New to lantus - help in dosing

Waheeda

Waheeda

Member Since 2017
Hi,
My cat had pancreatitis 12 days ago and his bg seemed to have crept up. Yesterday was 122, 115 and 158, readings taken after 2-3 hours of food. He was in remission since July 2017. I’m new to lantus and need help on dose to start.
Any advice is appreciated. My pm shot is in 4-5 hours time. If I miss this, then I can only start tmr.
Thanks!
 
How much does your kitty weigh? If he is still eating some dry food, that means using the Start Low Go Slow dosing method which says to start at 1 unit if a newly diagnosed diabetic. However, he’s not in very high numbers, just outside of normal, so I would go lower, maybe half dose or 0.25 units. But only start on a cycle when you can get a +3, +6 and +9 test.. and I would probably wait to start insulin, that 115 you got today is pretty close to normal.

In our dosing methods Sticky note, there is a document attached called “Management of Diabetic Cats...”. In that document is a section on fine dosing, with a link to a paper ruler that can be used with the BD Microfine syringes,
 
Wendy&Neko said:
How much does your kitty weigh? If he is still eating some dry food, that means using the Start Low Go Slow dosing method which says to start at 1 unit if a newly diagnosed diabetic. However, he’s not in very high numbers, just outside of normal, so I would go lower, maybe half dose or 0.25 units. But only start on a cycle when you can get a +3, +6 and +9 test.. and I would probably wait to start insulin, that 115 you got today is pretty close to normal.

In our dosing methods Sticky note, there is a document attached called “Management of Diabetic Cats...”. In that document is a section on fine dosing, with a link to a paper ruler that can be used with the BD Microfine syringes,
Click to expand...
Thanks @Wendy&Neko for responding. Thanks @Bron and Sheba (GA) too.
He’s 5.55 kg. I agree that I should start Low. Do you think I should start today or get another day worth of readings. Though he was close to 120 for the first 2 readings, he did jump up to 158.
I’m using the 0.3ml syringe, so that means 1 line is 1 unit? 0.25 means a quarter of that. Qte tricky to get exact.
 
I would wait at least another day.

0.25 is not much insulin, maybe the fine dosing rulers and magnifiers will help. Most of us use syringes with half unit markings, making the quarter units easier to see,
 
Wendy&Neko said:
I would wait at least another day.

0.25 is not much insulin, maybe the fine dosing rulers and magnifiers will help. Most of us use syringes with half unit markings, making the quarter units easier to see,
Click to expand...
I can’t get the half unit marking here. I’m in Singapore. I think I can manage 0.25. I did do a drop of vetsulin on this syringe before.
I’ll get readings today. Does it make sense to get readings 3 hrs after his food? That would show the lowest point ya? Sorry for all these questions. Out of touch after 2.5 yrs of remission.
 
I would wait another day at least too and get test in whenever you can. Maybe get a 2 hourly curve tomorrow if you can. I think you need to get more data before starting because some of the readings are in the normal range.

You can get 1/2 unit syringes online from the UK if you are interested.

Keep posting and asking questions and keep your SS up to date. That helps us help
you.
 
Testing three hours after food will tell you if his pancreas is working to bring down his numbers.
 
Bron and Sheba (GA) said:
I would wait another day at least too and get test in whenever you can. Maybe get a 2 hourly curve tomorrow if you can. I think you need to get more data before starting because some of the readings are in the normal range.

You can get 1/2 unit syringes online from the UK if you are interested.

Keep posting and asking questions and keep your SS up to date. That helps us help
you.
Click to expand...
I’ll do the curve tonite. At pmps, +2, +4 n +6. But he’ll be eating at times. Is that enuf? I’m very worried if his bg goes to 200. He suffered so much the last time. Broke my heart.
 
Waheeda said:
I’ll do the curve tonite. At pmps, +2, +4 n +6. But he’ll be eating at times. Is that enuf? I’m very worried if his bg goes to 200. He suffered so much the last time. Broke my heart.
Click to expand...
Hi,
This is what I did and the readings I got :
Food at 2pm

Bg at 5pm- 126

Bg at 7pm - 196

Bg at 9pm - 178

food at 9pm after test

looks like he needs insulin ya?
 
It is easier for us if you report BG in terms of + times, not clock times. His +6 shows his pancreas is working a bit. My suggestion for a really small dose hasn’t changed, provided he is mid blue or above at AMPS, provided you are around to monitor.
 
Wendy&Neko said:
It is easier for us if you report BG in terms of + times, not clock times. His +6 shows his pancreas is working a bit. My suggestion for a really small dose hasn’t changed, provided he is mid blue or above at AMPS, provided you are around to monitor.
Click to expand...
I have filled in the spreadsheet in terms of + times.
Mid-blue meaning more than 120? Or must it be higher than that. Yes I am around to monitor today. Do I take readings after insulin at +3, +6, +9? Is that enough for first cycle? And first amps is 2 hours after food rite?
My vet has the pen version lantus but I saw in the sticky I can still draw the insulin with the micro syringe. I don’t have to buy the 10ml vial. Am I right?
Sorry if I have too many questions. I’m just a bit overwhelmed and worried at the moment.
 
Mid blue means more than 150. AMPS is when you give the shot. Most of us test, feed, and shoot all within 15 minutes. Test as you suggest, unless he drops fast or low. Start a new post for the day, so it's easier to follow.

Yes you can use the syringe and withdraw from the pen (or cartridge if available there).
 
Wendy&Neko said:
Mid blue means more than 150. AMPS is when you give the shot. Most of us test, feed, and shoot all within 15 minutes. Test as you suggest, unless he drops fast or low. Start a new post for the day, so it's easier to follow.

Yes you can use the syringe and withdraw from the pen (or cartridge if available there).
Click to expand...
For amps, it has to be 2 hours after food so reading is not food-influenced. That’s what I recalled doing. Still the protocol ya?
how do I know if he drops too fast or too Low? Does that mean I need to test at +1?
 
Yes withhold the food for two hours before Preshot.
I would get a +1 and +2 to start with and then go from there. You will
Probably have to get further tests. Lantus is a depot insulin so it will take several days for the depot to fill in the beginning and you won’t see a full effect of the insulin until then.

You will need to stay on the starting dose for 5 to 7 days unless Jebat drops below 50 for Tight Regulation method or 90 if you are doing StartLowGo Slow Method.
When you decide what method please put it in the signature.
Have you decided to start on 0.25 units?
 
Bron and Sheba (GA) said:
Yes withhold the food for two hours before Preshot.
Depending on the Preshot number I would get a +1 and +2 to start with and then go from there. Lantus is a depot insulin so it will take several days for the depot to fill in the beginning and you won’t see a full effect of the insulin until then.

You will need to stay on the starting dose for 5 to 7 days unless Jebat drops below 50 for Tight Regulation method or 90 if you are doing StartLowGo Slow Method.
When you decide what method please put it in the signature.
Have you decided to start on 0.25 units?
Click to expand...
Yes. Cos I tested him this morning, 2 hrs after food and it’s 168. Safe to start. I need to get the insulin later and plan to start at 8pm. I actually emailed you privately cos I need info. So best I test him at +1, +2, +4 perhaps? Cos I do need to sleep.
if it’s depot insulin, the insulin I give should be going into storage and shouldn’t affect his bg? Or the body will still use some of the insulin.
 
I saw your PM and will answer here.
With a depot insulin only part of it goes into making up the depot each time so you may well see some effect from the beginning. The only way to find out is to test.
As this is your first time with Lantus I would get a +1 and +2 and then depending on that I would probably get a +4 and +6.
Obviously if the +2 is a lot lower than the Preshot you will need to get a +3.
It is all about gathering data and keeping Jebat safe.

In the beginning I would not give the insulin if the BG is under 150 at Preshot. If that happens, stall, don’t feed and test 20 mins later to see if the number is rising. Post and ask for help. In your subject line say something like ‘first dose Lantus BG xxx, stalling, please help’
This will get attention for you.
I’ll be around for the next 8 hours if you need help. You can tag me by typing @Bron and Sheba (GA) .. a box will come down and you click on my name. Or you can PM me to already me.
 
Answering PM.
Yes you just take the cartridge out of the pen and store it in the fridge somewhere safe in a container ( not the door) and withdraw the insulin with the syringe through the rubber stopper.
 
If you are going to start insulin tonight, I would get a +11 (ie 7pm your time) just so we can see when he is up to an hour before the Preshot.

What dose are you starting on?
I’ll watch for your posts.
 
Bron and Sheba (GA) said:
If you are going to start insulin tonight, I would get a +11 (ie 7pm your time) just so we can see when he is up to an hour before the Preshot.

What dose are you starting on?
I’ll watch for your posts.
Click to expand...
Thanks for guiding me. Really appreciate some hand-holding for now. I’m starting at 0.25u. U will b around for 8 hrs. But that’s when I’m doing the pre-shot. Lol. I’ll post on lantus forum the pmps and readings as I take them. He usually gets his food at 5pm so by 8pm it’s 3 hrs after. I hope u will be on line at least till 10pm my time. Is Sydney 2 hrs ahead?
 
No we are at 3.30 pm Saturday afternoon here so 3 hours ahead. I will stay with you to give the shot and will try and find someone who can watch for the +1 etc shots.

You will need to adjust his feed time to around his shot time. Can you do that or are you restricted?
For example can you give the shots at 6 am and 6 pm? Instead of 8 and 8. Are you restricted with work times?

If you feed at 5pm your time, that is at +9 in the cycle and it is really better to feed in the first half of the cycles generally speaking.
With Lantus you don’t need to feed a lot earlier like you do with Vetsulin. The onset of insulin for Lantus is around +2 so it is ok to test the BG, feed, then give the shot all in the spare of 10 mins.
 
Bron and Sheba (GA) said:
No we are at 3.30 pm Saturday afternoon here so 3 hours ahead. I will stay with you to give the shot and will try and find someone who can watch for the +1 etc shots.

You will need to adjust his feed time to around his shot time. Can you do that or are you restricted?
For example can you give the shots at 6 am and 6 pm? Instead of 8 and 8. Are you restricted with work times?

If you feed at 5pm your time, that is at +9 in the cycle and it is really better to feed in the first half of the cycles generally speaking.
With Lantus you don’t need to feed a lot earlier like you do with Vetsulin. The onset of insulin for Lantus is around +2 so it is ok to test the BG, feed, then give the shot all in the spare of 10 mins.
Click to expand...
I’ll do it at 5pm then. Usually he eats at that time. So I’ll take reading, feed him n shoot. I’ll do +1, then dash out to run errands but back for +2. That will be around 10pm in Sydney.
 
Waheeda said:
I’ll do it at 5pm then. Usually he eats at that time. So I’ll take reading, feed him n shoot. I’ll do +1, then dash out to run errands but back for +2. That will be around 10pm in Sydney.
Click to expand...
Will the 5 am 5pm shot times suit you moving forward?
I can stay with you for the +3 reading if you shoot at 5pm your time.
 
Bron and Sheba (GA) said:
Will the 5 am 5pm shot times suit you moving forward?
I can stay with you for the +3 reading if you shoot at 5pm your time.
Click to expand...
I’m on leave this month so it’s ok. Come January I hv to shift it. But Monday nite I am a concert. Can only do +1. Hope he’s safe or shld I skip a dose.
 
Waheeda said:
I’m on leave this month so it’s ok. Come January I hv to shift it. But Monday nite I am a concert. Can only do +1. Hope he’s safe or shld I skip a dose.
Click to expand...
How far will you have to shift the dose when you go back to work ?
We will have to wait til Monday to decide what to do with the dose for Monday evening.
 
Bron and Sheba (GA) said:
If you move to 6/6 after this month it won’t be too hard to do that over the period of 2 days.
You need to find the best time that will work for you to give the 2 doses 12 hours apart moving forward.
Click to expand...
6/6 is good for me. What happens if occasionally I have Long meetings and come back late?
Got the lantus pen. I just need to uncap it. Can’t remove the cartridge.
 

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Waheeda said:
6/6 is good for me. What happens if occasionally I have Long meetings and come back late?
Got the lantus pen. I just need to uncap it. Can’t remove the cartridge.
Click to expand...
Can you access the rubber stopper?

If you are sometimes late then you are sometimes late. Try not to but you have to live too.
Do you have an autofeeder for him for when you are not home and at night?
 
Bron and Sheba (GA) said:
Can you access the rubber stopper?

If you are sometimes late then you are sometimes late. Try not to but you have to live too.
Do you have an autofeeder for him for when you are not home and at night?
Click to expand...
Ya I thk I can push the syringe needle in. I don’t want to touch it. I have 2 other cats. Can’t use an auto feeder. I leave some Young Again kibbles for them to graze. I’m getting nervous doing this all over again.
 
You will be ok. We will help you.
If you feed any dry food you are only able to do the SLGS method. Have a look at it in the yellow stickies at the top of the Lantus page.
It means you hold doses for 7 days. And reduce the dose at BG 90

Do you have some higher carb wet food and some honey in case of low numbers?
 
Bron and Sheba (GA) said:
You will be ok. We will help you.
If you feed any dry food you are only able to do the SLGS method. Have a look at it in the yellow stickies at the top of the Lantus page.
It means you hold doses for 7 days. And reduce the dose at BG 90

Do you have some higher carb wet food and some honey in case of low numbers?
Click to expand...
Yes I have Fancy Feast gravy and also honey. The YA kibble is 0% carbs. It helped bring down his bg the last round. They don’t eat much dry actually. Mostly they eat wet food. I’m fine to go slow and take my time to learn and for jebat to adapt. Clinically he’s doing fine. No excessive eating, drinking or peeing. Only that he’s quieter than usual. If not for the episode of pancreatitis, I wouldn’t be able to tell he’s borderline diabetic.
 
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