Dosing Lantus

[TinaBobina]

Hi all,

Mom to a newly diagnosed diabetic cat. It's been about a month and a half and it's been a journey already.

I have a very specific question about dosing. I'm currently giving him 2 shots a day and 3 units per shot.

His numbers during the day do not drop very much (5 am pre shot number 430, nadir around noon 356), but during his second cycle, his numbers drop dramatically (5 pm pre shot 433, it is now 9:30 pm, still 2 and half hours before reaching nadir and his BG is already down to 120)

Is this normal? Would it make more sense to up the morning dose to 3.5 and lower the evening dose to 2.5?

Please advise. Every night I'm on edge, I can't sleep until I see his numbers are going up which isn't sometimes until 2 am. I need some stability and reassurance.

Also wanted to mention that I am using a Freestyle Libre to monitor his BG which has been amazing, since its been very hard for me to get a blood draw, but the Libre only lasts 14 days and I can't maintain the cost to keep one on him at all times, so any advice on how to draw blood on a squirmy uncooperative cat 4 times a day would be great.

Thank you.

Tina

 

[Librarianista]

Welcome!

To answer your specific question, generally Lantus needs to be dosed the same amount twice a day. It works best when it is consistent. Cats generally run lower at night. We don’t have the science to prove that - just years of empirical and anecdotal evidence.

Did your vet start you out at 3 units or did you increase to that? Sometimes cats’ bodies react to too much insulin in a way that makes it look like they aren’t getting enough. Generally the starting dose is .5 or 1 unit. And changes are done in increments of .25U.

It will also be very helpful for us if you set up a spreadsheet and your signature. I’m currently on my phone so I will post those links separately.

 

[Librarianista]

Here’s how to edit your signature:
https://www.felinediabetes.com/FDMB/threads/editing-your-signature-profile-and-preferences.130340/

Here’s how to setup and use the spreadsheet:
https://www.felinediabetes.com/FDMB/forums/spreadsheets-tech-support-testing-area.6/

Here’s the index to most of the getting started questions, including testing BG tips:
https://www.felinediabetes.com/FDMB/threads/index-health-links-faqs.194624/

As far as testing goes, since you have the Libre on, it’s a great opportunity for you to ease your cat into the process and take it slow. Every time he lets you pet and manipulate his ears, give a treat. If you’re using a lancing device, click it near the ears and give a treat so he isn’t freaked out by the sound. Warming the ear first with some good rubbing or holding a sock filled with rice warmed in the microwave for 20 seconds helps get the blood flowing. Give a treat if you attempt that even without the lancets. Whenever you prick the ear, give a treat, even if you don’t get enough blood for a test. You want to associate all parts of the process with a reward and something pleasurable. Many cats acclimate to the process really well and get into the swing of things.

 

[TinaBobina]

Welcome!

To answer your specific question, generally Lantus needs to be dosed the same amount twice a day. It works best when it is consistent. Cats generally run lower at night. We don’t have the science to prove that - just years of empirical and anecdotal evidence.

Did your vet start you out at 3 units or did you increase to that? Sometimes cats’ bodies react to too much insulin in a way that makes it look like they aren’t getting enough. Generally the starting dose is .5 or 1 unit. And changes are done in increments of .25U.

It will also be very helpful for us if you set up a spreadsheet and your signature. I’m currently on my phone so I will post those links separately.

Vet started him on 1 unit and then jumped to 2 units, 2.5 and now 3. Sounds to me like she rushed the doses. I will stick to 3. His current BG at 11 pm is 106 and it's close to the time where he's at his lowest so I feel like I'm over the hump.

"Cats generally run lower at night. We don’t have the science to prove that - just years of empirical and anecdotal evidence." These bits of information that you just don't know until you stumble upon a message board with a wealth of experience and wisdom. Thank you for that.

I will set up the worksheet over the next few days.

Thank you so much!

 

[Librarianista]

3 might be too much, but I am not an expert in that area.

What are you feeding? That will also make a big difference in how much insulin your cat needs.

 

[TinaBobina]

2 cans of fancy feast wet food a day 5 am/5pm and hills glucose support dry food as supplemental or freeze dried grain free stella and chewy morsels. it just depends on what he'll eat, picky like most cats. All grain free though.

Why do you think 3 is too much and what would you suggest I do? You may not be an "expert", but neither are vets. They know a little bit of everything, and honestly I trust people that have experience over a degree. I love my vet, but she's not a specialist in diabetes and it always feels like a guessing game.

 

[Librarianista]

I have fairly limited experience - there are members here with years more knowledge, and I hope they will chime in, too.

Fancy Feast is good. The dry is probably not. Grain-free does not mean carb-free. It’s often filled with starches like potatoes that aren’t technically grains. There are only 3 brands of low carb dry food, all of which I think will send samples if you contact the company and it’s about the same price as prescription food:
Young Again
Dr. Elsey’s
Wysong Epigen 90

Any changes in food should be done, slowly though, since cutting out carbs will definitely reduce the blood sugar and you will likely need to observe closely and reduce insulin to match.

I personally leave wet food out for my cat all day. You can add water to it to keep it moister longer if your cats don’t mind that texture. Some people also freeze it in ice cube trays and then it’s thawed later in the day instead of dried out.

Lantus takes 5-7 days to build up in a cat’s system. If the dose increases happened on a faster pace than that, the body wasn’t really getting used to the current dose. 3 sounds high to me this early on, but also cats need the amount they need, and it might be fine. If there were several days between increases and you were getting readings all the while, it might be what your cat needs right now.

Once you have your spreadsheet setup and any data you have filled in, we’ll be able to better help you recognize BG patterns and what to look for to indicate whether a dose is working or needs to be adjusted.

The first few weeks after I found this forum were the hardest. I was doing my best to manage diet and insulin changes and get as much information in my spreadsheet as possible. It was awful and my sleep habits were terrible. But it gets better! That knowledge gathering helps me now to recognize Chloe’s patterns and more or less what to expect. And middle of the night tests are much rarer.

 

[TinaBobina]

Thank you so much. This has been enlightening. 5-7 days, ok I didn't know that either, the dose changes happened at a decent pace and his numbers actually started lower than they are now, which is another oddity. He was in the 200-300 range for the first 2 weeks on 1 unit and then his numbers got a little higher and the dose increased as the number did. So confusing.

The dry food, is prescription that I bought from my vet, but we can do without it. It's only been a week since I introduced it to his diet. I was feeding him strictly wet since the diagnosis, but my vet suggested I add the dry food as supplemental because he wasn't always finish his wet food. I think I need to trust my own intuition a little more and stick with the original plan of only wet.

I will definitely get my spreadsheet up soon, sounds like an invaluable tool.

 

[TinaBobina]

One last question (for now) I took a peek at your spreadsheet and I see some of the numbers are in the 60s. Is that still normal range? I've read confusing and conflicting info - at what BG level is hypoglycemia probable?

 

[Bandit's Mom]

The dry food, is prescription that I bought from my vet, but we can do without it. It's only been a week since I introduced it to his diet. I was feeding him strictly wet since the diagnosis, but my vet suggested I add the dry food as supplemental because he wasn't always finish his wet food. I think I need to trust my own intuition a little more and stick with the original plan of only wet.

Most of us feed small meals through the day and night. Maybe you could try spreading out the fancy feast into smaller meals and see if he eats better? Diabetic cats cannot process their food and smaller meals are easier on the pancreas.

One last question (for now) I took a peak at your spreadsheet and I see some of the numbers are in the 60s. Is that still normal range? I've read confusing and conflicting info - at what BG level is hypoglycemia probable?

The normal range for blood sugar for a cat on a human meter is 50-100. Chloe's is actually one of the cats who switched from prescription kibble to low carb FF and her dose dropped from 3U to 1.5U.

These are the dosing protocols we follow here: Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)

Sharing a post authored by a senior member on testing : https://www.felinediabetes.com/FDMB/threads/9-9-bailey-amps-117-5-62.252712/#post-2851043
Here are Hometesting Links and Shooting Tips

I can help you with setting up your spreadsheet and signature. Won't take me a minute. Let me know

 

[Librarianista]

One last question (for now) I took a peek at your spreadsheet and I see some of the numbers are in the 60s. Is that still normal range? I've read confusing and conflicting info - at what BG level is hypoglycemia probable?

This depends on whether the meter is a human or a pet one. We call this a “Take Action” number - they are not having a hypo event, but you need to do something to prevent one.

On a human meter like the Libre, it’s 50. On a pet meter, it’s 68.

The first time I saw 60s and 70s after seeing reds and blacks, I was utterly freaked. But those are normal, healthy, and SAFE numbers, and they are the ultimate goal. Now if she crests 100, I get disappointed.

Ask away! It’s what we are here for!

 

[Librarianista]

Thank you so much. This has been enlightening. 5-7 days, ok I didn't know that either, the dose changes happened at a decent pace and his numbers actually started lower than they are now, which is another oddity. He was in the 200-300 range for the first 2 weeks on 1 unit and then his numbers got a little higher and the dose increased as the number did. So confusing.

This makes me wonder if the dose is too high. I don’t know the reasons behind it, but too much insulin in the system can also make BGs skyrocket, like his body is trying to overcompensate. 1U may not have been enough, but you maybe missed the optimum dose by increasing on your vet’s advice.

Glad your spreadsheet will be up and running soon. It’s such a useful tool, and I was already a data nerd. We try to advise here based on data, so don’t be surprised if a lot of the advice you get is going to be “get more tests” in the beginning. We also want the best for you and your cat, and numbers are the best we can go on from a distance.

 

[Wendy&Neko]

but too much insulin in the system can also make BGs skyrocket

A clarification. If 3 units is too much, you may see higher numbers, but you'll also see him drop low. Since you have the Libre on, you won't be missing any lows that tell you the dose is too high. It could be the glyco support dry is what is causing him to run higher and the times he eats the Stella and Chewy's are when you see lower numbers. Worth keeping track of what he eats when, and see if you see a correlation. If you completely remove the dry, his insulin needs could drop quickly, so do the food change slowly.