Dosing advice needed

[ehsuan]

Hi, I also posted this on the main board, but wasn't sure if I should post here as well.

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.

 

[Sam and S'mores]

Re: Starting Lantus tomorrow

I'm not sure how many people are still up now. I'm new, but I can help with some of your questions:

1. Needles/Pens: You have it all correct (I have the same needles). We don't use the screw on needles b/c the accuracy is pretty bad at these very low doses.

2. The Lantus regulation is a lot smoother, as you describe. Lantus primarily lasts for ~12 hours, but it also has some more subtle very long-lasting effects over 2-3 days, so if you yank the dose around, you can cause big problems. The big exception to that is when you get an unexpectedly low reading. Read this sticky completely, a couple times, before you get started.

The the "official" sticky for the protocol recommended on this message board is here
One of the key links in there is to the chart for the protocol used in a recent peer-reviewed scientific study with great results here
The members of this board will be invaluable in helping you translate this "formula" into what works for Tableau. Every Cat Is Different (ECID), so you will need to modify the base protocol at least some of the time.

3. Here are at least some of the questions the more experienced members will ask, so if you post answers you can speed things along:
What blood glucose measurements do you have recently (i.e. what data led to the new diagosis)?
What food is Tableau on? (Transitioning to one of the <10% carb wet foods is very highly recommended)
How big is Tableau (weight)?
Why are you starting at 2u BID? That is higher than the protocol recommends, and a pretty big jump from zero.
Can you start a spreadsheet? That helps the boardmembers help you. see this link (sometimes it takes a few tries before the "copy template" works right

 

[ehsuan]

Re: Starting Lantus tomorrow

Thanks, Sam, for your answers. I appreciate it! Thanks for confirming about the syringes - it's been so long since I've done this and I was worried I had the amount wrong.

To answer the questions you posted:

I've been testing him about 1 every 3 months for the last few years, as he's been doing so well in complete remission. He's had health issues of late, and over the last few days I noticed him drinking and peeing a ton. Last night I weighed him and realized he'd lost 3/4 of a pound in about 2 weeks. Yikes! So I tested him last night and his BG was 500. THat's when I knew the diabetes was back.

I took him to the vet today and she confirmed the diagnoses (his bg was 400 and something at the vet today). She then prescribed the lantus and said to start with 2 units.

I will start a spreadheet tomorrow, when I start with the insulin. I will re-read the stickies...Looking at one of the protocol guidelines, it looks like maybe I should be starting with a dose of 1.125 units (based on his usual weight of 10 lbs,) Wondering if others think I should start at a lower dose than the vet said, or start with the 2 units she prescribed.

THank you so much.

 

[Sam and S'mores]

Re: Starting Lantus tomorrow

You should edit the subject on the first post to start with "Dosing Advice Needed", in order to get the attention of the right people to give advice. Certainly don't use my advice on dosing, I'm very much a newbie.

The only other thing is which food he is on?

 

[Marje and Gracie]

Re: Starting Lantus tomorrow

Hi and welcome to Lantus Land. I'm glad Sam gave you some answers. Could you also let us know your name please?

I agree that 2 units seems like a lot to start a 10lb cat on. It's typically .25u/kg. For a 10 lb cat, that would be 1u. We often have new folks coming into Lantus Land with doses too high...as prescribed by their vet. IMHO, I think starting Tableau on 1u and then increasing as needed per the protocol would be better. Please be sure you read the sticky for new folks: New to the Group. Sam has given you some other really good stickys as well. Here is some additional info regarding the type of syringe you should be sure you have for lantus:

U100 3/10cc syringes with half unit markings are the best to use for fine dosing. BD, Monoject, GNP, and ReliOn are some of the brands available with half unit markings. Needle gauge and length is your preference They come in ½ inch or 5/16 inch needle lengths. Needle gauges 29, 30 or 31 (31 being the thinnest).

Here's what one unit looks like if you are using half-unit marked syringes; this page also shows some other gradations like .5u:

Fine gradations

Unlike PZI, lantus is dosed based on the nadir and not the preshot so you don't adjust your dose each cycle. Lantus also has a storage shed or insulin depot. So when you start the lantus, it may take 3-5 days (6-10 cycles) to start seeing some effect on BG numbers. Patience is the key

Please let us know how we can help....we are here to help you learn and to support you.

 

[ehsuan]

Food: I feed him homemade raw.

Thanks for the needles link - those are the ones I have and am using.

 

[Sienne and Gabby (GA)]

Sorry to hear your kitty is needing insulin. Hopefully, the health issues are easily dealt with and he'll be back in remission quickly.

Marjorie explained the main issue you're going to have to deal with -- you have to think very differently when using Lantus vs. PZI. PZI is a shorter acting insulin than Lantus. Lantus not only is a depot-type of medication, its effects are cumulative. Doses need a few days to settle in order for you to fully appreciate how the dose is working.

Just one minor correction, the initial dose of Lantus needs 5 - 7 days to form the shed. All subsequent doses take, in general, 3 days for the dose to be evaluated.

The Lantus pens do not dispense insulin in less than 1.0u increments. This is why we use syringes. As you read the protocol, you'll note that doses are typically adjusted in 0.25u amounts.

There is a formula that is used to determine the initial dose of Lantus: initial dose = 0.25 x ideal weight in kilograms. For a 10 lb cat, assuming this is Tableau's ideal weight, the dose would be a little over 1.0u (i.12 to be exact but I wouldn't want to try measuring that).