Lantus starting dose (professional reference)

Status
Not open for further replies.
MelanieP and Ninja

MelanieP and Ninja

Active Member
Help! I am new and very worried about my vet's suggested starting dose of Lantus for my cat Ninja. He is suggesting starting at 2 units, twice a day based on Ninja's current weight of 15 pounds. But from everything I have read, they are supposed to base the Lantus starting dose on her IDEAL weight -- which is probably closer to 10 pounds. Vet doesn't believe it when I tell him most on this site have recommended starting at 1 unit twice a day. Is there a reference from the Lantus company that I can show him? I am so worried!!! Newly diagnosed and today is the first administration of Lantus. Ninja's counts were "over 400" Friday, but vet didn't even test her today before suggesting the 2 unit starting dose. Also, he didn't know how to use the home meter I bought (took it with me so he could show me the ear blood testing thing for home). In any case, does anyone have any communication from Lantus on the "ideal weight" versus current weight dosing? Thanks all!!!!!
 
Is 2 units a significant danger for Ninja or should I just let the vet start there as he is insisting, then test her at home over the next few days and alert the vet if her numbers start to drop too low? Am I freaking out about this unnecessarily? I am new and terrified of injecting her with an amount that might kill her. But if 2 units is a reasonably safe zone I will relax a little. Thoughts?
 
HI Melanie, just remember once you inject insulin in you can't take it out again. So its always better to start low and work up. Your vet isn't standing in your shoes worried about hypo-ing your cat so I think its better to start at 1 unit - test to see how your cat is responding to that dose and slowly work your way up. Jan
 
MelanieP said:
Is 2 units a significant danger for Ninja or should I just let the vet start there as he is insisting, then test her at home over the next few days and alert the vet if her numbers start to drop too low? Am I freaking out about this unnecessarily? I am new and terrified of injecting her with an amount that might kill her. But if 2 units is a reasonably safe zone I will relax a little. Thoughts?
Click to expand...

2 units can be too much for some diabetics just starting out on insulin. It's better to start at a very low dose and not see much effect on blood glucose levels than to start too high and risk a hypo, especially if you are not testing blood glucose levels at home.

This boards recommends starting at 0.5 units or 1 unit twice a day.

You can tell your vet that you are NOT comfortable with starting at 2 units twice a day and insist on starting lower. Remember, it's YOUR cat, not the vet's cat. You are the one who lives with the cat and will give the insulin shots and test blood glucose levels every day. Even if the vet disagrees, you can just go ahead and start at 0.5 or 1 unit twice a day at home.

MelanieP said:
Is there a reference from the Lantus company that I can show him? I am so worried!!!
Click to expand...

You won't find any information about dosing diabetic cats or even using Lantus for animals from Sanofi-Aventis, the manufacturer. This is because Lantus is only FDA approved for use in Humans.

Mel posted the link to the well known published Rand study. Show it to your vet.


. Also, he didn't know how to use the home meter I bought (took it with me so he could show me the ear blood testing thing for home).
Click to expand...

A Human blood glucose meter isn't much different from a pet meter (AlphaTrack, iPet) unless your vet uses another way to test blood glucose levels. Here are the testing tips and info: http://www.felinediabetes.com/FDMB/viewtopic.php?f=14&t=287 There are good pictures in that thread of where to get blood from the ear.
 
There's what your vet said to do ... and there's what you actually do. You can choose to give just 1 unit as you hold the syringe.

If you have already made the dietary change to canned or raw low carb food and the vet data was collected before that, the dose may be based on now invalid data - numbers influenced by dry food. This could set you up for a hypo situation. (Have you printed out that link and obtained supplies for 'just in case'?)

I'd go for safety first and start when you can be home to observe, with just 1 unit.
 
MelanieP said:
Help! I am new and very worried about my vet's suggested starting dose of Lantus for my cat Ninja. He is suggesting starting at 2 units, twice a day based on Ninja's current weight of 15 pounds. But from everything I have read, they are supposed to base the Lantus starting dose on her IDEAL weight -- which is probably closer to 10 pounds. Vet doesn't believe it when I tell him most on this site have recommended starting at 1 unit twice a day. Is there a reference from the Lantus company that I can show him? I am so worried!!! Newly diagnosed and today is the first administration of Lantus. Ninja's counts were "over 400" Friday, but vet didn't even test her today before suggesting the 2 unit starting dose. Also, he didn't know how to use the home meter I bought (took it with me so he could show me the ear blood testing thing for home). In any case, does anyone have any communication from Lantus on the "ideal weight" versus current weight dosing? Thanks all!!!!!
Click to expand...

My first thought was 'dose is too high for a start' and my next thought was 'what's the cat eating?'

Most cats never need that much insulin, and it doesn't matter what weights they are.... starting at 1u has even turned out to be too much for some cats. Depending on the BG numbers that the cat is getting, and the fact that it will take a few days for the Lantus shed to fill, maybe 1u would be OK.

With food, if you are feeding any dry foods and/or treats, or even high carb wet foods, you could change the diet to a low carb wet diet and maybe not need insulin at all... many cats arrive here eating dry food but then once they switch to wet, their dose needs drop a great deal. Many are found to be DIET CONTROLLED diabetics, or very low dose cats.

It's great that you are testing at home; you will know exactly how the insulin and the dose are working.
 
Update: I was able to locate the site for the University of Queensland, where the studies of Lantus were conducted. On the site, they have recommendations for vets that you can download. http://www.uq.edu.au/ccah/index.html?page=41544 . It lists dosing protocol if you are doing daily curves as well as weekly curves (if I am reading correctly), suggesting different starting levels based on how often you do the curves. Again, if I am reading correctly, it says that for the weekly monitoring (I am guessing this would be doing the curves at the vet once a week) it says to start at .5 Units per kilogram of IDEAL WEIGHT if blood glucose is greater than 360 (which Ninja's was). Her ideal weight is around 10 pounds and a kilo is 2.2 pounds... which makes Ninja weighing around 4.54 kilos x .5 = 2.27. so that would be a starting dose of 2.27 U twice a day (is that right)? But the important takeaway is that it says she still has to be monitored for the first 3 days and the amount decreased if neccessary. And is says, "If no monitoring is occurring in the first week, begin with 1 U/cat BID." Maybe someone with more experience than I can interpret this. But I think it means that 2 units is not outrageous for her size, provided someone is monitoring her (which I intend to do) -- but since her vet is not encouraging of home testing -- and would not necessarily expect me to test her -- then he should have started with 1 U. Let me know if you all see it the same way. Thanks to everyone who helped me think this through today!!!!
 
I'd go with 1u as a starting dose.... you can always give more insulin but you can't take out too much insulin.
Once it's in the cat, that's where it stays. If 2.27u (how would you measure that?) is way too much, what would you do?
It's dangerous, so starting low is not a bad thing; it's a safe thing.
 
Please don't start at 2.27 u or even 2u. You only have one glucose reading from the vet. That is NOT enough information to go buy, especially because BG levels can be severely elevated by stress at the vet... and by dry food. As soon as Ninja gets home and in her home setting, her BG could drop up to 150 points and removing dry food will make her drop even more. So going by that 400+ reading is extremely unsafe. Vets dosing cats based on their numbers in the office has killed them. It is SO SAD that they don't know any better. Here is a thread I had to bear witness to where a kitty passed away because an ignorant vet increased her cat's dose up to a lethal 5u based on tests done in the office with no home testing done.

Some cats can go into regulation just on the diet change alone. Ninja might even be one of them... you don't know yet, because you have no more info on her BG.

There is a reason that we recommend 0.5u and 1u as starting doses... while your cat might eventually need a dose like 2u, once the insulin is in your cat you can't get it out, and hypo can kill VERY fast. My 13lb cat is regulated on .25 to .4u of insulin and if I gave him 2u I would probably send him severely hypo or kill him. ECID and going by weight is not always reliable which is why the UP TO DATE TR starting dose by weight is so conservative

Cats don't always show symptoms of hypo until they are full blown out cold or seizing, and home testing is really the only way to know if your cat is headed downhill. Since you're just starting out, what happens if you can't successfully test Ninja? What happens if she begins acting strange? How will you know? Can you afford to rush her to the ER and pay for intensive care if she goes hypo? And even if you catch a hypo situation early, sometimes the cat cannot recover, or not at least without permanent brain or eye injury.

You can always increase the insulin as you go. Having higher numbers for a few days is FAR better than being severely hypo for just a minute. This is a marathon, not a race, and rushing and cutting corners will only set you back farther than had you followed TR/the advice given. It's a lot of risk for no benefit. Please consider that.
 
MelanieP said:
Update: I was able to locate the site for the University of Queensland, where the studies of Lantus were conducted. On the site, they have recommendations for vets that you can download. http://www.uq.edu.au/ccah/index.html?page=41544
Click to expand...
This is actually not the most current protocol from Dr. Rand (interesting that it is still on the site). The one Mel linked above (Tight Regulation Protocol for Lantus or Levemir) is more current and is the protocol that we use in the Lantus Tight Regulation forum here. The recommended starting dose is 0.25/kg of ideal weight, or 0.25/kg of current weight if the cat is underweight. Based on an ideal weight of 4.54kg, your starting dose would be 1.14, but rounding off to 1 unit makes sense. This starting dose recommendation is for individuals who want to follow the Tight Regulation Protocol that is outlined on the document. Tight Regulation does require testing and has some prerequisites for it to be used safely, including being on a wet food diet. More information on can be found here.

If tight regulation does not suit your style, then the "Start Low Go Slow" method might be a good fit. That method recommends a low starting dose of usually 0.5u-1.0u BID.
 
I hear you and agree with you that 2.27 is too much. I was just referring to my earlier post this morning -- that the vet started Ninja on 2 units today (he gave it to her and has been monitoring her in-house today. She is still there now). Vet wants me to continue giving her the 2 units and won't listen to anything I say to the contrary. So I was looking for professional resources online to back me up (vets or something from the Lantus company saying he should start lower). The best I could find is from the Queensland site, who conducted the initial studies; and if I am reading that study correctly, they said that 2.27 would be an ok starting dose provided Ninja was being monitored and that the amount could be reduced if needed. But since I don't have confidence in my ability to monitor her (yet), and the vet is not going to monitor her this week either... I will certainly not give her the 2 units the vet recommends (demands). I probably won't give her anything more today... and then just start tomorrow at 1 unit or less. Honestly, I have been looking for a new vet all day today. This one just doesn't care what I say. He is completely inflexible (kind of a "know it all"). When I talk about the FDMB, his eyes glaze over. But where to find a vet experienced in this -- or at least open to LISTENING to other opinions? I put an ad on Craigs list today asking if anyone here in Gainesville FL has experience with a good vet. For the life of me, I can't understand why my vet is adamant about not starting her at a lower dose. Won't even discuss it...just says "we do it this way." :(

PS: Thanks Libby and Lucy for the updated link. I will take that to my vet!!!
 
Do what we call vet shopping... call around vets, ask questions, what insulin they use, how many feline diabetes patients theyve treated, how many of them have gone into remission, if they recommend home testing, etc. if they say "we use Humulin N" or "we usually euthanize diabetics" or "I don't know" or if they won't even talk to you or call you back later, run away fast lol.

Keep in mind, FDMB is your knowledge resource for anything diabetes. I take care of Scooter's diabetes solely with this site. I don't go to my vet for anything other than routine checkups, bloodwork, emergency, etc. things I can't manage from home. That's the thing... FD is a home-monitored disease. You've got your Lantus, syringes, meter, strips, lancets, everything you need to take care of Ninja's diabetes... you don't need, or need to pay for, a vet for the everyday parts of treating FD. :smile:
 
Great suggestions on the questions to ask potential vets. Thanks!!! This is so scary!! I will keep close to this site, and bless you all for taking the time out of your busy lives to help me. :)
 
Take a few deep breaths... everything will be OK! I just started this song and dance last December myself, and look at where I am in just a few months. Telling other people to breathe and relax. :lol: Folks are here to help you when you need. You're off to a great start. Next step, getting on top of home testing!
 
Change the subject in the original post you made for this thread to something like Need vet in Gainesville, FL. See what other members have to offer in the way of vets who are good, AND which vets are to be avoided!

Good luck finding a vet who really cares about you and your cat, and who is willing to work WITH you.

Test numbers at the vet office today are pretty much useless, and a waste of money. Lantus has a shed and needs a few days to settle the dose, so it's quite obvious that your vet knows almost nothing about Lantus.

Both my cats, and I bet most other animals, have numbers affected by stress at the vet office.
One always tested higher and the other often tested lower.
I tested the cat at home before we left for the vet, again at the vet office when arriving, again just before leaving, then 30min after arriving back home..... very telling numbers. Within 30min of getting back home, giving me a dirty look and settling into a favorite spot, the BG was back to that cat's usual numbers.
 
2.27 units? You can't even measure that amount on an insuiln syringe. The closest you can probably get is 2.25 units and that's not even quite accurate even with half unit marked insulin syringes and using the close up pictures in one of the Lantus stickies.

Here are more questions to ask when looking for a new vet: http://gorbzilla.com/decisions_decisions.htm
 
Here is the PDF the vet needs to read. The pertinent info about dose for cats is on the document's page 218, right column under "initiating insulin therapy."

http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf

It also gives the Rand weight formula, but again it's based on "lean body weight." You have documentation to prove it is the new standard. If that's what you the owner are asking for, he should abide by it, even if the clinic is not accredited by the AAHA.
 
For vet shopping:

You'll want a vet who:
1) supports home testing of blood glucose and is OK about using a human glucometer
2) supports feeding a low carbohydrate over the counter cat food, or raw low carb food
3) is either up to date, or willing to do the homework to become up to date on feline diabetes and common comorbidities.
4) if up to date, is familiar with the use of ProZinc, PZI, Lantus, and/or Levemir IN CATS; ask how they determine initial dosing and how often the dose is given (should either be based on body weight or starting low at 0.5 units and dosing should be twice a day)
5) has pricing you can live with - check office visit fee, vaccine fee, CBC and chemistry fee, etc. Ask how often they have you bring the diabetic cat in and for what reasons (if you are home testing, you can do curves and averages at home, and the cat doesn't get 'regulated' at the vet office where stress makes the numbers unreliable)
6) if currently treating diabetic cats, ask how long they usually survive (should be several years)
 
Thank you! This is great info!

Vicky & Gandalf (GA) & Murrlin said:
Here is the PDF the vet needs to read. The pertinent info about dose for cats is on the document's page 218, right column under "initiating insulin therapy."

http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf

It also gives the Rand weight formula, but again it's based on "lean body weight." You have documentation to prove it is the new standard. If that's what you the owner are asking for, he should abide by it, even if the clinic is not accredited by the AAHA.
Click to expand...
 
Status
Not open for further replies.
Back
Top