Lantus..IS 2U TWICE A DAY TO START TOO MUCH?

had vet visit Friday and he drew blood for a fructosamine test. During that visit we told him we wanted to switch from Humulin N to Lantus. He asked if we would wait until he got the test results thereby giving him time to research Lantus as he was not familiar with it. Since we didn't want to make any changes on Friday because we didn't want to have complications on a weekend we agreed. He called this morning with the results and said he did a lot of research on Lantus and called a University. He concluded Lantus was the best way to go and actually was happy saying "you learn something new every day." He wants us to start out with 2U twice a day of Lantus. I asked why so high and he said the recommended dose is 1/4U per Kilo and PurrFace weighs 12.8 pounds. Is this too high a dose? I'm concerned since Lantus has a depot and I don't want to give him too much. His average BG from the fructosamine test was 489. We're starting him on Lantus tomorrow. He said everything else looked real good. Thank you all in advance for your input and I apologize for being so long winded.

First things first! You are quite right to question the starting dose. It is so much easier to raise the dose if its not adequate than it is to take the insulin back out of the cat once you inject it. I think that most experienced people on this board would say that starting with one unit twice a day would be the safe route.

This brings me to the second point, and this is actually the first thing. I did not see any data from home testing in your post. Are you testing at home? If not, this is really the first thing to do. You'll need to purchase a glucometer, test strips, lancets for poking the ear to get a drop of blood, and to be on the really safe side some test strips for testing ketones in urine. Let me find the link to the supply list that another member posts. BRB

Yes 2u of Lantus is a high dose for a newly DX kitty. We recommend starting at 1u or even .5u but make sure your prescription is for the PENS not a vial. Greater upfront cost but they last a whole lot longer. The weight thing is more for dogs is some respect.

Other things to do-
The correct FOOD-
https://docs.google.com/spreadsheet/ccc ... hYXc#gid=0 (called Hobo's List)
http://binkyspage.tripod.com/canfood.html (called binky's list)
And a new list out today from Dr. Lisa but I don't have that one marked yet (sorry) :sad:

You want to look for canned food that is low carb. The two lists above are ones that we use- look for the %kcal/carbs- under 10 (5 is better) in both lists. Feed the best you can afford. Most do Fancy Feast, Friskies, 9-lives. This will also help with the UTI- dry food is, well, dry. Canned food has more moisture and when you add water to it the water content is increased- all the better to pee a lot. You do NOT need vet prescription food- it is overpriced, high carbs, and contains high quantities of liver- which most cats won't eat day in and day out. If you bought some just take it back and say your kitty stopped eating it. They should refund even if it is opened. You also should consider feeding several small meals throughout the day. Not only is a diabetic cat losing weight- the reason is because they are literally starving, unable to get the nutrients out of the food they are eating. Give more food in small meals and your cat will slow down once they start getting the nutrients out.

Home testing-
You need to get a glucometer to test your cat- a human one is fine and reliable to use. It reads different than the pet ones but all you really need is the consistency of the levels day in and day out. You might be able to get a free one- there is a spot just at the top of every page that says home testing kits. Here is a link to what's inside:
http://felinediabetes.com/FDMB/viewtopi ... 28&t=60261

If you purchase one here is a list from Consumer Reports:
http://felinediabetes.com/FDMB/viewtopi ... 28&t=70140

You need to look at the ones that have the cheapest strips- not the cheapest meter. The meter you will buy once, the strips you will continue to purchase over and over again. A lot of people on the board use the Relion micro/confirm meters from Wal-mart because the strips are the cheapest around- $.36 each and usually easy to get (and you can get the strips even cheaper online through the ADW site). Bayer is another popular one. Be cautious of the generic kinds that have the word TRUE in the name- those have been shown to be inaccurate at higher #'s or don't go above 299- and another bad one is the Freestyle Light with the butterfly on the strips- both of these have led many pet owners to believe their cats were okay when they were really in trouble. And you can do your own curves at home when you hometest- that is cheaper than doing it at the vet.

To keep up with the BG #'s there is a spread sheet (SS) that we link to our signature line. Here is the link to set up:
http://felinediabetes.com/FDMB/viewtopi ... =6&t=18207

Incidentals-
- I would suggest getting ketosticks (found in the diabetic supply aisle) to test your kitty for ketones that lead to DKA- this is a very serious and deadly (and EXPENSIVE) illness. For $7 you get 50 strips- the best insurance against ketones possible. If you catch it early the easier it is to treat.
- Lancets- for your first box go for the lowest gauge you can find- 26 or 28. His ears won't bleed that much at the start. There are so many u-tube videos out there that can show you how to test the ear. You can either use the lancet pen or free-hand. I free-hand as I feel like I have more control over the pointy end. After the first box is used up you can switch to 31 gauge.
- TREATS! In the videos you see the cats eager to be tested. That is because they are shamelessly bribed into sitting still because of a yummy treat that is given after testing. Freeze-dried chicken, beef, shrimp are no carb treats and there are others out there that get used as well. Give this treat ONLY a poke time- tests or shots. Your cat might not care for treats, mine never did.

This is a lot to take in at one time, while I am sorry you had to find us you will find that we are a very resourceful site to know.

Heather

Wow you guys are GOOD and fast!

Frosty...WELCOME to the BEST site on the planet to help YOU help your kitty!
There is a WEALTH of information here from people that live and breathe feline diabetes. The learning curve is kinda high but so rewarding. Again WELCOME.
jeanne

Thank you all for your input, we really appreciate it. He has been on Humulin N for about 4 weeks and I did "SOME" home testing, not every 2 hours or so as I'm finding this board recommends. His BG was always lowest about 5-6 hours after the shot...in the 265-300 range and then really go up after nine hours to 455 to 500. It was actually the results of this limited testing that convinced our vet to do his research on Lantus. He just called 5 minutes ago and said he called the pharmacy and discussed Lantus with the pharmacist concerning the vital vs pen. He said my research was right (FDMB info) and that it was the first time he heard that ANY vial of human insulin should be discarded after 30 days. I was using a size 30 lancers to test but found it hard to get blood. I will buy some of the 26 size today when I pick up the Lantus. By the way the rice in a sock trick works great. With your permission I'll copy the spreadsheet you posted and begin doing more consistent BG test. When I spoke to the vet this last time he called I asked him again about the dosage and he said he really recommends the 2U twice a day and to bring PurrFace in to see him in 2 weeks. I'm really confused on what to do. He is a great vet and thanked me for insisting he do research on Lantus but I REALLY respect the advice from the FDMB members. I thinking of just starting him on 1U twice a day rather than continue trying to convince the vet. If he suggest increasing the dose at our next visit in two weeks, say to 2.5U or 3U twice a week I would increase it to 1.5U. I really hate to deceive the vet like this but want the best for PurrFace.

Also we are feeding him Fancy Feast Classic basically whenever he wants some. He still seems to be hungry a lot. Our other 2 cats are in the process of getting off of dry food. They were eating iams but we purchased a bag of Wellness Core and are mixing the two. We are going to gradually lower the amount of iams and increasing the Wellness. They are also now getting canned Fancy Feast twice a day and they are starting to look forward to it. Once they are switched over to the Wellness we will increas the amount of canned food until they are eventually on canned food only. I looked for some low carb treats but have not been able to find them locally, any links to them would be appreciated. Thank you again.

To be safe we do the start low, go slow approach. You can't take it out once it is put into the body.

To be honest- a lot of people here don't use their vet to assign dosing b/c a lot of vets are not used to FELINE diabetes but CANINE diabetes and they are two different monsters under the bed. They get advice from us and we look at the spreadsheet and base it on the information you put on there. Hey- they don't want to see Frosty (?) for two weeks so that gives you at least a week to get numbers under your belt and some advice before you need to take him in. And I wouldn't spend money for the fructo(??) test as you will be testing (YAY!!!) at home and know EXACTLY what he was doing the last two weeks. Why waste money when it will tell you what his average was over the last two weeks? us it for food :lol: .

What is his current dose on Humulin? The response you got is understandable- Hum is out by 8 hours so the poor cat just gets higher and higher unless you dose on an 8/8/8 schedule which is hard for working people to do . Lantus is more like 14 hours and is slow acting so as the old dose is going the new dose is rising.

Everyone uses the template- it is really easy and we all can understand it. And it has such purty colors! People either print them out and take them to the vet to look at or email the link to the vet so they can get on when ever you have a question.

The smaller the gauge the larger the hole means more blood will come out.

The 2 hour testing is for a curve and should be done once a month, sometimes twice. Most people manage to get at least 3 tests/day- two pre-shot (PS) tests before shooting and one in between to see how low the kitty goes, more people do more testing- I do 5-7 in a 24 hour period... or at least until school started again and I didn't get so many evening tests :roll: . The upside to more frequent testing is you know what the insulin is doing in the body and the better advice we can give you. If you only do 3 tests we sometimes hesitate to be more aggressive if you don't know what is going on.

Just read your food posts- good choice on the canned and getting the civvies transitioned over. Frosty might be getting some kibble that is keeping his numbers up, too. He will be hungry until he gets regulated. My cat ate 18-20 oz/day until regulation but is down to 8-10/day. Do you have a PetSmart near you? Or a PetCo? Look in the food section for little pouches of freezedried foods that contain only meat. It took me a while to locate them. You can look in the dog food section as well and just cut the treats in half.

Hmjohnston. Thank you. They just opened a petstore here so I'm going there now. I'll pick up some 26 gauge lancets also. I'll be getting the SoloPen refills and drawing from them.

JT & Trouble & Just-as-apply thank you both for your input as well. I'm getting the larger lancets and treats and will start the spreadsheet tomorrow. Thank you again.

Frosty said:

I asked why so high and he said the recommended dose is 1/4U per Kilo and PurrFace weighs 12.8 pounds.

Click to expand...

I am confused. Your vet is correct the recommended starting dose for Lantus is .25u per kilogram of ideal weight. However, I have no idea where he got 2u as a starting dose from that formula? Assuming that 12.8 lbs is PurrFaces ideal weight and not just his actual weight, then 12.8 lbs =5.8 kg, and 5.8 x .25u = 1.4u, which I would round down to 1u, since it's a little tricky measuring 1.25u to start. Most cats on a low carb, canned diet never need much more than 1u.

I think your vet got his math wrong when calculating the starting dose?

If PurrFace is overweight, then you need go by what he should weigh, not what he weighs now. If he's underweight, then we do recommend using his actual weight.

Frosty said:

The has been on Humulin N for about 4 weeks and I did "SOME" home testing, not every 2 hours or so as I'm finding this board recommends.

Click to expand...

We recommend that you do a curve (every 2 hrs for a 12 hr cycle) once a week, not every day. Curves are important because they show you how your cat is reacting to the insulin dose for an entire cycle.

With Lantus, you want to test at least 3 times a day--once before each shot to make sure it's safe to give insulin, and a test about half way through one of the cycles to see how the insulin is working. That daily mid-cycle test is very important because that is the number you will use to adjust the dose. With Lantus, doses are adjusted based on the nadir, or the lowest number of the cycle, and not the preshots.

Of course, if you can manage a few more daily tests when you can that is great because more tests=more data, and data allows you to make more educated dosing decisions, but three is the minimum we recommend to get the best results from Lantus.

Frosty said:

I asked him again about the dosage and he said he really recommends the 2U twice a day and to bring PurrFace in to see him in 2 weeks. I'm really confused on what to do. He is a great vet and thanked me for insisting he do research on Lantus but I REALLY respect the advice from the FDMB members. I thinking of just starting him on 1U twice a day rather than continue trying to convince the vet. If he suggest increasing the dose at our next visit in two weeks, say to 2.5U or 3U twice a week I would increase it to 1.5U. I really hate to deceive the vet like this but want the best for PurrFace.

Click to expand...

I would ask your vet if the starting dose recommendation (found here) is .25u per kg of the cat's weight like he told you, then why is he telling you to start at 2u? I think this is just an oversight on his part, where he just didn't do his math quite right. However, considering that your vet has no experience with dosing Lantus, I would recommend you set up a spreadsheet and head over to the Lantus forum and get your dosing advice there instead: http://felinediabetes.com/FDMB/viewforum.php?f=9. You don't just want to raise the dose by .5u because that is often too big of an increase, as dose adjustments with Lantus are made every 3-7 days in .25u to .5u increments based on your daily nadir numbers. You risk missing your cat's ideal dose if you do that, and shooting over the dose your cat needs can keep his numbers just as high as too little insulin. This is why those daily nadir numbers are so important--you have no idea if the dose is too much or too little unless you're getting mid-cycle numbers each day.

I would print out the dosing protocol that I linked above and give it to your vet. It is possible he's looking at an old or outdated dosing protocol for Lantus. Personally, I would not feel comfortable getting dosing recommendations from him since he wasn't careful enough to get the math right on the starting dose. Here's a more user friendly explanation of the the dosing protocol if you're interested in learning and understanding it yourself, which I would highly recommend: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581. The people here are great and willing to guide you and answer any questions you might have about it.

Unfortunately, many vets are unfamiliar with how to properly dose Lantus. My vet was fantastic in that she put Bandit on Lantus, told me I needed to home test, and gave me a list of low carb, commercial canned cat foods, but her dosing advice with the Lantus was completely wrong. So I got dosing advice here, instead.

Hi,

I'll share my experience. I started out with 2u of Lantus for my cat, and it did not go well. After 7 months, and by using this site and following the advice I got here, my cat finally got good BG readings. Why did it take so long? The people on this site with the most experience think it was because we started out with a dose too high, and Max developed what is called "glucose toxicity" from getting too much insulin. In order to "break" the toxicity pattern, you have to raise the dose up even higher than you would have if you had started with the "Start Low Go Slow" approach. Then, the cat's insulin needs greatly decrease once the breakthrough dose is reached. (Also, I decreased the dose slowly first before raising it, and then raised it again to get to the breakthrough point. There was no way to know for sure, from my point of view, which way to go, and I thought going down was worth a shot. In my case, it took longer because of that, too.)

I hate to see other people go through what I did. I trusted my vet, gave my cat 2u, and didn't even know I could test his BG for a month! (Another thing I see on this site, too often, is a person doing exactly what I did, and the cat dies from a hypoglycemic event. So sad. I'm really glad you are testing! That could have happened to Max one day, but by then I was testing, and I caught the low number and fed him high carb food to get his BG back up.)

It is very, very hard in the beginning to hear your vet tell you one thing, and the "crazy cat people" on the internet tell you another. What I would like to share with you is that there is no harm at all in starting low and raising the dose carefully and by small amounts as long as you have Ketosticks* and are dipping them in the cat's fresh urine to check for ketones on a regular basis -- about once a day or more if you like. Cats are very resilient to high BG, (dogs are not) and it is much safer with an insulin that forms a shed to start out low. If you look at Max's spreadsheet you will see how long he was in high BGs -- months! Today, he is absolutely healthy -- his neuropathy is gone, his BG is normal, his purr is strong, and he feels great.

Ketosticks are available at any pharmacy, and are very inexpensive. It is very, very important that you use them while your cat's BG is up there above 300 or 400. You need fresh urine, and some people use (non-biodegradable) BB gun pellets or aquarium gravel for litter or there are special cat litter boxes to help you catch urine. I tried the BB gun pellets, and then I put a baby monitor next to the box so that I knew when he was going. Eventually, I just put a soup ladle under his little butt when he peed. (The look you get from your cat when you do this is priceless!) Follow the instructions on the Ketosticks vial exactly, of course. You do have to get a good baby monitor as the cheap ones pick up too much interference from your electronic devices. Try Craigslist or a baby resale shop.

Good luck!

EDITED: P.S. This is the Tight Regulation dosing protocol: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581 and this is the Start Low, Go Slow: http://felinediabetes.com/start-low-go-slow.htm I recommend using the Start Low, Go Slow first and then transitioning over to the Tight Regulation if you are able to. It takes a certain amount of time and the ability to be with the cat more hours in the day to use TR, in my experience. There are people who have found a way to make it work no matter what, and they will help you in the TR forum. Either way, I found that posting in the Tight Regulation forum is where I got the most advice, and if you are clear that you are not yet on TR, you will get advice for SLGS, too.

Oh, if your cat's BG is in the 50s, start testing every 30 minutes to watch for hypo. The idea is to PREVENT the hypo all together. Fifty (on a human meter) is not a hypo reading, nor is 40, but we prevent it from happening by using this procedure, and there is also a procedure for actual hypo. See below.

Here's a link for what to do about Hypo's: http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=15887 Most of us print it out and stick it to the fridge.

You should also have a hypo kit:
1. At least 15 test strips, preferably 20, set aside for hypo prevention
2. Meter, maybe an extra battery for the meter (I have two meters)
3. Karo syrup or honey or pancake syrup
4. High carb food -- see the lists others have posted for you for food with 10% or higher carbs.
5. An oral syringe -- this is not for giving food or syrup if the cat is groggy or passed out! That's dangerous. It is for putting the syrup in that place where the sun don't shine. If the cat is passed out or has seizures, rub the Karo on his gums, put it in his bottom, too and get to the vet asap. Keep rubbing Karo on his gums on the way there. Take the hypo kit with you.

Post for help when the cat's BG is below 59 or 55 or so, and someone will sit with you through the entire event until your cat's BG is in a safe range. The people on this board are so generous! You will get the moral support and step by step instructions when you are panicking that you need to keep your furball safe!

Here's another bit of info that you might need to know about food: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=79899&p=863252#p863252. I have been feeding Max Wellness canned for months and months. I hope it turns out that Wellness is okay, but I'm going to switch now.

If it were me, I wouldn't lie to the vet, it will only make his dosing advice invalid over the long term and possibly lead to him giving bad advice to his next patient. I'd give or send him the spreadsheet, and if he questions the dose, well...it is your cat, you're the one administering the insulin, and you weren't comfortable starting with the higher dose. Based on your research, 1U was the recommended starting dose for a cat your size. I don't think you need to lie or defend yourself. All any doctor/vet can do is advise us on home care, they can't make us take the advice.

I took Scout in for her diagnosis but she never had to go back after that - not for the diabetes anyway. No need to do a curve or fructosamine at the vet if you're testing at home.

Good luck, and scritches for Frosty.

Lori

Julie & Bandit PurrFace actual weight now is 12.8 pounds. His weight prior to being diagnosed was 17 pounds but he was over weight. I just did a pre PM shot test and he was 276 so I'm going to stay with the 1U at least a week and see how he does. Thank you for your input.

Lori&Scout. We had decided, shortly after I posted that, to just tell the vet we were giving a lower dose. We just couldn't bring ourselves to not be truthful and we also thought that since this his first sugarcat on Lantus he needed all the FACTS. At first he was not receptive to deviating from his "normal" treatment using Humulin N but we really pushed the issue and asked him to please research Lantus. That was a Friday and early Monday morning he called to say. He did his research and that "you learn something new every day and was actually excited to prescribe the Lantus. He also told me to continue home testing when earlier he said it wasn't necessary. Thank you so much for your input, it is appreciated.

Max&emmasmommie. Thank you for the wealth of information and links you gave me. I've read the SLGS article and will print it along with the hyper treatment. After reading about your experience starting with 2U twice a day I'm glad we are starting PurrFace with just one unit. I started a spreadsheet and thanks to and earlier post by a member managed to get the link to it in my signature. So far his numbers are looking ok to me, especially when compared to when he was on Humulin N. I only tested him once so far today but will do one more at +4 - +5. If you have time to look over his numbers your interpretations would be welcomed. Thank you again.

Hi, there are a lot of people here who could look at your numbers after a few days of testing and tell you how it's going on 1u. I would love to help you, but I'm not very experienced myself. I have had only Max on Lantus, and although I got very good results, I don't have the years of experience looking at spreadsheets and seeing all the nuances that some do. There were some people here who predicted Max's turnaround right before it happened! The good news is that you are in very good hands. Some people have been here for 4 or 5 years! This is their passion, and they work with animals in various other ways, too.

Please make sure to keep checking back on that link about the Wellness cat food. I hope it turns out to be a false alarm. Wellness is the only food, on the old list at least, that I can buy in large cans. :sad:

I'm happy to hear that you think your kitty's numbers are looking better all ready. Lantus is much better for cats than Humulin N, I believe.

***Oh, by the way, it is very important to test your cat right before you give a shot.*** When the Lantus starts to work very well, and we never know when that will be, there is a danger in shooting when the number is at 150 or below UNTIL you have gathered enough data (BG tests over a period of days or weeks) to know how your cat is responding.

Lantus works on the shed, and as the shed fills, it works better and better, sometimes too well. The cat's BG will start dropping about 2 hours after the shot, and it may keep dropping for another 6 hours. Other cats' BGs stop dropping at hour 3 or 4 and either level out (surf -- this was Max) or start slowly creeping back up. If the shed is overflowing, the cat's BG will be way too low at hour 2 and may stay there for hours. That is dangerous, of course.

When you see a pre-shot number near 150, don't feed the cat just yet. Post a question mark in your headline or use the icon button for "?." You can say "Urgent" or "Low Pre-Shot Help" if you like. Someone will come along, look at your numbers and help you figure out whether you have enough data to give a shot when your cat is testing at 149 or lower at shot time, and that person will also help you determine when you can feed and shoot. (If you feed first the food will make the BG go up for about the next 2 hours, and you will just have to skip the shot for that cycle, in most cases.)

MUY IMPORTANTE: If no one is around to help you and you have to leave the house, don't give the shot. Post the question, feed the cat, go to work or whatever, and get your answers to the question later to use for the next time you see a low pre-shot number.

The way this board works is that you post your numbers on your spreadsheet and every day (that you can) in TR with a headline like this "9/26 Max AMPS 156 +2 100 +6 97 +10 140 PMPS 149" for example. PMPS means p.m. pre-shot" & AMPS means "a.m. pre-shot." (We use +1, +2 -- meaning one hour after the shot, two hours after the shot, etc., so that people in other time zones don't have to know your time zone or do any math to determine where your cat was in the 12 hour Lantus cycle when that particular BG number was taken.) When you are starting to use Lantus, giving a shot at that AMPS number of 156 would be okay, for most cats, but the PMPS would be questionable. The other numbers in between are there to show how the Lantus worked throughout the day, and they are in the headline, of course, only if you took tests at all those times of day. Some days you won't; some days you will.

The more you can test at +1, +2, +6 and +10 or +11, the faster you will become "data ready" to shoot lower numbers at shot time. You can also test at other times, too, to be thorough. You want a scattering of these times across your spreadsheet; You don't have to do all 5 tests in one day, unless you want to, and there is no rush that justifies doing all of them every single day for most cats. If you can't get this information during the day, you can set your alarm and do it at night. It is advisable to do some testing at night anyway as the numbers can be different at night than during the day for some cats. It would be very good to get a +6 every night at the very least. Take your time, learn how to test, learn how to feed the cat and when, learn about your cat and how he uses Lantus in his body, and gather this information as quickly as you can without getting too overwhelmed.

In time you will be giving shots when his BG is below 100 without even asking for advice, and testing him up to 4 times a day or more. Until then, rely on the people here to help you.

If you post for help on dose, eventually, someone will see on your spreadsheet enough lower numbers in the middle of the cycle to advise you to reduce the dose or raise the dose or that person might tell you you need to test more at this time or that time in the cycle. Of course, you can use the protocol just fine on your own if the answer is clear, but this board is for support, and it is so nice to have others with which to bounce your ideas and concerns back and forth. The use of Lantus has a very steep learning curve, and it's too hard, in my opinion, to learn enough fast enough to do this on your own.

Dale thank you again for your input. I was able to test him several times two days ago but only twice yesterday. Today I got the AMPS # but wasn't home until recently. I will test him at PMPS and one more time tonight. I tried a test about an hour ago but after 3 sticks could not get any blood. This the first time for a failed test. After the 3rd stick PurrFace was not sticking around for any more. I was using 31guage lancets but switched to 26 gauge when starting Lantus. The bigger needle brings a nice drop of blood but PurrFace twitches when I stick him, he didn't on the 31 gauge but they didn't draw enough blood. Thank you again I really appreciate support.