Lantus dosing if I don't test at home

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tiffmaxee

tiffmaxee

Member Since 2013
Please don't beat me up for this. I don't think I can home test Max. He was difficult at the Vet's office and this is a usually docile cat. He is very timid and easily stressed. Just pilling and yes I give treats leads to him spending too much time under my bed. Vet trips usually bring on a pancreatitis attack. I am losing it. He was started on l unit of Lantus twice a day last Friday and spent the day with the vet. He weighs about 14 lbs. 7 oz. I will pick up the curve when I go back to the vet tomorrow. He is hiding right now and only ate his baby food so far this morning but I have someone here who comes every other week and his routine is off so this happens. He was in the middle of a panc. attack when I noticed him drinking. He has been urinating more too and his T4 was in the gray zone so I knew it was either kidney, thyroid or diabetes. He has had complete blood tests in May, June, September and again last week. I home tested his urine Wednesday and that's how I discovered the sugar in the urine. We saw my vet the next day to confirm. He's still drinking water which is unusual since he eats only canned food since he got pancreatitis 4 years ago. I dread the vet trip tomorrow and think his insulin will be increased.It will be about 6-6 1/2 hours since his insulin when I see the vet. I have totally switched to fancy feast classics for now from that and sliced which he prefers but is not low carb.

How can I do this without home testing. My sister and friends that have had diabetic cats never tested at home. I am alone here and can't get help with this even once a day let alone two or more. Quality of life for Max is a major concern because I feel he hasn't had that since July when I managed to get him out of his pancreatitis episode. Thanks for reading and advice.

Elise
 
You can if you can collect and test Max's urine for glucose using test strips. You always want the urine to show some glucose otherwise you risk the cat going too low.
Also, especially in your case, vet glucose curves may not be accurate. It may show an elevated BG because of stress.
What are you feeding Max? A low-carb canned food is recommended.
 
He's getting fancy feast classics and his treats are 100% chicken or turkey. Can I give him a little squash as he is on amlodipine and ondansetron which tend to constipate him. If he can get off the ondansetron that should return to normal.

That is good about the urine testing. I need to pick up some glass beads at a hobby store to see if that will work better than my waxed paper idea. My way worked last week but not as well today since he managed to burry most of the urine. I got some on the paper so I could test though but since it is the color of the litter was not as accurate I think.


Elise
 
When did you finalize the food change? It can take a few days for the numbers to drop.

Here are some urine catching tips:https://docs.google.com/document/d/1quta5WLEjdO0Y_t2dAYSwN84h-LNZWxOdtVsJDKZ16A/pub

Just because he won't like vet blood tests doesn't mean you won't have success at home. My Tiggy is a MONSTER at the vet.. Photo below. Literally he wants to kill the vet. He howls and growls and hisses and attacks everything that moves. They have to wear big gloves and wrap him in a towel and make him wear a face mask and he still goes nuts.

But at home when he is snoozing I can go up and rub his ears and he purrs and I go poke poke and test him and he doesn't even blink or wake up sometimes. How does Max feel about ear rubs?

8162236274_8769653678_n.jpg


Wendy
 
I wouldn't give up on the idea of testing at home because yes, a lot of cats are much worse at the vet's office than at home. Also why the dose should not be changed tomorrow based on a test taken at the vet's office. If kitty is highly stressed there then the glucose number is going to be inaccurate. And you don't want them to raise the dose based on a vet visit number then go home, have kitty relax, and you overdose kitty.

Sooooooooo, member BJM has put together info about other ways of monitoring progress in kitty at home that may be helpful. See if you could maybe do some of this for the time being
https://docs.google.com/document/pub?id ... fQqL3zX_88
 
I was just about to link the Secondary Monitoring tools and she beat me to it!

There is an older home monitoring protocol for using thirst, urine glucose, and urine ketone monitoring for managing diabetes. Note that urine testing only tells you what happened since the prior void, and the test strips are not super precise in what they record. You can get KetoDiaStix from many pharmacies, though you may have to ask.

You'll see urine glucose if the blood glucose level exceeds the renal threshold of about 240 mg/dL per the Merck Veterinary Manual. This means that since the previous void, the glucose was too high.

You'll see urine ketones when fat is being broken down for calories since the previous void. There may not be enough insulin to use the glucose. There may be concurrent infection (dental and bladder are common) and/GI upset such as pancreatitis.

You'll see excessive thirst and urination when the glucose is high, or when a cat is hyperthyroid, or when a cat has renal/kidney impairment. It isn't specific for diabetes.
 
R Max's New Number at Vet's since lantus started

Thanks. I am reading all your suggestions.I found the secondary monitoring tools and it sounds like they will help with high BG but not so much if it were to get low. With a pancreatitis attack he acts totally off. He hides as habit now and because he doesn't want his pill gel cap or a vet trip these days.

Now about our vet visit yesterday. Max got his insulin at about 7:15 in the morning and we had an appointment for 1:30 but his blood test was at around 2:15 I think. I was getting nervous waiting with all the dogs so we finally went into another room to wait for my vet. He was an angel for my vet like usual. It was so weird to see his chart labeled aggressive and hard to handle. His BG was 114. My vet reduced his night lantus to 1/2 a unit and kept the morning at l unit. We go back Monday at 1:30 for another test. I picked up copies of his labs and on Thursday his BG was 427 and his urine 3+

Since I found the glucose in his urine I started decreasing his carbs.So the drop could be a combo of both the food change and Lantus. I stopped giving him the sliced chicken fancy feast and chicken/salmon and started giving mostly classic liver & chicken. He wasn't eating as well so I put some Soulistic Triple Harmony on top. One pouch lasted a couple days but I checked Pierson's list and it's high carb so I stopped. Max is a picky eater since pancreatitis reared his ugly head. I asked my vet if I have trouble getting him to eat what I want him to if I can give him a little cyproheptadine and he said it was fine. Max just needs 1/8 a 4 mg pill a couple times a week to jump start his appetite.

I live near Westwood in So. Cal. Thanks again for the support.

Elise
 
Hi Elise and welcome to the board! :YMHUG: I'm down in Orange County.

For pancreatitis issues, have a read-through of this Pancreatitis Primer to see if there are some tips and tricks in there that might be of help.

As for home-testing, I would strongly recommend for you to reconsider since it's the best way to see immediately how Max is doing on the current dose and whether he's going too high or too low. Plus, it saves a ton of money in expensive vet visits for all the curves and to help prevent hypos and DKAs that occur more frequently when you're not home-testing.

I know what you mean about fearing that Max won't let you test him. I went through the same thing with Michelangelo. He was a little feral kitten rescue with a feral personality to match and then was diagnosed at only 6 months old. I was terrified that home-testing him would turn him even more feral, but it turned out to be a lot more of a non-event than anything else. Once I got over my initial fears and lack of skill and he got over his stubbornness, it became routine and now he'll willingly go to his test spot for a test if he feels like I haven't tested him in a while. :lol: I wrote up this Ear Testing Psychology document for help on creating a conducive environment for ear-testing even some of the most difficult cats.

tiffmaxee said:
My vet reduced his night lantus to 1/2 a unit and kept the morning at l unit.
Click to expand...
No, this will not work. Lantus is a depot insulin and the same dose needs to be giving twice a day in order for it to work properly. If you need to lower the dose, you lower it across both morning and night. In this case, that would be 0.75u both AM and PM.
 
Be very careful - even on 1/2 unit he can have a hypo if he is going into remission due to the food change. Read up on hypo symptoms and get your hypo kit ready.

Wendy
 
I see you are saying he needs the same dose morning and night so what do I do when my vet has directed me to give Max l unit in the morning and 1/2 at night?
 
Don't follow that advice. Give him 1/2 unit morning and night.

Have you read the information on the Lantus forum about dosing protocol?

viewtopic.php?f=9&t=1581

There is A LOT of information in that link, the gist is that you need to be consistent with the dosing, otherwise you will have a cat that's BG's are all over the place and will never get it under control.

And this can be dangerous for the cat, especially when not testing cause you just don't know exactly what effect the different doses will have.
 
We started with 1 unit morning and night. My vet said to give l unit in the morning and 1/2 at night. Why would I give 1/2 each time? I would think the earlier suggestion of .75 each time would make more sense but need to talk to my vet and will leave a message for tomorrow morning. I need to figure out how to understand his thinking. He only had 5 syringes with .5 markings. I don't know where to get them with .25. I HATE this !! I've adjusted dosing for things like epogen but that didn't have such a huge chance of error like this. I can't even give .75 with the syringes I have.
 
You can go with either .5u or .75u. I suggested .75u because we usually decrease/increase in .25u increments. He might need even more of a decrease so .5u could work and it'd be easier to load the syringe instead of having to eyeball it. If it doesn't work, we should see fairly quickly and you can bump him up to .75u.
 
Your vet is probably more familiar with PZI/ProZinc, which you can dose on a sliding scale and with disparate doses. With Lantus, due to the depot I linked above, you don't want to do that as it works best with consistency and you get much more even numbers.
 
fwiw, if you'd like i can put out a few messages to see if anyone is able to come help you with testing. if you want. i'm out in riverside county myself and work in orange county but there's a few others up closer to you. just let me know. :-)
 
Re: Lantus dosing

How do you measure just .5 or .75 of a unit? When I try to do this some of the time and get too much I try to squirt add the excess onto a towel and end of with nothing no matter I softly I try to push the plunger. Then I waste a syringe and start all over.

Elise
 
I've found it's helpful to practice measuring small doses with coloured water (to save wasting insulin). And you can also leave coloured water - measured to the amount you want - in a syringe to use as a comparison when filling subsequent insulin syringes. :smile:

And rather than pushing the plunger directly down to squeeze out excess, are you able to sort of gently screw/turn the plunger down (if that makes sense...?) I find that gives me a lot more control when measuring small doses.

Eliz
 
sending you hugs, elise. it sounds like you're doing your best to help Max and it's all pretty difficult. we all get it. this is a hard disease to manage in cats. they have a faster metabolism and are more difficult than both dogs and people to get regulated. but they have one huge advantage - cats can have their pancreas heal and become diet-controlled and go off of insulin. that's the point of the tight regulation - holding their blood sugar down (in a "tight" range) allows their pancreas to heal.

but people here will help you learn what you need to know. promise. there's a ton of experience here with people who do feline diabetes 24/7 and who know all there is to know about treating diabetic cats.

i completely agree with the same dose am and pm. lantus is a great insulin for cats - kudos to your vet for starting him on it. Lantus forms a precipitate in the body after it's injected and then slow releases over about the next 12ish hours. steady dosing is really important for it to do its best. in a well-regulated cat, the blood sugar will almost flatten out, ie, not wearing off and going high at shot time or too low in the mid-cycle. that makes the cat feel so much better.

i suspect all/most of us had the same reaction that you are having - i don't want to hometest and my cat won't tolerate it. i just want to encourage you to have an open mind about it. cats get used to it amazingly quickly if you give them a treat with each test. within a couple of weeks most have accepted it. it's not hard at all once you've got the hang of it - i realized once when i was talking on the phone while testing punkin that i had, yes, mastered it! :lol: for the first couple of weeks i had to pull him out by his arms from under the sofa (hoping i didn't dislocate anything!) and wrap him in a beach towel burrito to manage him. but he gave up and i got the hang of it and all was well. everyone gets to that point - it's just like any new thing you learn, you have to be kind to yourself while learning it.

the reason we encourage it so much (and totally not meaning to beat you up, just to educate you) is that it is the only way to know a cat is safe. there simply isn't any other way that's as accurate as testing the blood - that's why people do it for themselves. the other methods, which are great if you can't get to the point of hometesting, test the glucose hours later. by the time the sugar is in the urine it's hours after it was in the blood stream.

anyway, we all have a bag of tricks that work to test cats and have taught many people how to hometest successfully. once you've got it, it's easy, less-expensive than the vet doing it, quick and no stress!

Just let us know how we can help you. no one will criticize you for your choices, we just want to encourage and teach you what you need to know to help out your little guy.
 
Thanks everyone. The ideas on how to measure the small dose are great. Turning instead of pushing really helped ! I go back to the vet tomorrow and will post again after.
 
I got back from my vet appointment a little while ago. Max's BG was 182 and getting insulin 6 1/2 hours. We are keeping the insulin the same and I go back to recheck on Friday.I am attempting to give .75 of a unit each time but it still is hard for me to measure precisely. I asked if it was okay to give him a little baby food squash in his food and/or Miralax and he said to just give the Miralax. He sounded like he wanted to throw up a hairball and the squash has helped in the past. I was asking about it for the hard stool. Now we seem to have a new wrinkle. I gave him one of his hairball treats.
 
182 isn't bad at all at the vets. On a vet pet meter 80-160 is normal so this is just slightly higher than that.. If I were you I would drop him to 0.5 to be on the safe side - and it will be easier to measure too.

Many people here use pumpkin for cats (canned pure organic unsweetened - not the pie filling) to help with stool issues.

For hairballs I use a small dab of vaseline on the paw to lick off - many of these treats are high carb or have sugar in them which doesn't work for diabetes.

Wendy
 
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