info about lantus?

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cindycrowe

cindycrowe

Member Since 2011
I had posted in another area on the board and it was suggested that I post here as well regarding my questions about lantus. thank you so much:

Oscar is approximately one year old male cat. He is not neutered. I have adopted him from my son and trying to get him neutered started this whole health situation! On May 7 of this year, Oscar received his first vaccinations in preparation to be neutered the following week. He had a severe reaction to the vaccination and was diagnosed with pan leukopenia (spelling?) within 48 hours….he had no measurable white blood cells. After several days in hospital with minimal progress, I opted to treat him at home. My two daughters provided round the clock care for several days which included injecting Oscar with antibiotics, anti-nausea and providing fluids subcutaneously. This was no doubt an ordeal for Oscar but he did start coming around a little. The diabetes had not yet been detected but there were concerns for his kidneys.

Oscar deteriorated very slowly after that almost immeasurable to the naked eye. We did however notice the symptoms of always drinking and always peeing and I had my suspicions about diabetes. When I did realize that he was once again severely dehydrated and once again close to dying, we brought him to another hospital that provided care 7 days per week. I suggested that diabetes was now the culprit and Oscar was immediately diagnosed with diabetes on August 2/11. While he was in hospital, he responded very well to the ‘fast acting’ insulin that they are able to provide to him every couple of hours. The ‘longer acting’ Lantus that they sent us home with is not doing the job. We have steadily increased him from 1 unit in the morning and 1 unit in the evening to 2 units in the morning and 2 units in the evening. And Oscar has strictly been on the Purina Diabetic Management canned food. We were allowed to give him up to 3 cans per day. So a typical day, 8 am give him 1 can of his DM and inject him with his insulin. Around 2 pm give him another can of his DM. Then around 8 pm same procedure as 8 am. But Oscar always seemed hungrier. We had to take the other cat food away and the dog food because he preferred to eat that food and then would not eat his DM.

Last weekend we did not have anyone to care for Oscar when we went to camp so we decided to bring him with us. He seemed okay once we got out there although he was stressed as he didn’t know what was happening. He also got car sick and vomited both times (there and back). I knew this wasn’t good because Oscar is still dehydrated and underweight. He has still not bounced back to himself since his illness in May.

Then I noticed this past week that his appetite was ravenous on Wednesday and Thursday. We couldn’t fill him up and I know he needs to eat so we tried a little roasted chicken. Well he loved that and had some over a couple of days. Then Thursday, we purchased the dry version of the DM as our other cats need to have food out too and Oscar was willingly eating that. Then Friday morning, he would not eat…..only nibbled that entire day …..and I watched him deteriorate slowly. By Saturday morning and he still wasn’t eating, I knew we were in trouble. I called the vets and they suggested giving him anything to eat maybe tuna or salmon just to get him to eat and to try rubbing corn syrup on his gums. I did both and there was still no response. I brought Oscar back to the hospital mid-morning yesterday. His sugars were at 25. Obviously this insulin is not managing his sugars!

I had a discussion with a new vet yesterday and today and he agrees that it may be time to change to a different brand of insulin. In the meantime, Oscar is responding to the liquid in the IV and is eating and peeing. The vet gave Oscar his insulin last night before he left and Oscar was 20 when he came in this morning. Then he gave it to him again and he wants to see where he is at in 4 hours he said. I am frustrated that we are not taking other action!

I am looking for guidance for Oscar. He has been through so much! We are not prepared to give up on Oscar although the topic of euthanasia has been mentioned more than once.

Sincerely, Cindy (mother of 5 adult children and 7 beings)
 
Hi Cindy, wow, you and Oscar and everyone else have been through a lot! You are at the right place. I am fairly new here so I can't really give advice. Hopefully, someone will come along who can. Hang in there! Have you considered home testing? People here do a LOT of testing, several times a day to see how the cat reacts to insulin and food. The changes can be really dramatic, even in just 30 minutes.
Liz
 
hi Cindy - oh wow - what a trooper Oscar is. I too am not an advisor, and do hope one come along soon. It is a holiday weekend, and not may are around, hang in there and I am sure someone will get to you as soon as they can. I an say that the hunger is part of the diabetes. as the insulin begins to help, the appetite will gradually go back to normal. To me it seems that is oscar tested at 25 he was getting too much insulin - that number is very very low, indicative of too much, and not necessarily the wrong insulin. it is good you took him into the vet. I would encourage you to do home testing - it is easy to do, doesn't take too much to learn how, and it will give you better control over what is happening to Oscar.

I hope someone will be along shortly to review and advise. it is great group here, with much support.
 
Hi Cindy, I am so sorry you have been through so much withOscar, but diabetes is a very manageable disease.

First off, if Oscar went down to 25 the Lantus is definitely working, but he is probably getting too much. You said that you steadily raised the dose, in what increments? We usually increase by .25 units at a time or we can miss the correct dose. The management part comes from us. Are you home testing? It is very important to test at least before the shot. No one would give a human child insulin without testing first. Think of how much smaller a cat is and how much of an effect even the smallest dose will have on them. Another thing to consider is if Oscar has been going low mid cycle form the insulin he is probably bouncing afterwards.

On the food, most of our cats dislike the prescription diets, what is important is high protein low carb food. Any dry food by nature of the manufacturing process is higher in carbs and the low moisture content is hard on the kidneys.There is a great list put together which lists the carb % of most canned foods, many of us feed Fancy Feast, 9 live, Wellness etc. Here is the link to Janet & Binky's list, look for foods below 10% carb 4% or 5% is better. We often add additional water to the wet food as well to make sure that the cats are getting enough water. That is the natural way for them to get their needed moisture.

Please give us a little more info. What was the frequency of the increases and by how much/ Are you testing? When in relation to the shots if you are?
 
Hi Cindy and welcome,

Are you outside of the us an using a meter that measures mmoles/L?
edited to add - If so, that is equivalent to 450 mg/dL, which is high
 
I applaud your persistence - you are doing most of the right things. The one thing I am wondering about is home testing. The best way to regulate a cat's diabetes and insulin dose is to test at home. Lantus is a great insulin - gentle and long lasting. I think that I would prsist with the Lantus, but start home testing and read all you can on the Lantus insulin support group on this board. There is info about tight regulation and how to handle the insulin, among other topics. While it is important ot test b4 each shot to be sure that it is safe to give insulin at that time, the really critical nmber is the nadir, or the number at about mid-cycle when the influence of the insulin is at its peak and therefore the bg should be at the lowest. This is the number that tells you if you need to increase or decrease the dose. There are lots of videos on youtube that show you how, and we all have tricks as well. You need a human glucometre, test strips, and lancets from the pharmacy. Some people use polysporin with pain relief for the first little while.

The other thing is that he does need to eat, and wet, lo carb canned is the best. The prescription food from the vet is not necessary. As an example, most people aim for less than 10% carbs and I think that the DM dry is over 20%. The DM wet is 14%, but as happened with Oscar, many cats tire of it. Will he eat Fancy Feast, Friskies pate, Walmart Special Kitty? Any of these pate varieties are just fine. If you read the FAQ, you will find Janet and Binky's food lists. The carbs are listed for a variety of foods. Just choose some that he likes and fit the budget.
 
hi cindy!

we can help you - people come in with stories like yours fairly often.

sandy's question about your measuring scale is critical. a 20 on the scale we use in the US is critically low. in the worldwide number's it's high.

i would second the opinion that the lantus is working, but you need dose adjustments. we do those regularly with the information we get from hometesting our cats. it's a little scary to learn, but it's do-able, and once you've gotten the hang of it (and we'll bombard you with helpful ideas!) it seems like nothing but routine.

hang in there - don't give up on oscar yet! diabetes is a condition that is easily treated at home once you know what to do.
 
How has his weight been?

I agree - before changing insulin I would change the diet.
What the others have recommended regarding carb % will help tremendously. I would also mix some water in with the wet food to help keep him hydrated.

I too was told on several occasions to "prepare your mind" and written in Black kittys file was "prognosis poor".

Hang in there. you came to the right place.
 
ok, also seeing that you're getting simultaneous advice on both the main health board and here. that's fine, but you're going to go nuts trying to see it all and people are going to be telling you the same things.

i will add one thing - those post icons you're using - the rainbow and the candle - we use those when a cat has died. so you might want to stick a green smile on instead! the 911 is for a serious emergency - fortunately you're not there right now. but you're in the right place - either the main board or here - and people will help you get set up.

the 2 units he's getting is a reasonable dose, but if his numbers are high he might need more, but we always add the instructions to make dose adjustments with help from here. and we ALL home test. it's the only way to know what's going on in his body with the insulin.

i'd suggest you let the folks on the main health board teach you how to hometest and get set up with the right food and get a spreadsheet going, then we can really jump in and help you on fine-tuning mr oscar! they know what they're doing.
 
Welcome to Lantus Land!
Since you're getting a volume of information thrown at you all at once from two different Boards, let me try to summarize. Fortunately, there's a lot of overlap!!
  • Home testing is imperative. It is the only way for you to keep Oscar safe and to know for sure how the insulin is working. So, get a meter! I'm not sure where you are in Canada. Many people here use the Relion meter and strips from Walmart. Someone who's from Canada can probably advise you about what's both reliable and the least expensive.
  • Diet is a huge issue. My cat was started on the prescription diabetic diets. She's not a fussy eater and she would turn her nose up at the stuff. If you read the label, you'll understand why. The canned prescription stuff is mostly meat by-products. Even the lesser expensive brands of commercial cat food are better quality AND lower in carbs. Janet & Binky's list and this updated list with newer products has carb counts. You want to keep the carbs below 10% although most of us feed substantially below that -- usually 4 - 5% as low carb food.
  • Dry food is not recommended. Most of us transition our cats from dry to canned. Lisa Pierson, DVM has an excellent site for a discussion of feline nutrition as well as other health issues.
  • Read the sticky notes at the top of this Board. There is a huge (ok, overwhelming) amount of information there. There is information about how to get your cat better regulated, how to make sure you are treating your insulin to get the maximum use out of it, key concepts like the depot/shed, and how to get acclimated to this board.
  • Dose -- If your vet was having you increase your dose in 1.0u increments, it's possible you missed a good dose. We increase in 0.25u amounts based on the Tight Regulation Protocol we use to guide our dosing decisions. This protocol has been published in one of the top tier veterinary journals. In addition, dosing decisions are based on the nadir, not on pre-shot values.
  • If you want to get the Lantus Solostar pens (these are the 3 ml containers vs. a vial), if you're in Canada, you can walk into any pharmacy and get them. There is a reasonable possibility that on your trip, your insulin may not have been properly stored or got shaken, rattled, or rolled. Compared to some of the other types of insulin, Lantus is relatively fragile.
I'm not sure if I caught everything. Please, ask questions! The people here are very generous with their time and their knowledge. If you are able to get a glucometer, the folks over on the Health board are pros at helping you learn to home test. (I watched a ton of videos on YouTube and that's how I learned). They will also help with getting your spreadsheet set up so you can keep track of Oscar's numbers. Once you start testing, we can help you with dosing. Right now, I'm very reticent to suggest doing anything with dose without knowing what Oscar's numbers are like at nadir and without you're having control of the cycle.

Please let us know how we can help.
 
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