? Gnocchi 7/20 AMPS - 645, +3 623, +6 645. New to Lantus and have questions!

H

Hubert

Member Since 2020
My cat Gnocchi was diagnosed with diabetes last year but had been symptomatic for a long time with increased thirst, hunger, and urination. He's my family cat but my parents could not keep up with giving him insulin or with the amount he was urinating (up to 10-12 times a day) and I took over his care.

He was previously on vetsulin and PZI (up to 5 units twice a day!) before vet suggested that he was insulin resistant and recommended we switch to Lantus.

Back in May he had an episode of pancreatitis and now gets sub-Q fluids everyday.

So far it does not seem as if the insulin is having any great effect. I've titrated him up from 2 units all the way up to his current dose of 5 beginning at first with full units (I only had a Lantus pen) and now in 0.5 unit increments (using syringes for the Lantus pen).

I have been feeding him an exclusively wet food diet and he gets 3 cans of Against the Grain Chicken which has 0% carbs.

As you can see from his spreadsheet, his sugars are very high, often times in the 600 range even on insulin. His sugars have been somewhat lower in the evening. I was super excited that he had a BG below 400 last night. I have just started testing him for ketones which have been negative to date.

Clinically, he remains voracious, drinks, and urinates often. He has started to walk on his hocks and his backfeet are sometimes contorted in uncomfortable looking ways. I have started giving him zobaline to help with the neuropathy.

Should I get him worked up for a secondary cause of insulin resistance? His insulin dose is already higher than I am comfortable with. In the meanwhile, I plan on increasing his insulin dose to 5.5 units twice a day as 5 does not seem to be doing the trick.

Any suggestions for help would be greatly appreciated.
 
Popping in to say hi!!! Just helping with another kitty right now. I'm sure that someone will be by shortly to see if they can answer your questions :bighug:

LOVE the name Gnoccihi!
 
Hi! Are you able to make Gnocchi's spreadsheet viewable by others who have the link? It should be in the settings. Thanks!!!
 
I'm not a TR expert, and I'm sure that others will be able to comment more now that the SS is viewable. I have a few questions that might help the experts answer, if that's ok? :)

What was the most recent insulin before Lantus? How long was Gnocchi on that one? And do you have any data from that time? Or were the numbers pretty much the same? (trying to help others who have made a similar switch see if the starting dose made sense?)
When did you make the switch to Lantus? From the SS, it seems like in early August?

A note on the general guidelines for TR:
General Guidelines:
  • Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
  • Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
  • Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.
Click to expand...

Lantus is a depot insulin, so it needs some time for the depot to fill. I'm curious to learn their thoughts on how long to hold the doses in your case. :bookworm:

Again, I'm not an expert, but there are many who have lots of experience with switching insulins and also high dose kitties. Bumping your post for them to see it.

@Wendy&Neko @Bron and Sheba (GA)
 
thebigfuzz said:
I'm not a TR expert, and I'm sure that others will be able to comment more now that the SS is viewable. I have a few questions that might help the experts answer, if that's ok? :)

What was the most recent insulin before Lantus? How long was Gnocchi on that one? And do you have any data from that time? Or were the numbers pretty much the same? (trying to help others who have made a similar switch see if the starting dose made sense?)
When did you make the switch to Lantus? From the SS, it seems like in early August?

A note on the general guidelines for TR:


Lantus is a depot insulin, so it needs some time for the depot to fill. I'm curious to learn their thoughts on how long to hold the doses in your case. :bookworm:

Again, I'm not an expert, but there are many who have lots of experience with switching insulins and also high dose kitties. Bumping your post for them to see it.

@Wendy&Neko @Bron and Sheba (GA)
Click to expand...
His most recent insulin prior to Lantus was PZI. He was on this insulin for at least 4-5 months. Unfortunately, we did not measure his BG while he was on PZI or vetsulin outside of random checks during occasional vet visits. He was usually in the 500 range during these times. I am trying to rectify this with regular BG checks at a minimum pre-shot.

We made the switch to Lantus the day before the beginning of this spread sheet. So effectively he's been receiving it since August 2nd.
 
I forgot to mention, but if you would like to draw some attention to your thread, you can edit your thread title and choose the question mark '?' from the drop down menu and then in the text - you can type 'new to lantus, questions' at the end of your BG numbers. For those who skim the posts looking for where they can be most useful, this is the best way to have question answered :)
 
thebigfuzz said:
I forgot to mention, but if you would like to draw some attention to your thread, you can edit your thread title and choose the question mark '?' from the drop down menu and then in the text - you can type 'new to lantus, questions' at the end of your BG numbers. For those who skim the posts looking for where they can be most useful, this is the best way to have question answered :)
Click to expand...

Thanks for the recommendation. Have changed the title to reflect this.
 
Perfect! I've tagged a few people as well. If you don't get a response in a few hours...you can bump your post to the top again. Nice to meet you and Gnocchi!
 
Hello and welcome to Lantus and the forum here. To start out, if you haven't already, I'd really all the yellow starred Sticky notes at the top of this forum. And keep asking questions, we love to help here.

Looks like you might have a super sweet kitty.
Hubert said:
Should I get him worked up for a secondary cause of insulin resistance? His insulin dose is already higher than I am comfortable with. In the meanwhile, I plan on increasing his insulin dose to 5.5 units twice a day as 5 does not seem to be doing the trick.
Click to expand...
Wouldn't hurt to get the tests. When people get to 6 units, we suggest they get their cat tested for acromegaly (a benign tumour on the pituitary that send out excess growth hormone) and IAA or insulin auto antibodies. Think of it like an allergic reaction to injected insulin. My girl had both conditions. The tests are blood draws, both send to Michigan State University, provided you are in North America. Although I said 6 units as the guideline, there is no harm in testing earlier. We've had cats with both conditions on lower doses, just above 6 the chances are really good there is a secondary condition going on. And with his numbers as is, I don't think he's going to be regulated with just 1 more unit.

Cats with one or more of these conditions can need higher doses. My girl got up to 8.75 units, some need a lot more. The saying is "a cat needs however much insulin they need". I think you are good to increase to 5.5 units. Next time, you can increase sooner. As long as you aren't seeing anything below 300, you shouldn't be holding the dose longer than 6 cycles or three days with TR. We want to get him into better numbers as soon as possible. Do you think it'll be possible for your schedule to get a second test each and every cycle?
 
Wendy&Neko said:
Hello and welcome to Lantus and the forum here. To start out, if you haven't already, I'd really all the yellow starred Sticky notes at the top of this forum. And keep asking questions, we love to help here.

Looks like you might have a super sweet kitty.

Wouldn't hurt to get the tests. When people get to 6 units, we suggest they get their cat tested for acromegaly (a benign tumour on the pituitary that send out excess growth hormone) and IAA or insulin auto antibodies. Think of it like an allergic reaction to injected insulin. My girl had both conditions. The tests are blood draws, both send to Michigan State University, provided you are in North America. Although I said 6 units as the guideline, there is no harm in testing earlier. We've had cats with both conditions on lower doses, just above 6 the chances are really good there is a secondary condition going on. And with his numbers as is, I don't think he's going to be regulated with just 1 more unit.

Cats with one or more of these conditions can need higher doses. My girl got up to 8.75 units, some need a lot more. The saying is "a cat needs however much insulin they need". I think you are good to increase to 5.5 units. Next time, you can increase sooner. As long as you aren't seeing anything below 300, you shouldn't be holding the dose longer than 6 cycles or three days with TR. We want to get him into better numbers as soon as possible. Do you think it'll be possible for your schedule to get a second test each and every cycle?
Click to expand...

Thanks for the reply. I will bump his insulin up to 5.5 with the next cycle.

I can definitely get second tests for the evening cycles. It will be more difficult for the mornings as I work. But I'm close enough that I could pop away at lunch and test 6 hours after the injection.

I'm going to make a vet appointment to see if we can get these tests for IAA done. I'm a student so budget is somewhat of an issue. But this cat has been in my family over a decade so he's worth it.
 
Don't forget the test for acromegaly too - it's more common. One in four diabetic cats has it. The test is called the IGF-1 test (insulin growth factor 1).

Even tests like a +2 or a +10 can give clues what is happening on the cycle - if you can't get a +6 some days. Not all cats nadir at +6 anyway.
 
Hubert said:
I'm a student so budget is somewhat of an issue
Click to expand...
I see you are using Alphatrak meter and test strips. Most on this forum use human meters and test strips due to the high expense of Alphatrak. My vet didn't realize that each Alphatrak strip was about $2.00 each! I started out with the Alphatrak and switched over and have been using human meter/strips ever since. Most of the number guidelines on this forum are geared to human meters anyways. You will find that the strips can end up being the biggest cost to this whole feline diabetes thing so depending on where you live, members can give you recommendations on monitors/strips to help keep the costs down. Every little bit helps.
 
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