running around
But every few weeks I did see a slight improvement
Some members didn't even add the folic acid to the vitacost brand and it still helped and the neuropathy was gone

https://www.vitacost.com/vitacost-vitamin-b-12-methylcobalamin-5000-mcg-100-capsules-6

14.49 for 100 capsules

yes, he is getting zobaline at this time and it is expensive. But I will switch to vitacost after it is finished. No matter how much zobaline I give if his sugar remains high, his neuropathy is not going to get better. Perhaps I should just give vitacost since it doesn't have folic acid. Perhaps that's what causing his constipation?

 

[Wendy&Neko]

A lot of cats on Lantus are on 3 units or less (not 2) but it really varies by cat. There are a lot of other secondary conditions that can cause a cat to need more insulin or have insulin resistance, just as infected mouth needing a dental, hyperthyroidism, kidney disease, heart disease, eating high carb dry food, pancreatitis, overweight. But none of the medical conditions typically mean a cat needs 6 units or more. Dry food can do it. Once a cat gets to six units, there is a good chance one of acromegaly (benign pituitary tumour), IAA (insulin auto antibodies) or Cushings is likely. Note cats with any one of these 3 conditions can be on less than 6 units. In fact, one in four diabetic cats has acromegaly. My Neko had both acromegaly and IAA - think of it as an allergic reaction to injected insulin. Her high dose was 8.75 units, but much of her diabetic life she was under 3 units once I got her treated, and even spent some time below 1 unit. We've seen cats need a LOT more insulin. One of our sayings here is that a cat needs however much insulin they need.

Given what his spreadsheet looks like, I'd suggest getting testing done for acromegaly (IGF-1 test) and IAA as they are more common of the three. They are blood tests, both done only at Michigan State University. For a cat that is positive for one or both of these conditions, there are some tips we can suggest for getting to a better dose faster but safely.

U-100 insulin is more concentrated than U-40, so yes, you give more Prozinc as you do for the same dose of Lantus.

With high numbers, he's probably also dehydrated, which will contribute to constipation.

 

[Wendy&Neko]

Reading back on your previous post, Vetsulin (called Caninsulin elsewhere in the world) came out before Lantus, and is what a lot of vets were trained on. Frankly, more people treat diabetic dogs than cats. . My cat started on Caninsulin due to vet's lack of knowledge of Lantus, we still see people come here with their vet suggesting Vetsulin. It's too fast acting and doesn't last long enough in cats, who have faster metabolisms than dogs. Cats do a lot better on Lantus. Prozinc is also long lasting, but for higher dose cats, Lantus seems to last longer still. A better insulin is Levemir, but it's unfortunately been discontinued in the US.

 

[Tobby]

Reading back on your previous post, Vetsulin (called Caninsulin elsewhere in the world) came out before Lantus, and is what a lot of vets were trained on. Frankly, more people treat diabetic dogs than cats. . My cat started on Caninsulin due to vet's lack of knowledge of Lantus, we still see people come here with their vet suggesting Vetsulin. It's too fast acting and doesn't last long enough in cats, who have faster metabolisms than dogs. Cats do a lot better on Lantus. Prozinc is also long lasting, but for higher dose cats, Lantus seems to last longer still. A better insulin is Levemir, but it's unfortunately been discontinued in the US.

I have learned that degludec or trebiso is made by the same people of levemir. So it might be the same action as levemir. Have you heard of it?

 

[Tobby]

A lot of cats on Lantus are on 3 units or less (not 2) but it really varies by cat. There are a lot of other secondary conditions that can cause a cat to need more insulin or have insulin resistance, just as infected mouth needing a dental, hyperthyroidism, kidney disease, heart disease, eating high carb dry food, pancreatitis, overweight. But none of the medical conditions typically mean a cat needs 6 units or more. Dry food can do it. Once a cat gets to six units, there is a good chance one of acromegaly (benign pituitary tumour), IAA (insulin auto antibodies) or Cushings is likely. Note cats with any one of these 3 conditions can be on less than 6 units. In fact, one in four diabetic cats has acromegaly. My Neko had both acromegaly and IAA - think of it as an allergic reaction to injected insulin. Her high dose was 8.75 units, but much of her diabetic life she was under 3 units once I got her treated, and even spent some time below 1 unit. We've seen cats need a LOT more insulin. One of our sayings here is that a cat needs however much insulin they need.

Given what his spreadsheet looks like, I'd suggest getting testing done for acromegaly (IGF-1 test) and IAA as they are more common of the three. They are blood tests, both done only at Michigan State University. For a cat that is positive for one or both of these conditions, there are some tips we can suggest for getting to a better dose faster but safely.

U-100 insulin is more concentrated than U-40, so yes, you give more Prozinc as you do for the same dose of Lantus.

With high numbers, he's probably also dehydrated, which will contribute to constipation.

Do you know how much those acromegaly and IAA cost?

 

[Wendy&Neko]

We have a forum for Tresiba (degludec) so yes have heard of it. Unfortunately we've only had a few people using it so not much experience with it. We did have one person on Levemir try degludec, but she decided she liked Levemir better so went back to it. People in the US on Levemir are currently getting it from Canada.

Current price for IGF-1 test is $72 and IAA is $22. That is the cost from MSU. On top of that is the cost for the vet do to the blood draw and prepare the blood for shipping, plus shipping cost. You'd have to ask your vet what they charge. Some vets send it to Idexx to ship to MSU, but that just adds an extra layer of costs.

 

[Diane Tyler's Mom GA]

If you are ever interested in Levemir heys is the link to get it from Canada
https://canshipmeds.com/search-3/?drugName=levemir® penfill® (insulin detemir)


https://canshipmeds.com/

@Tobby

 

[squeem3]

I'd keep those U40 insulin syringes in a separate location than the U100 ones so that you don't accidentally grab the wrong ones to use with Lantus. Or donate the U40 insulin syringes. There's a Supply Closet forum here on FDMB where you can post them.

3.5 units of U40 insulin is about 8.5 units measured in a U100 insulin syringe. Since you're using Lantus now, don't worry about conversions. Just be sure to use only U100 insulin syringes to measure whatever Lantus dose your cat needs.

Miralax is often given to cats with constipation. Ask your vet if you want to give it a try. You buy Miralax or the generic equivalent OTC at any pharmacy. Mix a cat sized dose in some water to dissolve it and then mix into food.

 

[Tobby]

We have a forum for Tresiba (degludec) so yes have heard of it. Unfortunately we've only had a few people using it so not much experience with it. We did have one person on Levemir try degludec, but she decided she liked Levemir better so went back to it. People in the US on Levemir are currently getting it from Canada.

Current price for IGF-1 test is $72 and IAA is $22. That is the cost from MSU. On top of that is the cost for the vet do to the blood draw and prepare the blood for shipping, plus shipping cost. You'd have to ask your vet what they charge. Some vets send it to Idexx to ship to MSU, but that just adds an extra layer of costs.

Can treatments and lab tests be done at regular vet or have to be done by an internist? Not sure if my vet knows about this conditions?

 

[Wendy&Neko]

The blood draw can be done by a regular vet, but only Michagan State University (MSU) preforms the two tests I listed. Some vets will send blood to Idexx Labs who will in turn send it to MSU, but you just pay extra for the lab in the middle.

There are multiple types of treatments, depending on the conditions that are found. Acromegaly can be treated by surgery, radiation therapy or a drug given daily. The first two options are done by specialists and aren't available everywhere. The drug can be prescribed by a vet and given at home. My vet didn't know much about the conditions either. The practice owner called them "exotic tests" when I requested them. They were humbled whend both came back positive. I basically arranged treatment on my own - two of the people on FDMB got the same treatment done (radiation therapy) three weeks before and gave me the contact info.

 

[Tobby]

I have updated the spreadsheet and Tobby is now on 5.5 units. Do I increase or hold dose?
I have also included Tobby's spreadsheet while on prozinc, if you can see the difference between prozinc and lantus on him. I was following the sliding scale for prozinc dosing when I joined a diabetic online group. I don't like those high numbers while on prozinc and was hoping lantus to work better but from what I can see that lantus has more HI numbers. I heard of most cats are on lantus and the better regulation of it so I switched.
I have also included lab work of 1/25 when he had an ibd flare with no appetite, frequent loose stools, dehydrated. The vet prescribed clavamox, started on low dose prednisolone for 2 weeks only and also started lantus insulin. On 2/25, he had fur loss on head, neck, parts of the body and legs that started a circle formation. The vet ordered baytril, antifungal, antimicrobial, antibacterial wipes and I applied clotrimazole cream. Indeed it was a fungal infection but his fur is coming back especially in the head, neck. It was so miserable to see him without fur and how he felt those days. Hope to return his mobility with the diabetic neuropathy.
His ultrasound in 5/2024: ConsultReport_370331_TOBBY-LIM
Update: Not sure why the spreadsheet and ultrasound is not showing.

 

[Wendy&Neko]

Love that sunny yellow in there today.

Tobby is now on 5.5 units. Do I increase or hold dose?

Unfortunately, there were some fur shots in there. Same happened to me. The fur shots deplete the depot. It just means you need to stick with 5.5 units for two more cycles. You do want to hold each dose for at least 6 consecutive cycles. The count restarted the night of the 14th. If you don't see anything below 200 by two cycles from now, you are good to increase then.

Sorry to hear about the fungal infection. Ugh!

I don't like those high numbers while on prozinc and was hoping lantus to work better but from what I can see that lantus has more HI numbers. I heard of most cats are on lantus and the better regulation of it so I switched.

The other thing you are likely combatting is insulin resistance of some kind, which can get worse over time. Meaning you have to chase after that resistance with higher doses of insulin. Keep on increasing when you can, and you WILL get there. Every cat has a dose that moves them.

 

[Tobby]

Yes, happy with the sunny yellow. Any advice or tips on preventing fur shots. I need to fill the depot coz I'm getting fur shots almost everyday.
With insulin resistance, if the increase is able to chase the right dose on him, will it get lower later? Is there a treatment for insulin resistance?
With prozinc, i seldom see HI numbers so i am thinking that he might be better with prozinc and it's not high dose. I have attached the datas on the copy of 2024 tab. What do you think?
Tobby has IBD/pancreatitis, early ckd and that is probably he is requiring high doses.

 

[Wendy&Neko]

Check out this post, and the roll method of shooting, it might help: Testing and Shooting Tips

Insulin resistance is a generic term, many different conditions can cause it. Treatment depends what type of condition is causing the insulin resistance. I mentioned two of them above, acromegaly and IAA, as examples. What happens to the insulin dose is "it depends". If there is an underlying condition that is treated, then the insulin dose will likely eventually be reduced.

Neko had advanced CKD, small cell lymphoma, heart disease on top of her diabetes caused by acromegaly. It didn't mean she needed a higher dose, once I had the acromegaly treated. She did get mildly increased numbers during pancreatitis flairs.

Since Tobby has those other conditions, they would be useful to include on your signature. Other medical conditions can impact our suggestions. But I strongly suspect he IBD/p'titis and CKD are not why he needs 5.5 units with him being on a home cooked diet. It is very common for cats with conditions such as acromegaly to need a lower dose to start, then as the acro tumour grows, more insulin is needed. I suspect 5.5 units of Prozinc wouldn't be giving good numbers now either.

 

[Tobby]

Check out this post, and the roll method of shooting, it might help: Testing and Shooting Tips

Insulin resistance is a generic term, many different conditions can cause it. Treatment depends what type of condition is causing the insulin resistance. I mentioned two of them above, acromegaly and IAA, as examples. What happens to the insulin dose is "it depends". If there is an underlying condition that is treated, then the insulin dose will likely eventually be reduced.

Neko had advanced CKD, small cell lymphoma, heart disease on top of her diabetes caused by acromegaly. It didn't mean she needed a higher dose, once I had the acromegaly treated. She did get mildly increased numbers during pancreatitis flairs.

Since Tobby has those other conditions, they would be useful to include on your signature. Other medical conditions can impact our suggestions. But I strongly suspect he IBD/p'titis and CKD are not why he needs 5.5 units with him being on a home cooked diet. It is very common for cats with conditions such as acromegaly to need a lower dose to start, then as the acro tumour grows, more insulin is needed. I suspect 5.5 units of Prozinc wouldn't be giving good numbers now either.

The post says not to use neosporin as it is toxic to cats but in the video, the lady is using neosporin.
Tobby was only on 3.5 units on prozinc.

 

[Tobby]

Check out this post, and the roll method of shooting, it might help: Testing and Shooting Tips

Insulin resistance is a generic term, many different conditions can cause it. Treatment depends what type of condition is causing the insulin resistance. I mentioned two of them above, acromegaly and IAA, as examples. What happens to the insulin dose is "it depends". If there is an underlying condition that is treated, then the insulin dose will likely eventually be reduced.

Neko had advanced CKD, small cell lymphoma, heart disease on top of her diabetes caused by acromegaly. It didn't mean she needed a higher dose, once I had the acromegaly treated. She did get mildly increased numbers during pancreatitis flairs.

Since Tobby has those other conditions, they would be useful to include on your signature. Other medical conditions can impact our suggestions. But I strongly suspect he IBD/p'titis and CKD are not why he needs 5.5 units with him being on a home cooked diet. It is very common for cats with conditions such as acromegaly to need a lower dose to start, then as the acro tumour grows, more insulin is needed. I suspect 5.5 units of Prozinc wouldn't be giving good numbers now either.

The post says not to use neosporin as it is toxic to cats but in the video, the lady is using neosporin.
Tobby was only on 3.5 units on prozinc.

 

[Wendy&Neko]

The post says not to use neosporin as it is toxic to cats but in the video, the lady is using neosporin.

The research showing the Neosporin (neomycin ingredient specifically) is not good for cats came out recently. The post was updated but the video was made before then.

Tobby was only on 3.5 units on prozinc.

One thing I cannot stress enough is getting enough tests if you are going to follow TR. Without at least two test per cycle (the preshot and one other), I really can't tell if Tobby's dose is too much, or too little. If you can't do that many tests (I get that life happens) then you have to follow SLGS for dosing. In the last 10 days, 8 day cycles and 8 night cycles didn't have the required testing. This is for Tobby's safety. Seeing that many "Hi" can mean either the dose is too low and resistance is ramping up, or you are missing lows and he's bouncing up higher.

As far as Lantus vs Prozinc, that was almost two months ago you switched. A cat can change what insulin dose they need in that time. Doing dose resets, which it looks like you did end of February, almost always fail. The cat gets used to higher numbers, and glucose toxicity, a form of insulin resistance, sets in. The cure is more insulin until a breakthrough is needed. But it has to be done safely as the reaction can be quick when it happens.

 

[Tobby]

I was using sliding scale on prozinc which started in Aug 2024 and ended Jan 24,2025. Am I not getting enough two test per cycle? I thought that you do the 3 days (6 cycles) then you test or do the glucose curve. How long do I have to hold the dose?thanks.

 

[Wendy&Neko]

There are two cycles a day, the AM and PM cycle, each should have two tests, the preshot test plus one other. There was just 1 test on each cycle of the 12th and 13th, and just 3 tests each day for the 14th and 15th, with the PMPS test missing. And I'm not seeing any test data after the AM of the 16th. We determine how long to hold the dose based on how low the dose is taking the cat.

 

[Tobby]

There are two cycles a day, the AM and PM cycle, each should have two tests, the preshot test plus one other. There was just 1 test on each cycle of the 12th and 13th, and just 3 tests each day for the 14th and 15th, with the PMPS test missing. And I'm not seeing any test data after the AM of the 16th. We determine how long to hold the dose based on how low the dose is taking the cat.

I see, so I have to do the am and pm cycle. Each diabetic group has their own way of testing. Other group needs to test any cycle at least 3x, others prefer to have a curve after the cycle. I messed up the depot yesterday as I have to go to a training class. I have to leave early so I didn't give the shot but came back late. The 12 hour should be at 11am but I came home at 1330. I have to leave at 830am so I didn't give the shot. So I didn't do any nadir test yet. I have asked about the acro test and it is 632 dollars and my vet don't do the IAA test. It's so expensive. Is there other way of testing or alternate?

 

[Wendy&Neko]

You always test at preshot time, to make sure it's safe to give insulin. Other than that, the particular dosing method you use will have requirements for how many other tests you have to do.

The acro/IAA testing quote means the vet is likely going through Idexx, who charges a huge premium. This posts describes one alternative method:
MSU VDL testing instructions for IGF-1 and IAA

 

[Tobby]

You always test at preshot time, to make sure it's safe to give insulin. Other than that, the particular dosing method you use will have requirements for how many other tests you have to do.

The acro/IAA testing quote means the vet is likely going through Idexx, who charges a huge premium. This posts describes one alternative method:
MSU VDL testing instructions for IGF-1 and IAA

Great, thanks for this wonderful info. Will look into it.

 

[Wendy&Neko]

Heidi, you asked me whether you should stick with this dose or increase. When a kitty is following TR and seeing nadirs under 200, especially for the first time , we hold that dose at least 8-10 consecutive cycles before increasing. Since you gave a reduced dose the night of the 28th, that interrupted the count of consecutive cycles, so today is cycle count #5. Let's see if he'll go a little lower yet and you stick with 6 units. That 121 last night means he's trying.

 

[Tobby]

Heidi, you asked me whether you should stick with this dose or increase. When a kitty is following TR and seeing nadirs under 200, especially for the first time , we hold that dose at least 8-10 consecutive cycles before increasing. Since you gave a reduced dose the night of the 28th, that interrupted the count of consecutive cycles, so today is cycle count #5. Let's see if he'll go a little lower yet and you stick with 6 units. That 121 last night means he's trying.

got it, thanks.

 

[Tobby]

today he has the green ones on april fool's day. What would you do in this situation? Do I give half of the dose, skip, or wait till it goes up and dose? I thought I sent this email early this morning but it didn't show. Anyways.

 

[Wendy&Neko]

Just some clarification on the spreadsheet. He gave you a 84 for AMPS and 75 again at +11 tonight? Or was that 75 last night?

Your signature says you are following TR for dosing, but following TR means getting at least two tests per cycle, so the preshot test, plus one other. Can you get those 4 tests per day? With TR, experienced people shoot as low as 50. However, you aren't there yet. There are several options when you get a lower than expected preshot. Besides partial dose or skipping, you can also do what we call a stall. Which is to wait, maybe 1/2 to start, to see if he climbs to a number you are more comfortable shooting.

There is more information in the Sticky Notes at the top of the Lantus forum, including one on what to do with lower preshots. I'd recommend reading those Sticky Notes. You might also want to start posting over there, where you'll get more eyes on your situation.

 

[Tobby]

I checked the BG one hour early so that was +11 last night of 75. Then I rechecked after 1:45 which will be a Preshot, it was 85. Does 4 tests per cycle have to be per day? I thought I read that you don't have to do all those tests per day if you can't.
What do you mean wait, maybe 1/2 to start, when stalling. 1/2 dose? 1/2 hr?
Didn't know that I can post on the lantus sticky notes. I will next time.

 

[Kobe (Dean and Lesley) MO]

What do you mean wait, maybe 1/2 to start, when stalling. 1/2 dose? 1/2 hr?
Didn't know that I can post on the lantus sticky notes. I will next time.

Wait 1/2 hour to start, hoping that BG will have come up so the number is shootable

no posting on Lantus Stickies... but please do post on the Lantus Forum itself.

 

[Tobby]

after 1:45, bg was at 85 so I didn't give dose. After 3.5hrs, it became 208 around 2pm. Should I have given at that time at 2pm of 6 units?
In summary, what is the difference between the TR and SLGS? I read it but it looks the similar to me? It starts at a low dose but same as in TR. Am I not catching it?

 

[Kobe (Dean and Lesley) MO]

after 1:45, bg was at 85 so I didn't give dose. After 3.5hrs, it became 208 around 2pm.

Will you check this for a possible typo?

 

[Kobe (Dean and Lesley) MO]

after 1:45, bg was at 85 so I didn't give dose. After 3.5hrs, it became 208 around 2pm. Should I have given at that time at 2pm of 6 units?

if BG was 85 at 1:45, you wait to give food, test again around 2:15. If BG is over 200, you shoot!
If not, you'll want an experienced member to help you decide what to do. There are options: stalling again, smaller dose, shooting full dose, skipping the shot, etc. The option that is best for your cat depends on a number of factors like, whether kitty has ketones, how close is the BG to 200, is the BG decreasing, staying the same, or has it started to come up (but hasn't reached 200 yet). A member will help you pick the safest, most effective option.

 

[Wendy&Neko]

I checked the BG one hour early so that was +11 last night of 75. Then I rechecked after 1:45 which will be a Preshot, it was 85.

OK, then the 75 should have been recorded as being on the night of the 31st, not the 1st, as it happened before the AMPS of April 1st.

If at 1:45 the BG is lower than you want to shoot, do NOT feed, wait half an hour, then test again and see if the number is up to a level you feel comfy shooting.

Does 4 tests per cycle have to be per day? I thought I read that you don't have to do all those tests per day if you can't.

The four tests are per day, not per cycle. TR is a more aggressive protocol and requires you to know how he's doing in each cycle in order to increase as fast as TR lets you do. That second shot per cycle helps us figure it out. It doesn't have to be the middle of the cycle, but even a test 2-3 hours after the shot gives us a clue what is happening.l

 

[Tobby]

Your signature says you are following TR for dosing, but following TR means getting at least two tests per cycle, so the preshot test, plus one other. Can you get those 4 tests per day? This is what you wrote from previous post, at least two tests per cycle. I have at +4 and +7, at times +4 +6 +8 if you will look at it. I don't understand what you are asking but it is what I am already doing I think. And I read that we need the mid cycle to know if we are to go up or down.

 

[Wendy&Neko]

Maybe there is data missing from the spreadsheet? For example, on March 31st, I only see the two preshot tests. March 29th has only a AMPS and a PM+2 test value.

 

[Tobby]

Maybe there is data missing from the spreadsheet? For example, on March 31st, I only see the two preshot tests. March 29th has only a AMPS and a PM+2 test value.

I cannot do all 4 tests everyday as I go to work so there was no data missing. I wanted to clarify about testings, we need 4 tests in a day per cycle which is after 8-10 days, is that correct? Because of that low BG amps, I reduced the dose to 5.75.

 

[Wendy&Neko]

There are two cycles per day the AM cycle and the PM cycle. You need two tests per cycle each day. Some people who are working adjust their schedule in the morning so that they do the insulin routine first thing in the AM, then test again a couple hours later as they head out the door. Or shoot just before leaving and test again when they get home if there are a couple hours until PMPS shot time. At night, get a test before bed if it's 2-3 hours after the shot.

Good luck with the new dose.

 

[squeem3]

There are two cycles per day the AM cycle and the PM cycle. You need two tests per cycle each day. Some people who are working adjust their schedule in the morning so that they do the insulin routine first thing in the AM, then test again a couple hours later as they head out the door. Or shoot just before leaving and test again when they get home if there are a couple hours until PMPS shot time. At night, get a test before bed if it's 2-3 hours after the shot.

What if a person literally gets up, does the morning insulin / food routine, and is out the door and then doesn't get home until PMPS time or later? That's pretty much my weekdays so I can't do TR. Maybe SLGS is a better option for OP.

 

[Wendy&Neko]

As @squeem3 suggests, not all work/travel schedule allow during the day tests. In that case SLGS might be a better dosing method for you.