FINALLY Got Lantus WooHoo!!!

[cats_toy]

Hello All!!!

This is an updated post from previous thread found at http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=82904.

On Thursday the 15th, I paid a visit to my vets office, I hoped by showing up in person she would finally concede to my request for Lantus. Unfortunately, the vet was in surgery so I explained to one of the vet techs; if the doctor did not provide me with a prescription for Lantus I WILL find a vet who would.

It was mid afternoon when I got a call, I was told before vet would allow me to get Lantus I had to run mid-point tests and report these figures to her the following day. I was furious!!! I was not required to run these tests when she wanted me to increase the Novolin from 4 units twice a day to 6 units twice a day. Why now are these tests so IMPORTANT? I immediately called my previous vet who first diagnosed Clyde with diabetes. I asked her if she would consider writing me a prescription for Lantus, her response “Absolutely”! She told me Lantus is very good insulin many of her clients use it for their pets. Though I am comfortable with insulin vials I did opt for the Lantus SoloStar Pen. She wants me to give Clyde 2 units twice a day for two weeks. After that the dosage will be adjusted as needed.

His first dose of Lantus is tonight, I am very hopeful this insulin will provide my “Big Boy” with a healthier outlook.

 

[Melanie and Smokey]

had to run mid-point tests and report these figures to her the following day. I was furious!!! I was not required to run these tests when she wanted me to increase the Novolin from 4 units twice a day to 6 units twice a day. Why now are these tests so IMPORTANT?

Lantus is dosed based on nadir (the midpoint), unlike Novolin which can be adjusted based on preshot numbers. I hope now that you are on Lantus you will be getting midpoint numbers. It is a great insulin, but really cannot have the dose properly adjusted without nadir numbers.

 

[BJM]

Please go to the Lantus forums, if you have not done so already, and read about the handling and use of Lantus, including how to start it safely when also implementing a low carb, wet or raw diet. Generally, the starting dose in that situation will be 0.5 to 1.0 units every 12 hours (exactly 12 hours).

 

[hmjohnston]

Hello All!!!

This is an updated post from previous thread found at http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=82904.

His first dose of Lantus is tonight, I am very hopeful this insulin will provide my “Big Boy” with a healthier outlook.

My first question is what is the dose on Novolin? I see the vet increased to 6u BID and all others saying that is too high but no reply on what you do shoot. 2u is high for beginning Lantus so unless Novolin is given at a high dose so unless Clyde has been throwing ketones I wouldn't go that high at the start- you can't take it out again once given. (In FL you are an hour ahead of me so I might be too late.)

Test frequently if you can to see how he does on this. Novolin is fast acting, Lantus is not.

Continue to work on changing the food for him. Be more stubborn than that cat ! :lol:

Glad to hear that you finally got a good insulin to use.

 

[cats_toy]

Hello Again,

Clyde has been on 2 units twice a day every 12 hrs since Saturday evening. As of today Monday 19th, there is no change whatsoever with his BG levels. They remain above the meters range.

*hmjohnston The dosage for Novolin was 4 units twice daily (12hr intervals). When the vet recommended I increase Clyde's Novolin dosage to 6 units WITHOUT mid-point testing that's when I gave her the ultimatum; prescribe Lantus or I WILL find a vet who will. As for food, he is no longer on Purina DM beginning today just Iams Multi Cat. I will work toward a healthier diet in the coming months.

*BJM I have scanned the Lantus forums but didn't spend a great deal of time there, now that Clyde is on Lantus I will take your advice and read up on what I need to know.

*Melanie and Smokey The challenge I have with Lantus and mid-point testing is, I work from 7:00a until 3:30p. I don't get home until well after 4op. Clyde gets his shot at 6:30a (after BG test), his second shot comes at 7:30p (after BG test).

cats_toy (AKA Leilani)

 

[hmjohnston]

Hopefully Lantus users will jump on and relpy.

Being a normal cat (so far ) I would suggest keeping Clyde at the 2u since he has only been on it for two days, really. It does have a build up effect and it could take a full three days to five days to see some action with it. After you have the numbers and have given it space we can look at them and see if she needs more or less (as too much insulin gives high numbers like too little insulin :? )

Get night testing in- that is what i do as I am gone during the day as well. A pain in the butt but since I wake up at least twice for necessity and usually test her both times and give her some food as long as it isn't within 2 hours of her shot time. It keeps her level (and keeps her from waking me up with claws an hour before her shot time for some brekky like she used to do :lol: )

Can't wait to hear updates.

 

[Julia & Bandit (GA)]

The challenge I have with Lantus and mid-point testing is, I work from 7:00a until 3:30p. I don't get home until well after 4op. Clyde gets his shot at 6:30a (after BG test), his second shot comes at 7:30p (after BG test).

In order to dose Lantus correctly, you need the preshots and the mid-cycle test. Dose adjustments with Lantus are based on the daily nadir (the lowest point of the cycle). Without those tests, you have no idea how the Lantus is working in your cat. For example, you say there is no change in BG on 2u of Lantus (which is a high starting dose--2u is supposed to only be given to very large framed cats like Maine Coons or Bengals--for average sized cats the starting dose is 1u, and .5u for smaller cats). However, if 2u is too high a dose, his preshot numbers will be just as high as if it were too low a dose. That's because when a cat's BG drops too low, the liver releases glucose into the blood stream as a survival mechanism to raise BG back up. So a very low number will be followed by very high numbers a few hours later, and this will keep overall BG high. A cat can be chronically overdosed like this for months before a severe hypoglycemic incident finally occurs.

Also, Lantus works best when dosed on a 12/12 schedule--it's not like Humulin N where you have some wiggle room around shot time. Shot times need to be consistent. Can you change the pm shot time to 6:30pm so that it matches your AM shot time? That would mean you can get your PM mid-cycle check around 11:30pm-12:30am.

When Bandit was on insulin (he's been in remission for several years, and is doing great), I was working two jobs and going to grad school. My full time job kept me away from home for nearly twelve hours during the day, because I also had an 1hr commute in either direction (which meant I could not run home to test on my lunch break). Bandit's shots were at 7am/7pm. So what I did was test and shoot at 7am, go to work, get home a little before 7pm and test and shoot again, get a test before bed at 10-11pm (3-4 hours after the shot), and then I would set an alarm for 1am, get up and test him quickly, then go right back to sleep. Yes, it was a pain the first couple weeks while my body adjusted, but after that it wasn't even an issue. Many parents do this with newborns to a much greater extent.

The thing is, that little extra work you put into adjusting your schedule and getting those needed tests will pay off for both you and your cat in the long run. You'll have the data you need to make the correct dosing decisions, which will most likely lead to your cat no longer needing insulin (the large majority of cats go into remission when Lantus is dosed correctly). This is the most convenient situation for you (only having to test once every couple weeks or so), and is the safest and healthiest condition for your cat to be in. Also, it will save you loads of panic and worry because it drastically lessens the chances of a severe hypoglycemic incident, because nuanced dose adjustments combined with the the daily testing make sure you'll catch and adjust the dose as his pancreas heals and his need for insulin lessens.

 

[Melanie and Smokey]

The challenge I have with Lantus and mid-point testing is, I work from 7:00a until 3:30p. I don't get home until well after 4op. Clyde gets his shot at 6:30a (after BG test), his second shot comes at 7:30p (after BG test).

As others have mentioned, grabbing a night test, and then a day test on a day off is what people often do if their work doesn't allow for midcycle testing during most days.

Midcycle tests will not be your only problem with Lantus though. Lantus is a shed, or depot, insulin and really does need to be a 12/12 insulin. You could run into some dangerous results if you continue a 6:30am/7:30pm shot shedule on Lantus. Lantus is an insulin of consistancy. If your shot time is moving and continuously overfilling then draining the shed, it may never reach a point of being able to work efficiently or you may run into a hypo situation on one of the short shot cycles. A few members have run Lantus not on a true 12/12 schedule, but only after they've learned how their cat reacts to the insulin. If you need a flexible schedule insulin, one of the P insulins would be a better long lasting insulin as they are a little more forgiving in the schedule.

 

[cats_toy]

A few things before I address your concerns; 1) Changed 7:30p preshot time to 6:30p this is more inline with preshot at 6:30a. 2) What is minimum time for mid-point testing? 3hrs., 5hrs., or should these tests be conducted exactly 6hrs apart.

*Melanie and Smokey As mentioned above I have adjusted the time to 12/12, 6:30a/6:30p. What are the P insulin's?

*Julia & Bandit Clyde is a large cat standing 27" tall and before he contracted diabetes he weighed 25lbs. Schedule has been changed 6:30a/6:30p. Please see question above about time frame for mid-cycle/point testing.

*hmjohnston Yes, the time Clyde began Lantus has been short (4 days today), my patients though is shot! I want very much to get this illness under control as quickly and as safely as possible.

 

[Melanie and Smokey]

*Melanie and Smokey As mentioned above I have adjusted the time to 12/12, 6:30a/6:30p. What are the P insulin's?

Glad you adjusted the shot, Lantus will be much more stable and work better that way. The P insulins are Prozinc, PZI. I don't deal with them myself so I don't know which is still used, or what is used more often. They are longer lasting insulins so they are better than Humilin and such, but they are made for pets and they don't have a depot/shed like Lantus and Lev so they are more forgiving if you need a schedule that isn't 12/12.

There is no exact science on midpoint testing. It is estimated to be around +6 and I think a majority of cats do find their low close to that so that's what we shoot for and try to get at least a couple times a week. If you can catch +5 or +7 during the work week, that should be fine too. +3 might be a little early as the insulin is usually just kicking in. But a +3 here and there can also be good data collection and if it is an out-the-door number, it helps you know before you leave if you cat is at a safe place before you go to work. Catching some spots around the +6 will actually help you see where his midpoint might be.

 

[cats_toy]

*Melanie and Smokey

Thank you for clarifying the "P" insulins.

The information you provided concerning the mid-cycle testing is very insightful. Having options makes it much easier than trying to shoot for the +6 continually.