lantus dose in newly diagnosed kitter

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julie & punkin (ga)

julie & punkin (ga)

Member Since 2011
hi,
i've posted in the general forum for new people - but i have a question specifically about my kitty's dosage. i'm looking at the tight regulations for lantus and it says a starting dose would be 1.6 units for a 14.3 lb cat. i'm assuming that's 2x/day.

the vet has my cat on 3 units BID - today is his 10th day (so 20 doses) at that amount. I was taking him in to the vet for BG tests but started home testing on Sunday. I know i don't have very many numbers on the chart yet, but i just got the hang of testing him today.

Can i get some advice from some of you on whether I should reduce his dosage? Do I understand the tight regulation correctly that unless you get a BG of 50 or less you don't reduce the insulin?

some background:

punkin is 12 years old, has been generally healthy except for annual bladder infections. he's been on dry food from the vet (easy on your bladder kind) until about December 1st, when he was diagnosed with diabetes. We started a major remodeling project the week before, he's a very anxious cat, and apparently the stress of the remodeling triggered the diabetes. He went on canned dm and prozinc, and his BG improved. he went off insulin Jan 4 when he tested 158 at the vet's. At that time, not knowing the impact of dry food, i bought a bag of the dry purina dm.

Jan 27 his blood sugar was 428 and he went back on prozinc, still eating dry dm. His blood sugar remained high despite increasing the prozinc dosage.

so on Saturday, Feb 12 his blood sugar was up to 513, i found this site's food list, changed his food to fancy feast classics and the vet changed his insulin to lantus 2units BID. I had his BG checked at the vet's Tues 2/15 and it was ~350 - the vet increased the lantus to 3units BID. thursday 2/17 it was ~315 and the vet said to increase it to 3.5units BID. I kept it at 3. Saturday 2/19 it was 268 (am+3) and the vet tech told me i needed to follow the vet's direction and increase it to 3.5. I gave him one dose that evening at 3.5 and started testing the next day at home.

the basic daily schedule is
7am insulin, eat 1 can fancy feast
noon 1 can
5pm 1 can
7pm insulin
11pmish 1 can

i'm doing ok keeping the eating schedule and now i'll make sure and test him pre-shot and in-between, especially trying to get the +6 number. I've got the burrito wrap down and will do better in the next few days about regular testing. I'm just concerned after reading the info about "the storage unit" that he'll soon be getting too much insulin. i haven't tackled the ketones part yet.

his chart is below. thanks for any of your thoughts! i really appreciate all the people here. julie
 
Hi, Julie. I'm glad you found your way over here.

You are correct -- a dose reduction is earned if a cat's BG falls below 50 in a cat within a year of diagnosis. You're also correct on the calculation of initial dose and it is a twice a day amount. The one aspect of determining an initial dose that you're missing is that if a cat is on another insulin, the dose of that insulin is also taken into consideration.

I may not be interpreting this correctly, but it sounds like you are assuming that Punkin's nadir is at +6. There's no way to know that. The nadir isn't a fixed point. It can change from cycle to cycle. This is one of the reasons that getting spot checks is important. As I mentioned in your thread on the Health forum, you also need to get tests during the PM cycle. Many cats experience lower numbers at night.

Without more data, it's very difficult to know if this is a reasonable amount of insulin or not. I am concerned that Punkin may be dropping lower at night.

With respect to how you're feeding, we suggest not feeding within 2 hours of when you get your pre-shot test. In addition, you are feeding late in the cycle. Generally, you don't want to be feeding after +6 (or whenever the nadir is). If you are giving food at +10, this is at a point when the action of Lantus is at it's least potent. The food may be overwhelming the insulin causing a spike in the pre-shot numbers. Also, 4 cans of food seems like a lot of food.

If you take a look at the Tight Regulation sticky, you should note the following general guidelines:

WHEN FOLLOWING A TIGHT REGULATION PROTOCOL WITH LANTUS OR LEVEMIR...

* Kitty should be monitored closely the first three days when starting Lantus or Levemir.
Blood glucose levels should at least be checked at pre-shot, +3, +6, and +9.
More monitoring may be needed.

* It will be necessary to test kitty's blood glucose levels multiple times per day.

* Learn the signs of and how to treat HYPOGLYCEMIA and prepare a HYPO TOOLBOX.

* Test regularly for ketones and know about DIABETIC KETOACIDOSIS (DKA).

* Use U-100 3/10cc syringes with half units marked on the barrel for fine dosing.

* Feed a high quality low carb canned or raw food diet.

* Feed small meals throughout the day. Some kitties adapt well to free feeding.
Click to expand...
 
ok, thanks - that's a lot. let me see

- yes, i was assuming +6 was the nadir
- the vet had said to feed him smaller amounts throughout the day . . . which was why it's like that.
- the fancy feast cans say 1 can per 3 lbs body weight, except the fish ones which say 1.5 cans. so i think for 14 lbs (he's 14.3lbs last week, and 14-15 is about usual now, he used to be about 17.) that would be about right. he may have gained weight since he went on it, though - would that be a problem? should i take him in to get weighed?

i'm confused about what you're saying about not feeding within 2 hours of the pre-shot test. Do you mean not only 2 hours before the pre-shot test or also in the first 2 hours after the pre-shot test?

Could you give me suggested feeding times if i'm giving him the insulin at 7am and 7pm? sometimes he would eat more than the full can if he had it, sometimes he's leaving a little bit, but mostly he's always eating all of it and wanting to finish up the other cat's bowl.

sorry to be so dense about all of this! i do appreciate your info.
 
Sienne meant don't feed within the 2 hour window before a test. The problem is, cats can be very sensitive to food and it can cause an increase in BG. If you're feeding within that 2 hour window, the number you get at PS time could be falsely influenced by the food... so you think it is safe to shoot, but then the food quickly wears off and it turns out you shot a lower number than you realized. You can definitely feed after!!

I feed Willie smaller meals, and on most days we feed at shot time, +1 and +2, then I leave out a serving of food to last him the rest of the day while I'm at work. In the evening, we typically do the same... though Willie sleeps with me and doesn't get up to eat in the middle of the night, so I don't have to worry about picking up food at night.

I feed Willie a raw diet, so I don't have a lot of info about the # of FF cans to feed. I'm sure someone will chime in tomorrow morning.

Lastly, welcome to Lantus Land! This place is amazing... I would trust folks here with Willie's life (and have!!). You are in good hands!
 
Yes every cat is different with their Nadir and it does change. So you will save a fortune doing your own curves at home instead of having the vets do it. That way you can feed your own food and avoid the stress on the cat from being at the vets all day.

Every cat is different with how much food they need also. Maverick eats between 6 and 9 ounces and is maintaining 15.4 lbs. But some cats may need more. Maverick is very inactive due to arthritis. Do you have a baby scale at home? This is a good way to know if you are feeding enough. And an unregulated cat will likely need more food than when your cat gets regulated on Lantus.

This group is seriously amazing. We found that vets don't know about Lantus and how it works. Maverick is now on a microdose of Lantus. I couldn't imagine doing this without everyone here. You are in good hands.
 
I think you mentioned you're using Janet & Binky's food charts. The calorie counts for canned foods are listed. If 14 lbs is a good, lean body weight, then Punkin should be eating approximately 260 calories per day (13.6 x optimal lean body weight + 70 = calories per day). This formula comes from Lisa Pierson, DVM's website on feline nutrition.
 
I'm using a list off Lisa Pierson's site that just lists particular foods, it's not the janet & binky's one, it's somewhere on Lisa's site, but at the moment i can't find it and the list is through the dark & snow in the car! it's just foods, though, not nutritional info. i was going by the can wrapper that says 1 can per 3 lbs.

it may be too much - although sometimes he wolfs it down and wants more. i thought it was important for them to not drop weight - is that wrong? he's a bit solid although compared to felix, my previous cat, who weighed 24 lbs at his peak, punkin is practically skinny. not too active except when the 2 year old kitty attacks him. he does go up and down stairs several times a day, but he's an indoor-only cat.

i don't have a baby scale anymore - the last baby is a freshman in college now!

his BG at 11:30pm (+4.5) was 141 and 5:30am (+10.5) was 254.
 
Welcome, Julie and Punkin! :YMHUG: I'm so glad you found us! You are in good hands and you will get the support you need here.

As for feeding, it can be hard to figure out the optimal amount that Punkin needs, but the formula Sienne gave you is a great starting point. I don't have a baby scale either, so I weigh myself, then pick up Chaos and weigh myself holding him and find the difference. It's not quite as accurate as a baby scale, but it can give you a good idea of her weight if you have a decent digital scale.

Best of luck with getting Punkin regulated. I'll be watching to see how she does. :-D
 
thanks for the welcome Violet! i appreciate all the advice i'm getting. btw, i don't think it will offend punkin, cuz he is kinda girly, but he's a he, not a she! ;-)

i am still having trouble getting blood when i poke him. i'm using a 28 lancet and called the pharmacy this morning to see if i could get a 25 - she said they don't have them bigger because bigger hurts. so i increased the depth setting to 4, which is the deepest, but it really seemed to act the same. even on 3 it was going through his ear fairly regularly.

i've switched his food so it's in the first hours after his shot and i did manage to get a +3 number today. getting them takes at least a 1/2 hour on each sample.
 
Julie:

You may want to post your city/state both here and on Health. Maybe there's an FDMB member who lives near you who would be able to walk you through home testing. It sounds like you're trying a lot of different methods and getting frustrated. It can be tough at first. Testing does get easier. Sometimes having someone show you their technique helps. However, sometimes it's more a matter of your cat's ear needing a little more time to learn how to bleed.
 
I'm in Corvallis, Oregon - but i looked on the member list and the closest person listed is 2 hrs away.

i thought the bigger the number the tinier the poke - like i thought 25 was a bigger poke than 28. have i got it backwards? i think i saw some bigger number gauges when i bought this one.

yeah, everytime i poke him i just get the tiniest amount of blood and i can't seem to work out more. every time i've warmed his ear and rubbed it before i start, but it's still a tiny drop. i would love to see someone demo on him!
 
You are correct... bigger number = smaller needle. 28 is a good place for you. In addition to warming the ear, try to get as close to the edge as possible. I usually fold Willie's ear over to get more backing, and go at an angle so I don't poke through both sides of the ear where I've pinched it.
 
Yep the bigger the number the tinier the poke. We started with 25 gauge syringe tips from the vets office it was $10 for 100. We are now using tiny 30g lancets. We freehand it - a lot easier to get blood than using the lancet device.

How are you warming the ear? In the beginning we used a sock with rice inside and warmed it up in the microwave. Maverick loved the attention. We'd use it to warm his ear and rub it all over him LOL. And you milk the blood to come out. Someone gave us a tip to squeeze on one side of the vein to act as kind of a block to help the blood you are trying to squeeze out to pool. Does that make sense? Squeeze one side of the vein with two fingers and with the other hand try and milk the blood drop out. Someone also posted what direction the blood flowed but I can't remember now. One ear may tend to bleed easier than the other. Are you poking from the behind (furry part) of the ear?
 
aw, you guys are all so nice!

i got all excited because i got blood on the first poke this afternoon (at +6 = 104). it was sweet and easy! but just now at +9 I couldn't get any. poor guy, i poked and squeezed for 20 minutes until i was afraid he might actually bite me he was so worked up. i gave up and let him go and gave him a little tuna for a treat.

i checked at 2 pharmacies today and nobody had anything bigger than a 28. is there a suggestion for a particular brand and where you got them?

i'll try folding his ear. i am warming with the rice sock and massaging it too. i get what you're saying about trying to block the blood - another thing to try. i thought when it went well this afternoon that maybe it was because i had his ear pinned down harder (more like poking with a hard surface behind) but i did the same thing tonight without luck.

yes, i'm poking from the furry outside. i did the inside for the first couple of days but the outside seems to do better.

do i understand correctly that you basically don't feed your cat in the second half of the interval between shots? just double-checking.

for as discouraged as i feel, i realized today that we've only been doing it at home for 4 days, so i guess i need to be patient! :smile:
 
Hi Julie and Punkin and welcome to Lantus Land!
The ear-bleeding thing can be frustrating. I would suggest using a higher-gauge lancet (the higher the number, the thinner and more comfortable the lancet). I use BD 30-gauge lancets and have pretty good luck with them. Some of the people here swear by 33 gauge (also made by BD), but I haven't been able to find them in the pharmacy here. I've had good luck with the Accu Check Soft Touch lancet device: it is very rapid and I think that it pokes the ear much faster than I could do it "free hand". I use the 3.5 setting, but you have to experiment with the setting. I hold a small gauze pad behind the ear where I poke and after I get the blood drop, I fold the gauze over the ear and put a little pressure on it. This inhibits any bruising.

A tip: Shine a flashlight from the inside of Punkin's ear so that you can see the vein illuminated from the back of the ear. When you have a good idea of where it is, aim for the area between the vein and the edge of the ear when you poke. Blood flows DOWN from the tip of the ear, so if you pinch the ear at about mid-point and hold it while you prick with the lancet, you create a dam and it is easier to get the blood drop. I put a little vaseline on the ear to help the blood drop bead up. At bedtime I put a little Neosporin creme with pain killer (not the ointment, which is greasy) on the ear to help it heal overnight. Always give a treat after testing (e.g., freeze-dried chicken bites, which you can get in the dog section of Petsmart, or something similar).

Well, it is actually easier than it sounds!! You and Punkin will get the hang of it. Also, ears have to be trained to bleed. And usually one ear bleeds better than the other. If you can't get a blood drop after about 4 or 5 tries, give a treat and try again a little later.

Good job getting your spreadsheet up so quickly. Read as much as you can and don't worry if you have to keep looking stuff up: it can be overwhelming at first, but gets better very quickly.

Again, welcome!

Ella & Rusty
 
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