New on Lantus, need advise on diet

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worldtraveller

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Hi all,
Kitty was dianogned mid December and he was on Caninsulin from Christmas for about 6 weeks. I was giving him usually 3 units twice a day, lowered from 4 units (dosage is higher than with e.g. Lantus). I am doing hometesting since mid January, and usually his nadir was was around +3-4 hours. As an example of his BG curve was that AMPS was 18,6 mmol/l (335 mg/dl), and went down to 2,5 mmol/l (45 mg) in 3 hours. He was getting better, and could clearly notice that he was drinking less water.

Well, then I decided to change to Lantus as I have heard that it is better for cats, with better chances to go to remission. Started with Lantus last Saturday, 2 units twice a day. I have not done yet a full curve, but his BG levels are now typically higher than with Caninsulin, around 14-15 mmol/l in 3 hours after the shot and he also has started to drink more water and use more the litter box. I know it takes some time to stabilize after starting with Lantus, but we are now on day 6 so I was hoping to see better results by now... How soon have others usually seen better results after starting with Lantus? I am wondering if to increase by 1 unit in a few days or still wait for another week.

By the way, what are the best syringes for Lantus? I have now insulin pen which does not do half units. I think I should buy syringes so that I can change dosage in half units also. Lantus dosages are so little that I am wondering if all the insulin goes to Kitty. While I did not like using the syringe with Caninsulin (avoiding the bubbles, trying to read the small measurements in the syringe, etc), it was though easier to make sure that all the insulin went to Kitty.

What we struggle also is the change in diet. Kitty and non-diabetic Joey were all their lifes on dry food. I realize wet food is the way to go, but the challenge is to try to find something what kitties like.... Joey seems to be more happy with wet food (particularly HIlls canned MD - he loves it, but does not need it... :) ). Kitty just is pickier and does not seem to be eating well. He does not care much about canned food with meat, but he loves tuna in any form. Is tuna based diet ok for a diabetic cat? Any good tips how to change to the proper wet diet?

Help, please help. :?

- Mia
 
Welcome Mia!

It does get better :-)

You may find Binky's Page helpful in selecting foods. We aim for under 10% calories from carbohydrates. Lots of us feed Fancy Feast Classics.

To help you transition to canned food, check out Cat Info on transitioning dry food addicts to canned food. Dr Pierson has very good instructions in a PDF file on her web site.

When you make the transition, be sure to test your diabetic cat to make sure it is safe to give the insulin!!! Do not give insulin if the pre-shot glucose level is < 200.

You'll find it helpful to read some of the stickies about Lantus which are in the Lantus forum.

You may have started too high with the Lantus - because it is so long lasting, the recommendation is to start at 0.5 to 1.0 units. The numbers you get will be different than Caninsulin - Lantus does not hit as quickly, and it lasts longer than Caninsulin. It can help to space the food into several smaller meals - for example put down half of breakfast at 7 and the other half at 9, put down half of dinner at 7 and the other half at 9. and its OK to leave the food out so your cats can nibble; this helps ensure the diabetic has food if his glucose starts dropping too low.

Lantus is very easy to give using a 3/10 cc 8mm 30 or 31 gauge U-100 syringe. What a gobbledygook! Let me translate -
3/10 cc refers to the volume the syringe holds
8 mm is the length of the needle
30 gauge is the diameter of the needle (the higher the number, the thinner the needle)
U-100 means the insulin is 100 units per mL

And WalMart carries their brand behind the counter in the pharmacy, plus you can purchase syringes like that from ADW, one of our shopping partners listed up above.
 
worldtraveller said:
Hi all,
Kitty was dianogned mid December and he was on Caninsulin from Christmas for about 6 weeks. I was giving him usually 3 units twice a day, lowered from 4 units (dosage is higher than with e.g. Lantus). I am doing hometesting since mid January, and usually his nadir was was around +3-4 hours. As an example of his BG curve was that AMPS was 18,6 mmol/l (335 mg/dl), and went down to 2,5 mmol/l (45 mg) in 3 hours. He was getting better, and could clearly notice that he was drinking less water.

Well, then I decided to change to Lantus as I have heard that it is better for cats, with better chances to go to remission. Started with Lantus last Saturday, 2 units twice a day. I have not done yet a full curve, but his BG levels are now typically higher than with Caninsulin, around 14-15 mmol/l in 3 hours after the shot and he also has started to drink more water and use more the litter box. I know it takes some time to stabilize after starting with Lantus, but we are now on day 6 so I was hoping to see better results by now... How soon have others usually seen better results after starting with Lantus? I am wondering if to increase by 1 unit in a few days or still wait for another week.

By the way, what are the best syringes for Lantus? I have now insulin pen which does not do half units. I think I should buy syringes so that I can change dosage in half units also. Lantus dosages are so little that I am wondering if all the insulin goes to Kitty. While I did not like using the syringe with Caninsulin (avoiding the bubbles, trying to read the small measurements in the syringe, etc), it was though easier to make sure that all the insulin went to Kitty.

Help, please help. :?

- Mia
Click to expand...


You are testing at the wrong time for a lantus nadir. Canninsulin hits fast and then wears off fast, a lantus nadir is usually at +6 to +8 of your shot. At +3 the lantus may be just starting to onset. Lantus dosing is almost completely based on the nadir BG readings so you need to make sure you get the mid-cycle tests to see what is going on and make dosing adjustments. Also we do not recommend such a large increase with lantus increases are made .25 or .5 at a time otherwise you may miss the 'sweet' dose for your kitty.

I think you have made the right choice to swap, you need your patience pants with the first month or two of lantus, but then you should start getting a nice flat curve instead of the BG shooting up and down the way it does on canninsulin and yes you will have a much higher chance of remission, particularly if you are able to follow the TR protocol.

Please feel free to post daily on either the lantus tight regulation or the relaxed lantus forum with your BG numbers and experienced lantus people will keep an eye on you and assist you with dosing. To help these people help you you will need to set up a spreadsheet for Kitty, here is the link that shows you how http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207 it is also advisable to set up a profile so that people offering advice can ensure they base their advice on the basis of the full facts about Kitty, here is the link to do that http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=17766

Starting dose for Lantus under the TR protocol is recommended at .25 per kilo of the cats ideal weight.
 
Until you gather enough data, you won't know when the nadir is. +4 isn't a typical nadir on Lantus, but some cats do hit nadir early (mine is one; he actually nadirs around +3, but nadir can be any time from +3-+8 in most cats. When you have a whole day, you should do a curve, testing at least every two hours starting at one preshot and ending at the next one (so at PS, +2, +4, +6 +8 +10 and the next preshot. You can do every hour as well) A couple durves will tell you the nadir, and Lantus dose is adjusted based mostly on the nadir.

A 1 U increase is, IMO, way too big an increase unless the numbers are very, very high. Under the tight regulation protocol, increases are either .25 or .5U at a time, depending on how low the cat drops at nadir and how high the dose already was. Here is a link to the TR protocol that many Lantus users use: http://felinediabetes.com/Roomp_Rand_2008 dosing_testing protocol.pdf

I'm sure someone from Lantus Land with more expertise will drop by and advise you more on dosing.

As for diet, as someone mentioned, you want to aim for less than 10% carbs for sure, but most of us aim for less than 7%. The Fancy Feast classics are mostly under 5% I rotate between chicken, tender beef, and turkey & giblets as they have the most muscle meat listed in ingredients. There are some fish flavored ones, but in general, fish should be fed only once or twice a week as a treat as is is high in phosphorus, which can be an issue with the urinary system, and also can contain mercury etc. Here's a link to a good article on transitioning cats to wet food: http://felinediabetes.com/Roomp_Rand_2008 dosing_testing protocol.pdf

Welcome to the board!
 
hi mia! i'm also a lantus user who has followed the Tight Regulation protocol for dosing.

it's hard to say about your current dose - the formula for weight-based dose for starting is correct if it's a newly diagnosed cat, but you're transitioning from another insulin and in that case, the dose from your last insulin is taken into account.

lantus does like consistency. every time you change doses or shot times you will likely see wonkiness. it's probably ok to be giving the 2 units with the caveat that you want to be testing to catch the lowest point of the cycle so you can see how low that dose is taking kitty. cats can have their lowest point (nadir) anywhere from +3-+8, depends on the cat. a lot of what we do at the beginning is try to see the patterns in our own cats and learn what that point's going to be. i know punkin's low point is nearly always at 5.5 hrs after his shots. cats are all different about this, however.

in studies it has been shown that lantus, levemir and prozinc are by far the better insulins for diabetic cats. much better than caninsulin - which is an older insulin and if i recall correctly, is better for dogs. cats have a very fast metabolism - so the lantus cycle that lasts 24 hours in a human (1 shot per day) requires 2 shots per day in a cat. in the long run you have a much better chance of controlling kitty, with less damage to her body and a better chance of going into remission by using lantus.

regarding the syringe questions - i think you must be using a Solostar Pen, is that right? we use those, but instead of using the needles that go on them, we stick the needle in through the rubber stopper and withdraw the correct dose. it's more accurate than using the pen needles, and for lantus in cats you want smaller increments than 1unit for dosing. make sure you read the sticky on how to take care of your lantus so it lasts as long as possible and how to withdraw the dose. you can even watch the little video that punkin and i did on it. ;-) Lantus & Levemir, Info, Proper Handling & Storage any syringe with .5u markings are fine - try out different ones and you'll decide you like one better than the others.

your question about food - there's also no question that a low carb canned food diet is much better for a diabetic cat. there are some cats that are so carb-sensitive that even one bite of dried cat food will increase their blood sugar. giving a diabetic cat dry food and trying to compensate with increased amounts of insulin is possible if that is the only food the cat will eat, but it's a bit like trying to control a human diabetic who eats candy every day. it's simply more difficult.

however, cats can't tolerate not eating - so it's more important that the cat eat something than nothing. canned tuna is not a good diet for a cat. male cats shouldn't eat very much fish because it can cause bladder problems. cats need the supplements that are added to cat food. if you want to fix raw you must follow a recipe that includes supplements for them to be healthy. almost all of cats seem to like the fancy feast classics and they are all relatively low carb. i stick to chicken or turkey with a fish one on the weekends for treats.

measuring the amount of water kitty drinks is a good way to check and see how he's doing. he may very well need an increase in insulin, but before that happens if you can catch some mid-cycle tests that tell us how low he's going that would be helpful. some cats do need more insulin than average and if he's still drinking lots of water, that's a sign that's possible. you'll see quicker responses to dose with caninsulin, but you'll see better responses overall from lantus. you just have to be patient while it does its thing.

when you do increase, only increase by .25u. not one unit. that is too great of an increase for lantus and you may miss the "right" dose by skipping the possible doses in between. if you want to follow the dosing of the tight regulation protocol, which works best with a low carb canned food diet and at least one test before each shot and a test mid-cycle, you would adjust by .25 units. BJM gave you the link to the Lantus TR forum and you can read about the protocol there and decide if that's going to work for you.

you've found the right place! we'll give you a hand along in learning how to help Kitty as much as possible. i think you've made a good choice with lantus and will be happy with it in a little more time. keep asking questions and we'll do our best to help you!
 
Thanks all for your help - very helpful and comforting to know that we can get help here!

My challenge is that we are in Moscow (Russia), where I am on expatriate assignment. I don't have a regular English speaking vet contact here and don't speak Russian, so I am a bit on my own - and with your help :smile:
Today I figured out that Fancy Feast is called Gourmet Gold here so I think I found the food that Kitty SHOULD eat, but the issue is that he is not yet eating it. Thus, still giving Hills MD dry food also..... Also, I don't have syringes with with half unit markings, so I can effectively only give full units (will try to find the half-marking syringes tomorrow).

I have done a curve on Kitty yesterday and today, and this is not getting any better. Curves are quite flat with too high BG. Today his AMPS was 355, and nadir was already at +3 and 302. Yesterday nadir was +5 and 326. Kitty has been now 8 days on Latus, with 2 units bid. Before that he was on Caninsulin, and had nadirs on the right range (below 80), but got up too quickly also.
Kitty is now drinking A LOT, and also today he missed the box when peeing, twice. Not normal for him.

So, I am clueless what to do next. I have tried to attach his spreadsheet in my signature, can you see it? Any advise - to keep the 2U, lower to 1U or increase to 3U before I find the right kind of syringes? I am going to shoot in 2 hours, so would be great to get your help before that.

- Mia
 
hi mia - yes i can see your spreadsheet! great job getting that going. you wouldn't believe how much it helps for us to be able to "read" what's going on with Kitty by seeing a spreadsheet.

was Kitty eating the dry food all along? when you find the Fancy Feast/Gourmet Gold, you want the classic formulas - the pate style that comes out of the can in a big chunk with a little liquid around it. it's hard to say for sure, but i think most of the cat foods that are like that are low carb. being in russia you might just have to try different things. what a challenge. Here's a great site with tips for transitioning a dry food addict to canned food http://www.catinfo.org

you also want maybe 5 cans to keep on hand of high carb canned cat food - anything with gravy in it will work. the carbs are mostly in the gravy, not the meat, so we give a little of that gravy or karo syrup, honey, pancake syrup, anything like that with a lot of carbs will pull up the BG if you see a number less than 50.

also, if you can get the low carb canned, the insulin needs will decrease, so you'll want to make the adjustment from mostly dry to all canned slowly (over perhaps 5-7 days) and test Kitty's blood sugar as you make the changes so you can adjust the insulin dose if it becomes too much. people have seen significant drops in BG from making this change.

There are 2 dosing protocols that we use here - one is the Tight Regulation Protocol that adjusts doses fairly quickly to get the cat into lower numbers (50-120) as quickly as possible. The other is the Start Low Go Slow approach. I think i'm hearing you want to move as quickly as possible, is that right? You're home-testing, you've got a spreadsheet, you're knowledgeable already about insulin - I think you have the tools to follow the TR protocol if you want. Here is a link that explains the 2 approaches. http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581 Knowing which direction you want to go will help us give you the most appropriate advice. In order to have the best success on the TR protocol we have cats on an all canned, low-carb diet.

REQUISITES WHEN FOLLOWING A TIGHT REGULATION PROTOCOL WITH LANTUS OR LEVEMIR:

Kitty should be monitored closely the first three days when starting Lantus or Levemir.
Blood glucose levels should at least be checked at pre-shot, +3, +6, and +9.
More monitoring may be needed.
It will be necessary to test kitty's blood glucose levels multiple times per day.
Learn the signs of and how to treat HYPOGLYCEMIA and prepare a HYPO TOOLBOX.
Test regularly for ketones and know about DIABETIC KETOACIDOSIS (DKA).
Use U-100 3/10cc syringes with half units marked on the barrel for fine dosing.
Feed a high quality low carb canned or raw food diet.
Feed small meals throughout the day. Some kitties adapt well to free feeding.
Click to expand...

I'd like to get some more opinions on a dose for you. i think you're describing a cat without enough insulin - the continued thirst, the high nadirs. my reaction is that you should probably increase by .25u to 2.25u. That's advice from the TR protocol, which is what i've followed with punkin. we would watch how he does on 2.25u and re-evaluate the dose every 3 days. if you want to follow the SLGS it would be .5u increase and then the dose is held for 1-2 weeks. It sounds like .25u is nothing, but it isn't - cats are highly reactive to lantus and even a .25u increase can make a big difference.

no problem with not having .5u markings on your syringes - it's a little more of a challenge but you can figure out where it should be. take a used syringe (or waste one) and draw up 3 units of water - colored water/tea would be great. then twist the plunger to squeeze out one drop at a time. count how many drops are in between 3 units and 2 units. then draw up 3 units again, squeeze out 3/4 of those drops to see what it looks like for 2.25. you can save that syringe to use as a comparison.

then when you prepare the insulin dose, draw up 3 units and squeeze out that many drops again for 2.25 units. it's possible the lantus and water/tea may have different "thicknesses" so the drop number may be different - if so, adjust accordingly. i'm also going to post the link here that gives you photos showing tiny dose increments. it doesn't matter so much if it's exactly like the pictures, or a particular number of drops, what matters is that you know what you've done and can do the same thing again to give the same dose. Lantus likes consistency in dosing, so you just want to be able to repeat what you've done.

http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=18139 scroll down a ways til you see the photos of the syringes. these should be helpful.

2 units is more insulin that cats usually start on - but i think you need that higher dose because you're giving high carb dry food.

let me get some more opinions of other experienced lantus users for you. hopefully between us we can get Kitty adjusted.
 
Thanks Julie!
I have some old syringes when using Caninsulin (Caninsulin was 40U, but those syringes have also 100U markings). I'll try if I can feel comfortable with getting good .5 or .25 measuring with those syringes. If not, then I'll stick to 2U dose at least for tonight.

- mia
 
Hi, and Welcome. I am just checking in her real quick, as I am at work right now, and have very limited access to the internet from work. I agree with Julie. I would only increase by 0.25 units.
I am unfamiliar with the U40 syringes. They also have markings for U100 on them? Good luck with the colored water, and practicing those small dose changes.
 
The old syringes did not work well for trying to find accurate measurement between 2 units, so I gave 2U shot tonight. His PMPS was 317.

Thanks for explaining the difference between TR and SLGS. I would like to do TR, but I will be doing a bit of travelling for work during the next month, so I cannot do as much home testing, thus I think I better do SLGS. I think that will be easier for my kitty sitter as well (she does not check BG before the shots).

Keep your fingers crossed I will find syringes with half markings, and if I do, I'll increase the dose with .5 for the next week. I am anyways coming to the US in 3 weeks time, so will buy the syringes there then if I cannot find them here.

My main concern is that Kitty's BG continues to be high now and he is clearly not feeling as well as with Caninsulin. A far as I see, more patience is needed with Lantus, but hopefully there will be better chances to go remission.
 
Hi, Mia -- at the risk of stating the obvious, have you searched online for an English-speaking vet in Moscow? I just Googled "Moscow English vet" and found the site below. Wanted to share it in case you haven't yet seen it. Looks like there may also be info on the US embassy site.

http://www.moscowanimals.org/advice/vet.html

The people posting here are much more experienced than I. Listen to them! But you were asking about syringes. My vet prescribed BD Insulin Syringes, 31g, w/ an 8 mm needle. Have been using them since Aug 2011 w/ no problem -- my sugarkitty, Fred, doesn't bat a whisker when I give him his shots. They sound like the syringes mentioned in BJW's post and are marked in .5 increments.

Re: the food switch, you might want to try dribbling a little low-sodium chicken broth over the new food to tempt your baby. Someone suggested that to me at one point when I was trying to convince Fred to try one of the prescription-type foods. However, once we discovered that Fancy Feast Classic flavors were OK, no more persuasion needed! Hope you're able to find the foods you need and that Kitty grows to like them.

One of the posts from Julie & Punkin mentions that Lantus can be finicky and that inconsistency in shot times can result in "wonkiness." I can corroborate that. Last Sunday, Fred's appetite was through the roof; he wouldn't stop pestering me for food, which had me so upset that I posted for the first time on the FDMB. Looking back on it, there were a couple of days prior to Fred's "attacK" when my schedule got crazy and I'd dosed him outside of the 2-hour window that my vet recommended. And....G*d and Fred forgive me...I might even have missed a dose. I'm pretty sure that this is what caused the crazed appetite. This isn't earth-shattering -- only meant to illustrate that consistency really is important.

You're waaaaaay ahead of the game because you've started home testing.

Anyway, you've come to the right place. FDMB is proving to be a real blessing for me and I'm sure it will help you, too. Very best wishes to you & Kitty!

Andrea
 
Thanks for the tips Andrea!

I have seen one of the vets mentioned on Moscow animals website, but she is not familiar with Lantus. It appears that most vets in Russia still prescribe Caninsulin. There are some who know Lantus, but heard that they were not recommending it as it is a bit more difficult to manage. So I am still continuing the search. In my wildest dreams I would have never thought that I would some day be teaching Russian vets about insulin on cats?! I actually found myself doing that one Friday morning 2 months ago, and it was a quite bizarre situation :lol:

Any how - I just cannot understand Kitty's BG any more.... At +2 after the evening shot his BG continues to increase. Why is that happening? As much as Caninsulin is not recommended, at least I understood the curves :YMSIGH:
 
when you switch insulins, it seems people have to re-learn how it all works. don't worry about that - we will teach you.

a lot of vets don't have too much experience with lantus and many people come here for their dosing advice. many of us learn about cats and using lantus here and our vets basically give the prescription and go along with it. There's a lot of educating vets re feline diabetes being done by members here. I'm not bashing vets - they have to know a ton about many animals and diabetic cats are not all that common.

If you need help, there is almost always someone available 24/7 - two of our TR members are in australia, we have two in Turkey and all over north america. if you need immediate help the Lantus TR forum is the busiest place here - and you can follow SLGS there as well. The Relaxed forum is just getting going - it's for people who are looking for alternatives to TR because it hasn't worked for them. The Main Health board (here) has a lot of traffic as well. Probably post to Main and the Lantus TR if you're in an emergency.

One of the good things about Lantus is that it's very unusual to have a symptomatic hypoglycemia episode. They can have lower numbers and not show symptoms. That's different from caninsulin, as i understand it. it's a benefit to have a slower response.

I'm going to post this, then look again at his spreadsheet and see what you're talking about with the +2.
 
looking at his spreadsheet, i just think he needs more insulin. after 8 days, you don't have any curve.

a couple of things that could cause high numbers even though you've got a good dose - the cat could be bouncing from an undetected low number. there's no evidence of lower number and you're testing a lot.

you can see higher numbers directly after increasing a dose that last for up to 3 days. you haven't changed the dose for 8 days. we call that New Dose Wonkiness.

i can't see any reason for high numbers except the dry food and dose not being enough to compensate for that.

so let me ask more questions, just on the off chance that it's something else.

you just started the lantus - was it fresh from the pharmacy? have you watched the video and read the information on how to take care of it so it lasts? especially no shaking, rolling, mixing, etc. like many insulins need? are you keeping it in the fridge or unrefrigerated? for using the pen needles you're supposed to keep it unrefrigerated because the cold can change the pen-injecting mechanism, which causes the dose to be changed. that doesn't make much sense, but that's the reason it's not supposed to be refrigerated if you're using the pen needles.

i think the best advice i can give is to get some syringes so that you can increase the dose by .25units.

by the way, many people following TR simply reduce the dose while they are traveling so that there isn't such a need for monitoring. some cats won't let anyone else test them, for example, so the people drop the dose by half or so while they are gone, then return to the regular dose when they return home. traveling doesn't mean you can't follow it - i'm not trying to twist your arm, but i'm hearing you say you want some action asap, i see you testing a lot more than i do, and the SLGS leaves doses alone for a minimum of 1 week. it's not an action plan - when it says Start Low Go Slow, that's exactly what it means. it's a go slow plan.
 
oh - i meant to add that you should be testing Kitty's urine for ketones while we are working on the dose issue. hopefully you can find something to do that with in moscow. Here we would use Ketostix or Ketodiastix to test. if you can stick the strip in the urine stream, that's super. if not, some people will stick a spoon or old ladle under to catch some urine - my cat has furry thighs and he squats low so i can't manage that method.

you can put anything non-absorbent in the litter box and test from there. some people will bury a little foil cup or put some plastic wrap over the part where they pee and catch some that way. i have a cardboard box lid inside of a plastic garbage bag with lentils in it as a temporary cat box and use that when i want to test punkin. some people use aquarium gravel.

it's important to have fresh urine and it's VERY important to time the results exactly. I have Ketostix and it takes 15 seconds to read the results. if you are delayed reading them the color will change and you won't have an accurate result.

while he is so high please make sure to give him a lot of water. that will help prevent ketones by flushing the sugar through his body. i mix punkin's canned food with water til it's fairly soupy. he used to have bladder infections and hasn't had a single one since i switched his food.

also - are you giving shots 12 hours apart? we see the best results when you try to keep as much as possible to the 12 hr routine.

the broth idea - onions and garlic are bad for cats - so i don't think i'd use people broth to entice him to eat the canned. changing him over to the low carb canned food will improve his BG numbers. the Catinfo.org site i mentioned above has lots of tricks for transitioning - including grinding up the dry food and sprinkling it on the canned food.
 
I can't get syringes with the half units marked in Australia, however I find it quite easy to adjust by .25 doses as long as I use 3/10cc 0.3ml syringes. If you use a syringe that takes a larger amount the unit marks will be closer together which makes life very difficult for the small adjustments. With the 0.3ml syringes the unit lines are far enough apart to make the small adjustments.
 
Hi all,
Thanks again for the advise...
Let me start telling more about the background...

julie & punkin said:
you just started the lantus - was it fresh from the pharmacy? have you watched the video and read the information on how to take care of it so it lasts? especially no shaking, rolling, mixing, etc. like many insulins need? are you keeping it in the fridge or unrefrigerated? for using the pen needles you're supposed to keep it unrefrigerated because the cold can change the pen-injecting mechanism, which causes the dose to be changed. that doesn't make much sense, but that's the reason it's not supposed to be refrigerated if you're using the pen needles.
.
Click to expand...
​

The Lantus I have is "fresh" from the pharmacy (or it's been in my fridge since Christmas), and I've read storage and handling instructions (which - by the way - have been very helpful because Cansinsulin was different). I am still using pen needles because I cannot get accurate dose with U-100 syringes that I have (they are 1ml, not 0.3ml). I read that Lantus will last longer it is stored in fridge, so I have kept it there even though using the pen needles. Perhaps I should keep it on the counter now when using pen needles?? I am trying to give shots every 12 hours, but it really is +/-1 hour.

I have not yet figured out if I can get U-100 0.3ml syringes here, hope to find that out before Friday. Good tip that it may work out to do smaller dosages with the syringes without half-unit markings.

I have not tested for ketones. Can you please remind what was that for again?

I will be traveling now for 2 days and kitty sitter will continue to give 2U for now. I just feel bad for Kitty who continues to drink a lot... If you check Kitty's BG, they are a bit all over the place, I think, even increasing after the shot... Kitty is not eating that much these days, as I am trying to convert him to wet food addict. not much luck yet. When travelling, I will though have to leave enough Hills MD dry food just to make sure he eats something. Not perfect solution, but better than not eating.
 
here is a link on ketones in humans http://www.joslin.org/info/ketone_testing_what_you_need_to_know.html

i need to find something better for you that's specific to cats. i'll look and repost. we encourage people to test regularly for ketones when their cat's BG's are staying high, or if they begin to appear to be ill - not eating, behaving as though they feel yucky, etc. if a cat shows no ketones or only a trace, we can deal with it immediately at home. if it's more than a trace a vet will have to give insulin and an IV with glucose to get the BG's down and the ketones resolved. it can be an extremely expensive event (thousands of dollars) and cats get very ill and can die from ketones. that's why it's so important to get enough food and enough insulin into a cat. you should be able to get them at any pharmacy. people ketone strips work fine on cats.

i'm a little concerned about the dose and the high numbers, but not sure what to suggest. is there any possible way to get syringes right away? i don't know the answer about the pen - my guess is you're not getting correct dosing because it's refrigerated, but if you leave it out, it won't last as long. the best solution is definitely going to be to get the syringes asap.

have you had a chance to read those yellow starred stickies at the top of the Lantus TR forum? the ones with good basic information? you don't have to absorb it all at once - i know i've reread them a lot of times. that's the spot where you're going to find the best answers regarding Lantus.

sorry you waited all day for an answer - i was gone to work. i'm glad serryn (vyktor's mum) checked in with you. she's one of our australian members and also a Lantus user. *waves to serryn!*

i don't usually cruise the Main Health forum, but when you get back from your trip, i don't want to miss reconnecting with you. if you post again on this post I'll see it, because i check "view my posts." if you post on a new post, you might send me a message or post in the Lantus TR forum so i can follow up with you. i hate to leave you hanging because Kitty definitely needs some help and dose adjustments - so i hope you'll check back. have a good trip.

edited to add: http://petdiabetes.wikia.com/wiki/Ketones
 
Hi there!
I am back. I will still reply to this thread for the latest update and then perhaps move to Lantus group later.

the good news is that I got new syringes with half unit markings today - yahoo! Decided to increase Kitty's dose by 0.5 to 2.5U tonight, so let's see what BG readings he has tomorrow.
When I was gone, he continued to drink a lot of water and used the litter box a lot, and I also think he may have lost some weight. Not good. I yesterday got back home too late also for timely PM dose (flight was 5 hours late, ugh), and his BG was 400 in the middle of the night. I gave him then 2U, and then for the morning dose I also gave 2U even though I knew it was overlapping with the previous. The evening BG before the evening shot was again in the usual highs at 328.

I'll keep on eye on him tomorrow and check on BG more regularly to see if the 0.5U increase makes a difference. Keep your fingers crossed!

- M
 
I know you were probably expecting to see immediate good results with Lantus because of how much everyone praises it. I was the same way. Scooter's been on it for a month and a half now and his numbers are still higher than safe. But you have to understand that's just how it works. Lantus is gentle and long lasting, and doesn't make the BGs plummet like N and Caninsulin do, so with Lantus, there is a lot of tinkering to find the dose that works just right for your Kitty. That is the slow part, and especially for you, since Kitty is eating dry food. He will likely have to get a big dose to counterbalance all those carbs he's eating, just like a human diabetic would if they ate nothing but Twinkies and Coke.

Please try to get him converted to wet food - when I changed Scooter from dry to wet, his BG dropped from 500-600 to the 300's in about 2 days. That is the point where Scooter showed immediate improvement, especially with the litter box issues. If Kitty drops as much as my Scooter did, you have a very good chance of getting him well regulated and maybe even OTJ. He might even be food regulated with those numbers. But remember, when the change happens, his insulin needs will be reduced greatly, and you want to be able to catch that with testing and adjust/reduce his insulin.

Another thing I recommend is getting a spot check between +4 and +6 in every single cycle. I see you are doing curves and then only one or two spot checks in the later cycle - that is a good start, but because Lantus is dosed based on nadirs (lowest points in the cycle), the more numbers you have, the better. Just try to sneak a few more tests in there when you can. New cats on Lantus can bounce around a bit.
 
Is this a sign of better times? Kitty's BG was 266 at +3 PMPS after the 0.5 dose increase, lowest in almost 2 weeks.

I realize all the benefits with the wet food, and am trying to get him converted, but he's a tough cookie. My other non-diabetic cat would be easier to convert, I think.... Also, I will be doing quite a bit of travel in the next few weeks, so without testing during my travelling (kitty sitter does not do tests), I think Kitty would be safer with dry food / wet food combo, or what do you think?
 
worldtraveller said:
Is this a sign of better times? Kitty's BG was 266 at +3 PMPS after the 0.5 dose increase, lowest in almost 2 weeks.

I realize all the benefits with the wet food, and am trying to get him converted, but he's a tough cookie. My other non-diabetic cat would be easier to convert, I think.... Also, I will be doing quite a bit of travel in the next few weeks, so without testing during my travelling (kitty sitter does not do tests), I think Kitty would be safer with dry food / wet food combo, or what do you think?
Click to expand...

Well, to address the +3 BG of 266, you can't see that number as much because of your shooting overlapping doses. By giving a late shot and then the normal am shot, you have got two cycles of insulin working... you are lucky that Kitty's numbers are so high or that overlapping shot could have caused big problems. Even though the BG was high when you got home, it would have been best to wait till the normal cycle. Just like when you give a shot but you miss and you get a fur shot, you NEVER shoot again for that shot. You just record it as a fur shot and wait till the next shot time...

When you make the food change, you will see a drop in the BG for sure, so if you are not going to be around in town to test, it may be safer to stick with the dry till you are around. it's not great for Kitty's numbers or health, but it's safer..

When you switch to wet food, why not switch all of the cats? There's no reason to leave any of them on dry food, is there? By switching them all, you may be eliminating another diabetic later down the road. If they are already eating some wet food, you should be able to just pick up the dry and toss it. The cats who are hard to convert are the ones who eat ONLY dry food.

When you are done with the traveling, you may want to switch the food and get some good testing done so that you can find kitty's dose and bring down the high BG numbers.
 
hi mia! welcome back!

great on finding the syringes with .5u markings! that's awesome. you really have to have those to use the lantus accurately. that will make dosing much better - easier and more accurate!

a couple of things to file away on how lantus works - you want to stick to 12 hr apart shots. because it works in a sort of "timed release" fashion, shooting early or late can create problems. if you must shoot other than 12 hrs (within about 1/2 hr either way), it's better to shoot late.

i'm glad you increased Kitty's dose - for your future changes, think in terms of .25units increments instead of .5u. seems crazy, but we think in terms of .25u because that can make a difference and if you give too big of increases you can miss the "right" dose - and an overdosed cat can look much like a cat's ss that doesn't have enough insulin. crazy, huh? but it's true. cats are hard to regulate, so every little tip we have to help that along, we try to pass on to people.

i'm not sure what to suggest about your travels. if it were me, i think i'd still try to convert to 100% canned, but go to a plan B while traveling. we do have members that travel whose petsitters don't/can't test. those folks drop their cat's dose by 1/3-1/2 depending on where the BG is at that point for the duration of the trip and continue to give the canned food. personally, i'd go that direction. i just think you're going to struggle to get Kitty under control with things as they are.

Ry has a good suggestion about getting a mid-cycle test. that's how you'll know how low the dose is taking Kitty.

Keep posting your questions and we'll try to give you the Diabetes with Lantus 101! :lol:
 
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