New here - dosing 6 units of Lantus 2x/day!

Liz H

Liz H

Member Since 2020
Hi! My 10 year old female, Boots, was diagnosed in October. She has been prescribed 6 units of Lantus 2x/day after almost 6 weeks of numbers in the 500s (all tested at vet's office). She was also prescribed Hill's w/d dry and wet.
She had a fructosamine test last week that came back with good results, but a couple of days ago she woke up obviously low (staggered out from under the bed like a tiny, furry drunk)! After eating she was fine and has been since.
After reading the Facebook board and seeing that virtually NO CATS take this much insulin, I went out and got a glucometer today (Relion Premier Blu). Her first reading, 8 hours post shot with no food since breakfast, was 167. I picked up some Fancy Feast pate to start transitioning her. Any thoughts on where I should go from here? She hasn't had dinner yet, so I'm wondering if I should give her some FF with her w/d and whether I should stay at 6 units. Also whether I should test again tonight. I go back to work tomorrow and am afraid of her bottoming out during the day. I'd much rather deal with some highs than risk a low when I'm not home.

Thanks for any and all advice. You've already helped me so much already.
 
Hi Liz! Glad to see you over here from the FB group!!

Since you most likely have already had a hypo scare on 6U and feeding a really high carb food (the W/D), I'd definitely reduce the dose.

The tricky part is how far do we want to reduce it. If we reduce too much, you end up wasting a lot of time going back up. If we don't reduce enough, we risk another hypo.

How about this? Reduce down to 4U for now and transition Boots VERY slowly off the W/D. I'd start with a teaspoon of Fancy Feast and the rest W/D for now.

We'll want you to test before every shot (when he hasn't had food for the 2 hours immediately before feeding/shooting) and (if possible) get at least 1 mid-cycle during the AM cycle (4-7 hours after the shot) and at least a "before bed" test on the PM cycle.

When you return to work, is there anybody who can test during the AM cycle or can you get home long enough to test?

We'll also want you to start recording your numbers on our spreadsheet. Here are the instructions on getting the FDMB spreadsheet. (if you have any problems with it, feel free to send me a private message. I've set them up for lots of others) Just click on my name and choose "Start a conversation"

Also, it'll help to add your "Signature" (the info you see below my comments) so we don't have to keep asking the same questions over and over. To do that just click on your sign on name and there's a drop down menu. Choose "Signature" and a new box will pop up for you to enter information like:

Your name/cats name, age, sex, date of diagnosis, type of insulin, type of meter, type of food (you could say W/D wet/dry but transitioning to LC), any other health issues or meds? and a general location. Hit "save" and you're done.

When you get your spreadsheet link, you'd put that into your Signature too so we can see how he's been doing before giving you more advice.
 
Hi and welcome to you and Boots!
I am so glad you have found us.
I have to go out in a few minutes but wanted to just say a few things and I am sure someone else will be along to help you more.

First of all great you are home testing !
It does sound as if Boots had a hypo event when he staggered out from under the bed.
So you do need to reduce the dose of insulin.......oh I see Chris has just posted above and I agree with her ...go down to 4 units.
And I agree with transitioning VERY slowly over to a low carb diet as the insulin dose will need to be adjusted as well. I would wait a few days before transitioning the food and collect more data on the numbers first.

Here below is a link with information for new members and within the post are links to set up a spreadsheet and signature.

Do you have honey in case of another low number? Also some high carb food which you can read about in this link.
Did the vet ever mention ketones to you?

http://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/
 
I'm so glad you went out to get Boots a glucometer and tested her blood sugar! I agree with Chris and taking the reduced dose, slowly transitioning Boots off of dry, and testing Boots LOTS AND LOTS while you do this. We want to catch how low the dose takes Boots.

The next couple of cycles (every 12 hours) may be influenced by the 6 unit dose. So I wouldn't be surprised if you see lower numbers tonight.

And to echo Bron: Has Boots had a history of DKA? If so, our dosing advice changes.

Liz H said:
After reading the Facebook board and seeing that virtually NO CATS take this much insulin,
Click to expand...

This is more of an FYI and if you don't understand anything I'm talking about, don't worry about it :joyful: 6 units is a very large starting dose and over 5 units, we begin to suspect high dose conditions such as acromegaly or IAA and will typically ask the owner to do a test for those conditions. However, I don't think this is the case for Boots. It must be a combination of the dry food keeping her as safe as it can from a devastating or fatal hypo event and/or the body doing its natural thing and bouncing high as to protect Boots from a hypo event. Sometimes, cats don't display any symptoms when they have low numbers.
 
Hi Everyone,

I fed 1/2 can of w/d plus a spoonful of Fancy Feast for dinner, shot 4 units, and tested Boots again before breakfast and she was at 102. I fed the same amount for breakfast and shot 4 units again before work. I'll test again before dinner. Assuming she looks good, I think I'm going to stick close to this for this work week and then try to make a bigger food shift and get my spreadsheet up and running over the weekend. I have an hour commute and no one to check on her during the day, so I don't want to make too many changes too fast, but I am feeling like I have more control and definitely have a better understanding of all of this. Thank you all for your patience and help!
 
Liz H said:
After reading the Facebook board and seeing that virtually NO CATS take this much insulin,
Click to expand...
Hello and welcome. A clarification. My girl got up to 8.75 units of insulin. We have a couple other kitties who have been on higher doses, but they are ones who have secondary endocrine conditions causing insulin resistance. As a matter of fact, other that Chris's China, the other people posting so far here had kitties get over 6 units. So it's not that uncommon. But all those kitties on that size dose go there by increasing by safe amounts and testing to know it's what their kitty needed. Kitties also don't have to be over 6 units to have secondary endocrine conditions.

Looking forward to seeing the data with the new food. We've had lots of cats drop down in dose when they switched off of WD.
 
I just got home and tested and she was at 46 . She's wolfing down her dinner now. Is this what's been happening the whole time, even more so when she was getting 6 units? What should I do about insulin?? Just when you think you're on the right track, you get another curveball. When should I test again?
 
Liz H said:
I just got home and tested and she was at 46 . She's wolfing down her dinner now. Is this what's been happening the whole time, even more so when she was getting 6 units? What should I do about insulin?? Just when you think you're on the right track, you get another curveball. When should I test again?
Click to expand...
What type is meter are you using?
Either meter you need to test again in20 minutes to see she is coming back up.
Edit.. I see you are using a Human meter.
Retest 20 mins after food given and post result please
 
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And a signature with pertinent info please. You definitely need a reduction with that 46. With a high dose kitty that and mean a .50 reduction. Have you been increasing by whole units? By switching the food to lower carb it’s not a surprise she would drop low.
 
I'll PM about the spreadsheet now. Stating the obvious here...I'm holding her insulin dose completely, yes?
Also, after she tested at 46 I realize I left the strip in the glucometer. When I went back to test her again, the glucometer with the old strip still inserted showed a reading of 76. Any insight?
I am slightly freaked out here thinking about all the times I shot 6 units and went off to work My vet discouraged home monitoring (said Boots would start avoiding me at shot time) and I still haven't told him I'm doing it.
 
I would skip and let the depot drain. I’d just test again and not worry about the 76. They question then becomes what to dose in the morning. Let’s see the numbers tonight and in the morning and go from there. I’m sure Marje or Wendy will chime in.
 
First of all you don’t need your vets permission to home test. And thank goodness you are doing it.
Are you at shot time now?
If so I would skip the shot and let the depot drain a bit.
I wouldn’t worry what the meter said if you had left the strip in it. The immediate reading is the one you need.
I am going to ask a couple of people about the dose moving forward as you may need to drop more than the usual amount due to your circumstances.
Keep testing until she is higher... up around 100
 
Liz H said:
She's at 102 now, 2.5 hours post dinner and no insulin.
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That’s good. I have asked some other experienced people to look at the dose as it is not a straightforward case, and we will get back to you about that. So look here before the next dose is due.
Are you leaving food out for Boots during the day while you are at work?
 
She was given a urine test at dx and the vet said it was fine. I don't test urine at home.
I haven't been leaving food out during the day because she is ravenous all...the...time and will scarf it all down as soon as it's offered. Any tips for this? A few folks have asked if I'm doing this, so it seems important.
 
Investing in a timed feeder would be a good solution. You can set it to open when you want. I used one daily for Sheba as she would have eaten all the food at once too.
It would certainly be an advantage to be able to leave food out for her during the first half of the cycle so she could eat when the insulin is strongest. This could also help stop her dropping too low.
 
The Petsafe 5 is a popular automated feeder. I got mine at Petsmart, but you can get them on line too.

You should invest in some ketone testing strips. Ketostix is a popular brand available at most pharmacies. Any time you have high numbers and skip insulin, it's good to make sure there are no ketones.
Liz H said:
Is this what's been happening the whole time, even more so when she was getting 6 units?
Click to expand...
Aren't you at four units now? When you get the spreadsheet data going, it'll be important to comment in the Remarks section at what point you started changing the food. Also, if you have any data to the beginning of the year. Dry food really makes a difference, which is why we suggest people get a handle on testing first, then do the transition. I remember well a cat that went from 5.5 units to zero in the space of a day and a half when dry food was removed from the house. That kitty was not supposed to be getting into dry food, but was obviously raiding another cats food to keep safe.
 
Wendy&Neko said:
The Petsafe 5 is a popular automated feeder. I got mine at Petsmart, but you can get them on line too.

You should invest in some ketone testing strips. Ketostix is a popular brand available at most pharmacies. Any time you have high numbers and skip insulin, it's good to make sure there are no ketones.

Aren't you at four units now? When you get the spreadsheet data going, it'll be important to comment in the Remarks section at what point you started changing the food. Also, if you have any data to the beginning of the year. Dry food really makes a difference, which is why we suggest people get a handle on testing first, then do the transition. I remember well a cat that went from 5.5 units to zero in the space of a day and a half when dry food was removed from the house. That kitty was not supposed to be getting into dry food, but was obviously raiding another cats food to keep safe.
Click to expand...

I think I know why she's so low. I typically feed dry in the AM and wet in the evening. Today I fed wet for breakfast and dinner (though still Hill's w/d with a spoon of Fancy Feast). I mistakenly thought as long as I was sticking with the w/d I could switch to wet in the AM. Ugh! Now that I've "pulled off the band-aid," should I keep up with the wet or reintroduce the dry in the AM and taper off??
 
It is best to feed the same number of carbs at each meal so that the insulin has the same number of carbs to work with.
Feeding mostly dry at one meal and mostly wet at another would give a very unbalanced number of carbs for those two meals. Better to feed some of each, for each meal. As you are slowly changing over to a low carb, you can still do this by making sure the meals have the same amount of carbs except you are reducing slowly each day. Does that make sense?
 
The 46 today indicates that 4U is too much (which was what I thought from the beginning....that your vet raised it too fast and too high)

So tomorrow you'd need to give less (I'm thinking more like 2U IF she's over 150 in the morning) but let's see what @Wendy&Neko thinks
 
She woke up at 354. I entered what I have in the spreadsheet. If anyone is up, any thoughts on what to shoot this morning? She just ate a half can of w/d and I'm going to give her 1/3 c of w/d dry. My son is home today and can check on her, but doesn't test yet.
 
Good morning!
I went conservative and shot 2 units. Looking forward to seeing what you all think.
Side note...how on earth do you get a urine test on a cat at home?
 
Bounces can take up to 6 cycles to clear....bounces happen when 1. they drop too low, 2. they drop too quickly, 3. they drop into numbers their body isn't used to anymore (or any combination of all 3)

The liver releases stored sugars and hormones to bring the BG up quickly....it can take up to 6 cycles for those sugars and hormones to clear.

I'd stick with the 2U for now and work on transitioning her to the low carb food.

It's better for her to run too high for a day than too low for a minute.
 
I would stick with 2.0u for now. It can take 3 days/6 cycles for a bounce to clear.

I'd also suggest that you get some additional tests during the PM cycle. Many cats experience lower numbers in the evening. It's also important for your cat's safety to get a test before you go to bed every night.

One important aspect of using Lantus. You do not base your dose on the pre-shot number. That number tells you whether it's safe to give a shot. Dose decisions are based on the nadir -- the lowest number in the cycle. This is another reason why spot checks are important. It is entirely possible for Boots to drop from the current pre-shot number into much lower numbers.
 
Got it...thanks, all! I'll shoot two and check her before bed. As far as the food transition, beyond giving her a spoonful of FF with her wet w/d and maybe letting her scarf her sister's leftovers, I haven't made a big push because I'm waiting for the weekend so I can be home and test throughout the day. Am I on the right track, or should I be making a bigger change now while she's high?

Thank you all SO MUCH for your guidance. You've made this far less scary!
 
Since we've reduced her dose so much, I think you could "push it" a little...the sooner you can get her off the W/D, the better.

Maybe try half and half tonight? And if you can get a couple of tests (like at +2 and "before bed"), it'll really help
 
Chris & China (GA) said:
Since we've reduced her dose so much, I think you could "push it" a little...the sooner you can get her off the W/D, the better.

Maybe try half and half tonight? And if you can get a couple of tests (like at +2 and "before bed"), it'll really help
Click to expand...

What's funny is +2 is pretty much bedtime around here, LOL! I'll stay up and make sure we get another test in. She is so over me doing this, I swear she's rolling her eyes at me.
 
Okay, so she was 327 +2 and 322 +5. Assuming she's hovering around the same number AMPS, I'm thinking I should increase the FF to w/d ratio and shoot 2 units again at breakfast. If anyone thinks differently, as always, I'm grateful for input. Thank you for your incredible support
 
Liz H said:
Assuming she's hovering around the same number AMPS, I'm thinking I should increase the FF to w/d ratio and shoot 2 units again at breakfast.
Click to expand...

Sounds like a good idea to me!!

Do you have a day coming up when you can be home to test whenever you need to? That would be a good day to cut the W/D out completely.
 
Do you think you could start a new post tomorrow? This one is getting a little long, and you are no longer doing six units. :)
Just create a new post with a link to this one so people can go back and see the history.
 
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