Has anyone had Lantus simply stop working?

[Deeliza]

Another member suggested I repost my introduction here to this area. Thanks.

My cats name is Spot. He was once upon a time a 17 pounder which in 2010 dropped to 13 pounds in a few months. We took him in when it was actually noticeable (we had been dieting him so I was of course happy it had worked). Unfortunately the reason was diabetes which I can link back to having steroid shots for allergies. His numbers then we're the high 500's.

We started him on Lantus immediately, 1 unit twice a day and tested him for curve, and tested him daily as needed (pre shot and nadir). After a few months we had to reduce the dose and eventually went to one unit once a day. Then his honeymoon. Was lovely.

In February 2015, I noticed he was losing weight again (he had regained plus being on DM). But I grabbed the meter (I am also diabetic) and tested. High 500's. Back to the vet and back on lantus, 1 unit twice a day. This was keeping him never lower than say 90 or higher than 280, for a while. Then he needed an increase (vet suggestion as he was no longer holding good numbers). So we have done gradual and at times months long increases, all on the vets advice. And honestly, in the beginning it did seem to help, for a while. Then the roller coaster again.

He is now 16. This past year has been difficult. We have taken him in for blood work and he did have a chance of an infection once so he got the antibiotic shot. Really no difference in his glucose numbers. We took him in again on 12/12/16. Once again the doctor said to raise the lantus this time to four units twice a day. I asked is it possible that the lantus has ceased to be an effective solution, and perhaps a different form of insulin ? Please remember I also am diabetic and I deal with it daily for myself, so I'm familiar with glucose curves etc. I'm not comfortable with four units x 2 a day. But that was it. We have followed this and tested to the letter and he is still rising. We did have another antibiotic shot done that day just in case, despite his blood work not showing infection. He has had the usual dental surgery for an old guy couple of years ago for extractions etc. and she said his teeth look fine now, which they do to me also.

So here I am today. His numbers are back to 539 pre shot. I'm fed up with this not working so I call the vet and she is out of town until Tuesday. I give him his 4 units of lantus and 5 hours later I test 523. It simply is no longer working for him and I've had sugar in the 500's it feels horrible. So, I do what I had mentioned to his vet and give 1 unit of Novalin N. Tested in two hours down to 410. I will then test him at four hours. My poor cats ears look like a dogs chew toy.

He does not eat dry at all. When he did he was on Earth Born Holistic feline grain free low carb version. We have taken this away much to his dismay. The DM was not much better than feeding Friskies in my opinion. We changed him a year ago to the new dry along its wet. But now is is only on wet food (low carb) and home cooked chicken.

This is the course I will now take. It's going to be an interesting day of ear pricking and testing but I hope to have some idea of what, if any, dose of lantus to give before bed. Or I may only give the Novalin N depending on how the rest of the day washes out.

Have any of you had very long term kitties on lantus where it just seemed they built a resistance to it ? It seems to do nothing now and we did increase his dose slowly, .5 unit at a time for about 6-8 weeks each time.

Wish me luck, I know what I'm doing and what I'm looking for, but could be a hairy night. I know 500's won't kill him quick, but I know how crappy it feels.

Thanks

Deb

 

[jacereske]

Hi Deb, I'm not experienced enough to answer your question, but you may get a quicker response if you post this in the Lantus forum. (On the Message Board Menu look for the section called Insulin Support Groups - the Lantus/Levemir is the first one).

Also put the blue question mark in the title of your thread and that may help too (when you create a post to the left of the thread title there is a Prefix drop down).

Jeanette

 

[Deeliza]

Thank you, I just reposted it there.

 

[Larry and Kitties]

What are you feeding?
(from reply in Welcome: Spot only eats wet food. He has Fancy Feast Purely only. Made without fillers. Consists of skipjack tuna, fish broth, sunflower oil, vitamins and minerals. other than that he gets home cooked chicken breast.)

I give him his 4 units of lantus and 5 hours later I test 523.

Do you have a BG before the shot? That is needed to see what is happening. Maybe 4 units is too much.

give 1 unit of Novalin N. Tested in two hours down to 410.

Again, do you have BG before that shot?

Many of us here record our reading and other info in a spreadsheet. See:
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
This allows othersto better see what is going on.

Edited to add:
This was provided in response in Welcome:
Hi ... thanks for answering. I agree that four units is too much x 2 this is all on my vets advice and honestly I've had her for 28 years she's sharp and up to date, Cornell grad and a really nice person.

We increased from 1 unit x 2 a day by half units, no quicker than giving each previous dose a good trial of about 6 weeks.

And yes, his sugar number of 539 this morning was pre shot. The 523 was 5 hours post shot. At that point I gave him 1 unit of Novalin N. tested at 7 hours for the Lantus and 2 hours for the Novalin and got 410

The N inject at the 5 hour point after 4 units of Lantus is good for the cat by complicates determining what is going on.

I suggest either:
- restarting at 1 unit Lantus twice daily and getting at least a preshot and BG at about 6 hours after shot
- Trying one unit of N twice daily at taking at least a preshot and BG at about 4-5 hours.

As you may know, Lantus is a depot insulin and takes a while to build up and reach full effectiveness and to leave the body after stopping Lantus.