New to Lantus dosage query

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Gill & George

Gill & George

Member Since 2015
George has been diagnosed with diabetes and we have been trying Gliclaside for 2 weeks, to no avail. I've just got my home testing kit and based on the results (in the 400s ) I popped into see our vet and asked her to prescribe insulin. We've decided on Lantus. She suggested to start with an initial minimum dose of 0.25ui per kg once a day. George is 7.8kg (obese) he should weigh 6.8kg (he's a big lad). She said it was his current weight that I should base the dosage on ie 7.8 *.25= 1.95 per day given in one shot.

I have some doubts/queries
  • I've read somewhere that I should base it on lean body mass so concerned that 1.95u would be too high a dose
  • not sure about the single dose, from what I've read here it seems that splitting the dose twice a day is the way to go, should i just ignore her and split it?? or do some of you achieve control just administering once a day?
  • Been to the pharmacy and was looking at the Lantus pen available here in spain, I can only dose a minimum of 1 u, so I'm not clear on how I am meant to reduce his dose by 0.25u if I should need to or as the pen is not able to measure such a small amount.
Would like to get these point straight in my head before giving George his insulin, want to be prepared, I'm putting together his hypo kit, and will arrange to be in all day for at least the first few days till I get an idea of how he is reacting to the insulin.

I would be very grateful for your views or advice on my concerns, feeling a bit anxious about starting the insulin:nailbiting::nailbiting::nailbiting:

Gill
 
Hi Gill and welcome to you and George,
I'm not very good at converting metric measurements, and I know that some of our most experienced people will be along later today to advise you about the size of George's starting dose, so I would just like to comment on a few practicalities.

Cats have a faster metabolism than humans, so for Lantus to work properly it should be dosed at 12-hour intervals (i.e., every 12 hours).
There is a weight-based formula for determining how much insulin you should give when starting Lantus. @julie & punkin (ga) , @Marje and Gracie, and @Sienne and Gabby are members who will be able to explain it.
Most people begin with a starting dose of 1 Unit, but if George is really obese, it might have to be higher.

The Lantus pens are designed for humans (who typically need large doses). That is why they only dispense in whole units. We use traditional insulin syringes (U-100) to draw the dose and use the Lantus pen as one would use a vial. When you take off the cap of the pen you will see a small rubber gasket at the end. Insert the insulin syringe into the gasket and draw your dose. Do not purchase the "needles" that come with the pens. Buy a box of a good brand of U-100 insulin syringe (I don't know what's available in Spain, but try to find one that has 1/2-Unit markings. BD, ultra thin with 1/2-Unit markings may well be available in Spain; lots of people in Europe, Australia and Canada use this brand). Lantus doesn't like to be shaken or rolled, so treat your pens gently and always keep them in the refrigerator, even the open pen. The pen is pressurized, so do not inject air into it when drawing a dose. (The Lantus instructions tell you not to refrigerate the pen you are using; this statement is meant for humans, who will probably use up a pen within 28 days. If you return your pen to the 'fridge you will be able to get months out of it; do not throw it away after 28 days!)

There is so much to learn about Feline Diabetes and the learning curve is steep. The "stickies" at the top of this Lantus/Levemir Forum have lots of important information.
Diet is very important. What are you feeding George? We suggest low-carbohydrate, wet (canned) foods. NO DRY KIBBLE. Many cats who are newly diagnosed can successfully get off insulin if they are switched to a proper diet. You can find everything you ever wanted to know about diet in Dr. Pierson's website: www.catinfo.org. And she has lists of the carb content of a great number of foods.

If you are going to participate in the L&L Forum (we hope you will!), we recommend that you set up a Google Sheets spreadsheet for George so that everyone will know how he is doing and be prepared better to help you. There are instructions for the spreadsheet in the Tech Forum, but I'm sure that @Marje and Gracie will be happy to take a minute to set one up for you, especially since you will want to use the "World" format (which automatically converts the metric numbers into the US format, which most of us understand) (we Americans are very "provincial"!) Marje can do this very quickly and she will send you a private message via this forum so that you can provide her with the relevant data about George.

We wish you and George much success in this new journey. Everyone here wants to help, and there are some very experienced people who will be available to guide you, and lots of people to provide support.
Good luck!!

Ella & Rusty
 
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Ella & Rusty & Stu(GA) said:
Hi Gill and welcome to you and George,
I'm not very good at converting metric measurements, and I know that some of our most experienced people will be along later today to advise you about the size of George's starting dose, so I would just like to comment on a few practicalities.


Ella & Rusty
Click to expand...

Thanks Ella,
Will get onto the pharmacist to see if we can get hold of the small syringes with the 0.5 divisions, that was the conclusion that the pharmacist came to, but on initial investigation she couldn't find any with 0,5 divisions, but she was going to investigate further, she's very helpful. The Lantus pen available here is Lantus Solostar (I'm guessing that's the same?)

It's certainly a very steep learning curve!!! George is being an absolute trooper, he's putting up with my bumbling attempts at home testing, I've managed to get some readings today, I've set up the SS and have the link below on my signature. Prior to getting the confirmation of his diabetes I read Dr Piersons website on diabetic nutrition and immediately swapped him to a wet low carb food, (thrive complete wet Cat food, it has no grain and a high moisture and protein content, and George loves it:cat::cat: we noticed an improvement in his symptoms immediately, he was happier, more active and peeing less) I must admit that after reading Dr Piersons website I felt sooooo guilty, George has been struggling with his weight for so long and following our vets advice we'd been feeding him first royal canin diet dry food and then latterly hills metabolic dry, I was horrified at the carb content, so he came of that immediately and I have refused to put him on Hills diabetic dry, I think the vet believes the diabetic food will help, but after years of next to zero weight loss on the diet stuff and everything I have read I am not going to go there, Hills is off the menu for George, and I think he's pleased about that. I just wish I had got to Dr Piersons site sooner perhaps George could have lost weight and we would have avoided the diabetes......

I'm comfortable converting fro metric to imperial, being a Brit we have that sort of duallity, we are metric, because we're in Europe, but we still talk pounds and inches, miles and feet and are happy converting back and forth. The BG readings I'm taking are in the format that you guys use, bizarrely that seems to be the norm here in Spain (not so in the UK).

Well must go now George is snuggled up next to me and he is politely reminding me that it's time for his supper :)

thanks again
 
Hi, Gill and welcome to the Board.

Your vet's formula for the initial dose is correct (sort of): Initial dose = 0.25 x ideal weight in kilograms
In other words, you want to use the 6.8kg weight for calculating the initial dose. This would come out to 1.5u (I rounded the amount down.) This is the amount you want to administer twice each day.

You do not use the needle tips for the Lantus Solostar pen. Rather, you want to purchase syringes. I believe BD syringes with half unit increments are available in Europe. You want to see if you can track down U100, 3/10cc syringes with half unit markings.

You've done a great job with getting a spreadsheet (SS) set up, starting George on a low carb canned food diet, and getting started on home testing. The testing will become easier. It takes a few weeks for the capillary bed in the ear to build up. Once that happens, the ear bleeds more easily. The next step is to give some thought to which approach to dosing you want to follow. Take a look at the sticky notes regarding the Tight Regulation Protocol or Start Low Go Slow. These are the options for how you approach dose changes. Each approach has it's advantages and disadvantages. The biggest difference is that there is veterinary research that supports the TR Protocol.

Don't beat yourself up about the dry food. The majority of the people here were in the same position as you are. We didn't know about the evils of dry food (or carbs, for that matter) until we had a diabetic cat or some other reason to find Dr. Lisa's site.

Please let us know if you have questions. You're correct -- there's a huge learning curve. It's completely overwhelming at first. We're here to help.

 
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GTS said:
Will get onto the pharmacist to see if we can get hold of the small syringes with the 0.5 divisions, that was the conclusion that the pharmacist came to, but on initial investigation she couldn't find any with 0,5 divisions, but she was going to investigate further, she's very helpful. The Lantus pen available here is Lantus Solostar (I'm guessing that's the same?)
Click to expand...

Hi again,
I have a box of BD syringes and this is the information on the box:
"BD Insulin Syringes with the BD Ultra-Fine needle. 100 sterile singe use syringes (10 packs) for U-100 insulin. 1/2 unit [markings]. capacity: 3/10ml/cc (for doses up to 30 Units). length: 8mm (5/16''). gauge: 31G"

The product number (?) on the box is: NDC/HR# 08290-8440-01 328440

Maybe this will help. You are smart not to go with the prescription foods. The protein source is not as good as the "commercial" brands, and they cost much more.

Congrats on the spreadsheet!

Ella & Rusty

p.s. While I was writing this I see that Sienne has given you good advice. She is one of our most experienced people.
 
Hello and welcome to the group! Ella and Sienne have given you some general info to consider.
Let me add some to the mix:

GTS said:
I have some doubts/queries
  • I've read somewhere that I should base it on lean body mass so concerned that 1.95u would be too high a dose
  • not sure about the single dose, from what I've read here it seems that splitting the dose twice a day is the way to go, should i just ignore her and split it?? or do some of you achieve control just administering once a day?
  • Been to the pharmacy and was looking at the Lantus pen available here in spain, I can only dose a minimum of 1 u, so I'm not clear on how I am meant to reduce his dose by 0.25u if I should need to or as the pen is not able to measure such a small amount.
Click to expand...
Starting dose: There are two options (both have proven to be successful on the FDMB) for regulating your cat. You might want to read through them and decide which option fits your schedule/lifestyle. Each has it's own requirements and suggested guidelines for making dose adjustments.
  • The Tight Regulation Protocol - The tight regulation protocol was tested in 55 diabetic cats for Lantus/glargine and in 18 diabetic cats for Levemir/detemir from the German Diabetes-Katzen Forum. Owners measured blood glucose an average of 5 times daily and adjusted insulin dose based on the protocol. An overall remission rate of 64% was achieved in the cohort. Significantly higher remission rates were observed if good glycaemic control was achieved soon after diagnosis: 84% for cats started on the protocol within 6 months of diagnosis went into remission, and only 35% for cats that began more than 6 months after diagnosis. If you choose to follow the TR protocol, the formula for the initial starting dose of Lantus or Levemir is 0.25 IU per kg of the cat's ideal weight and is always dosed BID (two times a day, as close to 12 hours apart as possible). If George's ideal weight is 6.8 kg, the initial starting dose would be 0.25u x 6.8kg = 1.7 units. We would usually round that off to a starting dose of 1.5 units.
  • Syringes: I'm not sure if syringes marked in half units are available in Spain. It's something you'll have to look into. U100 3/10cc syringes with half unit markings are the best to use for fine dosing. BD, Monoject, GNP, and ReliOn are just some of the brands available with half unit markings. Needle gauge and length is your preference They come in ½ inch or 5/16 inch needle lengths. Needle gauges 29, 30 or 31 (31 being the thinnest). We make most dose adjustments in quarter units. Using syringes marked with half units makes it easier to eyeball smaller doses.
Ask any questions you may have. Hope to see you posting often!
 
I doubt that GNP or Relion are available outside of the US. The Relion is Walmart's proprietary brand. GNP is "Good Neighbor Pharmacy" brand. I've seen them on a few diabetes sites but I'm doubtful about their availability outside of the US. If you do a search for insulin syringes that pediatricians recommend, you or your pharmacist may have more success.

 
Hello and welcome to you and George from a BD syringe user (Canada). I'm tagging @suki & crystal (another ex pat) who is next door in France to see what she uses. I use the BC Ultrafine II syringes. They are the small dose ones used for children.

Regarding insulin - I get the Lantus (now Levemir) cartridges, which are like pen refills so smaller and you use it directly. There is a picture of the cartridge in the Info, Handling, and Storage Sticky Note. Not sure if the cartridge is available in Spain.
 
Wow guys thanks for all the info!!! It really helps, if the BD syringes are available elsewhere in europe I should be able to get hold of them even if it's by mail order, being out in the sticks means I am used to doing a lot of my purchases online!!
I was thinking of trying the tight regulation protocol but I'll take another look before I make the final decision. It's gone midnight over here so I think it'll be best to look it over when I'm more alert.

thank you all it makes me more confident about starting Georges insulin regime.

Night Night:)
 
You've gotten a lot of good starting information already, so I'll just add my welcome.

People here all remember how overwhelming the information is in the beginning. Just keep asking questions. If you have trouble with something, just ask - someone else no doubt has an idea of something that might help you.

Here's a couple of links for help with testing and shooting:
Glad to have you here! Sometimes even just the change to low-carb food with a little insulin support can make a tremendous difference in a cat's diabetes.
 
Hi Gill, sorry for not replying to Wendy's tag earlier, my PC server was down all last night. I'm also an expat living in France and I can get the BD syringes from my pharmacy. I'm using the BD micro-fine + demi (which is the half unit ones) 0.30mm (30G) x 8mm length. They cost about 32 euros for a box of 100. I hope they are readily available in Spain, let me know if you have a problem, I could always post you a box.

Welcome to LL&L, I'm sure you and George will benefit enormously from the wealth of experience and support from this amazing forum.

Suki
 
suki & crystal said:
Hi Gill, sorry for not replying to Wendy's tag earlier, my PC server was down all last night. I'm also an expat living in France and I can get the BD syringes from my pharmacy. I'm using the BD micro-fine + demi (which is the half unit ones) 0.30mm (30G) x 8mm length. They cost about 32 euros for a box of 100. I hope they are readily available in Spain, let me know if you have a problem, I could always post you a box.

Welcome to LL&L, I'm sure you and George will benefit enormously from the wealth of experience and support from this amazing forum.

Suki
Click to expand...
Thanks Suki, I'll try with our local pharmacy and see if she can get hold of them, as that will probably be quicker, I've found an online supplier that stocks them here in Spain, so I'm pretty sure our pharmacy will be able to get hold of them, they have been super helpful.
 
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