New to Lantus - Dosing Help

Status
Not open for further replies.
Elizabeth&Julia&Margaret(GA)

Elizabeth&Julia&Margaret(GA)

Member Since 2009
My original post http://felinediabetes.com/FDMB/viewtopic.php?f=28&t=97975

Julia (14 yrs old) saw the vet and is definitely diabetic. Her highest BG was 351 (that I've tested at home) and we've since put her on low carb food. Her last 2 readings were 251 and just now 245 (after her morning meal). We have a prescription for Lantus that we can fill today but I don't know where to start regarding dose since her numbers are higher than normal but not terribly high. I remember having a no shoot number of 200 when we started Margaret on insulin. So, I have no idea where to go from here. I'm figuring on starting insulin with tomorrow mornings dose since I'll be awake for sure to watch her then. If I started tonight I can't guarantee I'd be up to test as I'm recovering from surgery.

I should mention the vet did a full blood workup and everything is fine. A few values were slightly off they said, but can be explained by her being diabetic. They wanted to start her on 2 units twice daily but I think that might be too much. I did read, "If your cat’s blood glucose was less than 400 mg/dl (22.1 mmol/L) at diagnosis, or if your cat is on a low-carbohydrate diet, the starting dose should be only 0.5-1.0 units twice per day" on the start low and go slow approach. I'm not sure if tight regulation or go slow is more appropriate for us.

Any help is appreciated.
 
We have a prescription for Lantus that we can fill today but I don't know where to start regarding dose since her numbers are higher than normal but not terribly high.
Click to expand...
We tend to be conservative on the starting dose for Lantus insulin, 0.25U per kilo of ideal body weight, current weight if underweight, round down to the nearest 0.25u for safety and ease of measuring. You can't take the insulin back out if you have already injected it. Our thoughts are to start lower and work the dose up in 0.25U increments.

Dose is BID, 12 hours apart. Not sure which insulin you were using with Margaret.

How much does your cat Julia weigh?

For example a 10 pound cat = 10/2.2 kilos per pound = 4.5 kilos
4.5 kilos * 0.25U nits of insulin = 1.125 units, rounded down to the nearest quarter unit is 1U Lantus starting dose.

With the recent food change, you might want to consider an even lower dose and only give 0.5U units. Hope you have the 3/10cc syringes with the half unit markings.

I remember having a no shoot number of 200 when we started Margaret on insulin.
Click to expand...
Yes, we still like to have that 200 shoot/no-shoot threshold when beginning a new insulin. At least until we have enough data to know when to make a change, base on your cat. ECID.

You've already had a sugar kitty so you probably know some of this. But I wanted to make sure you had the Hypo instructions printed out and a hypo toolkit in place. You never know and like the Boy Scouts, we like to be prepared.

Hypo instructions: how to handle hypos

Hypo toolkit:

IN CASE OF EMERGENCY - YOUR HYPO KIT

Put together NOW the following items and put in an easily accessible place!
•Phone number of your vet
•Phone number, address and map/directions to your nearest emergency vet (or phone number of the cab company and some cash/credit card)
•Karo syrup, honey or corn syrup
•High carb canned food with gravy – 2-3 cans
•Some favourite treats
•Spare pack of 25 blood glucose strips
•Coffee for you ;)
Click to expand...

I'm figuring on starting insulin with tomorrow mornings dose since I'll be awake for sure to watch her then. If I started tonight I can't guarantee I'd be up to test as I'm recovering from surgery.
Click to expand...

You only switched to the lower carb food a few days ago. You can always give that a few more days to see how Julia does with the BG numbers. I'm suggesting that because you indicated you were not feeling well with your surgery recovery. Sending get better soon vines to you with that.

In your other post, you already said you were comfortable with home testing, were switching to a low carb food, getting ketone test strips, and I see you already managed to set up a SS and link it to your signature. Thank you so much.

Looks to me like you are prepared. Hope you feel better during your post-surgery recovery period and have a smooth, quick recovery.
 
Re: New to Lantus - Dosing Help (Updated #)

I'm not awake enough to figure out how to quote part of posts tonight but thank you for your help, Deb. You mentioned that I could give it a few more days to see how Julia does with her BG numbers and I'm inclined to think that may be a good idea. I'm recovered enough to test, shoot, and monitor if need be but her BG dropped to 214 tonight and she's had no insulin yet. Maybe (fingers crossed) a few more days of the low carb may be enough for now? I know her BG is still higher than normal and I certainly don't want to cause her any harm so if anyone thinks we should start insulin I can absolutely do that tomorrow. Not to sway things either way but I didn't see her standing over the water bowl today at all (she slept all day in her favorite spot) and is now up for food.

Also, going back to her initial problem over the winter of what we thought was behavioral peeing and pooping around the house, I wonder if she was/is really under enough stress to allow stress induced hyperglycemia to occur? I read about it briefly in the link to The American Animal Hospital Association published diabetes treatment guidelines in 2010. We were thinking about Prozac to help her but the diabetes and high BG came about before we made it to the vet for the medicine. The vet said we can get her diabetes under control and then think about the medicine if the behavior continues. I wonder if I should ask her for a prescription for the Prozac? If anyone has any experience with it I would love to hear about it

Any advice is always appreciated.

And thank you for your good thoughts. I really appreciate everything.
 
You mentioned that I could give it a few more days to see how Julia does with her BG numbers and I'm inclined to think that may be a good idea. I'm recovered enough to test, shoot, and monitor if need be but her BG dropped to 214 tonight and she's had no insulin yet. Maybe (fingers crossed) a few more days of the low carb may be enough for now?
Click to expand...

You've been on the low carb food for 6 days, including today. My opinion is to give the low carb food maybe 2 more days max before putting Julia on insulin. I would like to get a test in the morning if you feel up to it, before you feed her. Also, one in the evening, before you feed her. I want to see how high she is at different times of the day, about 2 hours before food.

I'm suggesting this because some cats drop lower over night. It could be helpful to see that morning low. Only if you are up for it because I know you are still recovering. Remember, you are free at any time to say "That won't work for me and here is why" in which case we go to Plan B. ;-)

Could I offer a couple of suggestions to improve the SS?

1. Insert a row for each day, even if you do not have any data. That way we can count the days easier. I noticed there were no dates for 6/21 or 6/23 and my mind had to go back and count the days correctly from the food change.

2. 6/24 AM +3 was really a +3.5. What some people do in that case, is to enter the test number and the hour difference directly in the cell. You then need to manually color code that cell. Using the paint bucket icon and pick a close color to the BG ranges. The color codes for the different BG ranges are at the top of the SS and have a list of the numbers in each color.

3. add food info to the remarks column. It's one way to keep track of how much you are feeding her. If you free feed, note that. If you feed at set meal times, put the meal times into the + hour format. Some times food management, when you feed can make a difference in the BG numbers. That is why I'm suggesting putting in the food amounts and times.

4. Put 0 in the units column for both AMPS and PMPS for now to show Julia is not getting any insulin.

Prozac takes time to be effective, from 2 up to 6 weeks. My vet required baseline bloodwork before prescribing. Behaviour modification needs to be used in conjunction with the Prozac to effect the desired change. The Prozac is not good for too long per my vet, forgot why. Cat may exhibit the behavior you are trying to change after they are off the Prozac again.
 
Hi! I'm hoping the food change will lower Julia's BG to acceptable levels. And if not, you are an "old pro" and will do perfectly managing Julia's FD. Ask, ask, ask away any questions you may have, and remember: the only dumb question is the one that wasn't asked :-D :-D :-D

Good luck! I'll be keeping an eye on your posts :mrgreen:

And I see you're in Ohio as well--yipee!!! dancing_cat
 
Thank you so much for your help everyone!

Her numbers seem to be slowly going back up. I'm thinking insulin is what we will end up with and I can get that today if we're on the same page which I'm thinking will happen. She's not going low enough and is going back up. We don't need her with those numbers as it's certainly not healthy. Today's goals are to find the Lantus for a good price and figure out a dose. Should I continue to spot check her for today to see what she does and then we'll plan to start tomorrow morning? We had a good 6 hours of thunderstorms last night so that may be influencing the numbers slightly. I will also make the suggested updates to the spreadsheet. Thank you!

Also, she does free feed but for some reason always eats a few cans in the morning and is fine for the rest of the day. We may not see her at the dish for the entire day. I'm going to try to test 2 hrs before the PMPS time as you suggested, Deb and direct her toward food this afternoon. In fact I hear her demanding her next can now. She figured out if she howls (enough that she could probably wake the neighbors) that will get our attention. :lol:

My concern is that she is not necessarily that high (compared to Margaret was at least who was 430 at diagnosis) and she isn't that far from the 200 "no shoot" number. Coming up with a dose will be interesting and I'll be busy reading today for sure.

And yes, I'm on the west side of Cleveland. It's good to see another Ohioan. :RAHCAT
 
Hello there

Yep I think you will be starting insulin soon to help out her pancreas - I think Deb said 0.5IU. And yes I would do a couple of spot checks on her.

Do you have all your supplies? like a high carb gravy food and karo syrup for emergencies like Deb mentioned? Good to have them at the ready.

Wendy
 
Does anyone know where I can get Lantus pens/cartridges individually? I've tried 6 places so far with no luck.

Walgreens, Costco, Drug Mart, Target, Walmart, and CVS all have to sell them in the box.

Edited to add: I'm rereading in the Lantus area and realizing I may have to buy the box. Time to find out the damage to my wallet.
 
Status
Not open for further replies.
Back
Top