Lantus protocol = slow going?

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schrusciel

Member Since 2010
Greetings all,

My cat Buddy has been an on again, off again diabetic for the last several years. His most recent bout started this past winter & has proven particularly difficult to regulate. He was experiencing wild swings in his BG levels this past spring so we switched from Humulin to Lantus to see if the longer acting insulin made any difference. We started at 0.25 units/kg & while the curves have certainly flattened out compared to Humulin, his BG levels remain very high (generally between 350-550) with no noticeable rebounds. He is suffering from neuropathy & in an attempt to expedite some relief I adopted the Rand "tight regulation" protocol two weeks ago. His current Lantus dose is 6.5 units b.i.d. but so far there is little difference in his daily BG levels going all the way back to 3 units . He is 12 years old & 18 pounds (not obese, just a really big frame) so could this have something to do with the low response? Perhaps he just needs a higher dose & it's taking a long time to get there? He is scheduled for an abdominal ultrasound next week to rule out any unanticipated internal conditions that could be affecting his ability to process insulin.

Any thoughts would be appreciated - this website has been a terrific resource during a very frustrating process.

Steve
 
Hi Steve,
That dose of 6.5u BID Lantus is pretty high, but not much can be said for sure without seeing Buddy's numbers. As you probably know, many people keep track of their BG numbers on spreadsheets, and those ss make it alot easier to see how the insulin has or has not been working.
If you have kept a record of his numbers from your testing, maybe you could start up a spreadsheet and add in his numbers.
I am thinking that just 2weeks following the protocol is pretty fast, as when first starting, the dose is usually held for 5-7days, then increasing by .25 or .5 based on the nadir. Is it possible that the increases were too soon and Buddy's optimum dose got missed?

Also, a profile is another good tool to eliminate the repeated questions such as what kind of food do you feed and how often and how much, plus do you feed wet food or dry. If you are feeding any dry foods or even treats, they may be a major reason for the high dose.There was another fellow here just recently who was feeding dry and had a dose of 22u; after a switch to wet low carb foods, his kitty is now getting 1u BID.
Even one of my own, Shadoe, eats just a small mouthful of dry food, and her numbers go very high - she must eat only low carb wet foods.

Health issues are important to know as well.
I know you mentioned the neuropathy and other details. but the next time you post, all that info will be lost to those who read your later posts.

With such a high dose, have you considered testing Buddy for acromegaly, IAA, or even cushings?
If Buddy is just not responding to the insulin at that dose, you may want to think about looking for the reason for the resistance.

You can look at the profiles and spreadsheets I have for my two cats, who both tested positive for acromegaly.

Sometimes, you just have to give what the kitty needs.
 
Hi Steve. Question.....how do you know when Buddy no longer needs insulin? Have you been monitoring his BG levels at home, if so, as Gayle mentioned, a spreadsheet of said numbers would be most helpful, we all have one. :mrgreen:
If you are home testing, have you done a curve? That's a BG test approx. every two hours to see how the insulin is working during the day and to catch his nadir (lowest test #).

You can give him some B12 which many use to help with the neuropathy.
 
Fleapunk,

I do in fact home test using AlphaTrak, typically AMPS & PMPS daily along with full curves every three days or so. I will get a profile & some BG data uploaded ASAP. Buddy has also been getting 6 mg of methyl cobalamin daily for about 3 weeks but if we can't get him at least reasonably regulated it's not going to be enough.

Steve
 
What food is Buddy eating at the moment?
Food is extremely important, and some cats even become diet controlled.

If your curves are showing as quite flat but still very high, you could just need more insulin. As I mentioned, there are some tests that can be done to possibly let you know the reason for the resistance.

I do consider my two cats to be fairly regulated, but as they are acro cats, their doses are quite high at 9u and 22u BID. They are quite healthy and doing fine on these high doses.
 
Buddy currently free feeds EVO Turkey & Chicken dry food - very low carb, grain free, about a cup a day. He also gets a raw food supplement of meat, chicken, or fish once a day, 1-2 oz, usually in the evening.

I'm working on uploading the profile but Google Docs is giving me headaches...
 
You are so on the ball Steve!

Good thinking re: vet visit, eliminating health issues is always a plus. Don't forget to inquire about IAA testing and acro.testing.

Do you know the carb content of the EVO? In looking at Janent & Binky's food chart, the lowest is EVO kitten and that's 8%, all the rest of the dry is way too high. IMO, I'd lose the dry altogether.

Something else to check, how old is the insulin? I use the lantus pens and I get about 30-35 days out of each pen.
 
Even the low carb dry foods are usually much higher than most FD kitties can handle Also cats evolved to get most of their moisture through their food and have a very low thirst drive. Dry food even though lower carb can cause a number of other problems for cats including kidney, liver and urinary tract problems. Check out Dr. Lisa Pierson's site for a lot of good info. http://catinfo.org/

If Buddy likes raw that would be a great way to go. There are a number of supplements that can be added to fresh raw to give a balanced diet. Tess likes Feline Future http://www.feline-future.com/index.php?map=USA There is also Platinum Performance. Wild Kitty and Better in the Raw to name a few.
 
The other question, in addition to the many we've already thrown at you, is how you arrived at your current dose? Since you recently adopted the Rand protocol, were your previous dose increases in amounts greater than 0.25 - 0.5u? If so, it's possible you missed an optimal dose.

It sounds like Buddy was in remission on Humulin. What was your max dose when using N?
 
Hi Steve,

I just want to say welcome to this great place.

From what I've seen, the "going" with Lantus ranges from lightening quick to sloooow.

I do want to encourage you to try switching to all canned food. I was very dubious when people first told me that here. But it was a startling difference in Basil's numbers I saw once I did. AND it was one of the best things I've ever done for my cats' health (I'm including Basil's civvy sister in that) that I can think of.

Hope to see you around.
 
When we switched from Humulin to Lantus, we used 0.25 units per kg which resulted in an initial dose of 2 units BID. Our vet was very concerned about ramping up too quickly so we re-evaluated dosage on a 8-10 day cycle using full BG curves. This took us from 2 units to 5 units in 0.5 unit increments but it took almost three months during which time his neuropathy continued to worsen, hence my decision to adopt the more aggressive Rand approach of increasing 0.5 units every three days when the nadir is >300.

The max Humulin dose was 7 units BID when we made the switch to Lantus. In previous episodes he had always had pretty tight regulation with 2-3 units of Humulin & he has enjoyed remission periods of over a year 100% diabetes free but this time around it just wasn't working.

I am all for eliminating the dry food from his diet but it just feels like there is something more insidious at work here.
 
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