Need help with Lantus dosage

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Robyn & Mika

Robyn & Mika

Member Since 2011
How fast can you reduce the insulin dosage? I have a 12 year old Siamese that was diagnosed on 7/20/11. My vet started him out at 3 units every 12 hours. Over the past month my vet has increased his dosage from 3 to 5 to 7, and now 8. I feel this is too aggressive and would like to follow the Rand protocol and drop him to a starting dose of 1.5 with home testing to get him regulated. Can I reduce his dosage from 8 to 1.5 overnight, or do I have to do it gradually? He has been on a low carb (fancy feast less than 6 percent) since the day after he was diagnosed. Lowest napir was 275 on 8 unit of Lantis. Thanks for the help.
 
I just posted this to your thread on Health:
Sienne and Gabby said:
Nancy/Payne posted on the Lantus board and asked that people stop by.

Are you home testing? If so, what kind of blood glucose numbers have you been seeing besides the nadir you noted? Or, what is your vet telling you about your cat's BG levels? Is there any relevant medical history -- like diabetic ketoacidosis?

We've certainly had people start over on their dosing regimen. I don't recall if anyone was on 8.0u BID, though. I've put out a note to a few people who have better/longer institutional memory than I do.

I'd suggest doing some additional reading about Lantus if you are planning on following the Rand protocol (which is what we use on the Lantus board). Below is an overview of the information in the starred sticky notes:
  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal versions -- the Tilly Protocol developed by the counterpart of this group in Germany and the Queensland/Rand protocol developed by Jacqui Rand, DVM and published in one of the top vet journals.
  • New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
  • Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
  • Lantus depot/shed: This is an important concept for understanding how Lantus works.
  • Lantus & Levemir: Shooting & Handling Low Numbers: What data you need in order to be able to work toward remission or tight regulation as well as information if you have a low pre-shot number or a drop into low numbers during the cycle.
Click to expand...
 
Hi, and welcome,
My experience isn't quite like yours because my cat, Stu (then age 12), had been diabetic for almost 4 years and was getting 4 units bid of PZI Vet before it was discontinued. But I think Stu's story might have some relevance. We were shooting blind and he wasn't well regulated, but he seemed viable. My vet (a new vet: we had moved) switched him to Lantus when we could no longer get PZI Vet and started him on 4 units bid. We took him in to be tested every other week and his blood glucose got higher and higher, and the vet kept upping his dose by a unit at a time. We were at 7 units of Lantus bid when I got really scared because he looked and obviously felt much worse: spending lots of time every day in his litterbox, peeing profusely; drinking lots of water. That was when I found the FDMB and started home testing. It seemed obvious to me that he was getting too much insulin and his body was trying to get rid of it. The wonderful people on this board helped me weigh my options, and I decided to take Stu down to 4 units bid to begin with and try to ease him down over the course of weeks or months. After a while it seemed that this approach wasn't working, so we went "cold turkey" down to 1.5 units bid and began at that point to follow the tight-regulation protocol. Stu improved dramatically. He was never truly regulated, but his diabetes were under good control and he looked and acted like a young cat again.

Your kitty is recently diagnosed and, unless there are other health issues affecting his numbers, I would be very cautious about following your vet's practice of increasing his insulin by so much, so quickly. The protocol we use here is safe and effective. I think that you could start over again with Lantus at a lower dose. There are people here very experienced with dosing (I am not one of them). If you decide to follow this route, test often for ketones (they are a danger when bg numbers are high), do home testing, and keep a spreadsheet. The list of "Stickies" Sienne posted above is the place to start reading. Start with "New to the Group". Post with any questions you might have and someone will always be here to help you.

Good luck with your kitty.

Ella & Rusty
 
that sounds so stressful! you've gotten good advice already, so i just want to say welcome.

i just want to confirm - are you home-testing? or just testing at the vet's? if you're not testing at home, that's essential and once you learn how to do it, it's fine. post again and we'll get you going.

sounds like you might not have started home testing - if not, let's start there. you will never be sorry. testing tells us everything we need to know about how your kitty is doing.
 
viewtopic.php?f=28&t=50672

I performed a glucose curve on Mika on Saturday, 8/20/11, and below are the results:

6:30 AM – Food
7:00 AM – 7 units of insulin
8:35 AM – 371
10:50 AM – 275
1:00 PM – 335
3:00 PM – 334
5:00 PM – 319
6:30 PM – Food
7:00 PM – 333 (right before insulin)
 
africanbb said:
How fast can you reduce the insulin dosage? I have a 12 year old Siamese that was diagnosed on 7/20/11. My vet started him out at 3 units every 12 hours. Over the past month my vet has increased his dosage from 3 to 5 to 7, and now 8. I feel this is too aggressive and would like to follow the Rand protocol and drop him to a starting dose of 1.5 with home testing to get him regulated. Can I reduce his dosage from 8 to 1.5 overnight, or do I have to do it gradually? He has been on a low carb (fancy feast less than 6 percent) since the day after he was diagnosed. Lowest napir was 275 on 8 unit of Lantis. Thanks for the help.
Click to expand...
hello and welcome to the group!

you've already been given some good advice, so i won't repeat. it's not necessary to gradually decrease the insulin dose. if you want to start over, you could shoot 1.5u at the next shot time. since the effects of one dose can affect up to the next 3 days it'll be a good 6 - 7 days before you can evaluate how well 1.5u is doing. roughly a week will allow the 8u shed/insulin depot to drain which will in turn give us a good look at what 1.5u can do.

however if you're looking for an opinion... dramatically reducing the dose to 1.5u is not something we can suggest based on the data from one curve. one day's worth of data doesn't give us enough information to make any suggestions one way or another. your cat could be a high dose cat or your cat could possibly be over dose. too much insulin can cause numbers to be high just as not enough insulin. more data may provide a clue.

if you've decided to start over at 1.5u bid, PLEASE use ketostix to test urine for ketones daily. if ketones present themselves the dose will most likely have to be increased.

i'd also encourage you to get a spreadsheet up and running. this is a very numbers driven forum. collecting data is the best way for us to help you help your kitty.

hope to see you posting often...
 
so just to clarify, i think you gave 3 units tonight and are considering going to 1.5 units in the morning?

i would feel better if you gave us more information as quickly as you can. if you can look back up to Sienne's post and start there, then just try to answer all of the questions going down this thread.

as much history as you have with dates of diagnosis, dates of BG tests and dose changes would be super helpful. also describe what you are seeing - drinking water, lethargic, eating a lot, anything like that. and what's his approximate weight and size - is he a huge cat? big face or feet? walking on his "elbows"?

also i think you're home testing - what brand of meter are you using? alphatrack from the vet? a human meter from the drugstore?

i saw Bonnie referred to my punkin in your last post. he is one of the cats with acromegaly - but of course we didn't know that until we arrived here and had been here for 3 months. we thought we had him on 3 units when we arrived in february, but it turned out we had u-40 syringes instead of the u-100 syringes required for Lantus, making the dose 7.5unit of insulin rather than the 3 we thought we were giving him. by may when we had him tested, i think he was at about 8units. i doubt hardly anyone even hears of acro or insulin resistance til they've arrived at this website - most vets don't seem to know about it. some do, mine didn't.

anyway, the point is that there are conditions that can cause a need for high insulin doses. there are also cats who come here who haven't come up the dosing ladder appropriately - it sounds like you've had very high dose increases. we increase by .25 or .5units about every 3 days, usually not more often than that. too much insulin can look like too little insulin.

you see the conundrum?

no one wants to tell you to drop the dose down to 1.5units without also saying if your cat needs 8 units then your cat's BG may go really high - and the risk of really high BG is that ketones can develop and your cat can develop an emergency situation that has to be dealt with in a veterinary hospital.

at the same time, no one wants your cat to be getting 8 units if he really only needs something significantly less.

if you could give us as much information as possible, it might be easier to untangle the situation and try to figure out what direction to suggest that you go.

can you look back through the posts and try to answer all the questions people have posed? that would be helpful. people will respond fairly quickly to you - everyone who has posted to you here has more experience than me. there are many people who can help - just give us as much data as possible and keep checking back in because you'll no doubt have more questions and responses coming in here.

you've found the right place. i felt like i'd hit paydirt - people here do diabetes with their cats 24/7 for years on end. there is a TON of experience here and you'll get the help you need. glad you've found it!
 
Thanks to everyone for the great advice. I work out of town all week, so I am transferring these instructions to my husband. He is good with administering the insulin, but does not do the BG testing (I do BG curves on the weekends when I am home.) We took Mika down to 1.5 units this morning, so when I get home tonight, I am going to buy the keotstix to start testing for ketones. I am having trouble accessing the spreadsheet. I am going to go to the vet tomorrow and obtain the initial blood gluclose level and the one BG curve he did in office as well as the second and third BG's I did at home and transmitted to his office. I will post his weight, the dates of the dosage changes, needles being used, etc. So appreciate that everyone is so willing to hold my hand through this scarey process. I truely believe he can be regulated at a much lower dosage and am excited to try. Will post all tomorrow and look forward to your advice. Thank you, thank you, thank you!!
 
Can we convince your husband to test? This is hugely important if you're out of town throughout the week. It's really the only way to make sure Mika is safe. We're happy to hold his hand, as well. (There really are guys who post here!)
 
LOL! I already told him last night that he will have to start BG testing when I am gone. God Bless him, his willing to learn! He knows how much I love my baby Mika!
 
I bribed my boyfriend to help me out testing Bandit during the day while I'm at work with dinner once a week--his choice of restaurant or cooked at home. :-D

Here's a workaround for the spreadsheet if the other is not working: http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=50130

I wanted to repeat my advice from the other thread about the frequency of testing:

With Lantus, you want to test at least three times a day. Before each shot, and then another test about 6 hours into either cycle. However, if you can get more mid-cycle tests you're even better off. For many cats the nadir falls about 6 hours into the cycle, but some have it early, around 4 hours in, or later, at around 8 hours. In the beginning you're going to want to get a few tests in to see where his nadir usually is.
 
africanbb said:
LOL! I already told him last night that he will have to start BG testing when I am gone. God Bless him, his willing to learn! He knows how much I love my baby Mika!
Click to expand...

Welcome to LL! :-D My DH hates the sight of blood, but even he learned to test and it doesn't bother him at all anymore. It really doesn't bother the cat either, especially once they learn there are treats involved. :roll: I think what Tess hates most is that the hairs inside the ear tickle when you hold it! :lol:
 
Hello again my new found best friends! I have been gathering information all day. Sorry to post it here, but I still can't get the spreadsheet to work, probably because I have an iPad. Here are Mika's stats:

12 year old male Siamese, over weight at 17.3 pounds. Has not lost any weight since being diagnosed. Has not been tested for any additional underlying health problems like acromalgy (sorry about spelling.) Does not appear to have any characteristics of acromalgy. Started eating, drinking, sleeping, and peeing a lot. Took him to the vet on 7/15/11. Vet took blood and urine. Called me on 7/20/11 to tell me Mika had diabetes. Blood glucose was 470, and fructosamine was 536. Vet started him on lantus BID 3 units the next day (7/21/11.). Lantus is being administered using u-100 bg insulin syringes.

7/29/11 - blood glucose curve performed at the vet's office:
6:30 am - food
7:00 am - 3 units of insulin
8:30 am - bg 459
11:00 am - bg 431
1:00 pm - bg 453
3:00 pm - bg 490

Vet upped bid to 5 units

Second bg curve I performed at home using an alphatrak meter and strips. Drew blood using a one touch delica lancet, 33 gauge.

8/5/11:

6:30 am - food
7:00 am - 5 units lantus
8:04 am - bg 411
10:40 am - bg 371
12:50 pm - bg 383
2:55 pm - bg 388
6:30 pm food
7:00 pm 5 units lantus

Took results of bg curve to the vet the next day. Vet upped lantus dosage to 7 units bid.

Third bg curve I performed at home on Saturday, 8/20/11:

6:30 AM – Food
7:00 AM – 7 units of Lantus
8:35 AM – 371
10:50 AM – 275
1:00 PM – 335
3:00 PM – 334
5:00 PM – 319
6:30 PM – Food
7:00 PM – 333 (right before 7 units of Lantus)

At this point I noticed Mika had slowed down on eating, drinking, and peeing so much. Transmitted above bg results to vet on Monday, 8/22/11. Vet called and told me to up the lantis to 8 units bid. Monday, 8/22/11, is when I actively became involved in this website as I had doubts to the extreme amounts of insulin Mika was being prescribed by the vet. After much reading, I lowered his Lantus dosage to 3 units bid on Tueday, 8/23/11, night. After additional conversation with members, we lowered the dosage to 1.5 units (based on Rand protocol) on Thursday, 8/25/11, night. Last night I took his bg right before food and insulin and it was 376 at 5:30 pm. Today, I gave him 1.5 units at 7:00AM and tested his BG at 11:00AM, it was 347. He appears to hit his napir 4 hours after his dose of insulin. I leave all this information in your good hands and look to your for any advice you may be willing to provide regarding getting him regulated and possibly OTJ. I have the following questions:

On the excel spreadsheet, what does AMPS and PMPS stand for? I assume AM and PM insulin dosage?
Am I correct in increasing his dosage based on his napir 6 - 7 days after I changed the last dosage?
How often should I test his bg's and at what time of the day?
When should I test for Ketones? Only when his bg is high? How high? Above 400?

Thank you all so much! I really appreciate the help. As of today, Mika is mildly eating, drinking, peeing, and sleeping to much. Not as much when he was first diagnosed, but still not his usual self.
 
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