Jan.10, 2017|Davey|Looking to Begin Using Lantus

Status
Not open for further replies.
Davey's Mom

Davey's Mom

Member Since 2016
Hello!

I joined the feline diabetes message board a bit before XMAS (a little skeptical at first I must admit) but the advice I've gotten so far has done absolute wonders for my cat and I am so grateful!

I took Davey into the vet a few months ago because I took notice of excessive thirst and was told he had diabetes. My vet did not give me the advice and support I needed and when I first reached out to this site he was up to 8 units of caninsulin (which I later found out was an extremely high dose) and was showing no signs of improvement.

He is now on 6 units and doing much better (he hit blues during a couple BG checks yesterday for the first time :)) but it looks like Caninsulin is not going to cut it for him and I would like to switch to Lantus. Recently I have changed him to an all wet low carb diet and this has helped tremendously with his BG. However, I have been given advice that switching to Lantus may help Davey along even further because it doesn't appear his insulin lasts long enough through the 12 hour cycle. I've already discussed this with my vet as well and she has contacted the pharmacy to let them know I'll be there soon to pick up medication.

Question - Given Davey's history and his current caninsulin dose (6 units) what should be my starting dose for Lantus?

Please note I am not home 9 hours a day Mon-Fri so the best time for me to make changes to diet, dosages etc. is on Friday evenings because I can closely monitor through the weekend. I would really like to start using Lantus this weekend if possible.

If interested my original thread I've been using up to today can be found here:
http://www.felinediabetes.com/FDMB/threads/diabetes-initial-treatment-need-advice.170191/page-3#post-1867254

@Critter Mom along with many others have been a great help!

Thank you and if there is further information needed please let me know.
 
Hello and welcome from the west coast of Canada.:bighug: My girl also like bigger doses of insulin and started on Caninsulin too. I still have to read your original post and have asked a few other experienced people to look in too to comment about dose. I'll get back to you later tonight. But I agree that going to either Lantus or Levemir would be a smart move at this point.

In BC and most other provinces, you can buy insulin over the counter without a vet's prescription. Though it's a good idea to get their buy in. You will also need to get the U-100 syringes with 1/2 unit markings. I use the BD Ultrafine II, purple and yellow box. And for Lantus and Levemir, it's a better deal to buy the 5 pack of cartridges instead of the vial. I have a very knowledgeable pharmacist who has a few diabetic kitty clients and she's the one who told me that and started me on the right syringes. :)
 
I'm scared off from the original post, honestly - it's 3 pages long with 212 posts! :eek: But I'm wading through and primarily just reading your posts to try to get a good handle on Davey's story. Please read my comments below and see if I've caught all the essential information about Davey.

Punkin was a high dose cat and honestly, I got the same reaction you have had on Main Health with calls to reduce his dose. We see many cats arrive overdosed, which is why the folks on Main Health have a careful eye out for that. Sometimes a cat is overdosed, sometimes the cat needs more than usual amounts of insulin. When I got here, Punkin was on 3u of Lantus per shot. After someone experienced here looked carefully at his spreadsheet, they gave me some basic information and two different options on how to proceed, along with the rationale for each. I'm going to find that link and let you read it. Here it is: http://www.felinediabetes.com/FDMB/threads/syringes-q-on-u-40-u-100-dosing.38467/

Dry food causes a need for larger insulin as do some medical conditions. Teasing out the situation and figuring out if Davey is overdosed or not will take some figuring out, and we'll ask you lots of questions, lol!

In the meantime, Wendy & I and some others are talking about Davey's situation. For now, just keep going as you are. Getting a ketone test daily is really important.

Are you able to add in more information to the spreadsheet? Specifically, I'd like to see the dose changes with dates, if you can come up with them even approximately. I had the appointments at the vet written down, called them and got the test results and could recreate sort of the basic outline.

I think it's also important if you can add anything about any meds he's taking, any other conditions or symptoms he has - there is a column on the right side of the spreadsheet for that. Sometimes we pick up little comments that are very significant there.

It's also helpful to note whenever you start a new vial or pen of insulin. I added the link to any threads (condos) where I thought the information was important - like that one above about Punkin having the wrong syringes for Lantus and the discussion about how to proceed with his dose.

I've picked up the following from the Main Health thread - do I have it all correct here?

Diagnosed in November 2016
You haven't noticed any difference in his behavior/manner since decreasing from 8u to 6u.
Eating great, more normal thirst (I also read he's laying against his water bowl - which is it now?)
thyroid has been tested - there is a lab tab in the spreadsheet that you can enter lab values in it - that can be really important
looking at the food - you said he ate three 85gr cans = 9ounces US. Punkin used to eat that amount every day - he weighed about 13 pounds, which is a pretty large cat.
Sounds like he's completely not eating dry food now - right? When was the last time he had any? If a cat is very carb sensitive it can take even another day to work out of the system. Do you have dry food for any other pet there? dog food? other cats?​

ah, I love that he purrs while he's eating. Punkin did that too! Nothing like enjoying your food!

You've gotten to the right spot now and will have a good insulin. If I had it to do over again, I'd go with Levemir instead of Lantus, but since your vet was kind enough to order the Lantus, you may want to just start there and see how it goes.

One of us will check back with you and look for your answers. Glad to have you here!
 
Whew, finally got through that first post. Lots of good info and some not so correct stuff in there. First, my Neko got up to 5 units of Caninsulin before I switched to Lantus. We started Lantus back at 1 unit (vet's advice) and that was the wrong thing to do. Turns out she had two high dose conditions (acromegaly and insulin auto antibodies) and ended up almost getting to 9 units of Lantus. Some of the people on your first thread called high dose conditions rare, but that's not true. Recent research shows that one in four diabetic cats has acromegaly. It's a benign tumour on the pituitary that sends out excess growth hormone, which causes the diabetes. We treat cats with this condition the same way as regards their diabetes, but they might need larger doses of insulin to get regulated. It's too early for me to suggest that's what Davey might have.

As far as starting dose on Lantus, I'm still waiting to hear from a few other people. We have until Friday and that'll give us a couple extra days seeing how Davey does with the monitoring you are now doing. Typically we'll consider the size of the dose on the current insulin before switching to Lantus. It was great seeing those blues last night.
 
Hi Guys! Sorry for the delay it's a crazy day with the kids and at work today. I will login later tonight to answer questions :)
 
Thank you for your help so far and sorry to scare you off with the original thread I guess it did get really out of hand haha. Don't feel like you have to review things on there of course. I have no problem explaining things over again on this thread to make it easier. I've typed a whole book below for you guys!

julie & punkin (ga) said:
Are you able to add in more information to the spreadsheet? Specifically, I'd like to see the dose changes with dates, if you can come up with them even approximately. I had the appointments at the vet written down, called them and got the test results and could recreate sort of the basic outline.

I think it's also important if you can add anything about any meds he's taking, any other conditions or symptoms he has - there is a column on the right side of the spreadsheet for that. Sometimes we pick up little comments that are very significant there.

It's also helpful to note whenever you start a new vial or pen of insulin. I added the link to any threads (condos) where I thought the information was important - like that one above about Punkin having the wrong syringes for Lantus and the discussion about how to proceed with his dose.

I've picked up the following from the Main Health thread - do I have it all correct here?

Diagnosed in November 2016
You haven't noticed any difference in his behavior/manner since decreasing from 8u to 6u.
Eating great, more normal thirst (I also read he's laying against his water bowl - which is it now?)
thyroid has been tested - there is a lab tab in the spreadsheet that you can enter lab values in it - that can be really important
looking at the food - you said he ate three 85gr cans = 9ounces US. Punkin used to eat that amount every day - he weighed about 13 pounds, which is a pretty large cat.
Sounds like he's completely not eating dry food now - right? When was the last time he had any? If a cat is very carb sensitive it can take even another day to work out of the system. Do you have dry food for any other pet there? dog food? other cats?​

ah, I love that he purrs while he's eating. Punkin did that too! Nothing like enjoying your food!

You've gotten to the right spot now and will have a good insulin. If I had it to do over again, I'd go with Levemir instead of Lantus, but since your vet was kind enough to order the Lantus, you may want to just start there and see how it goes.

One of us will check back with you and look for your answers. Glad to have you here!
Click to expand...

Should I just add the dosage information to another tab on the spreadsheet?

He started on 3 units week one and at this time his sugars were extremely high the vet had told me (in the 30's). Then she had us increase one unit every week from there until we got to 8 units which is when I finally reached out here. One week we did increase two units within the week, one increase at the beginning and one halfway. That week we went from 5-7. We were taking Davey to the vet every Thursday, she would test him twice, say his sugars were still in the 30's and send him back home. There wasn't one week that the vet told me they seen any progress and at this time I was not testing at home and was very uneducated on the whole matter.

Here is what I think the dates were:

Nov 24th- Started at 3 units
Dec 1st - Increase to 4 units
Dec 8th - Increase to 5 units
Dec 11th - Increase to 6 units (had two increases within a week)
Dec 15th - Increase to 7 units
Dec 22nd - Increase to 8 units
January 1st - Decrease to 6 units and remained at this dosage while changing his diet

He was doing better but the last day or two he's seemed to have taken a step back and I just noticed he peed on the floor in my basement which he hasn't done in a while. He never peed anywhere he wasn't supposed until November last year and we seemed to have had it under control but now he's done it again :(.

He takes no other meds and has no other conditions. Also I do check ketones. I will see on getting test results from the vet for thyroid and such and work on adding more to the spreadsheet.

I feel like he is a high dose kitty for sure but maybe you guys will have a different take on it once you review further. Everyone had me terrified that I was giving him way too much and I was panicking but I think he may need it....

I did not notice a difference in manner or behavior until we changed foods. This is the only time that I've seen a glimmer of hope through this whole process so far.

He's now up to 4 cans of low carb Fancy Feast a day (no dry at all) and is constantly hinting that he wants more. It's all he thinks about! He does laze around his food/water dish most of the time now but it seems to be because he is waiting for me to come in there and hoping I'll feed him. At the start of this he was drinking 2 bowls of water a day and now he drinks 3/4 of one so still a lot more than he used to but it is much better. On the "blue" day he drank not even half a bowl but now hes back up to 3/4. The bowl holds 2 cups (500 ml).

He's gained a 1/2 pound since I started using wet food a couple weeks ago. He's now 13 1/2 from 13 and last time he was at the vet before all this happened was two years ago and at this time he was 16 pounds. He's definitely always had some chub but he is also very big boned lol. We used to have two cats and our other had a very small frame compared to him and was about half his size. His whole life he has always had dry food and we've just filled the bowl and let him eat what he wanted so this switch has been exciting for him since he loves wet but also tough because there's no longer food available at all times. The can is gone within two minutes of me putting it into the bowl. There is no other food around except for the odd time he has something my toddler sneaked and dropped on the floor at supper for him like a piece of chicken.

I have no problems with using Levimar and I will talk to the pharmacy about it for sure if you think it's best. A co-worker of mine has a friend that's a vet in the community (small town haha) and she asked her a few questions for me and the vet mentioned that Lantus is the first choice here for many vets on PEI and they aren't as familiar with levimar which is why this would have been prescribed.

Just to give you an idea of my situation, I have been trying to avoid vet trips this past couple weeks because a) this has been really tough on the family financially so far and I have to be very careful now on what I'm spending. b) I feel like many of my past vet trips were really a waste of my time any $. The day he was diagnosed was the only useful trip and so far they've gotten about $600 from me since November c) I don't find my vet is well educated on the matter at all and the only progression I've seen so far is from advice on this site. I've thought of changing vets which may still happen yet but we only have two vet offices here and the other one I stopped taking him taking him to 3-4 years back because I wasn't happy with the service there for various reasons. My only option really is to see another vet in the same office as my current one which will be awkward but may need to happen.

Hope this post helps!
 
Thanks for answering those questions, that does help. You'll find that not many vet anywhere are familiar with Levemir as a cat insulin. It's not just an island issue. :p One of the reasons Julie mentioned Levemir is that Lantus has an acid base, and we've heard from people who use it, that it can sting, especially at higher doses. And we've seen over time that some cats on higher doses of Lantus seem to jump or walk away at shot time. My Neko got up to her highest dose on Lantus. I thought she was fine with it, but periodically she would walk away during the shot. Then I switched to Levemir when her dose got smaller, but she did get back up to a higher dose and she never walked away from the Lev shot. Often she purred. :)
 
Wendy&Neko said:
Thanks for answering those questions, that does help. You'll find that not many vet anywhere are familiar with Levemir as a cat insulin. It's not just an island issue. :p One of the reasons Julie mentioned Levemir is that Lantus has an acid base, and we've heard from people who use it, that it can sting, especially at higher doses. And we've seen over time that some cats on higher doses of Lantus seem to jump or walk away at shot time. My Neko got up to her highest dose on Lantus. I thought she was fine with it, but periodically she would walk away during the shot. Then I switched to Levemir when her dose got smaller, but she did get back up to a higher dose and she never walked away from the Lev shot. Often she purred. :)
Click to expand...

Ah, good to know! Sounds like levemir it should be then!:)
 
We use the same protocol (Tight Regulation) or method (Start Low Go Slow) for dosing with Levemir and Lantus. The biggest difference between the two is that Levemir typically onsets around +4 (Neko was +5) and nadir closer to +8 (Neko +9 to +12). That's a couple of hours later than Lantus. For some people, that can make getting mid cycle or nadir tests a little harder.
 
emjb14 said:
He's now up to 4 cans of low carb Fancy Feast a day (no dry at all) and is constantly hinting that he wants more. It's all he thinks about! He does laze around his food/water dish most of the time now but it seems to be because he is waiting for me to come in there and hoping I'll feed him.
Click to expand...

Are you adding extra water to the canned? It can help "fill them up" without giving them any more calories
 
A lot of us add quite a bit of water.....like a can of water to a can of food to help with both hydration and "filling them up"

Find a consistency that Davey will eat and keep trying to add "just a little more" water....China's to the point now where she only wants the "gravy" that I make....once she licks all that off and has the plain food left, she's not very interested
 
emjb14 said:
He was doing better but the last day or two he's seemed to have taken a step back and I just noticed he peed on the floor in my basement which he hasn't done in a while. He never peed anywhere he wasn't supposed until November last year and we seemed to have had it under control but now he's done it again :(.
Click to expand...

How is Davey doing today? When you say he was doing better but in the last day or two seems to have taken a step back, are you thinking that it might be since you reduced his dose to 6u?

Were you able to get Lev and are you still wanting to start it tomorrow? Morning?
 
julie & punkin (ga) said:
How is Davey doing today? When you say he was doing better but in the last day or two seems to have taken a step back, are you thinking that it might be since you reduced his dose to 6u?
Click to expand...
Hi Julie,

EMJB reported on the original thread that Davey's clinical signs were the best since Dx on the night he had the blues just after all the dry food was eliminated from the diet (less PU/PD and better sociability). Hope this info helps.


Mogs
.
 
Critter Mom said:
Hi Julie,

EMJB reported on the original thread that Davey's clinical signs were the best since Dx on the night he had the blues just after all the dry food was eliminated from the diet (less PU/PD and better sociability). Hope this info helps.


Mogs
.
Click to expand...
Hi Mogs, I was looking at this part below, which she posted yesterday in #7 thread above.

emjb14 said:
He was doing better but the last day or two he's seemed to have taken a step back and I just noticed he peed on the floor in my basement which he hasn't done in a while. He never peed anywhere he wasn't supposed until November last year and we seemed to have had it under control but now he's done it again :(.
Click to expand...
 
Hi Guys! I hadn't noticed any change in behaviour except for when we changed his diet as Mogs has mentioned. He didn't pee anywhere he shouldn't yesterday and seemed a bit better than my last post on this thread (he was sleeping at the foot of my bed for a bit) but he's still not back to his usual self by any means. I would say he's back to the same way he was at diet change.

As for BG levels I didn't do any home monitoring until he was already at 8 units and I think there is a couple days tracked at the start of my spreadsheet. His levels did get higher when I first changed him to 6 but then got lower after diet change I find but are still really high overall.

I would really like to start this evening on levimar but I was just sort of waiting for a final go ahead that you guys agree that's what I should do. Sounds like it is so I can run and get it after work :) it's another crazy day!

Also I should mention he's been slow moving going up and down the stairs. The vet checked him and said it's due to old age and probably from him being sick. She said his hind legs are weaker :(

Thanks!
 
Hello Again! I was going to start Davey's new insulin tonight but decided to wait to hear back from you on dosage. If someone could give me some advice before tomorrow morning that would be great so I can give it to him then and keep an eye on him through the weekend :)
 
What time do you shoot? I presume Altantic time. Did you get the Levemir and U-100 syringes with half unit markings? When you first start L insulins, you do want to be able to get a +3, +6, +9 mid cycle tests. Some cats have an initial strong reaction to a change in insulin.

As for the weak hind legs, many of our older kitties get arthritis. Remind me and I can give you my thoughts on that later.
 
Yep I'm atlantic time and I gave him his shot around 7. I have everything picked up from the pharmacy and ready to go :)

I'm hoping to start this weekend because it's the only time I can watch him around the clock.

During the week I can only check shortly after +9 after his morning dose and I can check +3 at night and then would have to get up through the night to check +6 and +9.
 
Did you go with Levemir or Lantus? Levemir sound better for your schedule as their nadirs are later. Neko's was often around +9.
 
OK, looks like we have a suggestion. I've heard back from Julie and Marje too. We typically take the dose of the current insulin into play when deciding what a starting dose is. You've done a great job testing Davey on Vetsulin, so we have a pretty good idea what 6 units of Vetsulin is doing. It seems that 6 units is sometimes getting him into blues. With that in mind, we are suggesting a switch to 6 units of Levemir. This is a larger starting dose, but he also seemed to do OK on 8 units of Vetsulin so 6 units is playing it a bit safer. The other option we considered was starting a little bit lower in dose (4 units) and fast tracking you up if his numbers stayed high. Make sure you have a few cans of high carb wet food on hand, some syrup, and plenty of test strips (at least 20).

As I mentioned before, if you can swing tests at +3, +6 and +9 mid cycle, that will help. Levemir usually has a later onset, more like +4, plus or minus cat's not liking to be too predictable, so it's possible you won't see much at the +3 test. "Typical" nadir is +8-ish (Neko was +9 to +12). Levemir is also a depot insulin, so you may not see much in the first cycle or two. At that size of dose, it may take up to 5 or 6 cycles to see the full effect of what the dose can do. Or Davey could be one of those cats that has a strong initial reaction to the insulin.

One or the other of us will try to keep an eye on you and Davey tomorrow. Go ahead and start a new post tomorrow and it'll make it easier to know what's new for the day.

While you are waiting in between tests tomorrow, take a read of the Tight Regulation Protocol and the Start Low Go Slow Method sticky notes and decide which one you'd like to follow. If a cat is stuck in higher numbers, the TR protocol will allow you to increase faster, but normally we'd hold the initial dose at least 5 days to build the depot, unless his numbers stay really high and flat.
 
Status
Not open for further replies.
Back
Top