Need dosing advice.

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Ginger Cat, Jul 20, 2020.

  1. Ginger Cat

    Ginger Cat Member

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    Nov 2, 2017
    Recently switched from ProZinc to Lantus and today's numbers have been great, but I'm not sure how much to dose him tonight. He had nadir in the 80-90 range and just tested at 138. Going to feed him now and he gets his insulin at 1/2 hour (9 pm Daylight Savings Time).

    Should I reduce his dosage back down to 1.5 from the 2 units???

    thanks,

    Gita (Ginger Cat)
     
  2. tiffmaxee

    tiffmaxee Well-Known Member

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    Nov 15, 2013
    It depends on your dosing method which I don’t see.
     
  3. Ginger Cat

    Ginger Cat Member

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    I think I'm doing the TR, but I just switched him to Lantus on the 14th. Started at 1 unit, upped to 1.5 for a day and now up to 2 units. He'd been on ProZinc for about 2 years (and was on Lantus prior to that for a short time). With the ProZinc, I felt comfortable shooting him when he was low, but it's been a while and I'm not sure about the Lantus and how much he could drop overnight on the 2 units... He is eating now so I know his BG will go up.
     
  4. tiffmaxee

    tiffmaxee Well-Known Member

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    It’s impossible to know for sure. A +3 is a good indicator as to whether you will need to test more. If TR I would shoot the regular dose provided you can monitor if needed.
     
  5. Ginger Cat

    Ginger Cat Member

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    I can definitely monitor him and take a +2/+3 reading. Thanks for the advice.
     
  6. Ginger Cat

    Ginger Cat Member

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    I read through the SLGS and TR protocols again and actually think I'm doing the SLGS. I gave him a scant 2 units and will watch him like a hawk.
     
  7. tiffmaxee

    tiffmaxee Well-Known Member

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    Would you please take down the 911? That way if you need it later folks looking will know it’s for real. Post the +3 and ask for help by changing the subject and/or adding the ? prefix if you need help deciding if more tests are needed.
     
  8. Ginger Cat

    Ginger Cat Member

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    Done. And thanks for suggesting this. Even though I've been dealing with my cat's diabetes for over 3 years, I haven't posted much so I appreciate the tips.
     
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  9. tiffmaxee

    tiffmaxee Well-Known Member

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    I hope you will start posting daily. It helps!
     
  10. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Hello and welcome.

    For a cat new to Lantus, you hold the initial dose 5-7 days to fill the depot. If on SLGS, that's 7 days. If you are going to follow SLGS, could you put "SLGS" on your signature. It'll help us help you better. With SLGS, all doses are held 7 days, and you only increase if nadir are above 150. Or decrease if they go under 90, which Wally did today. Your new dose should be 1.75 units.
     
  11. Ginger Cat

    Ginger Cat Member

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    I just checked his BG +2 and he was down to 69 so I fed him some more FF. I gave him a scant 2 units tonight. I'll check again in 30 minutes or so and continue to monitor him tonight.
     
  12. Ginger Cat

    Ginger Cat Member

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    I do update his spreadsheet every day.
     
  13. tiffmaxee

    tiffmaxee Well-Known Member

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    I thought you were following TR. . I missed that you decided on SLFS but I think that was after you shot. If he drops lower you will want to give some hi carb. If he stays around the same id give some middle carb food.
     
  14. Ginger Cat

    Ginger Cat Member

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    I just checked him again and he dropped to 57 so I gave a pinch of karo syrup and some Friskies gravy chunks with more gravy than chunks. Will continue to monitor.
     
  15. tiffmaxee

    tiffmaxee Well-Known Member

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    Check in 30.
     
  16. Ginger Cat

    Ginger Cat Member

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    I checked him at +3.5 and he was only up to 62 so I gave him a pinch more karo syrup, gravy friskies. Will check again in 30.
     
  17. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    With that 57 on the AT this early, you are going to be potentially busy for a while. He really wants that reduction!
     
  18. Ginger Cat

    Ginger Cat Member

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    Checked him at 12:45 am and he's up to 100! Finally...
     
  19. Ginger Cat

    Ginger Cat Member

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    So - starting tomorrow morning I reduce his dosage to 1.75 units or as close as I can get given the 1/2 unit marks...
     
  20. tiffmaxee

    tiffmaxee Well-Known Member

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  21. Ginger Cat

    Ginger Cat Member

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    Thanks to everyone for your help yesterday/this a.m. I took a reading at 5:30 a.m. and he was up to 429. Then his AMPS was 661 so I immediately took another reading and it was 596. Not surprising given the high carb food he got. Gave him 1.75 u this morning. He ate about 1/2 his normal amount of food but I'm sure he'll finish later.

    Does anyone who uses calipers also use the CarePoint syringes and could tell me what the measurement is for 1 unit? I read through the dosing with calipers doc and that brand isn't mentioned.
     
  22. Ginger Cat

    Ginger Cat Member

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    He's done it again. Low nadir and continued low numbers (despite eating more FF and some Zero Carb Dry) although he's now FINALLY up to 100. Just wondering how much I should reduce his dose tonight or should I skip it. Looking at the SLGS info, it seems like it would be .25 so I'd bring him down to 1.5. Would like any input. It's 5:21 pm Eastern Daylight Savings Time and he gets his shot at 9 p.m.
     
  23. tiffmaxee

    tiffmaxee Well-Known Member

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    As long as he’s over 150 you can shoot 1.25 tonight. That’s his new dose. If not, don’t feed and recheck in 20 minutes and post for help.
     
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  24. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    A lot of things can happen before 9:30 so it's really too early to say what you should do at shot time. What you might want to do is get a +11.5 so you have 30 minutes to ask for help if he's not a lot higher by then.

    Just for the future...if you get a PS under 150, you should stall, don't feed and test again in 20-30 minutes. Use that time to post and make sure you have a subject line that stands out (like "STALLING! NEED HELP!!"..lol) Once you get some help, you can go back and edit it.

    The reason to stall is to see if the number is going to go up without the influence of food...if it does, that's a good indication that the last shot is starting to wear off and it'll be OK to go ahead and shoot the scheduled dose.

    It's also a good idea that IF you shoot a lower number than you're used to that you get a +1 and +2 so you can intervene early if it's necessary
     
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  25. Ginger Cat

    Ginger Cat Member

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    Thanks, Chris. I do usually test at +11.5 (8:30 am/pm) so this works out just fine. I'm going to test him again in about an hour+ to see if he's continuing to go up without food influencing him.
     
  26. Ginger Cat

    Ginger Cat Member

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    Just tested him (7:17 pm EDT) and he's up to 292 so I'm feeling much better. But - I should still reduce his dose to 1.25 units vs. 1.5 units? He's been on 1.75 for a while...

    Just tested him +11.5 and he's up to 407.

    Gave him 1.25+ as it's almost impossible to measure out 1/4 doses accurately.
     
    Last edited: Jul 31, 2020
  27. tiffmaxee

    tiffmaxee Well-Known Member

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    Take him down .25
     
  28. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    You actually have two choices....He did earn a reduction today by dropping below 90 but you can shoot the 1.75 ONE more time to help with the bounce. We call it "shooting through the bounce" and then tomorrow morning you'd go down to 1.5. The extra just one more time can help him recover from the bounce a little faster.

    Or you could go ahead and reduce to 1.5 now.

    It's totally up to you!

    One thing though....you really need to get back in the habit of testing at least "before bed" on the PM cycle. Without PM testing, you're missing half the data. You don't have to stay up all night testing, but getting a +2 and a "before bed" (if you can since I don't know how late you stay up) will help.
     
  29. Ginger Cat

    Ginger Cat Member

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  30. Ginger Cat

    Ginger Cat Member

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    Just saw your postings come through - after I'd given him his shot. As I said, it was between 1.25 and 1.5. I usually go to bed around 11 pm so I could do a +2.
     
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  31. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    It's best to stick to .25 unit changes. He earned the reduction from 1.75 down to 1.5 today so that should be his new dose until he either earns another reduction or needs to go back up to 1.75.

    Those really precise doses (like between 1.25 and 1.5) we save for when we're really close to "dialing in" a good dose.

    Example....the 1.5 doesn't end up being enough so you go back to 1.75 which again drops him too low. If that happened several times close together, we might suggest doing a "fat" 1.5 or a "skinny" 1.75
     
  32. Ginger Cat

    Ginger Cat Member

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    Thanks. When I read through the SLGS instructions I thought the .25 reduction was called for and then another person said to go down .5 so it was a bit confusing. I'll see how he does over the next couple of days at 1.5.
     
  33. Ginger Cat

    Ginger Cat Member

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    Looks like Wally is going to go through another hypo episode today, similar to last week. Will keep checking his BG, giving food, karo syrup (if necessary) and will reduce his PM dose to 1.25 units. This boy keeps me on my toes, for sure.

    +5.5 = 61. Gave a little more Karo syrup, friskies and fancy feast. He's acting a bit more alert. Will continue to check.
    +6 = 67
    +6.75 = 84
     
    Last edited: Aug 6, 2020
  34. Ginger Cat

    Ginger Cat Member

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    At + 8.5 = 130! Just wondering, depending upon how he tests PMPS if I should skip tonight or just reduce by .25 units?
     
  35. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    Lots of time before PMPS but you're in the same situation you were last time.

    You actually have two choices....He did earn a reduction today by dropping below 90 but you can shoot the 1.5 ONE more time to help with the bounce. We call it "shooting through the bounce" and then tomorrow morning you'd go down to 1.25.

    The extra just one more time can help him recover from the bounce a little faster. If he were to bounce above 300 by PMPS, giving the 1.5 dose just one more time would (hopefully) help resolve the bounce a little sooner or keep him from continuing to go up even higher.

    Or you could go ahead and reduce to 1.25 tonight and that would be his new dose until he either earned another reduction or we decide he failed the reduction and needs to go back up.

    It's totally up to you!

    Keep trying to remember to always get at least 1 test on the PM cycle.

    On 8/4, he dropped from 530 to 342 in just 2 hours.....that would have been a really good time to get at least 1 more test later in the cycle (even if it meant setting an alarm to wake you up).

    If you get a lower number at +2 than you did at the Pre-shot, that's your "Early warning" the he might be dropping a lot lower later in the cycle.

    ETA....in this forum, we suggest starting a new thread every day. If you just keep adding to an old thread, they tend to get too long for people to keep track of. Just start a new one each day and put the link to the previous day's thread in the body of the post. That makes it easy for people to go back and see what's been going on
     
  36. Ginger Cat

    Ginger Cat Member

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    Thanks so much for this great advice. I'll let you know what happens tonight...
     
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  37. Ginger Cat

    Ginger Cat Member

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    He just tested 301 PMPS so I will give 1.5 u tonight and then start him at 1.25 u BID tomorrow.
    Of course, he didn't want to eat but he ate enough to get his shot. I gave him a 1/4 tab of mirtazapine as his appetite has been off since yesterday.
     
    Last edited: Aug 6, 2020
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  38. Ginger Cat

    Ginger Cat Member

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    He's up to 457 +2, eating more food, but acting weird. Vocalizing and pacing around. He's never had a reaction like this to mirtazapine so I don't know what else is going on.

    I just googled reactions to mirtazpine in cats and what Wally is manifesting seems to go along with what others have experienced...It's going to be a long night ahead.

    todaysveterinarypractice.com/mirtazapine...
    The most common adverse effects reported to the ASPCA Animal Poison Control Center in 84 cats intentionally or accidently exposed to oral mirtazapine included vocalization, agitation, vomiting, abnormal gait/ataxia, restlessness, tremors/trembling, hypersalivation, tachypnea, tachycardia, and lethargy. 6 Onset of clinical signs ranged from 15 minutes to 3 hours after ingestion, and clinical signs resolved in 12 to 48 hours.
     
    Last edited: Aug 6, 2020
  39. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    Yeah, we call it "Meowzapine" because of the crazy vocalizations that usually come with it
     
  40. Ginger Cat

    Ginger Cat Member

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    No kidding. And Wally is already a very vocal kitty. BUT - he's now settled down, on my bed, with his head on the pillow so I don't know if I can even get in bed. He normally does snuggle up next to me every night and literally purrs me to sleep. I'm hoping that if I get into bed, it won't set him off again... And I'm so wired I don't think I could even fall asleep for a while anyway.

    He's had mirtazapine a bunch of times and never had this kind of reaction. I also have the mirataz but it means I have to keep him separated from the other cats for at least 2 hours until it's completely absorbed into his skin. One of my other cats, Sebastian, constantly grooms Wally, especially his ears, so it's a bit of a challenge. But - as my vet said, it would mean that Sebastian would also get the munchies....
     
  41. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    Slide in slowly and just gently stroke him.....hopefully he'll just continue purring and you'll be able to decompress.

    A purring cat has been proving to lower our blood pressure, relieve anxiety and even help heal broken bones!!
     
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  42. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Do you think that next time you could start a new post? Due to the number of kitties here, we ask that people start one new post per day that they post, with a link to the previous post. More details on the conventions on this PSA post.

    If he needs Mirtazapine again, you really might want to try the Mirataz. It is absorbed much more slowly and has a lot lower likelihood of the side effects.
     
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