Got Lantus tonite. Very Low dose recommended

[sjewell]

So we picked up the Lantus tonite & headed to vet with Salem. He's 14 & current weight is 9.9 lbs. Vet said start off with injections 2x a day 1 unit which is a tiny amount. This seems low but since I'm new to this I'll listen to the vet. We're hoping Salem goes into remission soon. I'll keep all posted with his progress, his level was 412 tonite dwn from 466 last wk. these are pre insulin levels. We changed his diet to exclusively Ff classics. I ordered Young Again zero cat fd for him too.

 

[manxcat419]

After the number of us recently that have been started off on too high an initial dose, I'd say well done to your vet for knowing the right calculation for the starting dose for Lantus. Looks absolutely right to me

 

[bsmith]

So we picked up the Lantus tonite & headed to vet with Salem. He's 14 & current weight is 9.9 lbs. Vet said start off with injections 2x a day 1 unit which is a tiny amount. This seems low but since I'm new to this I'll listen to the vet. We're hoping Salem goes into remission soon. I'll keep all posted with his progress, his level was 412 tonite dwn from 466 last wk. these are pre insulin levels. We changed his diet to exclusively Ff classics. I ordered Young Again zero cat fd for him too.

Are your level numbers from a human glucometer or a pet glucometer?

Starting 1 unit Lantus 2x/day is what my vet started my 10 lb cat on also. Keep an eye on his numbers. I'm still new here, but I was advised to test before each shot and then two hours and six hours after each shot. When you're first starting insulin, it's good to keep a close eye on how your cat's BG numbers are reacting to the insulin. I ended up having to go to 0.5 units and then to 0.25 units, once or twice a day, as my cat seems to be very sensitive.

@BJM has an excellent guide here about when to give your cat a shot (or not) depending on your cat's BG numbers. Also, it's helpful to have the instructions on what to do if your cat becomes hypoglycemic. As has been said many times on this forum, "start low, go slow."

Starting a spreadsheet of your cat's BG readings makes it easier for other members to see what's going on with your cat if you have questions. Instructions for doing this and adding a link in your signature can be found here.

 

[sjewell]

Are your level numbers from a human glucometer or a pet glucometer?

Starting 1 unit Lantus 2x/day is what my vet started my 10 lb cat on also. Keep an eye on his numbers. I'm still new here, but I was advised to test before each shot and then two hours and six hours after each shot. When you're first starting insulin, it's good to keep a close eye on how your cat's BG numbers are reacting to the insulin. I ended up having to go to 0.5 units and then to 0.25 units, once or twice a day, as my cat seems to be very sensitive.

@BJM has an excellent guide here about when to give your cat a shot (or not) depending on your cat's BG numbers. Also, it's helpful to have the instructions on what to do if your cat becomes hypoglycemic. As has been said many times on this forum, "start low, go slow."

Starting a spreadsheet of your cat's BG readings makes it easier for other members to see what's going on with your cat if you have questions. Instructions for doing this and adding a link in your signature can be found here.

 

[sjewell]

So Salem got his first shot if lantus tonite (1unit). How long does it take for changes in levels? Do I test after shots? Salem was good. Didn't flinch but if course I was a nervous wreck even aftr watching many youtubers of injections. I'm hoping he doesn't have to be on insulin forever. He was diagnosed in late jan after having steroid shot it developed. First readkng at vets was 512 (lab screen). His last reading was 450 yest. He's on ff classics only & young again zero carb dry fd coming soon. I'll set up spreadsheet to keep track of shots/bg levels. Thks all for advice & support!

 

[manxcat419]

It can take time, and sometimes dose changes too for you to see much effect. Lantus needs time (days, not hours) to reach full, consistent effect in the cat's system because it takes time to build the depot. If you look at the start of Rosa's spreadsheet (in my signature) you can see that it took 5 days to really see any effect and she needed dose increases to begin with to get the Lantus working for her. Her reading at the vet was 680 on diagnosis and she hung around in the 600s for quite a while, consistently at first then on and off before starting to come down well on it. I was sure she was going to finish up needing fairly high doses for a while if not permanently because her level was so high and just didn't move at all to begin with, but if you look at the later part of her ss, she's come back down the dosing scale fast so getting Salem off insulin, or at least to a very small dose is certainly a possibility in the future if he reacts well to it.

However, that's not to say that it can't have a more immediate effect too - it depends on the cat and their individual reaction to the insulin. A test at +2 hours after each shot is recommended and then other tests during the cycle depending on the numbers you're seeing - the mid-cycle tests also help you to see how much effect the dose is having at maximum effect and it's that nadir that helps to make future dosing decisions.

 

[bsmith]

So Salem got his first shot if lantus tonite (1unit). How long does it take for changes in levels? Do I test after shots? Salem was good. Didn't flinch but if course I was a nervous wreck even aftr watching many youtubers of injections. I'm hoping he doesn't have to be on insulin forever. He was diagnosed in late jan after having steroid shot it developed. First readkng at vets was 512 (lab screen). His last reading was 450 yest. He's on ff classics only & young again zero carb dry fd coming soon. I'll set up spreadsheet to keep track of shots/bg levels. Thks all for advice & support!

I think @manxcat419 covered most of your questions especially dealing with how long Lantus takes to build up the depot effect. Test before each shot, 2 hours after each shot, and at mid-cycle (mid-cycle is most often 5-7 hours after the shot, many people tend to test at 6 hours after the shot). I think that sometimes starting testing and injecting can be more stressful on the human than the cat. It does get easier as you get more practice and it's promising that your cat tolerated it well.

It's good to see that you're home testing and have already implemented some food changes. Make sure to keep up your testing right after you get your Young Again zero carb food. I don't think the Young Again food should cause any big changes in numbers as you already have your cat eating low carb wet food, but better safe than sorry. If you want more information on food nutritional content, Dr. Pierson has compiled a list here.

One more question, are free feeding or do you feed on a schedule? If you feed on a schedule this may change when you give the shots and, thus, when you test. I free feed, so can someone who knows about testing and dosing cats who are fed on a schedule jump in here?

 

[phlika29]

It's great that you have been given lantus.

You should always test (on an empty tummy), feed and the give the lantus (ideally all within approx 15 minutes). With Lantus you need to keep to a good schedule and so should be given every twelve hours apart. If you inject too early or too late then it can act like a dose increase or decrease. So try to keep within 15 minutes of the same time you normally give it.

Then you really want to get another test during the cycle to see how far Salem is dropping to ensure he is staying safe and because dose increases or decreases are given based on the lowest point in the cycle.

 

[sjewell]

Thks for your help. I'm feeding my cats every 5-6hrs half can each.. Sometimes a full can each of FF if they're real hungry. Once I get the Young Again dry food I'll leave that out for them at least 1/4cup each to start. I have another cat Bailey, a ragdoll, who is 13 but not diabetic. I will do the injections every 12hrs. Will start testing 2-3hrs after ea shot. Have to read up more about how often to test now that we started w insulin. Thks for all your advice.

 

[Lisa and Witn (GA)]

1 unit is a good starting dose. It seems like a small amount, but it is amazing what that drop of insulin can do. You want to test before every shot. After a week at this dose, we can help you determine if you need to increase it a little. If an increase is needed, you will only increase by 1/2 unit. The goal is to find the best dose to control the BG levels. You will wait at least one week between dose changes before increasing it again if needed. Most cats only need 1 - 2 units of insulin.

 

[sjewell]

1 unit is a good starting dose. It seems like a small amount, but it is amazing what that drop of insulin can do. You want to test before every shot. After a week at this dose, we can help you determine if you need to increase it a little. If an increase is needed, you will only increase by 1/2 unit. The goal is to find the best dose to control the BG levels. You will wait at least one week between dose changes before increasing it again if needed. Most cats only need 1 - 2 units of insulin.

 

[sjewell]

Ok ty I'll start testing befr ea shot. Then after what 2-3hrs?

 

[KPassa]

There are a few different ways of doing curves. You can do a 12-hour curve, testing every 2 hours. You can do a 24-hour curve by testing every 2 hours on an AM cycle and a PM cycle (doesn't have to be the same day). You can do a mini curve, testing every 3 hours across a 12-hour cycle and then testing every other 3 hours across another cycle. You can even just do spot checks all week long and play "fill-in-the-blank" with the spreadsheet. Whichever method you choose, I still always suggest at minimum 3-4 tests each day:

• Before AM shot
• AM mid-cycle, if possible
• Before PM shot
• Before bed, lights out

 

[phlika29]

As you are going to be testing has anyone mentioned setting up an online spreadsheet. It is a great way to record you test results and if you link the sheet in your signature members can offer advice on dosing, testing times, etc.

http://www.felinediabetes.com/FDMB/...te-a-ss-and-link-it-in-your-signature.130337/

As Kpassa said you should always test before each shot and then I would test about 2 or 3 hours later and then if necessary test abit more.

 

[BJM]

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.

 

[sjewell]

we finally did the 2shots w/in the 12hrs.. The first day didn't go well, Salem was too nervous so were we so we just waited til last nite to start up again. We figured its easier when he's occupied, so we do it while he's eating. I'm feeding him 4x a day, every 6hrs, 1/2 a can of FF classics. I have another cat Bailey who is not diabetic, and they eat together. I also keep out some Young Again dry for them. The FF cans are small so it's not a lot of food. They both weigh about 10 lbs. Salem is getting better w/the shots, he actually doesn't flinch or notice it when we do while he's eating. The other nite me & my son just were hmm and hawing about it and I think we were all stressed and Salem was looking at us like "what the heck are you two doing"? LOL I have to set up a spreadsheet to start keeping track of e'thing. Is it ok to do shot at 6am and 6pm? That works best for both of us right now becz I work full time. If my son is going to do the shots exclusively we can change it from say 11pm and 11am. I haven't done the injection yet becz I'm afraid of needles, a fear I am now faced to deal with. I'm hoping Salem won't need Lantus forever. Keeping my fingers crossed.

 

[bsmith]

we finally did the 2shots w/in the 12hrs.. The first day didn't go well, Salem was too nervous so were we so we just waited til last nite to start up again. We figured its easier when he's occupied, so we do it while he's eating. I'm feeding him 4x a day, every 6hrs, 1/2 a can of FF classics. I have another cat Bailey who is not diabetic, and they eat together. I also keep out some Young Again dry for them. The FF cans are small so it's not a lot of food. They both weigh about 10 lbs. Salem is getting better w/the shots, he actually doesn't flinch or notice it when we do while he's eating. The other nite me & my son just were hmm and hawing about it and I think we were all stressed and Salem was looking at us like "what the heck are you two doing"? LOL I have to set up a spreadsheet to start keeping track of e'thing. Is it ok to do shot at 6am and 6pm? That works best for both of us right now becz I work full time. If my son is going to do the shots exclusively we can change it from say 11pm and 11am. I haven't done the injection yet becz I'm afraid of needles, a fear I am now faced to deal with. I'm hoping Salem won't need Lantus forever. Keeping my fingers crossed.

It's good to hear that you've started home testing and Lantus. It does get easier with practice and sometimes it's definitely the humans who are way more nervous and make it a bigger deal than the cat. It's nice that your son is able to help you. I'm not big on needles either, but you get used to it eventually.

It doesn't matter when you do the shots as long as it's at a consistent time and spaced 12 hours apart. Any change in shot time can act as an increase or a decrease in dose (give the shot early and it's an increase, late and it's a decrease.) If you do need to move your shot time, you can change the time by 15 minutes (earlier or later) at each shot time for a total change of no more than 30 minutes per day. By doing this you can slowly work your way to your new desired shot time.

 

[phlika29]

I found the 6am/6pm worked well for me as I could then get a couple of tests in the evening before I went to bed and in the morning could get in another test before I went to work.

I also found giving the steroid whilst he was eating was great as he didn't even notice it.

 

[sjewell]

I found the 6am/6pm worked well for me as I could then get a couple of tests in the evening before I went to bed and in the morning could get in another test before I went to work.

I also found giving the steroid whilst he was eating was great as he didn't even notice it.

 

[sjewell]

I'm thinking we should increase Salems 1unit of lantus as we've been doing thus for one week & he's still in low 400 range. Should I up dose to 1,5units? Advice appreciated.

 

[phlika29]

Hi

When you say Salem has stayed in the 400's when have you been taking the readings? Before each shot? And then during the cycle?

Can you list out the numbers for each day.that way we can see how things are going. Can you also remind me what food Salem is eating.

It would be great if you could add some info to your signature such as food using, insulin, any other conditions, etc.

 

[sjewell]

Hi

When you say Salem has stayed in the 400's when have you been taking the readings? Before each shot? And then during the cycle?

Can you list out the numbers for each day.that way we can see how things are going. Can you also remind me what food Salem is eating.

It would be great if you could add some info to your signature such as food using, insulin, any other conditions, etc.

 

[sjewell]

He's on lantus 1unit. Started one week ago. His level befr starting was 512 at vet wcw switched to ff can only. He list 2lbs in 2 mths. I don't think 1 unit is enough. We don't do testing as often as we should. It's been in range from 480-380. When is best time to test!? I'm going to do the spreadsheet soon. I called vet to ask abt increasing dose

 

[Critter Mom]

I remember when Saoirse first started treatment I felt completely overwhelmed with all the worry and trying to set up a new routine and it took me forever to get Saoirse's spreadsheet up and running. Once it was active, it really helped an awful lot because I just had to plug the numbers in every day. Would it help you if someone here could set up the spreadsheet for you? @Marje and Gracie often sets up sheets for new members.

 

[phlika29]

I don't think I would increase until you get a few more tests in. At the moment you don't know the lowest the dose is taking Salem. The ones you did got where were they in relation to giving the insulin and food?

You should ideally test before each shot, and then once more during the cycle.

So 10 minutes before the insulin shot is due you : test his blood, them feed and then give the insulin. Then I would try to get another test either two, three or fours hours after the shot. This will begin to tell you how much the insulin is making her drop.

As it's nearly the weekend I would suggest that you might like to do. A few more tests Saturday morning for example

Test and feed give insulin.
+2 hours later test again
+4 hours later test again
+6 hours later test again
+8 hours test again.

That way you will really get an idea of how low he is dropping.

 

[sjewell]

Ok. I talked to vet. She refused to tell me to increase dose becz she dsnt trust my relion meter. I brought my meter in a cpl wks ago & they tested him with their alphatrak2 & mine right after. Diff was 20points. She still refuses. Then says "if he had a reading w my meter of 300-400" yes he should be on 2 units of lantus. I'm going to go from 1unit to 1.5 starting tmrw. I know a lot of peopke use relion meters so I don't know why she's refusing. I'm annoyed!!

 

[sjewell]

Ok I'll wait bee will stay on 1unit. Retest 2more days. If no success will go to 1.5. Vet says if good reading is btwn 300-400 go to 2units.

 

[Critter Mom]

She still refuses. Then says "if he had a reading w my meter of 300-400" yes he should be on 2 units of lantus.

Lantus does not work on "IF this nadir after one week THEN this dose." It works on an "IF this nadir after holding the starting dose for 1 week THEN this dose adjustment. " It is a possibility that your cat may eventually need 2 IU BID (might be more, might be less), but that dose needs to be worked up to in increments.

The TR and SLGS protocols both recommend tiny dose adjustments - 0.25 IU usually - to allow the cat's body to acclimatise gently to any increase/decrease. Bumping the dose up by whole units can actually result in overshooting the optimum dose for a given stage in a cat's treatment. That then puts a cat at greater risk of hypoglycaemia and there is also the possibility of actually driving numbers higher if the dose is too high.

ETA:

I'm glad to hear that you're going to hold the current dose until you can get in more tests. I strongly recommend posting here to get feedback on the data from your extra tests before increasing the dose. (See above re 1-unit jumps.)

 

[phlika29]

Glad you are going to use the weekend to get more tests in. If you could make sure you always get a pre shot test and then as I suggested that would be great.

Then as Aine said if a dose adjustment is needed you only go up by 0.25 units at a time but please post back here first.

Do you think you could also spend some time this weekend setting up a spreadsheet. It really is the most useful way to record dosage and track trends.

http://www.felinediabetes.com/FDMB/...te-a-ss-and-link-it-in-your-signature.130337/

In the meantime I would recommend that you are testing for ketones and making sure that Salem is eating and drinking well. Do you have ketone test strips?

 

[BJM]

Please see my signature link Glucometer Notes with feline specific reference ranges using human glucometers. Note that the numbers are based on research done by Dr Jacquie Rand of the University of Queensland. She is an international expert on feline diabetes.

 

[Robin&BB]

I agree with Critter Mom on very small dose changes while on Lantus - it works differently than other insulins. (I'm finding that out, now that we're on Pro Zinc.) When Bat-Bat was treated with Lantus after her for DB dx, the dosage changes were usually in 0.25U increments. It takes a while to see changes in BG, but we found slow & steady gave us good results. And we stuck to feeding her every 12 hrs. right before her insulin - with NO feeding/ snacking in between, unless nearing the hypo zone. But ours isn't a multi-cat household, either, so was easier for us. She was exclusively on canned food once we began (she'd been eating mostly "healthy" dry food + a small amt. of canned pre-diagnosis). But had to transition her from higher carb Hill's w/d canned (vet rx'd @ start of treatment) down to Purina dm canned (much lower carbs @ 3%) over the course of her treatment.

That's some of what worked for us while treating with Lantus, but every cat is different ... must say now that had I not been in total panic/ shock 10 days ago when Bat was re-diagnosed, I would have insisted on Lantus again. (But vet assured me the Pro Zinc would work fine; I guess we'll see.)

Best of luck to you & Salem! Will be thinking all good things for his recovery.