Need Help - High BG and switching to Lantus

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dodgingwrenches

dodgingwrenches

Member Since 2010
Hi there,

My cat has very high BG readings that I can't get under control with Novolin. Spreadsheet is in my signature. History is here:

viewtopic.php?f=28&t=17201

Any advice on when I switch to Lantus (hopefully tonight) given the circumstances?

Thanks,

Sophia & Heart
 
Hi Sophia!

here is your first thread on the board with more info: viewtopic.php?f=28&t=17036&p=168686#p168686

I see you've got a ketones kit, please try your best to check the urine, you dont want ketones to sneek up on you with these high numbers.

others will be along to guide you with your lantus dose.

As far as I know you can start lantus anytime you're ready.
You'll want to get 1/2 unit marking syringes like BD brand (3/10cc's, 1/2 unit markings) you'll need those if you dont have them already.

read the stickies up above (the starred threads) in the meantime.

hang in there!
 
Welcome to LL. I agree with Ronnie. You will be fine here. Read and re-read the stickies. Make sure you have some HC (high carb) food for a hypo kit. Nice to be prepared just in case. Be Patient. Please check for ketones. I am not familiar with the insulin you are using so don't know what dosage of Lantus would be normally we start low and work up in .25 increments. It takes time to reach the proper dose but you can get there. Lantus is a kind insulin. Good Luck.
 
oh, my. with the high numbers i'd try a higher starting dose. mainly writing here to bump this thread up. personally i wouldn't start lower than 3u but jill & alex and a few others can put their heads together and give you an appropriate starting dose. (looks like the numbers on your spreadsheet are from novolin, which should have shown bigger drops, so i wouldn't expect you'd start with the standard 1u dose.)

other lantus groups do set the starting dose by the cat's weight, and it actually seems like a pretty good idea here. is he eating low carb canned food (under 10% carbs) and not dry?
 
From looking at your ss, and the previous post linked here, I would think it may be an idea to start at a dose lower than 3u, just to be sure you are not giving too much now. You can't really tell what's going on if there are not many checks between the am and pm shots. When I adopted Oliver, his numbers were very high, and at 4uLantus, but to be sure it was not too high, as some people claimed it was, we went back down to 1u and worked our way up following the protocol.
Tight Regulation Protocol
I don't know of anyone starting Lantus at 3u if new to insulins, but others can sort that issue out for you. There are times when changing from one insulin to another that one may start at a higher dose, but I don't know if that's the case here.

While you're waiting, here are some links for you.
This one's a good starting point for all sorts of info.
New to the Group
You will find that Lantus is quite different from your current insulin.
Tight Regulation Protocol
This one will help you eliminate alot of repeated questions like what you are feeding, or any other health issues, weight, age, etc.
Profile Creation
You can find lots of foods in this listing.
Binky’s Food Lists
 
gayle, i think the protocol amount we follow here on lantus would be 2 units for a potential high doser, tho there's plenty of precedent in Kristen's group for a starting dose based on weight or for adjusting the existing dose if the cat is coming from a different insulin.

from tilly: "In many cases, the starting dose of Lantus or Levemir has been 0.25 IU per kg of the cat's ideal weight and is always dosed BID (two times a day, 12 hours apart). If the cat received another kind of insulin previously, the starting dose should be raised or lowered by taking this information into account. When selecting a starting dose, it is important to know that while Lantus and Levemir have a longer duration than other insulins, they also have a lower potency in most cats."
 
From the Tight Regulation Protocol:

Tight Regulation Protocol said:
In many cases, the starting dose of Lantus or Levemir has been 0.25 IU per kg of the cat's ideal weight and is always dosed BID (two times a day, 12 hours apart). If the cat received another kind of insulin previously, the starting dose should be raised or lowered by taking this information into account.
Click to expand...

Based on an approximate ideal weight of 15 lbs, Heart's starting dose would be 1.75u. Looking at the SS, with an initial dose of 5u of Novolin that was then dropped by half, it's very hard to know what's going on. I'd really like to see the dose worked up systematically.

A couple of questions:
  • Do you have syringes with half unit markings?
  • Are you testing for ketones?

I'm going to see if I can get a few more people to take a look. How far are we from your shot time?
 
Hi Sophia and Heart from Ottawa!

Just wanted to say welcome. Lots of people pointing to the stickies... me two!
You will be satisfied with Lantus, I'm sure. You will however need to reprogram your brain... but you will be Ok!

Again, welcome.
 
I just had a chat with Libby, one of our experienced Lantus users. Her concern is much the same as mine. The starting dose of Novolin was high and there is a potential for lots of rebound.

We're thinking of a starting dose of 1.5u is both safe and will let you work up to an optimal dose. How does that sound?
 
Just want to welcome you and my Do Lou was also on N for 4 months and did not do well at all we have been on lantus now since March and Do Lou is doing so much better no dose advice from me I am still learning myself but others who know so much will guide you and again welcome :mrgreen:
 
Sienne types much faster than I do. :smile: First question, and very important, has Heart ever had ketones?

I agree, it's hard to tell what is going on because Heart's starting dose of N was so high. With the fast-acting insulins like N, it is possible for a dose that is too high to actually drive the numbers UP. That may or may not be what is happening, but the safest thing to do is to assume that the dose is too high and start over at a lower one.

IMHO, since he is a very new diabetic, there is no harm in starting over *IF* there is no ketone history. If Heart had been on high doses for a while, I would be more comfortable with a higher starting dose, but as it is, I'm just not comfortable keeping a high dose. We'll keep an eye on the numbers and "fast track" our way back up the dosing scale if it is apparent that the lower dose is doing nothing. We can increase the dose in as little as 2 days if the numbers still look the way they do now.

Do you have Ketostix to be able to test his urine for ketones? It is very important to test for ketones when you lower the insulin drastically. If you don't know how, ask and someone will help you.
 
Just to keep the advice coming....

I went over for a visit to help with testing and started on 1 unit of Lantus tonight.
Heart was sooo good with the testing, just patiently sat there while we chatted and messed with his ears. Then he got into the catnip and played :smile:

BG was still 33 (594) PMPS

Odiesmom
 
Thanks sooo much for stopping by odiesmom! I just did a BG reading following your flashlight trick and it was super easy. One prick and done! And he didn't even flinch, just sat there in my lap on his back.

Two and a half hours after his 1 unit of Lantus, his BG was "down" to "only" 475 (26.4 in Canada)... I can give him 1.5 in the morning?

Haven't been able to test for ketones yet as I have not caught him peeing. Barely been home the past two days unfortunately, and Sunday he wasn't drinking and peeing for me. Ketostix are sitting beside the litter box waiting...
 
dodgingwrenches said:
Thanks sooo much for stopping by odiesmom! I just did a BG reading following your flashlight trick and it was super easy. One prick and done! And he didn't even flinch, just sat there in my lap on his back.

Two and a half hours after his 1 unit of Lantus, his BG was "down" to "only" 475 (26.4 in Canada)... I can give him 1.5 in the morning?
Click to expand...


You're very welcome.
Yaaaay!! :RAHCAT Glad to hear the next test went better :smile:

As for dosing, hopefully someone else can tell you. What comes to mind is that Lantus is slower-acting, so he'll probably keep coming down until about +6 or so. If he was starting "fresh" without the prior insulin, I'd guess 1.5 might be fine, but with the Novolin, it's hard to say whether the high numbers are a result of too much Novolin and it'll work itself out in a few days, or if he really does need a higher dose.

Odiesmom
 
You can absolutely start with 1.5u tomorrow morning -- 12 hours from when you shot tonight. As Libby noted, we can always fast track the dosing if need be but I'd start with 1.5u. It's a dose that will keep Heart safe and allow you to move the dose up safely.

You may not see a great deal of movement in Heart's numbers for a few days. Lantus is a "depot" type of drug -- what we refer to as a shed. What this means is that there is a reservoir of insulin that is built up in the system and it takes several days for the shed to be built. It takes at least 5 days for this to happen. There's more information in the sticky (starred note) at the top of the board on this topic. Lantus requires a bit of patience, but it's worth the wait.
 
Well I don't know if it's the effects of the reduced Novolin dose or already the new Lantus, but either way, his pre-shot BG was 26.0 (468) which is much better than the 600's I've been seeing before previous shots dancing_cat
 
dodgingwrenches said:
Well I don't know if it's the effects of the reduced Novolin dose or already the new Lantus, but either way, his pre-shot BG was 26.0 (468) which is much better than the 600's I've been seeing before previous shots dancing_cat
Click to expand...


Awesome!!! :-D
(well, I mean, still high, but so much better than those black numbers!)
(btw - why aren't those really high numbers in black on your spreadsheet?)
 
Just a couple of housekeeping notes...

Rather than keeping the string going in one post/condo, we generally open one condo, per cat, per day. If you notice, the majority of the subject lines here look the same: date, cat's name, AMPS and then other test results. So for today, your new condo's subject line would read:

6/16 Heart AMPS-468​

You would also cut and past the link to the previous day's condo into your new condo every day. It will allow you and everyone to go back and easily find information, if necessary. It would also help if you could complete a Profile. The instructions are in the Tech Center. That way we won't keep plaguing you with questions about food, ketones or other health issues, etc. You can then link the Profile to your signature, just like you did with Heart's SS.

It's good to see the numbers are coming down.
 
I can start a new thread tomorrow if that is what makes it easier. I just didn't want to "spam" you with too many threads :)

Update: At +6, he's at 405
 
I finally got a ketone reading! Either negative or worst case "trace". The lamp by the litter box was too dark to tell, but I'm thinking it was negative. What a relief!

I scooped the litter box, topped it up with some fresh litter, and then just sat him in it and he actually peed! Such a good boy!
 
dodgingwrenches said:
I finally got a ketone reading! Either negative or worst case "trace". The lamp by the litter box was too dark to tell, but I'm thinking it was negative. What a relief!

I scooped the litter box, topped it up with some fresh litter, and then just sat him in it and he actually peed! Such a good boy!
Click to expand...


Oh yaaay! That's a huge relief, I was really worried about the poor guy
 
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