08/26 Kirby AMPS 670 - Start Lantus Day

[Staci]

yesterday's post
https://www.felinediabetes.com/FDMB...itching-to-lantus-from-humulin-dosing.234141/

Good morning, I started Kirby this morning on 2 units Lantus following a rough ride on Humulin. 2 units is the vet's recommendation. Kirby does not weigh very much (underweight) but was on 3-3.5 units for the past few days on Humulin. I will be checking his levels at +3, +6, +9 for now. There was a recommendation on the above link to give him 3 units but I feel bound to follow my vet for right now given his recent DKA.

 

[Olive & Paula]

Since it is a depot insulin, it will take some time to see what the dose will do. Are you checking for ketones? It might be good idea since DKA was recent. With DKA it's possible Kirby could be prone to it. Do not hold dose to long, TR might be a good protocol to follow once the 7 day initial dose is done. You should try to never skip a dose of insulin, make sure appetite is good and keep on top of dental and possible uti flaring up.

DKA happens because infection, not enough insulin, not enough calories.

 

[Staci]

Since it is a depot insulin, it will take some time to see what the dose will do. Are you checking for ketones? It might be good idea since DKA was recent. With DKA it's possible Kirby could be prone to it. Do not hold dose to long, TR might be a good protocol to follow once the 7 day initial dose is done. You should try to never skip a dose of insulin, make sure appetite is good and keep on top of dental and possible uti flaring up.

DKA happens because infection, not enough insulin, not enough calories.

Thank you. What do you mean by, "do not hold dose too long?"

I am also wondering, what to do if he doesn't eat a whole lot at his scheduled meal time. We don't have a settled "full meal" amount currently because sometimes he eats a lot more than other times. The ER vet had told me that if he eats "half" a meal, then give "half" a dose. This seems inconsistent with what I've read here and what my normal vet has said to do. My understanding is that I should give him his dose, as long as he eats at least some food (more than a few small bites).

Also, what are your thoughts on feeding him a snack between doses, as long as it's at least 2 hours prior to the next scheduled test?

thanks!!

 

[Chris & China (GA)]

What do you mean by, "do not hold dose too long?"

It will usually take 5-7 days before you see the full effect of the starting dose because Lantus is a depot insulin and the depot has to "fill up" before it can release enough so that your cat is getting the full dose. Once the depot is full, you'll have to be thinking about which dosing method you want to use. Tight Regulation or Start Low Go Slow. TR requires a little more testing, but gives the best chance at remission because you only have to hold the dose for 6 cycles (if it's not getting the results you want). On SLGS, you're supposed to hold the dose for a full 7 days even if they're running higher than you want.

I am also wondering, what to do if he doesn't eat a whole lot at his scheduled meal time.

One of the nice things about Lantus is that it's not necessary for the cat to eat a certain amount first before shooting. The shot usually takes 2-3 hours before it starts to "kick in", so as long as Kirby is willing to eat, he can take his time eating his meal

The ER vet had told me that if he eats "half" a meal, then give "half" a dose. This seems inconsistent with what I've read here and what my normal vet has said to do.

No...just no. Again, as long as Kirby is willing to eat, you can shoot the full dose unless his Pre-shot number is too low to shoot.

Also, what are your thoughts on feeding him a snack between doses, as long as it's at least 2 hours prior to the next scheduled test?

It's fine to feed mini-meals and/or snacks between the shots. It's actually easier on the pancreas to eat multiple small meals instead of 2 big ones. Human diabetes are told to eat 6 small meals a day instead of 3 big ones and it works the same for our sugarcats. The only time we don't want them to eat is the 2 hours immediately before shot times so that when you test, you get a number that's not influenced by food. At other test times (other than Pre-Shot), it doesn't matter when they've eaten.

 

[Staci]

It will usually take 5-7 days before you see the full effect of the starting dose because Lantus is a depot insulin and the depot has to "fill up" before it can release enough so that your cat is getting the full dose. Once the depot is full, you'll have to be thinking about which dosing method you want to use. Tight Regulation or Start Low Go Slow. TR requires a little more testing, but gives the best chance at remission because you only have to hold the dose for 6 cycles (if it's not getting the results you want). On SLGS, you're supposed to hold the dose for a full 7 days even if they're running higher than you want.



One of the nice things about Lantus is that it's not necessary for the cat to eat a certain amount first before shooting. The shot usually takes 2-3 hours before it starts to "kick in", so as long as Kirby is willing to eat, he can take his time eating his meal



No...just no. Again, as long as Kirby is willing to eat, you can shoot the full dose unless his Pre-shot number is too low to shoot.



It's fine to feed mini-meals and/or snacks between the shots. It's actually easier on the pancreas to eat multiple small meals instead of 2 big ones. Human diabetes are told to eat 6 small meals a day instead of 3 big ones and it works the same for our sugarcats. The only time we don't want them to eat is the 2 hours immediately before shot times so that when you test, you get a number that's not influenced by food. At other test times (other than Pre-Shot), it doesn't matter when they've eaten.

wow, thank you! this is so helpful! I just gave him a snack.

 

[Olive & Paula]

I see Chris answered you. My girl was fed every 3 hrs around the clock. You might want to consider an automatic feeder. The petsafe 5 is a popular feeder. My girl didn't always eat full meals. Sometimes she wanted more and other times she nibbled at it. As long as she was eating some, she got her shot. You have dka in the picture, he will need his shot and food to keep it from recurring.

 

[Sam&Milo(GA)&Singha]

This is very interesting...
Milo very often isn’t interested in breakfast. I thought I had to wait to shoot until he ate. Usually he’s willing to eat within the first couple of hours and I’d prefer to shoot and try to then convince him to eat...

 

[Chris & China (GA)]

I thought I had to wait to shoot until he ate.

In cases where there's a recent DKA in the picture, it's imperative that he get his insulin, even if it means feeding something high carb. Are you able to syringe feed if necessary?

 

[Sam&Milo(GA)&Singha]

I’ve honestly never tried. Milo has no history of DKA. Usually within the first couple of hours, he’ll eat. I can entice him with canned LC if necessary. He’s pretty open to this.

In cases where there's a recent DKA in the picture, it's imperative that he get his insulin, even if it means feeding something high carb. Are you able to syringe feed if necessary?

 

[Chris & China (GA)]

Milo has no history of DKA.

I had Milo mixed up with another cat I have been helping with (Kirby..the cat this thread is about). It's great that he'll usually eat for you! As long as you know he'll eat, he can take his time ....that's one of the nice things about Lantus. It's not required that they eat a certain amount before the shot ..as long as they'll eat enough over the next few hours, that's good!

 

[Wendy&Neko]

Hello and welcome. I didn't stop by and say hello yesterday because i was out of town for the day.

Are you checking for ketones?

This is key. At this point, because you went with a reduced dose and Kirby is in high numbers and recovering from DKA, you need to check at least daily for ketones. Please note the results of any ketones testing on the spreadsheet, the Remarks section is fine. If anything above trace ketones shows up, you'll need to take him to the vet. It's also possible you may need to use R again which is one of the tools we use to help a cat that is stuck in high numbers and recent DKA with ketones. It'll take several days for the depot to build, so he won't be getting the full effect of the 2.0 units dose until then.

 

[Staci]

Hello and welcome. I didn't stop by and say hello yesterday because i was out of town for the day.

This is key. At this point, because you went with a reduced dose and Kirby is in high numbers and recovering from DKA, you need to check at least daily for ketones. Please note the results of any ketones testing on the spreadsheet, the Remarks section is fine. If anything above trace ketones shows up, you'll need to take him to the vet. It's also possible you may need to use R again which is one of the tools we use to help a cat that is stuck in high numbers and recent DKA with ketones. It'll take several days for the depot to build, so he won't be getting the full effect of the 2.0 units dose until then.

Thank you!
I bought ketone strips but haven't been able to get a sample yet. I put some saran wrap down in the area he normally uses in his box and hopefully he will use it.

 

[Olive & Paula]

Staci, since Kirby is coming out of DKA episode, you might look into ketone meter. It is more accurate then trying to get urine sample and ketones show faster in blood than urine.