NEW to Lantus, need advice about changing dose

Status
Not open for further replies.
RockStar033

RockStar033

Member Since 2012
bit of background info:

My Annie just started her Lantus yesterday(since april 1st has been on 2u Caninsulin BID). Vet put her on 2u SID. We shoot her at 11am with food(she is on Wellness grain free chicken, beef chicken, and turkey), she also gets injectable B12, and Potassium with her food(vet said the potassium she is lacking right now will help absorb the b12 or something), we feed her in the am/afternoon/and evening, and if still hungry we feed her in between too. If you look at spreadsheet her AMPS was 342, gave her 2u, and figured the 135 was about her nadir before she started rising again. Now, i'm aware of the 2u being a high dose to start her on, my vet says he wants me to give her the 2u this morning, and he wants to see her preshot number, and then after today he will tweak it. He is very open to my suggestions and really does work with me on what i am confortable with. I think he is trying to see how long the 2u lasts her in 24 hours.

if i lower her dose this morning, what should i give her? The vet said to test her bg, and still give her the 2u, and he is going to tweak it from there. i'm going to test her soon and i'll post her preshot number and see what people say before i give her insulin. Although yesterday her preshot was 19, and the 2 units put her at 135 nadir, is it still wrong to give her the 2u considering it surfed in the target range?

please advise thank you
 
Re: NEW to Lantus, need lots of advice..

i know you have already heard this but I'm going to say it again...Lantus isn't normally dosed SID it needs to be BID. Unless the cat is being weaned off insulin because they are going into remission and then it becomes more "shoot as needed". I'm afraid what you are going to see if you keep shooting SID is a lovely curve during the day and then she will run high all night and you will be right back where you started the next morning.

Lantus works off a cumultive effect so that each dose supports the other, not only does SID dosing make it nearly impossible to regulate the cat, remission will be out of the picture because it isn't going to give the pancreas enough rest to recover and take up the function of producing its own insulin again...And well it makes the cat feel like crap to be quite blunt...they are on a constant rollercoaster ride.

I believe I am many others over on health have suggested this, it would be a far better plan to give her 1u in the morning and 1u 12 hours later. With 2u SID you are just going to be spinning your wheels and there is a very good chance that your cat will remain an insulin dependent diabetic, rather than giving her a chance to become a diet controlled one.

Mel, Maxwell, Musette & The Fur Gang
 
Re: NEW to Lantus, need lots of advice..

See that is exactly what I mean, she did great yesterday during the day and got a nice drop, but she is right back up there sky-high again this morning because she used up what little bit of a shed that she started forming yesterday, this is going to be an on going cycle with SID dosing.

Mel, Maxwell, Musette & The Fur Gang
 
Re: NEW to Lantus, need lots of advice..

1 unit BID ie 1 unit every 12 hours is what could be reasonable to give her and would provide a more level amount of insulin in her body to keep her more stable. He is dosing your cat the way one may dose DOGS. Please remind him that cat metabolism is twice as fast as dogs, thus the dosing should be every 12 hours.

After you're on that schedule for 5-7 days, then the curve data can be used to adjust the dose. That is the veterinary STANDARD for using Lantus and we have the documentation to back up that statement. Of course, as we've got the protocol here, so you could use curve data to adjust the dose yourself, as many of us do.

A real concern is if he tries to raise the once a day dose and winds up with a single dose that'll kill your cat, whereas dividing the dose in 2 and giving every 12 hours might help her.




BTW
RockStar033 said:
Although yesterday her preshot was 19, and the 2 units put her at 135 nadir, is it still wrong to give her the 2u considering it surfed in the target range?
Click to expand...
ACK! - Please keep your units consistent - all in mmol/L (World) or all in mg/dL (US). I almost had a heart attack seeing one of each in the same sentence without the units until I looked it up!

342 mg/dL -> 135 mg/dL = a 207 mg/dL drop US
19 mmol/L -> 7.5 mmol/L = 12.5 mmol/L drop World
 
Re: NEW to Lantus, need lots of advice..

Hi RoskStar!

Looking at your spreadsheet tells us that your cat's BG levels are more easily controlled with Lantus than Caninsulin (the numbers drop on a longer period giving your cat more hours at normal levels) which is great! But why not try 1U in the morning and 1U in the evening instead of 2 in the morning? Since the numbers get very high during the night, a ZERO unit in the evening migh just be the cause of the high morning levels.

Try giving 1 in the morning and 1 in the evening and test! You might find out that this is just what your cat need to stay in safer values (yellow and blue on your spreadsheet)every our of the day. Or otherwise maybe I missed something... could you explain why you give so much in the morning and nothing in the evening even though the AMPS shows red and pink values every morning since the beginning of the month. Did your vet asked you to give 2 + 0 ?
 
Re: NEW to Lantus, need lots of advice..

Yes for some reason they said to just give her 2u in the morning and nothing in the evening yet. But I really think she needs the evening shot. She just got diagnosed with pancreatitis on Friday so I didn't want to just go change the dose without knowing about how the pancreatitis factors in! My vet is on holiday right now but he gave me his cell phone email to contact him anytime.

As you can see on the spreadsheet, her numbers aren't getting better since the first day. :(
 
Re: NEW to Lantus, need lots of advice..

Doing 1 unit AM and PM will provide the most relief to the pancreas, by providing insulin it would otherwise have to try to generate in its inflamed state.
 
Re: NEW to Lantus, need lots of advice..

going against my vets recommendations.... I want to give her 1u BID.... can i safely do this starting this morning? keep in mind that i am only home until 2pm today and same with tomorrow, so noone will be home to watch her until 8pm.

I really want to switch her today to BID shooting. Is it ok to start that today?
 
Re: NEW to Lantus, need lots of advice..

Jennifer

Well you do pretty much what you have done, you reach out on the internet, you do your own research and you hopefully find us, which you did. :-D

Now while vets have to know about every species of animal out there and every disease that all those species can come down with, we here live, breathe, eat, drink and sleep Feline DIabetes. Everyone here that answers your questions and give you advice are treating or have treated their own cats successfully for feline diabetes, we have a huge collective knowledge about what works and what doesn't work. Unlike vets we don't have to try and treat hampsters, birds, lizards, dogs and cats...we just treat extra sweet kitties, sometimes with other underlying conditions that complicate matters, but feline diabetics none the less.

Partly because these cats are members of our families and treasured members at that and partly because feline diabetics are the only creatures we are treating we can stay ahead of the lastest treatments of the disease, we have each other that we communicate with and offer suggestions to, and we are thus a peer reviewed board, if one of us makes a mistatement or doesn't come across as clear as we would like, someone catches it and corrects the mistake.

But just like your vet, we can only offer suggestions for a plan of action, you are ultimately the one that holds the syringe, puts the food down for your cat and decides what and when they shall eat. And it is up to you to follow the suggestions offered here or to follow the advice of your vet...but if you cat isn't getting better on what your vet is telling you then I hope you follow the suggestions you find here. We have a pretty good track record of helping feline diabetics go on to live long happy lives and many of them become diet controlled and go off insulin altogether.

Mel, Maxwell, Musette & The Fur Gang
 
Yes, it is far safer to give her a 1u shot and leave her for the day than to give her 2u. Just remember to test before each injection and if she is below 200 post here for help.

I think you will find she does much better on B.I.D. dosing. :-D

Mel, Maxwell, Musette & The Fur Gang
 
Thank you Momma

I am excited about this dose change.... I just dont' understand why my vet chose to give 2u SID...

I am going to start her on 1u BID today :) i think this will make a huge difference :)

Thank you
 
I would imagine that your vet really doesn't understand the nature of Lantus in cats because of their high metabolism rate, in humans Lantus can be given once a day in a lot of cases, usually with a bolus insulin like NPH or Humalog at mealtimes. But since cats use it twice as quick...yeah hard to believe an animal that spends 16 hours sleeping could burn through anything that fast.. :lol: It really needs to be given twice a day. Both Lantus and Levemir are human insulins and really while they get excellent results in cats their use is still considered "off label" so a lot of vets dose according to what information is available of its use in humans.

I think you are going to love the results that you get for her with the twice a day dosing. :-D

Mel, Maxwell, Musette & The Fur Gang
 
how do i handle the overlap? usually at night around her pm shot, she's lower.... i guess i will wait and see and come here if i need advice.

**p.s - my fiance is extremely angry at me right now for changing the dose. he thinks we should follow the vet, but my gut tells me otherwise, it's hard because i could really use his support as well.
 
the overlap is what you want, that is what is going to help keep her BGs in the lower ranges longer, which in turn will help her pancreas heal. But yes if you are unsure you can always post either here or if you don't get an answer quickly enough post to health and someone will help you out. Right now as high as she is I wouldn't worry about it too much, she is going to need about 3-5 days on the bid dosing to settle into the dose and truly know how she is doing on it, as her shed has to fill up first.

Mel, Maxwell, Musette & The Fur Gang
 
Remember normal for a cat on a human meter is between 40-120, she has a long ways to go before you have to worry about her going too low. :-D

Mel, Maxwell, Musette & The Fur Gang
 
so the chances of her going hypo are greater? or not so? i guess it depends on me and my trusty meter. the whole hypo thing scares the crap outta me :( especially when she nears her target numbers etc.
I will probably have to get new needles eventually right? in case i need to give her tiny doses less then 1u?
 
Hypo is always a risk we take when they get closer and closer to normal numbers, but that is where you and your trusty meter comes in...testing tells you how she handles the insulin, it tells you in a moments notice if she is going too low and you can step in and steer her back to safe ground. But right now she is very far away from going hypo.

Even those of us that have been at this for a very long time occasionally have to step in to help our kitties back to safe ground as an example Musette and I last Sunday. But knowing your cat and how to handle that situation should it arrive will make it much less scary. Having your hypo kit together and directions how to handle low numbers printed out and all together in a place that everyone that cares for Annie to easily grab helps. Because even though I have walked hundred of folks through hypos on this board, when it was my own sweet trusting Musette I still had a knot in my stomach and my heart was racing, but I knew what to do, I knew what to check to rule out anything other than her just dropping too low and I had everything at my fingertips to get her through it.

You are eventually going to need new needles anyhow, afterall syringes only last so long since you only use each one once, so next time you buy syringes just get ones with half unit marks and you will be all set when you need to give smaller doses.

Mel, Maxwell, Musette & The Fur Gang
 
Mel, what do you think is an unsafe number to give your cat another shot of Lantus? Is it 50, or higher? I don't have to worry about that right now either, but I'd like to know in case my cat ever does go low.

Thanks, Jennifer
 
Mel, what do you think is an unsafe number to give your cat another shot of Lantus? Is it 50, or higher? I don't have to worry about that right now either, but I'd like to know in case my cat ever does go low.

Thanks, Jennifer
 
p.s - my fiance is extremely angry at me right now for changing the dose. he thinks we should follow the vet, but my gut tells me otherwise, it's hard because i could really use his support as well.
Click to expand...

I feel your pain. My husband's angry at me. We've been fighting about this. It's maddening.

Jennifer
 
As far as what is an unsafe number to give a cat another shot of insulin that depends on the cat. In the beginning it is 200 as you collect data from testing and get to know your cat and their patterns that number changes.

This next week you will get to see this played out in living color as they say because I will be adopting a new diabetic kitty and I pick her up on Saturday night and will start her on Lantus (she hasn't been being treated) Sunday morning.

Right now for Musette that number is 100 but last sunday even that backfired on me because she got sick after eating and getting her shot. Feces happens...lol.

With Maxwell I never gave him a shot under 110 before he went OTJ.

A lot of different factors go into deciding what is a safe and unsafe number to shoot as you go along..things like how much they spike on food, how early the onset of the insulin is (when the insulin starts bringing the numbers down) and how much they drop on a given dose. Those are all things you have to learn about each and every cat.

I learned this the hard way when I adopted Musette after adopting Maxwell. Maxwell and Musette both handled Lantus differently, and in Musette's case not well at all, which is why I switched her to Levemir...I will be starting my new girl Autumn on Lantus because she is really just a baby when it comes to Feline Diabetes..just 5 years old and Lantus has the best proven track record for getting a cat into remission.

Mel. Maxwell, Musette & The Fur Gang
 
Status
Not open for further replies.
Back
Top