Consistently high BG, Lantus insulin, 4 units/day

Hello, I'm new to the group. My Copper was diagnosed in November. Vet had me start out on 2 units of Lantus insulin a day. The first week it worked well, but he's been consistently high 300's. I've been raising him up gradually with the vets instruction. He's now up to 4 units a day since 2/26. The vet does not want to go any higher, as he's never treated a cat with more than that. I've been feeding him dry food Purina DM. I thought maybe switching to a different brand might help, so I'm currently transitioning him to Hill's M/D. He doesn't like wet food and won't eat it... I may try again. Over the past couple of months he's developed diabetic neuropathy in his back legs and has trouble walking.. I'm at my wits end! Does anyone have experience using more that 4 units of Lantus?

 

Hi Brooklyncatmom,

I am in a similar situation so I’m not the best person to give dosing advice but there is some fantastic info in the stickies section of this forum which has helped me understand some of what’s going on.

Does Copper have any underlying issues like pancreatitis, IBD or lymphoma?

 

Hi NyCatMom,

He has hyperthyroidism, which is actually pretty well controlled with his meds. A few weeks ago the vet ran a bunch of tests on his blood and urine, and did a urine culture to see why he might not be responding to the insulin. Everything came back great except for his blood sugar. He had me buy another bottle of Lantus, to see if maybe I got a bad batch of insulin, but alas, same results.

 

I went through the whole “maybe the Lantus was bad” thing too. I now order it from a Canadian pharmacy recommended on this forum.
My vet wound up sending me to a veterinary internist when she felt like we weren’t making progress. There was a lot of staff turnover at my local specialty hospital so I wound up driving my girl, Honey, to Cornell in Stamford but there are many specialty hospitals in NYC so you might have one closer to you. If you decide to go that route get copies of all the test results from you vet.

 

To get the best experience on this Forum, I know it recommended that you create a spreadsheet of doses and readings. I resisted doing it for a while but found it really helps with vet visits and advice from other members. I’m in the car now but will look to see where the instructions are and post the link here

 

Thank you. Good advice. Aww, I actually have a calico named Honeybee. It's been hard going through this during the pandemic. The only vet I was able to get in with was a mobile vet that doesn't take appointments, and you have to get on a waitlist and stand in line outside every time you go, and they are only there a few days a week. I'm grateful I was able to get the diagnosis and start treatment, and they've been great about letting me text them with updates, but I may try to get in with another vet for a second opinion, but I'm sure it will be a while before I can get an appointment. I've been logging his blood sugar on notes in my phone, but maybe I'll try the spreadsheet.

 

Hi Brooklyncatmom - You are in the right place. I second the spreadsheet! You are already logging his blood sugar so you're already on your way. The spreadsheet will really help.

There are a number of kitties out there on higher doses - take a look in the Lantus/Levemir forum. When I joined in early Feb I searched through the posts and looked at other spreadsheets to find other kitties with high doses and high blood glucose numbers.

Don't use my Minnie as typical example (though everyone will tell you Every Cat Is Different ECID) - but she was diagnosed in April 2020. We worked up to 4u Lantus twice daily, still uncontrolled numbers. Switched to Levemir in Feb, now up to 5u twice daily. We are still not there (and she tends to get ketones which is a whole other drama). It really is a process.

The other thing you will definitely hear is to try and move off the dry food. Have you looked at catinfo.org - and the stickies at the top of this forum
https://felinediabetes.com/FDMB/thr...r-more-than-just-carbohydrate-content.175004/
https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-chart.174147/

I imagine someone more experienced than me will point you in the right direction for next steps. If you need help setting up the spreadsheet, there are people who can help with that.

Good luck!!

 

Thank you! Wow, you are doing Lantus twice daily? Interesting. Also, I need to learn all of these acronyms!!

 

A-ha, you will learn...there are links to everything here! This is a good starting point (get ready to start a lot of reading) - Sticky - The Basics: New to the Group? Start here! | Feline Diabetes Message Board - FDMB

It used to be Lantus twice daily, we switched to Levemir which works similarly. My understanding is that these are normally dosed twice a day in cats. Take a look at the stickies in the Lantus/Levemir forum - this is a good start Sticky - What is the Insulin Depot? | Feline Diabetes Message Board - FDMB

Glossary is here https://felinediabetes.com/FDMB/threads/fdmb-glossary.194472/#post-2175654
Lantus/Levemir slang is here Info - Lantus, Basaglar, & Levemir ISG Slang Dictionary | Feline Diabetes Message Board - FDMB

welcome

 

Hi and welcome to the forum,
There are quite a few cats who need more than 4 units of insulin.....however I agree you need to get that spreadsheet set up and put your existing data in which will help up see what is going on. If you run into trouble with the SS @Bandit's Mom will assist you I am sure. She is great at SS setup.

I suspect that the dry food you are feeding is responsible for at least some of the high BGs.
HOWEVER DO NOT CHANGE OVER TO A LOW CARB DIET UNTIL YOUR SS IS SET UP AND THE DATA ENTERED AND WE CAN HELP YOU.
This is because the change over to a low carb diet can significantly drop the BGs and if you are not monitoring closely you can risk a hypo.

Ae you testing before every shot to see it is safe to give the dose?
Are you testing during the cycle to see how low the dose is taking Cooper?
Lantus dosing is based on the lowest point (nadir) not the preshot BG.

Do you have a hypo kit set up? This is really important in case it is needed.
Link to how to set up within this link https://felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/

Looking forward to seeing Coopers SS.

 

Are you just giving Cooper 4 units once a day?
Lantus is a twice daily insulin for cats. Humans need it once a day but cats have a much faster metabolism and need it twice a day.
Only giving it once a day means he is dropping down for half the day and staying up high for the other half of the 24 hours.
You would be far better off changing it to 2 units twice a day. But don’t do anything until the SS is set up and we can see what is going on with the BGs.

 

Yes, absolutely set up a spreadsheet. It is critical so we can monitor the test and the insulin injections. The people on this site cannot help you if you don't provide them with the data.

 

Yes, I am giving Copper four units, just once a day, as the vet recommended. I always test pre-shot, and I usually test once or twice later in the day. His lowest low is in the low 200's. I have a lot of data already, so I will get to work setting up the spreadsheet.

 

Not sure your vet knows a lot about feline diabetes or maybe Lantus. It’s always given twice daily to cats as it is a depot insulin which only lasts 12 hours in cats, and the depot needs to fill and settle. If the dose is only given once a day, the depot doesn’t get a chance to settle and fill as if is being used in that other 12 hours of the day. And Cooper is only being covered with the insulin for 12 hours not the 24 hours.
Once you are giving the Lantus correctly and have got rid of the dry high carb food I am sure you will see much better results for Cooper.

Have you been testing for ketones in the urine? Do you remember if the vet mentioned ketones at diagnosis?
Unregulated cats can get ketones which can be dangerous if not treated so I would go out and buy a bottle of Ketostix from Walmart or a pharmacy and test the urine daily for ketones. I’m not saying he has them but it is always a good idea to test for them at this stage when his BGs are high.

 

Yes, the vet did tell me to test for ketones, and I have some test strips. I test every few days, especially when his numbers are really high. No ketones.

 

That’s good!
I can see the SS. Well done getting it set up.
Can you enter in the signature and the SS what meter you are using please?You have used the human Meter SSO so I am assuming you have a human meter.
Looking forward to seeing some BG numbers.
Use the remarks column to enter the ketone results, what food is fed and when and any other issues such as bowel problems, vomiting, how is is generally etc.

 

As everyone has said Lantus should be given twice a day. In your signature and spreadsheet could your please put what meter you ate using .

 

For the neuropathy most of us use Methyl B-12




https://www.vitacost.com/vitacost-vitamin-b-12-methylcobalamin-5000-mcg-100-capsules-6


Alot of members use this , I use it myself you can buy it on line from Vitacost
Vitamin B-12 Methylcobalamin -- 5000 mcg - 100 Capsules
It's 17.99 just be sure this is the one you buy
Some us Zobaline , but it's expensive
This is the same thing
The only difference is the Zobaline has 200 mcgs of folic acid
So I buy the folic acid at the supermarket and crush it up and add it to the B-12
If you can't find the 200 mcg get the 400 mcg and cut it in half
The Vitacost brand is a capsule so just open it and pour the powder on the wet food
Has no taste, no need to crush it up
The Zobaline is 33.99 for 60 pills, too expensive
I saw a big improvement I'd say 3 months, could be sooner. One capsule a day.
Once you get your kitty better regulated the B-12 methyl will help


Vitamin B-12 Methylcobalamin -- 5000 mcg - 100 Capsules

 

Oh, thank you! I've been wondering about this!

 

Thanks for adding what meter you are using on your SS, could you please add it to
your signature also

 

Thanks for adding all the data to the SS. I can see it.

If I were you here’s what I would do:

• I would split the dose you are now giving and give 2 units for the morning dose and 2 units for the evening dose.

Start doing this at the pm dose so that you are not giving him 4 units at night and then 2 units 12 hours later in the morning.

• Pick a time that suits you best to give the doses as it needs to stay the same....so 7am and 7 pm. Or 6 am and 6 pm.etc. Whatever works for you.

• Test before every shot. And try and get at least one test in during each of the cycles. At the moment we don’t really know what is happening during any of the cycles, although you have managed to get a few tests in during the cycles at times. The insulin usually works hardest during the first 6 to 7 hours then gradually wears off at around the 12 hour mark, so try and get those tests in during the first 6 or 7 hours each cycle. If the BG is still dropping after that, then you need to keep testing. The sequence for giving the insulin is test, feed and shoot in that order.

• If you get a preshot BG under 200 at the moment.....stall, dont feed and test again in 20 mins to see if the BG is rising. Post and ask for help. You will gradually be able to shoot lower BGs but at first until we gather data it is better to start off at 200.

Hold the dose of 2 units twice a day for at least 5 to 7 days to let the depot fill and stabilise, unless the BG drops low (under 90 for now) in which case you would reduce the dose to 1.75 units each 12 hours. Are you using syringes to give the insulin? Or a pen.?

• Once we get more data I would start to give Cooper a low carb diet instead of the dry food which is high carb. Ordinary canned food from the supermarket and pet stores is fine. Here is a link to suitable foods. Look for cans 10%or under. But don’t start feeding it just yet.

https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

Give a couple of snacks during the first half of the cycles as well as the preshot meals.

 

Okay, I've added all of the data I have to the ss. Started him on 2 units twice daily today. I've got a lot of prescription kibble to go through before I try to transition to wet food. I also have two other healthy cats who are constantly trying to eat Copper's prescription food. I currently have both the Lantus SoloStar pens and a 10mL bottle because the vet had me buy a bottle to see if maybe the pens weren't working. They are working, so now I have a lot of good insulin to go through as well. I guess if I'm giving whole units I will use the pen and if I'm giving partial units I'll use the syringes. I know I shouldn't hang onto this for too long, once I've started using it, but I've opened both a new pen and this bottle just this month. Spent a lot of money on this kitty, so I'm going to try to get the most of it. Thank you everyone for your suggestions!

 

There is a ton of information in the sticky notes at the top of the Lantus board. (I suspect this will make you much more of an expert on diabetes than your vet.) It will truly give you a grounding on how to use Lantus, the dosing methods we use, etc.

FWIW, there is nothing "prescription" in the food your giving your cat. In fact, the dry diabetic diet is very high in carbohydrates which is one of the reasons Cooper's numbers are where they are. It's also fine to let your other cats eat the food. If you compare the ingredients in the food with what you may be feeding your other cats, there's likely not that big of a difference. If you switch Cooper to low carb food, it will be a more appropriate diet for your other cats, as well. Cats are obligate carnivores -- they can't process any of the carbs that are in many of the cat food products.

 

Hi Brooklyncatmom. My cat is on 4 units of lantus and hs been for about two years now and he is doing great, some cats just need more than others. The vet started him on 2 units and we had to go up from there but now he is very well regulated. In regards to food I highly reccomended not feeding hills, royal canine, or any other vet diet like those. I know this is a touchy topic for some people for some reason so I won’t get into it here but you if you just google “problems with (insert vet diet here)” you’ll find tons of research talking about it. Personally I would recommend trying to feel raw, it has seriously saved my cats life. I feed Smallbatch frozen raw but brands like Lotus, Northwest Naturals, Stella & Chewy’s, and Answers are all wonderful. I live in the PNW so there might be other brands available where you live but I’m sure they’re very worth trying out. I know people who’s cats won’t eat wet food but will eat raw, and even if your cat doesn’t like the frozen I would try a low carb dry food with some freeze dried raw toppers soaked in water and try and transition to raw that way. Let me know if you have any questions. Hopefully your Copper feels better very soon!

Edit: I just wanted to reiderate that you should be very careful about monitoring blood glucose levels when switching to raw, Copper very well may need a lower dose of insulin due to the low carbs so that hypoglycemia doesn’t happen. My cat was already eating raw and beinv monitored when his dose was upped so it is a different situation but here is an article that can help explain proper diabetic feline nutrition way better than I can https://catinfo.org/feline-diabetes/

 

Good luck with the change to 2 doses. How much does your cute kitty weigh?

 

Good info. Thanks, I will look into this.

 

Copper weighs about 12 lbs now. Down from 16 lbs at original diagnosis.

 

That's a good weight.

 

Hello, just wanted to add my greetings to the pile. You've got some great suggestions so far. My girl got up to 8.75 units twice per day, we have a number of cat on even larger doses. One of our sayings here "a cat needs however much insulin they need" and ECID - each cat is different.

Good luck with dosing twice per day, you'll get much steadier numbers that way. It might take a few days, for the Lantus depot to build.

 

Wow, that's a large dose! Good to know! I've been so afraid to go any higher, mainly because of what the vet said. But I think Copper may need to go a bit higher. ECID!