Lantus doesn't seem to be working?

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Christine Broad

Member Since 2012
This is my first posting, so please bear with me. In January, my cat Spooky's BG was normal at 6ish, but in May/June I noticed that he was drinking/urniating lots. Took him to the vet and his BG was 25 and she told me he was diabetic. They suggested putting him down but I researched feline diabetes and decided to try and give him a chance. I suggested to the vet that we begin with Lantus after much comparison with other insulins for cats, which we did at 1/2 unit, 2x's day. We have since done 6 glucose curves and his dosage has been increased on a regular basis to 3.5 units 2x's day but he dosen't seem to be responding. Last numbers were 15.8, 17.2, 20.6, 19.3, 14.0 taken 3 hours apart. My vet told me he would have started him on Caninsulin first and now I'm feeling guilty knowing the likelyhood of remission is slipping through my fingers as time passes. Also he was 23 lbs when we began and I had been free feeding him dry vet food for years (mixed-one a dental diet, the other for weight management). He is now being primarily fed a DM soft food morning and evening at insulin time and will sometimes sneak to our other cat's dish when she's eating. She's getting a high protein/low carb canned food I've researched and purchased over the counter. He is now down to approximately 17 lbs. He is a bigger guy, but I think they still want him thinner. He's not himself anymore and only seems to want to eat.....no more purring. Doesn't want to be held, paces when i'm home and will make this sound over and over again, especially when I'm sleeping and he wants to eat. Hard to explain...not a meow or cry or the sound cats make prior to vomiting. Doesn't sound like hes in pain, just wants something. Could he be in pain b/c he sometimes meows when I pick him up? As much as my vet is trying, I don't think they have any real experience in treating feline diabetes. If anyone has suggestions or feedback, I'd be grateful. I don't want to lose him.

We live in Woodstock, Ontario in Canada

Thanks,
Chris.
 
I'm sorry Spooky is not doing well. I hope we can help. The first thing I would do is to read the stickies on this page:

http://www.felinediabetes.com/FDMB/viewforum.php?f=9

It's our Lantus sport group and the starred topics have best practices for treating FD cats with Lantus. You might find some things you could change in his treatment plan.

Has he been tested for pancreatitis? It often causes tummy pain and is often an issue with diabetic cats. Many people deal with both issues successfully.
 
Hi Chris,
I have some questions based on what you posted -
First off, the vet suggesting putting him down tells me all I need to know about your vet. Feline Diabetes, if treated, is certainly not a death sentence. Many cats can live many years needing 2 shots a day, and looking at them, you would never suspect they have diabetes. Many cats can go into remission (which can't happen for humans), and live a long healthy life. The vet should know that, and should never give people the option of putting them down.

My vet told me he would have started him on Caninsulin first and now I'm feeling guilty knowing the likelyhood of remission is slipping through my fingers as time passes.
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Caninsulin works on dogs, doesn't work well at all on cats. Your choice of Lantus was the right choice because used correctly, it offers the best chance at remission.

Took him to the vet and his BG was 25 and she told me he was diabetic.
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Did they run a full blood panel and a urine analysis to verify the diabetes diagnosis, or was that determination made just from a BG test?

I suggested to the vet that we begin with Lantus after much comparison with other insulins for cats, which we did at 1/2 unit, 2x's day. We have since done 6 glucose curves and his dosage has been increased on a regular basis to 3.5 units 2x's day but he dosen't seem to be responding.
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The starting dose was appropriate. Safe to assume the increases have all been made in .5u increments? The problem with this method is that you can't base a dose adjustment on a single curve done at the vet's office or even at home for that matter. Lantus dosing is based on the number you get at "nadir", the lowest point his BG is at during a 12 hour cycle. It sounds like you have been given dose advice based on a single curve run on a monthly basis. All that one curve will tell you is how he did that one day and it doesn't represent the "big picture". That's why most people here track their numbers on a daily basis using a spreadsheet from googledocs. Lantus dosing is based on holding a dose for a number of days, and then adjusting that dose in increments of .25u based on the data that you collect over a period of days rather than on a single curve.

He is now being primarily fed a DM soft food morning and evening at insulin time and will sometimes sneak to our other cat's dish when she's eating.
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The DM canned food is fine, it's a low carb one. The problem many people have is that their cats eventually get tired of eating it because it only comes in one flavor. And it's expensive too. There are lots of other choices available that are at least as good quality, for much less money. Many here use Fancy Feast Classics and Friskees Pates, for instance. So, your diet is okay as long as he's not sneaking food from the other kittie's dish that isn't "low carb".
My question is how much is he eating on a daily basis, and are you only feeding at shot time? It is possible that he just isn't getting enough food.

Doesn't want to be held, paces when i'm home and will make this sound over and over again, especially when I'm sleeping and he wants to eat. Hard to explain...not a meow or cry or the sound cats make prior to vomiting. Doesn't sound like hes in pain, just wants something. Could he be in pain b/c he sometimes meows when I pick him up?
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Like Sue suggested, it might be related to pancreatitis. It might be due to hunger. How are his litter box habits? Any problems with constipation or diarrhea? Does he still drink and pee a lot? Have you noticed any difficulty walking, or any signs of dehydration?

I don't want to lose him.
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And we sure don't want you to lose him, and we will help you in any way we can to try to make sure that never happens.

Carl
 
Oh, Chris,
If you don't mind telling us, where are you located? We have members all over the world, and there may be one close to you that might be able to suggest a better vet.

Carl
 
Thank you Sue and Carl,
You have given me a sense of hope. To respond to your questions/comments:

I am from Ontario, Canada. Our glucose monitor provides readings as 1 mmol/L equaling 18 mg/dL. I hope that puts our readings into perspective for you. Not sure how that compares to your system.

Thanks re the Lantus feedback. I think we'll stay on it although we need to pay closer attention to his numbers. Are you suggesting that we take 3 BG's a day at 6:30 am prior to food and lantus, again at 6:30 pm prior to food and lantus and another at his nadir which we think is 9:30 pm based on his curves. We have done 6 curves. Our first BG is at 6:30 am prior to food and Lantus. BG are done every 3 hours until 9:30 pm. (15 hr curves).

I can't be sure of how in-depth his blood work was. He was originally given a urinalysis and I asked for a second when I thought he may have had an infection. Based on what the vet said, i suspect that they could have checked for more. I will ask if they based their assessment only on his BG or if there was other supporting results.

Regarding non-veterarian high protein/low carb canned food, I have referenced a list I found on-line but it's difficult to find a current list for food purchased in Canada. The DM is expensive and needs to be purchased from a vet's office.

Pancreatitis was never discussed with me and I will enquire about it with my vet tomorrow. I think he's very hungry and I would like to feed him through the day if possible. He doesn't seem to want to eat all his food at once. Litter box habits seem fine. There is a considerable difference in waste........definitely drinking less/urinating less post diagnosis. Spooky seems lathargic and I do watch to see if he's showing signs of neuroapthy. I would suggest he's weak. I'd like to give him as much food as he'd like for a few days and see if he responds positively but as weight management/loss seems to be a major factor in his treatment, I need to be careful. I think his weight loss has been too fast. Yes, i have been primarily feeding him only at shot time. He'll come back and finish food in his dish, usually within an hour or two after feeding time. Servings are approximately 3/4 of a 5.5 oz can, 2 x's day. I wonder if this is enough. I don't think he is dehydrated and i've never been told he has a fever. He has water available at all times.

Thanks so much for your help. I look forward to your response. I didn't mention, he's just over 11 years old.
 
I do think you need some specific Lantus advice. The first thing they will want is a history of his dosing and glucose numbers. We have a wonderful tool. - a color coded spreadsheet. And the World version will convert from your metric to our US numbers so we don't have to multiply by 18 and you don't have to divide. :-D

Here are the directions:

http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=50130

It is a little tricky so if you need help, just ask.

I like your idea of feeding more, asking the vet about pancreatitis and yes, you need midcycle numbers. Are you saying he reaches his lowest point(nadir) 3 hours after his shot? That would be an early nadir. When you did the curve (assuming they were at home and more accurate than one done at the vet) did he go down at +3 and then back up for the rest of the cycle. (you can see how his history at a glance would help us so much)

I would go back to your original post and choose edit and add your city and province and "Lantus" to attract people who can be of help.
 
Christine Broad said:
Regarding non-veterarian high protein/low carb canned food, I have referenced a list I found on-line but it's difficult to find a current list for food purchased in Canada. The DM is expensive and needs to be purchased from a vet's office.
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There are many Canadian members here. Fancy Feast in pate or President's Choice are two brands you could feed. I think Wellness is also sold in Canada, as well as Merrick and some other popular US brands.

Here's a thread with Canadian food suggestions:
http://www.felinediabetes.com/FDMB/viewtopic.php?p=45130
http://www.felinediabetes.com/FDMB/viewtopic.php?p=346692

Binky's non-US food list

You could start a new thread and ask for Canadian food suggestions.
 
Hi Christine. I'm just stopping by real quick to say Welcome. :-D
I mainly post over in the Lantus Tight Regulatin forum. My cat J.D. has been a diabetic for 7 years.
We can help you with Spooky. Keep asking questions. There are a lot of people here, with a large combined wealth of knowledge, that are very generous with their time, support, and suggestions.

When you get you spreadsheet up, we can help you more with dosing questions.

I agree with Carl about your vet :roll: .
 
I've attached Spooky's BC based on curves we have done at home. If you have comments to help us understand this information, we would appreciate it. Again, I'm new to this site and am working my way through it. Can anyone tell me the purpose of the icons? I'm afraid I don't see an area that tells me their meaning.
 

Attachments

Can you set your spreadsheet up to share to anyone with the link and then publish it to the web? The link now has to be downloaded each time someone wants to see your numbers and most people are unwilling to do that.
 
I found this conversion table which is helpful in getting a sense of the numbers on your sheet

http://www.joslin.org/info/conversion_t ... oring.html

Your vet has no clue about diabetes--AT ALL. I would change vets immediately and not trust any advice they give. If your vet suggested you murder your cat because he has a treatable disease--that vet should be de-barred, or whatever they do to vets. My Fred was diagnosed at 15 and died at 20 with diabetes for 5 years, twice a day on Lantus.

Your dose seems to high, it's hard to get a sense of much because your curves are very infrequent but he's dropping low--and then going pretty high...

On your Aug 26 dose his preshot was...about 100 mg/dl in US numbers--and you went ahead and gave him 3.5 units of Lantus?????? That's what your chart looks like...well youmissed the first 3 hours (no numbers there, but chances are you dropped him super low--almost dying--and his glucagon hormone kicked into counteract the dangerous low blood sugar, and by +3 he had rebounded in a Somogyi effect to 288 mg/dl (that's a 60 mg/hour increase which is super high super fast and is going to make kitty feel bad) BUT it had to happen or he would have died...so he continued to creep up and then the insulin was also acting to counteracting his own glucago and so he reached around 400 (21) and then the other Lantus started lowering him a bit...but it's a HUGE rollercoaster.

In my opinion this dose is TOOOOOOOOO High. I think you need to start from scratch and go low again, starting at 0.5 BID, or even 0.25 BID if you have the needles with 1/2 unit markings on them.

at first, it seems like you didn't give it enough time to adjust to a lower dose--which is always safer...he won't feel great by being too high if you give him too small of a dose but he can die from you giving him too large of a dose--which is what may be happening.

So better to take this rollercoaster out of the equation, and instead lower the dose and time his feeding around a lower dose rather than try to save him from plummeting too low by feeding him more.

Poor kitty is just on a rollercoaster right now, that is probably why he is not feeling good. But don't worry, this is a bit of a learning curve and you just need to stick to it and figure out what works. To give you a sense, my cat SEbastian is on 0.25 units of Lantus only once a day...this is very low and infreuqent) but it's working.

I would suggest that you start low again and give each dose a good 5 days to kick in as described in the posted Lantus procedures. One thing that can make a HUGE difference is when you feed him if the numbers are high.

So if you get a high preshot number like 16 or above, wait 1-3 hours to feed him after giving him his shot. That way, the Lantus can start to have an effect and when it starts working he won't have risen even higher from haven eaten, he will be at a good number and the Lantus can hold him steady and produce a stable flat curve--not a rollercoaster. But this only works on a low dose because if you give him a huge dose, like you are, and don't feed him, then he'll plummet.

This is a learning curve and scary but don't worry, you'll get it, and just be conservative give it time to work, hold back an hour or two from food if the number is high (this is not starving him, it's just delaying feeding a bit, which is fine) Keep that dose SMALL and let his body adjust, he has some of his own insulin STILL so you need to give his body to adjust. (If your kitties pancreas no longer had insulin he would be in the 600s and 700s with BG numbers (like 35 and above)

good luck. he will feel better once he's regulated, and then he can live a very long time. Change that damn vet and report him/her. That is malpractice. You don't kill a cat, or a human, for that matter, just because they have diabetes. BAD BAD VET.
 
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