Lantus Insulin

Status
Not open for further replies.
I

Izzy

New Member
I have an 8 year old female just recently diagnosed with diabetes. My vet prescribed Lantus Insulin starting with 3 units every 12 hours. 4 weeks later he increased this to 4 units every 12 hours. I immediately noticed a significant change in her personality. I am curious if anyone else has a cat on Lantus and how he or she is responding. Thanks!
 
We have lots of cats here on Lantus, in fact there is a special section under the ISG (Insulin support groups) that is just for those using Lantus.

However 3u is a huge dose for a newly diagnoised diabetic....What personally changes have you been seeing? Good or Bad?

My own diabetic was on lantus for about 2 weeks before going into remission and off insulin completely with a diet change.

What is your cat eating atm, as diet plays a huge role in managing this disease. Also are you home testing? And if not can we help you to learn? Testing at home is the only real way to know if she is getting enough insulin or too much. Testing at the vet's is practically worthless as all cats are under stress when at the vet's and stress will raise blood sugar numbers dramatically, thhus if the dose is based on the numbers at the vet's, when kitty gets home and relaxes their numbers drop resulting in too high of a dose.

Mel, Maxwell and The Fur Gang
 
Changed her diet immediately to Purina DM right before she went on Lantus. Just changing her food did lower her levels a bit. During the 4 weeks that she was on 3 units I did not notice any change in her extreme consumption of water or urinating. From this I assumed that upon her next Glucose curve that things had not changed much and her insulin would be increased. Her insulin was in fact increased to 4 units every 12 hours after her next testing.

Since her diagnosis, when I am home, I watch her behavior obsessively for any signs I've read about - lethargic, excessive drinking , urination, fruity breath etc. Within a day of her going on 4 units, I noticed a change in her personality/behavior. She has always been and extremely affectionate, clingy, needy cat and sticks to me like glue. If I'm sitting down, she's right there beside me or in my lap, in the bed, same, even sits on the side of my old fashioned bathtub when I'm taking a bath. There was a drastic change here. She did not have much to do with me at all. She did not appear to me to be lethargic. Just really not interested in me. I did not really notice much a change in her drinking and urinating - still a lot of both.

She was in for another Glucose curve this past Friday and has now gone to 5 units every 12 hours. When I took her in on Friday, I also gave my vet a page of typed notes of my observations on her behavior since her last visit. He really liked having these and decided not to bring her in for another curve but to call me in the next 3-4 weeks and talk about her behavior. He did talk about the stress factor on her and how that can raise her levels and over dose her insulin. I have noticed that she is not drinking as much or urinating as much. She seems a little more interested in me but nowhere close to her old self. This breaks my heart - most of us need them more than they need us...

I am not home testing, but have read about it. I'm sure that would give a truer reading. I would love to know more about the home testing.

When diagnosed, my vet mentioned that Izzybelle might be a good candidate for remission, but this does not seem to be the case. I am happy to hear that your cat in doing well. This has been a very stressful and upsetting period. She's my heart and like everyone here, I just want the best for her.

Thanks for the info. Any other advice would be greatly appreciated.

Gretta & Izzy
 
You really do need to hometest. Sounds scary but honestly, you will feel SOO much better. and 5 units is a huge amount without testing.
 
Hi Gretta,

First of all, welcome to the best place you could find to get help for Izzy! Please don't take anything I'm about to write to heart, because it is not your fault. Until you came to this board you trusted your vet, as we wish everyone could do, but I am really worried for Izzy and hope we can correct her treatment.

Quite frankly your vet has done something we see all too often here with the longer acting insulins - beginning the dose far too high. The standard starting dose is only 1U, regardless of the cats weight, although one formula calls for .25U per kilogram of the cat's ideal weight, that does not mean their current weight. From my own experience I disagree with that formula even because every cat is different and the starting dose should simply be no more than 1U for a newly diagnosed diabetic. But even using that formula, unless Izzy's ideal weight is 28 pounds (not ideal for ANY cat), 3U is far too high!

What you are seeing from your cat's behavior indicates she is uncomfortable and that is probably caused by the improper dose. Dosing cats higher and higher until they have a crisis - either ketones or hypo - is very poor management of feline diabetes, unfortunately this seems to have been standard veterinary care for feline diabetes for decades now. Members of this board have been spearheading proper management of feline diabetes for over a decade, especially regarding use of Lantus and Levemir, the 2 long acting insulins which work very very well in cats, if managed properly.

Standard beginning management includes the following:

1. Change to a low carb diet.
2. Low beginning dose of insulin, 1U.
3. Home testing.

Perhaps you can share the following document with your vet to get him or her on board:
http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf The formula for dosage in the document is similar to the one I listed above but says "lean" body weight and defines that as 1U/BID or twice daily. Many vets aren't keen on hearing form their clients, "Well, I read online that I should home test." or "I read online that 3U is too much insulin." The document is the new standard as directed by the American Animal Hospital Association and he should respect those credentials. If not, find a different vet.

We can help you learn how to home-test, everything from what meters to get and techniques to be successful. Here is the main page from the FelineDiabetes.com site on hometesting: http://felinediabetes.com/bg-test.htm

For now, if you decide to switch to low carb food, please please lower the dose of Lantus to 1U only!!

Hope that gets you on the right path, please ask any question that occurs to you! Sorry I got on a my soapbox a bit, it's very difficult to see inappropriate treatment given time and again when the resources are available to vets on how to best use Lantus.
 
Hi Vicky,

Gandalf is quite a handsome fellow. My Izzy is a pretty grey girl! She weighs 14 pounds by the way.

She is on the dry Purina DM which actually lowered her levels just prior to her going on Lantus. I have been reading that she might need to go on wet food, so I picked up a couple of cans of the DM wet last week but have not given her any yet. She's never actually eaten wet food. Any advice here?

You are right, I trust my vet and would think that he would know what to do here. He's also on the young side so I thought he would be up on all the latest and greatest treatments. maybe not.

Can you tell me what type of home tester you use? I'll read up in the meantime. I actually looked at some of the information about home testing when she was diagnosed.

I appreciate any and all feedback and you can get on your soapbox any day as far as I'm concerned. I am terribly worried about my girl and want her back to feeling like herself again.

Many thanks,
Gretta & Izzy
 
Izzy said:
She is on the dry Purina DM which actually lowered her levels just prior to her going on Lantus. I have been reading that she might need to go on wet food, so I picked up a couple of cans of the DM wet last week but have not given her any yet. She's never actually eaten wet food. Any advice here?
Click to expand...

Dry Purina DM is still too high in carbs for a diabetic cat. The canned Purina DM is ok to feed, but many cats will get sick of it quickly because of the high liver content. But you don't have to feed a prescription food. You just need a canned diet under 10% carbs (although below 7% is ideal, because many cats are carb sensitive). When Bandit was diagnosed, I switched him to the low carb flavors of Fancy Feast: http://felinediabetes.com/glutenfree.htm. Many people here also feed low carb varieties of Wellness, EVO, Friskies, and Merricks. Take a look at the cat food nutrition chart, and pick something below 7-10%: http://felinediabetes.com/diabetic-cat-diets.htm

As for switching, you're going to want to do it gradually, over the course of a week. Just start mixing 75% dry/25% canned for two days, then 50%dry/50% canned for 2 days, and 75% canned/25% dry for the last three. However, and this is very important, do not switch to a wet diet until you start home testing. Switching to a wet diet can cause your cat's blood sugar to drop by 100-200 points, and with the high dose of insulin she's on she's likely to have a hypoglycemic incident.

If your cat doesn't want to eat the canned food (and I would recommend trying a few different kinds of canned because it's possible she'll turn her nose up at the DM), then there are tricks for transitioning a stubborn cat to a wet diet: http://catinfo.org/#Transitioning_Dry_Food_Addicts_to_Canned_Food_

Izzy said:
Can you tell me what type of home tester you use? I'll read up in the meantime. I actually looked at some of the information about home testing when she was diagnosed.
Click to expand...

You can use any home glucose meter that takes a small sample of blood (less than .6ul) to test. Many people here have the Relion micro from Walmart, because it and the test strips are inexpensive in the store. I use the Aviva Accu Chek, but strips are expensive in the store so I buy them online.

You just need to pick up the meter, test strips, and lancets, and low carb treats:http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=9172. Pick up a bigger gauge box of lancets (26-28g) since it's hard to use the small ones (29-33g) when you are first starting out.
 
Gretta,
From what we've heard many vets receive minimal training/instruction in feline diabetes care, even recently. The thing is that they must learn about so many diseases and ailments for different species, not even just cats and dogs! Think of your local vet as a general practitioner type of doctor. If you have a specific ailment or disease, you may need more precise help than your GP type vet can provide. That's where we come in! Although most of us are not licensed in veterinary medicine, we understand feline diabetes from practical experience. Especially being young, that is something your vet may not have.

It sounds like you love Izzy very much. Gandalf says thank you for the kind comment!

One thing I forgot to mention about was how to test for ketones. Since Izzy's diabetes is not under control it is better to test the urine for ketones than wait till you might smell an acetone breath from her - at that point it could already be very serious. You can get ketone test strips from a pharmacy - ask for just ketone strips, since you'll be getting a meter to test her blood glucose, you don't need the kind of urine strips which test for both ketones and glucose in urine.

There are several ways to catch urine. If you can spot them in the box, take a large spoon and hold it underneath them or if that's too scary for them, try just using the urine strip itself! You can also empty the pan of litter as they will usually go in it without the litter. You can also cover the litter with plastic wrap so that the urine pools on it instead of being absorbed by the litter. That way you don't have to stalk them to see when they go! You need very little pee to get a test on a strip.

I know it's lots to do at once, but Izzy will be grateful!
 
Vicky and Julia. Thanks so much for your input. This is all quite overwhelming and a lot of information to absorb at the moment. I expect things will settle down once I get her regulated.

Julia, I gave her some of the DM canned food last night and she really seemed to like it. Thanks for the info on canned foods. I plan to check out some labels this weekend when I go to the market.

Vicky, how often to you test throughout the day?

Thanks,
Gretta & Izzy
 
Izzy said:
Vicky and Julia. Thanks so much for your input. This is all quite overwhelming and a lot of information to absorb at the moment. I expect things will settle down once I get her regulated.

Vicky, how often to you test throughout the day?

Thanks,
Gretta & Izzy
Click to expand...

BG tests need to be done before each shot, so that's twice at the very least. In the beginning weeks until finding a good dose, testing should be done to determine when the cat nadirs or peaks (the lowest BG they have during the cycle) on their current dose - on Lantus that can be anywhere from 7 hours after the shot to nearly the next shot time, 12 hours. So if there's a day you can test every hour beginning at 7 hours after their AM shot, that would be good. You could skip tests for the rest of the cycle till next shot time once you determine nadir that day, so it's not as often as it sounds. Then in subsequent days, you might test once or twice at different times each day so you get a strong overall picture of how a dose is working for them.

Sometimes it's good to see the progression of how fast or slow the BG lowers or rises, so getting 2 or 3 tests on as many days a week as you can in addition to the "preshot" tests is good data gathering. Lantus likes steady BGs, so a fast drop followed by a fast rise may mean a bounce or rebound caused by a nadir which is lower than they are used to. It may be a perfectly safe BG, but since she may have been hyperglycemic for a while her system doesn't think it's normal.

It may sound like a lot of work in the beginning, but when you consider it is less stressful for Izzy than spending the day at the vet to supposedly "regulate" their dose, it's worth it.
 
With Lantus, you'll want to test at least three times every day--before each shot, and then a test 6 hours into either cycle. Once a week, you'll also want to do a curve (testing every 2 hours for a 12 hour cycle).

It's great that she likes the DM! That means she'll probably not give you problems with the switch to wet food. There's nothing wrong with feeding the canned DM, but you can get better quality commercial food for less than what you're paying for the DM. They use pretty low-grade ingredients for it, and you can either get something of the same quality (Friskies, Special Kitty) for way less money, or a higher grade food like Wellness, EVO, or Merricks that's still cheaper than the DM.

Just remember, you have to start to test before you make the food switch with the dose of insulin she's on. Otherwise, you can have a dangerous hypo incident on your hands.
 
Got it with the the food changeover and testing and understand the importance of this. I only added a small amount to her dry food last night to see if she would like it. I also only gave her 4 units instead of the 5 units - not sure if I should have done this or not, but would rather give her too little than too much. I am terrified of a hypo incident. You can let me know if this was a good call or not.

I have a pretty horrible schedule, I leave my house at about 5:30 am and returning around 5:40ish in the afternoon so I will only be able to test her on Saturday and Sunday throughout the day. I also have an elderly motherly that takes up a lot of my time when I'm not working. Miss Izzybelle was diagnosed on March 26th and between work and looking after mom, I have been able to stay on her schedule with a maximum variance of 20 minutes for her p.m. shot. I try to carve out Sunday for myself and this should be an ideal time for curve testing or just more frequent testing during the day.

Along with the food, I plan to look at meters this weekend and will probably pick up some keytone strips as well. I read about these (keytone strips) when she was first diagnosed.

You ladies sound like pros. I hope one day I can be as knowledgeable and not be so freaked out about every little thing.

Thanks again for all your advice and tips.
G & Izzy
 
Gretta,

One day and sooner than you think you too will be a pro. :-D And the bond between you and Izzy will be like nothing you have ever had with another cat. And maybe, just maybe, you will end up so sure of yourself and this wonderful sugarcat dance, that you will find yourself dancing with another sugarcat...lol.

Some of my friends thought I was crazy to adopt a diabetic cat after my extra sweet Muse earned her angel wings....But I find it is an honor to dance with a sugarcat, they are so very special.

Happy dancing to you and Izzy.

Mel, Maxwell and The Fur Gang.
 
Hi Izzy,

so far you've gotten some great advice, and the best thing i can say is keep going.

a couple quick things to add:

1. many supplies like strips, syringes, food, etc... can be purchased online at a lower cost so you can avoid trips after and before work, which will be especially nice for you since it sounds like you have a very full schedule. just start asking, and people will direct you to their resources.

2. when you head out to do your initial stock up this weekend, also pick up a tube of neosporin pain relief. everyone here can walk you through home testing, and this is a must have. it helps numb up and heal kitty ears faster, making testing easier. best $3 you'll spend.

3. hypo kit. it's better to have this than not to have it because you'll never know when you'll need it and it's better to be prepared than not, it puts you back in the drivers seat. knock on wood, you'll never need it. grab some high carb wet food (18% or more- something with gravy) and karo syrup. I also usually put an extra tube of strips in my hypo kit so I have less chance of running out. And print this post: http://www.felinediabetes.com/FDMB/view ... =9&t=40073 to tuck into it.

4. keep asking questions!!! ;)

so far you are taking the right steps. keep posting and we'll see you around soon.
-mo
 
Gretta and of course you too extra sweet Izzy,

We are more than happy to hold your hand and paw through it all. Just remember to breathe, read, reread and asked questions, the only silly question is the one that goes unasked.

If you look at the list of names in my signature you will see I have lots of kitties, so ....I didn't need another one when I adopted Maxwell as a diabetic, and this next saturday I will be welcoming home Musette, another sugarcat that I'm adopting. If this wasn't so easy to do, I wouldn't be adopting yet another diabetic. If I can do this with cats that I don't have any real history with, think how easy it is going to be for you with Izzy who already knows, loves, and trust you. And I have to tell you I have been so blessed to have Maxwell in my home, heart and life, he is a wonderful 12 year old guy that if you didn't know how old he was you couldn't tell him from my 2 year olds.

With the help of these wonderful people not only did I get the chance to adopt Maxwell and now Musette, but they helped me get Maxwell into remission, and I'm sure they will help me do the same with Musette and even if Musette never goes into remission...a few pokes on the ear and a couple shots a day is such a small price to pay for the love of a wonderful new addition to our large furry family.

Mel, Maxwell and The Fur Gang.
 
Glad to see you are getting some great help from great people and are absorbing some of the information. We used Lantus with my Smokey girl. Here is what our time line looked like.

12/21/09 - DXed vet tested @459
12/28 - started 1U Lantus b.i.d. ; transitioning to dry Purina DM, with some soft DM
1/4 (?) - raised to 2U vet tested @352 at nadir (6 hours after am shot)
1/11 - raised to 3U vet tested @ 225 at nadir
We continue with weekly checks at the vet, freefeeding the dry DM with am and pm meals of the wet DM, but all the cats are starting to dislike the wet DM so the majority of diet is the dry DM
02/01 - vet tested at 103 and holding 3U dose and moves to 2 week checkups, we are getting a bit nervous with the dose level but she is feeling healthy again
2/16 - vet tested at 83 and vet wants to hold the dose and go to a month checkup. Husband refuses to go that long without checking again with her numbers dropping and each time and the insulin that high, someone refer me to FDMB
2/21 is our first home test. OMG is all I can say, poor Smokey. But we still give the vet's dose of 3U after a 77. I think I was just reading and not posting yet so maybe I didn't get a butt chewing for that one :shock: (We have removed the hard food, feeding only soft, no more DM - all FF, ProPlan, Wellness, Friskies, Whiskas, whatever their picky butts desire this day)
2/24 the first test after am shot is 52, call vet worried about possible hypo, evening shot is skipped, dose lowed to 2U going forward.
3/2 dose lowered to 1U
3/9 dose to 0.5
3/16 dose to 0.25
3/23 dose to drops
3/29 last shot of insulin

Barely over a month from our first home test and diet chnge to the last shot and we were a pretty slow step off. I think they liked torturing us :-D as many may have looked at the numbers and said a newbie under 200 shouldn't shoot at all and we may have never given another shot the day I showed up here. But Lantus is a wonderul healing insulin. It is a long term, gentle insulin that allows the pancreas to heal while it holds those sugars low until the kitty can produce the insulin on its own.

I would recommend taking the advice you get here. They have so much joint experience with Lantus on this board. Hometesting can't be stessed enough. The power over what you are doing that you will gain when you actually know what is going on is amazing and also so comforting.
 
I have not started my home testing yet and have a couple of questions before I begin. I thought I had everything I needed until I read about the control testing.

I purchased the Accu-Check Avia and the instruction book talks about performing a control test prior to actual testing to ensure the meter is testing properly. I think this is something that I should do and will have to order the solution(s) online. Have looked high and low and can't locate any of the solution so will need to order. I assume that all of you would recommend doing this.

Also, I got the Accu-Check Multiclix Lancing Device with my meter. It's a little difficult to actually tell where it will stick. I've tried it on myself and have a general idea, but there's a lot more room to stick on my finger vs. that thin little vein on my sweet Izzy's ear. Any suggestions here to other lancing devices? I've checked out her vein and it appears that this will be quite the challenge.

As stated in an earlier post, I started giving Izzy a small amount of wet food with her dry DM and changed her insulin from 5 units twice a day to 4 units twice a day. (I will not change the amount of wet food or her insulin until I can home test her.) I am happy to say that she has shown signs of improvement. Her behavior has changed and she is more like my Izzybelle. She is also not drinking and peeing as much. I can't wait to begin her testing and increase her wet food into her diet. I'm hoping I will see significant changes as I gradually add the wet food to her diet.

I also have a box of Ketone test strips on hand now.

Look forward to your responses. As always, thanks for the advice and encouragement.

G & Izzy
 
I did not use the Avia but wonder if you could get the control solution from the drug store or the store where you bought it? I do see that it is available on line. You could also call the Avia 1-800 number to see where and how to get it. (Be sure to tell them it is for your son Izzy, not your cat, Izzy. :mrgreen: If you say cat, they will tell you the device is not made for animals. If you say son, they will be very helpful.)

With our lancet, we had more success when we took the clear cap off the end. Then we could see where the lancet was actually going to poke. Also, many lancets come with gauges that are too tiny. Usually with beginning diabetic cats, we suggest 25-27 gauge so you might look for some of those also.

You really don't want to poke the vein. You are poking in that general area, but looking for the capillaries that run off the vein toward the edge of the ear. Here is some info on where to poke: Where to poke

If you want, you could start a new post with your city and state and ask if there is someone nearby who could come help you get started the first time.
 
Izzy said:
I have not started my home testing yet and have a couple of questions before I begin. I thought I had everything I needed until I read about the control testing.

I purchased the Accu-Check Avia and the instruction book talks about performing a control test prior to actual testing to ensure the meter is testing properly. I think this is something that I should do and will have to order the solution(s) online. Have looked high and low and can't locate any of the solution so will need to order. I assume that all of you would recommend doing this.

Also, I got the Accu-Check Multiclix Lancing Device with my meter. It's a little difficult to actually tell where it will stick. I've tried it on myself and have a general idea, but there's a lot more room to stick on my finger vs. that thin little vein on my sweet Izzy's ear. Any suggestions here to other lancing devices? I've checked out her vein and it appears that this will be quite the challenge.

As stated in an earlier post, I started giving Izzy a small amount of wet food with her dry DM and changed her insulin from 5 units twice a day to 4 units twice a day. (I will not change the amount of wet food or her insulin until I can home test her.) I am happy to say that she has shown signs of improvement. Her behavior has changed and she is more like my Izzybelle. She is also not drinking and peeing as much. I can't wait to begin her testing and increase her wet food into her diet. I'm hoping I will see significant changes as I gradually add the wet food to her diet.

I also have a box of Ketone test strips on hand now.

Look forward to your responses. As always, thanks for the advice and encouragement.

G & Izzy
Click to expand...

I have the accu-chek and I called them and they mailed me the control solution for free. However, you can use your own blood as a control as long as there isn't a reason why your blood sugar would fluctuate, so you can get started right away. Just test yourself a few times, and if you're in a normal range each time you should be good to go. Then when the control solution arrives you can use it just to make sure.

I could not use the multiclix lancet because it was too hard to judge where to aim it. If you have a Walmart near you, run out and grab the relion lancet if you can't freehand it (I never had any luck freehanding the lancet). the top of it is just a single circle, so you can aim by making sure the center of that circle is where you want to go. The Aviva softclix is the same way, works just like the Relion device of you don't have a Walmart. Also, make sure you get larger gauge lance (something between 26-28g), too, because the smaller lancets (30-33g), don't work very well with the ears. I know it seems like the smaller gauge will hurt the cat less, but I guarantee that your cat will handle the larger gauge better because you'll finish sooner because it will be easier to get the drop.
 
Izzy said:
I purchased the Accu-Check Avia and the instruction book talks about performing a control test prior to actual testing to ensure the meter is testing properly. I think this is something that I should do and will have to order the solution(s) online. Have looked high and low and can't locate any of the solution so will need to order. I assume that all of you would recommend doing this.
Click to expand...


I never ran a control test on my Aviva and it worked just fine :smile: If you want to run a test, you can probably get the control solution by calling AccuChek customer service.

Also, I got the Accu-Check Multiclix Lancing Device with my meter. It's a little difficult to actually tell where it will stick. I've tried it on myself and have a general idea, but there's a lot more room to stick on my finger vs. that thin little vein on my sweet Izzy's ear. Any suggestions here to other lancing devices? I've checked out her vein and it appears that this will be quite the challenge.
Click to expand...

I didn't like the MultiClix either. Have you tried the clear alternative testing site cap that comes with the MultiClix? The blue end cap of the MultiClix comes off so you can replace it with the clear cap. The main problem I found with the MultiClix is that the cap has a little hole where the lancet comes out of. For a Human diabetic, this is fine. But for trying to get blood between the very thin area between the ear vein and the edge of the ear of a cat, it's hard to line the hole up with the area you want to prick :-Q

I preferred the AccuChek SoftClix which I had gotten with my previous Advantage meter. I later got a free replacement SoftClix from AccuChek customer service :smile: They didn't ask who was using their product.

Any lancet device you can find in the pharmacy will work. But don't use the CVS brand one. It's impossible to use.

And you don't want to use the really thin 31 or 33 guage lancets. They're so thin that very little blood will come out of the prick hole that is made in the skin.
 
Status
Not open for further replies.
Back
Top