Lantus Learning Curve

[bev5477]

Hi, I'm new to this board and have a 13 yr. old male (Gus) cat who was diagnosed about 4 weeks ago. After extensive reading and studying about Lantus dosage, I'm afraid that Gus's dose is too low and being increased too slowly. My vet has acknowledged that Gus is his first patient to be on Lantus. He started him off at 1.5U when the protocol calls for 3U to start for a cat of his weight (13lbs). Over the course of the 4 weeks, I've been able to prod this doc to increasing the dose to 3U. Gus has had consistently 'HI' BG levels at each testing. I test him 4x/day. I've taken it upon myself to begin testing for ketones. This wasn't suggested by the vet, but I've learned a lot by researching this site. I am suspiscious that Gus may have ketones present and that this may be the reason for nadirs of >600. I am following a strict high protein diet with Gus and am frustrated by his lack of response. I see that in cases such as this, it is reccommended to hold the dose for 3 days and then to increase by .5U. I'm hesitant to be so over the top assertive with this vet because I don't want to put him 'off' but I wonder if his lack of experience with this insulin is hindering Gus's regulation. I don't call his office often because, again, I don't want to be a pest about this. When the staff answers the phone, they sort of sigh and become quite overly patient when they hear my voice. I guess my questions are : Should I be overly concerned with Gus's resistance to regulation? Just how much input should I seek from my vet on this? Is this common with the relatively new advent of Lantus to the market? Thanks for any help.

 

[Sue and Oliver (GA)]

Welcome!

I am sorry Gus is having a a hard time, but it sounds like his mom is doing her homework! I am thinking you have read the stickies on the Lantus support group site: viewforum.php?f=9

I would suggest you also post over on that board. They all use Lantus and can help you with the dose. Put NEWBIE and DOSE ADVICE in your subject line. That board moves very fast and you want to get noticed. They will ask if you have read the stickies so, if you have, be sure to indicate that in your post. Keep checking back in to read your responses.

I don't use your insulin so can't advise on dosage. What specific food are you feeding? We feed wet lo carb and try to stay under 8-10% carbs. This food chart is very helpful in figuring out carb numbers: Janet and Binky’s chart

It is wonderful you are testing blood and ketones. I hope the Lantus folks can get the dose figured out.

 

[BJM]

You actually may have started too high - many of our kitties start at 1 unit twice a day - and the high glucose could be the liver trying to pump out enough glycogen to maintain.

Have you done a curve? Lantus doseage is based on the nadir, or lowest value in a 12 hour curve (tests taken every 2-3 hours).

Dental disease, infection, acromegaly, insulin antibodies, and other health problems may result in higher glucose levels. Be sure to have those ruled out.

What and how are you feeding? Scheduled meals or free-feeding?

The protocol here? Or one you've found elsewhere?

And print out the Lantus stickies for your vet and take them in, especially the ones with the articles by Dr Janice Rand. Several are posted here: http://www.uq.edu.au/ccah/index.html?page=41544&pid=43498

 

[Karrie and Maverick]

Maverick is a 15.5lb cat and he was started on 2 units and that was way too high. If I hadn't known about home testing and gone and gotten a meter and strips (relion confirm was ultra cheap and test strips are a great price) I'd never have known and it would have been very scary. Cats read higher at the vets due to stress and vets sometimes feed them kibble to do a curve. Preshot readings are not much of a factor in dosing with Lantus. Experts will come along and explain this.

It is always best to start lower 1unit and go from there. If you go up too fast and don't follow the protocol you risk a hypo and also missing his right dose.

You have found an amazing board that will provide you with advice and support with Gus. You are in great hands. Welcome to FDMB.

 

[Julia & Bandit (GA)]

He started him off at 1.5U when the protocol calls for 3U to start for a cat of his weight (13lbs).

Bandit was 13 lbs when he started Lantus, and his starting dose was 1u. After a dosing argument with my vet (who only wanted me to give him insulin once a day, while raising the once a day dose to 2u), I switched vets. But I also went into my new vet with the protocol and said "This is what I'm using as a dosing guideline. I just need your help to make sure I'm following it correctly." And she was more than fine with that. In fact, she was very pleased I was taking such a hands-on approach with Bandit's diabetes.

So at 13 lbs, I restarted Bandit at 1u twice a day (Lantus isn't really dosed by weight, and a start low/go slow approach is best to find the correct dose), and that was the most insulin he ever needed the entire year.

Are you testing for ketones at home? You can pick up the ketone urine strips at any pharmacy. If Gus does have ketones present, then he needs to be aggressively regulated, possibly at a vet's office who is experienced with Lantus.

 

[Lisa and Witn (GA)]

For cats, insulin should not be dosed by weight. It is better to start low and then gradually increase it. Your starting dose may have been too high even though it does not sound like much. Unless there are other health issues going on, we generally recommend starting at 1 unit twice a day and over a period of weeks, increasing it to find your optimal dose. Increases should be in .25 - .5 increments at least one week apart.

Diet can also affect BG levels. What are you feeding Gus? Is it canned food or dry? If dry, even though it may be a high protein diet, dry food will still raise BG levels significantly.

 

[Carolyn and Spot]

Your insulin may be bad. Lantus has an open shelf life of 28 days in the vial. It *can* last longer, but only if it was handled properly before you got it. You might check the lantus board for recommendations on getting the lantus cartridges or pens, they should last much longer. Also, if you start testing and can get a spreadsheet of numbers going, feel free to post in the high dose group for help on dosing. In the meantime, please do check for ketones on your own, and don't worry about going off the reservation with your vet, many people here have done this.

Just go pick up bayer ketostix or ketodiastix and either hold them in your cat's urine stream if he will allow that or "catch" some urine in a ladle or you can also stick them straight in the puddle in the kitty litter the minute he gets out of the box. Just get some clean litter first, get it wet with water, and stick the strip in the litter. If it doesn't react, it's fine to test his urine this way. Just make sure it's very fresh urine. Hang in there, there's always a way

 

[Phoebe_TiggyGA_NortonGA]

Just another voice saying -- don't dose by weight.

My current diabetic cat, Tiggy, is well regulated on a dose of 0.5u BID and he weighs about 15 lbs

That said, my first diabetic cat Norton had a condition that caused insulin resistance - Acromegaly. We discovered this after we found this board and got help from the experienced members here.

Norton weighed about 14 lbs, and he needed 8 units BID to be close to normal Blood Sugar. Details about his condition are available in the Insulin Support Group - Acromegaly.

 

[Nina and KB]

I'm not sure when you're testing, but if Gus is going low at some point he may be protecting himself by countering and going extremely high. At a minimum, try to get a test before each shot and one before bedtime. Any other data in between will be even more helpful to determine what's going on.

 

[Blue]

Hi Bev and Gus,
I don't rely on my vet for info/guidance on the insulin, I use Levemir (similar to Lantus), but I keep my vet office updated on what I am doing, taking a copy of our spreadsheets of test numbers. What I need my vet for is dental issues, and sicknesses and meds, also xrays and ultrasounds because that's the vet's business. I also gave my vet a copy of the protocol and keep her updated all the time, but I don't ask her for dosing advice ever.
Here's some food info:
Binky’s Food Lists
Feeding Your Cat: Know The Basics of Feline Nutrition

The Lantus info links:
Tight Regulation Protocol
Lantus & Levemir – Insulin Depot –AKA- Storage Shed
Lantus & Levemir – Data Ready to Shoot Low Numbers

As others have said, Lantus dose is not based by weight.
It could be that the dose you are giving may be a bit too high but if you could do a curve, testing every 2-3 hours in a cycle, you will have some valuable info to make some decisions on what dose is good for Gus.
Most people are tracking their BG numbers in Google spreadsheets. It helps you to see what's been going on with Gus' numbers, and it also provides data to others so that they can offer some suggestions. There are a few times when testing is MOST IMPORTANT: Before each shot, so you know if it is safe to give the shot, and a before-bed test. Many cats go low overnite and by testing just before you head to sleep, you may catch a low.
How to do a Curve
Example of a typical curve:
+0 - PreShot number.
+1 – Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 – Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.

As mentioned by Carolyn, testing for ketones is quite important. The Ketostix are easy enough to pick up at any pharmacy and another method is with some BG meters that have strips to test for ketones along with the BG. The Xtra precision meter can be used with special test strips but they are really expensive strips, so the ketostix are a cheaper choice.
If you get even a trace register when you test for ketones, mention it here so people can help you.

Be sure to ask questions; there will be someone around who will have an answer for you or will be able to tell you where to go to find your answer.