Lantus dosing question

SaraMV

SaraMV

Active Member
I apologize in advance if this is the wrong forum to post this, and I can move it if so. Taz was diagnosed on Sunday, and has been at the Emergency vet's with Pancreatitis since Monday. There's a possibility that he'll be coming home tonight.

He was originally prescribed lantus at 1unit. But since he's been at the vet's, they had him on an IV insulin drip until yesterday. They started him on Lantus on Tuesday but his numbers were still high, so from what I understand, he was getting both insulins at the same time until he stabilized in numbers. Yesterday his BG dropped down to 86, so the IV insulin was stopped. They currently have him on 3 units of lantus twice a day, and I believe the vet said he's been in the 300-400 range today. They still have a reading to do at 4 and then 7, to see how his numbers are before we pick him up.

He is being fed at 10 (morning and night) at the vet's, but I need to move his feedings to 7:30. He has been fed 3 times daily for years, so I'm still deciding if 2 or 3 feedings will be best for him/us. If they gave him insulin at 10 this morning, he'll be due for another shot at 10 tonight. How do I change his feeding time and shot schedule? I work and am not home for a 10am schedule. Do I skip a dose of insulin to get him to the right feeding time?
 
Most of us feed small meals more often. My boy had chronic pancreatitis and my vet said to always feed several small meals a day. That was done for a few years before he became diabetic. Feeding more often seems to keep them more steady as far as diabetes goes as well. That is a huge increase in Lantus. Do you have your AT and plenty of test strips? We need you to start a spreadsheet as we are very data oriented here. We use to dosing methods and you can read about them if you look at the methods sticky at the top of his forum. You will find that Lantus is dosed upon how low it takes your cat and not on the tests before shots.

We have a pancreatitis handbook that I strongly suggest that you read the basics there. Make sure Taz comes home with Cerenia or ondansetron for nausea and pain medication. It will be best if you can be home two hours after you shoot but at least an hour as Lantus starts to onset, work, usually around two hours after injection.

https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/
 
Thank you. My monitor and test strips will arrive tomorrow. We are quite busy in the early evenings as we have horses and that's when my husband and I are both off from work, and I leave for work at 8:30 in the morning, so I can't think of any way for us to do his feeding and insulin earlier or later than 7:30. I really wish I was a stay at home "mom" where i could feed breakfast later, but unfortunately that isn't the case.

I was reading about the spreadsheet, but I don't have access to a computer or laptop. Is there a way to create one using my Samsung phone? I'm not very tech savvy. :(
 
Do you have a google account? It is all you need to set up your spreadsheet. @Bandit's Mom can help you with that. She is in India but will be online tonight. You might want to invest in an auto feeder that you can set to go off while you are at work several times a day. It helps when you are sleeping too. Food just needs to be picked up two hours before feeding. What country

Are you feeding wet or dry food or a combo? We suggest all wet low carbs but if feeding dry you can follow our SLGS method. Are the in the US or another country? It is helpful to know what tie zone.
 
When you pick up your boy, get as much of the blood sugar test data as you can that they've done, and the times. Also what times they've been doing the shots. It's easy to change the food times, not as easy to change to shot times. We typically change shot times 1/2 hour once per day, or 15 minutes per cycle (shot). Unless they are really high.

Did the vet mention anything about ketones? That'll make a difference in whether or not you skip.
 
I'm in California. :) Taz has been on a wet food diet (friskies pate) for years, with just an occasional handful of dry food with his lunch. He's only fed 3 times a day due to weight issues in the past.
 
Wendy&Neko said:
We typically change shot times 1/2 hour once per day, or 15 minutes per cycle (shot). Unless they are really high.

Did the vet mention anything about ketones? That'll make a difference in whether or not you skip.
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What does it mean to change shot times half hour once per day?

I know he had ketones but the vet didn't seem worried about them. I'll post his lab results from last Sunday. They're the only ones I have so far.
 
Ketones are in the urinalysis, not blood work. You might want to stock up on some Ketostix which are dipstick for testing for urinary ketones. Low levels of ketones are OK, but should be monitored as they can change quickly. High levels, along with inflammation (eg. pancreatitis), not enough insulin, and not enough food can lead to DKA which is very expensive to treat. For some reasons we see a number of vets who don't worry about ketones.

By moving shot times, I mean changing the times. So if they gave it at 10:00 this morning, you could do it at 9:30 tonight. Then tomorrow either 9:00 for shot times, or 9:15 in the AM and 9:00 in the PM. Normally Lantus does best if given 12 hours apart, with a little bit of wiggle room.
 
Wendy&Neko said:
Ketones are in the urinalysis, not blood work.
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His number was a 1 for ketones. Can you test for ketones using dipsticks with clumping litter?

If he was given a shot of insulin at 10 this morning, would you skip tonight's dose and start him at 7:30 tomorrow morning? I think I have to either skip tonight's or tomorrow morning's dose because I won't be here after 8:30 in the morning. I'd take the day off from work but I've already missed two days this week and I can't afford to get into trouble. I am so unbelievably stressed right now.
 
Wendy&Neko said:
Are you reading to try blood glucose testing at home now? A cat with high ketones shouldn't have a shot missed.

It is stressful to start, and with a learning curve. We'll try to help you. :bighug:
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Thank you for those links. I am reading all of the articles that people are sharing with me. We're getting ready to leave to go get him. I don't have my glucose meter yet (it comes tomorrow), so I can't start testing until it gets here.

My biggest worry is that they have been playing with his units for the past couple of days. The vet told me two days ago that an hour after he ate, his numbers hadn't gone down after insulin, so she gave him another unit, and then another one after that. So she expected something big to happen immediately, and when it didn't, she increased his Lantus two more times within 2 hours. They had said they were taking him off of the IV insulin Tuesday, but today I was told that he was given it again yesterday with the Lantus to stabilize his numbers. I am confused beyond belief because every time we're told something, it changes. I just want my baby to be better from the pancreatitis so that he can come home and we can figure the insulin out with our normal vet.
 
Lantus doesn’t usually kick in until about two hours after injecting. At +1 there is usually a food spike. I’m concerned that the vet doesn’t understand how lantus works. It reaches its peak, called the nadir, often mid cycle. Lantus dosing is based upon how low it takes your cat.

Perhaps it’s the other insulin which is fast acting that she keeps dosing. I suggest when you pick Taz up you ask for copies of his chart and all labs. Then we can help you sort it all out.

I’m in California as well.

Most here use human meters instead of the pet meters because test strips are so much cheaper and our methods were designed before pet meters existed. There are plenty that do use the AT though.
 
tiffmaxee said:
Lantus doesn’t usually kick in until about two hours after injecting. At +1 there is usually a food spike. I’m concerned that the vet doesn’t understand how lantus works. It reaches its peak, called the nadir, often mid cycle. Lantus dosing is based upon how low it takes your cat.

Perhaps it’s the other insulin which is fast acting that she keeps dosing. I suggest when you pick Taz up you ask for copies of his chart and all labs. Then we can help you sort it all out.

I’m in California as well.

Most here use human meters instead of the pet meters because test strips are so much cheaper and our methods were designed before pet meters existed. There are plenty that do use the AT though.
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I can not express how much I appreciate the help you guys are giving. I've cried numerous times over the last 4 days. I know once I start understanding how it works, it will become like second nature, but it's so overwhelming right now.

I'd like to discuss 2 meals vs numerous little ones with my vet tomorrow. I read an article today that for people, 2 meals is proven to be better, but I'm not sure that cats have the same needs or reactions as we do though.

Do you think I'll hurt him by skipping his dose tonight?
 
Diabetic people eat multiple small meals. It's much easier on a fragile pancreas. Cats in the wild eat multiple smaller meals too.

If you can't test tonight with no meter, I'd ask them to test before he leaves the vet. If you can't test, I wouldn't give him 3 units tonight either.
 
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4 or 5 doses of Lantus in a single day, on top of the shirt acting?? Good grief.

Please make sure you know what doses they gave when, of both insulin.

I'm actually a little concerned about hypoglycemia - is there any chance you can stop tonight for a hypo kit? Others gave links. Even if you don't give insulin tonight (I can't recommend either way, Elise or Wendy will guide you), there is still the depot to contend with
 
SaraMV said:
What is the depot?
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Death by links!
https://www.felinediabetes.com/FDMB/threads/what-is-the-insulin-depot.150/

In summary - whenever you give a shot of Lantus (or a few other depot insulins), some of it gets stored in the tissues and not used right away. It is slowly released over time, which helps Lantus give relatively flat BG curves. There is no way to know how much insulin is sitting in reserves so to speak. But obviously the more insulin you give (higher doses, or frequently like the vet did today), more is sitting there. If it is too much, as it gets released it can drop BG dangerously low.
 
FrostD said:
Death by links!
https://www.felinediabetes.com/FDMB/threads/what-is-the-insulin-depot.150/

In summary - whenever you give a shot of Lantus (or a few other depot insulins), some of it gets stored in the tissues and not used right away. It is slowly released over time, which helps Lantus give relatively flat BG curves. There is no way to know how much insulin is sitting in reserves so to speak. But obviously the more insulin you give (higher doses, or frequently like the vet did today), more is sitting there. If it is too much, as it gets released it can drop BG dangerously low.
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:(
 
Oops, fixed that. I'd suggest getting more data before deciding on a dose. I would not give 3 units tonight if you cannot test.
 
SaraMV said:
I was reading about the spreadsheet, but I don't have access to a computer or laptop. Is there a way to create one using my Samsung phone? I'm not very tech savvy. :(
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Hello and welcome to FDMB! :-)
I can set up your spreadsheet and you can use your smartphone to input test data into it. Will send you a PM with the details I need. Look for it in the Inbox at the top right corner of this page.
 
We just picked Taz up and are on our way home. It's a 90 minute drive for us. He acts tired and is resting in his carrier. I can only imagine how stressful the last four days have been for him. I think I'm going to miss work tomorrow, so that I can monitor him through the night. I'm a helicopter parent when I know the fur kids don't feel well, so I have to remind myself to not bug him too much. He's due for more insulin at 10pm, but I can't tell if he's not feeling well or if he's just resting. I'm terrified the pancreatitis is going to flare back up.

I'm pretty upset with the ER vet's office right now. I asked about sub fluids but the vet said he's well hydrated and giving liquids like that would stress him out more than he already is. I had to badger 3 different employees to get a printout of his records. They kept trying to email it to me. They also didn't give us the discharge records, so I had to go back and request them. I know they gave us cerenia and an antibiotic, but I'm not sure what the third medication is (maybe pain?). It's currently in the front seat (I'm in back with Taz). When they handed me his records, they said they also emailed them to me. I went to the email and it came through really glitchy, so it's a good thing I waited there and had them print them out for me. To make everything even worse, when we dropped Taz off on Monday, we tried to give them his insulin. They told us to take it home. On Tuesday when I talked to them and they said they were going to start him on Lantus, I asked if I should bring his bottle down to them (90 miles away). The lady said it would probably be only about $100 worth. So I didn't. We just got the bill and for the 9 units that they gave him, they charged us $460. I already spent $300 on the bottle I was going to leave there for him on Monday. :banghead:

So $5500 later, I pray that he's on his way to recovery, and that we can avoid the ER! I'll try to get the records posted tonight or tomorrow. I'm not going to give him insulin tonight.
 
The vet spoke with the internal medicine doctor and they said that the best time to take a reading at home is 10-15 minutes after they eat, and that this number should be the one to determine if you give a full dose of insulin, half it, or don't give it. They said that if this number is under 200, not to give insulin. Thoughts?
 
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Wow! What a nightmarish experience! And total daylight robbery!

SaraMV said:
The vet spoke with the internal medicine doctor and they said that the best time to take a reading at home is 10-15 minutes after they eat, and that this number should be the one to determine if you give a full dose of insulin, half it, or don't give it. They said that if this number is under 200, not to give insulin. Thoughts?
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On the contrary, we ask members not to feed 2 hours before the shot is due so that the preshot test is not influenced by food. You don't want to shoot a number that is high only because of a food spike because when the food wears off the numbers might drop and head much lower when the insulin kicks in.

Fast acting insulins like Vetsulin, Caninsulin etc. require that food to be given about 30 min before insulin but this doesn't apply to depot insulins like Lantus.
 
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The sequence is test, feed, then shoot. Often people shoot the insulin when the cat's head is in the bowl. The whole process takes around 15 minutes. As for the cat's numbers to shoot at, for brand new people we suggest not giving insulin if under 200, unless there are ketones in the picture, in which case you shouldn't skip. Once you are more comfy testing, we lower that 200 number. On this forum, we tell people that if you see a number below 150, you do not feed, and post here for help. At that point you have a few options that we can walk you through, based on the situation.

I would definitely try to avoid that ER. Charging what they did for the insulin!!:mad:
 
Is the closest ER that far away or was it the only one with space? I see he has possible teeth issues. That could be bringing his numbers up. Once we get him somewhat regulated a dental might be helpful.
 
Wendy&Neko said:
I would definitely try to avoid that ER. Charging what they did for the insulin!!:mad:
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Taz is home but they forgot to include his pain meds in his bag. I am so upset. He wants to eat but has only ate half of a can (over the last hour). Of course I was stupid and I mixed his omeprazole (helps with gastric acid) and his antibiotic (amoxiclav) in the food. His spirits are better today but not pigging out is definately not normal for him. I'm leaving the food down for him to eat at will. They said he ate like a champ for them. Last night it took him about 2 hours to eat a can of friskies pate. I did not give insulin last night because he seemed kind of loopy when we got home. He might have still been slightly sedated, but I didn't want to take any chances. Right now I just gave him half of a unit of insulin. He seems very clingy but like he's being careful when moving or laying down (maybe hurting?). He's peed 3 times (not huge amounts) and he isn't attacking the water bowl but I did catch him drinking some.

I took pictures of his records but they don't make any sense to me. I don't know what else to do to help him feel better. We see his regular vet today at 3:30. I'm ashamed to say that Taz hasn't been to a vet in over 3 years before this. I just never wanted to put him through the stress because our vet is 30 miles away. It's taking me a long time to convert these so I can post them, so this is the first half.























 
What will you be feeding him? Most here feed fancy feast pates, friskiest pate, lower canned low carb food or raw. There’s no magic in expensive veterinary food and the dry is too high in carbs. It looks like they are suggesting 1.0 lantus. Is that correct?

I don’t understand why they didn’t do a blood test for pancreatitis. They say he didn’t seem to be in pain but that’s well hidden by cats.

Omeprazole is bitter. He’s not going to eat with the meds in his food and could develop food aversions. Do you order from Amazon? I would get empty gel capsules size 3 or 4 only and put the meds in one and pill him that way so he doesn’t taste the medications.

How is his weight? Ideal, too skinny, or too fat?

It sounds like you live in a rural area. Is that correct?
 
tiffmaxee said:
What will you be feeding him? Most here feed fancy feast pates, friskiest pate, lower canned low carb food or raw. There’s no magic in expensive veterinary food and the dry is too high in carbs. It looks like they are suggesting 1.0 lantus. Is that correct?

I don’t understand why they didn’t do a blood test for pancreatitis. They say he didn’t seem to be in pain but that’s well hidden by cats.

Omeprazole is bitter. He’s not going to eat with the meds in his food and could develop food aversions. Do you order from Amazon? I would get empty gel capsules size 3 or 4 only and put the meds in one and pill him that way so he doesn’t taste the medications.

How is his weight? Ideal, too skinny, or too fat?

It sounds like you live in a rural area. Is that correct?
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Originally they wanted us to give him 1 unit but when he was released last night, they told us 2.5. I'm not comfortable with that number though, unless we know he needs it.

I'm going to try to continue his friskies pate but I'm scared he's associating it with not feeling good. I just offered him some friskies chunks in gravy and he was more willing to eat some of that, which I know is worse for him but for now I just want him to eat.

I'll certainly see what I can do about getting the pill into him. I'm so upset that they didn't give me pain medication for him. I'd say he's a chucky boy. He used to weigh about 20 pounds but over the years I've cut his food down and I think they weighed him in at 14 pounds. He hasn't lost much weight yet, so I'm praying we can get him on the right track and feeling better before he does.
 
Ok. When Bhooma gets back she can help with the spreadsheet since it's a little complicated with how they did things. I think I would just call AMPS/PMPS what you want your shot time to be, and then fill in from there. So if you want shot time to be 7a/7p, and they gave 1U at 10a, 2.5U at 2p, then 3U at 9p (I'm not saying these are the times, I'm on my phone and hard to sort through the images, just an example) - in the +3 column you would put 1U, in the +7 column 2.5U, and in the PM +2 you'd put 3U. And then fill in any readings as well. Bhooma may have other ideas, that's just what makes the most sense to me right now. But it actually doesn't look like they noted times...ah well. Do the best you can.

I also see they added IV dextrose at a BG of 162...unreal. If it were me I'd be throwing one heck of a fit, refusing to pay that full bill
 
tiffmaxee said:
Is the closest ER that far away or was it the only one with space? I see he has possible teeth issues. That could be bringing his numbers up. Once we get him somewhat regulated a dental might be helpful.
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We have one closer but they are only open when other vets are closed. So we would need to pick him up before other vets open and pray one would see him. The one he went to is 24 hours.

He eats funny, like kinda turns his head to the side sometimes. We think it might be sensitivity, but the 24 hour vet didn't have the right machine to do dental exams. She said he has gingivitis but at his age, it's normal. She said xrays would need to be done to know if there's anything deeper.
 
SaraMV said:
Originally they wanted us to give him 1 unit but when he was released last night, they told us 2.5. I'm not comfortable with that number though, unless we know he needs it.

I'm going to try to continue his friskies pate but I'm scared he's associating it with not feeling good. I just offered him some friskies chunks in gravy and he was more willing to eat some of that, which I know is worse for him but for now I just want him to eat.

I'll certainly see what I can do about getting the pill into him. I'm so upset that they didn't give me pain medication for him. I'd say he's a chucky boy. He used to weigh about 20 pounds but over the years I've cut his food down and I think they weighed him in at 14 pounds. He hasn't lost much weight yet, so I'm praying we can get him on the right track and feeling better before he does.
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With pancreatitis yes prioritize eating over carb count. I just straight pill my cat - stick it in the back of his mouth then syringe some water to chase it. If he's being particularly difficult I crush them all up, mix with the Gerber food I mentioned, and syringe just enough of that to get it in him. He associates the Gerber with feeling ill, but at least not his normal food.

Once you get your meter we'll have a very quick idea of where he's at, I wouldn't give 2.5U either
 
So you did not get the gabapentin that you paid for? They need to get that to you or credit you and send an RX to your local vet.
 
tiffmaxee said:
So you did not get the gabapentin that you paid for? They need to get that to you or credit you and send an RX to your local vet.
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I made them credit it back ($78). They're 90 miles away, but asked if I wanted to come back to get them. :o
 
FrostD said:
With pancreatitis yes prioritize eating over carb count.
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That's what I thought. I'll offer him food all day long, in order to help him feel better. We wouldn't even know about the diabetes if he wasn't acting off from the pancreatitis, and he would have went longer without insulin. So right now that isn't my priority. I want him to survive the pancreatitis, so that we can work on his glucose without pain/stress being a factor on his numbers.
 
One thought is if he truly is diabetic to begin with. My cat is in remission, but when he was sick not too long ago his BG shot up to 300/400, then came right back down once he was better.

When was the last time he had labs at regular vet?
 
SaraMV said:
I will discuss this with my vet. Thankful for mentioning it.
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It's not that specifically, it's that combined with everything else. 162 is perfectly fine BG, I have no idea why they would add IV dextrose. It just shows incompetence/lack of awareness.

Here's the AAHA Feline Diabetes Management Guidelines . Explicitly states Lantus is q12h it is not a short acting insulin and should not be used as such. So at minimum I'd be requesting money back for that somehow some way. They made mistakes on dosing, and then had to correct with IV, so I'd be bothering them about that too. If they're difficult I'd also be leveraging a complaint to the CA veterinary medical board

I'm not normally a complainer. I've had my share of bad vets, bad ER vets with questionable practices and price gouging, and just gone home without another word. But in my opinion what they are doing is dangerous. I'm actually very mad for you.
 
I was scared to say too much when they had him in their care. And we've used them several times in the past and loved their care. But I wasn't a fan of the female vets we had this time. I'm so stressed out. Right now I just want to concentrate on him, and then I will definately be getting in touch with them about things. He's currently sleeping, which I'm sure he's exhausted. I want him to rest before we load him back up into his carrier. He's going to freak out!

Dextrose is sugar, correct? So they were pumping sugar into him while trying to level out his BG numbers.
 
Is 14 pounds a good weight fur him? I agree you need to prioritize him eating right now. Too rapid weight loss can lead to fatty liver in cats. It sounds like the weight loss was gradual so that’s good. Fatty liver happens much more often in overweight cats.
 
tiffmaxee said:
Is 14 pounds a good weight fur him? I agree you need to prioritize him eating right now. Too rapid weight loss can lead to fatty liver in cats. It sounds like the weight loss was gradual so that’s good. Fatty liver happens much more often in overweight cats.
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Whoops, I'm wrong. He's currently 17.64 pounds according to their scale. I think at his highest he was 22 pounds if I remember correctly. But we started cutting down on his food and he's maintained his weight. He's a big guy, twice the height and length of our girl. She's tiny though, probably only weighs 6 or 7 pounds though.
 
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