? Dosing advice, please

[Sara and Mr. Kitty]

Good morning everyone! Mr. Kitty’s out of remission and has his first vet visit today to get an insulin prescription. I’m taking him to a new vet who seems to understand the sugar dance more than his previous doctor and I’m leaning towards Lantus or another depot insulin. Can anyone help me on what dose we should start at? I know there is a calculation based on weight, but since Lantus is new for us, and I would prefer SLGS, I’m not sure and want to be sure BG pre-breakfast was 391 and he’s 18 pounds, so I calculated 2U - does that sound right? I haven’t been testing him as much lately mainly because I know he needs insulin since his numbers have been high for the last 10 days even with low carb wet and a little Zero Mature here and there, so our spreadsheet is kinda scarce, but the old data is still there from when we used Vetsulin. Thank you!!

 

[AmandaE]

Good Morning!

So sorry to hear Mr Kitty is out of remission. Good thing you caught it early! you're awesome

If you're interested in SLGS the following starting dose information would apply (from the TR /SLGS Sticky)
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
• Generally, shots are to be given 12 hours apart.

I only have experience with Lantus although many members love Levemir for their kitties too. One important thing to know about a depot style insulin like Lantus is that the dosage amount is based on the nadir of kitties curve, when you change the dose depends on the method you follow if you want to follow SLGS you hold your starting dose for a week, if kitty has a number below 90 at any point during that week he qualifies for a 0.25u reduction immediately. At the end of the week do a 12 hour curve, and hold, increase, or reduce as below:

• If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
• If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
• If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

Another major difference between vetsulin and Lantus is that Lantus is a u100 insulin not a u40, this means you cant use the same syringes as you would have with vetsulin. We use u100 syringes with 0.5u markings and 8mm needle (needle size is personal preference), you can get the relion brand at walmart. We use the smaller markings for help with fine dosing since we increase or decrease dosage by 0.25u at a time

For Lantus a lot of members here prefer to get the Lantus pens instead of the vial, they come in a set of 5 x 3ml pens. We like these because you only have to use one at a time, they aren't breakable, and you don't risk contamination / loss of efficacy in all of the pens at once when you use them. This means that you basically purchase a years worth of insulin in one go. We use the pens as if they were a vial, when you take the cap off of them you will see it has a similar top to a vial that you can draw insulin from using a u100 syringe. Some people here order their insulin from Marks Marine Pharmacy in Canada since it is more affordable than buying in the states. One cool thing about Lantus is that if you keep it in the fridge it will keep its efficacy until you basically use it all, it doesn't lose efficacy after 28 days like it says on the box

One more thing to consider is that all dosing advice for Lantus is written for a human meter. I see you are using an alpha track, you can continue with your alpha track if you want to but human meter strips are much cheaper and all the guidelines here are written for them, if you want to stick with the AT I will try and think of who to tag to provide guidance on the dosing protocol numbers to use for increases or reductions.

Ask lots of questions, everyone here is awesome and will help you if we can

 

[Marje and Gracie]

Levemir is an excellent insulin, as well, as long as you understand the cycles are different. Onset is typically around +4 instead of +2 and nadir is +8 - +12. I really love it over Lantus because Gracie’s overall curve generally stayed lower, she bounced a little less, and with the nadir at +12 (which she usually was), it gave me a little more time before onset if she was lower or, more frequently, she just stayed flatter and got better overlap and carryover.

The starting dose for Lev (or any insulin) is the same if you are using SLGS.

 

[Sara and Mr. Kitty]

Good Morning!

So sorry to hear Mr Kitty is out of remission. Good thing you caught it early! you're awesome

If you're interested in SLGS the following starting dose information would apply (from the TR /SLGS Sticky)
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
• Generally, shots are to be given 12 hours apart.

I only have experience with Lantus although many members love Levemir for their kitties too. One important thing to know about a depot style insulin like Lantus is that the dosage amount is based on the nadir of kitties curve, when you change the dose depends on the method you follow if you want to follow SLGS you hold your starting dose for a week, if kitty has a number below 90 at any point during that week he qualifies for a 0.25u reduction immediately. At the end of the week do a 12 hour curve, and hold, increase, or reduce as below:

• If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
• If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
• If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

Another major difference between vetsulin and Lantus is that Lantus is a u100 insulin not a u40, this means you cant use the same syringes as you would have with vetsulin. We use u100 syringes with 0.5u markings and 8mm needle (needle size is personal preference), you can get the relion brand at walmart. We use the smaller markings for help with fine dosing since we increase or decrease dosage by 0.25u at a time

For Lantus a lot of members here prefer to get the Lantus pens instead of the vial, they come in a set of 5 x 3ml pens. We like these because you only have to use one at a time, they aren't breakable, and you don't risk contamination / loss of efficacy in all of the pens at once when you use them. This means that you basically purchase a years worth of insulin in one go. We use the pens as if they were a vial, when you take the cap off of them you will see it has a similar top to a vial that you can draw insulin from using a u100 syringe. Some people here order their insulin from Marks Marine Pharmacy in Canada since it is more affordable than buying in the states. One cool thing about Lantus is that if you keep it in the fridge it will keep its efficacy until you basically use it all, it doesn't lose efficacy after 28 days like it says on the box

One more thing to consider is that all dosing advice for Lantus is written for a human meter. I see you are using an alpha track, you can continue with your alpha track if you want to but human meter strips are much cheaper and all the guidelines here are written for them, if you want to stick with the AT I will try and think of who to tag to provide guidance on the dosing protocol numbers to use for increases or reductions.

Ask lots of questions, everyone here is awesome and will help you if we can

Thank you for all of this information! We think Mr. Kitty may have had a bit of IBD/pancreatitis like my other kitty did since we tried to switch from Zero Mature to Dr. Elsey’s. Sigh. What was I thinking!!??! We are waiting on further testing to confirm before starting insulin, which is quite a relief, because his BG right before the vet was 391 then at the vet it was 231 and then 261 - I wondered if my test strips were bad or if the tester needed recalibrated because my numbers were way higher!! We’re going to retest with the alpha trak and the new relion I bought today before his diner to compare.

 

[Sue and Luci]

Welcome to the forum! You're in the right place to treat Mr. Kitty! It's a great group - lots of support and a little humor now and then too.

Try to read the stickies - especially the first one about getting started - tons of information - welcome!

 

[AmandaE]

Thank you for all of this information! We think Mr. Kitty may have had a bit of IBD/pancreatitis like my other kitty did since we tried to switch from Zero Mature to Dr. Elsey’s. Sigh. What was I thinking!!??! We are waiting on further testing to confirm before starting insulin, which is quite a relief, because his BG right before the vet was 391 then at the vet it was 231 and then 261 - I wondered if my test strips were bad or if the tester needed recalibrated because my numbers were way higher!! We’re going to retest with the alpha trak and the new relion I bought today before his diner to compare.

I hope Mr Kitty feels better soon!! I’m sure he will I also hope you get a positive report from the vet

Since you’ve been here before you probably already know this but just in case: readings between human meters and alpha track meters vary greatly, you’ll drive yourself crazy trying to come to a conclusion about a relationship between readings from the two. They especially vary at higher numbers. That’s why we use two spreadsheets on the site