Glargine less effective after a couple months

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Dragonfly92

Dragonfly92

Member Since 2023
Hi!

My cat Socks was diagnosed with diabetes in March. He was started on 2 units twice a day. After a few days, he was dropping too low with the 2nd dose. My vet told me not to inject another dose if his numbers were in the 200's. After a month, I was only giving him 1/2 unit in the morning and his numbers were staying consistent for weeks. A couple of weeks now his numbers are back in the upper 300's to lower 400's. I am now giving him 1 unit in the morning and 1 unit at night, but he is not dropping as much as he did when he was only given 1/2 unit once a day. The vet told me the insulin would last for 6 months, but I have read articles that it starts to lose effectiveness after 28 days. I'm wondering if he is becoming insulin resistant, or if I need a new bottle of insulin. Is it normal to have to increase the dosage after a couple of months?

Thanks!

Missy
 
Welcome Missy and Socks, you couldn't have found a better group to join. We have a lot of experienced members here and if it wasn't for them giving advice Tyler would not be in remission since 1-24-21

When you are a new member the moderators would like new members to post on the Feline Health Welcome and Main Forum to start
Here's the link, in your title put NEW MEMBER first
https://felinediabetes.com/FDMB/forums/feline-health-welcome-main-forum.28/

Just copy and paste what you wrote here
Your vet is correct Glargine should last for about 6 months
The 28 day is for humans
I'm sure members will reply back :cat:
 
2 units is a high starting dose. We recommend starting at 1 or even .5 units. If the bg is in the 200s your cat still needs insulin, but even at the 100’s, I was still giving Bobo insulin. It may just be that he needs more insulin now than he did before.

can you tells us what you’re feeding him? That can also make a difference in the bg. If you can set up a spreadsheet and plug in all the test readings you’ve been getting, we can help you with the dose and dose adjustments. Are you using a human or pet meter?

Here is a helping us to help you link. If you noticed, our members have some basic information about their cat's in their signature. This helps us to not pester you by asking the same questions (your cat's name, insulin type, date of diagnosis, etc.) repeatedly. We also have a link to our spreadsheet in our signature. We are very numbers driven. The spreadsheet is a record of your cat's progress. By linking it in your signature, we can follow along and provide feedback should you need the help.

With a diabetic cat you need:

  • A low carb wet diet that is 10% carbs or under. Most of us use around 4-7% carbs
  • A suitable insulin such as Lantus or Prozinc which are long acting, more gentle insulins than the old insulins.
  • We recommend hometesting the blood glucose with a human meter…it is not necessary to use a pet meter which is expensive to run and is no better. It will keep your kitty safe and you will know how the dose is working for your kitty. Only testing every so often will not tell you what is happening in between those times and an awful lot can happen in even a day.
We are happy to help you with setting up the spreadsheet, sorting out what food to buy, how to transition safely to a low carb diet, how to learn to home test and much more.

This is an excellent site for diabetic cats…it has been around for more than 25 years and has very experienced people to help you.

Keep asking lots of questions.
 
Welcome to FDMB!

Your vet is correct -- the insulin will last considerably longer than 28 days. I used a glargine pen and would routinely use up all of the insulin in about 3 mos. Lantus/glargine is an insulin that was only tested on humans and humans use a considerably larger dose than cats. The manufacturer's tests lasted only 28 days since that's how long they assumed humans would need a prescription for.

Insulin needs can vary. However, a cat has a much faster metabolism than a human and typically need insulin on a twice a day basis. Once you have a spreadsheet set up, we can give you more feedback based on what we're seeing with respect to Socks' numbers.
 
https://docs.google.com/spreadsheet...KrqrqNXqOFey4sqQhR7j19gp8Rd2GSNI2ecA3/pubhtml

Here are Sock's numbers from last month and so far this month. When I used to give him 2 shots early on, he would drop in the 70-90 range. This would result in a very high number the next morning. I have only been giving him a shot if his morning number was over 350. I spoke with my vet yesterday, and he said that even though the insulin will last 6 months, it may not have the punch as a new bottle. I purchased a new bottle yesterday, and gave him a unit this morning. I will see if it makes a difference.

Socks eats only wet food, and I give him 1/4 cup of fresh pet for snacks. I test daily with a human meter. When first diagnosed, he was in the 600's. I have been working to get him down at a gradual rate. He is himself when his readings are in the mid 200's to low 300's. When he drops below 200, he wants to eat everything in sight.

I'm so glad I found this sight! Thanks!
 
Can you please set up your signature that Ale gave gave you the link
Here it is again
Here is a link helping us to help you link. If you noticed, our members have some basic information about their cat's in their signature. This helps us to not pester you by asking the same questions (your cat's name, insulin type, date of diagnosis, etc.) repeatedly. We also have a link to our spreadsheet in our signature. We are very numbers driven. The spreadsheet is a record of your cat's progress. By linking it in your signature, we can follow along and provide feedback should you need the help.

You can tap here n your name above then tap the word signature and add all the information that is asked in the Blue Help us you blue link , also on your spreadsheet can you put the
DX date , insulin you are using ,meter you are using and what method you want to follow TR or SLGS

They are a lot of times I see on your SS you have no PMPS tests or how many units you gave
Are you giving any insulin at night because there are a lot of missing units of Insulin
You said you are only giving him a shot in the morning if his BG is over 350 ,I don't agree with this and I don't think other members will either. You should have been giving insulin to Missy
With new members we suggest if the BG is under 200 to stall for 20 minutes and see if it comes up in it's own , don't feed though when you stall
You can post for help something like this ? Help Stalling and put the BG # whether it be AMPS or the PMPS cycle

Lantus likes consistency , give the same amount of insulin for both cycles


I see you have your spreadsheet link in your post above post #5
After you set up your signature copy and link your spreadsheet link at the end of your signature

I'll give you the link to read about Lantus/Glargine
Read all the yellow stickys
https://felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/

@Dragonfly92
 
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Dragonfly92 said:
https://docs.google.com/spreadsheet...KrqrqNXqOFey4sqQhR7j19gp8Rd2GSNI2ecA3/pubhtml

Here are Sock's numbers from last month and so far this month. When I used to give him 2 shots early on, he would drop in the 70-90 range. This would result in a very high number the next morning. I have only been giving him a shot if his morning number was over 350. I spoke with my vet yesterday, and he said that even though the insulin will last 6 months, it may not have the punch as a new bottle. I purchased a new bottle yesterday, and gave him a unit this morning. I will see if it makes a difference.

Socks eats only wet food, and I give him 1/4 cup of fresh pet for snacks. I test daily with a human meter. When first diagnosed, he was in the 600's. I have been working to get him down at a gradual rate. He is himself when his readings are in the mid 200's to low 300's. When he drops below 200, he wants to eat everything in sight.

I'm so glad I found this sight! Thanks!
Click to expand...
@Suzanne & Darcy

@Sienne and Gabby (GA)
Has her SS set up and I have asked her to please do her signature
Thank Ladies
 
It works!!

Missy -- Socks isn't getting enough insulin. Like I said previously, cats have a much faster metabolism than humans. They really need twice a day dosing. If you have been giving Socks a PM shot, the only day I see that indicated is yesterday and 2 other days.

If you're nervous about giving Socks 1.0u twice a day, you can always reduce the dose. What about 0.75u twice a day?

Numbers in the 70 - 90 range are normal blood glucose (BG) numbers. When you saw a spike back into high numbers, this is what we refer to as a "bounce." Looking at Socks' spreadsheet, he's not used to being in normal numbers. When he drops into that range, his liver and pancreas panic and release a stored form of glucose along with counterregulatory hormones that cause the upward spike in numbers. This is incredibly annoying to us but it's a normal part of the process of his getting regulated. He's just not used to being in a lower range of numbers and it's also why he acts like he's starving when his numbers go lower. As he gets more accustomed to lower numbers, this will all improve.
 
70-90 is within the normal range as Sienne pointed out and it’s where you want him to be ans that means the insulin is working.

I think it’s a mistake to only give him insulin if he’s above 350. That’s very high and you should be giving him insulin if he’s above 200. Most vets don’t know a lot about feline diabetes and they know even less about dosing adjustments. They get nervous when they see a bg in the 70-90 range. My vet would also tell me to skip or give 1/2 the dose and it wasn’t until I stopped listening to the vet and followed the advice from the experts here that Minnie started to get better. At one point I thought she never would, but she did! And with Bobo I already knew what to do so in less than 2 months I had him regulated and in remission.

If you follow one of our dosing protocols called SLGS, every time he goes under 90 you decrease the dose by 1/4 unit but you’re still giving him insulin. Skipping a dose is not ideal especially since glargine requires consistency. We can help you get your cat regulated. Take a look at Bobo’s spreadsheet linked in my signature to see how I was still giving him insulin even in the lower preshot numbers and how that really helped get him regulated and in remission. You want your cat to be in the normal range for as long as possible because that’s when his pancreas can start to heal.
 
Ale & Bobo & Minnie (GA) said:
70-90 is within the normal range as Sienne pointed out and it’s where you want him to be ans that means the insulin is working.

I think it’s a mistake to only give him insulin if he’s above 350. That’s very high and you should be giving him insulin if he’s above 200. Most vets don’t know a lot about feline diabetes and they know even less about dosing adjustments. They get nervous when they see a bg in the 70-90 range. My vet would also tell me to skip or give 1/2 the dose and it wasn’t until I stopped listening to the vet and followed the advice from the experts here that Minnie started to get better. At one point I thought she never would, but she did! And with Bobo I already knew what to do so in less than 2 months I had him regulated and in remission.

If you follow one of our dosing protocols called SLGS, every time he goes under 90 you decrease the dose by 1/4 unit but you’re still giving him insulin. Skipping a dose is not ideal especially since glargine requires consistency. We can help you get your cat regulated. Take a look at Bobo’s spreadsheet linked in my signature to see how I was still giving him insulin even in the lower preshot numbers and how that really helped get him regulated and in remission. You want your cat to be in the normal range for as long as possible because that’s when his pancreas can start to heal.
Click to expand...


I looked at Bobo's chart. It gives me hope that Sock's can get better. I am working on finding the right consistent dose. When I started him on insulin in March and he was dropping too low too fast. I quit giving him insulin for a few days to see what he actually needs for dosage. You are right about quit listening to the vet. Mt vet originally told be to give him 2 units twice a day, and not to worry about checking his levels for 3 weeks. If I would have done that, Socks would not be here today. So glad Bobo is doing well! Thanks for your advice and now I'm on a mission to get Sock's in remission!
 
Sienne and Gabby (GA) said:
It works!!

Missy -- Socks isn't getting enough insulin. Like I said previously, cats have a much faster metabolism than humans. They really need twice a day dosing. If you have been giving Socks a PM shot, the only day I see that indicated is yesterday and 2 other days.

If you're nervous about giving Socks 1.0u twice a day, you can always reduce the dose. What about 0.75u twice a day?

Numbers in the 70 - 90 range are normal blood glucose (BG) numbers. When you saw a spike back into high numbers, this is what we refer to as a "bounce." Looking at Socks' spreadsheet, he's not used to being in normal numbers. When he drops into that range, his liver and pancreas panic and release a stored form of glucose along with counterregulatory hormones that cause the upward spike in numbers. This is incredibly annoying to us but it's a normal part of the process of his getting regulated. He's just not used to being in a lower range of numbers and it's also why he acts like he's starving when his numbers go lower. As he gets more accustomed to lower numbers, this will all improve.
Click to expand...


I started a new batch of insulin today. I updated my numbers from March, and he was dropping too low with even 1 unit. His numbers today with 1 unit aren't dropping too low, so I will start him back on the evening shot. Thanks for your advice :)
 
Dragonfly92 said:
I started a new batch of insulin today. I updated my numbers from March, and he was dropping too low with even 1 unit. His numbers today with 1 unit aren't dropping too low, so I will start him back on the evening shot. Thanks for your advice :)
Click to expand...
Let’s try to stay with 1 unit twice a day for at least 7 days before adjusting the dose. If numbers are higher than 200 at preshot, stick with it. If we see that he drops below 90 then we reduce the dose but only by 1/4 unit. If you’re not sure what to do, post here and ask for help. The goal is to keep him at the same dose for 7 days so we can give the glargine a chance to work. The only exception is if he drops below 90
 
This is according to the SLGS protocol btw. Bobo was on TR which requires more testing and is a bit more aggressive when it comes to dosing so I was increasing his dose at first every 3 days but I think you should start with SLGS and as you learn more, you could always switch protocols later.

I would also recommend you read all the yellow sticky notes on the Lantus forum here, but especially the one about the 2 dosing methods: https://felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/

I copied this part so you have it here:

Starting Dose:
  • 1u BID if kitty is not on a wet/canned low carb diet
  • 0.5u BID if kitty has been switched to a wet/canned low carb diet
  • If the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration
  • Generally, shots are to be given 12 hours apart.
Hold the dose for at least a week:
  • Unless your cat won’t eat or you suspect hypoglycemia
  • Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.
After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases. If you decide to change another factor (e.g., diet or other medications), don't increase the insulin dose until the other change is complete (but decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change).

Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments-- no matter how high your cat's blood glucose is! Rushing towards regulation will cost you time in the long run, because you may shoot past the right dose.

Lather, Rinse, and Repeat!
 
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Can you also add the DX date, insulin, SLGS if that's the method you will follow and the meter you are using to the top of your spreadsheet. Oh and can you ADD SLGS to your signature
Thanks. It makes it much easier for members when they are looking at your spreadsheet
@Dragonfly92
 
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I forgot to mention that I didn’t want to wait for a vet appt to get Bobo started on insulin so I found a local member who gave me an unused Lantus pen she had had for 2 years and the expiration date was 5/23. That’s the insulin I used and it got him into remission so that’s how long the glargine will last. Def up until the expiration date on it and sometimes even past it!
 
@Ale & Bobo & Minnie (GA) -- I don't think the information you provided is clear. The expiration date refers to how long an unopened pen or vial will last. It's usually up to a couple of years from the date of purchase (or should be). Once a container is opened, the glargine is typically good for months. It's unlikely that an open container will last years although I don't know of anyone who's tested the duration of an open container. I have had glargine lose potency after a relatively short time due to the carelessness of a pharmacy tech. The insulin didn't appear to have crystals or appear to be damaged but I actually saw the person slam the box on the counter and one of the pens stopped being effective after a few weeks. There's no way to know how the insulin has been stored.
 
Sienne and Gabby (GA) said:
@Ale & Bobo & Minnie (GA) -- I don't think the information you provided is clear. The expiration date refers to how long an unopened pen or vial will last. It's usually up to a couple of years from the date of purchase (or should be). Once a container is opened, the glargine is typically good for months. It's unlikely that an open container will last years although I don't know of anyone who's tested the duration of an open container. I have had glargine lose potency after a relatively short time due to the carelessness of a pharmacy tech. The insulin didn't appear to have crystals or appear to be damaged but I actually saw the person slam the box on the counter and one of the pens stopped being effective after a few weeks. There's no way to know how the insulin has been stored.
Click to expand...
Thank you for the clarification. Yes, you’re correct :)
 
I had an urinalysis done on Socks on Friday. Everything came back normal except glucose in urine was 3+. I bumped Sock's insulin up to 2 units, but his numbers were higher than previous day with 1.5. My vet told me to hold the same dosage @ 1.5 for 3 weeks to see if we can see a consistent pattern. Still confused on why more insulin is not helping to bring his numbers down. When I first started him on 2 units he was in the greens and blues, now I am struggling to get him into the 200's. Still not sure what dose will make a difference. Any advice?
 
You bumped him to 2 then you went back down to 1 in the evening and then 1.5 the next day.

The main issue I see is that you have not been consistent with the dose so you’re not giving it a chance to work. Your vet is right about staying with one dose for one week. Lantus requires consistency and you have to have patience. Feline diabetes is a marathon not a sprint and rushing the process is not going to get you the results you want. This is why the protocol is called Start Low Go Slow and the dose adjustments are in 1/4 increments. I get wanting your cat to feel better quickly, but you’re not doing it any favors by rushing the process. you have not staying with one dose long enough and you’re giving a different dose in the am and the only. Lantus does not work well that way. I think we’ve said it before, you need to give the same dose twice a day. And once you make a dose adjustment you stay with the new dose for another 7 days. This is the process.

I recommend you stay with 1.5 in the am and in the pm for a week. The only exception is if your cat drops below 90 and then you decrease by 1/4 unit, not half and not a full unit, to 1.25. Does that make sense?
 
Ale & Bobo & Minnie (GA) said:
You bumped him to 2 then you went back down to 1 in the evening and then 1.5 the next day.

The main issue I see is that you have not been consistent with the dose so you’re not giving it a chance to work. Your vet is right about staying with one dose for one week. Lantus requires consistency and you have to have patience. Feline diabetes is a marathon not a sprint and rushing the process is not going to get you the results you want. This is why the protocol is called Start Low Go Slow and the dose adjustments are in 1/4 increments. I get wanting your cat to feel better quickly, but you’re not doing it any favors by rushing the process. you have not staying with one dose long enough and you’re giving a different dose in the am and the only. Lantus does not work well that way. I think we’ve said it before, you need to give the same dose twice a day. And once you make a dose adjustment you stay with the new dose for another 7 days. This is the process.

I recommend you stay with 1.5 in the am and in the pm for a week. The only exception is if your cat drops below 90 and then you decrease by 1/4 unit, not half and not a full unit, to 1.25. Does that make sense?
Click to expand...


I went back down to 1.5 because my vet said to keep him @ 1.5 for 3 weeks. I see some charts on here that bump after 3 days or some 7. My vet is saying 3 weeks, so just trying to find the right time to increase. I'll just keep him at 1.5 for another week and see where he's at. Thanks!
 
I was just about to say this. The other protocol option for dosing is TR and you’ll do dose adjustments every 3 days when following TR. I did with Bobo. But you cannot be giving your cat any dry food and you have to do a minimal of 4 tests per day every day. It’s a bit more aggressive and you also only reduce the dose if Socks goes under 50. Some folks don’t like having their cats go lower than 50 so they stick with SLGS. You can pick which dosing method to follow. Did you read the yellow sticky notes on the lantus/glargine forum? There’s one that explains both dosing methods at length.

if you’re doing SLGS, you stick with 1.5 for 7 days. 3 weeks is too long. If you’re going to follow TR, you’d increase after 3 days. Once you selected the protocol, please add it to your signature and spreadsheet :cat:
 
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