Dosing question

Is it ok to give a dose or reduced dose of lantus if my Oliver’s glucose reading was 125 before eating.

 

Are you following SLGS or TR? That will change your answer depending on your dosing method!

https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

How long has Oliver been getting insulin? What have his blood glucose numbers looked like lately? Can you provide a little bit of background information so we can better help here?

 

Oliver has been all over the place with lantus. Sometimes high then others low. I can’t be home with him today to monitor him. My vet wants to change his insulin to a vet one.

 

I could test him right now again . He has eaten some of his food

 

January 24 2023

Glucose 4:42 am GB 505

Food 5:30

Insulin 5:50am little over 1 unit

Glucose 6:05 pm GB 428

Food 1 can 6:10

Insulin 6:30 just under 1.5 units

Glucose 7:30pm GB 606

January 25 2023

Glucose 4:55am GB 404

Food 5:40 1 can

Insulin 6:10 1.5 units

Glucose 5:55pm GB 220

Food 6:00

Insulin 6:25pm 1.5 units

January 26 2023

Glucose 4:55am GB 125

Food 5:45 1 can

 

His number is 255 and he has had around 1/2 of his food

 

I’d want to give insulin with the numbers heading up like that! Is this 30m past normal shot time ish?

Any chance of getting some tests in beyond the preshot ones? It’s important to know how low any given dose is taking the numbers and and adjust dosing from there.

 

Yes I gave him about half what he had last night. I will try and come home to test him around 1pm in a little over 6 hours

 

Lantus is really one of the best for cats - I’d push to keep with it for a bit and gather more data about how the Lantus is treating him. It takes a while to find a good dose, and patience is required!

 

Thank you. I will update later today

 

Welcome to the FDMB. Please do not change to a vet insulin. Lantus is the one that gives the best chance at remission. We need to see a spreadsheet to help you figure out dosing as well as know what food he’s eating, type of meter and history.

We ask all new members to post an intro on the main/health forum. I will ask the mods to move this there.

@Wendy&Neko @Sienne and Gabby (GA)

 

If your vet wants to switch to Prozinc it’s fine. Just don’t use Vetsulin. I’m partial to lantus so forgot it might be Prozinc being suggested.

 

Thank you. I’m not sure if the name yet. But I do know you can only use the u40 syringes

 

Please ask. You definitely do not want Vetsulin as it is not long lasting and too harsh for cats. It is ok for dogs.

 

I just called our Veterinary office and it is prozinc . I also checked Oliver’s glucose 20 min ago and it was 73. I think our vet feels the lantus ( I bought the generic form) may stay in his system to long.

 

. I will also write up an introduction for Oliver tonight. Thank you all for your help

 

Sorry to jump in the thread like this. I have a similar case but with Prozinc since December 21, and I am thinking of switching to Lantus due to the horrible numbers (you can see Sharess' Spreadsheet). Do you think my Sharess would do better with Lantus?

@Donna n How long have you been with Lantus? What kind of food do you give to Oliver? These data also have a lot of influence. We recommend feeding a low carb wet food 10% or under carbs. Here is a link to suitable foods FOOD CHART

 

Oliver has been on lantus since 12/1/22. Originally 1 unit which BG must have been high since he continued to loose weight. He is know having 1.5 units but a couple times recently his pre shot numbers were low so i cut back or didn’t give him one which made the next reading high. He is on purina DM wet food

 

Maybe 2 weeks it's not enough time to let Lantus acts, but I do not know about Lantus, but about Prozinc. With Prozinc you have to lower the dosage by 0.25 every time the Nadir drops below 90 and keep the new dosage for at least a week. There is also a protocol to handle a lower than normal preshot number when following SLGS.

I can see that it's almost the same protocol for Lantus:

Starting Dose:

1u BID if kitty is not on a wet/canned low carb diet
0.5u BID if kitty has been switched to a wet/canned low carb diet
If the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration
Generally, shots are to be given 12 hours apart.

Hold the dose for at least a week:

Unless your cat won’t eat or you suspect hypoglycemia
Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.

After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.

If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

If the preshot number is far below usual preshot numbers:

• Do you need to stay on schedule? Then skip the shot.
• Do you have some flexibility with your schedule? Then stalling to wait for the number to rise might be a good option. Don't feed, retest after 30-60 minutes, and decide if the number is shootable.
• Repeat until the cat either reaches a number at which you are comfortable shooting, or enough time has passed that skipping the shot is necessary.

If the preshot number is near kitty's usual preshot numbers:

Look at your data to see what numbers you have shot in the past and decide what would be a safe, shootable number for your cat. Don't feed. Stall until kitty reaches the preshot number you've decided on and then shoot.
We usually don't suggest or recommend shooting a preshot number less than 90 mg/dL when following the SLGS Method. Remember that with SLGS, generally speaking, your goal is to achieve flat numbers that are greater than 90 mg/dL. However, let experience, data collected, knowledge of your cat, and availability to monitor help in making the best decisions for your cat.

If kitty is dropping faster or lower than you'd like, please see "Don't Panic! or How to Handle Low Numbers" and post for help or suggestions.

I can see that Purina DM is a good option. You are doing great with Oliver

 

I would not swap to a new insulin yet. It sounds as if your kitty is bouncing.
Here is an explanation about bouncing forum the Basics on the lantus page

• Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

If I were you I would set up a spreadsheet and add any data you have so we can see it.
I am sure we can get Oliver into much better numbers. We have a lot of people arrive here with the same problem you have.
It is very common for new diabetic kitties to bounce. The answer is not to change insulin, especially if he has only been on it a few weeks. Also patience is needed for the bouncing to settle.
I don’t agree the lantus is staying in the system too long. Lantus is one of the best insulins for cats
Many vets do not know a lot about feline diabetes and tend to treat them like dogs. Cats have a faster metabolism than dogs.
What type of food are you feeding?
Are you giving snacks during the cycles?