First dose Lantus +6 562

I know our spreadsheet is patchy ( Sushi is difficult) and that will hinder advice but I could use some guidance. We just started Sushi on her first unit of Lantus this morning. She’s been on 2.75 units Vetsulin. Her vet told us to start at only 1unit. We gave her just a hair over the 1unit mark this morning probably closer to 1.25. I know it takes 5-7days for the depot to build but her +6 of 562 concerns me. Should we bump her up to 1.5 tonight? She’s been testing negative for ketones thus far but I know that can change abruptly. Thank you for any help you can provide!

 

Hi Nicole! Happy to see you over here from FB for dosing advice - it’s the best place to be!

As I mentioned over there, we usually consider the previous insulins dose (along with the data) when switching insulin so 1u may have been a little lower than a normal switch would have been but I’ll leave that to folks here to discuss.

Since you’re on SLGS protocol, and just starting lantus, you might continue with this dose for 5-7 days and see what the numbers say once the depot is full and reevaluate the dose then. Continue to monitor for ketones.

I’ll tag a few members to help you out with dosing and if you should stick with 1u for the week or not.

@tiffmaxee
@Chris & China (GA)
@Suzanne & Darcy

 

Thank you!!! I wasn’t planning on checking her today because I knew she’d be sky high and I would get myself worked up over it which is exactly what happened.

 

I wouldn’t worry as much about the highs, but rather catching the lows. The highs can be frustrating to see but there’s not much we can do but get to that perfect dose as soon and as safely as possible.

You’ll want to test at minimum preshot test, to make sure it’s safe to give insulin. Then if possible, one mid cycle per cycle around nadir - but you can sprinkle them around a bit. How low the dose takes them at nadir is what dosing is based on.

I know sushi is of the spicy variety, so do the best you can. Do you think you’ll be able to get a curve in at the end of the week? I believe I remember you thinking about trying the Libre? It could be a good option while everyone (Sushi…) gets more comfortable with the testing process.

 

I would have started with at least 2 units, possibly 2.5 units. Speaking as someone whose kitty was on 5 units of Caninsulin (what Vetsulin is called in the rest of the world) and the vet suggested starting on 1 unit of Lantus, going back in dose is a big step backwards. And it'll take a long time to get back to where you should have started.

 

I think we’ll be able to do a mini curve on her this Saturday! We’ve got a system for testing down pat using her back feet at this point! She ripped her microchip out from under her so I’m not sure how the libre would hold up hahahaha. I think her dad and I could manage to get it on her, I’ve watched a bunch of videos… the vet would have to use full anesthesia to put it on her. She’s way more ridiculous for anyone but us! I’ve considered getting her one just for the sake of her looking cute in a onset to try to keep it on her lol

 

Thank u my initial thought was 2U… her vet doesn’t seem super familiar with using anything but vetsulin. I understand her wanting to err on the side of caution but I’m also worried about set backs!

 

Ripped her microchip out!!!! My goodness!

I’m glad she’s better with those she trusts. The Libre is definitely an option. But if she’s ok with testing using a hand held meter, it’s the best, most accurate device for testing.

The onesies sure do look cute but heck, if she didn’t want a little microchip that most don’t feel, not sure how that onesie is going work out

 

I agree with Wendy. I would have started with a higher starting dose of Lantus.
You are risking ketones starting, going back to 1 unit, and having Sushi remaining in high numbers unnecessarily.
Would you mind drawing a thick line in the SS and colour it and say….Started Insulin ….so we can see where the change to Lantus was..thanks.

 

Hi can you Nicole can you add to your signature Started Lantus 2-8 so members are aware of this and like Bron said draw a blank line above the date you started lantus and write Started Lantus and color it

 

Do you think we should increase to 1.5 tonight or even higher? I’m really worried about DKA. I couldn’t figure out how to draw a line on the sheets app on my phone but I added a new row above the start date and colored that in to mark the switch!

 

What you did in the spreadsheet is perfect. I'm not experienced to give you dosing advice I would also tag Wendy also about that

 

Hooray! Thank you

 

Yes what you did on the SS is great!
I would do what Wendy suggested and start with at least 2
If you start with 2 you need to hold the dose for 7 days to let the depot fill unless the BG drops under 90. Then do a curve and ask about an increase in dose. Don’t forget to get some tests in during the PM cycle as well as that is just as important. A before bed test is a good habit to get into.

 

Thank you!

 

I agree, if Sushi were my cat (and with her history of DKA), I would follow Wendy's recommendation and start with the higher dose tonight (probably 2 units). It's not too late. You only just started this morning. Then hold for 14 cycles unless numbers indicate a reduction. And you are testing for ketones, right ... either urine or blood ketone meter?

 

We are using urine strips for ketones, neg so far. I didn’t realize you could test with blood! Does it require more blood than for a BG check? As much as she’s a PITA to get blood checks on watching and waiting for her to pee isn’t always ideal! I’m thinking blood readings could be more accurate also?

 

You need to buy a specific blood ketone meter and the test strips are expensive. You test in the same way as a BG blood test. The test is more accurate in that it is up to date and can pick up ketones earlier, whereas a urine test, the urine has been in the bladder for a while but if you test properly, the results are usually accurate.
If you are just checking for ketones…and there is no history of DKA according to the signature….I think a urine test would be fine.

 

Well, ketones reportedly show up in blood before they show up in urine. I used a blood meter because of DKA and because I didn't think I would be able to stalk him to the litter box. It takes about the same amount of blood as a BG test. I never had problems. Do you get a good amount out of her back foot paw pad? I've never done that before. Does it seem to hurt or not? Does she react? Do you alternate paws?

 

I agree with Bron that if it is easier and if you have no DKA history and she is agreeable to letting you stick the strip in her urine stream... and she's negative so far (a lot of ifs I know, but so far so good!) then the urine strips are fine for her.

 

She’s finally got to the point that she doesn’t react and doesn’t try to pull her leg away. I get a decent droplet each time and what’s great is that even if it looks like I didn’t stick her at all I can squeeze the pad and almost every time a big juicer emerges lol. I tried the ears initially because that’s the only part of her body she really enjoys being touched but she just flails her head way too much. Once dad gets her into the football position it’s smooth sailing. I’d like to try it on her non weight bearing front pads but can’t figure out how dad can hold her to where she won’t bite at me and hurt herself on the lancet needle. That was my biggest concern with the ears too. More worried about hurting herself than me to be honest! We do rotate add I clean her box out completely pretty much daily But I’m constantly worried about her peets getting infected. It’s just sooooo easy to get a sample I couldn’t believe it. Was about to throw in the towel until we tried the toe beans!

 

Alright guys so we decided to up it to 2 full units last night! Did not get any PM BG readings but we just got an AMPS of 397. She RAN from dad this morning as he went to grab her. I’ve not seen her move like that in a long time lol. She’s much more lively today than she was yesterday. She tested negative again in her urine for ketones. I know 397 is way over the renal threshold but if you look at our patchy spreadsheet she rarely had pink numbers PS on Vetsulin. Trying not to get too excited I know there’a lots of variables at play but I’m very glad we brought this to the forum and you confirmed our suspicions. I did not think 1 unit to start was going to be good for her. We are going to check her again +6 today to see where she’s at. Going to attempt an ear prick instead of using the toe pads this time. Wish us luck! Thank you all so much for your help and guidance!!!

 

I think a pink preshot is something to get excited about. It’s a lot better than black! Just be patient and keep trying to gather data to see how she’s going on this dose as the depot fills.

 

It’s definitely a lot better than 500+ midday that’s for sure! We will hold the course for at least another 5 days before doing a curve on her. Gonna continue to spot check her as much as we can until then!

 

And we just got a +6 of 268! Still high, I know, but much better than yesterdays +6. 2U seems to be a good starting point so far! I wimped out and went for the toe beans again instead of the ear but I’m happy we have a system that works for now. I’ll get there eventually!

 

Wow. Already. I am thrilled with this number. How is she acting?

 

She’s currently napping with her belly up! She’s not done that in a while. Hopefully we can get her to even lower numbers as the depot fills otherwise we will adjust accordingly. So thankful for all of your help and for guiding us in the right direction. She seemed so uncomfortable yesterday and there’s no point in prolonging that by starting from scratch. I also ordered a blood ketone meter to keep on hand should we need it!

 

That's a nice +6 (268) already

 

I hope you will update us and your spreadsheet. How is everything? I wanted to check up on how it’s been going today.

 

Thank you for the follow up! We decided to give her little toe pads and herself a break today because she just wantwasnt having it this morning lol but she’s acting good! Asking for porch time and laying with her belly up all day so she must be feeling better. On the day we only gave her 1 unit of Lantus she chugged 14oz of water… whereas yesterday she only drank 8 ounces! She’s been hovering around 10-12 the last few months so I think that’s a good sign. I have been measuring her water daily for five months I’m ridiculous lol. I figured if we can’t manage daily blood checks at least I can do that. She’s spent less time in front of the water bowl today! I’m hoping she’s cooperative and that dad is able to be home so we can get some more readings in tomorrow. **fingers crossed**

 

I would definitely try to not skip the preshot tests if possible. But I understand if she’s fighting you. I hope she will get more used to being tested because we really won’t know how to adjust the dose if we don’t know the nadir. I’m very glad to know that she seems better and is happy. Are you giving her treats after you test her?

 

Yes! She gets a little dehydrated turkey each time which for now she loves lol

 

I’m going through similar stuff with Pumpkin. I use a little kitchen scale to weigh her water before in grams and after refilling and then convert to oz. I’ve got a spreadsheet, a graph, and everything.

I’m working on testing my own spicy cat too. I feel really bad about not getting pre-shot tests, but after pushing too hard she started to get wary with me, so I slowed way down. Yesterday, I just worked on petting her head and neck and giving her lots of treats to remind her we’re friends. Today, it was gentle touches on the backs of her ears with lots of treats.

I figure as long as she’s drinking tons of water all day she’s still above the renal threshold and nowhere near the danger zone. Testing would be much better but I’m trying to play the long game.

 

I’m glad we aren’t alone on this!! Focusing on playing the long game is a great way to put it haha. Preshot tests are a lot harder for us because after 5 months Sushi has now learned when it’s shot time so she’s already on high alert. Spot checks when dad happens to be home to help hold her midday is a lot easier because she’s decompressed and isn’t expecting it. I know the preshots are super important but if we could at least manage to figure out when her nadir is on this new insulin then we can spot check her randomly every few days to at least make sure she’s not going too low midday. I know the more data the better… but if our babies get to the point where they are hiding from us during insulin time etc… then we have to really pick our battles!

 

Well we haven’t pulled off as many readings as we hoped but we just got a +5 of 191 and I’m very happy to be seeing blue numbers and wanted to share my excitement! She had a really high AMPS yesterday of 562 and I think it’s because i gave her extra YA Zero Mature kibble overnight that she was eating before I took her food up in the morning. After yesterdays high reading she went back to only getting her fancy feast pate, her dehydrated turkey chunks, and like 5 pieces of YA after her shots. hoping we can pull off another reading today but happy we managed this one at least