New Lantus user...suggestions? dose?

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macal

macal

Member Since 2012
Hi, we're not on tight regulation yet, still learning Molly's trends, but I'm cross posting from the "regular" lantus board in case you have any dosing suggestions. I'm new to this and a consult would be helpful. Many thanks,

Hi,
My cat Molly was just diagnosed with diabetes during a dental about 4 weeks ago. I had noticed she was losing weight...no hanging around the water or increased urine output though. I asked them to check her urine while she was under and BINGO diabetes.
So a brief synopsis
Molly is 11, female calico.
Her diet was changed to canned only (FF classic and Purina DM) approx 3 weeks ago, and about 1 week ago we began Lantus. Molly is quite feral (but an indoor kitty) so the vet suggested 1U every 12 hours to start (vet's fructosamine analysis before and after diet change indicated levels in the mid 500s and her BG in the high 300s)
I started with this protocol, but braved it and started checking her BG levels and pulled off the insulin because her levels were suprisingly different than the vet's....turned out this was because of the meter I was using (TrueTest brand) which apparently many users on this board have had issues with.
I've now switched to a Relion micro and starting Molly on a tentative 0.5 U morning and evening when BG is above 200 (and I'm able to get a reading).
I've been making little discoveries over the holidays....like the fact that she was getting into the dry dog food in the evenings, so that was remedied today.
Just wondering what your thoughts were on the patterns you see in her spreadsheet. Is 0.5 U too high? I opted not to dose her tonight since she was well below 200 an hour before PMPS.
Should I have fed her a big supper (which I did...I've put her 1.5 hr post supper BG here ) and then dosed her anyway?
Thanks for any advice you can give.
 
Re: New Lantus user...suggestions?

Hello and welcome to LL! I took a peek at your SS and really hard to make any conclusions given she was sneaking into the dog food.. Bad kitty!! ;) not having that could make a huge difference to her numbers so it will be interesting to see how she does without it. It's great that you have started monitoring her blood.. It really helps probably manage this condition.

In terms of dose, what weight is she... And would you say she needs to lose or gain weight?

We base initial dosing on her ideal weight .. Check out the sticky on the protocol on this board. Saying that though, the 0.5 looked not too bad and I wouldn't go higher as a starting dose given you got a 58 the other day and that was while she was still eating dog food.

I might be inclined to give her a few days without insulin now that she isn't eating dog food and measure to get a baseline and if she continues above 130, start her on 0.5iu or less depending on weight. But let's see what the experts on here say!! (And let us know on weight)
 
Re: New Lantus user...suggestions?

Hello.
Welcome to LantusLand.
I can't give you dosing advise but wanted to welcome you here. It doesn't matter if you aren't doing the tight regulation. Everyone is welcome.
I've been having a little of that sneaking dog food lately too.
Dry food (cat or dog) stays in the system for a bit of time so tomorrow's numbers may look a little better now that you've stopped that
contraband. :-D
It's good that you figured out the meter issue quickly.
You seem to have a grip on the testing. Having that data is essential for shooting lower numbers later on when you start knowing how
Mollie responds to the insulin.
Someone who can address your dose will be on soon.
In my opinion, you did good reducing from the amount the vet started you at. Mollie seems to be responding well to the 0.5 u and you'll
see better when the contraband is out of her system.
Hope you keep posting. You'll have lots of support here.
 
Re: New Lantus user...suggestions?

Thanks for your help! Molly is currently 10.8 lbs. She has a small frame so her optimal weight is less than this (there's a heavy dangling belly). Her max weight was about 12 lbs and she looked really obese. I'd guess about 9 lbs would be optimal.
 
Re: New Lantus user...suggestions?

Ok cool. The protocol we use says 9lbs which is 4kg .. so would recommend 1IU and that's what your vet started you on but you already discovered that was probably too much!!

0.5IU looks better and safer.. But even that might end up being too much now that she has stopped being a dry food junkie ;)
 
Re: New Lantus user...suggestions?

Hi Macal. I can not offer any dosing advice but suggest that you put the "?" and DOSE in your subject line. The folks that are very experienced look for signals like that from members needing help. You can click on the circle to the left of the "?" that's among the icons above the subject line. You won't see the "?" until after you submit your post.

Here is the link to the STICKY on the TR main page.Lantus & Levemir -What is the insulin depot. Definitely read the STICKIES on the main page, especially Shooting & Handling Low Numbers and Tight Regulation Protocol & New to the Group.

It is important to get a AMPS reading and a PMPS reading before giving the shot. Most of us T-F-S...Test-Feed-Shot. I also use the Relion micro.

Again more experienced people will be along to help you with that decision also. I just noticed that the more experienced ones are posting while I'm slowly typing this so I'll close with a Welcome to the forum.
 
Ok, have edited the title thank you : ) Also I will read the depot article. It does seem like this insulin has some hang time and unexpected rebound unless Molly's got a little insulin pulse response of her own going too ( I can always hope! : ) )

Glad to hear that 0.5 is a little better as far as her ideal weight indicates. 1U made me a little nervous but that was with the wonky glucometer.
 
Re: New Lantus user...suggestions?

Welcome to Lantus Land!

Did you shoot 1u on 11/20 in the a.m. and p.m.? If you did, the 58 could easily be due to the insulin depot of the 1u. If you didn't, it's likely the .5u. However, that is still a safe number. It is difficult to tell if the pink numbers are due to food or "bouncing". When a cat is first diagnosed with diabetes and the numbers are high, the liver acclimates to those higher numbers. Then when insulin is started and numbers come down, the liver, not being used to those lower numbers, releases counterregulatory hormones into the bloodstream to bring the BG back up to what it believes is "safe" (the higher numbers). Most cats bounce and do so until they don't. Some cats stop quickly, others bounce a long time. She looks a little bouncy to me but some of the higher numbers could be the dog food.

The goal is to shoot a dose you can safely shoot every 12 hours. We recommend new members without much data post here for assistance if they get a 150 or below as a preshot number. Then we can help you with some options. Lantus likes consistency and so shooting a safe dose every 12 hours is the best way to help your kitty.

Are you still feeding DM? We don't recommend it....there are many other, better quality low carb foods that you can get using Dr. Lisa's Food Charts as a reference.

For now, I'd continue shooting .5u. I would not skip insulin until we see whether this dose actually is too much.

I'd also recommend you read the "Stickys" at the top of this forum. They have great information but members here are also very generous with their time in answering questions and helping you.
 
Re: New Lantus user...suggestions?

Welcome to Lantus Land!!

I think you mean you've been posting in "Relaxed" Lantus. You're more than welcome to post here regardless of whether you're following Tight Regulation or the Start Low Go Slow approach. Many who started out on the other board have been posting here since this is a very active board and there's usually someone around pretty close to 24/7 if you need help.

Molly's numbers are looking pretty good -- especially good if she's been sneaking contraband doggie kibble in the evenings. For now, I would hold Molly's current, 0.5u dose for at least 5 days in order to establish the insulin depot.

In response to your question, stalling a shot is fine. Generally, you don't want to feed if you're stalling. As an example, if you shot 1.5 hours late, then your shot tomorrow morning is 12 hours from when you actually gave Molly her injection. In addition, if the 239 was the test where you gave the shot, that number would become your PMPS. You can begin to move your shot time back to your usual schedule by moving the time 15 min. earlier at each shot time or by 30 min. once a day. FWIW, I would recommend that you always test at your usual pre-shot time. It's quite possible that Molly's numbers were rising between +11 and PMPS and it would have been fine to shoot. (While on other boards here 200 is often used as the "no shot" number, we use 150 and encourage you to post and ask for help until you are more comfortable shooting lower numbers.)

I also want to encourage you to try to not skip shots. Right now, you're in the process of allowing Lantus to form an insulin depot. The depot is what gives Lantus is duration and allows for overlap between doses. Every time you skip a shot, if effects the depot which takes roughly 5 - 7 days to form. If you start running into numbers that are below 150 on a routine basis, then it's best to reduce the dose so you can shoot twice a day rather than skip the shot.

Looking at your SS, did you give any insulin in the AM on 11/22? Your comments sound like you gave some insulin but there's no indication of the dose on the SS.

Wendy mentioned that there's a weight based formula to establish initial dose. (initial dose = 0.25 x ideal weight in kilograms). However, since you've started at 0.5u, I would stick with that dose for now. I would not stop shooting -- there's no indication that Molly is getting too much insulin.

There are several possible reasons that your numbers and the vets differ. The first is stress. Many of our cats routinely experience higher numbers when at the vet's office. This is one of the many reasons that home testing is so important. Your vet was also most likely using a serum chemistry analyzer for blood work or a meter calibrated for animals. These instruments generally test about 30 points higher than a human meter.

Please let us know how we can help. The people here are very generous with their time and information and we will do everything we can to lend a hand.
 
Thank you all for your help. I stopped Molly's insulin on the evening of 11/18 when I realized something different was going on than the vet was seeing. I made up some test solutions of dextrose and found that while the meter I was using was great for straight sugar water, when it came to blood it was WAY off.
I got a new meter (Relion Micro) and started Molly back on insulin on the 21st but backed it down to 0.5 U out of caution.
On 11/22 I did not give the morning dose because I couldn't get a AMPS...she's very uncooperative in the morning. She's been eating every 12 hrs regardless of shot or not.
Good to know about the holding the food thing. I've been feeding at 12 hr cycles whether the shot is given or not just to hold the peace (2 other cats....one of whom is aged and on a high carb diet due to kidney failure and hyperthyroid...so between this and the dog food it's all quite a juggle keeping Molly out of undesirable food).
If I hold food from her, I'm probably not going to be able to get a BG....she gets very mean....should I just not feed until the next dose time?
Thanks
 
Thank you all for your help. I stopped Molly's insulin on the evening of 11/18 when I realized something different was going on than the vet was seeing. I made up some test solutions of dextrose and found that while the meter I was using was great for straight sugar water, when it came to blood it was WAY off.
I got a new meter (Relion Micro) and started Molly back on insulin on the 21st but backed it down to 0.5 U out of caution.
On 11/22 I did not give the morning dose because I couldn't get a AMPS...she's very uncooperative in the morning. She's been eating every 12 hrs regardless of shot or not.
Good to know about the holding the food thing. I've been feeding at 12 hr cycles whether the shot is given or not just to hold the peace (2 other cats....one of whom is aged and on a high carb diet due to kidney failure and hyperthyroid...so between this and the dog food it's all quite a juggle keeping Molly out of undesirable food).
If I hold food from her, I'm probably not going to be able to get a BG....she gets very mean....should I just not feed until the next dose time?
Thanks
 
There are many here who free feed, but take the food away at certain times in relation to testing times.
You generally don't want them eating 2 hours before shot time, some make that gap longer.


In my opinion, 12 hr feedings are a long time to go in between meals. My own cat prefers 4 hour gaps and I never let her go more than 6
hours between getting something, a snack or smaller portion of food.
 
Well it looks like I probably should have given her shot this evening....she's up to 302 at the +4. I'll get the hang of this.
While I do work, I come home for lunch, so a mid day snack is possible. Thanks,
 
Welcome to Lantus Land! You've got the best experts helping you out. You are doing a great thing for Mollie (feeding wet food, testing, and giving insulin).
Liz, Zener's other bean
 
Have you found Tanya's site for cats with kidney issues? With kidney issues, it's not so much that the cats need high carb as they need low protein or, more importantly, a low phosphorus diet. Lisa Pierson, DVM put together a list of cat food that's low in phosphorus. If you can find a food that's low phos and low in carbs (under 10%) you could feed both cats the same food which will make your life much easier.

Many of us use a timed feeder so we can make sure small meals are available throughout the day if we're not home. It tends to be much easier on a cat's pancreas to feed several small meals than to feed a large meal twice a day. We pick up any food 2 hours prior to shot time so food doesn't influence your pre-shot numbers.

Are you giving Molly treats when you test? Having her associate treats with testing will go a long way to calming her down despite her being hungry. Many of us use freeze dried chicken (or other freeze dried protein) as a treat or will cook off a chicken breast and cut it into small pieces for treats.
 
Yes thanks for the tip. This morning I had Molly munch on a teaspoon full of tuna while I did the reading and it worked much better.

Thank you also for the low phosphorus link. I'll see what I can find that they can all eat. This will be a good food for me to free feed when I'm not home!

Molly's BG was 396 this morning and I realized I'd forgotten to give her the usual bedtime snack.....her liver must've kicked into gear as one of you mentioned and blown up her glucose levels.

So thank you all for your advice. I'm going to go with the 0.5 U and try not to skip any doses unless things are really really low. Will report her +3 in a new message.
 
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