Ok, I spent some quality time with your spreadsheet and have talked it over with another member just to be sure I’m thinking clearly. Obviously we have an unusual situation, learning tonight that Punkin’s dose has been quite a bit higher than we all realized. Normally when a cat changes to Lantus from another insulin, we suggest a starting dose slightly lower than their last dose of the old insulin. Most of the time they end up needing
more than their dose of their previous insulin, but we start lower so we can work up to the correct dose and be sure. If Punkin’s last Prozinc dose was 4 units and his numbers weren’t great, I probably would have suggested a Lantus starting dose in the neighborhood of 3 units, even knowing that the dose would probably need to be increased from there. You inadvertently started Punkin on 5 units of Lantus, and have since increased to 7.5 units. Anyway, that is water under the bridge and there is no sense in worrying about it now. Let's just figure out where to go from here.
First, can you please update your spreadsheet with the actual doses you have been shooting (the 7.5 units)? You can add a note in the Remarks about what happened so people who look at your spreadsheet in the future don’t question why you were at that high dose. Second, if you haven’t already done so, please stock up on high carb wet food (stuff with gravy, and I would go ahead and get quite a bit of it – for my high dose cat I keep at least six 5.5 ounce cans of Friskies with gravy in the pantry, and more than that would not be a bad idea). Also stock up on test strips and never let yourself run too low on them.
There are a few ways we can go from here.
- 1. You can reduce the dose, maybe to half of this dose, and see if Punkin is able to maintain his great numbers on a lower dose. Pros – you will be more certain that Punkin is safe from hypo because you will be starting at a lower dose and working up to his breakthrough dose systematically, like the rest of the cats here do. You will have more confidence that your dose is safe because you will have worked up to it, instead of working down from a higher dose. And if it turns out that you do have to keep increasing Punkin’s dose and you end up back at 7.5 units or more, at least you will know for sure that he really needs that dose. Cons – Punkin’s spreadsheet actually looks really good at his current dose. Reducing the dose significantly could result in him losing momentum and going back to high numbers. Once the cat starts spending a lot of time in high numbers, sometimes their insulin resistance builds and it takes longer to build back up to a dose that will cause a breakthrough. If Punkin really is a higher dose cat, taking the time to reduce the dose and work upward could possibly result in him needing an even higher dose of insulin to get back to these good numbers again. Also, if you reduce Punkin’s dose this drastically you will need to be diligent about checking his urine for ketones. Has Punkin ever had ketones?
- 2. You can keep the dose where it is and let Punkin earn dose reductions when/if he needs them. If you choose this option, PLEASE promise that you will keep posting in Lantus Land regularly (daily) so we can help keep an eye on Punkin’s numbers. Pros – Punkin will maintain the pretty blue and green numbers he has now. He is currently running mostly below renal threshold and not bouncing too dramatically. It is possible that 7.5 really is a good dose for Punkin, and if so then holding this dose will probably be his fastest path to regulation. Lots of people work very hard to get numbers like these, and you already have them. :smile: Cons – it is also possible that this dose is too high. If so, it is possible that one day Punkin will have a major breakthrough. If his dose is much too high and his number goes low, it could be very difficult for you to keep his numbers up. Where you see other people feeding a tsp. or two of high carb gravy to bring their cat’s number up, if Punkin’s dose is too high he might need a lot more, or he might need karo syrup instead of gravy. You would need to be prepared with lots of high carb, syrup, and test strips just in case you find yourself in that situation. Also, many of our cats go into a phase where their pancreas starts to heal and they start racing down the dosing scale. If Punkin’s dose is too high and then his pancreas starts to heal too, his trip down the dosing scale could be a very, very fast one. It seems from your spreadsheet that you have good availability to test during the day, so this can help you keep Punkin’s numbers under control.
- 3. There are some conditions that cause cats to need higher than usual doses of insulin. Read this link for more information. Usually if we see a cat needing 5-6 units or more of Lantus, we start to think about the possibility of these conditions. That being said, usually the cats in Lantus Land that are on high doses have already worked their way up the dosing ladder according to protocol, so we know they really do need a high dose. With Punkin and the way he arrived at this dose, I’m not yet ready to say “Julie, you need to have Punkin tested for acromegaly and IAA.” If you want to test, though, the tests are relatively inexpensive (except FedEx charges!) and would tell you for sure if this dose might be in the ballpark. When I acquired Jazzy as a foster, she was on 7 units BID of PZI and not responding much. Her dose had not been arrived at systematically, so her situation wasn't really very different than Punkin's, but I went ahead and did the tests anyway just so I would know what I was working with. It gave me a lot of peace of mind, but I know I'm not like most people. :lol:
Whatever you want to do, we’re here to support you. We have helped people through dropping the dose and starting over, we have helped people with cats with acromegaly and IAA, and we have also walked people through the wild ride down the dosing scale. We had one cat who went from 6 units BID to OTJ in a little over a month!
Questions? Concerns? What feels right to you?
or maybe you did - when you said you dropped Jazzy's to 3. I guess i was thinking of the 1 unit that most people start with as a "new" beginning shot.