Switching to Lantus this week.

[Harley Baby & Michele]

Hello Lantus users! Per tracking info my Lantus should arrive from Canada on Wednesday, 7/11. I plan to begin use Saturday when I can be home all day Saturday and Sunday.

I was planning to use TR protocol with a starting dose of 1 unit based on current weight. Harley has a hx of DKA x 2 before starting insulin. I can not remember the time frame or reason for not starting insulin after the first episode of DKA. His first dose of Novolin N was 6/1/2018 at 0.5 units. I have slowly been increasing his dose based on his high numbers, his response, reading this site daily and my gut feelings. He has been stable except the continued lousy numbers therefore, the switch to Lantus.

The last 2 days he has been fussy with the cat food and not eating it. He would eat anything off my plate he could get his face into; therefore it was not a problem with nausea or something else. He ate 4 pieces of tiny diced turkey deli meat yesterday without any issues (among other food items). He is on Mirtazepine due to picky eating. His numbers are way off again and I have decreased the insulin dose. His attitude is fine, and he is back to eating normally again. I must say over the past 1 1/2 weeks his water intake and voracious, constant hunger has decreased. Better insulin response?

My questions are: Based on the above and his spread sheet, would it be better to start with TR protocol at 1 unit Lantus or use the SLGS method at 0.5 units?

 

[Chris & China (GA)]

One of the nice things about Lantus is that they don't need to eat a particular amount before shooting....as long as they're willing to eat and you can get them to eat enough in 2-3 hours, it's usually fine to go ahead and shoot the scheduled dose.

As long as you're going to be home and able to test, I'd go with the 1U dose... and that may actually not be enough.

When a cat has been on another insulin, we take that insulin into consideration with the starting dose of Lantus. With Harley getting up to 4U, starting him back at 1U may be too much of a decrease and just leave him in high numbers longer than necessary while you work your way back up.

You might want to consider starting at 2U instead so you're not wasting a lot of time working up to a dose that will work better for him, especially with his DKA history

@Wendy&Neko ...opinion?

 

[Beck and Philly]

I worry a little about mirtazipiene for picky eating. I've always been told to use it sparingly as a last resort if the animal has no appetite. If your kitty is willing to eat, I wonder if it is better to save the mirt?

 

[Sienne and Gabby (GA)]

I'm going to be a worry wort. When was the last episode of DKA?

Given the seriousness of ketones, let alone DKA, we treat cats who have recently recovered fairly aggressively. Ketones develop as a result of infection/inflammation, not enough insulin, and not eating. Some cats can be prone to developing ketones especially if they have been through a recent episode.

I'm concerned about ketones since you mentioned that Harley's appetite is off. I would also not be leaning toward dropping his insulin dose until you can test for ketones on a very regular basis. It does look like you're testing but I would suggest testing at least daily, if not more, especially if you are using urine test strips.

I do not have any concerns about using mirtazepine especially in a post-DKA kitty. It's critical that your cat eats.

It looks like you are continuing to feed Harley dry food. Is that any chance he can be transitioned over to an entirely canned food diet? If your kitty is on dry food, your options for a dosing method are constrained to Start Low Go Slow although it may be a moot point if ketones are an issue.

 

[Wendy&Neko]

I agree with Sienne, I would not start back at the beginning dose, especially with recent DKA history.

If mirtazapine works, keep using it. If you are concerned about side effects, the transdermal form absorbs more slowly and doesn't have the same side effects.

 

[Harley Baby & Michele]

Thank you everyone for your answers and concerns. I'll try to address all. I think I tend to delete bad news from my memory as I can not remember details of Harleys history!
1. I may split the difference and start @ 1.5 units. Then take it from there. That would be the recommended dose for his ideal weight anyway. That is if I go TR route. I will decide by end of week based on his appetite. I suppose.
2. Mirtazapine: He has been on it about 6 months or so. He never had any side effects. I did read that it is an antidepressant in humans and needs to slowly be tapered off. I feel better keeping him on it since he does continue to have his "picky days".
3. History/Diet: About one year ago he had a dental cleaning with 2 teeth removed. His glucose was "slightly elevated" and attributed to stress. About 6 months later back in for weight loss and poor appetite. Again glucose slightly elevated, attributed to stress, not bad enough to start insulin. My Doc gave me a case of Purina DM. All the cats refused to eat it. That is when I first found Dr Lisa's dietary recommendations. Started Fancy Feast Classic Pate. I added Dr Elsy's Dry Chicken Food. I also bought a case of his canned and unfortunately none of the cats liked it?! I do free feed the dry food but Harley never eats it. I tried using it as a treat and he turns away. I need to leave dry down as the other cats refuse to eat enough canned to sustain them. ( maybe 2 oz each)
4. DKA: first episode sometime in mid May I think. (again I blacked out) He stayed 2 days and nights for hydration and insulin. Still did not start insulin as apparently his glucose was staying to low. I continued SQ fluids at home for about 1 week. Poor appetite. 2nd DKA May 31. Stayed the day for insulin and fluids. Home for SQ fluids, not eating. Started insulin 6/1. His appetite picked up over few days …….and I found this Forum!
5. I do have Keto-diastix and check daily. I just don't post it. Ketones remain negative. I have a book with daily details!

Harley no longer has a voracious appetite and stopped constantly yelling for food, standing in the kitchen. Water intake better. For a while the water bowel was empty in the morning. He has gained a bit of weight so I assume the insulin is doing its job. What is weird, when he won't eat the cat food he crawls on me trying to eat human food. Maybe he gets bored? I have added Fancy Feast and Paws Happy Life pate to mix it up a bit.

Again, Thank you for the support and assistance. I will be back!

 

[Sienne and Gabby (GA)]

I am VERY relieved that you're testing for ketones. Frankly, I don't know how your vet could not start insulin for a cat that is producing ketones. Just so you have the information handy, any ketone level that is over "trace" is when we strongly encourage you to get your cat seen by a vet. Ketones that are able to be testing in the urine appear later than if you were testing ketones in the blood. That's one reason we are careful about ketones given how serious they can be.

 

[Harley Baby & Michele]

Hi Sienne. Yes, looking back now and reading info on this site I am also surprised we did not start insulin sooner. Maybe hyper cautious due to lower glucose readings with Vet after first DKA episode. Who knows. Keep plowing ahead as best we can I guess.

 

[Jill & Alex (GA)]

I was planning to use TR protocol with a starting dose of 1 unit based on current weight.

1. I may split the difference and start @ 1.5 units. Then take it from there. That would be the recommended dose for his ideal weight anyway. That is if I go TR route.

From the TR Protocol
STARTING DOSE:
The weight based formula for determining a starting dose of glargine or detemir when following the Tight Regulation Protocol:

• the formula is 0.25 unit per kg of the cat's ideal weight
• if kitty is underweight, the formula frequently used is 0.25 unit per kg of kitty's actual weight
• if the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration <---- emphasis mine

From the Start low, Go slow method
Starting Dose:

• 1u BID if kitty is not on a wet/canned low carb diet
• 0.5u BID if kitty has been switched to a wet/canned low carb diet
• If the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration <---- emphasis mine
• Generally, shots are to be given 12 hours apart.

Harley falls in the third category in both methods. With Harley's history of DKA and considering data accumulated to date, I urge you to reconsider a starting dose with Lantus. If you're able to test often, I don't think I'd start Lantus with anything less than 2u bid... and I'm not sure that will be enough.

No matter what you decide, I encourage you to test for ketones and post often. If the starting dose is too low and/or Harley throws as little as "Trace" ketones... advice may change. Fast-tracking may be suggested, but let's cross that bridge if we come to it.

Good luck with the switch to Lantus!

 

[Tanya and Ducia]

I do have Keto-diastix and check daily. I just don't post it. Ketones remain negative.

Yay! - on negative for ketones!

Since you are using Keto Dia Stix - are they Bayer's? - why not also record the Glucose in Urine reads in the SS? It's the same stick you are using for the ketone's detection.

The Bayer Keto Diastix that I use reads both -the ketones presence (dip and count' till 15 sec) and the level of Glucose in Urine (count to 30 sec on the same testing pad) . Do yo u have the same?
I'd rather record the reads in your SS because people will keep asking if you do test for ketones.
On the other hand testing the glucose level in urine - knowing at what BG he starts leaking the glucose into the urine - will help you with determining his "better not to go above" BG level and to adjust his dose accordingly.

I hope Lantus works well for your boy!
I, too, order Lantus from Canada - nothing but gratitude for this great product from all of us here!
Best of luck with Lantus!

 

[Harley Baby & Michele]

I need an intervention. I am addicted to the Forum!! Must clean house, must do work, must get my as* off the couch! This is worse than gaming!

Anyway: Thank you for the help. I will use the TR protocol and start at 2 units. I am home all weekend so can monitor closely. My hours during the week are also flexible so can continue to monitor. I have my hypo supplies ready. I printed out both protocols and highlighted an awful lot.

Yes, I have the Bayer product for Ketones. I will post results.

I ordered from Mark's Marine. 20 minutes after leaving the Vet the Rx was calling me to get shipping info. Very helpful as I had concerns shipping in the heat; I did order the extra insulator.

Will chat more on Friday with updates!

 

[C&C]

Yay! - on negative for ketones!

Since you are using Keto Dia Stix - are they Bayer's? - why not also record the Glucose in Urine reads in the SS? It's the same stick you are using for the ketone's detection.

The Bayer Keto Diastix that I use reads both -the ketones presence (dip and count' till 15 sec) and the level of Glucose in Urine (count to 30 sec on the same testing pad) . Do yo u have the same?
I'd rather record the reads in your SS because people will keep asking if you do test for ketones.
On the other hand testing the glucose level in urine - knowing at what BG he starts leaking the glucose into the urine - will help you with determining his "better not to go above" BG level and to adjust his dose accordingly.

I hope Lantus works well for your boy!
I, too, order Lantus from Canada - nothing but gratitude for this great product from all of us here!
Best of luck with Lantus!

Hi--I just started using the urine strips but its been tough to get a same time reading. So the idea is that cats shouldn't have glucose in their pee..is that correct? What level is normal then? If it reads negative for the glucose then that is a sign that the level of insulin is too high? My cat started out at 3+(from lab tests ) and sometimes shows 2+ as the reading doesn't have a 3+ I have gotten some 1+ and a few lower readings too. We had her at 1.0 insulin twice daily but due to her blood work vet wants us to increase to 1.5 so we are checking the urine as we slowly increase her to that level. Any knowledge you can share on what this all means and the best times to try to do it would be appreciated.

 

[Tanya and Ducia]

Hi--I just started using the urine strips but its been tough to get a same time reading. So the idea is that cats shouldn't have glucose in their pee..is that correct? What level is normal then? If it reads negative for the glucose then that is a sign that the level of insulin is too high? My cat started out at 3+(from lab tests ) and sometimes shows 2+ as the reading doesn't have a 3+ I have gotten some 1+ and a few lower readings too. We had her at 1.0 insulin twice daily but due to her blood work vet wants us to increase to 1.5 so we are checking the urine as we slowly increase her to that level. Any knowledge you can share on what this all means and the best times to try to do it would be appreciated.

Hi there,
sorry for the late response but I do no log in every day. Time of urine testing is not as important as just having it done. Your goal is to see no glucose in their urine at all.

I just started using the urine strips but its been tough to get a same time reading. So the idea is that cats shouldn't have glucose in their pee..is that correct? What level is normal then?

It is correct that cat's should not have any glucose in their urine. The norm is Negative glucose in urine (and low in their bloodstream, too).
To avoid it, one adjusts the insulin dose accordingly.
How one does it depends on the insulin in use and, of course, on the cat in question.

If it reads negative for the glucose then that is a sign that the level of insulin is too high?

No, it does not mean that the insulin dose is too high.
Rather, if you cat does not spill glucose into it's urine then that level of BG is to be maintained by adjusting the dose.

Unless you have a Spreadsheet that tracks your cat's BG levels/ current dose it is hard to form an opinion.(SS like one I have in my Signature - Ducia SS below my post) as what the current dose does for your cat.

If you need help with the Spreadsheet starting please let us know, someone can help.