New member - lots of questions

Hi all.
Sorry, it seems that I did not read the rules quite well enough. Trying to do too much at once it seems!
Anyhow, my very first post was made earlier today, under the topic below "
"? re Toujeo, insulin pens, Libre"

In it, I describe my 15 yr old, newly diagnosed diabetic cat. He was prediabetic before, and after a short course of budesonide (steroid) for IBD, the diabetes has declared itself overtly now.

He has significantly hyperglycemic likely for about 2-3 weeks now, and on insulin for the past week, which is when the also when the budesonide was discontinued. But I confess I am really struggling to try to get his BGs under some semblance of control. They have been consistently running in the 20's despite consistent monitoring on my part, and cautious insulin increases. Ugh. Frustrating.

I haven't posted the entire story again here, but can certainly edit and do so, if it would make more sense.
Otherwise, it can be found under the topic above.

Any suggestions and guidance would be most appreciated!

I'll work on adding the info to my signature as recommended.
And will do a spreadsheet once I read all the directions and figure out how.

Thanks in advance!

 

https://felinediabetes.com/FDMB/threads/re-toujeo-insulin-pens-libre.245467/
Previous post.

I see you said the insulin you are using is Toujeo Pen




What is difference between Lantus and Toujeo?


Toujeo and Lantus are both long-acting insulins that are used to treat people who have insulin-dependent diabetes. ... The biggest difference is that Toujeo is highly concentrated, making injection volume much smaller than Lantus.

I have never heard of that but I will tag a few members who might be able to help you out.
We use syringes with half unit markings and draw it from the pen because we increase or decrease by 0.25 or 0.5 units

I will post the links on how to set up your signature and spreadsheet.
If you have trouble with the SS we have 2 members that will do it for you

 

https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/
This link will tell you how to create a SS and explains how to use it
Like I said if you have trouble just ask

 

https://felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/

How to set up your signsture

 

Have just downloaded SS template. Will start working on it.
Got my signature done and downloaded a photo of my kitty, Simon
Thanks!

 

Thank you Yvonne, Simon is a handsome kitty
I am going to tag
@Wendy&Neko
to see if she can help you out

Hi Wendy I don't know if Toujeo insulin is exactly the same as Lantus since this is what it said about
Toujeo and Lantus are both long-acting insulins that are used to treat people who have insulin-dependent diabetes. ... The biggest difference is that Toujeo is highly concentrated, making injection volume much smaller than Lantus.
I didn't know who else to tag , she is in BC Canada
Thank you Wendy

Her first post goes into more detail , such as how many units she is giving twice a day
and more questions

Thanks again Wendy
@Wendy&Neko

 

We haven't had anyone here use Toujeo, for a couple reasons. One is the high concentration a glargine 300 U/mL insulin, meaning it's really hard to get small doses that we can do with insulin syringes. Second, you have to use the pen, there are no syringes for that concentration. Using syringes also allows us to do small increases at once. Going from 1 unit to 2 units like your vet just did is like going from 3 units to 6 units - a much larger increase than we'd do here. I've read about a cat on Toujeo - see the last case in the article attached to this post: (2020) Updates in Feline Diabetes Mellitus and Hypersomatrotropism And I did hear of a very high dose cat on this insulin for a while, but not someone who posted on this forum so don't have any details.

 

Toujeo is more concentrated than Lantus, by 3x. So that would mean a starting dose of 1u on Lantus would be 3u on Toujeo. I suspect that may be why you are having problems with low numbers, since if my understanding is correct, it is not something that you can administer in smaller doses, which means when you inject 1u of toujeo, that's as small as you can go, and is why not many people use it in cats.

 

Re the Toujeo

The premise behind this, as I was told by my vet, is that by concentrating the insulin, it gives it an even slower release time and more even/levelled out action curve. And decreases the chances of hypoglycemia which of course in a pet is a plus (especially in a fussy eater like my guy!).

And even though on first glance, in theory it is three times as concentrated, in fact, it has similar dosing to regular lantus, or possibly someone on it may even need a bit more. Thus if a person (or animal) is needing one unit of lantus, they would be started on 1 unit of Toujeo.

The benefit in humans of course is the small dosing size. Which of course is a detriment in a small animal such as a cat as it is harder to do tiny corrections. And one is limited to using the pen, which as others have mentioned, has no ability to do partial unit doses since it must be administered in one unit increments.

This is a nice short synopsis of it
https://www.drugs.com/medical-answers/toujeo-lantus-difference-between-3420904/

I did see reading through this that the time to reach steady state is a minimum of 5 days, so I expect I am being impatient and expecting instant results. I work in a hospital and am used to seeing correction doses of regular rapid acting insulin to get the BGs right where we want them, very quickly. I think that I need to cool my jets and just continue the course for now...

 

Re Toujeo

From dvm360.com

https://cdn.sanity.io/files/0vv8moc6/dvm360/06898dd95493e594e97993db4f8936fdecfc195c.pdf

As a 300-U/ml suspension, Toujeo is a super-concentrated form of glargine that generates a greater tissue reaction that results in even slower absorption. “Because of that tissue reaction, some of the glargine being given is going to be degraded before reaching the systemic circulation,” Dr. Langlois said. He also noted that Toujeo’s duration of action and time to peak activity are longer than with detemir, so this also leads to having to give a larger amount—but you should have a smoother glucose curve.

As such, Toujeo may be helpful for difficult to control cats in which you’re struggling to get optimal control. “Several clinical trials of Toujeo are currently in process at other institutions, and we have received anecdotal reports suggesting that several refractory diabetic cats have been successfully managed with this insulin,” he said.

 

Sorry Yvonne, I am Canadian and yet didn't recognize when you said 20 you meant 20 mmol/L. I suppose I've spent too much time reading what most people here follow which is the US mg/dL numbering. I always felt the syringes were better, because my understanding with pens is you need to inject and hold in place for quite a few seconds. Some cats don't tolerate that too well.

Some explanation for the consistently higher numbers may be attributed to the dry food, which is quite high in carbs. Most of us here find feeding low carb canned food under 10% works the best, although there are exceptions to every rule.

 

The link to the paper that I gave earlier, is for an article about using Toujeo for a "brittle" diabetic, or one that is hard to regulate. Which is not something you could say about Simon who is such a newly diagnosed diabetic. And as before, the problem with Toujeo is being able to give smaller doses or make smaller increase. We have many cats on doses smaller than one unit and a 1 unit increase is much larger than we would make - cats are sensitive to very small changes in dose. My cat was even sensitive to 1/8 of a unit changes at one point. One other problem with Toujeo, because of it's limitations in dosing, there isn't much practical experience out there with it yet. As your quotes say - it's in the research stage at this point. Maybe find one of the universities/institutions who are trialling it and find out what methods they are using for dosing? I'd love to know the answer for future reference.

Out of curiosity, what part of BC are you in? I'm in the Vancouver area and curious to hear about a vet suggesting Toujeo. There are still so many here still recommending Caninsulin.

Answering some of your questions on your earlier thread - yes, human BG meters are perfectly find and the test strips are so much cheaper. Plus our dosing methods were written with them in mind. So we prefer them to the AT, it's what we are used to.

On the food, have you ever tried freeze dried raw? There was one kibble head here who was OK with that - plus you can get the novel proteins you need for IBD. Those higher carb dry foods will all mean you need a higher dose than if you fed low carb food.

 

My apologies. I work in Canadian Health care and am so used to using SI units, that I posted in these. Yes, my cats BGs of 20ish are in mmol/L so running pretty consistently about 400 in US units. So no where near worrying about his having a hypoglycemic reaction at this juncture.

I know that canned food is ideal, but I honestly tried to convert him over to that for a year, trying many different varieties (pretty much anything available in Canada), real protein foods, raw proteins etc. My cat out-stubborned me and let me know he'd rather starve that eat any of that stuff. Over the course of about 6 mo, he lost 2 lb which is a whole lot in a 12 lb cat. Even my vet said that I needed to admit defeat and go back to giving him something that he'll at least eat. Sigh.

The one good thing is that this guy is SUPER cooperative. So he'll let me poke him and take blood as much as I'd like, and has been fine with giving injections with the pen too, even to waiting for the 6 second hold time before withdrawing it. I feel bad for the little guy though as I was making him a pin cushion. Have decided I'll only check his BGs every 6 hrs now while they are so consistently high.

 

I have created a spreadsheet for my cat Simon. I entered his data on the world sheet, but see that not all the fields accurately transferred over to the US chart (eg said no insulin given this morning when 2 u were).
Here it is: https://docs.google.com/spreadsheet...Lv8OQopXbjRE-ec5glYhHFBUpoX498rqrBaci/pubhtml

 

You should be able to go to the US tab and overwrite what is there.

You might want to consider getting a "before bed" test each night. Many cats go lower at night. I rather suspect he went lower than he's used to the night of the 28th and since then is doing what we call bouncing. Definition: Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

 

@Wendy&Neko

@Christie & Maverick

Thank you ladies for answering my tag

 

Thanks. I was wondering about rebound hyperglycemia myself. I'll try checking later at night.

 

@YvonneHills I just want to alert you to be Observant of the Onset Time for the Toujeo verses the Lantus.
It say Onset for Toujeo at + 6 hours from the insulin shot.
That's way different than Lantus Onset time +1,1 1/2-2 hours from the insulin shot.

Monitor Simon closely and get as many +Hour readings as possible to see how that functions in Simon with that.