Advice Needed

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If Mugsy's ideal weight is 11-12 pounds (guessing) and his BG numbers are fluctuatiing widely (59 - 319 see chart) should his first dose of Lantus be 6 units bid (11 x 2.2 x .25) or is this number divided by 2 (3 units bid)???? What does your experience suggest? His current weight is 8.8 pounds although he eats plenty and gets 5 units bid of Vetsulin (possibly unstable). He's active but, losing weight. I don't want to overdose him and one unit seems too little. Help. :?
 
I don't believe lantus is based upon what a cat weighs. The motto here is start low and go slow, I believe we started at 1.0 after switching from vetsulin.
 
I don't know a thing about Vetsulin, but Mugsy sure was getting a lot...at least to me!!
As far as Lantus, it is best for you to start over with 1u every 12 hours. Have you read the stickies at the top of the page and read the protocal? I suggest that you do that. Also, more tests would be advisable, especially since you are starting a new insulin.

BTW...Welcome to LL!!
 
Its been awhile since I've read the dosing by weight guidelines but they are typically for the maximum starting dose so your max would be 3 twice a day??? I think given what you've seen so far, 1 unit is a fair starting dose.
 
The starting dose used here according to our protocol is 1.0 Unit--Then we adjust as the cat's BG dictates--A newbie cat must hold the dose 5-7 days to see if it is working..Please read the stickies--Lantus use is not measured by cat's weight, but the bg, especially the nadir(midpoint of the bg cycle) Insulin is administered every 12 hours only! Read, ask questions, and bg test..That's helpful in the beginning!..Welcome to LL!
 
The starting dose is based on ideal weight and takes into consideration his dose on his current insulin. If his ideal weight is 11-12 lb, the starting dose would be 1.25u BID (11 divided by 2.2 X 0.25u), but I would advise waiting for one of the more experienced folks to help adjust it to take the Vetsulin dose into account....I don't know how that will affect it.

ETA: That is exactly what the protocol states.... ;-)
 
Jen & Squeak said:
Its been awhile since I've read the dosing by weight guidelines but they are typically for the maximum starting dose so your max would be 3 twice a day??? I think given what you've seen so far, 1 unit is a fair starting dose.
Click to expand...
I also was going to say - what may be being referred to here is the Queensland University & 'Tilly' protocols which say the max starting dose is 0.25u BID per Kg of IDEAL weight. An 11lb ideal weight is 5Kg (that's 11 / 2.2 not 11 x 2.2!) so the max dose per those protocols, would be 5 x 0.25 = 1.25u (not 6 !!)

BUT since the recommendation here on FDMB, is apparently to start at 1.0u BID - regardless - then all the above becomes academic..!!??
 
Are you saying that the Vetsulin is possibly unstable at this point?
When will you be starting with your first Lantus dose?
I am hoping one of the dosing people will stop by and take a look although you do not have too much data on your SS. It is up and running so that is good.
We started the first 6 weeks on Vetsulin and I shudder when I think back on it. that 59 Mugsy got yesterday is one of the reasons why I didn't like the action of that particular insulin. It would drive them low at some point but they would fly high after it's potency had left them. Very high peaks and low valleys. I think you will find that Lanuts has gentler curves and is a longer duration in their system.
Have you read the stickies at the top of the page?

At his weight, you will definitely NOT be starting at 6u so forget that completely, okay? :mrgreen:

Tell me: will you be able to monitor his during the first cycles on Lantus? There is no way to predict what each kitty will do when they start with a new insulin so it would be best if you were home to do a cure and watch him. You are welcome to look at both of my kitty' SS and see their ending dose and Vetsulin and their beginning doses on Levemir which is a longer duration insulin similar to Lantus....

What food are you feeding Mugsy and what is your feeding schedule?
 
It is all so confusing but, I'll follow your advise and go with 1u twice a day to start. the PO just told me the Lantus is in so, I'm heading to town to pick it up. I'll start him on it in the morning. thanks. :smile:
 
Perry and Sooty said:
Jen & Squeak said:
Its been awhile since I've read the dosing by weight guidelines but they are typically for the maximum starting dose so your max would be 3 twice a day??? I think given what you've seen so far, 1 unit is a fair starting dose.
Click to expand...
I also was going to say - what may be being referred to here is the Queensland University & 'Tilly' protocols which say the max starting dose is 0.25u BID per Kg of IDEAL weight. An 11lb ideal weight is 5Kg (that's 11 / 2.2 not 11 x 2.2!) so the max dose per those protocols, would be 5 x 0.25 = 1.25u (not 6 !!)

BUT since the recommendation here on FDMB, is apparently to start at 1.0u BID - regardless - then all the above becomes academic..!!??
Click to expand...

There is nothing in the modified version of the protocol that advises starting at 1.0u BID, it simply says to hold the starting dose for 5-7 days.....not to step on anybody's toes.....go read it for yourself.

I know many, many people DO start with 1.0u BID, but when I switched from ProZinc, I posted first to ask about a starting dose, and Libby advised me to start at 1.25u BID based on ideal weight and current dose.
 
Sally and Mugsy said:
If Mugsy's ideal weight is 11-12 pounds (guessing) and his BG numbers are fluctuatiing widely (59 - 319 see chart) should his first dose of Lantus be 6 units bid (11 x 2.2 x .25) or is this number divided by 2 (3 units bid)???? What does your experience suggest? His current weight is 8.8 pounds although he eats plenty and gets 5 units bid of Vetsulin (possibly unstable). He's active but, losing weight. I don't want to overdose him and one unit seems too little. Help. :?
Click to expand...
the tight regulation protocol most of us follow suggests a starting dose dose based on 0.25u per kg of a cat's ideal weight.
as practiced in human medicine, when a kitty is underweight we would use the actual weight of the cat to determine a starting dose.

8.8 pounds = 4kg
4kg x 0.25u = 1u

to further complicate matters, this starting dose should be raised or lowered by taking the dose from the previous insulin into account. however, my personal feeling is there's not enough hard data to know if mugsy is currently at a good dose of vetsulin... not to mention the tests done prior to 10/8/10 were taken at the vet's office. those numbers *could* reflect vet stress and may not necessarily be accurate.

it may be a good idea to start lantus at 1u bid. i know 1u doesn't sound like much, but the dose can be increased quickly if needed. if you choose to start at 1u bid, please be vigilant about checking for ketones... daily if at all possible.

just my thoughts...
 
That's good to know, Jill, about using actual weight when the cat is underweight. Is there some way we could incorporate that into the protocol to eliminate confusion?
 
Laurie and Mr Tinkles said:
That's good to know, Jill, about using actual weight when the cat is underweight. Is there some way we could incorporate that into the protocol to eliminate confusion?
Click to expand...
sure, i could add something to the effect. not a bad idea at all! thanks, laurie!

in an effort to clear up some of the confusion in this thread regarding starting doses...

from the Start Low, Go Slow (SLGS) method:
A conservative starting dose is 1.0-2.0 units, twice per day. If your cat’s blood glucose was less than 400 mg/dl (22.1 mmol/L) at diagnosis, or if your cat is on a low-carbohydrate diet, the starting dose should be only 0.5-1.0 units twice per day. Fast-acting insulins such as Humulin Regular, Humulin 70/30, and Humulin N (NPH) are not suitable starting insulins for cats, in the experience of FDMB members because of the high risk of hypoglycemia; Humulin N may be appropriate later on if you discover that longer-acting insulins cause problems for your cat. Vetsulin, also known as Caninsulin, is less harsh than Humulin N, but still appears to carry a risk of hypoglycemia, particularly for cats who are not meal-fed high-carbohydrate food, so please be aware of the risks.
http://binkyspage.tripod.com/SLGS.html

from the Tight Regulation Protocol using Lantus or Levemir:
Begin with 0.25 IU/kg of ideal weight BID
OR
If the cat received another insulin previously, increase or reduce
the starting dose taking this information into account. Glargine
has a lower potency than lente insulin and PZI in most cats.
http://www.uq.edu.au/ccah/docs/diabetesinfo/link4.pdf

In many cases, the starting dose of Lantus or Levemir has been 0.25 IU per kg of the cat's ideal weight and is always dosed BID (two times a day, 12 hours apart). If the cat received another kind of insulin previously, the starting dose should be raised or lowered by taking this information into account. When selecting a starting dose, it is important to know that while Lantus and Levemir have a longer duration than other insulins, they also have a lower potency in most cats.
http://www.tillydiabetes.net/en_6_protocol2.htm


the protocol followed by most in this insulin support group is the Tight Regulation Protocol as described here:
STICKY: LANTUS & LEVEMIR - TIGHT REGULATION PROTOCOL.
 
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