Lantus Dosage Question and Introduction

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Seth&Bell

Seth&Bell

Member Since 2024
Hello all, first off I just wanted to give a huge thank you to this message board. I just started Bell on Lantus a few days ago (7/2/2024) and this community has been an invaluable resource to help me through the steep learning curve and stress of all of this. You all have saved me from some minor bad vet advice (that I should roll Lantus before use, use syringes twice, etc) and some major ones (vet wanted to start Bexacat without checking for ketones, vet wanted to dose Lantus once a day).

Some background on Bell: She's had a difficult month. The vet found that she had severe back pain, which we treated with a combination of Onsior, Gabapentin, and Tramadol. During this treatment I noticed she had an enlarged anal glad, which ruptured when the vet expressed it. She was in a cone for 10 days while that healed. During the bloodwork for the backpain, the vet noticed her BG was high, so we rechecked that while her rupture was healing. Sure enough it was still too high and we proceeded with treatment for diabetes. The vet initially wanted to try Bexacat, but I pushed for a ketone check beforehand (vet was going to check after we had already started the treatment), which turned out positive and pushed us to start Lantus. Oh and, also, Bell's a sweetie :)

Before starting the Lantus, Bell had a Freestyle Libre 2 installed. Her BG ranged 210-280 on a daily basis. Her diet consisted of mostly kibble with some Stella and Chewy raw chicken that I make into a soup. The kibble was a mix of Epigen 90 (low carb) and Petcurean Go (not low carb). I have since transitioned her to low carb canned food per the advice of this community. I actually did not see major spikes after her dry food intake with the Libre, but I transitioned her regardless.

The vet recommended 1 unit of Lantus daily, but I pushed for 0.5 units twice a day. It seems even the 0.5 dose is too high for Bell. Today, even on a slightly reduced dose (somewhere between 0.25 and 0.5 units) her BG numbers dropped to the low 50s. I gave her some maple syrup at this point. It seems like 0.25 might be her ideal dose.

Since her numbers dropped so low today, I'm not even sure the 0.25 dose will be safe for her PMPS. I'm looking for some advice on what levels I should skip the dose entirely and what levels are ok for me to shoot with a reduced dose of 0.25. Previously, I skipped a dose entirely because we had just started insulin and her numbers were 152 at dose time. I think this was the right call, but her BG levels proceeded to increase and it took me three cycles of 0.5 dosage to get them down again.

Thanks so much for the help.
 
Hello and welcome. Kudos to you for doing the research on feline diabetes and knowing what to do. We've unfortunately seen a few kitties started on Bexacat that shouldn't have been. :(

Are you testing at home for ketones? If the vet found some, you should be checking daily. You can get urinary ketones test strips at most pharmacies. I'm hoping the healing anal gland means no more infection which means ketones not as much a worry. If you do a ketones test, note the result in the spreadsheet Remarks, so we stop asking about them. You should put "ketones on Dx" in the signature as that's important.

The lower numbers today were probably due to the depot of the 0.5 units dose you have been giving. The depot can influence 4-6 cycles after you reduce the dose.

Are all the numbers in your spreadsheet from the Libre? You should double check low Libre numbers with a hand held meter, as the Libre can test artificially low in lower numbers.

Are you using syringes with half unit markings? They make it easier to eyeball the 0.25 units dose.

Sorry for the multiple questions.
 
Thank you so much!

I am testing her urine at home for ketones. The same day the blood test showed 5.7 mmol/L, her urine tested between "Small" (15 mg/dL) and "Moderate" (40 mg/dL). If I had to guess by the color strip it was around 20-25 mg/dL. I've been testing her every day since and it has steadily gone down. Now I am somewhere between "Negative" (0 mg/dL) and "Trace" (5 mg/dL). Yay!

The numbers in the spreadsheet are from the Libre, but I've been spot checking them (especially the low ones) with a Relion Premier Classic meter. They have been aligning, although the Libre seems to lag a bit, which I think make sense based on what I've read.

I am using syringes with half unit markings. I honestly couldn't believe that was the best granularity we have when the vet tech showed me how to administer the insulin. I'm using all the resources here to try to key into that 0.25 dosage on the syringes with the half dose markings.

I will update my spreadsheet and signature.
 
bluesunshine said:
I'm using all the resources here to try to key into that 0.25 dosage on the syringes with the half dose markings.
Click to expand...
In case you haven't seen this :cat:
49822973683_0559ae843a_o.jpg
 
Thank you both for the help.

I've got to step away for an hour or so, but her AMPS 9+ measurement was 79. Do either of you have any thought on how to handle the PMPS? If I skip a dose, I'm worried that the depots that have been built up will be used up. But if I give her a 0.25 dose, I obviously don't want to push her too low. Any thought on the BG at PMPS time that you would be comfortable shooting?

Y'all rock.
 
bluesunshine said:
Thank you both for the help.

I've got to step away for an hour or so, but her AMPS 9+ measurement was 79. Do either of you have any thought on how to handle the PMPS? If I skip a dose, I'm worried that the depots that have been built up will be used up. But if I give her a 0.25 dose, I obviously don't want to push her too low. Any thought on the BG at PMPS time that you would be comfortable shooting?

Y'all rock.
Click to expand...

@Wendy&Neko
 
Can you get a +11 and post it? That'll give us time to figure out what to do, based on more current data.
 
She's gone up quite a bit, hoping that +12 or PMPS is even higher. One other trick is to stall. That would mean not giving food, and waiting 1/2 hour to see if she comes up more. You can't stall too long, cause they can drop if going too long without food.
 
She's still at 154, about 5 minutes before the normal shot time. Would you recommend I stall a bit?
 
And if I do stall, would I still do the next AMPS at the normal time? Or does this set a new baseline shot time?
 
Would a very small dosage (less than 0.25) be an option? Or is it just better to make a call to dose or not dose? Apologies for the multiple questions
 
Yes, a small dose is an option. As is delaying. You can usually move the Lantus shot time 1/2 hour once per day or 15 minutes per cycle.
 
I took a blood sample with the Relion (she's not too happy with me right meow). It read 156. I think i'll try to do a smaller dose (<0.25), if no one objects in the next 5 minutes.

Sincerely appreciate the help today.
 
Think of it as data gathering. When following SLGS you aren't supposed to dose if under 200 when you are new. But with some history of ketones, we are bit more aggressive. Note, as you get more data, that no shoot number will come down.
 
I did give the 0.1 (or as close as I could) about a half hour later than her normal PMPS. I used this as my guide :nailbiting:
49822973598_359300d752_o.jpg


I have a couple follow up questions.

1) How low a BG level should I start getting sugar (maple syrup in my case) into Bell? My instinct today was to do so in the low 50s, but I want to be prepared tonight if she drops low again.
2) This may be a dumb question, and I'm not sure if the phrasing is quite correct, but here goes: is the effect of insulin on a cat's BG a linear thing? Or is it more logarithmic, meaning it takes more insulin to drive BG lower when it is already low than when it is higher? Because I see the Lantus really quickly dropping Bell from ~200 into the 70-80 range. I'm trying to get a gauge on how easy it would be for her to drop from, say, 70 to 30-40. From my understanding cats have a defense against this (the bounce) where the pancreas dumps glucose into their system to protect them from low BG. But I'm assuming that depends on how functional a cat's pancreas is and is not something to rely on.

Really both these questions are getting at how hair-trigger do I need to be when I see her BG get into the 50-60 range. I don't have the experience to make a judgement call on that, and that probably plays a lot into your above point about the value of data collection. I would just prefer the data collection to not include a hypo event if I can help it.

Thanks so much to you both.
 
When Bell first hits green (if she does) give her a couple tsps of her wet food. That can help steady them at that safe range. Typically we don't give syrup or high carb food until they go under 50, but it can vary a bit by cat. Note, I have tested 3 non diabetic cats, two in the low 50's and one at 49. However, there's a big difference if they have insulin on board so we play it safer then. In the beginning you may decide you want to give higher carb, or even medium carb food when she goes low. Cats differ in how carb sensitive they are, so you may have to play with this. Note extra food/carb/syrup amounts and timing on the Remarks section and it'll help you see what Bell needs.

Almost all cats bounce - not a function of how well their pancreas works. More related to liver. What it is related to is how long kitty has been in higher numbers, how used to lower numbers they are, and how fast the numbers drop.

There are differences in how a cycle looks from cat to cat. We say ECID or every cat is different here a lot. Data gathering is your friend.
Learn how YOUR kitty is responding to insulin:
  • Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
  • Peak/Nadir - the lowest point in the cycle
  • Duration - the length of time insulin continues to lower blood glucose
Some cats drop fast at onset, some don't. And it can very somewhat from cycle to cycle. In the beginning it will be harder to figure out blood sugar patterns, as kitty's body is learning how to use this hormone.

I can't answer the logarithmic question. This Sticky Note about the depot might help:
What is the Insulin Depot?
In general with Lantus, shooting lower numbers gives you flatter cycles. But again, in the beginning it's hard to generalize what Bell may do as her body is learning how to react to the Lantus. However, she is doing really well for a cat so recently diagnosed.
 
You are welcome.

When the +2 is higher than the preshot, it is typically a quieter cycle. She may be bouncing from today's lovely run.
 
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