Help needed please for Lantus dosing

Hi I am new here today so forgive me if I am on the wrong thread and if anyone can tell me where I should post that would be really helpful. My lovely Luna (aged 11) has lost around 3kg (6.6lbs)in weight and just been diagnosed with diabetes just over a week ago. She was a big 8.7kgs healthy cat but immediately after (during last week of) steroids for unknown infection/fever in mid February started losing weight and displaying what I now know to be signs of diabetes. She is now only 5.7kgs (12.54 lbs) She was given caninsulin by vet at 2 units, once per day for a week which resulted in her in visibly spiralling down within 30-40 minutes every time and having a fever. Her Nadir with caninsulin was about 7-8 hours after injecting. The vet wanted me to give her another 1 unit at night but I refused due to what I consider to be an adverse reaction. The vet finally agreed with me that it must be the caninsulin causing her to have a fever. We changed her to Lantus 2 days ago. For the record, we are finding the Lantus pen difficult to use (there is no 'feeling' with the very fine needle as it goes through the skin) and you can't actually visibly see if any insulin has been delivered - you have to trust in the pen. Also, it only has a choice of delivering 1 unit or 2 units - no other measures. We are testing BG at home (poor Luna having me and my husband for cat parents lol) . First day she had 1 unit at night, second day (yesterday) she had 2 units in morning and 1 unit at night. BG readings yesterday were 10:36hrs - 455, 13:16hrs - 316, 16:49hrs - 324, 22:34 hrs - 401. We really expected the readings to go down at the 16.49hrs test so were really surprised to see they had gone up. This morning she has had 2 units @ 10:22 and her BG was 425. We tested her again at 14:24 and her bg is 363 . These readings seem weird/very high and it doesn't seem possible that the nadir is going to be much under 300 right now? The vet wants us to give her 2 units in the morning and 2 units at night but I am so scared of overdosing her and yet 2 units in the morning and the different amount of 1 unit at night also doesn't seem logical either Can anyone please help as we have no idea what we are doing and it is just so horrible to have to make such big decisions with no experience at all. We don't really know the best time to test her again today now but will probably go for 18:30 hrs plu the one at 22.30 before next dose. Any advice would be really really appreciated. Thank you

 

Hello and welcome. A couple of notes. First, we don't use the pen needles here, but rather insulin syringes with half unit markings. If you let us know what country you live in, maybe we can suggest a brand to get at the pharmacy. It's much easier to make smalle changes in doses with the syringe, and you get a better feel for when things are going in.

Lantus is a depot insulin, meaning that one dose builds on the other. You may not see action right away until the depot builds. Think of the depot as a reserve. Some of the insulin injected goes into the bloodstream right away, and some goes to the reserve, and there is a constant seeping from the reserve or depot into the bloodstream. With the dosing methods we use here, we find it best to give the same dose in the AM and the PM.

More details on the depot and Lantus in general can be found in the starred yellow sticky notes at the top of the Lantus/Levemir Forum. http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/

Good on you for home testing. If you could record your results in the spreadsheet formatmost of us use here, we can help you better with dosing. The instructions for the spreadsheet are here.

Deep breathe. You are doing so many things right.

What food is Luna eating?

 

Hello and thank you so much for your quick reply and I will look at the spreadsheet and complete it asap.

We are currently living in Gran Canaria (Spain) and don't even speak the language so it is really hard for us right now as you can imagine. Sounds much better idea for me to use a syringe if it is possible to get the insulin out of the pens? The vet showed us a U100 syringe and said the first line was equal to 2 x units but I couldn't even see the markings on it they were so small and there is no way I could use that. She doesn't have any others. A syringe which has half units would be fantastic if I know what to ask for.

Food - I have started her on Royal Canin Diabetic dry food. I cant read the ingredients for any of the wet food products here in Gran Canaria and so have no idea what I could give her with high protein and less carbs. She has only ever eaten dry food since I rescued her 9 years ago and the only wet food she will even look at is either Purina Gold gourmet pate or a chicken/turkey whiskas plus 1 in gravy. She will not even look at anything unless it is soft pate or gravy. Help??

It is such a worry to give her 2 units twice a day when she is so skinny, but her numbers seem to be still very high throughout the day I feel more confident to give her only 1 unit tonight. I am so confused. Poor Luna and I are so stressed with the constant testing, she hates it and it seems that evry time i speak to her it is to pick her up for more testing! What time would you suggest we test her next? we last tested at 1430 and her pm dose is due at 22.30? I am so so grateful for any help and advice you can give me.

 

I think you can get the BD Microfine syringes in Spain. Tagging @Gill & George , though I know she is about to head out on holidays. She lives in Spain too. You might be able to get syringes on line from the Uk. Take a look at the Sticky Note on Lantus syringe and insulin info in the Lantus forum, it shows you how to get insulin out of the pen. Basically take the top off and use it like a mini vial.

As for food, Gill would know better. Somewhere around here is a list of foods available in Europe. Sorry, don't have the link. I am in Canada.

As for testing, test before every shot, and somewhere in the middle of the cycle (time between doses, two cycles a day). Cats typically have their nadir or low point somewhere between 4 and 7 hours after the shot, but cats are also individuals and can do it later or earlier. Basically you are trying to get an idea how low the dose is taking the cat. That's the information we used to figure out what dose to give. Getting a test before you go to bed is also helpful, as many cats go lower at night. Make sure you are giving her a nice low carb treat each time you test her. Soon she'll come running when she knows it's test time. A good treat is pure meat. A piece of a boiled or baked chicken breast is one example, here I can buy freeze dried meat treats.

How is her appetite?

 

Yes we can definitely get the BD make here because that's what we use for Lantus pen, so that sounds positive. What exactly should I ask for? I will take a look and find out how to get the insulin out of the pen, thanks.

I am just panicking because we don't seem to be finding her lowest point on this yet. I really don't want to keep stressing her out and we ended up with her ear pouring with blood all over the garden today because I didn't see where my hubby pricked it and must have held the wrong place. Like some sort of geriatric comedy show! She's been sleeping for a few hours now but I can see she has been up and eaten and seems OK - sleeping is what she normally does most of the day so no worries there.

I have pretty much decided I will just give her 1 unit tonight again even though her lowest point we have found in the last two days is above 300 - I am way too scared to give her 2 units twice a day right now as I feel sure the lowest point must be much lower than that. My gut feeling is to do 2 units in the morning and 1 unit at night for a week then test every 2 hours until we find the lowest point. Does that sound sensible to you?

Luna is a grazer - she eats little and often all through the evening, the night and first thing in the morning. She seems to eat less during the day which is probably because she tends to sleep a lot of the day. Her appetite is OK, but not great as she used to be forever emptying the biscuits dishes left our for her all day/night.

Sadly this strange sweet girl doesn't like treats of any sort. Won't eat any type of cat treats, or raw or cooked chicken or meat but to be honest she is normally such a stressed cat there is no chance of her even looking in the direction of any treat after the testing as she is terrified and fighting me all the way through and runs and hides for at least an hour after each one. Runs and hides for hours if anyone comes to my door and cystitis if I dare to have a visitor so you can imagine the stress these tests are causing her. I think her stress-head sensitivity may be due to her breed (Balinese) combined with being abandoned as a young cat. I think I will have to accept that testing is never going to be great for her

Thanks so much for your help and advice, really appreciate it

 

Hi there,

I'm on the mainland, but you should be able to get most things delivered to Gran Canaria.
These are the syringes I use
It has to say demi so that you get the 1/2 unit markings, I just went to my pharmacist in the little village near our house and she kindly ordered them in for me, I would think that would be your best bet, alternatively you could order from UK, some members in finland used this UK company
https://www.vetuk.co.uk/veterinary-...-0-3ml-u100-insulin-syringes-box-of-100-p-296

I find it difficult to get the right sort of food locally so I order all my pet food on line from Zooplus.es they will deliver to most of their products to Gran Canaria.
Dry food that is low in carb is not easy to come by here in Europe, more recently, thrive UK have started doing a dry food that is around 10% carb http://www.zooplus.es/shop/tienda_gatos/pienso_gatos/thrive/661928, still a bit high, but better than the Royal Canin Diabetic food which is higher at about 28% carb. I bought a bag of the stuff when George was first diagnosed and ended up never using it, after I came on here and got informed.

George recently went off his food because he was having tooth issues, this is a low carb wet that might be worth giving a try http://www.zooplus.es/shop/tienda_gatos/comida_humeda/kattovit_dieta_especial/alergia_sensiblidad/55927 food that he found irresistible, its a soft pate type consistency, similar to the purina gourmet pate ( which incidentally some of the varieties are below 10% carb in the 7-9% range what flavour does Luna like? They are not my favourite because of some of the ingredients in them, but I used them occaisionally with George as a higher carb low carb wet food)

Transitioning to a wet food diet for us was easy, because George is very food orientated, but I know that many have had success in following the tips on Dr Lisas site for how to transition kibble addicts. https://catinfo.org/docs/TipsForTransitioning1-14-11.pdf

Here is the food chart for the UK/Europe https://docs.google.com/spreadsheets/d/1J5JpMe6TDXrHq_aTl9hUtHy6Gs9oRBqlz4nPGKxtySA/pubhtml
There is another low carb dry food on the list, ZiwiPeak, though it's not really a traditional kibble, it's not available on Zooplus, but some other spanish pet food sites stock it, I don't know which of the top of my head, since George has not eaten dry since his diagnosis I've not needed to source it.

If understanding the ingredients is a problem then you can use zooplus.co.uk they list the ingredients and nutritional analysis in English.

Also available from zooplus are these freeze dried treats from Canadian supplier Orijen, I've seen cats on this site that won't eat treats really love these, they are Georges favorite
http://www.zooplus.es/esearch.htm#q%3Dorijen%26catl%3D1%26p%3D1%26ci%3Dtype_food%253D1%253Asnacks%26type_food%3Dsnacks

I hope that helps, let me know if you need any help with translations, if you need me to write a note for you explaining what you need for the pharmacist in spanish let me know, I'd be happy to help. Or if you have any info from the vet in spanish that you don't understand I can translate for you. I was born in Gibraltar so Spanish is not a problem for me.

I'm off to the UK for a holiday tomorrow and I'll be away for 10 days, so I might not get back to you straight away, as I will have limited time to check in on the board.

 

Have fun on your vacation!!

 

First of all I want to thank you everyone so much for taking the time to help me. I can't believe how kind you are and a huge thanks to Gill and George for all that information, and to you too Wendy & Neko - you cannot begin to imagine how much this helps me! My totally diminished faith in the human race is currently being restored by this amazing site and you lovely people - seriously brings tears to my eyes to see the kindness so visible on here helping each other through this nightmare,

It is so very difficult for my husband and I as we don't speak Spanish and this is combined with the fact that my husband and I are running around like a pair of geriatric lunatics with zero medical knowledge and no memory between us! Luna is still alive this morning so we must have done something right thank goodness. We are going to do a curve today (we hope) even though Luna and I are totally stressed by taking blood it seems it is completely necessary as we still have no idea when her nadir is.

Gill - I am going to the chemist at sometime today in between blood taking and see if I can get those syringes which I am sure will make a huge difference to my confidence as I will be able to see that the insulin has gone and also be able to 'feel' the shot. I feel more calm already at the thought of being able to use a syringe instead of the pen. I am grateful beyond words for your food information and will be reading through properly later and looking at all the links you have given me. Again we are so grateful to you for the offer to help with any Spanish translation issues.

We will try to find the spreadsheet and complete it asap so we can upload it to the site.

I can see I should have called my profile Av and Luna (as my name is Av) but I don't think I can change it now can I?

I hope you have a wonderful holiday Gill & George

 

Here you are:
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
http://www.felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/

 

I think you can change your profile name, in any case you can include that in your signature. See the smaller font, grayed info below our posts? That's info on our kitties. Go to your name in upper right hand corner, select, then select signature. This can be updated, edited at any time.

 

That's really great, thanks to both of you for info and spreadsheet. Having a calmer day so far but Luna glucose levels all above 300 for every test for last 3 days so bit worried. We are doing 3 hourly BG today and will stick to it irrespective of the trauma lol. We need to at least try to find the time of the nadir so we have an idea how low it is actually dropping because I find it hard to believe it doesn't ever drop lower than 316 with 2 units in morning and 1 unit at night. Really don't want to increase to 2 units at night and feel like we need to see the first week out on Lantus first then if levels still high, increase the night one to 2 units. I am just writing my thoughts here but if anyone thinks that doesn't sound like a good plan please please do tell me.

 

With the dosing methods we use, we find it better to give the same dose in the AM and the PM. If you aren't seeing anything below 300, maybe dose 1.5 units when you get those half unit marked syringes? With different doses in the morning and evening, the depot will not be able to stabilize.

 

A quick note about using the pen(or syringe) and not being sure of getting the dose injected: Lantus has a very distinctive smell. And it's very strong. Just a small drop is easily recognizable. If you don't get the needle through the skin and shoot the Lantus into the cats fur(furshot), you can sniff the spot and you will know it. No doubt about it.

Also, except in extremely rare cases, it is advisable to give the same dose twice a day. This allows the depot to build up and even out the curves. If your not comfortable with 2 units twice a day, lower the dose and work your way up. Consistency is the key to Lantus and to diabetes in general. In some cases it can take a couple weeks to see any results when starting insulin. Be patient.

 

Thanks to both of you for the info and advice. I have got the syringes tonight and will start tomorrow with either 1.5 or 2 units both am and pm. Not sure at all which one to go with.

I've uploaded the spreadsheet but had a problem with getting the preshot BG tonight (gave up after 6 attempts and everyone stressed) but given the high readings at 2000 hrs I felt pretty safe to give her 1 unit without it this one time.

It seems from the spreadsheet that she would be OK with 2 units morning and 2 at night too and my husband and vet are wanting to go with that but I am not sure if a jump of an additional full 1 unit at night is too much. What do you think?

Also , I have left my spreadsheet open because if I close it I don't know how/where to find it again as I don't have any experience using google - can anyone help please?

 

I have mine "bookmarked" so when I open my browser, it's along the top for me to click to open, but your spreadsheet will always be listed in Google Drive

You may have to sign into your Google account

 

Ok that’s a great idea to bookmark thank you

 

Hi everyone Luna is still drinking a lot in the night and after this morning reading of 437 I have pretty much decided to increased this evenings dose to 2 units (from 1 unit). The alternative would have been to reduce the morning shot to 1.5 and increase the evening shot to 1.5 but I think her readings are consistently much too high. It would really help me so much if anyone could please let me know if you agree/disagree with that. Thanks

 

I think your on the right track.

 

Thank you