? Lantus depot

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Olive & Paula

Olive & Paula

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Is there a way to know if the insulin depot will kick in or not so another hypo episode doesn't happen? Yesterday he was in the 300 all day. Should I have given him a reduced dose at PMPS with the possibility of the depot will kick in? Maybe a lower dose at night would be better for him since the episodes happen at night on him.

Still trying to understand Lantus. I keep reading but all of it just hasn't sunk in yet.
 
woodsywife said:
Is there a way to know if the insulin depot will kick in or not so another hypo episode doesn't happen? Yesterday he was in the 300 all day. Should I have given him a reduced dose at PMPS with the possibility of the depot will kick in? Maybe a lower dose at night would be better for him since the episodes happen at night on him.

Still trying to understand Lantus. I keep reading but all of it just hasn't sunk in yet.
Click to expand...

Lantus works best when given the same dose every 12 hours. Because it builds up the depot is already there when you see the drop so you are dosing based on the buildup and reducing at night won't necessarily cause higher numbers that cycle. Many cats drop at night. Mine us one of them. What you can do is feed slightly higher carbs when he starts to get too low to keep him surfing. I test and then feed small amounts depending on the results. You could also reduce both doses by a little to keep him a little higher all the time but please ask for dosing advice if you choose to go that route.

Did he have hypo symptoms or just drop too low?
 
Practically speaking, there's no way to know the answer to your question. The depot doesn't quite work the way your conceptualizing. Functionally, what it does is allow Lantus (or Lev) to have a longer duration as it provides for overlap between doses. "Depot" is a pharmacological term and, in the case of Lantus, refers to the microcrystals that form and are deposited in the fat tissue. Those crystals slowly dissolve over the course of the cycle thus giving the insulin a longer duration. Various metabolic factors influence the speed of the crystals dissolving. What it also means is that there may not be an instantaneous response to dose changes. If you increase or decrease the dose, the depot has to catch up with the change.

What it looks like to me is that once you had given the 2nd shot at an increased dose, the depot caught up and you saw lower numbers. I suspect that the drop was more than what you were expecting due to having increased by 0.5u. Given that Smokey's nadirs were in the 200s and regardless of whether you are planning on following either the Tight Regulation Protocol or the Start Low Go Slow (SLGS) approach to dosing, we would have suggested an increase of 0.25u. Unless your kitty's nadirs are consistently over 200, you want to increase by 0.25u so you don't bypass what could be a good dose.

I'm assuming you know to decrease the dose today?

 
tiffmaxee said:
Lantus works best when given the same dose every 12 hours. Because it builds up the depot is already there when you see the drop so you are dosing based on the buildup and reducing at night won't necessarily cause higher numbers that cycle. Many cats drop at night. Mine us one of them. What you can do is feed slightly higher carbs when he starts to get too low to keep him surfing. I test and then feed small amounts depending on the results. You could also reduce both doses by a little to keep him a little higher all the time but please ask for dosing advice if you choose to go that route.

Did he have hypo symptoms or just drop too low?
Click to expand...

No symptoms until the +5 drop. I normally give snack +3-4 before I go to bed. Because of new dose given by vet I decided to test him and immediately start treatment. He just kept dropping.

It was safer to treat @ home because I would not be able to administer anything during drive to hospital which is 45-60 minutes away. It always seems to happen when hubby is not home.
 
Sienne and Gabby said:
Practically speaking, there's no way to know the answer to your question. The depot doesn't quite work the way your conceptualizing. Functionally, what it does is allow Lantus (or Lev) to have a longer duration as it provides for overlap between doses. "Depot" is a pharmacological term and, in the case of Lantus, refers to the microcrystals that form and are deposited in the fat tissue. Those crystals slowly dissolve over the course of the cycle thus giving the insulin a longer duration. Various metabolic factors influence the speed of the crystals dissolving. What it also means is that there may not be an instantaneous response to dose changes. If you increase or decrease the dose, the depot has to catch up with the change.

What it looks like to me is that once you had given the 2nd shot at an increased dose, the depot caught up and you saw lower numbers. I suspect that the drop was more than what you were expecting due to having increased by 0.5u. Given that Smokey's nadirs were in the 200s and regardless of whether you are planning on following either the Tight Regulation Protocol or the Start Low Go Slow (SLGS) approach to dosing, we would have suggested an increase of 0.25u. Unless your kitty's nadirs are consistently over 200, you want to increase by 0.25u so you don't bypass what could be a good dose.

I'm assuming you know to decrease the dose today?
Click to expand...

Yes I decreased dose. I guess I won't follow the vet to closely. I doesn't even like half doses so I should have known better. I don't know how familiar vet is with Lantus. Smokey doesn't really fit with either protocol so we were doing a mix of both. I have been pushing to get him more regulated. Vet is happy if he is in the low 300's. I'm not. But he is willing to work with me. I had to demand changing insulins. When i brought some and went in with it, is when he agreed to help me. I think he is learning with me. The other vet won't work with me. I guess we have to go more gently with Smokey. He is 17 and been through the ringer this past year.
 
You did a great job last night. PJ parties are never fun, especially the first one. We all have to make adaptations due to our cats and our lives. Many vets are not familiar w/ Lantus and tend to want to use it the way they are used to w/ the in and out insulins. Quarter unit adjustments are a head scratcher for many, but some of us have found that we need to make even smaller adjustments. Insulin is a very potent drug and our cats are so small. I have a little old lady who is almost 18 and we know how things can pile one on top of another.:bighug::bighug::bighug:
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You may also see these high numbers for several cycles due to that sharp drop, we call it bouncing. When the liver senses not enough glucose in the system it releasees glucgon and counter regulatory hormones to bring BG up. The effect can last for up to 6 cycles.
 
Are you going to follow the TR or SLGS protocol? How long and when you increase or decrease depends on which you follow.
 
Bounces can last up to 3 days (6 cycles) so for now, you stick to the 1.75

Once he's cleared the bounce, if his nadirs are in good, healthy numbers, then you'd just hold the 1.75, but if they start to climb, he may need to go back to 2U

It looks like he's starting to break this bounce already, but sometimes they bobble around a bit before settling back down
 
woodsywife said:
So I should stick with the 1.75u for like 5 days?
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If you were following TR you would wait for the bounce to clear and see where his nadirs land then. If they weren't green, you would go back up. If you were following SLGS, you would wait a week, do a curve and then evaluate the nadirs to see what to do next. Since you haven't picked either SLGS or TR, we can't advise what to do - you'll have to see what you think works for Smokey.

I know all about bobbling too. :rolleyes: Probably means a better sleep tonight.
 
woodsywife said:
Yes I decreased dose. I guess I won't follow the vet to closely. I doesn't even like half doses so I should have known better. I don't know how familiar vet is with Lantus. Smokey doesn't really fit with either protocol so we were doing a mix of both. I have been pushing to get him more regulated. Vet is happy if he is in the low 300's. I'm not. But he is willing to work with me. I had to demand changing insulins. When i brought some and went in with it, is when he agreed to help me. I think he is learning with me. The other vet won't work with me. I guess we have to go more gently with Smokey. He is 17 and been through the ringer this past year.
Click to expand...
Hi. I have a Smokey who's a sugarbaby too. He's 13 and I'm trying to regulate him as well. I'm learning to trust the board over my vet. Not that I think my vet is bad... It was just brought up to me that he may not be familiar with how some things work. So far the members of the board have been very helpful!
Hoping all goes well for you and Smokey!
 
It's completely up to you, but the people who really need SLGS are those who can't test enough, or if their cat eats dry food.

The huge advantage of Tight Reg is that you can adjust the dose as often as every 3rd day. Holding a dose for a week when you can see (because you test frequently) that it's clearly not enough insulin can feel like torture. Who wants to watch their cat be in high numbers for an entire week? Because of that, I'd encourage you to choose Tight Reg - you can always wait to increase if your schedule (or your life) needs it. It's obvious from his spreadsheet that you're able to test more than enough for tight reg. I think it has a lot more flexibility.

Don't worry if it doesn't all make sense yet - you're getting a good handle on things.
 
It doesn't make sense yet. I'm still reading both of them over and over. There are aspects of both I like and don't like.
 
To add on to Sienne's description about the depot - I think it's helpful to think of it sort of like timed release meds. Once the depot is in the body, it continuously gives out. Yesterday you gave Smokey 2.0u both morning and evening. This morning you reduced the dose to 1.75u - the depot from the 2.0u is larger than the depot that will exist at 1.75u, so that 2.0u depot will continue giving out at the same rate for as many as 6 cycles after you reduce the dose. By the time 6 cycles are passed, the depot will have reduced to be commensurate with the 1.75u dose. The effect from the 2.0u depot would be greatest soon after you reduced, and would lessen as you got farther away from the 2.0u shot. Not sure if I'm explaining that well, but perhaps you get it.

The practical implications of that are that if Smokey had gotten into the 50's again this morning after you reduced the dose, we'd probably have "blamed" today's 50's on the depot from the 2.0u and suggested that you might want to still hold the dose at 1.75u while the depot adjusted. If he gets to 50 on the 5th cycle after you reduced him to 1.75u, then I'd assume he was reacting to the 1.75u dose and probably needed a dose decrease again.

Another factor that can be at play is that absorption rates can vary from one shot to the next by as much as 50%. Meaning that you can keep giving the same dose, but the response in the body can vary because it can absorb more or less from one shot to the next.
 
April and Smokey said:
Hi. I have a Smokey who's a sugarbaby too. He's 13 and I'm trying to regulate him as well. I'm learning to trust the board over my vet. Not that I think my vet is bad... It was just brought up to me that he may not be familiar with how some things work. So far the members of the board have been very helpful!
Hoping all goes well for you and Smokey!
Click to expand...

Hi, your baby is a handsome fellow. Maybe it's the name, think is we change it they won't be a member of the sugar babies? LOL.
 
julie & punkin (ga) said:
To add on to Sienne's description about the depot - I think it's helpful to think of it sort of like timed release meds. Once the depot is in the body, it continuously gives out. Yesterday you gave Smokey 2.0u both morning and evening. This morning you reduced the dose to 1.75u - the depot from the 2.0u is larger than the depot that will exist at 1.75u, so that 2.0u depot will continue giving out at the same rate for as many as 6 cycles after you reduce the dose. By the time 6 cycles are passed, the depot will have reduced to be commensurate with the 1.75u dose. The effect from the 2.0u depot would be greatest soon after you reduced, and would lessen as you got farther away from the 2.0u shot. Not sure if I'm explaining that well, but perhaps you get it.

The practical implications of that are that if Smokey had gotten into the 50's again this morning after you reduced the dose, we'd probably have "blamed" today's 50's on the depot from the 2.0u and suggested that you might want to still hold the dose at 1.75u while the depot adjusted. If he gets to 50 on the 5th cycle after you reduced him to 1.75u, then I'd assume he was reacting to the 1.75u dose and probably needed a dose decrease again.

Another factor that can be at play is that absorption rates can vary from one shot to the next by as much as 50%. Meaning that you can keep giving the same dose, but the response in the body can vary because it can absorb more or less from one shot to the next.
Click to expand...

Very good explanation. I see how it works now. Thanks. Maybe it should be a sticky for others starting with Lantus.
 
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