2/3 Otis's first day on Lantus, PM +1/2hr 528. I'm worried!

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otisangel

otisangel

Member Since 2010
Hi,
Otis just started Lantus this morning. He has been on Humulin-N since 2004, I'm new to checking his diabetes glucose levels and have learned a lot from this board, so thank you!
Today Otis' numbers seemed high, which I expected since he had been on 4 units of Humulin and is now starting lantus at 1 unit (although I know that lantus can regulate on a lower dosage, the vet said he would probably need 2 units, but to start low to be safe.)

AMPS 383 +2 380 +4 282 +8 310

the PM glucose test I just did scares me though, its 528. It was taken about an hour after eating and 1/2 hour after shot. Is this normal for lantus because it needs to build up a shed? (I'm probably remembering the term wrong!!)
I've never seen him have this high a level, is it something to worry about?

Thanks
Marley
 
Re: 2/3 Otis's first day on Lantus, PM +1/2hr 528. I'm worri

Hi, Marley, and welcome to Lantus Land! You are starting out with some good knowledge, and you are for sure in the right place to get help for Otis.

You're right about the shed. Lantus needs to build one up. Here's the URL for more info: viewtopic.php?f=9&t=150

Also, Lantus has a slower onset. Your results for 1/2 hour after the shot don't indicate where this cycle is going. Try testing again in an hour.

So it will take a little time to get a good response to Lantus. Just hang on -- as you'll hear often here, this is a marathon, not a sprint!

It's great to hear that your vet recommended starting low and working up. That's exactly what is recommended in the protocol we follow here, and it's a great strategy for getting Otis to the best dose.

Don't worry. Stick with regular shots, twice daily, 12 hours apart. Test often. Post your numbers, and you will get wonderful support.
 
Re: 2/3 Otis's first day on Lantus, PM +1/2hr 528. I'm worri

I think most of us test, and then feed. So the numbers aren't skewed by food. And you are feeding a dry food? Most of us feed low carb wet food.

The gang here is amazing. Welcome to Lantus Land :)
 
Re: 2/3 Otis's first day on Lantus, PM +1/2hr 528. I'm worri

Thanks for the welcome, I'm glad this forum exists. It makes the diabetes treatment much more understandable and less overwhelming.

He is still on the dry but I'm going to start phasing it out soon, once he's been on the lantus for a bit. I was unsure about changing too much at once.

Otis gets so crazy and harder to handle when he thinks its near dinner time, so I have checked his blood after he eats. It affects the reading a lot? The only way I can do it before his food is if I swaddle him in a blanket! Any other tips for a overly-obsessed with food cat?
 
Re: 2/3 Otis's first day on Lantus, PM +1/2hr 528. I'm worri

The dry food can definitely create a sizable food spike, and it can stay in the system longer. That said, I think you made the right decision to wait until transitioning to lantus before changing the food over... especially when Otis was previously on Humulin N.

For a little perspective, Willie is on a purely raw diet, and can still get a 50+ point spike that lasts through +1, and I shoot at the same time he eats. By +2, he's generally back down near the pre-shot number, maybe lower. I typically don't have a good idea of where the cycle is going until at least +3.

I know the numbers are high, and that is scary, but it will get better soon, especially once Otis' shed is filled. I would try to get a before bed poke if you can, I'm guessing that, if nothing else, it will give you some peace of mind.

Good luck, and welcome to Lantus Land!!
 
Re: 2/3 Otis's first day on Lantus, PM +1/2hr 528. I'm worri

Welcome, Marley and Otis!

The 528 is probably a food spike. Generally at pre-shot times (AMPS; PMPS) we test, feed, shoot in that order, all within 10 minutes or so. We test first to make sure that it is safe to give insulin. Since you didn't get a bg test before you fed or shot, you don't know how much of a food spike the 528 represents. In any event, don't worry about it!
There is a lot of information about how Lantus works in the "Stickies" at the top of the Lantus Forum. Much reading here, and pretty intense, if not to say overwhelming at first. But it will all come together. Just keep in mind that Lantus is a long-lasting insulin that needs to build up a "shed" under the cat's skin before it can begin to really work. It takes about 5 days to build the shed. You may see whacky numbers during this time. Try to follow the Tilly Protocol (see the Stickies) and ask as many questions as you need. There are some very knowledgeable people on this board and everyone will be willing to help you. I don't know anything about Humulin N except that it is a fast-acting insulin. You will undoubtedly have to forget all the procedures you followed with Humulin N now that you have started Lantus. As Kathy says: every 12 hours; and I would add: don't shake or roll the Lantus and don't inject any back into the vial or cartridge. Treat it gently and keep it in the 'fridge.

Best of luck,

Ella & Rusty

p.s. many people here are expert at interpreting spreadsheets and offering help in dosing.

p.p.s. my post crossed with Karrie's and your answer to Karrie. Do try to transition him off dry food. You will notice huge differences immediately in his blood glucose numbers. Most of us feed a number of smaller meals throughout the day. This might make Otis less "antsy" before eating and will enable you to test, feed, shoot.
 
Re: 2/3 Otis's first day on Lantus, PM +1/2hr 528. I'm worri

This forum has guided so many of us through "the sugar dance." It's full of experienced and supportive "beans" (aka human beings :) ).

Good thinking about changing the diet slowly. Some kitties can have big drops in BG when the kibble -- which has long-acting high carbs in it -- is removed. It's very important to test frequently when you do start removing the kibble, to be sure that Otis doesn't drop too low.

I'm not sure how much you know about feline diabetes, but it's no wonder Otis is eager to get at the food. Diabetic kitties aren't able to take nourishment from their food; it's called "the starving disease" for a reason.

What's CRUCIAL is to get your test BEFORE the shot. Although Lantus dosing is based on the "nadir" value (its lowest point in the cycle), you need to know whether Otis has dropped too low to get his dose.

Many people here give the shot while the kitty is eating. I'd guess that giving the shot immediately after eating is probably done too. Others can comment.

You can also try a treat
 
Re: 2/3 Otis's first day on Lantus, PM +1/2hr 528. I'm worri

Hi Marly and welome to Lantus.
This is a terrific place to get help for your Otis.

High prorein, low carb is the way to go. It is very hard to get the numbers down while
Otis is eating dry food but I do understand your concern in changing too much at one time.

With regards to testing we like to test the Am & Pm shots without any few on board within 2 hours. This makes sure that number you are shooting is not high because food is on board.

In order to distract my Max while I tested him, I would give him Purebites, freeze dried chicken pieces that he ate while I tested.
 
Re: 2/3 Otis's first day on Lantus, PM +1/2hr 528. I'm worri

I had read some other post and I thought Beans was someone's last name! :)
I guess I already have a humulin habit that I can change, we've always needed to feed otis most of his food about 20min before his shot since the insulin would make him drop quite a bit quite fast.
I'll read over the protocol and the stickies in this board, there is definitely a lot to learn. When I opened the insulin this morning I was shocked at it being absolutely clear. I had read that it was clear, but I guess I imagined a milky tinted clear, but this is crystal. I did roll it, but I should not? I did remember from one of the things here not to inject air into the bottle. When Otis started the Humulin, the vet told us to inject air into the vial, that it made it easier for the needle to pull out the insulin. Does the Lantus get harder to get out of the vial (more bubbly or something) from the vacuum?
 
Re: 2/3 Otis's first day on Lantus, PM +1/2hr 528. I'm worri

Great questions Marley and please keep reading the stickies.
Lantus is slow acting insulin.
You do not roll ir or shake it and do not put air into the vial.
Don't worry about the learning process. You are doing great.

Question for you, with Otis's high numbers have you been testing for ketones??
 
Re: 2/3 Otis's first day on Lantus, PM +1/2hr 528. I'm worri

It's amazing what vets will tell you about the Lantus. You're not the only to be told to inject air. NOOOOO! I'm not sure what the scientific explanation is, but do not roll, do not inject air. It does NOT become more difficult to withdraw.

Some people have trouble toward the end of the vial with keeping air bubbles out of the syringe. That's why we draw more into the syringe than the dose, then gently twist the plunger (with the needle straight up) to force the air bubbles out. There are stickies for this too, if you need help.

Yes, Lantus acts differently, and there's a lot to learn. But it becomes second nature quickly!

Randi raises a great question about testing for ketones, with urine sticks that you can get at the drugstore.
 
Re: 2/3 Otis's first day on Lantus, PM +1/2hr 528. I'm worri

Welcome Marley & Otis.

You've gotten some great information already! Congrats on having started to home test and for getting your spreadsheet (SS) up and running. Those are huge steps -- especially the home testing. I think you'll be amazed at the sense of control you'll have over being able to manage Otis' diabetes that testing gives you.

I also switched from N to Lantus. I suspect you're used to seeing a quick response to insulin - or at least that's what's notable on your SS (e.g., a 300 point drop in 3 hours). Lantus is very different in that regard. It's long acting -- the duration can run 12 hours and sometimes a little more. In fact, we rely on the overlap between doses. It's onset is also much later. Where N can hit like a ton of bricks and drop blood glucose (BG) levels quickly, Lantus onset is generally at around 2 - 3 hours after a shot. It is also much more gentle than N. Where a curve on N is sharper (and more of an actual curve), an ideal Lantus "curve" is flat.

With N, it was imperative that you feed before you gave a shot because of how quickly the insulin would kick in. Not so with Lantus. As others pointed out, the typical pattern is test, feed, and shoot. I shoot when Gabby is eating. You might want to give Otis some treats to gnaw on while you're testing. A lot of people will dice some chicken breast. It may keep Otis preoccupied while you get your pre-shot test.

Because of the shed, dose changes need a chance to settle. This is also different than N.

The biggest adjustment is that dosing is based on the lowest point of the cycle (the nadir) vs. your pre-shot levels. The Tight Regulation sticky outlines how we approach dosing.

Some important aspects of using Lantus and a Tight Regulation protocol include:
  • needing to test the blood glucose levels of your cat multiple times per day
  • needing to know about hypoglycemia and be prepared to deal with it
  • needing to test for ketones regularly to start with and know about ketoacidosis, but be aware that ketones don't occur once a cat is (and remains) properly regulated
  • needing to use syringes which allow you to measure tiny doses: U100-type, 3/10 cc = 0.3 ml volume and with the half-unit increments printed on the barrel
  • needing to feed the right diet: high-quality low-carb canned food or raw food exclusively
  • needing to feed your cat lots of small meals spread over the day, free-feeding canned food can be an option for some cats
For now, getting used to home testing and how Lantus is working is essential. Once you are comfortable, it will be very important to start to transition Otis to a low carb, canned food diet. You will be impressed at the difference this will make. You might want to take a look at Lisa Pierson, DVM's site on feline nutrition.
 
Re: 2/3 Otis's first day on Lantus, PM +1/2hr 528. I'm worri

I have been checking Otis' Ketones. Thats actually what got me so involved in Otis' care. He had started wobbling a bit, I thought it was weird so I started searching the internet and read about ketoacidosis. The tests have always been negative (I checked his vet urinalysis and culture tests too to see if they were there in the recent past, but they weren't). Otis definitely thinks I'm a weirdo when I follow him about to the litterbox!
Oddly enough, I started giving otis some trader Joe's tuna for Cats about a week ago- as a treat he gets a bit a day- and the wobbling has almost gone away. I feel like the diabetes and his set amount of food was making him so skinny and weak. More food seems to help
 
Re: 2/3 Otis's first day on Lantus, PM +1/2hr 528. I'm worri

Once you get him moved to the low-carb food, you can and should feed him as much as he wants. He's trying without success to get energy from the food, but the more kibble he gets, the more his numbers stay high. Vicious cycle.

Many of us phased in the low-carb food. They're addicted to kibble, but when they're so hungry, they'll eat anything! (Until they get fussy again. :smile: )

Are you familiar with Janet & Binky's list of low-carb foods? Here's the link: http://binkyspage.tripod.com/canfood.html

We usually aim for a food not more than 7 carbs.

And while you're buying prospective foods for Otis to pass judgment on, get a few cans of the high carb flavors with gravy. Put these aside as part of your "hypo" kit. You'll be able to help steer his numbers with food in the not distant future!
 
Re: 2/3 Otis's first day on Lantus, PM +1/2hr 528. I'm worri

Thanks for the info. I'm glad to change over to all wet, and Otis actually likes it more than the dry food. he sure won't mind!

I just took another glucose reading and it is now+3 285. On Lantus, is that too quick of a drop only 3 hours post shot? I really wish I had gotten a pre-feeding reading
 
Re: 2/3 Otis's first day on Lantus, PM +1/2hr 528. I'm worri

Just wanted to welcome you to Lantus Land!!! We're glad to help you in any way we can.
 
Re: 2/3 Otis's first day on Lantus, PM +1/2hr 528. I'm worri

WELCOME! you are doing great! you are DEFINETLY in the right place! I won't weigh in on the drop, but I would definetly try and test every hour or two being that you just starting over with a new insulin..as they say the stickies say it al loll, and a curve with lantus makes alot of difference and will begin to make alot of sense! again WELCOME and good luck! Btw don't kick yourself for the no PMPS that will come with time!
 
Re: 2/3 Otis's first day on Lantus, PM +1/2hr 528. I'm worri

otisangel said:
Thanks for the info. I'm glad to change over to all wet, and Otis actually likes it more than the dry food. he sure won't mind!

I just took another glucose reading and it is now+3 285. On Lantus, is that too quick of a drop only 3 hours post shot? I really wish I had gotten a pre-feeding reading
Click to expand...
hello and welcome to the group!
since we don't have enough info (ps number or know how much of a food spike otis usually gets), we don't really know how much of a drop we're seeing here. i would get a +4 in order to get an idea of the rate of the drop.

if otis will eat canned low carb food, i'd go ahead and switch his diet before ending up on a higher dose and then making the diet switch. a diet switch alone can impact some kitties numbers.

please spend time reading the stickies (starred threads) at the top of this forum. a lot of your questions will be answered. there's a huge learning curve when switching from n to lantus. ask any questions you may have.

please post the +4 after you get it, k?
 
Re: 2/3 Otis's first day on Lantus, PM +1/2hr 528. I'm worri

he is now +4 278, much smoother than N
 
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