Glargine--This Friday

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kkoka1

kkoka1

Member Since 2013
Hi,

While we were hoping not to be back on the Diabetes Forum, we are here again. Jinglebells may be an EPI kitty (Pancreatic Insufficiency) and her diabetes has never gone away, so the Specialist we consulted wants to try a new kind of insulin this Friday. Long story short, Jinglebells tried PZI twice in the last two years. Both times, she did not do well. Within a matter of days, she "tanked" and we almost lost her with BG's as low as 39. Mind you, this was on the lowest dosage possible. Her BG's off insulin are usually around 310. So, it is with a heavy heart that we are beginning this journey again.

Her Specialist wants to see how she does on Glargine. So, I would welcome any advice from Glargine experts. I hear it is longer acting (sort of worried about that) and doesn't have quite as severe peaks and valleys. We (and she) absolutely hate ear pricks, too. Sigh. With the past two PZI tries, she is just "not our cat" on insulin. She is very "out of it," spacey, twitches, etc. When can never tell when she is dropping because she can be high and low and acts the same. We get no sleep and end up constantly feeding her to keep her from tanking. We are praying for a different outcome this time.

Any positives would be appreciated, but at the same time, I'd like to be prepared for the truth. Thanks for any help you can provide. We are doing it Friday so that we at least have 4 days to stay home with her and watch her 24 hours a day. We didn't feel she could make it 20 more days until summer.

One question I would like answered is what is the lowest dosage possible on Glargine with U100 syringes? Is it .5 once a day?

Kristi
 
I'm not a glargine user (more commonly known here as Lantus) but just chiming in on a couple of things.

1. You can use u100 syringes with pzi (prozinc) and get much smaller doses than you can get with u40's (my cat has been around .1 to .4 for many months now)
2. The smallest dose is dependant upon how you like to see it. Some u100 syringes come with half unit markings, and you can mentally split that in half for .25, so on so forth, it does become more difficult as it gets smaller, but you can get a tool called a caliper that can assist in getting near identical dosing for even tiny amounts, and there are some people that even dose by the drop method (takes practice)
3. Insulin as far as I know should ALWAYS be dosed twice daily at least, as the duration simply doesn't last a whole day, although occasional skipped shots may occur (this leaves your cat with nothing in the interim if their pancreas is not functioning)

Lantus is a .. what they call a 'depot' insulin, which means each dose is kind of overlapped with the last. Doses are typically based on the nadir of the insulin dose rather than the pre-shot value. Do you home test?


ETA: also, Diabetes doesn't ever 'go away' ... best possible outcome is remission.
 
Hello and welcome. There is a lot of information about Lantus (glargine) on the Lantus TR forum, including some pictures of fine dosing. As part of the protocol we use there, people will often do doses of .1U or even a drop or two twice a day before completely stopping insulin. Checked out the starred Sticky Notes at the top of the forum.

For ear testing, are you giving her treats after each test? Putting Neosporin with Pain Relief on after? Once cats associate special treats with testing they will happily follow you to be tested.
 
You mention difficulty testing the glucose, so it may be helpful to look at my signature link Secondary Monitoring Tools for some supplemental assessments which may be helpful.

In particular, I would suggest these:
Urine testing for urine ketones and glucose
- only tells you what has happened since last void
Water consumption - high thirst suggest lack of control
Urine output - swamped litterbox daily? Poor control OR another medical problem
Breath odor - 2 out of 3 ketone types have distinctive odors of fruit or nail polish remover. Obviously not as good as urine or blood testing.

Giving a low carb treat after every attempt to glucose test the blood can go a long way towards getting a cooperative cat.
 
Hi,

With regards to your questions, we are feeding Royal Cainin Wet-Reduced Calorie food. While I am not fond of it, it is the only food that she has been able to tolerate with vomiting 2-4 times a day. We do pee sticks...in 3 years she has never had ANY keytones whatsoever, which is good. We do home test, although she absolutely hates it and it is stressful for us. We have witnessed the excessive drinking A LONG TIME AGO (almost 2 1/2 years ago) when she was first assessed for diabetes. It has not reoccurred since. She does get fluids daily (for suspected pancreatitis/dehydration)--seems to have made a difference in keeping her on the upswing.

We just did the all day glucose thing at the vets yesterday. They were so nice to let us hang in the back room with her all day, so she snuggled down with us--so much less stress than in a cage left with them like the last vet. We have also done this ourselves, and think that is what we will do for the next one.

Specialist put her on .5 of Lantus once a day for now. I know most on here probably wouldn't agree with that, but we were happy because we don't have to worry about her too much during the night. This morning I am not sure I did it right. We can't locate the 1/2 marking syringes and we had to eyeball it the best we could. We are getting conflicting reports of how to deal with the "bubble" effect--some say to NOT to measure over and push it back in as it contaminates the Lantus in the bottle...others are saying it is better than injecting with a bubble that throws off the dosage. So we are not feeling confident on what to do with that regard.

Also, at over $200 for a vial and on such a small, small dose, I am also wondering how long this vial is good for. Note: We store it in the box, in a coffee mug, on the 3rd shelf of the fridge.

We did an ear prick today 4 hours after administration of the Lantus and it was 330. Ugggghhhh! I'm guessing I didn't even get anything in her. Doc said to test 4 hours after administration because that was her lowest point yesterday. I'm trying to figure out her peaks and valleys, but I'm not very good at it. She may have EPI as well, so she is famished every 2-4 hours. We fed her at 6:30 am yesterday + a little on the car ride to the vets (nothing significant). She received her dosage at 8:30. Prior to Lantus injection, her BG was 310. At 10:30, it was 277. Vet said go ahead and feed her. We did at that time. We expected it to raise her BG for the 12:30 reading. Instead, it fell to 185. If we hadn't fed her, she probably would have tanked as she has in the past. At the 3 pm reading, it was 237. We fed her again after the reading. At 4:45 reading, her glucose was 290.

This morning, vet said to feed and give insulin 1/2 hour afterwards...then do BG prick at 4 hours later. That's when it was the 330. So, not sure if perhaps the time difference in feedings is why this is off or whether I just didn't give her the proper .5 dosage. I'd swear the tech yesterday gave her 1 and not .5, but it just all blurs together when you are asking a bunch of questions.

So, I'm going to look at all the links you provide now. On a hunt for the 1/2 marking syringes to make this easier. Thanks for any thoughts. We need to get some weight on this baby. It has been a long 3 years :(
 
Is she getting pancreatic enzymes with her food? That should help reduce vomiting.
There is a hydrolysed protein food - Z/D - which may be useful as it has already broken down the proteins to reduce allergenicity, another cause of vomiting. Although an off-label use, it could be helpful too, by reducing the load for the enzymes available to process it.

We typically test, feed, and shoot within a 15 minute time span. Eating often causes a glucose rise with a peak of about 2 hours, followed by gradually reducing numbers to nadir. Perhaps the vet is having you wait to make sure the food stays down?

Nadir for Lantus, once the cat has been on it for a good 5 days or more, is generally between +5 to +7 hours after the shoot.
Some folks here use calipers to dose, others have determined the number of drops in 0.5 units and dose by drops.

The Lantus can last up to 6 months, refrigerated and moved minimally.
 
Peaks/Nadirs

Hi,

Thanks, BJM for the info. She hasn't thrown up in months, since switching to the Royal Cainin and eliminating some heavy meds the vet prescribed, so I don't think that is the reason we are testing at +4 hours. He wanted us to test at +4 hours because that is where she went low on the all day curve

She got fed at 12:30 am, 2:00 am, 4 am, and 7 am today. We gave insulin at 7:30 am. She was fed again at 9:30am. We tested at 11:30 am. She is at 277 at that +4 marker. She won't be fed again until 2:30 pm, 6 pm, and 10 pm.

I know all of these feedings are messing with the curve, but if she doesn't eat, she is voracious--she goes over and eats anything in sight like the plastic on her litterpan (symptoms of an EPI cat).

The good news is she was at 7 lbs. 5 oz. today. After the poop, she was at 7 lbs. 3 oz. Still up from the 6 lbs. 13 oz about a week ago.

Just wish I could figure out her curve to know when her highs and lows are. I guess we will need to do some spot readings ????
 
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