Just started Lantus- Dosing questions

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horselo285

Member Since 2011
Hi everyone,

I started giving Louie Lantus this am- following my vets advice of bg<360= 1 unit; bg>360=1.5-2 units.

I tried to get a basic baseline on him throughout the day today, but I have a feeling that I gave him a fur shot this am. ugh! I havent done one in weeks, but this am his fur felt a bit wet after his shot. With the Humulin, I always knew if it was a fur shot as it has as smell, but I am not sure with Lantus. His bg levels went up and then dropped a tiny bit...so I am really not sure.

I gave him 1 unit tonight and will check him at +1, but I have work tomorrow am and do not know if I will be able to check him again. My dad give him his insulin on the mornings that I work, but does not check his bg levels. This means he won't have his levels tested at all tomorrow until I get home from work. I assume my dad should go with the lower dose of 1 unit.

Any thoughts or advice are appreciated. :-)

Thanks,

Laura and Louie
 
Re: Just started Lantus

Welcome, Laura!

I tried opening Louie's spreadsheet. Can you make sure you have the access permissions set to "anyone with the link?" Right now, Google says I don't have permission.

I'd encourage you to find out from your vet if he's familiar with the Lantus Tight Regulation Protocol. Based on the published research, Lantus doses are not based on the pre-shot number. Rather, dosing is based on the lowest point in the cycle. (Dose reductions follow a drop into numbers below 50 for a cat within a year of diagnosis.) The article that I've attached is from one of the top vet journals and it describes the approach that we use here.

The protocol is also described in a less formal way in the Tight Regulation Protocol starred, sticky note. There is a great deal of information in all of the sticky notes. They will help to familiarize you with how to care for Lantus (unlike Humulin, do not shake or roll your Lantus), the basics of this Board, and key concepts regarding this long-acting insulin.

You are going to need to adjust how you think about managing Louie's diabetes. Lantus requires a very different mindset than Humulin N. Humulin is in and out of the system in a few hours whereas Lantus is a depot type of medication that has a much longer duration than Humulin. It will also take 5 - 7 days for Lantus to form this depot. You will also need to get spot checks. If you can't get tests during the AM cycle (and you can't convince your dad to learn how to test), getting sets during the PM cycle and on the days your not working will be important.
 

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Re: Just started Lantus

Hi Laura, welcome to Lantus Land - the greatest place you never wanted to be! The dosing protocol that we use here is based on the nadir (the lowest BG during a cycle, usually about 6 hours after the shot). We also keep the dose the same for several cycles and decide to change the dose very gradually(sometimes just by a drop) based on readings over the past few days. You can check out the stickies at the top of the page that have lots of good information that takes many readings to understand. :lol: :lol:

I wasn't able to read your spreadsheet. I think there is some permission you have to set but I don't know the specifics. Hopefully someone will come along who does. I don't have any dosing advice as I'm rather new to all this. You could edit your subject line to add "dose question" to get an expert's attention.
Liz
 
Re: Just started Lantus

hi laura! welcome to you and Louie!

There are several starred stickies on the top of the lantus forum that you'll want to read. Here's some links

New to Lantus/Levemir? start here

Tight Regulation Protocol

Care & Storage of Lantus

Insulin Depot/Storage Shed

Shooting & handling Low Numbers

I'm sure someone with more experience will be along, but i will suggest that you read through these stickies. I'm not very familiar with Humulin, but i do know that with Lantus there are some different actions and you will have to shift your thinking if you have learned how to use humulin.

dosing is based not upon preshot numbers, but upon the lowest number that a cat gets to in each cycle. mid-cycle BG checks are essential.

initial dosing is held for about 5 days before changing - same dose am/pm unless a cat gets too low. you have to build the "shed" that lantus creates. when it's injected, the lantus forms a precipitate under the skin that is slow-releasing the insulin. you want to be very consistent with it for best results - same dose, same time of shots, etc.

also, i'm not sure about Humulin, but lantus is a clear solution and you don't shake, rattle or do anything to mix it. make sure you watch the video about how to draw it up. lantus is expensive and you don't want to contaminate it.

that's probably enough from me! read through those stickies and ask questions - as much as you want. it takes a bit of explaining to learn it all, so no one minds you asking a ton of questions. we'd encourage you to post every day and we'll teach you how to take the best possible care of Louis.

have you been on FDMB already with the Humulin?

is Louie on low-carb canned food? does he eat on a schedule or graze?

anything else you can share about his diagnosis and previous experience? the more you can tell us the more helpful info you'll get!

glad to meet you! julie
 
Re: Just started Lantus

i can see both ss now - great job on getting quite a few tests! seems like you've done a good job learning that.

so was he only diagnosed Oct 8th? or is that just when the Humulin ss was started?
 
Re: Just started Lantus

Hey guys!

Thanks for the replies! I believe that I have fixed the spreadsheet, please let me know if there is still an issue.

Julie- Thanks for the advice and the information! I actually knew not to shake or roll Lantus, someone had told me that before (which is opposite of Humulin). I will watch the video you suggested...I definitely dont want to contaminate it! I have been posting in the main health board on FDMB up until now and Louie is on low carb canned food. :-) He eats on a schedule, twice a day and when I am home, I try to give him lunch as well.

Here is some background info on Louie: He is actually my brother's cat and was diagnosed with daibetes a few years back. My brother was able to keep him healthy and happy without testing bg levels. He had some method of figuring out when he needed increases or decreases. Whatever he did, it worked. Louie was healthy, happy and a good weight.
My brother moved to Boston and could not bring Louie with him. He asked my parents if they could take him (I live in separate apt in their house with my two children) and they agreed. My dad took over his insulin but had no method of figuring out what he needed and did not keep him on a schedule.
We have an overwhelming amount of animals in the house- I have 2 dogs, my mom has a dog and my parents have 2 other cats plus another 3 that really arent ours but we have ended up caring for. A friend of mine had asked my mom if they could stay here for a little while while she found homes for them. Long story short...they never found home (If anyone in the Long Island area is looking for a cat..let me know...lol). So total, including Louie, that is 6 cats. I have switched them all to low carb canned food twice a day so that Louie (hopefully) does not get a hold of any other food which.

Anyway, back to Louie. Under my father's care, he lost a bunch of weight. I had not even realized until a friend of mine was over and picked him up. She couldn't believe how much weight he had lost. I picked him up and was also shocked. I started bugging my dad about getting him on a better schedule, but he didn't take it seriously. So, about a month ago, I took over his care. I have no money an not much time, so the beginning was very stressful. I was incredibly lucky to find this board and meet so many wonderful people, including people who have helped me to afford Louie's care. It amazes me that such wonderful people exist! There really are good people in this world!
Within the month that ive been caring for Louie, he has gained some weight, his coat has begun to shine again and his peeing (he pees everywhere when he does not feel well) has decreased a bit. However, his bg levels have not regulated well on Humulin. It was suggested by many people on here that I switch him to Lantus....so when I finally got my mom to agree to help me pay for a vet visit (all basic vet care, {shots, etc} for all animals has been done by a friend on my mom's who is a vet. She however had not done anything with his diabetes...I finally brought him to his first outside vet apt (in a long time) last week.

So...thats Louie's story! :-)

Anyone reading this, do you agree with 1 unit twice daily to start? Should I not raise it if bg over 360? At what bg level would I lower dose? What about the days when I can't test? I will try to talk my dad into checking his bg levels...but I doubt it will happen. I will do my absolute best to get good bg readings on him throughout the day- but it can be tough. I work monday and sometimes friday, plus I am going to school full time. He gets his shots at 10:30 am and 10:30 pm (give or take 20 mins)- I do my best to be as exact as possible. Tomorrow, I will hopefully be able to get home a bit earlier then usual, maybe around 4 and will test him right away. Sat, I should be able to test throughout a decent amount of the day. Sunday is my baby son's first birthday and we are taking him to the zoo. I will test in the am and when we get back. Monday I have work, so I will not be able to test until later in the day. Tues, wed, thurs, I should be able to test on some sort of schedule. What hours after dosing do you guys recommend?

Thanks for the help,

Laura and Louie
 
cats are all so different - if you look at the "new to the group?" sticky it has an "ideal" lantus curve, showing the nadir (lowest BG point) about +6. but some cats lowest point is as early as +3, some later. by testing you'll be able to figure out when it is, although it can shift later or earlier. some cats (punkin) are pretty consistent and predictable, some cats are not.

you don't have to test at exactly the same times every day, the goal is to get different test times and as your ss fills in some, patterns will begin to emerge. the first 5 or so days on lantus are going to have some of the lantus from each dose filling that shed.

i test about every 3 hours am preshot, +3, 6, sometimes in the afternoon, pm preshot and pm +3. but that's based on what i know punkin needs. what Louie needs we'll be able to help you figure out over the next couple of weeks. in the meantime, test when you can and keep your ss up to date as much as possible.

what does louie weigh?
 
Hi Laura!
I just wanted to drop in and say that I'm glad you've made it over to Lantus! I see you have shared Louie's story with everyone, and it looks like you've gotten lots of help already. I don't visit here much, but I know that anytime there is an emergency in Health, lots of the people you've already "met" here are quick to jump in and help when asked. You're part of a group of folks that really knows a ton about Lantus and treating feline diabetes.

Hoping to see good things for Louie really soon!

Carl
 
Many people here have challenging schedules. If you can twist your mom or dad's arm into testing once or twice when you're not home, it will give you peace of mind that Louie is safe. The best way you can get them to think about this is how they would care for your 1 year old if he were diabetic. A cat and a child are not dissimilar -- they don't always have an effective means of communicating their needs. Testing is the best way to insure that Louie is safe.

For the first 5 - 7 days that Louie is on Lantus, keep the dose at 1.0u. While the initial dose of Lantus can be based on a cat's ideal weight, his dose of Humulin needs to be considered. You should also be aware that with the Tight Regulation Protocol, you will not stick with a dose the way you did with Humulin.

I'm a big fan of getting a +2 test and then deciding from there how much more testing may be needed. Basically, if you can test at various points over the course of a few days, you will be able to fill out most of the blanks during the AM and PM cycles. A before bed test is also a very good habit to get into.
 
Thanks Julie! I will test as much as possible and update!!

Carl- I was about to e-mail you and let you know I got the Lantus and began it today! Ive been racing around all night and was literally about to open my e-mail. lol Thank you so much for all your help! I am so excited to have lantus to to hopefully get Louie regulated! :-) I gotta go to bed soon, just trying to get some last minute cleaning done as I won't be home much tomorrow- and when I am home I need to get my history assignment done (due tomorrow night). I really wish I didn't have to work tomorrow. lol

Thank you again for all your help!!

-Laura and Louie
 
Welcome!!

I only have one thing to add...

regarding the furshot...
Lantus has a very sharp antiseptic smell... like Bandaids...
you'll know it when you smell it :-D

celi & binks
 
Hi Celi!

Thank you! That is good to know! Whatever was on his fur didn't seem to have a smell (I have a little cold, but I think my nose is still working ok...lol) so I guess it wasn't a fur shot! :-)

Thanks,
Laura
 
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