Dosing advice needed - Lantus

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ehsuan

ehsuan

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Hi, Not sure if I should post here or in the Lantus board.

Tableau (who was in remission for 4 years) is starting on Lantus tomorrow. THe vet prescribed a starting dose of 2 units 2x per day. In looking at the Lantus board, it looks like, even if prescribed the lantus pens, that people are using the pens but with regular syringes (not the syringes that screw onto the end of the pen). So I just want to make sure I have the right dose. If I am using the BD Ultra-fine ii insulin syringes, (for U-100 insulin) that I would fill it to the 4th marking (because these are marked every 1/2 unit). Is this correct or do I have it totally wrong. Also, is there a reason people don't use the screw on needles (maybe because it's easier to fine tune the dosage with the syringes)?

Also, i did tight regulation with my cat 4 years ago when he was on PZI. This involved taking BG readings throughout the day, and adjusting the dose as needed, on a daily basis, and shooting more than 2 x a day. From reading the Lantus board, it looks like regulating with Lantus is done less aggressively, with doses changed every few days, according to the BGS, as opposed to daily. DO I have this right?

Thanks in advance for your answers.
 
Re: Starting with Lantus

If you need an answer to the syringe question quickly, then you should post it on the Lantus board for sure.
As far as the Lantus protocal, there are sticky threads at the top of their forum with all the details. As I understand it, yes, Lantus is a long-lasting (12 hour) insulin, and the prefered dosing schedule is twice per day, 12 hours apart, with a consistant dose for several days straight. You would still do a BG test just prior to each shot, and more tests during the day between shots. Most people when running a glucose curve check every 2 hours.
Sorry I can't help more, but I'm a PZI guy (u40 syringes) and have no experience with pens or u100's.

Carl in SC
 
Re: Starting with Lantus

Thanks, Carl. Where do you get your PZI? My vet did not want to prescribe it, even thought I gave her the info on BCP PZI.
 
My vet called in a prescription to Vet Pharmacies of America. I think it shipped from Houston, TX.

Carl
 
We typically recommend a starting dose of either 1 unit or 1/2 unit, no matter what insulin. Are you home testing?

Regarding the lantus pens - it is correct that you don't purchase or use the needles associated with the pens and rather use regular insulin syringes. The reason is, that the needles that go with the pens, don't have the 1/2 unit markings and won't give you the control you need for shooting the cat. They are designed for humans who require more insulin (typically) than a cat.

The pens are great to use, as you won't have as much wasted insulin and unopened pens (keep all pens in fridge) are good until the expiration date. Opened pens will last at least 30 days and sometimes longer.

Do your syringes say they are 1/2 unit markings?

Here is a link to pics of what the syringe and 1/2 unit and 1 unit doses look like, as well as other micro doses: http://www.flickr.com/photos/29764149@N ... otostream/
 
ehsuan said:
Hi, Not sure if I should post here or in the Lantus board.

Tableau (who was in remission for 4 years) is starting on Lantus tomorrow. THe vet prescribed a starting dose of 2 units 2x per day. In looking at the Lantus board, it looks like, even if prescribed the lantus pens, that people are using the pens but with regular syringes (not the syringes that screw onto the end of the pen). So I just want to make sure I have the right dose. If I am using the BD Ultra-fine ii insulin syringes, (for U-100 insulin) that I would fill it to the 4th marking (because these are marked every 1/2 unit). Is this correct or do I have it totally wrong. Also, is there a reason people don't use the screw on needles (maybe because it's easier to fine tune the dosage with the syringes)?
Click to expand...

Tableau’s mom or dad,

My name is Roberta and my sugarcat is Casey. I have not been using Lantus (or any kind of insulin) for very long, but I asked a lot of questions and learned a lot.

I am not sure about this, but starting at 2.0u bid sounds a little high, as the saying goes: Start "slow - go slow", we would not want a Hypo situation.

As for using a syringe verses the pen needle, there are a couple of reasons I am aware of.
1. The pen only distributes in whole units. Many of the dosing changes are in fragments of units like .25, .50, etc.
2. The syringes are less expensive than the pen needles.
And yes, as long as you are using a U-100 syringe with half unit markings, 2.0u would be the 4th mark.

Also, i did tight regulation with my cat 4 years ago when he was on PZI. This involved taking BG readings throughout the day, and adjusting the dose as needed, on a daily basis, and shooting more than 2 x a day. From reading the Lantus board, it looks like regulating with Lantus is done less aggressively, with doses changed every few days, according to the BGS, as opposed to daily. DO I have this right?

Thanks in advance for your answers.
Click to expand...
They do encourage taking BG readings throughout the day, however making daily dosing adjustment are discouraged. Lantus is a long-lasting insulin that works best with consistency and with subtle changes.

I hope this helps,

Roberta
 
The long-acting insulins, Lantus and Levemir, are excelent insulins for cats and I think you will be quite comfortable with Lantus after you have a little experience.

What foods are you feeding your cat? Does your cat have any other medical problems?

Food and medical issues have a huge impact on blood sugar. If your cat is eating low-carb food (under 10% carb from Janet & Binky's list) and has no other medical or dental problems, then 2 units is a high dose to start with.

Another bit of information to keep in mind with syringes. Most humans use insulin syringes that hold 1cc of insulin which is 100 units. These syringes are annotated every 5 units and have slash marks every 1 unit. You want 3/10cc syringes. They hold 30 units and have .5 unit markings on them.

In the Tech Forum, you will find a sticky titled, "How to Create Your Own SS and Publish It in Your Signature ." Get that set up so we can see your blood sugar test results.

Lana
 
Oh, a little more information about Tableau (and I'm Emily).

He recently underwent a series of radiation treatments for Nasal Carcinoma. Those ended at the beginning or June. Since then he has had a major Herpes flareup (which has involved ulcers in the eyes - he ended the systemic treatment for that and is now on eyedrops).

He also had a terrible runny nose that the cancer specialist said was more than just a reaction to the radiation. He was on three rounds of different antibiotics before he was finally diagnosed 4 weeks ago with Bordetella ( AKA Kennel Cough - didn't know cats could get this) and has been on doxycicline for about 4 weeks now.

He has also had high blood pressure, which has been controlled with amlodipine for several years now.

YEs, I do home testing. Had only been doing it every few months as he'd been in remission for 4 years, But will start doing several times a day testing now.

He eats a completely homemade raw diet (which is what I switched him to 4 years ago when he was diagnosed the first time with diabetes). Although because of the herpes, I had been giving him Optixcare treat 2 x a day, which I've now stopped as they are hi carb, from what I can tell. He was also on lactulose until yesterday - I've now switched him to miralex. He's had terrible constipation problems off and on for years. Right now he's at the vet getting a second enema (he had one yesterday).

He did get a full blood panel yesterday, and except for a slightly elevated BUN and liver value, everything else is completely normal (except the BG, of course, which was 425). He's 16 and such a sweet boy.

I think that's everything. I spoke with a different vet today (at the same office) who also said I should start with 2 units 2X a day...I'm inclined to start lower, based on all of your feedback. I will be starting tonight.

I'm actually glad that I don't have to do the same daily dose adjustments as I did when he was on PZI. THat was really stressful, although it did get him OTJ within about 6 weeks. I'm hoping we will have similar success with lantus.

We are using the Lantus pens. Even though the literature for humans says it's 1X a day, you all are giving shots 2 x a day, correct - even with the pens? Just want to make sure we aren't overdosing him! And can I just say - WOW are those expensive!!!

Thanks for all your insight and opinions. I really appreciate it. I will start a spreadsheet later today.

Cheers and thanks.
EMily (Tableau's mom)
 
The cost of lantus, I believe in general is more than PZI (and they no longer make PZI) - there is a new product called prozinc.

And while the cost of the pens are higher, it's actually cheaper overall then purchasing a vial, which most of it will go to waste.

You can check with your local pharmacy even costco pharmacy to see if they will sell you one pen at a time. This will help reduce your costs as you may not need to use more than one pen (if he can get off insulin fairly quickly again).

And yes, twice a day is what we shoot cats - as they're metabolism is faster than humans.

Given everything else that is going on with your boy, I say you are safe starting at 1 unit and after a few days at this level, the bg's will tell you whether you need to change the dose. and the good news, you can easily adjust it.

Oh and when adjusting dose, we recommend in small increments, such as .25 or .50 units at a time, not whole units.

Our motto is start low and go slow. Start at a low dose and slowly adjust in small increments as needed.

If you visit the lantus board, you can read up on the protocols of lantus, dosing, storage, etc. Plus the people there will be able to help you with dose adjustments as you start this process.
 
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