need advice with Lantus asap

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3cats

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My cat, Fred, was diagnosed with diabetes on 1/4 - blood glucose was 609. He is about 10 years old, weighs 15 pounds and has hypertropic cardiomyopathy & arrhythmia for which he has been on medications for 3 years. I have another cat that was diabetic a few years ago but quickly went into remission on Lantus. However the vet that I used during that time has moved away, so I took Fred to another vet who agreed to prescribe the Lantus but wasn't as familiar with it (I gave them materials from this website). My cats are picky eaters and prefer dry food. I immediately switched him to Purina DM (he was on cardio food prior) and he supplements that with about a jar of chicken baby food (0 carbs), I have been able to get him to eat some FF-Classic canned and trying to wean off the dry.
Fred started out on 1 unit of Lantus twice a day and had weekly vet visits to check his glucose levels. By week 2, the dose was increased to 3 units twice a day because his glucose was 490. The next week he was at 320 and the dose was increased to 3 1/2 units twice daily. The next week he was at 258, kept at same dose. The next week he was 450 and dose increased to 4 units twice daily. The next week he was 325 and dr. wanted to increase to 5 units but I didn't agree so no change made. The next week he was at 287 and dose was decreased to 3 1/2. The next week he was at 393, dose kept the same - that was week #7. Week #8 started yesterday and I was finally able to get some blood for a home test and he's at 595 before his a.m. injection, 560 3 hrs. post injection. I panicked and gave him 4 units for p.m. injection and he was 493 1 hr. later; today his pre-morning injection level was greater than 600 (meter won't show the actual #), then at 562 6 hrs. after the injection. He is not showing extreme signs like hanging out at the water bowl or excessive urination (his water in-take is currently a little above his normal) - in fact he slept all day in between the a.m. injection and when I tested him 6 hrs. later. Sorry I don't have a better curve of numbers to show but it is literally hit or miss with me getting blood from his ear and him cooperating. I've decided to take him to the original vet that moved further away that has more experience with Lantus but can't get an appointment until Thurs. From reading posts on this site, it appears he could be having the rebound effect from too much insulin or be insulin resistant or that the insulin is bad after 7 weeks. My question is whether I should continue to give insulin until Thurs., and what amount? His next injection is due at 7:30 tonight so maybe someone can give some advice before then. Thanks for any input.
 
I usually do not give advice but lantus cannot have dosage jumped around like that. It needs to build a shed and that can take 2-5 days to do so.
If it were me,
first I would learn to test (think you are already doing that)
would make sure I tested before each shot (every 12 hours) make sure get
at least a +6. 6 hours after shot. you need to find the nadir (when insulin peaks) . lantus is dosed according to this and not the pre shot number

second switch food to low carb canned. check janet and binky food chart for foods <10 grams carbs

third reduce dose back down to 1u and start over. I think cat is bouncing form too much insulin

hopefully others will be around to expand on this.
go to lantus board and read all the stickies on lantus. BIG HELP there
 
Could be too much insulin or not enough. I would start over a 1 undit twice daily.

My Tonis initially responded like your Fred. BG went down and then went up with increasing does. I finally got good BGs with using 9 units of Levimer and 4 units of N twice daily. I started on Lantus but then switched to Levimer since the Lantus was not doing much.
 
3cats said:
My cat, Fred, was diagnosed with diabetes on 1/4 - blood glucose was 609. He is about 10 years old, weighs 15 pounds and has hypertropic cardiomyopathy & arrhythmia for which he has been on medications for 3 years. I have another cat that was diabetic a few years ago but quickly went into remission on Lantus. However the vet that I used during that time has moved away, so I took Fred to another vet who agreed to prescribe the Lantus but wasn't as familiar with it (I gave them materials from this website). My cats are picky eaters and prefer dry food. I immediately switched him to Purina DM (he was on cardio food prior) and he supplements that with about a jar of chicken baby food (0 carbs), I have been able to get him to eat some FF-Classic canned and trying to wean off the dry.
Fred started out on 1 unit of Lantus twice a day and had weekly vet visits to check his glucose levels. By week 2, the dose was increased to 3 units twice a day because his glucose was 490. The next week he was at 320 and the dose was increased to 3 1/2 units twice daily. The next week he was at 258, kept at same dose. The next week he was 450 and dose increased to 4 units twice daily. The next week he was 325 and dr. wanted to increase to 5 units but I didn't agree so no change made. The next week he was at 287 and dose was decreased to 3 1/2. The next week he was at 393, dose kept the same - that was week #7. Week #8 started yesterday and I was finally able to get some blood for a home test and he's at 595 before his a.m. injection, 560 3 hrs. post injection. I panicked and gave him 4 units for p.m. injection and he was 493 1 hr. later; today his pre-morning injection level was greater than 600 (meter won't show the actual #), then at 562 6 hrs. after the injection. He is not showing extreme signs like hanging out at the water bowl or excessive urination (his water in-take is currently a little above his normal) - in fact he slept all day in between the a.m. injection and when I tested him 6 hrs. later. Sorry I don't have a better curve of numbers to show but it is literally hit or miss with me getting blood from his ear and him cooperating. I've decided to take him to the original vet that moved further away that has more experience with Lantus but can't get an appointment until Thurs. From reading posts on this site, it appears he could be having the rebound effect from too much insulin or be insulin resistant or that the insulin is bad after 7 weeks. My question is whether I should continue to give insulin until Thurs., and what amount? His next injection is due at 7:30 tonight so maybe someone can give some advice before then. Thanks for any input.
Click to expand...

OK Lantus is good for 28days; that's the guarantee. I think by the 7week mark your insulin could be toast.

You are giving an awful lot of insulin so you really need to be home testing and know the signs of hypo incidents. Get a blood glucose meter at the pharmacy, test strips and lancets for the meter, and also pick up a container of KETOSTIX. With such high BG numbers, you need to be testing his urine for ketones. Pick up a Relion meter as it's got the most inexpensive test strips.

I would get fresh Lantus; don't get a vial, but instead ask to get Lantus pens or cartridges and you won't have waste.

Any cat that is needing 9units of insulin as well as an additional insulin had an insulin resistance condition, so whether your insulin is still working or not, I would think to drop back in dose to maybe 2units, until you are able to test regularly and be using fresh insulin.
 
Yes I agree, you should get a new vial of Lantus and better yet, to save money and have the vial/vials last longer, I would highly recommend getting the Lantus in 'pen cartridges'. They come 5 to a box so not only are you going to be able to have the equivalent of 5 smaller 'fresh' vials so the won't expire so soon, but that makes it cheaper still in the long run.

You'll have a fresher batch of Lantus if you suspect your vial has finally pooped out and it will be ready at hand.

A very important thing I learned when getting the prescription from your vet for the Lantus pen cartridges (they look like skinny vials with the same rubber stop at the end like the big vial) is that your vet Must Write the script for Pen Cartridges. If she/he doesn't, the pharmacy will only give you the Lantus in the vial container. So save time by asking the vet to write the script for 'pen cartridges'. And because most vets are so busy, they can accidentally without thinking, quickly write the script without saying 'for pen cartridge'. Better yet, just have them call it in to your pharmacy while your standing there.

It will save time and money in the long run with the cartridges. Best thing I ever did! V
 
I also feel you should drop back to 2U and keep each dose for at least 3 days before deciding that he needs more and then raise by 1/2 units at a time. As long as he eats dry food, a dose of 4-5 units bid is not unusual and in fact is what my Racci needed. Even now that she is on wet with dry as snack treats, she still needs 3.5 to 4units. She weighs about 18.5-19 lbs now. I have to weigh her again. She lost some weight. She was raised slowly but was practically resistant to insulin. Lantus was her second type.

I would also be testing for ketones as suggested any time he's in the 400's just to play it safe. Sleeping a lot can also be a symptom. It's hard to tell if he needs more or less but I suspect more. It's just a real pain to have to go back and reduce when you miss the ideal spot.

Melanie & Racci
 
Update on Fred: I went ahead and gave 3 units last night and I removed all the dry Purina DM. I only left out chicken baby food and FF chicken classic wet foods. This morning I awoke with 50 pounds of cats (all 3 of them) sitting on top of me wanting to be fed dry food. It was hard, but I resisted. Fred tested 531 this morning which would have been around 12 hours after last insulin and with barely any carbs eaten. I gave 3 units this morning. I tested him at 6 hours post-shot and he was at 414. He is still not drinking that much water or urinating more than usual - which seems odd with #s that high.

I have already considered getting the Lantus pens this time and my pharmacist is actually holding it until after our appointment with the vet tomorrow. Thanks for the heads-up about getting the rx written correctly. How are you giving 1/2 units using the pens? The pharmacist is trying to rig me up some syringes with the appropriate sized screw-on needle, so I can shoot the pen dose of 1 unit into the syringe and then give him 1/2 unit of it. Is this what others have done?
 
Regarding Latus dosing, I recently read in "AAHA Diabetes Management Guidelines for Dogs and Cats" (I found it on-line) published 2010 in the Journal of the American Animal Hospital Association, that the dose should not exceed 3 units per injection during the first month, and it also says the majority of cats do not need greater than 3 units every 12 hours to control diabetes.
 
The Lantus pen has been discussed in years past (I've been here since 2004) and from the many discussions on this subject, it has been found to best not use the Lantus pen mechanism and only use the pen cartridges to use in drawing the insulin into the syringe.

You get better acuracy by using the syringe. So do get the pen cartridges as you will have a longer lasting 'fresh' supply of Lantus at the ready though. They are like having mini vials which have the same rubber stopper at the tip for easy syringe drawing/filling. V

Edited to add.. Do be careful with the amount of insulin you are giving if you are cutting way back on the carbs. What can happen is that the numbers can go waaay down and then you either have a problem with a potential hypo or go into 'rebound'. Also known as the Somogyi Effect. Please take the few moments to read about this at the link as it's very important to be aware of this effect which is also called 'rebound'. http://felinediabetes.com/concurrent-somogyi.htm
 
You do not use the pen needles; you use syringes to extract the right dose from the pens.
see attached.


you get a box of syringes with 1/2 unit markings on them. I have always bought BD syringes as there's no others around me.
 

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Please post again after your visit. There are many people who are willing and able to help you! It sounds like you have a good baseline of knowledge from your previous cat. You definitely want to get him off dry food--totally! Sometimes the switch to a low carb wet food will make a big difference.

We would be interested to see your blood glucose values in a spreadsheet so that those (not me!) with the most experience can advise you. Here is a link with instructions.
http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207
I think you will also benefit from running a curve: test every 2 hours in a 12 hour cycle. This will show if you are getting a lower blood glucose that you don't know about. His nadir, or low point, may not be right at 6 hours.

Where have you been keeping the Lantus and how do you handle it? If you're careful with it, it is not necessarily bad at 28 days. Keep it in the refrigerator, don't shake it, and don't inject insulin back into the bottle (it can contaminate it with the lubricant in the syringe). Here is more info on that: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=151. IT won't hurt to get a new pen, though.

In general, read the new to the board stickies and you will find lots of info. See all the things in caps and bold here http://www.felinediabetes.com/FDMB/viewforum.php?f=9
 
Talk about confusing.... He was 532 pre-shot this a.m. After a very stressful wait to see the vet today, he tested at 350. I explained the high numbers he had this week and about removing his DM dry food and was basically scolded and told to let him go back to free feeding on the DM dry along with low carb wet food. I was told not to keep testing him throughout the day, just to test in 5 days pre-shot and report back with the number. (Not sure if this was their normal protocol or they told me this because I was in such a state of stress about his numbers.) I did get the rx for the Lantus pens and will start using the new stuff tonight (3 units). Thanks to everyone for all the input and advice! This site is an amazing resource. I'll post an update later.
 
3cats said:
Talk about confusing.... He was 532 pre-shot this a.m. After a very stressful wait to see the vet today, he tested at 350. I explained the high numbers he had this week and about removing his DM dry food and was basically scolded and told to let him go back to free feeding on the DM dry along with low carb wet food. I was told not to keep testing him throughout the day, just to test in 5 days pre-shot and report back with the number. (Not sure if this was their normal protocol or they told me this because I was in such a state of stress about his numbers.) I did get the rx for the Lantus pens and will start using the new stuff tonight (3 units). Thanks to everyone for all the input and advice! This site is an amazing resource. I'll post an update later.
Click to expand...

Great that you got the rx and have fresh insulin.
Now please be sure that you test at pre-shot and at +2 and +3, just to be sure you are not seeing a fast drop of his numbers from the fresh Lantus.

Also, start looking around to see if you can find a real vet near you.
Toss the dry food out the window.

maybe you can give this link to your 'vet' and suggest the vet visit the site and READ the reasons for testing blood sugar.
http://www.diabeteshome.ca/how-can-blood-sugar.php
Glucose Monitoring

How can I tell what my Blood Sugar is?

Many varieties of blood glucose monitors are currently available in Canadian pharmacies. They all involve pricking a finger with a needle to get a drop of blood, applying the blood to a testing strip, and having the monitoring machine measure the glucose from the testing strip. There are various "pokers" (lancing devices) on the market. Some are less painful than others, by virtue of an adjustable depth of penetration of the needle (lancet), the fineness of the needle, how much vibration is produced, and so on. The specific type of monitor and lancing device appropriate for you should be discussed with your diabetes educator.

Why should I Monitor?

There are many reasons.

Monitoring shows you what your blood glucose is doing at the best of times, while you are feeling good and in your usual routine. This allows you to interpret the readings under more unusual circumstances. It also lets you to catch any changes in your glucose as time goes by.
It shows you how your blood glucose varies over the course of the day, indicating trends.
It shows you what happens to your blood glucose if there is a change in your diet, such as going out to supper.
It shows you what happens to your blood glucose when there is a change in physical activity, such as playing sports.
It shows you what is happening to your blood glucose in times of illness.
It shows you what happens to your glucose when there is a change in medication (for diabetes or any other illness), and where further changes need to be made.
To let you know if a sensation that you are feeling is due to a glucose that is too low or too high.
If recorded properly, it shows your doctor all of the above so that he can better advise you about your diabetes medications.
The readings are not for the doctor (although they certainly help him/her) - they are mainly for you!

When should I Test my Blood Sugar?

Testing the blood before meals and after offers different information. As a general rule, readings taken before meals indicate how low your glucose can get. Testing after meals shows you how high the blood glucose went, due to the absorption of the food. It should be done 2 hours after eating. Both pre-meal and post-meal testing supply important information. The most common mistake people make in testing is always testing at the same time of day.

Testing once daily at the same time of day (typically before breakfast) does not supply sufficient information about what is happening. You have diabetes 24 hours a day, so you should explore what happens to your blood glucose at various times! Testing times should be rotated.

Ask your vet why your diabetic cat is not important as human diabetics.
See what kind of answer you get.
 
Re: (update) need advice with Lantus asap

Update and more questions:

I lowered the dose to 3 units twice daily and checked his glucose pre-shot & + 2,+3,+6 during the day but on pre-shot in the p.m. For 5 days, he has been consistently >600 with the lowest # @ 540. I'm now reducing the dose to try to rule out chronic overdose as the cause of the high numbers. How slowly do I need to decrease? Do I need to keep the same dose for 3 days each while decreasing (e.g., move from 3 units to 2.5 for 3 days, then decrease to 2 units, etc.)? Also, any ideas on how long should it take to see a change in #s?
 
Hi, I'm not experienced, but I came over from the Lantus board. Someone put up a link to your post and hopefully you'll get more eyes soon!
 
It would really help if you could get the data that you have into a spreadsheet for us as per the link supplied earlier by Kim.

Do not change the dose for at least three days and then seek advice on one of the lantus forums before you do. Let's see what Fred is doing with this dose before deciding whether to move up or down. Please continue to get a pre shot test everytime you shoot and at least one mid cycle test per cycle between about +5 and +7 and any other spot checks you can get. The sooner you can get a curve (tests every two hours between cycles) the better, not every cat has their nadir mid cycle.

Please feel free to post daily in one of the lantus forums with Freds numbers in the meantime. I would recommend the Tight Regulation forum as it is the busiest. You will get the most experienced eyes on Fred there and people will get to know you and Fred and be able to tailor their advice specifically for you.

Are you testing for ketones?
 
Once you get a REAL VET, (I had one that told me the same thing yours did once, I smiled pretty walked out of the office and replaced them with a vet that had some sense) I would suggest that you take your glucometer in with you and have them compare numbers when they check the sugar. Just have them take it with both machines, theirs and yours. This way, you ensure that yours is accurate. Regular home testing is the way to go. It will help you be a little more comfortable in the levels.

Check out the tight regulation page for how to do the curve testing and set the amount to scale up and down to get a good dose for control.

Consider a raw food, wet food or a low carb diet so that you can work on getting better control. I found that feeding dry food caused more spikes in my cat’s BG.

I have to say that I feel you on the waking up to cats wanting to be fed… I won’t tell you that they get any better but I will say that the break from Dry food (especially the DM stuff) is a good move.

You may consider keeping the insulin dose the same (3 units b.i.d.) and looking for other causes of the high sugar. Look at what all they are eating, the treats your giving them, are they accessing any other foods? I say this because mine hid a pack of hot dog buns once and that was why his sugar was spiking. Another time, he ripped into a bag of spaghetti noodles… needless to say, he was having some separation anxiety from the free range eating.

Consider a full panel of bloodwork to make sure he doesn’t have an infection or other medical issue that is causing the problem. I would do that with the new vet, see if you can find one that has a specialization in diabetic animals or at least knows a little about it.
 
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