New on Lantus, need advice about low number

Status
Not open for further replies.
RockStar033

RockStar033

Active Member
Just put her on lantus this morning, it was 2u at 11am.

amps - 342
+0 - 2u
+1 - 360
+3 - 234

i'm a little panicked, haha. is a drop like that normal for Lantus? i have to leave for work in like 20 minutes and hubby won't be home till 7. will she be ok, or will she drop more? i thought i read Lantus doesn't have big drops .... i'm really scared right now only because when she was on Caninsulin, it had the huge drops that scared me, so now i'm carrying baggage over with this new insulin, someone advise please.
 
I'm curious on why you started with 2u? That's a high starting dose, especially when you considered how far she was dropping on 1u of caninsulin. 1u twice a day is the usual staring dose for Lantus. Is she eating a canned, low carb diet?
 
Lantus usually takes about 24 hrs to start working on BG, so if you leave food out for her I think she'll be ok. However, with that high starting dose I just don't know. If it was a normal starting dose of 1u I'd say you were fine.

According to the Lantus protocol, the starting dose should be .25u per kg of ideal weight. That works out to be about 1u for most cats. 2u is the maximum starting dose and usually only given to very, very large cats. Most cats on a low carb, canned diet only ever end up needing around 1u of insulin. Bandit is 13 lbs and never needed more than 1u.

I would print out the protocol and bring it to your vet. It also states the recommended starting dose in the AAHA diabetes guidelines (p. 4). I would print these out as well. Also, as both of those state, Lantus should be dosed TWICE a day, not once. See bullet three under "indications for using glargine" in this document: http://www.uq.edu.au/ccah/docs/diabetesinfo/link5.pdf.

I understand that you want to go with what your vet is saying, but that may not be what is best for your cat. Some vets are not using current or updated information on which they are basing their decisions. More often than not, vet's don't understand how Lantus is dosed with cats. My vet also had me dosing once a day in the beginning--until I did research on my own and realized her advice was wrong.
 
she was on 2u Caninsulin BID....

she's on Wellness grain free low carb diet.

i just called my vet... she now went froom 234 a half hour ago, to now at 180.

called vet, he said to watch her, but he really doesn't think she will dip lower then 90, he was hoping the nadir would hang around 90, but i have to leave for work at 3 30, and hubby is now going to be home at 5 he is going to leave work early.
i usually feed them again now.
 
i'm really panicking right now..... because i have to leave for work no later then 3 30 and she will be alone till around 5... during her nadir
 
She was getting low 100s on 4/13 on 1u of Caninsulin. That's an indication that the 2u was too high.

Starting with too high a dose is not only dangerous, it's counterproductive. Too much insulin will keep BG just as high as too little insulin. You need to find the right amount, and the only way to do that is to work up to an ideal dose.
 
I understand that now but moving forward, the dose has been givin already and I've been checking and depending on the nadir the vet sais he will change the dosing.
 
I'm not sure what advice to give you for now, since you have to leave for work. I would leave her access to food, and you could also feed her some higher carb gravy food before you go. That will give her a boost to work with to be on the safe side. Then make sure she gets tested again as soon as someone gets home.

How are you getting the nadir for your vet if no one will be home to test her mid-cycle? Since you only shooting once a day, she's likely going to have a high number this evening. That's not a true measure of how the insulin is affecting BG. Nadirs usually occur at around 6 hrs after the shot, but can be earlier or later depending on the cat.

Regardless of what your vet says, I would highly recommend shooting 1u twice a day, rather than 2 u once a day. It makes no sense to shoot likely too much insulin for half the day, and then nothing the second half. All you're going to see is crazy dips and spikes. If 1u isn't enough, your testing will show that and you can raise the dose slowly and safely in .25u-.5u increments.
 
i know.... that's the thing, noone will be home when she reaches her nadir. :( i called work and said i'd be late so i can test her up until 4pm, then hubby will be home just after 5....
 
RockStar033 said:
i know.... that's the thing, noone will be home when she reaches her nadir. :( i called work and said i'd be late so i can test her up until 4pm, then hubby will be home just after 5....
Click to expand...


Then I think she will be fine, especially if you leave food out for her. You'll be able to get a good idea of how low she goes at least. I would hold off feeding gravy foods unless she's she's still dropping right before you leave.

Lantus doesn't work like other insulins--it builds up an insulin depot under the skin, and once that is full the insulin slowly goes to work on BG. That's why we usually don't see the effects of a dose change for 24-72 hrs.

When you can, please read over the lantus dosing protocol that I linked to above. If you have any questions at all, there's a ton of helpful people here that can help out. Then you can give it to your vet and say that is what you want to follow, because it's been proven to be safe and effective in cats. I've also attached an article that shows this. Remember that she is YOUR cat, all the decisions for treatment are ultimately yours. When I went into my new vet who was not familiar with the protocol, I said this is the dosing protocol I'm following, and I'd be happy to have you read it and offer me advice with it, but this is what I am sticking to because of it's proven results. She was very happy that I was taking such a proactive approach towards Bandit's treatment, and she hadn't seen the protocol since the article I've attached wasn't published until recently (2009). Many vets just haven't seen all of the research.
 

Attachments

Thank you Julia.

I just tested her again. She was 180 at +4 and still 180 at +5

My vet is very knowledgeable and very open to my opinions and suggestions I have total faith in him.
Although he is very experienced specifically with feline diabetes doesn't make him perfect, I still have faith he knows what he's doing. It is a working relationship between us and givin that every cat is different we have to work together to come up with what the best specific need for my Annie. I can't dismiss everything he has said or suggested unless I know it's absolutely wrong.
 
Not every solution works for every cat. My vet has 2 diabetics herself and several of the vet techs in the office have diabetics as well. They all use and swear by PZI. Which is great because it works for them. It didn't work for Ruby. Do I think that makes her any less than a good vet? No, I don't. She's goes by what she knows. She also wasn't as keen on hometesting when we were first diagnosed. The first time we brought Ruby into the office for an all day curve, Ru threw 400s at them the whole time. Based on what she saw in the office, Dr. K raised Ru's dose by .5 unit. The next night...Bam! Our first nosedive into double digits.

A couple of weeks later I sent Dr. K the curves I'd been doing at home and we decided the best plan for Ruby is to keep her out of the office unless its unavoidable. She stresses like crazy and those weren't accruate numbers. I send in my charts every now and then and we do phone consultations. The good thing is that Dr. K is willing to learn along with me. Now she has more guns in her arsenal for use with other diabetics who come into her clinic.
 
My first vet that was supposed to be an expert in diabetes did most things right, but her dosing was still way off. She just wasn't familiar with the dosing protocol.

Please at least read the information I've provided for you, and then decide if you want to bring it to your vet. It outlines what starting doses should be, how often Lantus should be dosed, and how dose adjustments should be made.

A vet can have a good working knowledge of diabetes (an expert compared to most vets), and still not get everything right. In all my years on these boards, some vets have come close, but very, very rarely do they get as far as give correct dosing advice. My vet started Bandit on Lantus, told me I had to home test, and handed me a list of low carb, commercial canned foods to choose from at the store. However, her dosing advice was just not right.

If he's open to opinions and suggestions, just give him the research I've provided for you and see if that changes his opinion. If he's as knowledgeable and open as you've described, I guarantee you he will start using it.
 
hi - amy put a call out for help from some of the lantus TR folks, and i'm one. i'm glad your issue has passed for today, the question is what to do next!

i wondered what meter are you using? when your vet says "under 80" that makes me think he's using a feline-calibrated meter, the AlphaTrak. if you are using a human meter, the numbers are lower. most of us use a human one, and the number we would generally get concerned about is 50. if you're using an AT, make sure and let us know, because that makes a difference.

if you'd like to check the BG maybe a half hour before shot time, we can help you with a dose if it needs to change. what time would that be, and what time zone? if you don't check in with anyone, i'd agree with julia's suggestion to just drop to 1unit twice a day, 12 hrs apart, and go from there.

is the Wellness grain-free a canned food or dry? do you know the carb content?

very, very glad you've switched from caninsulin to glargine (lantus). caninsulin is for dogs and isn't good for cats. lantus, levemir & prozinc are all much better for cats.

julia has given you some great information. she has a ton of experience and won't lead you wrong! people here "do" feline diabetes 24/7/365. we can give you a hand and teach you what you need to know to help your kitter and keep her safe.
 
Her nadir today on the 2u was 135 and then she stared rising.

We use the Bayer contour and we took it with us to the vet to compare it to theirs and it's .6 off.

We always check the BG before we shoot her. We are supposed to shoot her once a day right now until I talk to the vet again tonight.
 
RockStar033 said:
We are supposed to shoot her once a day right now until I talk to the vet again tonight.
Click to expand...

You are the one holding the syringe.

And we're the ones telling you that it may not be safe to follow those vet's instructions.

We lost a kitty just yesterday because the vet was not up to date and instructed the owner incorrectly.

I hope you will reconsider our information about how Lantus should be dosed for feline diabetics.
 
Just checking in....how is your cat doing??
You should try posting in the Lantus threads, you will get a quicker response.
I hope you're doing well - I KNOW how nerve-wracking it can be at the start when this board tells you one thing and your vet another. Hard to know who to believe. The people on this board definitely know their stuff!!
Hang in there!! ;-)
 
Hi and thank you

Yes the people on this board definately know their stuff and i am in no way doubting them. It is very hard being pulled 2 different directions, i just feel that whether i go against my vets instructions or not i should always communicate it with him, they have been so good at communicating with us, and even if i called today and said listen i'm putting Annie on 1u BID, he wouldn't argue against me. Also, one of the links he gave me to look up and read was a link to this message board.... by his own notes! so he knows about this board and how informative it is.

i will post over in Lantus board
 
RockStar033 said:
Hi and thank you

Yes the people on this board definately know their stuff and i am in no way doubting them. It is very hard being pulled 2 different directions, i just feel that whether i go against my vets instructions or not i should always communicate it with him, they have been so good at communicating with us, and even if i called today and said listen i'm putting Annie on 1u BID, he wouldn't argue against me. Also, one of the links he gave me to look up and read was a link to this message board.... by his own notes! so he knows about this board and how informative it is.

i will post over in Lantus board
Click to expand...

I agree 100% that you should absolutely communicate with your vet that you're changing the dose based on information provided, and I would even go so far as to email the information to him so he can see why you made the decision you did. It sounds like you have a GREAT vet.

When I decided not to go with my old vet's dosing advice, I called her, explained why I was going to not take her dosing recommendations, and I sent her all the research I had done so she knew why. She said she had 3 diabetic dogs and therefore had a lot of personal experience with dosing Lantus, but she understood my decision based off of the research I provided her. I ended up switching to a vet that specialized in cats that was a bit closer to my house because of my other cat's health issues, but I would have had no problem staying with the first vet because even though she wasn't perfect (who is?) she was still a very good vet with the right attitude who was easy to communicate with.
 
Status
Not open for further replies.
Back
Top