Lantus overdue 6.5 hours (AWOL cat) now what?

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Lylene & Barry

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This is my first post on my new sugar cat Paisley. About 6 yrs old, about 8 pounds but too thin. Shelter rescue.

She came on 3 units of Lantus at 9a & 9p. BG remained high (300's and a couple in 400's)). Last night started with new pen of insulin and dropped to 1 unit. Then she disappeared, got outside and I didn't find her until 2:30p. House looks like tornado struck. Fed her.

What do I do about insulin?


8/3 2:45p 394 & 428 (I tested just before she started scarfing food the realized there was no lancet, so had to put in lancet and test, tested twice so that's why second is higher. fed ~3 1/4 oz Wellness Chicken & Beef, she ate a little more than 1/2 of that.)
8/3 9:00a AWOL
8/3 1:30a 116, fed 2 oz Wellness Chicken & Beef
8/2 9:00p PSBG 256, 1unit Lantus, fed 2 oz Wellness Chicken & Beef

Lylene, Barry & Paisley
(sorry, no spreadsheet yet)
 
Hold on just a minute. I'm going to see if anyone is over in the Lantus forum. brb


Carl
 
Hi Lylene,

I'm Jennifer with DCIN. Thank you for taking sweet Paisley.

She's indoor only, correct? Just missing in your house?

Once you catch her can you confine her to one room for a few weeks while she gets used to you and the new home. This will help you also get her used to hometesting. Since she was just spayed I don't think she had much of a home life before, she may need a small area of confinement to feel safe.

Once you do catch her, give her insulin and then can we work back down to the regular schedule.
 
Thanks for the quick catch, Jennifer.
Is that the standard "what you need to do" with Lantus? Just so I'll know how to respond if nobody is around next time...
Give dose, and then adjust next cycle?

Carl
 
No, I don't think it's the standard, but Paisley was just adopted from a shelter and she only started Lantus because we (DCIN) convinced them to and sent it to them. Being that they aren't there 24/7 I don't think she was routinely given shots at 12/12 like we want. We are simply thankful that they didn't put her down and treated her while we found her a home. She was scheduled to be put down originally.

Thankfully Lylene adopted this beauty.

Normally I believe Lantus would be handled differently from the advice I gave and I should have noted that in my reply. I'm glad you asked the question. I would defer to the lantus ISG folks on how to properly handle a situation like this with a kitty that has been in his/her home for a long time.

You can read about and see Paisley here: http://fdmb-cin.blogspot.com/2011/06/paisley.html
 
as long as you're giving the shot late, it's ok to go ahead and give it. the important thing is not to give lantus early because there is overlap from one dose to the next. if you give late, you just know that is "now" becomes the shot time and give the next shot 12 hours later.

even in a perfect world where the cat gets every shot 12 hours apart there are times when you give a fur shot - you just regroup and try to get back on schedule with the next shot.

if you can't give a shot 12 hours after the shot that was given out-of-schedule, it's better to wait and just call it a skipped shot and begin again at the time when you can give shots. so what i mean is if it's 2pm and 7am is when you give shots, and you normally are at work at 2pm so there's no way that can be a good shot time, just skip the 2pm one and wait til 7pm for the next shot. if that happened your cat would be 24 hours from the last shot, but at least you'd be able to work with it in the future. does that make sense?

good for you for taking in this new kitty! well done!
 
Since you are re-establishing the insulin, plus working out the correct level after missing several hours and just re-starting dose adjustments, you have 2 options:

1: wait until the normally scheduled time; the BG will be high due to missing a dose. It may take 3-5 days to settle if 1 unit is the correct dose. If the cat has ever had ketones, go with option 2.

2: give insulin as soon as possible, then each day shift the dose times by a total of 30 minutes each day (15 min per shot is most gradual transition). Be aware that while you are shifting earlier, this is like a dose increase, so you will NOT know what the maintenance dose is going to be. You'll be settling that 3-5 days after you are back on the regular schedule.
 
If the shot was missed you also have the option of setting the shot time earlier than the 9:00 if that is more convenient for you. In other words you do not have to wait until 9:00 if an earlier schedule is more convenient or if you did shoot late, you do not need to work all the way back that far if you would rather shoot earlier..
 
Weird, I posted but it didn't show up.

I had Paisley back when I originally posted. I gave her 1u Lantus at 3:45p. I can work with slowly moving it. She was getting it at 9a/p but there's some flexibility until school starts. Actually, I needed to move it to 6:30a or 7a, have to check school start times again.

It was a fluke she go outside. My mistake. She does well with testing and shot. Great ears. She needs lots of attention. I nap with her. Just started bring her out and putting her behind me on the chair when I'm on the computer. I make a tent with a sheet for her when I have to get up. She's funny. She and Barry are napping in her room. Barry has taken up marathon napping and is practicing right now. Wait, I'm the only one not napping. Gotta go get with the program.

Thank you everyone.

Lylene, Barry & Paisley
 
Then the time adjustment won't bee too bad. I have found w/ Tess that even though I have adjusted her by just 15 minutes, her numbers can be a bit wonky until she gets settled into the new time. Just something to be aware of that could happen.
 
Actually, I needed to move it to 6:30a or 7a
Click to expand...

Since you're still adjusting the dose, and as long as she isn't ketone prone, taking it from 3:45p to 6:30 am can be done in one step to get it over with. Her BG will probably be high, unless she functions better on a lower dose of Lantus.

Once you're back to a normal time and doing 12 hour dosing, you'll be able to start adjusting the dose, usually waiting 3-5 days between changes - follow the Lantus stickie guides on that.
 
I go by the flow with Lantus actually. Also being an heretic when it comes to that.

I have major injuries from a car accident and a fall down a staircase, so my sleep isn't the best.

Simba is on 2 U, and , I would prefer to keep Simba on a strict 12/12 schedule, with 10 am and 10 pm, but I normally don't wake up until 11, so I give him his shot then. The latest I give him his morning shot is 11.30. If I wake up after that I simply don't give him any morning shot at all, since the Lantus (at least ours) can be stretched for 1.5 hours but not more.
If I have given an early 10 or 11 am shot, I give him his night shot around 10 pm, but sometimes tardy with it and can give at 10.30 pm or 11 pm.


I am more relaxed and flexible now about this after 5 years of giving shots, plus I also make sure he has food out day and night so he can eat whenever he wants.
 
Thank you to everyone for your explanations. I'm saving this thread!

So with Lantus, you want to keep the dose the same, but change the shoot schedule. If you're late today, you can either have that become the "new" scheduled shot (i.e. if you were normally on a 7am and 7pm schedule, and were 2 hours late, then you could go from that point onward with a 9am and 9pm schedule), or, if you wished to maintain the 7 & 7 routine, then you would adjust each scheduled shot "back" by 15 minutes until you were back on your 7 & 7 routine. Most importantly, you would not lower the dose just because you were late.
AND if the cat has ever had ketones, you would never skip the shot, but shoot as soon as possible.

Do I have that correct?

I know life can't be all in black and white, and there's exceptions to every rule, but this would be a good "rule of thumb"?

Thank you all,
Carl
 
well -- the time adjustment can vary according to the "Every Cat Is Different" rule.

Tiggy is pretty stable and we can change his shot time as much as an hour earlier or later without much bouncing. So we don't have to worry about adjusting time in 15 minutes steps. Of course Tiggy is getting a skinny 0.5u BID, so maybe that affects how sensitive ... or not ... he is to time adjustments.
 
yes, carl, you've pretty much got it. i think there's more flexibility when you're moving the shot later than earlier. i'm sure it probably does vary from cat to cat on how bouncy they are if you change their time.

i'm going to post a doc in a second on how lantus and levemir work as long-lasting insulins, because understanding that will be helpful to you. basically they inject as a liquid but when they hit the body they form a solid. it forms an actual spot under the skin with a deposit of solid insulin. that solid slowly dissipates to continue releasing insulin.

so if you shoot early you are adding more insulin when some is still being released - in general, that's why we stay to a 12-12 schedule. BUT, life happens and sometimes you have to do what works for you, so you just go with it. also speaking generally (knowing every cat is different) when you change a dose by either changing the time or the volume of insulin, the cat's BG will get wonky for up to 3 days.

as strange as it sounds, if you increase the dose you might very well find their numbers increase for a time. that's why we change doses by .25 amounts and then let them settle in for 3 days minimum to see what they are truly going to do. so every time a person (especially if they aren't hometesting) changes the dose or the timing it could have a significant impact on the cat.

might not, though - cats are all different.
 
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