1st day on lantus - have we started too high?

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Vyktors Mum

Vyktors Mum

Member Since 2011
Vyktor dx Nov, no treatment (on advice of 2 vets) until admitted to hospital with DKA and Triaditis on 13 Dec (except change from FF to low carb diet). Spent four days there and they started him on caninsulin (3U BID). Horrible bounces and higher preshot numbers than he'd had since I started testing back in Nov so I insisted we change to lantus (on caninsulin highest recorded 25.5/460; lowest 4/72). Started lantus at 1U BID last night and have recorded the following numbers:

PMPS 18.6/335
+4 16.7/300
+8 18.3/330
AMPS 16.9/304
+4 7.8/140
+6 3.5/63
+7 4.2/76

He's been eating well until today. Today he's only had a couple of moutfuls of his canned (it has an antibiotic crushed in it so he's not so keen) and 1 to 1 1/2 teaspoons of raw chicken after each test and injection. He seems ok though, well as okay as he has been since he came home from hospital. He has spent about 95% of his time lying in a cupboard since he came home but has put some weight back on and got his purr back.

Have I started him on too high a dose (very glad I didn't start at the vet's suggested 1.5U dose!) or is he likely to have dropped so low so quickly because he hasn't eaten very much (about 30-35grams of chicken plus a couple of mouthfuls of canned)?

What do I do with his dose tonight? Does it depend on what he eats?

Thanks Serryn
 
Hi, Serryn,

Welcome to Lantus Land! It sounds like you've made a wonderful start taking care of Vyktor. These numbers are a great sign that he'll do well.

If I were in your situation, I would not give the next shot. It's essential that Vyktor be eating, for one thing. For cats newly on Lantus, also, we don't suggest shooting when the BG is below a cut-off. I'm having trouble finding that number, but Vyctor is definitely under it.

I'll be back shortly with some suggested reading. Just wanted to chime in.
 
Serryn,

If you haven't already had a chance, read the stickies at the top of the forum, in particular:

STICKY: LANTUS & LEVEMIR - TIGHT REGULATION PROTOCOL
http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

and
STICKY: LANTUS & LEVEMIR - NEW TO THE GROUP? PLEASE READ...
viewtopic.php?f=9&t=18139

Note the following in particular (which you seem already to know!)
Kitty should be monitored closely the first three days when starting Lantus or Levemir.
Blood glucose levels should at least be checked at pre-shot, +3, +6, and +9.
More monitoring may be needed.
Click to expand...

I don't think you started at too high a dose, to answer your original question, but Vyctor is showing a significant response, and as you said, he isn't eating well enough. So I would hold off on the next shot.

I am curious about something you said - that Vyctor went from FF to a low carb diet. What type of FF were you feeding? The Classic varieties (Tender Beef, Turkey, Chicken) are quite low carb and are relied on by many of us here.
 
ETA: Disregard. Better input given below by others.

Ah, here it is! The guideline that answers your question:

http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=147

IF YOU'RE A NEWBIE (without much data) the FDMB FAQ section 4.4 applies:

Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?

A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines. Below 150 mg/dl (8.3 mmol/L), don't give insulin. Between 150 and 200 (8.3-11.1 mmol/L), you have three options: a.) give nothing; b.) give a token dose (10-25% of the usual dose); c.) feed as usual, test in a couple of hours, and make a decision based on that value. Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise. In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine. Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.
Click to expand...

For cats new to Lantus, for BG BELOW 150 : Don't give insulin.

You'll get a lot of valuable input when daylight hits the US. If you're able to get another test around +8, it would be great to make sure Vyctor is continuing to rise.

I hope you can encourage him to eat, meanwhile.
 
Hi! Just wanted to say welcome.

I think 1u is a good starting dose. But food does make a huge difference. If kitty isn't eating much, numbers can come down faster than if they were eating normally.

Merry Christmas ;)
 
Kathy and Kitty said:
I am curious about something you said - that Vyctor went from FF to a low carb diet. What type of FF were you feeding? The Classic varieties (Tender Beef, Turkey, Chicken) are quite low carb and are relied on by many of us here.
Click to expand...

We don't have the classic varieties in Australia. He was eating grilled varieties.

If I miss the shot do I miss it completely and start again tomorrow morning? I have read somewhere that it's important with lantus to try and stick to BID dosing so would it be better to do a half dose or something like that tonight?
 
in general we say the choices when faced with a low number at preshot time are to

- stall 30 minutes without feeding, retest and if the test # is high enough for your comfort zone you can shoot your full amount. that can be repeated, if you want, as long as you don't feed. then note that your next shot time is 12 hours later.

- shoot a big chicken shot - in other words, give a significantly reduced dose, perhaps 1/2 of the regular dose.

- skip the shot entirely.

skipping isn't ever a great solution, but it can be the best solution if you aren't going to be able to monitor, or you can't delay and still be able to give shots 12 hours later. for example, if you have to go to work and can't get off your shot schedule. i wouldn't worry too much about skipping.

however, with a cat that has had a recent DKA we don't like to skip entirely, so stalling 30-60 or 90 minutes and still giving the full dose might be a better option. if you can handle having the schedule change. otherwise, shooting a partial dose would probably be the next best good choice.

what sounds good to you?

also after having gone low vyktor may go high enough at shot time to not be a problem. what + time are you now and what was his latest test?
 
Kathy and Kitty said:
If you're able to get another test around +8, it would be great to make sure Vyktor is continuing to rise.

I hope you can encourage him to eat, meanwhile.
Click to expand...

Tried for the +8 (three times) but insufficent blood and he was getting quite grumpy. He had another teaspoon of chicken after my failed attempts to test. I think, make that thought, he didn't want to eat the wet because of the pill but I just went and shoved the bowl under his nose in the cupboard and he ate about half - who knew he was waiting for home delivery!

I guess that should make him pretty safe for now and I will review the situation PS in accordance with the guidelines and how much more he's had to eat.
 
i'll bump up the moving post on low numbers - i like that one a lot. there's also the sticky yellow starred one on shooting and handling low numbers, but i think that one is a tiny bit more confusing.

sounds like you've got a good handle on things! i feel like i recognize your names - were you on here before?
 
however, with a cat that has had a recent DKA we don't like to skip entirely, so stalling 30-60 or 90 minutes and still giving the full dose might be a better option. if you can handle having the schedule change. otherwise, shooting a partial dose would probably be the next best good choice.
Click to expand...

Julie, thanks for correcting me!
 
julie & punkin said:
skipping isn't ever a great solution, but it can be the best solution if you aren't going to be able to monitor, or you can't delay and still be able to give shots 12 hours later. for example, if you have to go to work and can't get off your shot schedule. i wouldn't worry too much about skipping.

however, with a cat that has had a recent DKA we don't like to skip entirely, so stalling 30-60 or 90 minutes and still giving the full dose might be a better option. if you can handle having the schedule change. otherwise, shooting a partial dose would probably be the next best good choice.

what sounds good to you?

also after having gone low vyktor may go high enough at shot time to not be a problem. what + time are you now and what was his latest test?
Click to expand...

I'm on holidays now so I can easily fit myself around stalling if that's what's best for him. I'm just worried that a full dose will make him drop even lower than he did today given that his storage shed will be building up.

It's 2.30pm here now, last test was at 1pm and he's due for his next shot at 6pm. I'm supposed to be going out for dinner tonight but they have a diabetic dog so I'm sure they'll understand if I just drop the dessert off and run back home. Or would it be safe for me to be out for 2 or 3 hours after his shot given that it shouldn't be starting to work at that point?
 
I think both Kathy and Julie have good points but the underlying issue here that concerns me is he is a DKA kitty. Three things are very important for these kitties: (1) food (2) water (3) insulin and I think they are all equally important.

That is why I lean towards not skipping the shot. Are you able to syringe feed him if he won't eat on his own?

If you are just at +8 now, it's possible some of the East Coast folks will be on in four hours but probably not very many. If his AMBG is not rising to at least 150 by then, I'd stall if you possibly can. If you are able, it's ok to stall up to two hours and then shoot his normal dose provided you can be there to closely monitor him and you can get him to eat. If he's not eating, then perhaps a half dose is ok as long as you can try and syringe feed him and still monitor him closely.

But a DKA kitty needs insulin.
 
julie & punkin said:
sounds like you've got a good handle on things! i feel like i recognize your names - were you on here before?
Click to expand...

Since he got diagnosed I have spent many many days researching so I have gathered a lot of theory, looked at a lot of spreadsheets and thought I was quite prepared, it's a bit scary in practice though!

I have posted on the main health forum a few times and may have posted here once with a proposed plan for Vyktor before we started treatment - I had a few things a bit wrong at that point though!
 
thanks for weighing in marje & kathy. more heads work better than one, don't they!

you've got a complicated situation here - kitty not eating, new dose that is sending him lower than we would've expected, and the very recent history of DKA. so together we can figure out what's best for the little guy.

i wouldn't be surprised if he increased enough in the next 4 hours to not have to worry about shooting, but you never know.

can you grab a test now and let us look at his numbers while several of us are still up?

and i would think if you're going to be home by 3 hours after his shot time you would be ok leaving vyktor at home. check him as soon as you walk in the door.
 
You're in good hands now. I will be turning in now, but I think you have good input now.

Just one thing:

It's 2.30pm here now, last test was at 1pm and he's due for his next shot at 6pm. I'm supposed to be going out for dinner tonight but they have a diabetic dog so I'm sure they'll understand if I just drop the dessert off and run back home. Or would it be safe for me to be out for 2 or 3 hours after his shot given that it shouldn't be starting to work at that point?
Click to expand...

Whatever you shoot for a dose at 6pm, I would suggest getting a test before leaving him alone. You don't really know yet what Vyctor's normal "onset" will be, so you want to be sure there are no big drops in the offing. Also, be sure he eats after his shot. Maybe you can give him some of his meal without the antibiotic in it - he seems to be willing to eat that!
 
Marjorie and Gracie said:
Are you able to syringe feed him if he won't eat on his own?
Click to expand...

He has eaten a bit now so hopefully I won't have to syringe feed. I've never tried it before. Do I just water down some canned food. Is there a special way of administering it (anything to be careful of) or do I just shove it down his throat (so to speak) ? If he's not eating how much food, how mauch water and how frequently?
 
marje is also headed for bed.

i agree with kathy about mixing the meds in just a small amount of the food rather than the whole thing. you might also mix it in a food he doesn't normally eat so he doesn't develop a dislike of his regular foods.

to syringe feed - i haven't done it, just read people's directions. basically you can use a blender to pulverize it pretty fine adding enough water to make it like applesauce consistency, then suck it up in syringe that doesn't have a needle in it. the syringes people use are specifically for feeding, but anything you have that's a bit like that might work. kinda squirt it into the kitty's mouth without aiming towards their throat. you don't want to choke them. i'd probably try the side of the mouth. some people will put a little on the cat's nose or front paws to try to get them to lick it off.

you can also put some on your finger and wipe it off on the inside of their lips.

not having done it, i'm just trying to remember what people have said.

there are a few tricks for enticing eating. one is to heat the food a tad to make it a little smellier. another is to pour the water from a can of tuna over food. you can sprinkle oregano on it- a relative of catnip. many cats love that. try a sprinkle of parmesan cheese.

also, if a cat won't eat, even high carb foods with gravy (those fancy feast grilled foods, for example) are better than nothing. while we want them to eat low carb canned food overall, it's more important to get a cat to eat anything if they aren't eating, even if it's the high carb food or the dry food.
 
If you just take his normal portion of food, add warm water to make a slurry (I use a blender), and feed it to him a few milliliters at a time, that would be helpful. The important thing, though, is not to shoot it straight down his throat or he could aspirate. You want to put the syringe into the side of his mouth and angle it up towards the roof and then just give him a tiny bit at a time (1 ml) and let him swallow it on his own. Don't force it in him and don't shoot towards the back of his mouth.

It's best if he eats on his own and if he is, it would be good to add 1-2 tsps of water in each of his food helpings so he is getting plenty of water.

I hope that helps and I also hope he comes up for you. You do not want to shoot a dropping number....that is one that keeps on dropping down into his next preshot. You'll have to stall, don't feed, and let it rise before you give any insulin. The important part here is to not feed if you are stalling. If you feed and retest, you'll get a food-spike number that will come back down. So by stalling and not feeding until he rises, you know you are shooting a real number.

Good luck....please post when you get his +11....there easily could be someone here or in health.
 
julie & punkin said:
can you grab a test now and let us look at his numbers while several of us are still up?
.
Click to expand...

I'd rather not retest now that he has eaten a little and is safe because that means another treat and even less chance of getting the antibiotic food into him (thankfully he has nearly finished the course just one more to go tonight which I will attempt to shove down his throat to make sure he's happy to eat the pill free food in his bowl).

If he's not above 8.3/150 at shot time I will stall for up to two hours and depending on how close he is I plan to either miss or give him a half dose. BUT what if he is above 150 but has eaten in the last hour or two, i.e. the number is higher from food?
 
Welcome to Lantus Land!!

I completely agree with what you've been told regarding insulin and having a cat that was recently diagnosed with DKA. (And, did the vets who told you to hold off on insulin offer to pay for that hospitalization?! Yeesh!!)

When you have a chance, it would help us if you could set up a spreadsheet. The "World" version will allow you to enter numbers in mmoL/L and they will be automatically converted on a separately tabbed page to the format we use in the US. The spreadsheet will allow you to keep all of your test data in one place and to share it with us.

Are you testing for ketones? If not, please pick up Ketostix. These are strips you dip in your cat's urine and let you know if ketones are present. In a cat that's had an episode of DKA they are the best prevention that money can buy.
 
Sienne and Gabby said:
Welcome to Lantus Land!!

When you have a chance, it would help us if you could set up a spreadsheet. The "World" version will allow you to enter numbers in mmoL/L and they will be automatically converted on a separately tabbed page to the format we use in the US. The spreadsheet will allow you to keep all of your test data in one place and to share it with us.

I've tried to make the spreadsheet work but I think my version of excel isn't current enough because it won't happen. However I have copied the same idea and made my own but I'm not that clever with the formulas so I have to manually enter the colours and will have to manually do two versions as well (world and US). Tomorrow I'm going to try and make it all happen with the google account - you'll probably hear me cursing from there!

Are you testing for ketones? If not, please pick up Ketostix. These are strips you dip in your cat's urine and let you know if ketones are present. In a cat that's had an episode of DKA they are the best prevention that money can buy.
Click to expand...

Yes testing for ketones and kept telling the vet that the tests were positive but he'd just say, oh well the dipsticks aren't that accurate don't worry about it unless there are symptoms. What's worse is I did worry anyway so went to a different vet for a second opinion only to be told the same thing ...
 
I am so sorry that you and Vyktor had to go through that. You are both very lucky. I would have been furious and writing letters to the state licensing board. The very good news is that Vyktor survived.

There is a meter, the Precision Xtra that will test for blood ketones. The downside is that the strips are very expensive. FWIW, there are research papers that note the relationship between urinary and blood ketones and that document that urine ketones are a good indicator of where the blood levels are.

If you use the template that I linked, you can plug all of the information that you've collected into the Google document. Some people here don't have Excel whereas anyone can access a Google document. Just an FYI, sometimes the Google template is temperamental so we may hear you "grumbling" on this side of the planet!
 
Sienne and Gabby said:
Welcome to Lantus Land!!

When you have a chance, it would help us if you could set up a spreadsheet. The "World" version will allow you to enter numbers in mmoL/L and they will be automatically converted on a separately tabbed page to the format we use in the US. The spreadsheet will allow you to keep all of your test data in one place and to share it with us.

I've tried to make the spreadsheet work but I think my version of excel isn't current enough because it won't happen. However I have copied the same idea and made my own but I'm not that clever with the formulas so I have to manually enter the colours and will have to manually do two versions as well (world and US). Tomorrow I'm going to try and make it all happen with the google account - you'll probably hear me cursing from there!

Are you testing for ketones? If not, please pick up Ketostix. These are strips you dip in your cat's urine and let you know if ketones are present. In a cat that's had an episode of DKA they are the best prevention that money can buy.
Click to expand...

Yes testing for ketones and kept telling the vet that the tests were positive but he'd just say, oh well the dipsticks aren't that accurate don't worry about it unless there are symptoms. What's worse is I did worry anyway so went to a different vet for a second opinion only to be told the same thing ...
 
Sienne and Gabby said:
I am so sorry that you and Vyktor had to go through that. You are both very lucky. I would have been furious and writing letters to the state licensing board. The very good news is that Vyktor survived.

Thank you it was a horrible experience for both of us. The vet started every conversation with "well he survived", I was a total wreck because in my heart I didn't believe what the vets were telling me but they were both so calm about it I thought I must have been getting paranoid. I have taken charge now I told the new vet I will not feed MD wet or dry and insisted we use lantus and told them the starting dose would not be 1.5 but only 1 (although after today I'm wondering whether even that was too much and we should have started on 0.5). If it wasn't for this board I would never have found the knowledge and the confidence to do that

There is a meter, the Precision Xtra that will test for blood ketones. The downside is that the strips are very expensive. FWIW, there are research papers that note the relationship between urinary and blood ketones and that document that urine ketones are a good indicator of where the blood levels are.

My Xceed meter will also test for ketones but I haven't tried it yet because his urine is coming up negative (for the first time since I started testing it).

If you use the template that I linked, you can plug all of the information that you've collected into the Google document. Some people here don't have Excel whereas anyone can access a Google document. Just an FYI, sometimes the Google template is temperamental so we may hear you "grumbling" on this side of the planet!
Click to expand...

Thank you for the link, I thought I needed to do the spreadsheet on my computer and then upload to google, it will be much easier for me if I don't have to enter everything twice and add colour manually. I will give it a shot tomorrow when my brain is working better. For now, with Vyktor eating again (thankfully the antibiotics are now finished so he's got pill free food) and having got a 14.7/265 at +5 I'm thinking I can safely go to bed and get a solid 6 hours sleep before we continue the roller coaster again tomorrow.
 
Welcome to LL! I'm really glad to see that Vyktor is making such good progress! Our vet is good and we check everything she tells us with people here. BTW, Zener has two beans. I sign my posts and Anne doesn't so you know who's "talking". Happy holidays!
Liz
 
Serryn (what a pretty name!)

If you have problems with the SS, please let me know and I'll help you. Just "PM" me (click on the "PM" button below Gracie's pic to the right and you can send me a private message).

Glad all went well last night :-D
 
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