Lantus use with low numbers

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bkt

Member Since 2015
Hello,
I have a 14 year old cat who I have maintained his diabetes last 4 years, high 100-200's, with low carb wet food and herbs, Vit B12 and chromium/vanadium. However this winter he developed a UTI and pancreas somewhat inflamed and not able to control numbers (high 300-450). In April started him once a day on Lantus 1 unit. After a week, went to 2x a day 1 unit. Started to test middle of May, and his numbers were 200-300. Then, somedays in the AM it would be in the high 100's. (seems like AM is lower than PM) Have gone thru 2xs a 88 and a 68 in the afternoons. First, My vets suggestion was if under 300 not to give insulin. So, now I am more confused than ever! Now she says to go ahead and give AM & PM no matter what. If he is feeling low sugar he will come and eat, as I am leaving out some food or offering it to him in the afternoon. Has anyone just given Lantus once a day? This AM at 6:15 he was at 268, so I figured insulin. Then after he ate at 7:30 he was at 233??? So, I didnot give it. I gave him all the Glucoensure, Vit B12 and drop of chrome/vanadium. I have done a series of tests and vet keeps saying he is all over the place, not much consistence. It is obvious the 6-8 hrs after insulin it is low. That is how I caught the 68.. it was 7 hrs after shot. So. . quick food and back up to 100 after 1 hr. Thinking of getting another meter and using the two to test. I did calibrate at vets office and we were 10 low.
 
Hi

It sounds to me like the one unit is just too high a dose and your cats levels are dropping too much or too quickly and then bouncing back up again. Hence you are getting a series of differing values. Ideally the lantus should be slowly dropping the level and then once in the system maintaining it fairly level.

I am not experienced enough to advise on dosage but if he were my cat I would be thinking about lowering both doses so for example 0.5 unit twice a day. As lantus doesn't like inconsistency it is better to give the same amount twice a day.

There will hopefully be others who can advise better.

@julie & punkin (ga)
@Marje and Gracie @Wendy&Neko to name just a few
 
Thank you. I am using the Lantus pen and 1 unit is as low as that goes. Do you know if they have a pen with .5 unit?
 
See my signature link Glucometer Notes for feline-specific reference ranges using a variety of meter types.
So long as he stays above 50 mg/dL on a human meter or 68 mg/dL on a pet meter at the lowest glucose post-shot (aka the nadir), you can shoot lower numbers. Pop into the Lantus/Levemir forum and take a look at the sticky posts on Lantus and at some folks posts about their cat's responses to Lantus.

We use a syringe to withdraw the insulin from a Lantus pen. Syringes measure in 0.5 unit increments, plus we eyeball or use calipers to measure 0.25 unit increments.
 
You need syringes to dose cats with insulin. Changing a dose by 0.25u (one quarter of one unit) can make a very significant difference in a cat's blood sugar. We've seen the best results for most cats if they get insulin twice a day.

From the New to the Group sticky (on the Lantus/Levemir support group)
U100 3/10cc syringes with half unit markings are the best to use for fine dosing. BD, Monoject, GNP, and ReliOn are some of the brands available with half unit markings. Needle gauge and length is your preference They come in ½ inch or 5/16 inch needle lengths. Needle gauges 29, 30 or 31 (31 being the thinnest).​

Many people order syringes from www.AmericanDiabetesWholesale.com, but you can also get them at pretty much any pharmacy. It's important that you get ones with the 0.5u markings - it's hard enough to fine tune doses with those markings, but really difficult without them.

I would not trust that you can protect a cat from low blood sugar (ie, a hypo event) by just having food out. It can help, and some cats will go eat if their blood sugar drops low, but we advocate testing here, because that is the only way to know exactly what's going on and protect your kitty. Sounds like you've already got a good handle on testing and you are asking all the right questions!

Here is a great link on hometesting, with a compilation of links within, including videos and pictures, that might have something helpful for you.

Your meter is probably fine. Lantus dosing is decided based upon how low the dose takes the cat. You're seeing a low in the mid-cycle (which is typical, but also the low point will move around) in the 60's, which is good if a person is hometesting enough to keep their cat above 50. I'm not sure how often you are testing, so if you're not testing at least 3-5 times a day, that's probably a little low. It's a great number, though, for your cat. Does that make sense? What I mean is that it's about perfect as long as you are testing enough to keep him over 50. If you are only testing every few days, then it's probably a little low and you might be better off reducing the dose. I just don't know enough to suggest more specifically about his dose.

If you can get a spreadsheet going and put whatever test and dose information you have on there, that would really help. Here's the link for that. Since he's been diabetic for 4 years you've probably got a pretty good idea of what works for him.

Keep asking questions, and if you want to post on the Lantus/Lev insulin support group, feel free to do so. There are no dumb questions - we've all been in your shoes trying to figure things out with our cats. Ask away. And welcome to FDMB - the best place you never wanted to be. :D
 
julie & punkin (ga) said:
You need syringes to dose cats with insulin. Changing a dose by 0.25u (one quarter of one unit) can make a very significant difference in a cat's blood sugar. We've seen the best results for most cats if they get insulin twice a day.

From the New to the Group sticky (on the Lantus/Levemir support group)
U100 3/10cc syringes with half unit markings are the best to use for fine dosing. BD, Monoject, GNP, and ReliOn are some of the brands available with half unit markings. Needle gauge and length is your preference They come in ½ inch or 5/16 inch needle lengths. Needle gauges 29, 30 or 31 (31 being the thinnest).​

Many people order syringes from www.AmericanDiabetesWholesale.com, but you can also get them at pretty much any pharmacy. It's important that you get ones with the 0.5u markings - it's hard enough to fine tune doses with those markings, but really difficult without them.

I would not trust that you can protect a cat from low blood sugar (ie, a hypo event) by just having food out. It can help, and some cats will go eat if their blood sugar drops low, but we advocate testing here, because that is the only way to know exactly what's going on and protect your kitty. Sounds like you've already got a good handle on testing and you are asking all the right questions!

Here is a great link on hometesting, with a compilation of links within, including videos and pictures, that might have something helpful for you.

Your meter is probably fine. Lantus dosing is decided based upon how low the dose takes the cat. You're seeing a low in the mid-cycle (which is typical, but also the low point will move around) in the 60's, which is good if a person is hometesting enough to keep their cat above 50. I'm not sure how often you are testing, so if you're not testing at least 3-5 times a day, that's probably a little low. It's a great number, though, for your cat. Does that make sense? What I mean is that it's about perfect as long as you are testing enough to keep him over 50. If you are only testing every few days, then it's probably a little low and you might be better off reducing the dose. I just don't know enough to suggest more specifically about his dose.

If you can get a spreadsheet going and put whatever test and dose information you have on there, that would really help. Here's the link for that. Since he's been diabetic for 4 years you've probably got a pretty good idea of what works for him.

Keep asking questions, and if you want to post on the Lantus/Lev insulin support group, feel free to do so. There are no dumb questions - we've all been in your shoes trying to figure things out with our cats. Ask away. And welcome to FDMB - the best place you never wanted to be. :D
Click to expand...
Thanks. I found out I would have to get a new vile of Lantus. I am using the pen which has a 1 unit as the lowest. To get to .5 I am going to have to get a new set up.
I do have some numbers that I am going to put on the spreadsheet and will be testing all day Monday or Tuesday. Today at 6:25 he was at 263, no insulin. He ate his breakfast. Then at 7:35 he was at 238 ?? so I gave him his usual herb formula, B 12 and drop of chromium/vanadium. When I got home at 3:55 he was at 250? I had not left any food out, so I gave him a little. So, probably higher at 6:30 dinner time. I am having a hard time figuring out the testing, when to eat, because they are used to eating small amts during the day. etc. I am looking around some of the questions to see if there is a suggestion for this.
Thanks again.
 
You can just buy U100 syringes and use what's left of the pen as a mini-vial. That way you won't need to buy new Lantus and you can still reduce the dose. :) A lot of people here do exactly that with the pens as it gives a chance at using up all the insulin before it stops being effective - it's unlikely you'd be able to do that with a vial unless you have a high-dose cat, which it looks as though you don't.
 
Funny, I was at Walmart Pharmacy today asking him about this and he said I would have to buy a new vial!!!! And he showed me all the different needles. So, I am on your information. Thank you.
 
julie & punkin (ga) said:
You need syringes to dose cats with insulin. Changing a dose by 0.25u (one quarter of one unit) can make a very significant difference in a cat's blood sugar. We've seen the best results for most cats if they get insulin twice a day.

From the New to the Group sticky (on the Lantus/Levemir support group)
U100 3/10cc syringes with half unit markings are the best to use for fine dosing. BD, Monoject, GNP, and ReliOn are some of the brands available with half unit markings. Needle gauge and length is your preference They come in ½ inch or 5/16 inch needle lengths. Needle gauges 29, 30 or 31 (31 being the thinnest).​

Many people order syringes from www.AmericanDiabetesWholesale.com, but you can also get them at pretty much any pharmacy. It's important that you get ones with the 0.5u markings - it's hard enough to fine tune doses with those markings, but really difficult without them.

I would not trust that you can protect a cat from low blood sugar (ie, a hypo event) by just having food out. It can help, and some cats will go eat if their blood sugar drops low, but we advocate testing here, because that is the only way to know exactly what's going on and protect your kitty. Sounds like you've already got a good handle on testing and you are asking all the right questions!

Here is a great link on hometesting, with a compilation of links within, including videos and pictures, that might have something helpful for you.

Your meter is probably fine. Lantus dosing is decided based upon how low the dose takes the cat. You're seeing a low in the mid-cycle (which is typical, but also the low point will move around) in the 60's, which is good if a person is hometesting enough to keep their cat above 50. I'm not sure how often you are testing, so if you're not testing at least 3-5 times a day, that's probably a little low. It's a great number, though, for your cat. Does that make sense? What I mean is that it's about perfect as long as you are testing enough to keep him over 50. If you are only testing every few days, then it's probably a little low and you might be better off reducing the dose. I just don't know enough to suggest more specifically about his dose.

If you can get a spreadsheet going and put whatever test and dose information you have on there, that would really help. Here's the link for that. Since he's been diabetic for 4 years you've probably got a pretty good idea of what works for him.

Keep asking questions, and if you want to post on the Lantus/Lev insulin support group, feel free to do so. There are no dumb questions - we've all been in your shoes trying to figure things out with our cats. Ask away. And welcome to FDMB - the best place you never wanted to be. :D
Click to expand...
Thank you. QUESTION:
I am going to do a 12 hr curve testing this Monday or Tuesday. I am still uncertain when to start this and record my numbers. I leave food out during the night, so he may eat at 3 or 5 AM without me knowing it. I am up around 6 ish and feed him some., sometime take a reading while I am feeding him. Then around 7-8 or so I will take a reading to see where his numbers are after he has eaten something. Then decide if giving insulin. If I give insulin I know that 6-8 hrs will be the low. Then around 6 or so (or 12 hrs from the insulin shot) I will test again, and feed him. Then after eating if his numbers were not high before, test him again to see if over 300 or higher to give insulin or not. Is this correct? I guess I need to know when to start to test, when to feed and when to test after food. I can do the every 2 hrs. It's just working around the food and insulin shot that I am confused about. Thank you. I am going to look at the link you posted above on home testing.
 
bkt said:
Funny, I was at Walmart Pharmacy today asking him about this and he said I would have to buy a new vial!!!! And he showed me all the different needles. So, I am on your information. Thank you.
Click to expand...
They probably don't realize that the pen is basically just a small vial - it has the same rubber seal on it that the vial does and you can draw the insulin through that with a syringe. If they've never taken a pen apart, they wouldn't know about that.

To do the 12 hour curve, you start off with your AMPS test and then test every 2 hours through to PMPS. We usually recommend taking food away 2 hours before a shot so that the pre shot number isn't influenced by food, but if he usually free feeds right up until shot time, then it's probably best to stick with your usual routine as those are the readings you'd use every day. If you finish up not giving insulin, I wouldn't do the curve either - you want to do that on a day when he has had insulin so that you can see where the shot takes him during the cycle.
 
Will I be able to use the pen as a pen to give him the 1 unit, or will I then have to use the syringes to use the rest of the insulin? (I have never seen a syringe and I am going to google it)
 
people usually start a curve with a test before the shot. We call that the preshot, amps or pmps. A curve is testing every 2 hours for 12 hours, or every 3 hours for 18 hours.

Cycles will vary. Nadirs, the low point of the 12 hour cycle, will move around.

There are some things that override the normal Lantus cycle. Some cats react to a dose increase by having higher numbers for the following day or 2. We call that "new dose wonkiness."

A cat's body gets used to whatever range their blood sugar is usually in. Then when the blood sugar gets into any range lower than what it is used to, the body will perceive it as a hypo and release sugars and hormones to bring it back up high. We call that a bounce. Bounces can last as much as 3 days before things clear out and it drops back down again.

Those are 2 circumstances where higher blood sugar levels don't mean a cat needs more insulin.

Because of the way Lantus works, we look at the previous week or so. Individual tests don't tell as much as everything in context, for the past week when a shot is skipped, that changes the story too.

On the Lantus group, we encourage new members to ask for an experienced person to look at the spreadsheet if they think they want to increase the dose. Once you know what to look for, you won't need help, but until then it can help to have someone walk you through what you are looking at.

Syringes = needles for shots...it's more accurate to use them instead of the pen needles.
 
One you start drawing insulin out of a pen with a syringe you typically gt a little air in the pen. When there is air in the pen using the pen with pen needles to inject insulin will result in a reduced does since the air in the pen is compressible. Thus, when yo start using a syringe with a pen you should not go back to using the pen needles.
 
Wanted to put data on the spreadsheet, but can't figure out how to get to the spreadsheet.
 
Instructions are here.

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.
 
BJM said:
Instructions are here.

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.
Click to expand...
I have a gmail acct but can't get to the spreadsheet. Have a Mac and have always uses Yahoo so not familiar with Google
 
I got to the spreadsheet and have started to put in numbers. Now if I can get it to my acct for viewing!!! Today was unusual. Started out at 309 and was in the high 300s all day! Maybe the pen didnot work. I know I stuck him, but who knows?? I was going to do the 12 hour curve today, and about 4 hrs into it realized we were going up and not down!! So, I am waiting till 8PM to give him his insulin. Getting more confused in this whole process. Is there information somewhere I can read or someone explain 123 steps I should follow My vet had me giving food, then insulin and I was not originally testing.We actually went like this for the first month. Just giving the shot every 12 hours. When I started to test realized his numbers were all over the place, some as low as 68. She feels his pancreas is working some of the time. Thanks for suggestions.
 
How to add a few tidbits to your signature. (It will help us give you feedback without having to go look in all your past posts.)

Editing your Signature

In the upper right corner of the screen, within the dark blue bar, you will see ID, Inbox, and Alerts

Click on your ID.

On the left, under Settings, Click on Signature.
This is where you will put information that helps us give you feedback.
This is where you paste the link for your spreadsheet, once it is set up.
Add any other text, such as
your name,
cat's name,
date of Dx (diagnosis)
insulin
meter
any other pertinent issues like if there are any food issues, history of DKA, hepatic lipidosis, pancreatitis, allergies, IBD, etc.
Click the Save Changes button at the bottom.

Always click the Save Changes button at the bottom when you have changed anything.
 
Have saved some info in the Signature. Question: why do the numbers keep coming down after 12 hrs? 7AM 377 insulin shot 1 unit Lantus with food; at 2 PM checked and numbers were 227. He ate some during the day and slept as it is rainy and cold. At 7 PM tested and he is at 220. I didnot give him the insulin. Gave him the herbs and chrom/vanadium he has been on the last couple of years that held his diabetes in check. It has been a roller coaster of numbers. Original instructions from vet was not to give if under 300. Then changed instructions and am to give 2x a da 1 unit no matter. Confused as why we are lower after 12 hours? Shouldn't it been going up? Or is the Lantus still working and may not start going up for hours yet, and a shot would have been the thing to do? Thanks
 
You want him to stay safely above 50 mg/dL on a human glucometer and above 68 mg/dL on a pet glucometer.
We use a 'no shot' limit of 200 mg/dL on a human glucometer until the caretaker has test data showing it is safe to shoot lower.
See my signature link Glucometer Notes for info on feline specific reference ranges.
Also, see our 2 Lantus protocols:
Tight Regulation
Start Low, Go Slow
You may be able to follow one of these to optimize Shakes care.
.
 
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