Need dosing help - gone hypo twice in past 7 days

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MrW

Member Since 2012
Hi all,

In dire need of dosing advice. I have a 19 year old kitty, Mr. Wendall, who was diagnosed in early June. I have been told to give him .5 units of lantus if he drops below 300. Which means of late once a day dosing. This is based on a fructosamine test done last week - he had a 236 which the doctor thought was low. I've given him a couple of .5 doses while he's been in the mid 200 range and he has indeed gone hypo. Twice that I know of in the past week. I'm at a total loss as to what to do. I know with lantus he should be dosed twice a day. I didn't give him insulin yesterday morning and he went up to 344 in the evening. I gave him a fat .5/.75 unit last night. He went down to 232 this morning and I gave him .25 units. I would love more consistency. I could really use some advice.

A bit of background. He has been on canned food only for at least 3 years. He has been on prednisolone for 3 years and we are currently in the process of weaning him off. He had a bad day today - very weak and lethargic. His blood work was ok. The doctor thinks he's being weaned off the pred too quickly so she wants him to increase to 2.5mg once a day for 2 weeks. Then taper down from there. His doctor believes he may have steroid induced diabetes so we're trying to get him off.

At his age, should I expect him to achieve normal range? Or do I find a new normal for him, and how is that determined?

Much appreciation,
Lorin
 
Lantus like consistancy and as you know works best with cats when given twice a day (every 12 hours).
Hopefully, you can figure out a dose that you can give consistantly, twice a day. You will need to get some more night time tests. I would test him before you go to bed, and then set your alarm clock to test him at around what you think is his nadir time.
 
MrW said:
He has been on prednisolone for 3 years and we are currently in the process of weaning him off. He had a bad day today - very weak and lethargic. His blood work was ok. The doctor thinks he's being weaned off the pred too quickly so she wants him to increase to 2.5mg once a day for 2 weeks. Then taper down from there. His doctor believes he may have steroid induced diabetes so we're trying to get him off.
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Hi Lorin-
I had a cat with steroid induced diabetes. I weaned her off and attempted another medication. Her BG's looked real good, but she did not. I put her back on the steroids the remainder of her life and did my best to manage the diabetes around it. What is your kitty using the steroids for? If it is a quality of life issue, AND it helps than I would consider keeping him on them.

I am not sure what kind of numbers you are referring to as hypo...200's are considered diabetic (I see your ss). However, if you were weaning the pred and indeed he does have pred induced diabetes, that would have possibly affected his BG's to go lower. If my kitty vomited her pred, or I could not get it in her I knew I had to watch numbers like a hawk in that cycle. Steroids really can make a BIG difference.
 
Thanks for the reply. Do you have any suggestions for dosing? He was on .5 for a few days, but I haven't been able to consistently dose twice a day with it because of late it brings him down too low mid day. I will try to get more evening shots too to see how he's doing.
 
When did you start weaning the pred? 7/7? How did you do that? And one more question...is he completely off the pred now?
 
I was just wondering if you would have better luck with a smaller dose.
You could try to give a .25u dose, and it may be helpful if you can get a before-bed test in the pm cycle as many cats go lower in the evenings.
 
Hi Carolyn,

Thanks...Mr. Wendall was diagnosed with small cell lymphoma in 2009. He was on leukeran and prednisolone. We eventually weaned him off the leukeran, but kept the pred on as maintenance. He also has arthritis and pancreatitis. So we thought the steroids were helping him with those issues as well. He's developed quite a bit of muscle wasting on his hind legs over the past few years. We believe it's from the steroids. At this point he is unable to walk on his own. Though I'm not attributing this to the steroids. He is currently in rehab to teach him to walk and rebuild his muscles. He's doing great. Yeah! While in therapy he's been receiving acupuncture daily and he gets adequate weekly to help with his arthritis. He just had a check up with his oncologist who did bloodwork and an ultrasound and feels the lymphoma is(knock on wood) still in remission. With the muscle wasting and the diabetes it was felt if we could get him off the steroids then let's do it.

In regards to hypo numbers. On the 17th he went down to around 44, while at the vet. Then this past Sunday during another vet visit I had them check his numbers and he was mid-40's again. An hour later when I brought him home he was 37. This was all while he was dosed with .5 units. And both times around 6-7 hours after his am shot.

I'm curious, when you say your cat did not look good off the steroids, what exactly do you mean?
 
MrW said:
Hi Carolyn,

Thanks...Mr. Wendall was diagnosed with small cell lymphoma in 2009. He was on leukeran and prednisolone. We eventually weaned him off the leukeran, but kept the pred on as maintenance. He also has arthritis and pancreatitis. So we thought the steroids were helping him with those issues as well. He's developed quite a bit of muscle wasting on his hind legs over the past few years. We believe it's from the steroids. At this point he is unable to walk on his own. Though I'm not attributing this to the steroids. He is currently in rehab to teach him to walk and rebuild his muscles. He's doing great. Yeah! While in therapy he's been receiving acupuncture daily and he gets adequate weekly to help with his arthritis. He just had a check up with his oncologist who did bloodwork and an ultrasound and feels the lymphoma is(knock on wood) still in remission. With the muscle wasting and the diabetes it was felt if we could get him off the steroids then let's do it.

In regards to hypo numbers. On the 17th he went down to around 44, while at the vet. Then this past Sunday during another vet visit I had them check his numbers and he was mid-40's again. An hour later when I brought him home he was 37. This was all while he was dosed with .5 units. And both times around 6-7 hours after his am shot.

I'm curious, when you say your cat did not look good off the steroids, what exactly do you mean?
Click to expand...

Latte had IBD/Lymphoma, also pancreatitis, arthritis, ARF/CRF, and prone to urinary infections. I took her off the steroid when she became diabetic. She stopped eating and was vomiting a lot. The pred obviously helped her a great deal. We tried Leukeran, but her reactions to the chemo I think almost killed her. She would not move, eat, nothing. 12 hrs back on the pred and she was back to her old self.

Interesting about the muscle wasting from pred. I guess I never thought of that. Latte had 2 episodes of tweaking her back, or legs, or something and could not walk. The first time it lasted a few days and improved. The final time it was a week...even tried acupuncture. She never walked again. I had to let her go due to numerous reasons. I am so glad you are able to do all this therapy for him AND he is responding. Sounds like you have a great team of vets working for you guys! :mrgreen: And you...juggling all these issues. Bless your heart!

I am wondering if you remember when you started weaning him off the steroids? Was he off completely for a bit of time? Is he back on them? If you can share that, it may help folks (and you) figure out how much the steroid affects his bg's and what kind of insulin needs he may have.

I am also wondering if maybe a lower dose than 2.5 (twice/day or once?) would be a good place to start with the steroid? Do you usually give it in the a.m., p.m., or both?
 
His oncologist reduced his pred on July 18 - from 2.5 mg bid to 2.5 mg once a day. I was to do this for two weeks then decrease again. Then on the 20th his regular vet decided to get more aggressive and wanted to give him 1.25 mg once a day every other day for a week - then discontinue completely. Which is what I've been doing. Today - he totally crashed. He's extremely weak and lethargic. I've now been told based on the number of years he's been on pred this was too much too soon. So, I've been instructed to go back to 2.5mg once a day for 2 weeks and then we'll taper more.

I'm going to try .25u and see how it goes. And I'll definitely get more pm cycle numbers.

Thanks!
 
Welcome, Lorin.

One way that I suspect your not thinking about Mr. W's numbers is that we make a differentiation between symptomatic hypoglycemia and low numbers. Most of the cats here will dabble their paws in the 40s and in some cases the 30s and not exhibit any symptoms of hypoglycemia whatsoever. In fact, the dosing protocol that we use specifies that if a cat's blood glucose (BG) test numbers drop below 50, it warrants a dose reduction.

Vets are extremely cautious about these numbers since the majority of their clientele does not home test. The vet does not want to put a cat at risk so they will often suggest what we could consider a high "no shot" number. If you scroll down the board, you'll see that most of us shoot low -- once we have sufficient data to know how our cats will respond -- or that the cats drop into lower ranges. While unnerving at first, the lower numbers are usually easy to steer back up with food.

Do you have syringes that are marked in half-unit increments? These types of syringes make giving smaller doses easier. Gayle's suggestion is a good one and given Mr. W dropping into dose reduction range, it stands to reason that you may want to lower his dose to 0.25u. Having the syringes with half unit markings will make it easier for you to dose in small amounts. There are photos of how we micro-dose in the New to the Group sticky. Hopefully, lowering the dose will keep your cat in a better range and will allow you to give a shot twice a day.

One quick question, how is Mr. W's weight? Is he underweight and if so, is he significantly underweight?
 
If you look at the beginning of Latte's ss, you will see she has decent numbers (the beginning was w/o the pred) with notes as to how she was responding. You can see the numbers continue to be good during the leukeran trial. Then a week or so after restarting the pred they go up again (as did her dose, I believe).

If you are giving it once/day, you may find your cycles lopsided (one high/one lower). The higher one will usually be the cycle you give the pred. You might ask if you can give 1.25mg in the a.m. and one at night.

I think starting at a lower consistent dose with the insulin is a good idea.

If you can, maybe mark the times on your ss that you give the pred.
 
Boy, can I relate to what you went through with Latte. Mr. Wendall has also been diagnosed with CRF, though he's been holding his own over the years. His creatinine has stayed in the normal/high normal range which is great. He also has hypertrophic cardiomyopathy and a heart murmur. But he keeps on keeping on. What a journey this has been. I actually packed up and moved across the country with him for therapy. My dear hubby stayed home and is watching our two other cats. Some days I honestly don't know how I keep it together. Between the insulin and not being able to walk on his own - it's a full time job. The things we do for love!

His gets his pred in the mornings. His appetite has been off for the past 6 weeks. I had to start syringe feeding him about 3 weeks ago. He will eat on his own, just not enough. I think part of it was that he was on antibiotics for about a month straight after his diagnosis which just made him nauseous. He had a possible abscessed tooth. Then two back to back uti's. And just recently an upper respiratory infection. He's now off the antibiotics and receiving probiotics to rebuild his system. Whew.... He's dropped from 11 1/2 pounds down to 7 1/2 pounds over the past couple of months :YMSIGH: It breaks my heart to see him so thin. But with everything that's going on, believe it or not, he's a trooper. He's normally active and curious. He likes "walking" around the house ( I hold his tail which acts as a rudder). He still pees and poops on his own. :-D He definitely has a zest for life! I just need to get him over this hump.

Gayle...thanks for your response! Yes, I do have strings with half-unit increments. So, we'll see how the .25u goes. I looked at it this morning. It such a tiny amount, I thought there was nothing in the syringe. I'll check out the micro-dosing sticky. That will help.
 
One additional thought and I have no data to back this up -- it's speculative. The pharmacology of Lantus is such that it forms it's insulin depot in the fat tissue. If Mr. W is that underweight, he may not have sufficient fat stores so you're getting more insulin into his blood than he would if his weight were in the normal or closer to normal range. He may do better on Levemir. Levemir binds to albumin, (i.e., a protein) when it forms the insulin depot. This may be something to discuss with your vet. Here's a link to information on the difference between Lantus and Lev. (There are plenty of Lev users who post on the Lantus board since the dosing is the same.)
 
MrW said:
Gayle...thanks for your response! Yes, I do have strings with half-unit increments. So, we'll see how the .25u goes. I looked at it this morning. It such a tiny amount, I thought there was nothing in the syringe. I'll check out the micro-dosing sticky. That will help.
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If you like, you can practice measuring the .25u ..... take a used syringe and fill it with water to the .5u marking. Then, with the needle tip pointing up, twist the plunger so that you see a single drop form at the end of the needle tip. Flick off that drop and repeat until there are no more drops, water all gone.

Practice to see how many drops you get from that .5u amount. I think you should be able to get it to 4 drops, drops with your consistency. Once you are comfortable with your drops, you can measure a .5u in the syringe and twist out 2 drops to make a consistent .25u dose.
 
Lorin

I just wanted to welcome you and Mr. Wendall. I think you are doing an amazing job of balancing all of his health issues.

Please let us know if you have any questions regarding the use of levemir vs lantus. Several of us have used both and are happy to answer any questions you may have.
 
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