Lantus Insulin/ Need help regulating /choosing correct dosage for a cat who just started insulin

[Anastasia]

https://docs.google.com/spreadsheets/d/173mOpK9dfKUzZRSBqYMQF6ZXE7wlcB5_RKwgBnQ1XDM/pubhtml

Hello. Need help and advice on Insulin dosage and regulation protocol. Daisy the cat just started Lantus (Glargine) on Thursday June 1. She is fed wet food only Fancy Feast Classic in last 2 months. Kidneys are enlarge, possible underline kidney deases, cat is young 3-5 years old. BG levels 320-500 (based on human meter). Keytones at 5 trace. Insulin started at 2 units/twice per day for 3 days - dose increased to 3 units/twice per day. Any thoughts? Suggestions?

Spread sheet via link to take a look at

 

[BJM]

We have 2 methods for using Lantus here:
Tight Regulation
Start Low, Go Slow
Please read over each to see what is involved and what might fit best for you and your kitty. Both include guidance on dose adjustment based on home blood glucose testing.
One common element is that we do increases in small amounts after keeping it consistent for a minimum of 2 full days (for cats with high nadirs who need rapid adjustments).

 

[tiffmaxee]

Hi and welcome too the best place you never want to be. Have you read about the two protocols, TR and SLGS. which you choose will help guide you. It looks like you are able to test a lot and enough aren't feeding dry food, you can do either one.

Daisy is awfully young for kidney disease. Do you have a copy of her labs? What were the creatinine and BUN? Was a urinalysis done and what was the USG?

 

[Anastasia]

We have 2 methods for using Lantus here:
Tight Regulation
Start Low, Go Slow
Please read over each to see what is involved and what might fit best for you and your kitty. Both include guidance on dose adjustment based on home blood glucose testing.
One common element is that we do increases in small amounts after keeping it consistent for a minimum of 2 full days (for cats with high nadirs who need rapid adjustments).

THANK YOU
Daisy was put by veterinarian on 2 units for 3 days, veterinarian advised to increase to 3 units so she has been on 3 units in last two days. I do not see any difference in BG numbers though, but maybe not enough days yet

 

[tiffmaxee]

We increase by .25 because it's easy to miss the right dose. Too much insulin can act the same as too little with high numbers.

 

[Anastasia]

Hi and welcome too the best place you never want to be. Have you read about the two protocols, TR and SLGS. which you choose will help guide you. It looks like you are able to test a lot and enough aren't feeding dry food, you can do either one.

Daisy is awfully young for kidney disease. Do you have a copy of her labs? What were the creatinine and BUN? Was a urinalysis done and what was the USG?

 

[tiffmaxee]

Her kidney values do not show kidney disease. Was a urinalysis done? Were the labs done fasted? The creatine is good and so is the SDMA so I'm not sure why kidney disease is suspected. I don't know why the phosphorus is so high though. Is there any chance of an infection? That is why I asked about a urinalysis.

 

[Bobbie And Bubba]

Hey there ! So glad you found us. Her BG's according to the SS from 6/1 would not warrant her to be increased yet and not by 1 unit. As Elsie said in post # 5 we don't increase the insulin in 1 unit measurement but rather .25 unit so you do not miss the correct dose and as Elise said, too high of a dose can look not enough. Would you like the people here to help you with dosing. (sadly the forum understands Feline Diabetes more than vet do ) Just keep asking questions and when you have a dosing question, tag the post with a question mark and the peeps here will gladly assist.

 

[Anastasia]

Her kidney values do not show kidney disease. Was a urinalysis done? Were the labs done fasted? The creatine is good and so is the SDMA so I'm not sure why kidney disease is suspected. I don't know why the phosphorus is so high though. Is there any chance of an infection? That is why I asked about a urinalysis.

the urine culture was done showing NO infection. Her kidneys were very enlarge on scans; vet said its either tubular kidney desease or diabetes. Yes she was fasted prior to labs.

Last urinalysys

 

[Marje and Gracie]

Her labs do not show kidney disease, I agree with Elise. Often an early indicator is the Urine specific gravity on the urinalysis is low but she is still concentrating her urine just fine and her kidney values are all good. Phosphorus can be increased if you feed her really high P foods or bone broth.

There are some diseases, like polycystic kidney disease, where the kidneys might be enlarged but still function properly for a time but if she had PKD, they should have been able to see the cysts in the kidneys.

If you decide to follow the TR protocol which was linked, instead of decreasing her dose, if she were mine, I would raise the dose to 3.25u. Even though you shot just 2u tonight, I think it is fine to increase tomorrow morning. You are testing enough.

If you wish to do SLGS, you'll continue to hold the dose for 7 days and then do a curve.

Although your vet took the dose up way too fast and likely started at too high of a dose, I don't see a place where she might be coming down. I would continue to get nighttime tests, though, as cats tend to go lower at night.

 

[Anastasia]

Her labs do not show kidney disease, I agree with Elise. Often an early indicator is the Urine specific gravity on the urinalysis is low but she is still concentrating her urine just fine and her kidney values are all good. Phosphorus can be increased if you feed her really high P foods or bone broth.

There are some diseases, like polycystic kidney disease, where the kidneys might be enlarged but still function properly for a time but if she had PKD, they should have been able to see the cysts in the kidneys.

I feed her Fancy Feast Classic wet in last month but prior its was 9 lives wet (i only had cat for 2 months after rescuing her). So is she diabetic?

 

[Marje and Gracie]

She's definitely diabetic. Please see my post above as I added some comments after I posted.

 

[Anastasia]

Her labs do not show kidney disease, I agree with Elise. Often an early indicator is the Urine specific gravity on the urinalysis is low but she is still concentrating her urine just fine and her kidney values are all good. Phosphorus can be increased if you feed her really high P foods or bone broth.

There are some diseases, like polycystic kidney disease, where the kidneys might be enlarged but still function properly for a time but if she had PKD, they should have been able to see the cysts in the kidneys.

If you decide to follow the TR protocol which was linked, instead of decreasing her dose, If she were mine, I would raise the dose to 3.25u. Even though you shot just 2u tonight, I think it is fine to increase tomorrow morning. You are testing enough.

If you wish to do SLGS, you'll continue to hold the dose for 7 days and then do a curve.

Although your vet took the dose up way too fast and likely started at too high of a dose, I don't see a place where she might be coming down. I would continue to get nighttime tests, though, as cats tend to go lower at night.

do you mean increase dose to 3.25 units (three and a quarter unit?)
Daisy was on 2 units for 3 days increased to 3 units 2 days ago - no change in BG levels. I decrease back to 2 units tonight. Not sure fits good? I think SLGS is good protocol however she was started on 2 units right away

 

[Jill & Alex (GA)]

If you decide to follow the TR protocol which was linked, instead of decreasing her dose, If she were mine, I would raise the dose to 3.25u. Even though you shot just 2u tonight, I think it is fine to increase tomorrow morning. You are testing enough.

Although your vet took the dose up way too fast and likely started at too high of a dose, I don't see a place where she might be coming down. I would continue to get nighttime tests, though, as cats tend to go lower at night.

I agree with Marje.

Yes, your vet took the dose up too quickly. However, you can see it not only took 5 cycles at 3u bid to stop her from throwing ketones, but 3u bid got rid of the 400 - 500s and held her rather flat after 5 consecutive cycles. You might want to read this. It will explain the cumulative effect of Lantus:

LANTUS & LEVEMIR - WHAT IS THE INSULIN DEPOT?

As Marje suggested, if Daisy were mine, I would increase the dose to 3.25u in the morning (no matter what protocol you decide to follow), test often, make sure she gets enough to eat even if it means assist feeding, and I'd mix as much water as she'll tolerate in her food. The extra water will help flush ketones from her system. You want to prevent ketones from developing.

The basic recipe for developing DKA = an insufficient supply of insulin + inappetance + infection OR other systemic stresses.

More reading material:
Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters

Has her UTI been treated and resolved?

 

[Marje and Gracie]

Yes, 3.25u.

The reason I am suggesting you increase her dose is because she is high and flat and has had ketones. I am seeing no evidence that she is dropping low. You do not want the ketones to increase or take a chance that she will develop Diabetic ketoacidosis which is caused by the kitty having an infection and not having enough insulin or eating enough food/drinking water.

 

[Anastasia]

UTI was treated with clavamox atibiotic and resolved a month ago. She drink a lot of water, constantly. Pees a lot. Eats a lot - always hungry. She finishes little can in 2 min. I give her 4 cans and 1 piece of frozen raw diet. BUT I think she can eat much more. Should I give her more food? Will her BG rise?
Keynote showed NEGATIVE for the first time on this evening test; will test in the morning and few tines tomorrow to confirm

 

[Jill & Alex (GA)]

UTI was reolved a month ago. She drink a lot of water, constantly. Pees a lot. Eats a lot - always hungry. She finishes little can in 2 min

Happy to hear the UTI is no longer in the picture and her appetite has improved since June 1st.
She drinks and pees a lot and she'll want to eat a lot because her blood sugar is not yet regulated. That'll change with treatment... as her blood sugar numbers come down.

More info on feeding and appetite:
Feed Kitty As Much As They Want?


Edited to add: We suggest adding water to kitty's food because even though kitty might be drinking a lot, they're peeing so much that they could become dehydrated.

 

[Jill & Alex (GA)]

Keynote showed NEGATIVE for the first time on this evening test; will test in the morning and few tines tomorrow to confirm

Just a quick note about testing for ketones...
Using a blood ketone meter will give you current results.
Testing urine for ketones will provide you with a snap shot of what was happening in kitty's body hours ago... some say 4 - 5 hours ago.

 

[Marje and Gracie]

Keynote showed NEGATIVE for the first time on this evening test; will test in the morning and few tines tomorrow to confirm

It's an excellent idea to keep on top of the ketone testing. I just noticed that American Diabetes Wholesale has a free ketone blood meter with purchase of the strips that go with it.