Lantus not working

[CindyJ]

My cat was diagnosed about five weeks ago and I am doing my second glucose curve which is really not a curve but a flatline . We started with two units of Lantus twice a day and now he's at 3 units twice a day and as I'm doing his glucose curve today the blood sugars are still very high 5-600. I'm very upset thinking Lantus is doing nothing The insulin is not old enough to be bad yet and I've kept it in the refrigerator the whole time as per my vet's instructions . Should I be switching to a different insulin ? Need help and feedback as I'm very upset about his results so far .

 

[tiffmaxee]

It would help to start a google spreadsheet and fill in as much info as you have. Are you getting mid cycle tests whenever possible? Have you been increasing in .25 unit increments? It's impossible to advise without more facts.

 

[Bronx's dad (GA)]

Hi Cindy. I thought the same exact thing when I was getting all 400&500s for the first few months and was extremely frustrated. Coming here, finding out I wasn't the only one kept me sane. ECID (Every Cat is Different) & it can take a while for some cats to get to the right dose. But I would advise following one of the protocols listed on the top of this forum, important that you don't skip over that right dose.

 

[CindyJ]

Hi Cindy. I thought the same exact thing when I was getting all 400&500s for the first few months and was extremely frustrated. Coming here, finding out I wasn't the only one kept me sane. ECID (Every Cat is Different) & it can take a while for some cats to get to the right dose. But I would advise following one of the protocols listed on the top of this forum, important that you don't skip over that right dose.

Thank you! I know this form will be a great support for me . I think what makes it more frustrating for me is that I am a dietitian and a diabetes educator for humans . You would usually see some effect with insulin with people. It may not be the right dose, but you would see some effect and I'm so frustrated because I just see Baxter's numbers getting worse not better . Well I will finish his glucose curve today and talk to my vet tomorrow and see what she says . Thanks again

 

[CindyJ]

It would help to start a google spreadsheet and fill in as much info as you have. Are you getting mid cycle tests whenever possible? Have you been increasing in .25 unit increments? It's impossible to advise without more facts.

We've only adjusted his insulin once.....from 2-3 units Lantus twice daily. If I saw some effect I would feel better but I just see his blood sugars getting higher

 

[D Marchus]

Cindy, you're not alone! Neo and I have been at this game a little longer than you and we're having the same issue. I recently found FDMB and already feel more hopeful that we'll get things dialed in. However, high 4-500s are the norm for us right now and I'm striving to make sense of the massive amount of information provided. It's pretty daunting but the people here have been incredibly helpful already. A super useful link was shared with me last night: Where Can I Find? Lots of great info there that I'm just starting to delve into.

 

[Sienne and Gabby (GA)]

Hi, Cindy. The good news is that given your profession, you are probably a bit further along on the learning curve than most people who join the group. It may help to keep in mind that you're dealing with a cat and they have a tendency to make you want to tear out your hair. Unpredictability seems to be all of their middle names!

A few things to keep in mind. As Elise (tiffmaxie) noted, it will be of enormous help if you can start a spreadsheet so that along with you, we can track your kitty's progress. The link for the spreadsheet (SS) instructions is here. Please let us know if you need help. We tend to be very data driven and most of us are reticent to offer suggestions about dosage without seeing a SS.

I doubt that Lantus is doing nothing. As you know, Lantus is a depot type of insulin. With cats, it can take 5 - 7 days for the depot to form and stabilize. Many cats do not have much of a response to insulin until after the depot is formed. While Lantus is very safe for use with cats, it is not a potent as the other shorter acting forms of insulin. If numbers are high, short acting insulin will "yank" the numbers down -- sometimes precipitously which increases the risk for hypoglycemia. Lantus "grabs on" and works best when the numbers are lower and ideally, you see a gentle, flat curve. Also, depending on when and how often you're testing, it's possible that numbers have dropped and then bounced back into a higher range. (Without being able to see the pattern of your testing and your kitty's numbers, I can't say that this is the case.)

I'd encourage you to read through the sticky notes at the top of the board if you've not done so already. One issue we're pretty dogmatic about is that people are providing their cat with a low carb diet -- preferably canned food. Lisa Pierson, DVM has an extensive list of canned cat food with their nutritional information. I suspect you will find a kindred spirit on her website on feline nutrition. If you look on the menu bar on the right side of the webpage, you'll find the link to her food chart.

One other point is that we don't raise doses by more than 0.5u and generally, the increases are by 0.25u. It can be rather easy to fly past what would be a good dose if you increase by too much. Frankly, too much insulin can look like too little insulin so increasing the dose in a systematic manner insures that you haven't gone past an effective dose.

Please let us know how we can help. The people here are very generous with their knowledge and their time and we love questions!

 

[CindyJ]

Cindy, you're not alone! Neo and I have been at this game a little longer than you and we're having the same issue. I recently found FDMB and already feel more hopeful that we'll get things dialed in. However, high 4-500s are the norm for us right now and I'm striving to make sense of the massive amount of information provided. It's pretty daunting but the people here have been incredibly helpful already. A super useful link was shared with me last night: Where Can I Find? Lots of great info there that I'm just starting to delve into.

Hi, Cindy. The good news is that given your profession, you are probably a bit further along on the learning curve than most people who join the group. It may help to keep in mind that you're dealing with a cat and they have a tendency to make you want to tear out your hair. Unpredictability seems to be all of their middle names!

A few things to keep in mind. As Elise (tiffmaxie) noted, it will be of enormous help if you can start a spreadsheet so that along with you, we can track your kitty's progress. The link for the spreadsheet (SS) instructions is here. Please let us know if you need help. We tend to be very data driven and most of us are reticent to offer suggestions about dosage without seeing a SS.

I doubt that Lantus is doing nothing. As you know, Lantus is a depot type of insulin. With cats, it can take 5 - 7 days for the depot to form and stabilize. Many cats do not have much of a response to insulin until after the depot is formed. While Lantus is very safe for use with cats, it is not a potent as the other shorter acting forms of insulin. If numbers are high, short acting insulin will "yank" the numbers down -- sometimes precipitously which increases the risk for hypoglycemia. Lantus "grabs on" and works best when the numbers are lower and ideally, you see a gentle, flat curve. Also, depending on when and how often you're testing, it's possible that numbers have dropped and then bounced back into a higher range. (Without being able to see the pattern of your testing and your kitty's numbers, I can't say that this is the case.)

I'd encourage you to read through the sticky notes at the top of the board if you've not done so already. One issue we're pretty dogmatic about is that people are providing their cat with a low carb diet -- preferably canned food. Lisa Pierson, DVM has an extensive list of canned cat food with their nutritional information. I suspect you will find a kindred spirit on her website on feline nutrition. If you look on the menu bar on the right side of the webpage, you'll find the link to her food chart.

One other point is that we don't raise doses by more than 0.5u and generally, the increases are by 0.25u. It can be rather easy to fly past what would be a good dose if you increase by too much. Frankly, too much insulin can look like too little insulin so increasing the dose in a systematic manner insures that you haven't gone past an effective dose.

Please let us know how we can help. The people here are very generous with their knowledge and their time and we love questions!

Thank you very much! I will check out those links.

 

[julie & punkin (ga)]

I'll add a couple more points - along with a welcome!

Cats can be extremely sensitive to even small changes in insulin. We typically adjust the dose in 0.25u or 0.5u increments - not in whole unit increments unless a cat's dose is over 10u or there is some special circumstance.

There are several circumstances where a cat might have high numbers:
1. A cat that is overdosed can have continuously high numbers

2. A cat that has just gotten a dose increase might have "New Dose Wonkiness" - unexplained high numbers for a day or so after a dose increase. In the second post in this same thread is a description of bouncing . . .

3. A cat that has either had their blood sugar drop too fast (perhaps more than 50 points an hour, ECID), or the blood sugar has gone into a range lower than they have become accustomed to, will "Bounce." Bouncing is a temporary response to the lower numbers or fast dropping blood sugar. They can last as long as 3 or so days.

4. A cat that hasn't gotten to a "good" dose yet might not have much movement in their blood sugar. You would think that increasing a dose a bit would lower the blood sugar a bit, but often things will stay basically the same until you get to a good dose, and then BAM, the action begins. That doesn't always happen, but it does sometimes.

Because there are all these other factors that influence blood sugar, we do like to see a spreadsheet. We look at dose changes - size of increment, when did the last one happen, etc. - and look at the numbers over the past several days. An isolated test numbers means very little. Cats can go from 400 to 40 in 3 hours, literally, and then be back to 400 again by the end of the 12 hour cycle. We need to see context of tests.

It's more complicated that it seems it ought to be, but there are many experienced members here who can help you learn what you need to know to help your kitter. If you have trouble starting a spreadsheet, just holler. We have people who can start one for you and turn it over to you to maintain. They really are an essential tool. It's a bit overwhelming for many people in the beginning, but you'll get the hang of it in no time and then it just becomes routine.

Keep asking questions. Glad to have you here!

 

[CindyJ]

Thank you. Yes..... I'm learning that it's much more difficult to control a cat's diabetes than a human's with insulin . My cat is on the Lantus pen so you cannot do increments other than whole units . I would like to think that my vet knows what she's doing but do you recommend that I go see a veterinary endocrinologist? I hope they exist because I certainly would recommend any human go see one

 

[julie & punkin (ga)]

No, you don't need a specialist. You can learn everything you need to know here - unless you have a medical crisis, or something like that. But you do need syringes so that you can dose in finer increments. The pen is only by whole units and it is too easy to bypass a good dose doing it this way. Take a look at the sticky about syringe and dosing information. I did a video that's linked on there about how to use a syringe with a pen. You don't use the pen needles and instead you use the pen like a little vial. It's simple and far more accurate than using the pen mechanism.

Another reason for using syringes is that most people want the insulin to last as long as possible, which requires refrigeration. With refrigeration Lantus will last even 6 months. Some people have reported using it even longer. But refrigeration makes the dosing mechanism less reliable, which is the reason that the Lantus manufacturers say to keep it at room temperature once you begin using it, but refrigerate any unused pens.

This site has a wealth of information and experienced people pretty much 24/7/365 who can help you. We aren't vets, so we rely on data to help us help people. You'll pick up on things quickly and it won't be long before it all makes more sense. People here taught me what I needed to know to help Punkin, and I was asking the vet to do what was suggested here.

This link "Where Can I Find?" can help you navigate around this Lantus/Levemir group and access the information we most commonly refer to. Many people bookmark it.

 

[SantaCruzSPCA]

Thank you. Yes..... I'm learning that it's much more difficult to control a cat's diabetes than a human's with insulin . My cat is on the Lantus pen so you cannot do increments other than whole units . I would like to think that my vet knows what she's doing but do you recommend that I go see a veterinary endocrinologist? I hope they exist because I certainly would recommend any human go see one

Cindy, I was in your boat just a few weeks ago, having switched from NPH to Lantus, and was so frustrated with the consistent high numbers I was seeing! After looking over the data I had collected on my spreadsheet, the folks on this forum helped me realize that I was giving too MUCH insulin and it was causing the high numbers, not too LITTLE (due to the "bounce" phenomenon). I so badly wanted to increase the dose because all I was seeing were numbers in the 500-600's. But I trusted the advice I was being given here and the minute I began steadily decreasing the dose, his numbers began steadily falling into the healthy lower ranges. Of course, that was just my situation and may not be what you're dealing with. However, if you start collecting test results multiple times a day and allow your spreadsheet to be view-able to the forum members, they will be able to help guide you.

If you stick around this forum you will learn an incredible amount of truly lifesaving diabetes management info and you'll also start to realize how little most vets actually know about the proper management of the disease. This forum has acted as such a valuable (and free!) resource that I'd now trust over my vet. Of course there is a time and a place for a veterinarians help, especially in an emergency, but for the every day...I know who to turn to!

Also, you can most definitely give fractional doses while using the Lantus pen, you just need to purchase syringes with half unit markings. I bought these...https://www.adwdiabetes.com/product/monoject-ultra-comfort-insulin-syringes_2552_178.htm. You can draw from the Lantus pen using any syringe.

Welcome to the forum!

 

[Phoebes (GA)]

Phoebe was diagnosed in Jan. If you look at her ss you will see the definition of pancake, by her flat numbers. It us frustrating beyond description. However I was told this FD is a marathon not a sprint. Although that is annoying at the least, it's true. A cat will come down when it's ready. I just get on my knees and plead with her to cooperate. And if course get the " I see your lips moving but can't hear what your saying look."

 

[Ella & Rusty & Stu(GA)]

Hi Cindy,
You have gotten so much good information here that I won't add to it except to say "welcome" to you and Baxter.

Just a brief autobiographical note: my previous diabetic cat, Stu, was overdosed by his vet, who raised his dose by 1 or 2 units at a time over a period of weeks because his high numbers were not coming down. The poor kitty finally crashed. That's when I found this board and got fantastic help and advice from the great people here.
We are glad you found us.

 

[CindyJ]

Phoebe was diagnosed in Jan. If you look at her ss you will see the definition of pancake, by her flat numbers. It us frustrating beyond description. However I was told this FD is a marathon not a sprint. Although that is annoying at the least, it's true. A cat will come down when it's ready. I just get on my knees and plead with her to cooperate. And if course get the " I see your lips moving but can't hear what your saying look."

Thank you sooooo much! I really appreciate all your input. Could be that yes we went up to fast from 2 to 3 units of Lantus . So very odd how different it is to manage a cat with diabetes than a human . I will look at other people spreadsheets and start posting some of my own to get feedback . Thx again!!

 

[CindyJ]

Hi Cindy,
You have gotten so much good information here that I won't add to it except to say "welcome" to you and Baxter.

Just a brief autobiographical note: my previous diabetic cat, Stu, was overdosed by his vet, who raised his dose by 1 or 2 units at a time over a period of weeks because his high numbers were not coming down. The poor kitty finally crashed. That's when I found this board and got fantastic help and advice from the great people here.
We are glad you found us.

Thank you so much. Yes, Baxter is probably getting too much insulin already.... sigh

 

[CindyJ]

Cindy, I was in your boat just a few weeks ago, having switched from NPH to Lantus, and was so frustrated with the consistent high numbers I was seeing! After looking over the data I had collected on my spreadsheet, the folks on this forum helped me realize that I was giving too MUCH insulin and it was causing the high numbers, not too LITTLE (due to the "bounce" phenomenon). I so badly wanted to increase the dose because all I was seeing were numbers in the 500-600's. But I trusted the advice I was being given here and the minute I began steadily decreasing the dose, his numbers began steadily falling into the healthy lower ranges. Of course, that was just my situation and may not be what you're dealing with. However, if you start collecting test results multiple times a day and allow your spreadsheet to be view-able to the forum members, they will be able to help guide you.

If you stick around this forum you will learn an incredible amount of truly lifesaving diabetes management info and you'll also start to realize how little most vets actually know about the proper management of the disease. This forum has acted as such a valuable (and free!) resource that I'd now trust over my vet. Of course there is a time and a place for a veterinarians help, especially in an emergency, but for the every day...I know who to turn to!

Also, you can most definitely give fractional doses while using the Lantus pen, you just need to purchase syringes with half unit markings. I bought these...https://www.adwdiabetes.com/product/monoject-ultra-comfort-insulin-syringes_2552_178.htm. You can draw from the Lantus pen using any syringe.

Welcome to the forum!

Thank you very much for your feedback. I really appreciate
it!

 

[MJW]

Yum and I know how you feel! Hang in there. Look at other charts for hope.

 

[CindyJ]

Thank you!

 

[Veronica & Babu-chiri]

No much more to say other than welcome !! and be patient, you've already started on the right path by being here

 

[Kako & Tux]

I also thought the same in the past! Now Tux is OTJ. Welcome to L&L Land!

 

[Yvonne & Tig]

Hi...I've read most of these and will go back and reread them. My cat was diagnosed 2 weeks ago and the vet started with 2 units, with high numbers a week later moved me to 3 units, this week numbers still high and moved me to 5. After reading these posts I am worried. I go back next week for a recheck. I am thinking I may have to not follow vets advice. I had a diabetic dog and managed that with vetsulin, but this cat thing is new to me. I've yet to test his blood myself.

 

[Yvonne & Tig]

Hi Cindy,
You have gotten so much good information here that I won't add to it except to say "welcome" to you and Baxter.

Just a brief autobiographical note: my previous diabetic cat, Stu, was overdosed by his vet, who raised his dose by 1 or 2 units at a time over a period of weeks because his high numbers were not coming down. The poor kitty finally crashed. That's when I found this board and got fantastic help and advice from the great people here.
We are glad you found us.

I wanted to ask you because my vet is increasing Tiggers dose like you said (with Lantus). Did Stu pass from too much insulin?

 

[Kris & Teasel]

I wanted to ask you because my vet is increasing Tiggers dose like you said (with Lantus). Did Stu pass from too much insulin?

In my opinion Tigger's Lantus dose has been raised far too high far too fast. The recommended starting dose is 1 u twice a day and many vets start there. On FDMB we recommend much smaller increases of only 0.25 u at a time. Too much insulin can looks like too little - ie., BG stays high.

 

[Sienne and Gabby (GA)]

@Yvonne & Tig - In case Ella doesn't see your note, Stu did not pass from too much insulin. His vet found multiple masses and he had kidney disease.

 

[Yvonne & Tig]

In my opinion Tigger's Lantus dose has been raised far too high far too fast. The recommended starting dose is 1 u twice a day and many vets start there. On FDMB we recommend much smaller increases of only 0.25 u at a time. Too much insulin can looks like too little - ie., BG stays high.

Thank you, I am wondering if I should cancel my appointment for next week, he will probably want to raise it again. I've never tested him myself yet. I heard they don't really feel the ear pokes, hope that is true.

 

[Kris & Teasel]

Thank you, I am wondering if I should cancel my appointment for next week, he will probably want to raise it again. I've never tested him myself yet. I heard they don't really feel the ear pokes, hope that is true.

We have lots of tips to help you with home testing of blood glucose. It's not as hard as you might think and even cranky cats learn to tolerate it. Do you have a glucose meter? Many here use the Walmart ReliOn brand. The test strips are much more economical.

 

[Veronica & Babu-chiri]

Thank you, I am wondering if I should cancel my appointment for next week, he will probably want to raise it again. I've never tested him myself yet. I heard they don't really feel the ear pokes, hope that is true.

I couldn't be sure that they don't feel it but it does seem to not bother them so much, after they get used to you handling their ears ( I think is the touching of their ears that they don't like) at least Babu seems no to mind so much what he really hates is the insulin shoot so my guess is that it hurts him more but either one is for their own good that we do it and they are both necessary

 

[Sandy and Black Kitty]

I've never tested him myself yet.

Testing is the key to "knowing thy cat" which is the foundation for safely and successfully treating FD.
You can do it.

 

[Kris & Teasel]

Thank you, I am wondering if I should cancel my appointment for next week, he will probably want to raise it again. I've never tested him myself yet. I heard they don't really feel the ear pokes, hope that is true.

Hi @Yvonne & Tig
Please start your own thread on this forum because I know you're looking for dose advice and your posts are lost here in someone else's thread. When you make a title for your thread, click in the icon box to the left end of the thread title bar and select the blue question mark icon. It will attract more attention to your post.

The reading you got recently on your AT meter is too low! Start a thread now so we can discuss it. First, though, give Tig 1 or 2 teaspoons of high carb food.

 

[Ella & Rusty & Stu(GA)]

I wanted to ask you because my vet is increasing Tiggers dose like you said (with Lantus). Did Stu pass from too much insulin?

No, Stu had many health issues: CKD, Hyper-T, and cancer. Stu got fairly well regulated on Lantus. His previous insulin (PZI Vet) had been discontinued; he had been on that for 4 years and we had to find a new insulin. The vet dosed Lantus the way the older insulins were dosed, not realizing that it is a depot insulin.
Definitely get a meter and start testing. When a cat is only tested at the vet there are too many variables: stress, time of day, etc. Lantus dosing is based on the nadir: the lowest number in the cycle. So this is really only something you can do--unless your cat lives at the vet's!