Lantus insulin recommendations

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Chrisa Hotchkiss

Chrisa Hotchkiss

Member Since 2023
Hello.

Chrisa & Jackson again. Thanks to Chris R., I have finally filled out the spreadsheet and added a link to my signature. Hope the link works. Jackson's numbers are all over the map, which hasn't always been the case. The backstory is that for about 2 weeks (late Feb./early March), the insulin pen cartridge was not lined up, so he was receiving very little if any insulin. I'm embarrassed that it took me so long to figure out what was gong on. All his drinking and peeing should have been a clear message. Anyway, I realigned the pen cartridge and it's working fine now, but we haven't been able to stabilize him since.

I was giving him 2IU twice a day to fairly good effect before the pen cartridge issue. Now I can't get a handle on it. Clearly, I have some learning to do. I think I've been giving him too much insulin, so then he bottoms out and I don't give him any in the morning, but by the evening his numbers are through he roof. He is still drinking a lot and peeing a lot, but not as much as before. We have a consultation with our vet on Monday. His insulin tonight is higher than it's ever been. :( Anyway, sorry for the long post. I need guidance.

Thank you.
 
Hi Chrissy and Jackson.
I can see the SS thank you. Can you move the US SS ocr to the far left please so that is the one that automatically comes up when we click on it please?
Here is you first post https://felinediabetes.com/FDMB/thr...w-blood-glucose-question.275281/#post-3054998
please go back and read this first thread.
In it, it is recommended you buy insulin syringes (details in the last thread) and how to use your pen to draw up the insulin into the syringe.
It was also recommended you reduce the dose to 1.75 units, because the 2 units is too much insulin and dropping the BGs too low.
However until you get the insulin syringes, I would reduce the dose back to 1 unit until can get the syringes.
Jackson’s BG is dropping too low and then he is bouncing up high and that is why you are getting very low numbers and then high numbers. The way to fix that is to follow what we have said above and in the first post.
Explanation on bouncing from the Bssics
  • Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
I would also look at the dosing methods. Because you are feeding dry food, you will need to follow SLGS, start low go slow, dosing method.
Could you put SLGS into the SS and the signature please?
DOSING METHODS
 
Hi Chrisa, did you actually give Jackson 3u tonight?

I believe the recommendation was to reduce to 1.75u (or perhaps 1u until you get proper syringes) twice a day. Lantus dosing is based on how low the BG goes, not on the high numbers.

Lantus is best dosed twice a day at the same amount both times.
 
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Bron and Sheba (GA) said:
Hi Chrissy and Jackson.
I can see the SS thank you. Can you move the US SS ocr to the far left please so that is the one that automatically comes up when we click on it please?
Here is you first post https://felinediabetes.com/FDMB/thr...w-blood-glucose-question.275281/#post-3054998
please go back and read this first thread.
In it, it is recommended you buy insulin syringes (details in the last thread) and how to use your pen to draw up the insulin into the syringe.
It was also recommended you reduce the dose to 1.75 units, because the 2 units is too much insulin and dropping the BGs too low.
However until you get the insulin syringes, I would reduce the dose back to 1 unit until can get the syringes.
Jackson’s BG is dropping too low and then he is bouncing up high and that is why you are getting very low numbers and then high numbers. The way to fix that is to follow what we have said above and in the first post.
Explanation on bouncing from the Bssics
  • Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
I would also look at the dosing methods. Because you are feeding dry food, you will need to follow SLGS, start low go slow, dosing method.
Could you put SLGS into the SS and the signature please?
DOSING METHODS
Click to expand...

Okay, thank you. I went back and reread the first thread. I will talk to my vet tomorrow and get syringes, which she also recommends, so I can get more precise dosing. I am having trouble understanding some of your post because I don't know the abbreviations/acronyms. I don't know what Bssics is, and the numbers in the quote don't make sense to me (Canada). I will look at the US spreadsheet as a reference, which I have moved to the left as you requested. I added SLGS to the spreadsheet as the method. This is a good reminder. I have not been thinking clearly, obviously! Thanks for your help.
 
JL and Chip said:
Hi Chrisa, did you actually give Jackson 3u tonight?

I believe the recommendation was to reduce to 1.75u (or perhaps 1u until you get proper syringes) twice a day. Lantus dosing is based on how low the BG goes, not on the high numbers.

Lantus is best dosed twice a day at the same amount both times.
Click to expand...

Okay, thank you. I should read up on Lantus dosing. I gave him 3IU last night based on what my vet recently recommended (she provided the following range of BG numbers), which is obviously not aligned with what you are saying. (Sigh.)

If BG <13 - no insulin.
If BG 13.1-18.0 - 1 IU insulin
If BG 18.1-22.0 - 2 IU insulin
If BG 22.1 upward 3 IU insulin.

I do understand that vets aren't necessarily experts on diabetes because they can't keep up with the research, as stated in some of the materials here. Now I have to switch my mindset because I have trusted my vet with Jackson's care, and overall, she has been really great and her recommendations have worked well in the past. She does recommend using a syringe instead of the pen. I should be able to make the switch this week. This morning, he bottomed out again, as I expected, so I didn't give him any insulin. We got up at 5:30 because he vomited (just bile, no food). I tested his blood and fed him because he was so low (3.3). I'm not sure what to do next. Normally I test him at 7:00 and give him insulin with his breakfast. I think I'll test him again at 7:00 this morning, but he has already had breakfast.
 
Chrisa Hotchkiss said:
Okay, thank you. I should read up on Lantus dosing. I gave him 3IU last night based on what my vet recently recommended (she provided the following range of BG numbers), which is obviously not aligned with what you are saying. (Sigh.)

If BG <13 - no insulin.
If BG 13.1-18.0 - 1 IU insulin
If BG 18.1-22.0 - 2 IU insulin
If BG 22.1 upward 3 IU insulin.
Click to expand...

Lantus (glargine) works best with a constant dose because glargine (and Levemir) are depot insulin and build up in the system after a few days. If you keep widely change dose like the table shows you will likely never get a good dose. With in-out insulins like Prozinc one can use a sliding scale.
 
Larry and Kitties said:
Lantus (glargine) works best with a constant dose because glargine (and Levemir) are depot insulin and build up in the system after a few days. If you keep widely change dose like the table shows you will likely never get a good dose. With in-out insulins like Prozinc one can use a sliding scale.
Click to expand...

Okay, thank you. I will stop doing that. I'm not sure what to do next, though. I will test him again in a few minutes. Assuming he is still too low for insulin, should I wait until the evening dose and give him 1IU? (I can't do 1.75 yet because we use a pen, and 2 is probably too high.)
 
You can get syringes over the counter in Canada. Give me a minute to switch to the desktop and I'll post a picture of what you should ask for.
 
This one. Not sure packaging is the current one.
They have half unit markings.
Not all pharmacies carry them (or think they don't). Call around. Ask them to look in the back. Tell them the purple and yellow box.
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Just so you have a bit more information regarding what to do when you see a lower than expected pre-shot number, these are some suggestions from the Lantus dosing sticky note:

Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
    • a.) give nothing
    • b.) give a token dose (10-25% of the usual dose)
    • c.) feed as usual, test in a couple of hours, and make a decision based on that value
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
  • In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
  • Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.
Keep in mind these are general guidelines, and they should be personalized to your own cat's response to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then personal experience should be your guide.
 
I hope you can get the syringes today. I know you said you are having trouble with texting from your previous post, but its really important to get a test every morning and at night and then some tests in after each 12 hour cycle to see how the insulin is working and how low she's dropping
 
Ale & Minnie (GA) said:
I see you didn’t give insulin and that’s probably the best call given that low amps. Do you think you can get the syringes today?
Click to expand...
I can't get them until tomorrow. His numbers are rising today, as I expected. It's probably best to give him only 1IU tonight even if his numbers are high. I have to get out of this bouncing cycle. I was wondering if I should give him 1IU earlier than usual today to try to break the cycle, but I know with Lantus it's important to keep the shots consistently at the same time of morning/evening. Maybe this is an exception?
 
Diane Tyler's Mom said:
I hope you can get the syringes today. I know you said you are having trouble with texting from your previous post, but its really important to get a test every morning and at night and then some tests in after each 12 hour cycle to see how the insulin is working and how low she's dropping
Click to expand...
I will be able to get them tomorrow for sure. Morning testing has become easier with the great advice some members have provided. So testing isn't a problem. He is unbelievably cooperative and chill about the whole thing, too. I'm so lucky!
 
Ale & Minnie (GA) said:
I see you didn’t give insulin and that’s probably the best call given that low amps. Do you think you can get the syringes today?
Click to expand...
Hi Ale please see her post #14

@Chrisa Hotchkiss
Hi Chrisa, I think it's best to only give 1 unit tonight , I would not give it to him earlier
let's see what Ale has to say.
Then when you do get the syringes you would post that you have then and see what the members suggest about how many units to give
I see in your previous thread it was recommended to tedu e to 1.75 units.
So when you get the syringes tomorrow I would post and ask
 
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Bouncing is a normal phenomenon. The drop to 59 would have likely triggered a bounce and on top of it, you skipped the shot. A bounce is at least in part a protective mechanism. Your cat's liver and pancreas interpret a low number, a fast drop into lower numbers, etc. as something that's potentially dangerous and respond by releasing a stored form of glucose along with counterregulatory hormones. This causes the numbers to rise. It can take roughly 3 days/6 cycles for a bounce to clear.
 
Diane Tyler's Mom said:
Hi Ale please see her post #14

@Chrisa Hotchkiss
Hi Chrisa, I think it's best to only give 1 unit tonight , I would not give it to him earlier
let's see what Ale has to say.
Then when you do get the syringes you would post that you have then and see what the members suggest about how many units to give
Click to expand...

Absolutely. Thank you. I'm so grateful for the help. Geese, 3 years in and I just now found this site. Phew. Game-changer.
 
Chrisa Hotchkiss said:
Absolutely. Thank you. I'm so grateful for the help. Geese, 3 years in and I just now found this site. Phew. Game-changer.
Click to expand...
I was blind shooting 4-6 units of Novolin & switched to prozinc again blind shooting4-6 units for a year & a half & found this wonderful life changing forum. I truly think my boy would not be here now without there guidance & all of the information to learn & learning by other people's posts & kitties spreadsheets. The FDMB is a great family to have for your sugar baby & you, it truly is :bighug:
 
Diane Tyler's Mom said:
Well at least you found us now :cat:
I would try and get as many tests in tonight if you can :cat:
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I started at 5:30 this morning b/c he woke up vomiting and I figured his BG was low. It was, so I fed him. Now the increments on the spreadsheet don't make sense b/c I wouldn't normally test until 7:00. I tested again at 7:30, then 12:30. I was going to test again right before his shot (7:00 pm), but that's an odd increment that I'm not even sure how to record. Newbie. Do you recommend that I test into the evening, even after his dinner/shot? And would I put that in the right side of the spreadsheet? Newbie here, obviously.
 
Chrisa Hotchkiss said:
I started at 5:30 this morning b/c he woke up vomiting and I figured his BG was low. It was, so I fed him. Now the increments on the spreadsheet don't make sense b/c I wouldn't normally test until 7:00. I tested again at 7:30, then 12:30. I was going to test again right before his shot (7:00 pm), but that's an odd increment that I'm not even sure how to record. Newbie. Do you recommend that I test into the evening, even after his dinner/shot? And would I put that in the right side of the spreadsheet? Newbie here, obviously.
Click to expand...
So your shooting times are 7 AM and 7 PM correct if so you put the night time number in the correct spot
The only time you withhold feeding is 2 hours before you test first thing in the AM and the first test in the PM because you don't want the BG to be food influenced.
We don't use times when talking about tests
If you test 2 hours after giving insulin you would say +2
If it's 3 hours after giving insulin it would be +3
Instead of telling us 7:30 or 12.30 you would use the + and whatever it was.
We are all in different time zones so that's the reason why.
If you can get one more test in tonight before you go to bed that would be great :cat:
 
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