Need advice re: holding lantus

Vanessa Curry

Vanessa Curry

Member Since 2019
Hi. I am a newbie here. My cat Mr. Bean just started Lantus. He has had 2 doses. His first reading (we bought an AlphaTrak2 on recommendation of vet) was 365. Gave 2 units of Lantus. Next reading was 125. We never received any guidelines as to when to "hold" the insulin. (My vet is now out of town.) We just held it. Next reading was 315, gave 2 units. Can anyone provide any guidelines in the meantime of when to hold? We feel pretty adrift here.

Misc info: Bean is 12 yo, 10 pounds, eats 70/30 wet to dry. We are going to start transitioning over to wet, and stop free feeding dry. He also just stopped prednisone for IBD after being diagnosed.
 
Hi Vanessa! Welcome!

Good job on holding on insulin until you were comfortable giving it. How long after the 125 reading did you do the second test?

Have you read through the stickies on the Lantus forum? One of the most important tools we use here is the spreadsheet. Are you able to set that up and input all the readings as well as the doses of insulin you gave? Here are the instructions: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

Is Mr. Bean a newly diagnosed diabetic? Or did you switch from another type of insulin? If so, what was it and how many units was Mr. Bean on?

In regards to the prednisone, when was the last dose given and how is Mr. Bean doing now since stopping pred?
 
I would also advise doing a curve today if you're able. A test every two hours for 12 hours would help gather a lot of info and would tell us how 2 units is working on Mr. Bean. If you're not about to, please try to get at least 1-2 tests this cycle. A good time to test is usually 2 hours after you've given insulin as well as 4-6 hours after insulin.
 
Good morning and welcome to the group! Mr. Bean is a wonderful name. I'm happy you found FDMB. This is an awesome group of collective knowledge. Very informative people and documents! You may want to look this document over http://www.felinediabetes.com/FDMB/threads/the-basics-new-to-the-group-start-here.18139/ if you haven't already. It's a good place to begin. I'm new to the group, as well. LOVE it here!!!!! I just wanted to give you and Mr. Bean a BIG welcome!!! Have a wonderful day!!!:)
 
Thank you for the warm welcome!

Yes, Mr. Bean is a brand new diabetic. He was just diagnosed about 4 days ago (it took us a couple of days to get the Lantus pen and all the supplies). Out of all of our cats, he is the one I least expected this to happen to!

I will make a spreadsheet today. (I just found the site, so I will try to spend some time today reading the stickies, just wanted to post in case his reading was lower again.)

After his first dose of insulin, I rechecked his glucose before his next dose, so about 12 hours later. That was when his glucose dropped from 365 to 125. I held the insulin, then another 12 hours passed, and he was back up to 315. Just now (another 12 hours past the reading of 315), he was back up to 360. We gave the 2 units of lantus again. I am comfortable giving the lantus in the 200-300s, but just not sure when to hold below that.

So far, he has been off the prednisone for 3 days (but really only missed one dose - he was getting every other day dosing). He had been on it for a couple of months. His stools were *much* better on the pred, so I am hoping stopping it doesn't flare this up as well. I understand that the prednisone exacerbates the diabetes.

He has an appt today with a rehabilitation specialist to see if some intervention might help his arthritis/mobility difficulty too. They offer cold laser therapy, acupuncture, etc. That should be interesting!
 
2 units seems like a large dose for a new diabetic. I strongly recommend you do a curve this cycle to make sure 2 units is not too much for Mr. Bean. Most cats start at 0.5 to 1 unit.

Can you do another test now? How long has it been since you gave insulin?
 
Are you able to test Mr. Bean every two hours today? However, I would test him at +1 and +2 (1 hour after and 2 hours after insulin) just in case. So your next test should be in 30 minutes.

With Lantus, we dose based on the nadir which is the time within a cycle that insulin is working at its peak or the lowest blood glucose level in the cycle. We only take some consideration in regards to pre-shot numbers.
 
The vet wanted to do the curve at 7 days after starting. Is that too far out? She wasn"t going to have us test daily either, but I was just not comfortable with that. I am a nurse, used to checking the glucose on a patient before they get their injection, so not testing, especially at the beginning, seemed crazy to me!
 
That's a common thing vets recommend but as a nurse, I'm sure you know it's much safer to test! I'm so glad you listened to your instincts!

Did you vet also recommend to feed twice a day? It's best to feed several small meals throughout the day. It's easier on the pancreas and keeps kitty happy.
 
I will have to do the extra testing tomorrow, as I have several doctors appointments today, but I will be home all day tomorrow, so can make sure to do it then. Bean does not seem to be a fan of the ear sticks. Hopefully that part will get easier.
 
Okay, since you won't be home today, let's see what Mr. Beans numbers are like at the next test and go from there. You may need to leave food out for Mr. Bean to eat while you're away.
 
Yes, vet recommended twice a day feedings too. We do wet food twice a day now for everyone, and there is dry free feeding (grain free). We are doing to start taking that up. Some of our cats prefer wet, some dry, and some will eat whatever. I am working from home now, so I can be home to do some feedings during the day if that is a better option.

Is everyone feeding the prescription diets or just low carb foods? We normally feed Fancy Feast pate. I read that these aren't too bad, carb-wise.
 
Oops, I glossed over the part where you’re taking Mr. Bean to a vet appointment. So at least he’ll be with you for part of the day :)

Most of us here feed fancy feast classics or Friskies pates. They’re low carb and affordable. Prescription DM wet food is acceptable but it’s expensive. Dry food should be cut out for diabetic cats. I know however that can be difficult for a multi-cat household. Perhaps someone in that situation can chime in with some advice. There ARE low to zero carb dry food options if it’s absolutely needed.
 
No problem! We all know how it feels and how overwhelming it can be. Take some time tomorrow and read through everything. I’ve been on this journey for about a year and it’s still so important to re-read everything.

Continue to ask questions, even if you have to ask them multiple times. There’s always someone willing to help.

Let us know what Mr. Bean’s next reading is :)
 
Welcome Vanessa and Mr. Bean! We'll be looking forward to seeing your spreadsheet. It will be upon seeing the SS that most members will be more comfortable giving advice. In the meantime, please try to get as many tests as you can...and I agree...I think that's too big of a starting dose. However, most vets always seem to want to send their patients home with that advice; give 2 units twice a day - fortunately I only did that one time...Luci dropped like a rock from her first dose...scared me half to death...upon the advice I received from this forum, we backed down and increased slowly over time...it was a long time before Luci needed 2 units...

:)
 
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