Back on Lantus again. treatment advice appreciated

[George&Bert]

Disagreement between vets of whether Andre had/has DM or not stopped my from injecting him.

He has had a persistent and troublesome URI and has been on meds for over two months to beat it. he is doing better with that.

When he first got sick his numbers were 360. But it was thought to be transient,
Two weeks later his number at a different vet was 375 he said Andre had DM Started on Lantus
A few days later another vet checked him and did a urine test..no sugar in urine..BG 149 he said he did not have DM
A few days later the same vet did a Fructosamine test that came back very high..so he changed his mine and said he did have it.
I was reluctant for a few days and took him to original vet who said be careful it still may be transient, but his numbers went through the roof.
I checked it myself the next day and they were still through the roof so I put him back on yesterday. I unit u100 BID

I am easing him into lower carb dry and eventually canned, giving him a little more every few days.

My other cat was on PZI so I am new to Lantus and not DM or testing.

How does Lantus work. I read about the "shed" effect. but know little about what to do and what to shoot and when to test.

 

[Sandy and Black Kitty]

Re: Back on Lantus again. treatment advice aooreciated

Hello

Lantus is a different animal than PZI.
It likes consistency with timing (12/12) and dose (no dose hopping). Dosing is based on nadir, with only some consideration given to PS numbers.

There are a couple choices regarding protocols and they can be found here

I suggest you get a spreadsheet set up. The instructions, along with a ton of other valuable info can be found here

Keeping track of shots, doses and BGs is key to keeping kitty safe, particularly with the change in diet and the URI. Once those 2 items are addresses it could be a whole other picture - for the better

 

[Sienne and Gabby (GA)]

Re: Back on Lantus again. treatment advice aooreciated

Lantus is a long-acting, depot-type insulin. The doses become cumulative which is, in part, what gives Lantus its duration. Like Sandy said, consistency is key. Keeping as close to a 12-hour schedule as possible is helpful as an early shot acts like a dose increase whereas a late shot acts like a dose reduction. Because dosing is based on the nadir, getting spot checks during both the AM and PM cycles is very important. Initially, getting a mini-curve (testing every 3 hours) can be very helpful. Did your vet give you a starting dose?

Please let us know what questions you have.

 

[julie & punkin (ga)]

Re: Back on Lantus again. treatment advice aooreciated

hi george! just saying welcome! you'll no doubt have a zillion questions - ask away. we'll be glad to help you learn to use lantus - it seems to take a bit to shift the thinking away from dosing based upon the preshot.

 

[George&Bert]

Re: Back on Lantus again. treatment advice aooreciated

Hi Julie and thanks folks.

I started him on one (1.0) unit u100 syringes.

Now, before he was diagnosed all my guys were on a 90% dry food diet using canned as treats.

I never realized one of the food was so high carbed at almost 31% "California Natural Chicken and Brown Rice" dry by Natura until I looked closer. All my my cats seemed to be happy on it. I have 20 cats now as I have lost one to cancer and one to a bad heart within the last six weeks. They were both twelve year old former ferals turned lovers.

Anyhow, they got a combo of California natural and "Taste of the Wild Venison" for which i have no dependable numbers yet.

I have pulled all the California Natural from everyone fairly abruptly letting my sugar guy have it for a while as I substitute more wet in all their diets
and gradually replacing all the dry with Evo dry and Core dry and as I said tripled the amount of canned they all get. I will settle on 50% EVO and 50% Core dry that I will always keep out and feed them each a half can of wet twice a day going forward.

Andre' hates getting his shot, but I can deal with that and work it out. However, testing him is a big problem. He is a lover boy and loves to snuggle, but when I grab his ear it is wildcat time. Keep in mind he has been tortured by me and three vets for ten weeks trying to cure his URI and possible Pancreas problems He does not test for anything so it has thrown everyone a curve. He has lost his tolerance for poking, prodding and sticking.

I might be able to test him once every three days and doubt I can time it use strips as I did my Bert.

You all are awesome..thanks

 

[julie & punkin (ga)]

Re: Back on Lantus again. treatment advice aooreciated

hmmm, george, you have quite the situation! you must be a very kind-hearted person to have rescued so many cats. good for you! i can imagine with 20 cats you need to leave dry food out. and not being able to test every day, i'm thinking you will want the Start Low Go Slow protocol with Bert. The TR protocol requires a minimum of a test before each shot and one mid-cycle test, both day and night, and a diet that is exclusively all low carb canned food.

if you can get him to all LC canned and to a point of being able to test more, then you could consider the TR protocol.

One very significant way that Lantus is different from ProZinc is that it builds up in the system and slow releases - we call it the shed, but you can think of it as cumulative & timed release. i'm not aware of a safe way to find a dose and just give it. what might be a really great dose right now can end up too much in a week or two. Insulin is a powerful hormone.

Here's the link for the SLGS method. it has you doing a curve every week or so. the one change we've made to it is that we encourage all dose changes to be by .25u instead of .5u. a tiny dose change can make a big difference in BG, and because of it's slower-acting character, lantus can't be used to "knock down" numbers. you have to be patient with it.

let us know how we can help you more!

 

[George&Bert]

Re: Back on Lantus again. treatment advice aooreciated

Thanks.

I was never worried about it all with Bert. He hated the pinch, but he never fought me on it. He was a dream. He did not die of DM. he died of pneumonia as a complication of cancer. Namely..squamous cell carcinoma...it's a bad one.

I believe he got it due to long term steroid use for Asthma. Now I use inhalers.

Anyhow, I am worried about Andre' because I don't know if he is really diabetic. Two vets think so and one vet says it could be transient and to be very careful.

From your description of Lantus it builds up and the body takes what it needs. What happens if there is too much in storage. Will he all of a sudden bottom out?

Maybe I should be on a faster acting, less duration insulin. Is Levemir similar in action to Lantus?

The Clindamycin and Orbax seem to be curing his URI which right now seems to be improving. He is in a very good mood and wants to rub noses. He is being social again.

BTW..I am the founder of an animal rescue group that specializes in feral and stray cats. We are raising money for a twenty acre sanctuary for cats. There will be other critters as well such as foxes that are endangered by people and horses who need a resting place. Dogs will have their own area in which to run.

 

[mybuddybinks]

Re: Back on Lantus again. treatment advice aooreciated

Hi, George and Andre!!

bless you for providing an animal sanctuary...

:YMHUG: :YMHUG:

celi & binks

 

[Blue]

Re: Back on Lantus again. treatment advice aooreciated

From your description of Lantus it builds up and the body takes what it needs. What happens if there is too much in storage. Will he all of a sudden bottom out?

Maybe I should be on a faster acting, less duration insulin. Is Levemir similar in action to Lantus?

it's really hard to say what you should do if you can't home test, but I don't think a faster acting insulin is a good idea at all; I look at it as a dangerous idea.

Lantus and Levemir are quite similar, working in the same fashion/style, but many have found Levemir to be a bit gentler, giving much flatter curves, safer numbers to me.

As for the shed and the buildup, you don't have to worry about a sudden bottom out.

One of my cats was on 37u BID and within a few weeks his dose dropped down to around 21u BID. He was at that dose for a few weeks, then his need for insulin almost disappeared after he got his vaccines. In December he was getting 21u BID, then daily dropped to lower doses or even several skipped shots and he never went dangerously low.
If you think of a bag of fluids, dripping down and into a cat.... even though you have that big bag of 1000cc, at the end of the line the tubing there is a needle and you can see how the fluids drip slowly, drop by drop, out of the bag and into the drip chamber.
My Oliver never went hypo; his shed just seems to have been used in a safe fashion by his body.

Just think of the shed as a spare gas tank. It will get used on a need basis, and if you don't have high BG numbers saying please help me, I am running low on insulin, then you just don't give a shot.

That's my worry here. If you can't test and are just shooting insulin based on a maybe situation, for sure you don't want a fast acting insulin as they are harsh and quite powerful. Why give an insulin that will force his BG low very fast and maybe cause a hypo state?

Now, this suggestion may sound odd but what about trying to test at odd times, like mid cycle?
I am thinking that you can't get all the tests just before giving a shot, and if you try and fail, maybe try to get a test about 4hrs after the shot? He should be feeling better after the insulin, and a test at +4 will give you an idea of whether the 1u dose is good or needs to be adjusted.
Lantus dosing is based on the lowest point in a cycle, the nadir, so why not try to catch the low and it will help you to know what way you need to go.

 

[George&Bert]

Re: Back on Lantus again. treatment advice aooreciated

I guess the nadir is plus six hours?

 

[Blue]

Re: Back on Lantus again. treatment advice aooreciated

Nadir for many cats is around +5 or so, but others are all over the place.
My two cats are around +4.5 and +10 or +11; I learned the info by alot of testing, many curves.

For many cats, around +4 is going to be a fairly telling number as it's around about the time the insulin starts to work. if you test at +4 and get a really low number, you might be wise to have some high carb food handy, just in case your cat keeps dropping too low. If you have a decent number at +4, you may be able to think that your dose is fairly OK and it's not too high a dose.

You can change up the times you test as well ... maybe try a +4 today, and maybe a +6 tonite. Tomorrow, you could try for diff times. Be sure to give some praise and treats with every test, even if the test failed and maybe your cat will associate the testing with a good thing.

ETA: my suggestion is not going along with the TR way, so if you are considering an alternative, you may consider posting in the Relaxed Lantus forum.

 

[kim and simon]

Re: Back on Lantus again. treatment advice aooreciated

Welcome to LL! I just got here in January and the folks here have been so helpful. I hope that you will find a way to give Andre food that works for him (along with all your civvies!) We have enough trouble keeping Simon out of the dog's food. It can be quite a headache! You are doing a great job. Thanks for taking care of so many precious kitties.

 

[Sienne and Gabby (GA)]

Re: Back on Lantus again. treatment advice aooreciated

I agree with Julie that if you are feeding dry and are having difficulty with testing, it would not be in Andre's best interest for you to follow Tight Regulation. The TR Protocol requires the following:

REQUISITES WHEN FOLLOWING A TIGHT REGULATION PROTOCOL WITH LANTUS OR LEVEMIR:

• 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.
  
• It will be necessary to test kitty's blood glucose levels multiple times per day.
  
• Learn the signs of and how to treat HYPOGLYCEMIA and prepare a HYPO TOOLBOX.
  
• Test regularly for ketones and know about DIABETIC KETOACIDOSIS (DKA).
  
• Use U-100 3/10cc syringes with half units marked on the barrel for fine dosing.
  
• Feed a high quality low carb canned or raw food diet.
  
• Feed small meals throughout the day. Some kitties adapt well to free feeding.

If you can't do the above, TR will not be well suited for Andre. The Start Low Go Slow (SLGS) protocol will be a better option. You can certainly continue to post here or you can post in the Relaxed Lantus forum if you're using SLGS. Most of the people posting in this forum use the TR Protocol.

What we refer to as the "shed" is what happens when Lantus is injected. The insulin forms micro-precipitates located in the fat tissue that are gradually released. While it's possible for a cat that is needing less insulin to have numbers drop, the image you're using of the shed isn't how it works. it's not like the shed becomes overfilled and you have a hypoglycemic crisis.

Gayle's point about nadir is well taken. However, her comments should be put in the context that her diabetic cats have acromegaly and are/were on Levemir. Lev has a later nadir. (Lantus onset begins at +2 whereas Lev onset begins at +4.) What I would add is that the nadir is not a fixed point. It can change. My cat typically has a nadir at around +3 or +4. However, a few days ago, her nadir was at +7.

 

[George&Bert]

Re: Back on Lantus again. treatment advice aooreciated

With my former Diabetic kitty it was easy. He was easy to test, easy to shoot and easy to dose. I used PZI on a sliding scale and always knew where I was or should I say he was. This Lantus insulin is said to be superior in many ways to PZI and it most likely is. but I have a lot of trepidation with this insulin and method.

My doc wrote a scrip for Lantus and refused to write one for Lev because he never heard of it. I nagged him enough he looked it up and is going to try it on his own cat. This vet keeps trying to push dry DM on me. He dopes not believe in wet food for cats. He and I argue about that too.

I have a question? If Lev is a bit easier or safer to use why are you all using Lantus?

I am surely not in a position to do a TR....so I think I will saunter on over to the other Lantus with my tail between my legs and see who hisses at me.

 

[Sienne and Gabby (GA)]

Re: Back on Lantus again. treatment advice aooreciated

The only differences between Lantus and Lev is that they have a different pharmacology and Lev has a later onset and nadir. The same TR protocol is used for both. Lev is no easier or safer to use.

 

[Blue]

Re: Back on Lantus again. treatment advice aooreciated

I agree that there is really not that much difference between Lantus and Lev, but there is enough for my Shadoe to act visibly more relaxed in the first week I switched her from Lantus to Lev. I don't know all that much about the differences, I think ph is different and there are even some vets who are suggesting Lev to their diabetic clients over Lantus, so there must be something to it.

I also know the curves are flatter, at least going by Shadoe.

There's the ph difference and a few other areas where there are differences so if your cat is having some issues with Lantus, you could try Levemir.

 

[julie & punkin (ga)]

george, no worries and no need for a tail between the legs!!! you just want a good fit for your situation.

there's no reason to be afraid of using lantus - you've just begun it and you can see many of us use it. it takes a little while to learn it. everyone here started at the beginning at some point.

personally, i think you would want to give the insulin a chance to work before you consider another insulin. if you were giving PZI to Bert you would want to get a BG test before shooting. this isn't much different.

would it be more helpful for us to share ideas on how to train Bert to accept testing? i would not want to give any insulin without some testing.

 

[George&Bert]

One of the problems I have is the vet tech at the last visit. they thought they were helping by doing the ear instead of the standard draw site. They held him down and lanced him several times with a long needle form a syringe going through every time until I yelled at them to stop. He still has a black strip running up the sweet spot area. Ever since then I can see him get a glimpse of the meter and he takes off. Then it is a battle royal to get blood.

To day was a perfect example of ho hellish it is getting blood from him. Otherwise he is the sweetest most loving kitty you would ever want to see.

I have no way to separate him from the rest of the gang and when I pay attention to one they all want to see what's going on. After all, I may be giving treats (which I am). So, I get out the kit to test and i am immediately surrounded. And here comes Toby, my 29 pound former reigning tom cat from the next town, galloping towards us. In the midst of all this I've got Andre' held tightly and with a hand that shakes due to an injury trying to hold him with just one hand and hit that little spec of blood with the other. I went through two lancets and three strips before I got a reading. During this whole time he is gagging, chocking and coughing from his URI. It was bad for him and me.

I have tested hundreds of times before and have tried many techniques and was nearly always successful. This is entirely different.

I am going to buy another and smaller meter he may not recognize.

Follow the next post please. It's on "relaxed"