Confused about Lantus not seeing results

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Tuxedo Mom

Tuxedo Mom

Member Since 2014
Tuxie has been on Lantus for 2 weeks....he started with 1 unit twice daily. I had a human glucometer but was having trouble getting readings.

His before starting treatment BG was 22 (400) After his first dose I got a reading at +3 of 8 (145). The next day I did another reading at +3 18 (325) but really stressed him out and I think hurt him so I don't know how reliable the reading was. I was out of strips and not comfortable with the human glucometer so I did not do readings at home until yesterday. He did seem to be improving at least to look at him. A bit less water and peeing and a bit more energy.

2 days ago he went to the vet for an all day glucose curve. He does stress easily so I wasn't sure how well it would go. After 4 readings the vet said it never went lower than his starting point of 22 (400) so I picked him up. I bought an AlphaTrak, which is working fine for both Tuxie and me. The vet wanted him to go to 2 units twice daily. He was sick that evening...I am thinking from the stress and all so I only upped it to 1.5 unit for the night dose.

Yesterday I used 1.5 units twice. His morning pre shot BG was 28.9 (over 500) his +6 hr was 24.7 (440) and his evening +2.5hr was 23.1(414).

Today I started the 2 units twice a day the vet suggested. His morning pre-shot BG was 20.4 (370) and his +5.5 was 21.9 (385).

I am very confused. He started off with a good reaction after his very first shot. His 12 day glucose curve was not good and even with having increased the dose..50% yesterday and one shot at double, the levels are still far too high. Is this normal to have a good start with only one shot then level down a bit then go up and stay high even with an increase? How many days should I wait before trying another increase? I am confused and I don;t want to do anything to hurt Tuxie, but I want to get his levels in a much better range. One other thought..since this is a vet filled vial (1ml) is there any chance that it could have lost its effectiveness..it is only 2 weeks old and I have been super cautious with it. It is only out of the fridge (I have a thermometer in the fridge to watch the cold level) for as long as it takes to fill the dose then I put it away before actually giving the dose.

Any input would be appreciated. Thanks
 
Lantus is a depot insulin it takes time to build up in their system. It doesn't give an immediate reaction when injected, because it needs to form a "spare tank" under the skin before the cat can use it to lower its blood sugar.

When you first start using it or change a dose, most of what you are giving is going into that 'spare tank' and very little to the cat.

Think of it like trying to fill up a funnel so the water stays level at the top of the funnel. When you first start using it there is a cork in the bottom of the funnel then once the funnel is full you remove the cork and try to keep filling the top so it stays level with the water now running out the bottom. Pour too much or too fast and the top overflows (hypo), but if you don't pour enough or fast enough then the level at the top drops (high bgs).

Then couple that with the fact that since insulin is a hormone that should be naturally occurring in the body, rather than a drug, the body has a build in self-protect mode. If the cat has gotten use to running in the 400's this now feels normal to their body, so when we add insulin that has been missing, and it brings them down to even the high 100's their body reads that as the onset of a hypo. So the pancreas reacts first and signals the liver to basically do a 'sugar dump' to drive the numbers back up again to where it is now comfortable being and feels normal. That is what we call a bounce. Bounces aren't a bad thing, in fact they are a good thing in that Tuxie's body is doing just what nature designed it to do, it is trying to keep him safe from going too low, just it has forgotten what too low really is. And when they are bouncing all you can really do is grit your teeth and ride out the high numbers. It can take up to 3 days or 72 hours for them to clear a bounce.

Mel and The Fur Gang
 
Mel

Thanks for the reply. I am guessing I should give it about 3 or 4 full days before I would see any true results of the increased dosage? If I don't get any lowering after 3 or 4 days at the increased dose should I increase .5 unit. Unfortunately everytime I go to talk to my vet it costs me $60 and I seem to end up having more and more questions as I go along.

I am still in the panic mode and although I understand that reaching the right dosage takes time I was thrown off with Tuxie's initial good response to his very first shot. Since it was so positive to start I was really hoping that after 2 weeks it would still be good. Probably just my naivety as a newbie.

Thanks for any advise in this matter.
 
If you're able to home test (since you say you're using the Alphatrak without problems, I'm assuming you can) there's no need to keep going back to the vet for expensive curves. There's nothing you can learn from them that you can't learn at home (and at home, your numbers are going to be more "normal" since there's not the stress of the vet visit involved)

Here's the general rules for Lantus

"General" Guidelines:
Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Reducing the dose:
If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. See additional notes in the next paragraph about drops into the 20s and 30s. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.
Click to expand...

You should probably go back to the 1.5 unit dose and hold it for at least 3 days, get at least 1 test in somewhere between +5 and +7 during the morning cycle and at least a "before bed" test in on the PM cycle and then let us take a look at his spreadsheet and guide you

It will help a LOT if you'll set up our spreadsheet and start keeping track of his results too..Here's How to set up our Spreadsheet and link to your signature. If you have trouble, let us know and someone can set it up for you!
 
I'm hoping Tuxedo is doing better and not having any more G/I problems! Are you testing for ketones? There are a lot of great people here who will be able to help you with his dosing, but you definitely can help them help you by creating a spreadsheet and making it available in your Avatar.
 
Hello and welcome. Good job getting started on the at home blood testing. I notice that you purchased a repackaged vial of insulin from the vet. That is not recommended. Here is a post on the Handling and Storage of Lantus. You can buy Lantus at any human pharmacy, and depending where you live, it might be cheaper there.

Also, the Alphatrak numbers will read about 30-40% higher than those of a human blood glucometer. So after you made the switch in meters, the numbers may have looked worse than they actually were.
 
I would put much faith in the 30-40% higher statement

9-14-2014
I just did two tests with my original AlphaTrak and my human Easy Gluco Plus meter. Both comparisons used same drop of blood from two different cats

Dulce OTJ
AT = 72
Easy Gluco Plus = 54
The AT is 133% of the EGP value
Badgar
AT = 377
Easy Gluco Plus = 331
The AT is only 113% of the EGP value



Wendy&Neko said:
Hello and welcome. Good job getting started on the at home blood testing. I notice that you purchased a repackaged vial of insulin from the vet. That is not recommended. Here is a post on the Handling and Storage of Lantus. You can buy Lantus at any human pharmacy, and depending where you live, it might be cheaper there.

Also, the Alphatrak numbers will read about 30-40% higher than those of a human blood glucometer. So after you made the switch in meters, the numbers may have looked worse than they actually were.
Click to expand...
 
All the information I am reading everywhere is becoming overwhelming.

As far as the differences in the human glucometer and the AlphaTrak the first 3 readings I did at home were with the human one. The rest have been with the AlphaTrak. The readings I got after the failed vet glucose curve were higher than at the vet. I am hesitantly putting this done to stress from the visit, plus he did not eat or drink during the 8 hours he was there.

The vet sells my the lantus in a 1ml bottle so it is obviously repackaged. However the vials from the pharmacy are 10 ml which is way too much before the expiry time suggested by lantus. I realize that you could go beyond the 28 day time but a 10 ml vial would last me 6 months (at 2 units twice a day) which I am not comfortable with. The pens from reading I have done fall into the same expiry time and some reading I have come across suggests that there is more chances of contamination using the pen by drawing insulin out with a needle. I will be asking the vet how long their original bottle has been "open" since that affects my use time. However she has 15 diabetic cats at this point so I would think that using a 10ml bottle originally that it can't be opened for too long before it has been sold out to all the patients.

I am more worried about how long until I should start seeing more positive glucose readings with the increased dose. I will continue doing Tuxie's readings and will do a curve after 7-10 days on the new dose. I understand that it takes time to start levelling out but I am just worried that maybe the lantus is not going to work well enough for him. I am not comfortable with doing a tight regulation and making dose decisions based on his readings. At least not at this point.
 
All caretakers gt a lot more than 28 days. With luck you can get over 6 months. Just this week I finished a 10 ml via of Lantus that cam with Badger when I adopted him him March of this year. It was 3/4 empty then.

The pens are best since almost always you can use up a pen before it loses effectiveness which you can tell by measuring BGs
 
Most people here get 5-6 months out of their vials, if they are stored properly in the fridge. If you can find a pharmacy that will sell you a single pen, that is the most convenient. When Neko was on Lantus, we almost always used the pen (cartridge) to the last drop. We've had other members have problems with repackaged insulin.

Many cats read higher at the vet. My non diabetic cat once read 210 at the vet, then 53 at home the next day. That's why we recommend home glucose testing, as numbers can be higher at the vet and you don't want to decide the dose based on stress inflated numbers.
 
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