Lantus not working!

Kathy v

Kathy v

Member Since 2026
My sweet baby , Bob, was diagnosed with diabetes on April 13 and immediately started on Lantus. He is only 6 years old. I haven’t been able to get him out of the 300s even with slow adjustments. He is now on 2.5 units twice a day. Initially his symptoms subsided greatly but now they are back, urination, thirst. I have been doing a curve every 4-5 days and no real progress. I don’t want to give up on Lantus because I have read it is the gold standard, but it’s been 2 1/2 months and I’m getting scared. Any suggestions?
 
Hi Kathy, Sorry to hear you're struggling to get Bob's numbers down. Do you have a spreadsheet you can share so that folks can see how the numbers have been going? Also, don't be surprised if your post gets moved to the main forum; the moderators prefer people to post there first.
 
Kathy v said:
How do I move it to the main forum? I need help! Please.
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It's okay--you don't need to move it (actually you can't). I just wanted to mention it in case they do move it. Are you keeping up with Bob's numbers on a spreadsheet? I know when someone more experienced pops in here they are going to ask you about that, so I wanted to go ahead and get that information gathered for them.
 
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And if you don't have a spreadsheet, that's okay too. We'll get you set up with one so that you can track his numbers (whether you stay on the forum or not). We're very data driven here on the forum, and the spreadsheets give us a picture of daily bg numbers along with increases/decreases. That information is essential in order to identify issues and offer guidance, if necessary.
 
Mary & Jude said:
And if you don't have a spreadsheet, that's okay too. We'll get you set up with one so that you can track his numbers (whether you stay on the forum or not). We're very data driven here on the forum, and the spreadsheets give us a picture of daily bg numbers along with increases/decreases. That information is essential in order to identify issues and offer guidance, if necessary.
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I don’t have one but I would greatly appreciate it if you can help me with that. I have all of his numbers written down very accurately so I have the information but not a spreadsheet. Please help me. I feel like every day that goes by more damage is being done because I can’t regulate him.
 
Hello and welcome. Some cats need larger doses of insulin. 2.5 units isn't very large. My girl got up to 8.75 units of Lantus. Once we see your spreadsheet data, we'll be able to help you more on dosing. Tagging @Marje and Gracie to help, though she has a big volunteer gig on Saturdays so it might take a minute to get to you.

In the meantime, I recommend you read the yellow starred Sticky Notes at the top of this forum: Lantus / Levemir / Biosimilars. If you want our help with dosing we'll need you to eventually decide which dosing method you want to use. They are described in one of those Sticky Notes.

A few questions from me, how did you figure out he needed to see the vet? What symptoms was he showing? Does he have any other medical conditions?

And most important, what food are you feeding him?
 
Kathy v said:
I don’t have one but I would greatly appreciate it if you can help me with that. I have all of his numbers written down very accurately so I have the information but not a spreadsheet. Please help me. I feel like every day that goes by more damage is being done because I can’t regulate him.
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We will definitely help you with the spreadsheet! I'm going to tag @Marje and Gracie who will be able to set up the spreadsheet for you. She is not always on the forum on Saturday until later in the day, but she'll get to you asap.
 
Wendy&Neko said:
Hello and welcome. Some cats need larger doses of insulin. 2.5 units isn't very large. My girl got up to 8.75 units of Lantus. Once we see your spreadsheet data, we'll be able to help you more on dosing. Tagging @Marje and Gracie to help, though she has a big volunteer gig on Saturdays so it might take a minute to get to you.

In the meantime, I recommend you read the yellow starred Sticky Notes at the top of this forum: Lantus / Levemir / Biosimilars. If you want our help with dosing we'll need you to eventually decide which dosing method you want to use. They are described in one of those Sticky Notes.

A few questions from me, how did you figure out he needed to see the vet? What symptoms was he showing? Does he have any other medical conditions?

And most important, what food are you feeding him?
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He had all the symptoms, large amounts of urine, increased thirst and he lost 6 lbs.
we are feeding him fancy feat pate. And purinompro plan dm dietetic . No other medical conditions.
 
Kathy v said:
He had all the symptoms, large amounts of urine, increased thirst and he lost 6 lbs.
we are feeding him fancy feat pate. And purinompro plan dm dietetic . No other medical conditions.
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I don’t see the yellow starred sticky notes. Where are they?
 
Welcome. I can see your spreadsheet. For some reason the colors are not there. It is important to get at least one test during the night cycle as cats often go lower at night.
 
tiffmaxee said:
Welcome. I can see your spreadsheet. For some reason the colors are not there. It is important to get at least one test during the night cycle as cats often go lower at night.
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By night cycle, do you mean later than 8pm? I am literally at my wits end, so stressed. I have had two diabetics, one cat and one dog and now my good boy ,Bob. The others did well on nph but I have read that that is not a good insulin for cats. Please help. Bob is only 6 years old and my heart is breaking to think it is my incompetence that will cut his life short. I need to get him regulated. I will do another curve tomorrow. I will post the results here. If he is still in the 300s I will increase by 0.5.
 
Kathy, Are you testing Bob before each shot? You should be doing this if you aren't. That's going to tell you what his blood glucose is, and let you know if it is safe to give him a shot. Also, are you shooting at night? Lantus should be administered twice a day, 12 hours apart.

I cannot believe this is your THIRD diabetic animal. I'm so sorry!! I'm not sure why you are concerned about your "incompetence." It appears to me that you are doing everything you possibly can to help Bob, and that is completely competent.
 
Mary & Jude said:
Kathy, Are you testing Bob before each shot? You should be doing this if you aren't. That's going to tell you what his blood glucose is, and let you know if it is safe to give him a shot. Also, are you shooting at night? Lantus should be administered twice a day, 12 hours apart.

I cannot believe this is your THIRD diabetic animal. I'm so sorry!! I'm not sure why you are concerned about your "incompetence." It appears to me that you are doing everything you possibly can to help Bob, and that is completely competent.
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Thank you for your kind words. Yes I am testing him before each shot, he is always in the 300s. I am shooting every 12 hours. Nobody can believe it, not even my vet. I guess I am the chosen one. I feel incompetent because my dog and other cat were regulated pretty quickly. I don’t know what is going wrong this time.
 
Bless you, my friend! I'm not sure why you are the chosen one either, but I hope I'm not ever the chosen one 😜 because feline diabetes is so difficult to treat. One diabetic animal is a gracious plenty for a lifetime.

Okay, so on the spreadsheet, where it has AMPS and PMPS that stands for AM preshot and PM preshot, and that is the preshot number. So when you perform the preshot test, you'll put that number in that cell. Each cell stands for an hour from the preshot number.

I'm going to ask you to take a few minutes to complete your signature and link your spreadsheet in it. Here are the directions: Sticky - New? How You Can Help Us Help You!. Scan down to the section on setting up a signature. This information is super important as people look at your posts.
 
Kathy v said:
By night cycle, do you mean later than 8pm? I am literally at my wits end, so stressed. I have had two diabetics, one cat and one dog and now my good boy ,Bob. The others did well on nph but I have read that that is not a good insulin for cats. Please help. Bob is only 6 years old and my heart is breaking to think it is my incompetence that will cut his life short. I need to get him regulated. I will do another curve tomorrow. I will post the results here. If he is still in the 300s I will increase by 0.5.
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When I looked at your spreadsheet it was blank at night. Unless the +3 is a lot lower than the preshot you won’t need more tests at night. We often say it’s a marathon and not a race. You will get plenty of support here.
 
Kathy v said:
By night cycle, do you mean later than 8pm? I am literally at my wits end, so stressed. I have had two diabetics, one cat and one dog and now my good boy ,Bob. The others did well on nph but I have read that that is not a good insulin for cats. Please help. Bob is only 6 years old and my heart is breaking to think it is my incompetence that will cut his life short. I need to get him regulated. I will do another curve tomorrow. I will post the results here. If he is still in the 300s I will increase by 0.5.
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Hi Kathy! Welcome! You’re getting a lot of really great advice here. I just wanted to say - while it’s incredibly overwhelming at first, there’s so many knowledgeable and supportive people at FDMB. You’re definitely in the right place. While I can’t point to my cat Moonie as we’re still in the process of working towards regulation, there are so many members here whose cats started out with very bad numbers, DKA, and/or multiple ER visits who worked their way towards tight regulation and even remission.

Even for my cat Moonie, in the short time we’ve been following TR, we’ve seen huge improvement. We never used to see a number below 300, much like your kitty, and since then while it’s not consistent, we’ve seen so many blues (below 200) and even greens (below 100).

So please don’t lose hope. Also incompetence is the last word I would use to describe anyone who loves their kitty enough to be overcoming the steep learning curve of feline diabetes and asking questions on this forum.

I hope that you’ll feel welcomed and supported and heard here. This is such a wonderful community where so many people share their knowledge and root for every cat and caregiver.
 
From what I see on the spreadsheet, Bob is seeing some numbers in the 100's. That is great! The Lantus is working. We determine how to change the dose based on the nadirs, or how low Lantus is taking him, not the preshot values. I see by the dates that it looks like you aren't testing every day? Please don't increase the dose again until we can see more data on this dose.
 
Those numbers in the 100s are long gone, that was at the very beginning of this journey. I just fed him and tested him, 365 this morning. I am having a very hard time filling in the spreadsheet, so for now, I will post his numbers in my replies.
 
Bob’s number was 365 this morning. Fed him gave him his shot, 3 units , tested him 3 hours later and his bg was 420!! I am really getting scared. I will test again at 2pm
 
You don't need to test him again later today. He is doing what we call a bounce, because he went lower over night. Here is the description of a bounce:
Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
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I suspect 3 units may be too much insulin. On a regular basis, it would help if you can get more tests in the 4-7 hours time frame after the shot. At night, if you can get a test just before you go to bed, it will help tell you if he's going to go down a lot at night.

With Lantus, a test 2-3 hours after the shot will give you a clue what the rest of the cycle (time between shots) will look like. A test that is higher than the preshot value means a quiet cycle and likely a bounce as is today. If that test shows quite a drop from the preshot value, then it's an active cycle needing either more monitoring or a lot of extra food left out so he can eat to stay safe.
 
I just tested him and his bg is 365. Will this level out at some point? I’m thinking of asking my vet to change him to Novolin N . I know it’s not as long acting but I regulated my other cat on it and he even went into remission. Should I lower his dose on his next shot?
 
Please don't ask for a change to Novolin N. It only lasts about 6 hours in the cat and is a much harsher insulin. It is not recommended for cats. What I do recommend is getting some more mid day or later at night tests and see what is really happening. It is possible he is overdosed on Lantus but we cannot tell without data. If you cannot, for whatever reason, do more testing, you might want to talk to the vet about getting a Freestyle Libre installed which give you test data 24 hours a day for up to two weeks.

With a cat that is bouncing because he is going lower than expected, you can see one cycle with lower numbers, followed by up to six cycles with higher numbers. Which is why we need to see more data to capture data from that one cycle with lower numbers. As above, we determine how to change the dose based on how low it is taking the cat. The preshot tests we do to make sure it is safe to give insulin.
 
But he has never gone low, ever. So how is that considered a bounce if his numbers were never low. I’m so confused.
 
Kathy v said:
But he has never gone low, ever. So how is that considered a bounce if his numbers were never low. I’m so confused.
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So it doesn’t look like you’ve tested him at night, so it’s possible that he’s going super super low in the evening, which makes his body dump glycogen like crazy and makes his blood sugar high in the morning (see definition of bouncing above that Wendy linked). Evening cycles can be more active for some cats - it’s a lot more active for my cat Moonie for example.

If you look at Moonie’s spreadsheet, for example, there have been days where she starts really high and then goes quite low. 6/15 - she starts out at 272, not too far off from the 300 numbers you’re seeing especially with 20 percent meter variance. But that night she got to 68 which is the “take action” number for the pet meter - and could have gone lower if I hadn’t intervened with MC food. Then you’ll see the next day she starts bouncing and if you tested her mid day the following, you would have just seen 314. So if you had just tested her mornings, you’d conclude Moonie’s blood sugar was way too high all day but that doesn’t show the reality of what happened.

Hopefully that makes sense.
 
It is very common for cats to go lower at night. Which is why we suggest those test 2-3 hours after the PM test, to try to catch if that is happening.

Bounces happen when they hit a number they aren't used to, that can even be if below 200 but still vary safe. Or can happen if they drop very fast.
 
Kathy v said:
Just did a 6pm test , 343.
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Kathy

Now that I’ve done a SS for Bob, I have a few comments I hope will help.

--Because we have members all over the world, we don’t refer to the time in our specific time zones. I think someone already told you the preshots are referred to as AMPS (am) and PMPS (pm). In between, if you take a test, it’s referred to in the number of hours since you last shot. So if you shoot at 8 am, a test at 10 am is the +2 and a test at 4 pm is the +8. You’ll get it! Sometimes, if you skip a shot for any reason, then you might be talking in terms of +14 which means it’s two hours past when you normally would have shot.

If you skip a shot, then the AMPS becomes AMBG which tells us you didn’t shoot and the PMPS becomes PMBG.

--Like others said, please do not switch insulins. Lantus is the best for Bob and you haven’t been seeing any progress because you haven’t known how to properly use it. It’s not a “set and forget” insulin. You will get the best results by using the Tight Regulation Protocol which we will teach you how to use if you post daily. We have an amazing track record of getting cats into remission using TR. You must be feeding canned or raw food only (which you are doing). I would ditch the PurinaPro DM and get something lower carb. Alot of our members use Fancy Feast and you’ll need to have different ranges like low carb, medium carb, and high carb. Please ask specifically about that as I am not up on what members are feeding their cats these days

--Please never ever shoot without getting a PS test. And because many cats go lower at night, you are missing half your data if you aren’t testing in the evening. Ideally, starting out, you would get the following tests daily:
AMPS, +2, +6, +10, PMPS, +2, before bed. You can vary the daytime ones a bit starting out like perhaps an AMPS, +2, +5, +9.

if you post daily in the Lantus forum once you have feeding and testing figured out here, we can help you with the appropriate tests to get for that day.

--While we have hundreds of spreadsheets we could show you, I’ll just show you a few of current Lantus users so you can see what can be accomplished:
Mister’s Spreadsheet
Jude’s Spreadsheet
Moonie’s Spreadsheet you will definitely see some similarities here

--Most members use a human glucometer instead of a pet meter. It’s MUCH less expensive for supplies and our methods of regulation are based on using human glucometers. If you switch, please PM me and I’ll update his SS (same SS, just need to change formatting).

Please ask questions. It’s why we are here....to teach you and help you use the Lantus correctly so Bob will start seeing much better results.
 
Marje and Gracie said:
Kathy

Now that I’ve done a SS for Bob, I have a few comments I hope will help.

--Because we have members all over the world, we don’t refer to the time in our specific time zones. I think someone already told you the preshots are referred to as AMPS (am) and PMPS (pm). In between, if you take a test, it’s referred to in the number of hours since you last shot. So if you shoot at 8 am, a test at 10 am is the +2 and a test at 4 pm is the +8. You’ll get it! Sometimes, if you skip a shot for any reason, then you might be talking in terms of +14 which means it’s two hours past when you normally would have shot.

If you skip a shot, then the AMPS becomes AMBG which tells us you didn’t shoot and the PMPS becomes PMBG.

--Like others said, please do not switch insulins. Lantus is the best for Bob and you haven’t been seeing any progress because you haven’t known how to properly use it. It’s not a “set and forget” insulin. You will get the best results by using the Tight Regulation Protocol which we will teach you how to use if you post daily. We have an amazing track record of getting cats into remission using TR. You must be feeding canned or raw food only (which you are doing). I would ditch the PurinaPro DM and get something lower carb. Alot of our members use Fancy Feast and you’ll need to have different ranges like low carb, medium carb, and high carb. Please ask specifically about that as I am not up on what members are feeding their cats these days

--Please never ever shoot without getting a PS test. And because many cats go lower at night, you are missing half your data if you aren’t testing in the evening. Ideally, starting out, you would get the following tests daily:
AMPS, +2, +6, +10, PMPS, +2, before bed. You can vary the daytime ones a bit starting out like perhaps an AMPS, +2, +5, +9.

if you post daily in the Lantus forum once you have feeding and testing figured out here, we can help you with the appropriate tests to get for that day.

--While we have hundreds of spreadsheets we could show you, I’ll just show you a few of current Lantus users so you can see what can be accomplished:
Mister’s Spreadsheet
Jude’s Spreadsheet
Moonie’s Spreadsheet you will definitely see some similarities here

--Most members use a human glucometer instead of a pet meter. It’s MUCH less expensive for supplies and our methods of regulation are based on using human glucometers. If you switch, please PM me and I’ll update his SS (same SS, just need to change formatting).

Please ask questions. It’s why we are here....to teach you and help you use the Lantus correctly so Bob will start seeing much better results.
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Should I continue with 3 units?
 
We don't have enough data on 3 units to know how it is doing. If you can get a couple more days (and nights) worth of data, we'll be able to give better suggestions on what to do with the dose.
 
Wendy&Neko said:
We don't have enough data on 3 units to know how it is doing. If you can get a couple more days (and nights) worth of data, we'll be able to give better suggestions on what to do with the dose.
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I have ask, it looks like you are testing every day. I don’t think Bob will tolerate that and the Libre left an ugly sore on his back so that’s out. I test him with ear pricks and a small treat or at feeding time. I don’t think I can test him every day, I’m trying for every 3 days.
 
Kathy v said:
I have ask, it looks like you are testing every day. I don’t think Bob will tolerate that and the Libre left an ugly sore on his back so that’s out. I test him with ear pricks and a small treat or at feeding time. I don’t think I can test him every day, I’m trying for every 3 days.
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Yes, everyone here tests every day and usually at least four times a day. We are very data driven. It’s because, as an example, my own kitty could start the day at 300 and by midcycle be 40 then skyrocket back to 300 by the next shot. If I hadn’t done the midcycle test, I’d have thought she needed more insulin.

We don’t typically recommend dose increases unless we know how low the current dose takes them. Please read my post above which discusses how often they need to be tested. Wendy and I are very, very good about being able to discern from “some” data if an increase is needed but we need at least 4-5 tests a day to be able to have an idea.

Here are some Testing Tips. We also have quite a few members using Libre CGMs and they have put this great info together on how to attach h them and keep them attached.

One other thing I meant to tell you is feeding after midcycle often nips the duration of the insulin. If they are running lower after midcycle, yes, you want to give a little bit of LC food. But, other than that, it’s best to not feed after +6. We especially recommend no feeding between +10 and preshot (unless he’s in the 40s or lower) or you could be shooting a food-influenced number and then the BG could drop rapidly after as the food wears off. If he’s hungry, a zero carb treat like freeze-dried chicken is fine.
 
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