My first Lantus curve isn't going well

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NatCat

NatCat

Member Since 2015
Hi, Friends.

My cat is newly diagnosed (April). He's still not stable. We have been on Novalin for months and we just made the switch to Lantus. My cat's fasting blood sugar is in the 500's each morning. Today I did a curve (non-fasting) and it doesn't look good:

7AM: 606
9AM: 510
11AM: 531
1PM: 633

He gets 3 units twice a day. Any ideas on what is going wrong here. My numbers are from an Alpha Trak monitor.
 
What IS good is that you are gathering data, and that will help us help you figure out what is going on! Can you share a little more information with us...your name and your kitty's name? What time did you shoot this morning? What is he eating? How long has he been on Lantus? And by any chance to you have a spread sheet set up?

Since people here are from all over the world, one convention we use to "tell time" is +1, +3, etc. To explain, "+1" is one hour after shooting; "+3" is three hours after shooting, etc. That way we can tell where the kitty is in the cycle regardless of where everyone is.

I'm sure others will be along to help as well....we'll get you there, no worries!!!
 
Hi and welcome to L&L Land! How long have you been using Lantus? It usually takes up to a week for the shed to fill when you start Lantus. Until then part of the dose goes into a reserve in the body and you will not see the full effect of the dose.

Using Lantus is a lot different than using Novalin, here's a link w/ a lot of info for those who are just starting w/ Lantus. Numbers on the AlphaTrak meter will be slightly higher than the ranges you see in the references, most of us use human meters. The strips are much cheaper and the clinical trial on Lantus was done using human meters.

It will help us understand what's going on w/ Nat (?) if you can get a spreadsheet set up. Then experienced members can look at the trend in his numbers. Follow the steps in this link to set up a spreadsheet. We link our SS in our signatures so other members can tak a look and give advice.

There are a few other questions we usually ask new members:
  • Where are you? Just the city. We have members in time zones all over the world and it helps to have a frame of reference. Also there may be a member near you who can help in an emergency.
  • What are you feeding? We try to feed our furbabies wet/canned food under 10% carbs. Dry food and higher carb food can dramatically increase BG.
  • Are you shooting on an exact 12 hour schedule and consistent 3u doses? The timing and dosing of Lantus needs to be stable, any variations can result in the shed rebalancing and numbers will get strange for a few cycles.
Remember, Lantus is dosed on how low a dose taking the cat not on how high the preshot is.
 
You are doing a super job! Give yourself a ton of credit for everything you do for your sweet kitty. :bighug: The folks around here have a ton of experience with feline diabetes and they will help you figure out what's going on and how to get some better numbers.
Liz
 
Well done on doing a curve and on getting your kitty switched to Lantus when you found the Novolin wasn't working well for him. :) As others have already said, depending on how recent your switch to Lantus is, it's possible that you're not seeing the full effect of the dose just yet so it might be that his numbers will come down a little further over the next few days.

Can you give us a little bit of background on the switch to Lantus please? How much Novolin was he on and how much did you change the dose when you switched to Lantus? 3 units seems like a high starting dose for Lantus, but depending on how much Novolin he was on before that and what was happening with his numbers, it might be fine as a starting point.

On the positive side, although your Alphatrak is giving you readings in the 500s and 600s, an approximate conversion to a human meter (there are no absolute conversions, especially at higher ranges, but you can get a rough idea) would put him in the mid-300s to low 400s, which if you compare it to the numbers other people get when they start out on Lantus suddenly doesn't look quite as bad! :) We don't usually suggest even attempting to convert numbers from one meter type to another, but occasionally it can be useful (and reassuring) to have an approximate idea of the difference at times like this.

You will get him to where he needs to be - and there are a lot of people here to help you do that. Because Lantus works differently from Novolin, you have to be a bit more patient with the numbers as it doesn't bring them down quickly like Novolin can. But over time, it can not only bring the numbers down into a healthy range, but keep them fairly level within that range so it really is worth persevering with. :bighug:
 
Aw, you all are so nice! Let me try to answer your questions.

My cat is Pax. That's his photo. I'm Nat(alie). I'm in Philadelphia. Pax is about 10 years old. He was diagnosed in April after losing weight. The vet was really surprised because he doesn't crave water and his behavior and coat show no changes. No kidney issues, no other health problems.

I give him each dosage with food. Usually around 7am (when I get my breakfast) and 4 or 5PM (when I get home from work). I am currently on summer break so I have lots of time to mess with this kind of thing, though.

Right now I'm transitioning him. I have four cats, all with different food issues, so it has been complicated. I was giving him Science Diet Kitten Salmon because my vet recommended the highest protein content I could find. Then, we switched to Purina Muse. I found some with 14% protien. As of yesterday, when I discovered you guys, I realized I am doing it wrong. Once I go shopping again, I think I'm going to switch to Wellness. I hear good things and my vet was really against Fancy Feast, so it seems like a good compromise.

As for the numbers that I gave you, those were after I gave him the shot at 7AM. I have see n the spreadsheet that you guys do, but they seem a bit intimidating. I'm going to sit down with it later this week. Since he was diagnosed, I have been keeping my own spreadsheet at: https://docs.google.com/spreadsheets/d/1DslliD4TKsRMw7d6FL37JKQ02Ivmn8UcjBqa64sDwcM/edit?usp=sharing
 
Manx Cat, That's why I haven't switched away from my Alpha Track. The vet understands it. I have been used to it... I wish it was cheaper, but I figure I'll swallow the cost while I am getting him stable, and once he is, I'll switch to a human meter.

If you click the link above, you will see my entire journey with Novalin we were at 7 units 2 times a day! A lot! We were on it since April. Now I'm on 3 units of Lantus 2 times a day. I sent my info to the vet- who doesn't seem to really know that much about Lantus.

I was actually thinking that maybe I should to to U Penn Veterinary Endocrinology if my veterinarian can't figure this out. It would be expensive, but it is around the corner, and it may offer me some help if my vet can't.
 
Good job on getting your own SS up. You may still want to take a look at ours, it's more compact and the color coding gives an overall view at a glance. You can just copy the SS template and paste it into a new sheet on your existing SS. The trickiest part is getting it posted and linked and you have already done that. It isn't bad once you get used to it, the colors fill in automatically.

Try to keep the shots as close to 12 hours apart as you can (within 15 minutes is best). There is an overlap w/ Lantus and an early shot can have the effect of a dose increase and longer than 12 hours can act like a reduction. Every time the dose is "increased' or "decreased" w/ Lantus the shed needs to rebalance and you can get wonky numbers for several cycles.

Take a look at this food list that Dr. Lisa Pierson put together. She contacted all the pet food makers and got the actual nutrient info from them. The list shows % of carbs from calories and is the format we use to compare foods here. There are some newer foods that aren't on the list and some have changed formulas , you can check w/ us here and we can let you know if we have any newer data. Some of the newer food that are pretty good are Nulo (available at PetSmart), Wild Calling and Dave's (usually at smaller pet stores.) Weruva also has some pretty good foods as does EVO and several others. Raw foods are usually quite low in carbs too.

I'd have to look up how the AT numbers are converted to compare to human meters. I think it is something like human meters read 18% lower, but I'm not sure. If you stick w/ the AT strips can be much cheaper online. Check out ADW, the AT strips are $56 a box there, but I only pay a little over $10 for my Agamatrix Presto strips. I wonder how hard it would be to set up a conversion sheet for the AT readings the way we have one for the World SS?
 
Hi Nat,
Welcome to LL! You are doing really good. Just keep in mind that Lantus is a depot insulin, meaning that it is absorbed slowly by the body. The result is an extended action. Lantus tends to display a cumulative effect, meaning that what happens in one cycle can affect the next cycle, or even the next several days. It will take a bit of time for the depot to build up. Typically you shoot Lantus at 12 hour intervals, so if you are feeding & shooting him at 7am, his next shot & feeding should be at 7pm.

You typically can move a shot +/- 15 minutes at a time but an early shot will have the effect of a dose increase and a late shot can have the affect of a decrease.

Due to how Lantus works, being consistent with the shot time is really important so you need to find a time that works best for you and Pax.

With food, the key is low carbohydrate food. Dr Pierson has a food list that shows the amount of carbohydrates in various cat foods - http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf Ideally, you want to be under 10% carbs. I feed Clyde EVO 95% chicken and turkey. He seemed to like it and it was only 2% carbohydrates. Max had beginning CKD and I was able to feed him the same food because it was relatively low in phosphorus.

Will
 
Thank you - that gives us all a lot more information to work from. :) It's great that you've looked at the food list and found some alternatives to try that will be low enough in carbs for him too - I'm sure that will help. :)

I'm not sure that you need a veterinary endocrinologist at this point - if he finishes up as a high-dose cat there are tests that can be run to find out if there's an underlying condition such as acromegaly or insulin resistance that's causing the high-dose requirement, but it's early days yet and we don't know if he'll actually need a high dose at this point. One thing to bear in mind is that we don't usually do whole unit increases with insulin as there is the possibility of skipping over the ideal dose. With a 3 unit dose, we would usually only increase by 0.25u at a time. And especially if you're switching to a lower carb food, you'll want to be careful that you don't drop him too low with a combination of a fairly big dose increase and the reduced carbs.

I do understand your reasons for sticking with Alphatrak for now. My vet really wanted me to use one, but I just couldn't afford to run it on top of the initial cost of Lantus. Fortunately, I'd already found this board at that point, so I was able to tell my vet "thanks, but no thanks". They weren't really happy about it, but as I wasn't using them for dose adjustments either, it wasn't really up to them!! ;) You're not alone in having a vet who doesn't fully understand Lantus - or Feline Diabetes in general. A lot of us have had similar issues with our vets and have finished up relying on the information that's available here rather than anything our vet tells us. :)

It does look as though Pax's dose increases were done in fairly big increments - that might be normal for Novolin, I'm not sure. But it's also possible that his ideal dose was skipped accidentally and you might find that he settles on a lower dose of Lantus than you expect. Working with Lantus really is an exercise in patience - it won't ever give you the hard, fast drops that Novolin does on a regular basis, but what it is very good at is keeping cats in a good number range throughout the cycle once you find a dose that works. :)

Ann & Tess said:
I'd have to look up how the AT numbers are converted to compare to human meters. I think it is something like human meters read 18% lower, but I'm not sure. If you stick w/ the AT strips can be much cheaper online. Check out ADW, the AT strips are $56 a box there, but I only pay a little over $10 for my Agamatrix Presto strips. I wonder how hard it would be to set up a conversion sheet for the AT readings the way we have one for the World SS?
Click to expand...
The number I see quoted most often is that there's a 30-40% difference in the readings between human meters and AT at normal levels. There was some discussion about conversion charts in one of the other sub-forums, but I think the general feeling was that, with the +/- 20% variance on all meters, plus the 30-40% difference between the 2 types, it was too complicated and not accurate enough to attempt a full conversion. I did a rough conversion on the numbers Nat has got from Pax today using 35% but I doubt that would hold up if a human meter had actually been used - it was just to give her an idea that the AT numbers might not actually be as bad as they look compared to what other people see using a human meter. :)
 
Hi Nat-

This is a very quick response because I'm at work right now, but another thing that will probably help is shooting insulin as close to a 12 hour schedule as possible. Every time you shoot early (ie, less than 12 hours) it acts like a dose increase, and every time you shoot late (greater than 12 hours), it acts like a decrease. When you shoot 12 hours apart, things are more consistent and hopefully Pax's pancreas will settle in with that consistency.

I agree that I don't think you need to take Pax to an endocrinologist just yet. It can take a while for a kitty to adjust to being on insulin.

Other very important factors to consider is how Pax is feeling and acting - remembering that he is more than his numbers, he's a "whole cat"! The main goal is to make sure he is healthy and feeling good.

There are stickies at the top of the forum here with a TON of information. It can be very overwhelming, so please ask as many questions as you need!
 
Nat, my Cooper was diagnosed at the end of March. Before I found this board, I was so upset and started to think Cooper also was a high dose cat and needed an endocrinologist. He was running high all the time.

However, I got on this board and got awesome advice. Take a look at Cooper's spreadsheet (in my signature). He has generally been running in the 100's or less now (on an AT meter as well) for the last week and a half. Prior to that I had lots of 400 and 500s. It sucked.

It's very important to get a spreadsheet set up like a lot of us have here. I started out just like you with my own version and once I switched to the color-coded one, it all made soooo much more sense. I could start to see patterns and the people on this board could help me better that way.

You need to be very consistent with your dosing as others have said. If possible, you need to do more testing during each cycle. Especially as he hopefully starts getting into lower numbers. The dosing of Lantus and Levemir are based mostly on the nadir (lowest point of the cycle), not the pre-shot value.

I encourage you to read the "stickies" at the top of the page here: http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/. These will help you get a better understanding of the different dosing protocols that are followed here. Personally we are following TR (tight regulation).

You're going to get great help on this board!!
 
mstyles said:
Nat, my Cooper was diagnosed at the end of March. Before I found this board, I was so upset and started to think Cooper also was a high dose cat and needed an endocrinologist. He was running high all the time.

However, I got on this board and got awesome advice. Take a look at Cooper's spreadsheet (in my signature). He has generally been running in the 100's or less now (on an AT meter as well) for the last week and a half. Prior to that I had lots of 400 and 500s. It sucked.

It's very important to get a spreadsheet set up like a lot of us have here. I started out just like you with my own version and once I switched to the color-coded one, it all made soooo much more sense. I could start to see patterns and the people on this board could help me better that way.

You need to be very consistent with your dosing as others have said. If possible, you need to do more testing during each cycle. Especially as he hopefully starts getting into lower numbers. The dosing of Lantus and Levemir are based mostly on the nadir (lowest point of the cycle), not the pre-shot value.

I encourage you to read the "stickies" at the top of the page here: http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/. These will help you get a better understanding of the different dosing protocols that are followed here. Personally we are following TR (tight regulation).

You're going to get great help on this board!!
Click to expand...


Thanks for giving me hope! I really appreciate this!
 
Hey Nat, welcome!

Looks like everyone pretty much covered the details for you so far. I'm no expert as of now but I've been doing the Lantus dance since April and it appears we may be neighbors - so if there is anything you might need help on, just shoot me a PM :)

My vet is actually in Jersey (25 min drive) since I couldn't find any I liked in Philly. She's not 100% sure what I'm doing with TR and this forum, but she is open minded and is letting me do my thing.

Good luck!

Edit - Oh and I use wellness core for my kitty. I get a pretty good deal by doing an auto ship from Chewy.com.
 
Welcome to the Lantus and Lev board.

I still consider my self as being from Philly (grew up there) but I've been living in the midwest for a very long time! I do miss Philly!!

Novolin is a good insulin for some cats. It wasn't for Gabby. My vet felt that it was a better insulin for dogs than cats. A cat's metabolism is about twice the tempo of a humans and Novolin tends to not last the 12 hours between shots. This may be why his numbers were less than wonderful on Novolin (we also refer to it as "N" or Humulin N -- it has a bunch of names).

I'd encourage you to take a look at the sticky notes at the top of the board if you've not done so already. There's an overwhelming amount of information in the notes and links. The info will, however, give you a solid foundation on how Lantus works and the dosing strategies that we use. It looks to me like your vet isn't familiar with Tight Regulation and has been raising Pax's dose in much larger amounts than the research would recommend. Let us know if you want the actual journal article(s) to share with your vet.

I feed Wellness. My rationale may be a bit different than your vet's, though. I don't feed my guys fish and even some of the poultry flavors of Fancy Feast contain fish. You should be aware that Wellness is high in fat and therefore calories which is the downside of that particular brand. We are big advocates of a canned food diet. If you want to do more reading on feline nutrition, the site I linked is excellent.

Please let us know if you have questions. The people here are exceptionally generous with their time and knowledge.

 
Aw, thank you!
I'm planning on spending some time with the Sticky notes today.

Could I have the journal article? My boyfriend is actually the one I need to convince.

My vet actually did not choose wellness. Strangely enough, my vet said any kitten food would be fine. I chose wellness because my boyfriend refuses to give Fancy Feast. Our vet said Fancy feast is really bad, and he won't shake that. That being said, my cat lost a lot of weight and we want to get him a little fatter, so we chose Wellness to bulk him up a bit.
 
I've attached the original journal article where the research on the Tight Regulation Protocol for Lantus and Lev were first introduced. There's been a more recent descriptive article. For the science oriented people, I like the article I attached better.
 

Attachments

Thank you... I will share this with my veternarian and with my boyfriend. Let's hope this teaches me something too!
 
NatCat said:
Could I have the journal article?
Click to expand...
Sienne and Gabby said:
I've attached the original journal article where the research on the Tight Regulation Protocol for Lantus and Lev were first introduced. There's been a more recent descriptive article. For the science oriented people, I like the article I attached better.
Click to expand...
Here's the link to the most recent journal article published (2013) from the creators of the Tight Regulation Protocol which is used by some on the FDMB:

Management of Diabetic Cats with Long-acting Insulin.

This link is also found in the Lantus & Levemir - Tight Regulation Protocol sticky.


 
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