9/22 Apollo AMPS 579, dose?

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John & Apollo

John & Apollo

Member Since 2011
I have another thread on going here. It was suggested I start a new condo asking specifically about what dose I should start out with.

Well I started with 2 units since he was very high and before I had a chance to get all the great advice from the group. I then changed to 1 in the evening because his blood sugar did come down a bit. Then back to 2 in the AM shot because he went back to very high again. I realize it makes more sense to stay with 1 consistent dosage at the beginning, but I just don't know for sure what starting dose he should be on based on his circumstances? My vet isn't much help as he has no experience with Lantus. He told me to give 2 units 1 time a day which I now know is totally misinformed.

So how much should I be giving him to get started? With his numbers so high I am afraid starting at just 1 unit twice a day isn't enough? At his peak he was on 10 units twice a day with Humulin N and still not in normal ranges. I realize they are both completely different in the way they work though. I just want to get his numbers down as quickly and safely as possible. But not sure if I should give 1 unit, 2 units, 3 units etc twice a day to get started? Or do I just have to wait to do a curve before I make any changes beyond 1 unit twice a day? I bought more strips and should have them tomorrow, so I can do a curve then.

I just joined the message board and started on Lantus yesterday, so I'm a little overwhelmed, but trying to get everything started on the right track.

I am also in the process of trying to get Apollo converted from dry food to wet food, but concerned he won't eat the wet. The last thing I want to do is have him not eating and then I can't give him any shots. I'm going to grab several varieties from the store and give it a try. Wish me luck.

Thanks in advance for your help.
 
Welcome again! Nice to see you on here. If it were my kitty, I would start out at 2U twice a day. Hopefully some of our most experienced members (Jill, Sienne,Libby, etc.) will come along and give you some advice. A constant dose is what is most important.

I know all about the crunch addicted kitty. You will want to slowly transition him over from dry to wet. We just started by putting out canned and dry. Each day we would slowly decrease the amount of dry we had out and increase the amount of canned. It took about a month, but he eventually got all the way off dry. He is still severly addicted to it. If he hears me get into the temptations treats he is right there yelling wanting one.

I know you haven't read enough, so the following link is about transitioning. Sprinkling tuna on the canned food, adding tuna juice, parmesan cheese, fortiflora, salmon or chicken dust, boiled chicken breast, etc. are all great ways to try and kick start them eating canned. http://www.catinfo.org/docs/Tips for Transitioning PDF 1-14-11.pdf


Good luck and welcome!! Ask lots and lots of questions.
 
John --

I would go back and look at the note that Jill posted in your other thread. If you can keep getting BG tests even while on Humulin N, that will help to guide us with regard to how to calibrate Apollo's initial dose. While there is a weight based formula, the caveat is that when a cat has been on an insulin other than Lantus, the dose on the other insulin needs to be taken into consideration.
 
Glad to see you got a new condo open for today and good work getting the link in to yesterday's. :thumbup We do a new condo every day so things don't get lost in the length.

Melissa is right, keeping the dose consistent is the key. So stick w/ one dose until you hear differently. It takes several cycles (we usually give it up to 6) for the shed to get established and every time you change the dose you have to start the wait over again.

I hope your strips get her on time so you can get a good curve in. That will tell the dosing experts a lot.
 
Hi guys .. I know this is all very overwhelming to take in and you probably have a ton of information going through your head at 100 mph's .. just remember to breathe, there are many many experienced eyes in lantus land and they will help guide you to the right dose with apollo .. Just hang in there, it DOES get easier .. :thumbup
 
Sienne and Gabby said:
John --

I would go back and look at the note that Jill posted in your other thread. If you can keep getting BG tests even while on Humulin N, that will help to guide us with regard to how to calibrate Apollo's initial dose. While there is a weight based formula, the caveat is that when a cat has been on an insulin other than Lantus, the dose on the other insulin needs to be taken into consideration.
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Apollo is no longer on the Humulin N. He was for many months and I had to keep slowly increasing the dosage, then having a fructosamine test done to see where we were. Yes, I now know that was not the right approach and I should have been home testing the entire time. Once I got to 10 units twice a day without him reaching normal levels I started looking for insulin alternatives. That brought me to Lantus and here. My vet told me to take Apollo off Humulin N for 48 hours and then begin giving Lantus.

So I'm trying to figure out how much to start him out on. I figured 1 unit twice a day or 2 units twice a day would be a good starting point, but didn't know for sure based on his current dry high carb diet and high blood sugar numbers. I am in the process of switching his food from dry to wet too, so that can affect how much he should be getting too I know. Basically I just don't want him to have sky high numbers while we slowly give him small amounts of Lantus. Does that make sense? I think your answer is going to be the only way to know for sure how much I should be giving him is by doing a curve, correct?
 
Ann & Tess said:
Melissa is right, keeping the dose consistent is the key. So stick w/ one dose until you hear differently. It takes several cycles (we usually give it up to 6) for the shed to get established and every time you change the dose you have to start the wait over again.
Click to expand...

When you say cycles do you mean days? So 6 days total (12 injections) or 3 days total (6 injections)?
 
A cycle is the period between shots, so there are 2 cycles per day. I'm not a dosing expert, I hope they show up before the next shot. I would say that you should stick w/ the 2 units you shot this morning, but since you are low on strips 1unit might be safer. Whenever you are making changes you want to test a lot to make sure they don't drop suddenly. We have a saying (actually we have lots, ;-) :lol: ) "Better too high for a few days than too low for an hour or even minute."
 
I think what Sienne was referring to was the following excerpt from STICKY: LANTUS & LEVEMIR - TIGHT REGULATION PROTOCOL: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

Using a weight based formula for determining a starting dose of Lantus or Levemir:
1. The formula is 0.25 unit per kg of the cat's ideal weight. If kitty is underweight, the formula frequently used is 0.25 unit per kg of kitty's actual weight.
2. If the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration.

If Apollo is 12 pounds, then that would be 5.5 kg. The starting dose would be 1.375U based on the above formula if he had never been on any other insulin before. It says to take into consideration data from the previous insulin. However, it sounds like you were up to 10U and still nothing, so you really don't have any data other than that, right? I am with Ann and would start at 2U twice a day and go from there based on all that information. Just my thoughts.
 
Hello and Welcome! :-D

I know Sienne has been here...but seeing how high your BG's are I hope you do some dosing regulation quickly! I started my Stella at 3U because she was at 535. High BG's are very dangerous and do as much damage as a hypo. Don't want to scare you...just read as much as you can as quickly as possible!!! I was crying every day for the first two weeks because the learning curve is HUGE. You CAN do it!

Good luck, and I hope I wasn't too straight forward. You have found the right place to get your furry one regulated and healthy again.

PS High BG's cause nerve damage. If you see the hind legs becoming weak your baby may have Neuropathy. You can start with B12 Methylcobalamine I use the following : B12M You open the cap and sprinkle and mix it into the food.

Again, good luck!
 
Hi John,

Good job with the condo! As you can see, each kitty opens a new condo each day.

I don't have experience converting from another insulin to Lantus. Hopefully someone who does will chime in.

In the mean time I too think a 2u Lantus dose is a safe start for Apollo at this time.
Consistency is very important - "dose hopping" (different doses each shot) can cause wonky numbers.

Good luck with the food - something tells me Apollo will go for it!
 
Thanks for all your input. I decided to go with the 2 units twice a day for now and see how it goes. I just got back from the pet store and picked up some purebite treats. Apollo LOVES them! Woohoo! I also got 6 different varieties of wet food to try. Here is what I got:

Fancy Feast Classic Chicken
Wellness Chicken
Wellness Chicken and Herring
Wellness Turkey
Merrick Cow Boy Cookout
Merrick Granny's Pot Pie

I hope out of all these my 3 cats can find one they all like.
 
Mary and Stella said:
Hello and Welcome! :-D

I know Sienne has been here...but seeing how high your BG's are I hope you do some dosing regulation quickly! I started my Stella at 3U because she was at 535. High BG's are very dangerous and do as much damage as a hypo. Don't want to scare you...just read as much as you can as quickly as possible!!! I was crying every day for the first two weeks because the learning curve is HUGE. You CAN do it!
Click to expand...

That is exactly how I feel. I just want to get his numbers down as quickly as possible, but wanted to be sure I was doing it safely. I was afraid by being too conservative from the start would cause him more harm then good in the long run, since his numbers have been so high and all.

Mary and Stella said:
PS High BG's cause nerve damage. If you see the hind legs becoming weak your baby may have Neuropathy. You can start with B12 Methylcobalamine I use the following : B12M You open the cap and sprinkle and mix it into the food.
Click to expand...

That is exactly what is happening to Apollo. To be honest it is what scared me the most. He is turning his feet outward to help give him more stability in the backside. Also sitting more then he usually does. He is able to walk fine and jump ok, but I can tell it's not "normal". I'm going to pick up some of the B12 and see if that helps him improve. Thanks for the link.
 
Hi John,
Those are great food choices. I'm sure your kitties will like them. Rusty loves Wellness Turkey (and also FF Turkey & Giblets). Stu (my diabetic GA) loved Cowboy Cookout and Grammy's Pot Pie. Never tried the Wellness Chicken & Herring, but I know that lots of people here feed it.

Good luck with the 2-unit dose. Follow the protocol and I'm sure that you will see improvement soon. Apollo has to "build his shed" and then get stabilized on the dose. After a week (or less) you will know when and by how much to adjust it. Consistency is the magic word for now: try always to shoot 12 hours after the previous shot. If you haven't already read it, do read the Sticky on how to handle Lantus. Never shake it, as with some other insulins. Treat it gently. It doesn't like to be shook up!

Have a fine evening,

Ella & Rusty
 
Hi, John,

Welcome! I read your story about Apollo getting up to 10 units, and I just had to say hello.

Someday when you've got less going on (yes, that happens!), you can read Kitty's history. I'll just say that his story resembles Apollo's -- and Kitty is doing very well.

Try not to worry too much about his BG right now. With a consistent dose, set with the input from these wonderfully knowledgeable people, it will start to come down. Even the neuropathy goes away.

You have the best pool of feline diabetes knowledge here, so steady on, and welcome.

Kathy
 
Hello John, and good evening to Apollo! I forgot to let you know that Stella had a terrible case of Neuropathy to the point where she couldn't make it to the litter box, or jump. We just thought she was old (shame on us). She is now fully healed and well! So if you caught the neuropathy in a very early stage that is great!!! I started with one tab at night and one in the morning, but now I only add the B12M with the evening meal. I am sure if your Apollo can still jump then the evening dose will do fine. :)

My kitties love the wellness. We buy Chicken and Herring, Turkey, Beef and Chicken and Turkey and Salmon. I do a different flavor every day to keep a balanced diet. My kitties tried some of the others you suggested, but my healthy kitty Boo would have none of them. :lol: I still free feed the prescription dry DM, but that is a big no no. I will try the dry Evo Cat and Kitty now that I know it is also acceptable (if you can call a no-no acceptable!) My schedule is such that if I leave town I have to make sure they have food if my sister can't get to them right away.

Good luck with Apollo...my fingers are *crossed, and I hope you are a lucky one who finds the way off of Lantus in record time!!! :mrgreen:
 
hello john. welcome to the group!

without data from the days when apollo was on humulin N, it's difficult to come up with a good starting dose. however, you have to start somewhere. i agree with the suggestion to start at 2u BID. given apollo was up to 10u of N, i'm not so sure 2u will be enough, but we can always help you fast track up the dosing scale if it appears 2u BID isn't making a dent in apollo's numbers. however, it would be a real good idea to pick up some ketostix to check his urine for ketones... daily if at all possible. you might have to isolate him for a couple hours with a litter box in the room to get a sample. follow the directions on the box. there's an increased chance of him developing ketones if 2u is grossly under his insulin needs. i highly encourage you to do whatever it takes to test him for ketones during this period while we're "feeling around" for the correct dose.

i do want to caution you about starting at a higher dose simply because the numbers are high. this is NOT the way this insulin works. this insulin is all about making dose adjustments based on nadirs with minor consideration given to preshot numbers. we've seen kitties who are started with too high of a dose experience huge drops or they experience high flat numbers. too much insulin can cause high numbers just as too little insulin can cause high numbers. if kitty starts out at a reasonable dose we methodically suggest increases which will avoid kitty becoming over dose.

happy to see you're attempting to transition all your kitties to canned food. imho, all the more reason to start out with 2u in case the change in diet makes a dramatic difference in insulin requirements.

hope to see you posting often!


edited to add: here's a link to methyl B12 which is safe and made specifically for diabetic cats: Zobaline
 
p.s. Our Kitty is one who was started out too high....so, what Jill said. It's easier to find the right dose by starting low and moving up.
 
This is a form of methylB12 that is formulated for cats Xobaline and the 3mg dose is what is recommended. Ordinary B12 will not work it must be methyl B12 (methylcobalimine) to help the neuropathy. I think you can get the same brand on Amazon.
 
FWIW, we used this product for Kitty: liquid methycobalamine from Pure Encapsulations.

http://www.purecaps.com/PDF/pi/Methylcobalamin_B12liquid_B125L.pdf

I don't do well pilling Kitty. This is a liquid; you put two droppers in food. He never rejected food with this in it, so it worked for us.

Here is the store link:
http://www.pureformulas.com/b12-liquid-30-ml-by-pure-encapsulations.html

p.s. This was recommended to us by a holistic vet.No dairy, wheat, gluten, sugar, yeast, corn, starch or hydrogenated oils.
 
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