New to Lantus and post DKA

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SantaCruzSPCA

SantaCruzSPCA

Member Since 2017
Hi All! Not sure how many of you have seen our previous posts but Rusty is a shelter cat who was previously on NPH, had a recent episode of DKA (brought on by an URI I think), and is now newly on Lantus (as of nearly three days). After five days with the vet, we have him back and he seems to be doing much better. However, I've learned to be guarded and not get too excited about what looks like progress! lol.

I don't know much about Lantus, but am trying to be a quick study with all the stickies! The vet has put him on 6 u's (after starting small and progressively increasing when his numbers were shooting into the 700's and ketones were large!). Today is really the first full day I've had him back and have been able to see any of his numbers. They look a bit weird. Apparently the nadir is supposed to be +6 but with him, it was his highest number? Anyway, the vet has told me that this dose will most likely begin to decrease and has actually advised I back him down to 5 u's tonight based on his 89 today.

Anyway, rambling aside, I hope to learn more from everyone as I continue on this crazy diabetic journey! :)
 
Hello and welcome. Good job starting to read those stickies. Lot of info in there (a bit overwhelming at first), so feel free to answer questions.

Rusty was started on 12 units on insulin! Yikes! :eek: Glad he's still alive.

6 units is indeed a little high to start him. Lantus is a depot insulin and we hold the initial doses 5-7 days to build the depot, unless he's high and flat or still throwing ketones. Without the DKA incident, we probably would have started Rusty on 4 units of Lantus, as we take the dose of the previous insulin into consideration and 4 units of NPH was getting him into greens.

Are you able to test daily for ketones? How is his appetite? Is he still on antibiotics? Putting info like ketone test results, meds in the Remarks section can help us.

As for the nadir, the +6 is the "typical" nadir and doesn't take into consideration that cats don't like to be predictable. :cat:My Neko on Lantus reliably nadired anywhere from +3.5 to +13, though most often from +7 to +9.:p I've seen some that nadir around +2. Today was a really odd cycle with that red number there between the blue and green. It's always good to test again if you get a number that seems out of place.
 
I have to wonder if that 496 was a wonky test strip.....it would make a lot more sense than having him drop from 496 to 89 in just two hours.

Anytime you get a test that out of whack, it's best to re-test

6U is a HUGE dose....so is 5U so I'd keep a close eye on him and test again soon

Lantus works totally differently than NPH and it looks like he was only on 3-4 units of NPH....We usually start Lantus a little lower than they were on using a different insulin
 
Oh and by "shelter cat", I mean he's currently AT a shelter, not an adopted shelter cat :)

@Wendy&Neko Thanks! And here I had just learned how NPH works...now I'm starting all over again, lol. And yes, his original dose was 12! :nailbiting: He was surrendered to us on that dose, but he was also being fed a super high carb diet (Purina cat chow dry). According to them he'd been on that dose for months. We quickly began reducing his dose while changing his diet to low carb. However, when we got down to the 2's and 3's and the URI hit we got into the DKA trouble. I believe the 6 u's was arrived at when he was high and flat and still throwing ketones (during his time in ICU). As of yesterday, he was neg for ketones (it's labeled in the cells in grey on my sheet, however, I was unable to test today because he peed while I was away). However his appetite is pretty good, he's drinking normally and is more alert than I've seen him in a while. He's still on antibiotics (Azithromycin) for 8 more days.

As far as dosing goes, should I stay at five and get a few days of data or lower it to 4? So soon after a DKA I know enough insulin is of the utmost importance but the last thing I want is hypo right after. Thoughts?

@Chris & China The dosing started while he was at the vet and I believe they did start him on something like 2 u's. But I think the drastic increase was due to his state of DKA and wanting to get enough insulin in him and the ketones out of him. Although, I'm in agreement that the dose is probably going to be too high for him now that he's on the mend and his BG isn't in the 600-700's amymore. I'm just not sure where to go from here given he's so newly post DKA. Another challenge I have is that he's a shelter cat and while I get up early to come in and do his AMPS and stay late for his PMPS, I'm not here to monitor overnight (and neither is anyone else unfortunately).
 
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What dry food does he have available to eat? Just wondering how high carb it is. If he's on a higher dose of insulin we want to make sure he can stay safe by eating when he needs to.

We had one caregiver who adopted a surrendered kitty that was way overweight and on 13 unit of Levemir.:eek: Kitty only survived by eating himself to safety. Caregiver dropped him to something less than 2 units and wet food and he eventually went off of insulin, a much thinner cat. Another story of a cat on 5.5 units, caregiver though he was on LC diet, but he was stealing dry food from elsewhere in the house. She removed all dry food from the house and after a very scary day and a half, the cat was off insulin. Dry food is powerful stuff.
 
@Wendy&Neko The dry food he's eating is Acana. From what I've read it's lower carb but not ideal. However, it's the lowest carb one we have that he'll eat and actually likes. Is it helpful right now for the food to be higher carb if I'm not there to monitor overnight while he's on this higher dose?

Before the DKA he was on wet food only (Friskies), however, he's definitely more of a dry food cat and right now will only take a few bites of wet. I'd like to go get some of the EVO kitten or the Young Again and see if he'll switch over, however I just saw the price of YA...and after seeing his hospital bill I'm going to have to probably get the EVO first. lol.

Overnight he'll have some wet food and about a half cup of dry to nibble on if he gets hungry. Is that advisable?
 
So awesome that you are working so hard to care for Rusty. He looks like a good boy.
Is it possible to find a FD-friendly foster to take him so overnight monitoring can be available?
 
With Lantus, you don't want to change the dose too often, unless it's bringing him really low. I'd also be worried about lowering the dose enough that DKA becomes a worry again. Keeping on top of ketone testing will help guide the dosing along with those mid day tests.
 
Hi Rusty's Caretaker,

I'm so glad you posted here to get help from these very knowledgeable people. Yes, Lantus demands a whole new mindset but you already have a handle on some key post DKA issues. :)
 
I'm pretty worried by his numbers today :( As far as physically, he's acting normal, as well as eating, and drinking. I've taken all the litter out of his box aside for a handful so when he pees, I'll be able to get a ketone test. I emailed the vet (who's an internal medicine specialist and seemingly more experienced with diabetes than others) his spreadsheet yesterday so she'll be able to watch his numbers as well. I sent her a note about today's highs. Any advice? Could this be from the higher carb food? What about the use of Insulin R in conjunction?
 
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SantaCruzSPCA said:
I'm pretty worried by his numbers today :( As far as physically, he's acting , eating, and drinking. I've taken all the litter out of his box aside for a handful so when he pees, I'll be able to get a ketone test. I emailed the vet (who's an internal medicine specialist and seemingly more experienced with diabetes than others) his spreadsheet yesterday so she'll be able to watch his numbers as well. I sent her a note about today's highs. Any advice? Could this be from the higher carb food? What about the use of Insulin R in conjunction?
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Looks like big bouncing from the green yesterday. Notice the blacks a while ago after a couple of greens. That's the pattern of a bouncy kitty. Just stick with the dose for now.
 
Hi There.

First, awesome job keeping Rusty safe and giving him a chance for a happy, healthy life. :):bighug: So many people think shelter cats are not worth the trouble, and managing FD can be a lot of trouble, but it is so rewarding.

Those numbers today are scary, especially with DKA in the picture, but he is most likely bouncing from the low numbers he had yesterday. This is normal. Yes, higher carb food could play a role, too.

I don't see that anyone answered your question about leaving higher carb food overnight. Yes, since he has proven he can dive at will, that would be the safest thing to do. When ketones are a possibility, we often suggest feeding a higher carb food in order to safely give more insulin. It's a balancing act, preventing hypo but still giving enough insulin to keep ketones at bay.

We're really glad you found us and we hope we can help you help handsome Rusty!
 
Hi SantaCruz and welcome to Rusty (from another Rusty),
@Kris & Teasel and @Tricia Cinco(GA) & Harvey just posted what I was going to say: those black numbers look like a bounce from the 89 of yesterday.
You are doing a great job getting on top of Rusty's issues. Keep reading the "Stickies" (informational posts at the top of the Lantus Forum)! I would only caution that you stick to the protocol when making changes in dose. Lantus can do weird things when it is increased too frequently and by too much. I almost lost my previous diabetic cat, Stu, because his vet was raising his dose by 2 units every 3 or 4 days. That's when I found this board and learned what to do.

Best of luck to you and to Rusty. Perhaps you'll be able to find an experienced person to foster him (or adopt him).

Ella & Rusty
 
SantaCruzSPCA said:
As far as physically, he's acting normal, as well as eating, and drinking. I've taken all the litter out of his box aside for a handful so when he pees, I'll be able to get a ketone test.
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It's good to hear Rusty is feeling well and eating. My girl used to bounce to black when she first saw green at the beginning of her diabetic journey. He will come down. Just keep testing for ketones. Instead of removing litter, you can also used washed lentils or aquarium gravel, just in case Rusty really needs something to dig around in the box.
 
Thank you all for the quick replies! Oh and by the way, my name is Mandi, I didn't realize I hadn't even identified myself yet! :)

My heart can stop pounding just a teeny bit knowing that this is most likely a bounce. So thank you for that. I need to accept the fact that I'm in charge of a real bouncer, lol. But I'll be continuing to test and monitor him closely and stay on the same dose.

I will be picking up some EVO kitten today. Would it be helpful to replace the higher carb food or stay with the carbs for now? If I should keep the carb food for now, when is the best time for the switch?

@Kris & Teasel Good to see you here too! I've been using your suggestion of putting warm water in his wet food and he's been lapping it up happily. Makes me feel good to see some more liquids going in. :)

@Tricia Cinco(GA) & Harvey Thank you, I'm doing my best. I never realized how difficult this would be but I won't accept the other option if there is a fighting chance. So here we are - and my hair is almost gone! lol Thanks for answering the question about the food. I'll make sure to leave food overnight so he can hopefully "eat himself to safety" if it ever comes to that.

@Ella & Rusty & Stu(GA) Another Rusty! I really appreciate the kind words and support. This is quite the journey. I've been on the hunt for an experienced foster or adopter, so far no luck, but you never know when that gem of a person will come along.
 
Hi Mandi.

Nice to know your name. :) You might add it to your signature, so you don't have to keep repeating it.

If you are going to switch Rusty to a lower carb food, it's best to do it when you will be able to monitor - so during the day. A change in the amount of carbs a cat is getting can cause the numbers to change dramatically. Since he can't be monitored at night right now, staying with the higher carb food and adjusting the insulin accordingly is probably a better plan, in my opinion.
SantaCruzSPCA said:
No ketones! :)
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YAY!!! :woot:

 
I wouldn't be quick to move to a lower carb dry food unless you can find a way of getting a test in at night. His current dose might be too high for low carb food. It can take a day or so for the high carbs to move out of the system, so I don't think I'd even do it during the day.

Seconding the YEAH for not ketones.:)
 
Wendy&Neko said:
I wouldn't be quick to move to a lower carb dry food unless you can find a way of getting a test in at night. His current dose might be too high for low carb food. It can take a day or so for the high carbs to move out of the system, so I don't think I'd even do it during the day.

Seconding the YEAH for not ketones.:)
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Good point, Wendy.
 
The vet just recommended giving 1 unit of R now that he's at 423 at +6. Any thoughts?

Also, I see a lot of threads in this room are something similar to "3/24 Osha AMPS 118 +2 164 +3 159 +4 135 +9.5 285" This is obviously the day's numbers but is this something you recommend posting about often?
 
SantaCruzSPCA said:
The vet just recommended giving 1 unit of R now that he's at 423 at +6. Any thoughts?
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Bad idea. Using R insulin on top of the basal insulin is an advanced technique, and only something you should use when you know your kitties onset, nadir and duration on Lantus. Rusty is far too new on Lantus for you to know that. Some cats can dive from a lot less insulin. My Neko had two high dose conditions, and she never needed more than 0.5 units of R. When she was on smaller doses, a drop or two would be enough to cause a dive. Those dives can trigger yet another bounce, as well as possibly taking them too low. And finally, some cats react really strongly in the cycle after you give R. Since Rusty is not monitored at night, using R may make him go low when no one is around to test.

On this forum, we typically start a new thread each day. There are a few of us that scan the board for cat's that might be in need of help, the title format helps us do so.
 
Having the cat's readings in the subject line can also tell others when the Caregiver needs a little encouragement or sympathy, etc. We try to provide emotional support, as well as helping with dose suggestions and other FD related issues. Just having someone stop by your condo and say how great it is to see your kitty in good numbers really helps with your journey.
 
Okay something weird is going on...something must be up with my meter or strips. The strips are relatively new and have been kept closed and room temperature.

Literally within the same minute I got 655, 701!, and 561. I mean they all suck but how is this possible? Is it common for this much of a variation from strip to strip?
 
SantaCruzSPCA said:
Okay something weird is going on...something must be up with my meter or strips

Literally within the same minute I got 655, 701!, and 561. I mean they all suck but how is this possible?
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All meters including the AT2 (which I also use) can have an allowable variance of up to 20%. With higher numbers that spread will appear to be much wider. But take the 561 and if the 20% variance is taken into account (112 points) it could be as high as 673. Although there seems to be a huge spread the readings could all fall within the 20% variance. If you have any test solution you could do a test and make sure the meter reads within the acceptable ranges. Also make sure that the code number from the vial of test strips is the same on the meter. If the code changes between test strip vials you need to reset it on the meter.
 
I second Sandy's post. Is there any way you can take him home with you at night time, to keep him safe? I worry about him being alone with no one to monitor him at night. I guess I would test again in 15 minutes and see if there is any sense to these test numbers.
 
Okay, I'm an idiot. Apparently I messed with the setting when I was doing the test solution and it got set to code 28 and not 38. I just tested again twice in a row and the numbers were similar but horrible (620 and 690). I don't understand how he's acting so normal right now? How long does a high bounce like this usually last? Could this be still bouncing from when he was at the vet and they had his BG's super low with insulin CRI?

And no unfortunately I can't bring him home, my husband is horribly allergic. :(
 
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Hi Mandi,
Cats get used to being in high numbers, so when they get a low number they bounce to what to them is "normal". There isn't anything you can do about a bounce except to wait it out. It can take up to 72 hours to clear a bounce. So don't panic if he stays high for a few cycles. As Rusty gets more used to his routine, his dose, etc, the bouncing will probably get less frequent, but keep in mind that some cats are, simply, bouncers. :cat:

Hang in there!
 
It's great that you are able to keep on top of the ketone testing and it's negative. :) The vet's idea of R, albeit smaller amounts and if you could monitor, is a technique that could be used with kitties showing ketones.

Paws crossed tomorrow brings another color in Rusty's spreadsheet.
 
Thank you all for putting up with my crazy anxiety and constant questions today! All of your assurances have brought a lot of comfort during my freak outs when I see his numbers so high at each test. :bighug:

How did my vet handle my freak outs? Told me not to test all weekend unless he wasn't feeling well. Check him at +6 on Monday and if it's high we can go up to 6 units! So basically shut up and stop freaking out over nothing. How does she not feel it's important to understand how he's handling the new insulin and the trends it's causing? She's going to want to raise his insulin a full unit based off of one +6 test that could very well NOT be his nadir?

Now she did a great job with him while he was in her care, but I don't have another 3k at my disposal if something goes sideways. I think I'll take it from here (with the help of FD folks of course!) :)
 
A question for you, do you have the syringes with the 1/2 unit markings? Typically we make dose changes much smaller than 1 unit at a time.
SantaCruzSPCA said:
Check him at +6 on Monday and if it's high we can go up to 6 units!
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As you can see from testing the last couple of days, high numbers can be caused from a bounce so not a valid way to decide an increase is needed. You are doing great. :bighug:
 
I'm not, unfortunately. I'm just using single unit syringes someone donated after their dog passed away. The ones you can use for up to 30 units. So I'd have to eyeball any fractional doses.

Where would be a good place to get some and are they more expensive than the singe unit syringes?
 
One more dosing related question before I lay my questions to rest... For the night :)

Is there a pre shot number that would warrant a "no shoot" and if so what would that be? Also would there be a pre shot number that would warrant a smaller dose. Say for example his pre shot was 110. Would I still give the 5 units?

I read the sticky about "Shooting Low Numbers" or something of that nature but it seemed to be geared toward people who have a lot of data and understand how their cat reacts to the insulin. I do not at this time. I just want to be prepared and to prepare my staff who will be doing his testing and shots over the weekend. I've already written them a book about his care, I'm sure they appreciate more, lol.
 
I'm in Canada, but I've heard that in the US you can buy the Relion syringes at Walmart for quite a good price. Another good place to buy syringes is ADW online.

Good question about the no shoot number. I think it would be more relevant to the PM cycle than the AM, as you can monitor during the day. Typically Lantus has much shallower flatter cycles if you shoot low numbers. As you saw yesterday, he could still see green even if starting in the 300's. On this forum, we typically say that if you see a number below 150, to not feed, and post for help on what to do. For people who are new on the Health Forum, we suggest not shooting if the preshot is less than 200. Since there's a possibility the 5 units dose is still too much, I wouldn't want to shoot much lower on a PM that you did last night. One thing you can always do is to stall, which is wait without feeding for 20-30 minutes, and see if the numbers come up to a shootable number. Over time and as you learn Rusty's patterns on Lantus, you can lower the no shoot number.
 
SantaCruzSPCA said:
I'm not, unfortunately. I'm just using single unit syringes someone donated after their dog passed away. The ones you can use for up to 30 units. So I'd have to eyeball any fractional doses.

Where would be a good place to get some and are they more expensive than the singe unit syringes?
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You can get syringes at Walmart that have 1/2 unit markings. I have a picture of the package saved on my PC, but unfortuntely, it is down right now. I will look in my past posts and see if I can find a picture.

As Wendy just mentioned, they are the Relion brand, and the packaging is white and purple. In CA you need a prescription to purchase syringes, although some Walmarts will sell you a bag of just 10 without one. They are not any more expensive than syringes with unit markings.
 
One thing to add onto what I said about a no-shot. In a kitty with a recent DKA, it's really not ideal to skip a shot. Another option is to leave high carb food around. If you still have high carb food around that he likes, you can feed it as one way to deal with lower preshots and keep him safe. As you can see, there are a few options. So it's ideal to post for help if you get a lower preshot.
 
As mentioned, syringes and other supplies super cheap at Walmart (box of 100-33 gauge lancets is $1.48 & 100 Relion syringes under $13) Test strips for Relion meters are cheap, too, but I thing you are using AT2. Also, there is a discount card for $10 per Lantus pen for any pharmacy. I'll tag you in my recent post about that.

Have you checked out the DCIN (Diabetic Cats In Need) Facebook page? People from this forum are involved. Perhaps they can assist in finding a FD experienced foster in your area.
 
Tricia Cinco(GA) & Harvey said:
Okay, found the picture. In this condo, post #21 , there is a picture of the bags the syringes come in. http://www.felinediabetes.com/FDMB/threads/switching-to-lantus-need-help.174513/#post-1918344
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Thanks! ☺️ We don't have a Walmart anywhere nearby, just CVS and Walgreens. I'll see about ordering them online, as I have a feeling I'll need them soon. Appreciate you digging that up!

Wendy&Neko said:
One thing to add onto what I said about a no-shot. In a kitty with a recent DKA, it's really not ideal to skip a shot. Another option is to leave high carb food around. If you still have high carb food around that he likes, you can feed it as one way to deal with lower preshots and keep him safe. As you can see, there are a few options. So it's ideal to post for help if you get a lower preshot.
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I'm thinking we will be dealing with a lower pre shot number tonight. If that's the case I'll post for help and leave higher carb food in with him.

Taffysmama said:
As mentioned, syringes and other supplies super cheap at Walmart (box of 100-33 gauge lancets is $1.48 & 100 Relion syringes under $13) Test strips for Relion meters are cheap, too, but I thing you are using AT2. Also, there is a discount card for $10 per Lantus pen for any pharmacy. I'll tag you in my recent post about that.

Have you checked out the DCIN (Diabetic Cats In Need) Facebook page? People from this forum are involved. Perhaps they can assist in finding a FD experienced foster in your area.
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Thanks for the tag! I'd LOVE to take advantage of that! I'll talk to my shelter-friendly vet (who knows the cost issue) about writing a prescription for a pen. That would help out a ton!

I actually have joined the DCIN page and they posted about Rusty a few weeks back! :) No hits but I'm thinking of doing a more in depth story and adding more photos and video. At this point, I'd literally take him to anyone (experienced with FD obviously) in the US who would give him a home on my dime!
 
SantaCruzSPCA said:
Thanks! ☺️ We don't have a Walmart anywhere nearby, just CVS and Walgreens. I'll see about ordering them online, as I have a feeling I'll need them soon. Appreciate you digging that up!



I'm thinking we will be dealing with a lower pre shot number tonight. If that's the case I'll post for help and leave higher carb food in with him.



Thanks for the tag! I'd LOVE to take advantage of that! I'll talk to my shelter-friendly vet (who knows the cost issue) about writing a prescription for a pen. That would help out a ton!

I actually have joined the DCIN page and they posted about Rusty a few weeks back! :) No hits but I'm thinking of doing a more in depth story and adding more photos and video. At this point, I'd literally take him to anyone (experienced with FD obviously) in the US who would give him a home on my dime!
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Wish I could take him, I'm just in SoCal...but my live-in BF would kill me :( I do love the orange kitties.

Also, just to be clear, we mostly all still draw out the insulin with syringe on the pen. I think a few use the pen cartridge needles, but you can only adjust by 1u, I think, if you use with the pen needles.
 
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