Intro and Help with Lantus/Humulin R

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Saoirse and Stanley

Saoirse and Stanley

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Hello,

My name is Saoirse and my cat, Stanley is 3 years old and was diagnosed with diabetes and IBD in December. (I also really think he has had bouts of pancreatitis, but the vet said he doesn't have it now.) He has been on Lantus for a little under 4 months and he also takes Budesonide for the IBD. It seemed like he was starting to get pretty well regulated after a couple of months, but then a few weeks ago he started having an IBD flare-up and his blood sugars never went below 250. The vet told me to use a "sliding scale" and basically adjust the insulin dose based on his bg before the shot. Then I came here and read about the Lantus protocol, and understand that the sliding scale was not a good idea. So now I am basically starting over and I am going to try to use the protocol correctly. He is currently on 3 units twice a day.

My question is, the vet also gave us some Humulin R to use if I tested Stanley say, 6 hours after his Lantus and it was still very high. However, after reading a lot of posts about Lantus here, I am thinking that this may not be a good idea because it won't help to properly regulate him on the Lantus. I feel really bad for him though when his blood sugar is high (right now it is 348 and he had his Lantus over 3 hours ago.) He starts peeing everywhere and looks miserable. What do you guys think about using a tiny bit (1/2 unit) of Humulin R in conjunction with Lantus? Thanks so much in advance for advice!
 
Hi Saoirse,

Have you given Stanley R before? I don't suggest giving R to him if you are going to bed now. It might be better to use R at the beginning of the cycle, because R can bring the number down about the time the Lantus kicks-in, so I would urge you to err on the side of caution and only if you are around to monitor the blood glucose numbers, and know how, and are prepared, to deal with lower numbers should a hypo happens.

3 units is a medium + dose to start with, so, how long has he been on this dose? If this is the first time you've shot the 3 units I would urge you to hold off on giving R insulin, and start, if needed, at the beginning of a cycle when you will be awake/and/or home to monitor him.

Lantus is a great insulin but the sliding scale is probably contributing to the higher numbers (maybe, maybe not). Lantus works best with consistent dosing on a regular schedule. The R insulin can be used in conjunction but I would suggest seeing what tomorrow brings after a couple of days on a steady dose.

Best,
Pam & Layla
 
No disrespect to your vet, but it sounds like he or she did not give you very good advise on the insulin use. Lantus is not used on a sliding scale and I would not advise using the Hum. Insulin it would only further complicate things. If you get back on tomorrow with more informtion about your cat's BG levels you can get some more advice onthe lantus dosage.
 
We have a Lantus support group (where you saw the protocols). I have asked some of the more experienced people to come over and offer advice on the insulin.

The other parts of this puzzle are food and hometesting. It sounds like you are already testing, which is wonderful. If you could start keeping a record of her numbers = particularly mid cycle - that will really help you figure her out. We have this wonderful tool - a color coded spreadsheet - that will help you and us. viewtopic.php?f=6&t=18207

What kind of food are you feeding? This website by a FD vet has info on IBD and a discussion of the best food to feed: www.catinfo.org
 
Welcome to FDMB!!

I'm one of the people Sue asked to stop by. The information you read and that people have already provided about Lantus is correct - it is not like other insulin and is best used when you provide a consistent dose at each shot time. As you're probably already aware, it is a depot-type of medication and dose is based on the nadir, not on the pre-shot blood glucose (BG) value which is why sliding scale dosing is not effective. Your vet is advising you based on his/her experience with other types of insulin vs. experience with long-acting insulin like Lantus or Levemir.

Given that Stanley was diagnosed in December, how old is your Lantus? The manufacturer recommends discarding Lantus after 28 days. Many people get longer use from their insulin but if you've been using the same insulin since diagnosis, chances are that your Lantus needs to be replaced and this is contributing to Stanley's high numbers.

As for giving R, it can be done but it can also be rather dangerous. Humulin R is a very potent, short-acting insulin. A dose of 0.5u of R is not small and unless you know when the R onset and nadir are, as well as it's duration in your cat, it is not advised to use it without having an experienced user guiding you. In addition, I would not give R at 6 hours after shot time. If your cat's nadir is later than +6, you could easily have the Lantus nadir and the R nadir coinciding which could potentially drop numbers dangerously low.

Did the vet increase the dose of Budesonide at the time of the IBD flare? If so, either the IBD flare and/or the meds may be affecting Stanley's numbers. Often when a kitty is not feeling well, the insulin dose needs to be increased.

If you've not seen the sticky notes on the Lantus board, I've provided a guide to what's in them and linked them for your convenience:
  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal versions -- the Tilly Protocol developed by the counterpart of this group in Germany and the Queensland/Rand protocol developed by Jacqui Rand, DVM and published in one of the top vet journals.
  • New to the Group: Everything you wanted to know about the Lantus forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
  • Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
  • Lantus depot/shed: This is an important concept for understanding how Lantus works.
  • Becoming Data Ready: What data you need in order to be able to work toward remission or tight regulation.
As Sue noted, providing information about your test data will allow us to take a look at Stanley's numbers and provide better input. In addition, what you're feeding can make a huge difference in Stanley's BG values.
 
Wondering if a raw diet has been suggested to you for the IBD? Many vets will poo-poo it (no pun intended) because of the bacteria factor, but if purchased from a reputable supplier like Felinespride.com or made with the same care as you do human food prep, it should be fine. There are testimonials on the Feline's Pride site about how quickly an IBD cat's symptoms resolve when given raw food. I have seen it myself and highly recommend raw food for intestinal issues. It is what cats are meant to eat.

Please see Dr. Lisa Pierson's website for instructions on how to make raw food. http://www.catinfo.org/?link=makingcatfood
There are other sites and YouTube videos as well on how to do it easily.
 
Thank you so much everyone for the replies and thank you Sue for the template. I don't know if posting his bgs right now would be very useful because they are really all over the place since I've been intermittently giving him Humulin R, and I've been messing around with his food. He was eating Fancy Feast but if he took his steroid even an hour or two late he would start burping and vomiting, so I am trying FreshPet select and Merrick. I would like to leave the raw food as a last resort since I do not even make meat for humans and it's difficult to obtain the premixes.

I guess the changing around of food could be why his levels could be high right now. I am just worried that he will never be well regulated on the Lantus becuase he was pretty well regulated on 3.5 units bid and then all of a sudden his levels skyrocketed for no apparent reason. We were going up to 4 and 5 units without them ever going below 200. This time I want to try to be more systematic and I will save the values to show to you guys. For now I will also stop using the R because it is just complicating things.
 
Oh I also forgot to say before that the Lantus is new. I've replaced it about 3 times. I also was giving it in the scruff of the neck until I read on here last night that the scruff is a bad place to inject, so this morning I tried using the side of his stomach (he wasn't happy about it.)
 
I sometimes use R in conjunction with Lantus for Mitten and used to use it for Bailey (GA). Both had intestinal problems and were on Budesonide. I uses the R to get the high BG down without having to increase the Lantus dose. It was a slow learning to find an acceptable R sliding scale.
 
welcome saoirse! i just wanted to make sure you knew that several people posted in your thread in the Lantus forum overnight with suggestions for you.
 
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