Help with Lantus dose

Rupert and Angie

Rupert and Angie

Member Since 2019
Hi everyone,

Firstly, I've been lurking here for a few weeks since Rupert was diagnosed on December 11 but this is my first post so please bear with me. I need help with Lantus dosing so hope I'm in the right place. But first back story...

Rupert is my 12-ish year old (I got him as a rescue so not sure exactly his age) baby. He's been in great health since I got him 6 years ago but I took him into the vet after he had been peeing outside the litter box a couple of times and drinking a lot more water. He also has some weakness in his back legs (trouble jumping) which I'm guessing is mild neuropathy (the vet didn't seem concerned about it but I, of course, feel terrible).

Rupert had high numbers at diagnosis (459, or 25.5 for me since I'm Canadian) which the vet suggested we try lowering with a diet change first. So, he went on Purina DM for a week (I know this isn't the greatest food from all the info here, but wanted to stick with it at first since it's what the vet suggested). He had always been getting wet food in the morning and evening (Friskies pates) but was also allowed to free-feed on dry food. So, I removed dry food entirely for him and his sister (his sister still gets Friskies).

He was still high when I took him in a week later so he was prescribed 1 unit of Lantus. He weighs about 12 lbs (5.4 kg). I gave him his first 1 unit dose the evening of December 18 but think I might have gave a fur shot. I didn't test before his morning shot on December 19 (my vet only said I should test once a day, which I now know is too little) and gave him the next dose the morning of December 19. By that evening, his PMPS was 142. My vet wanted me to skip his shot if he was under 180 so I called her to confirm. She thought he might be on too high a dose so said I should skip that shot and then start him on 0.5 units the next morning as long as his BG wasn't under 180.

His BG was 372.6 the next morning and I gave him his half unit. So he's been on a half unit dose since December 20. I've updated my spreadsheet (hopefully I've done correctly) and his numbers are all pretty high. I was away for 4 days over Christmas (which I felt awful about but have parents in poor health as well) and my friend gave him his Lantus but didn't do BG testing.

I did his first full curve on December 29 and his lowest point was 309. Since it's the holidays my vet is in and out of the office so I couldn't get her opinion about raising his dose.

So, last night (December 31) after a PMPS of 356 I gave him a 1 unit dose instead of 0.5. This morning, his AMPS number was 185 and I was worried since it was close to 180 so didn't give him anything this morning. I'll test again tonight and am not sure if I should continue with 1 unit (I know 180 isn't too low but was worried about how low he could have gone overnight if he was at 185 before his scheduled dose).

Anyway, looooong story short - does it make sense to increase his dose to 1 unit? Should I be riding out 0.5 units even though it's been 12 days and doesn't seem to be lowering his numbers?

Thank you in advance for any advice. I'm completely overwhelmed with all this and feeling like I'm not doing enough to help Rupert. It's kind of breaking my heart.
 
Hello and welcome from a fellow Canadian (west coaster). Your Rupert looks like a handsome gentleman.

If you haven’t already, read through the yellow started Sticky Notes on the top of this forum. Keep asking questions, there is an overwhelming, at first, amount of information. One of the things you’ll notice is that people here use one of two dosing methodologies, the Tight Regulation Protocol or the Start Low Go Slow method. Eventually you will want to pick one of those to follow. But with both of them, we only make changes by 0.25 units at a time, when safe to do so. At this point in time, we don’t have enough data to say whether 0.5 units is too little insulin. We suggest getting a test before each and every shot, and spot checks where you can. The two dosing differ on testing requirement. But both agree that we also dose based on how low the dose can take the cat. With the Lantus curve, that is typically somewhere in the middle of the cycle, hence the spot checks. Including the night time cycle, as many cats go lower at night. A before bed test is a good one to get.

I think you have two options for dose at this point. One is to stick with 0.5 units and gather data to help us decide how low he is getting on 0.5 units. The second option is to go to 0.75 units, yes, you eyeball that. If you are new, it’s best to start on a dose you can shoot twice a day. He may eventually have to go up to 1.0 units, but best to get your routine going first and increase when you know it is safe to do so.
 
Welcome!
Do you have the ability to test after your pm shot? Cats tend to go lower at night, so it is quite beneficial to get at least one reading before bed. Your daytime values are saying 0.5 is not enough, but we don't know how low he is going during the night.
also, just a tip- if you put your cdn values into the "world" sheet, it will automatically populate the us sheet-no calculator required!

What type of syringes do you have?
 
Is the DM food he was on the Savory selects? If so, you can keep a couple cans to have some mid carb food with gravy that you know he will eat, and return the rest to the vet.
I was feeding the large cans of friskies poultry platter, and found too many ufo's inside (ew). I've found the PC extra meaty line to be quite cost effective, and seems better quality than friskies. I can see if I can find the spreadsheet for you with the values if you'd like. The 156 gram cans of chicken, and the oceanfish with tuna are both good, and often on sale.
 
Thanks for all your quick replies! I really appreciate it. I have read a lot of the info and think I will follow the SLGS method since I'm at work during the day and don't have the ability to test a lot during weekdays. I will start to do before bed testing though. Now that the holidays are over, I can fall into a better routine. I'm currently using a pen with half unit increments but also have the BD pet syringes with half unit markings (just have been avoiding them because it's so hard to get the dose exactly right). I will hold out for a couple days at 0.5 units, do some night time testing and get back to you with more info.
Thanks for the info about the world spreadsheet! I hate fussing around with the stupid calculator on my phone, haha.
The food he's on is Purina Pro Plan Veterinary Diets DM - doesn't say anything about flavour. I'm almost done the case so am happy to get a cheaper and healthier alternative. Thanks for the info about the PC line - do you get those at Superstore or...?
 
Rupert and Angie said:
Thanks for all your quick replies! I really appreciate it. I have read a lot of the info and think I will follow the SLGS method since I'm at work during the day and don't have the ability to test a lot during weekdays. I will start to do before bed testing though. Now that the holidays are over, I can fall into a better routine. I'm currently using a pen with half unit increments but also have the BD pet syringes with half unit markings (just have been avoiding them because it's so hard to get the dose exactly right). I will hold out for a couple days at 0.5 units, do some night time testing and get back to you with more info.
Thanks for the info about the world spreadsheet! I hate fussing around with the stupid calculator on my phone, haha.
The food he's on is Purina Pro Plan Veterinary Diets DM - doesn't say anything about flavour. I'm almost done the case so am happy to get a cheaper and healthier alternative. Thanks for the info about the PC line - do you get those at Superstore or...?
Click to expand...

Superstore or any of it's other incarnations- here it's Independent. Is your DM food a pate, or chunks in gravy? The pate is *just* within range for diabetics, but the chunks is 14% iirc.
If you are changing to a lower carb food, that's another reason to hold off on the dose changes. Food can make a huge difference!
 
OK, I live in Victoria - I think Superstore is our only option. It's out of the way for me but worth it if it's the right food for him. The DM food is the pate - looks like it's 6% from the food spreadsheet. Although the Friskies I was feeding him was also in that range (but he was getting dry food too so I know that made a difference).
 
Welcome to the group!

Like Wendy noted, you are way ahead of most caregivers since you're home testing. It's the best way to keep your kitty safe and to manage his diabetes.

With either dosing method, pre-shot tests are crucial. As many other tests, including a before bed test, will help you to sort out when Rupert's onset and nadir fall. If you have any inclination to follow TR, you may want to take a look at the sticky on using this method if you work/go to school full time. I was able to follow TR while working full time.

Also, if you enter the "Canadian" numbers on the world tab of your spreadsheet, they should automatically appear in US numbers on the US tab.
 
Hello islander, I am a mainlander. Any of the independent food stores like Tisol or Bosley’s/PetValu or even Petsmart will have low suitable low carb options. This pet food list contains a lot of the options available in Canada, though I would add Canada Fresh to the list too. https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf You want items under 10% carbs. I fed mostly raw food. If you want to try that, let me know, I know the locally available foods. Dry food makes a huge difference, glad it is gone from the picture.

@majandra that food list is linked in the New to the Group Sticky Note.
 
Something worth picking up if you haven't already are keto-diastix. They give you the ability to check for ketones in the urine, which is a good idea when his numbers are in the pinks. I suggest the diastix, because unless you can catch Rupert in the litter box- you know you are testing the right puddle/clump if the sugar is positive! (at least till his sugars are lower)

@Wendy&Neko Thanks! It get's hard to remember which of the billion things I read had which info!
 
Oh, and on syringes, you can get the BD Ultrafine II syringes at any people Pharmacy. I got the ones with the purple and yellow on the box. Cheapest price for me, go figure, was Safeway Pharmacy. Also my cheapest source for insulin and lancets. I cross border shopped for test strips. :) Which meter are you using? That’s good information for the signature, along with date of diagnosis and any medical history if pertinent.
 
Thanks! I will look into the keto-diastix. You can just test the litter? I think it will be hard for me to catch him peeing (he's quite private, haha) but he also shares a litter box with his sister. Where do I get those?
I ended up getting syringes at Walmart although tried several pharmacies before that - they acted like I was crazy for suggesting that something like that even exists. So frustrating.
I use the GE200 monitor (cheapest test strips I could find). I hope it updated in my signature - I kept getting a message that there was an error updating because it contained spam...?
 
Your sig looks good :)
You can pick up the sticks from any pharmacy.
I could rarely catch Rhubarb in the box, so I just settled with racing down when I heard her scratching stop. Her pees were much larger than my other cats which helped. Testing the clumps only seems to work when fresh and still wet.
Link to some tips
 
How do you find using that meter? I just looked at the guide, and it seems awkward. Rupert must be an amazing cat!!
 
Hmm, I don't know any different because I've only used this one monitor apart from the vet's office where she had me try hers. It's easy enough - just prick his ear, hold the strip to the blood and then wait 5 seconds for a reading. He's such a good boy - meows a bit when I prick him but holds still for the whole process. I was able to do it the first time I tried! Feeling guilty about the bruising on his ears though :(
 
Rupert and Angie said:
Hmm, I don't know any different because I've only used this one monitor apart from the vet's office where she had me try hers. It's easy enough - just prick his ear, hold the strip to the blood and then wait 5 seconds for a reading. He's such a good boy - meows a bit when I prick him but holds still for the whole process. I was able to do it the first time I tried! Feeling guilty about the bruising on his ears though :(
Click to expand...

Have you read the stickies about testing tips? Some of those may help. I found that testing as close to the edge of the ear as possible allowed me to get a good sample, and it wasn't too large. I also have a generic neosporin with pain relief ointment that I put on before poking when I was doing curves. seemed to help with the pain and itching. When I first started, I was squeezing out likely 10x what I needed, and she bruised of course. I also put pressure on the test spot for 30s to minimize the bruising.
 
majandra said:
Have you read the stickies about testing tips? Some of those may help. I found that testing as close to the edge of the ear as possible allowed me to get a good sample, and it wasn't too large. I also have a generic neosporin with pain relief ointment that I put on before poking when I was doing curves. seemed to help with the pain and itching. When I first started, I was squeezing out likely 10x what I needed, and she bruised of course. I also put pressure on the test spot for 30s to minimize the bruising.
Click to expand...
I've read the tips and test at the outside of the ear and do apply pressure/water after poking him. The bruises don't seem to bother him -probably look more painful than they are. Good to know about neosporin though. I just use vaseline now to help prevent the blood from just getting into his fur but would be feel better knowing any pain from poking was diminished!
 
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