Hello everyone. Oliver is a returning diabetic 16.5 year old kitty who has been in remission for over 2 years. He was put back on lantus yesterday and was given his first shot last night. Below is his spreadsheet. I'm looking for advice on the dosage of lantus for him. The vet prescribed 2 unit which I knew was likely too much. We started with 1 unit last night and that also appears to of been too much since I he was too low to be given the next shot. Any advice on what dose I should use for his next shot would be great.
Newbie- 6/7 Oliver 0.5u +2 467 +6 474 Need doseage help
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Deb & Wink
Member Since 2013
Re: Newbie- 6/7 Oliver +7 403 +8 421 +9 419 Need doseage hel
I'd cut the Lantus dose back to 0.5U BID. You can always move the dose rapidly up from there if the 0.5U isn't enough.
Roughly 5 days for the depot to fill when first starting on the Lantus insulin.
When have you decided to test?
I'd cut the Lantus dose back to 0.5U BID. You can always move the dose rapidly up from there if the 0.5U isn't enough.
Roughly 5 days for the depot to fill when first starting on the Lantus insulin.
When have you decided to test?
Deb & Wink
Member Since 2013
Re: Newbie- 6/7 Oliver +7 403 +8 421 +9 419 Need doseage hel
This sticky in the Lantus forum explains the depot and what it does. http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=150
My explanation is not as good but here goes. Lantus is a depot type of insulin. Think of the depot as a storage area for later use. The shot you give does not go to work all at once. Some of the insulin is stored in the body of your cat. When you give 1U of insulin, part of it goes to the depot, part of it goes to work to help process the food. Each day, some of the shot goes to fill the depot, some right to work, a little bit less each day to storage, a little bit more each day to work. It takes about 5 days to 'fill' this storage area. After the storage area is filled, the entire dose will then be used. After the initial storage depot is filled, it takes about 6 cycles or 3 days for changes in the depot storage and the action of the insulin to be seen.
When using Lantus, what you did a day or two ago, will impact today and maybe tomorrow as well.
Testing:
1. AMPS and PMPS. Always to make sure the BG's are high enough to give the insulin
2. +2 Often tells us if this is going to be an active or normal cycle.
3. Around +5- +7 to try to find the nadir. Dose changes are based on the nadir
4. A test before you head to bed. To see which direction the BG's are headed.
This sticky in the Lantus forum explains the depot and what it does. http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=150
My explanation is not as good but here goes. Lantus is a depot type of insulin. Think of the depot as a storage area for later use. The shot you give does not go to work all at once. Some of the insulin is stored in the body of your cat. When you give 1U of insulin, part of it goes to the depot, part of it goes to work to help process the food. Each day, some of the shot goes to fill the depot, some right to work, a little bit less each day to storage, a little bit more each day to work. It takes about 5 days to 'fill' this storage area. After the storage area is filled, the entire dose will then be used. After the initial storage depot is filled, it takes about 6 cycles or 3 days for changes in the depot storage and the action of the insulin to be seen.
When using Lantus, what you did a day or two ago, will impact today and maybe tomorrow as well.
Testing:
1. AMPS and PMPS. Always to make sure the BG's are high enough to give the insulin
2. +2 Often tells us if this is going to be an active or normal cycle.
3. Around +5- +7 to try to find the nadir. Dose changes are based on the nadir
4. A test before you head to bed. To see which direction the BG's are headed.
Re: Newbie- 6/7 Oliver +7 403 +8 421 +9 419 Need doseage hel
I'm sorry to hear that Oliver fell out of remission.
Before making any suggestions, I've got a few questions. It sounds like Oliver was in to see your vet. Was blood work done in order to rule out any infection tht may have caused him to need to be back on insulin? Likewise, when was the last time Oliver had a dental? An infection or the need or a dental are two of the most frequent reasons that we see kitties come back from being in remission.
What was Oliver's highest dose of insulin during his first round on the juice? Does Oliver have any medical condition that we need to be aware of especially any history of ketones?
We don't suggest always testing at the same time. Random tests can help to fill in the white spaces on your spreadsheet (SS). A +2 or +3 test, if it's markedly lower than your pre-shot test (which you should always get) can tell you if numbers are dropping during that cycle. Since not all cats follow the rules and have their nadir in the middle of the cycle, when you test depends a great deal on your cat. In the beginning, getting a curve (testing every 2 or 3 hours) can help you to sort out when Lantus begins to kick in (onset) and when the lowest point in the cycle (nadir) is. However, nadir can move around. Getting a before bed test is helpful -- the point, though -- is to get at least one test during the PM cycle. We encourage people to get a pre-shot test so you know it's safe to give a shot and to get at least one test during both the AM and PM cycles.
I'm sorry to hear that Oliver fell out of remission.
Before making any suggestions, I've got a few questions. It sounds like Oliver was in to see your vet. Was blood work done in order to rule out any infection tht may have caused him to need to be back on insulin? Likewise, when was the last time Oliver had a dental? An infection or the need or a dental are two of the most frequent reasons that we see kitties come back from being in remission.
What was Oliver's highest dose of insulin during his first round on the juice? Does Oliver have any medical condition that we need to be aware of especially any history of ketones?
We don't suggest always testing at the same time. Random tests can help to fill in the white spaces on your spreadsheet (SS). A +2 or +3 test, if it's markedly lower than your pre-shot test (which you should always get) can tell you if numbers are dropping during that cycle. Since not all cats follow the rules and have their nadir in the middle of the cycle, when you test depends a great deal on your cat. In the beginning, getting a curve (testing every 2 or 3 hours) can help you to sort out when Lantus begins to kick in (onset) and when the lowest point in the cycle (nadir) is. However, nadir can move around. Getting a before bed test is helpful -- the point, though -- is to get at least one test during the PM cycle. We encourage people to get a pre-shot test so you know it's safe to give a shot and to get at least one test during both the AM and PM cycles.
Re: Newbie- 6/7 Oliver +7 403 +8 421 +9 419 Need doseage hel
Oliver had full bloodwork and urinalysis done. The vet said everything was okay apart from the blood sugar and he did have some ketones but the vet didn't seem too concerned as long as we got him on the insulin. He has never had a dental. I'm not sure what the signs are for needing a dental? He does not appear to have an infection. He has been on 7mg of Methimazole twice daily for hyperthyroidism for awhile now. He has lost weight recently and is underweight, but he does not have a problem eating. He was recently switched to a kitten food to try and help that.
Previously oliver was on 2units of insulin. He had been eating science diet dry food for most his life, the switch to low carb wet food threw him off insulin before we could really figure out much far as dosing. He was on insulin less then week if I recall.
Oliver had full bloodwork and urinalysis done. The vet said everything was okay apart from the blood sugar and he did have some ketones but the vet didn't seem too concerned as long as we got him on the insulin. He has never had a dental. I'm not sure what the signs are for needing a dental? He does not appear to have an infection. He has been on 7mg of Methimazole twice daily for hyperthyroidism for awhile now. He has lost weight recently and is underweight, but he does not have a problem eating. He was recently switched to a kitten food to try and help that.
Previously oliver was on 2units of insulin. He had been eating science diet dry food for most his life, the switch to low carb wet food threw him off insulin before we could really figure out much far as dosing. He was on insulin less then week if I recall.
Re: Newbie- 6/7 Oliver +7 403 +8 421 +9 419 Need doseage hel
Well I gave him 0.5 unit shot. It was a bit early. I use a relion confirm to test him and all it gave me was 'Hi'. I was also very lethargic and dehydrated, but at my encouragement he did drink quite a bit of water. I think I am going to start mixing equal wet food and water together for his meals until the insulin start taking effect.
Well I gave him 0.5 unit shot. It was a bit early. I use a relion confirm to test him and all it gave me was 'Hi'. I was also very lethargic and dehydrated, but at my encouragement he did drink quite a bit of water. I think I am going to start mixing equal wet food and water together for his meals until the insulin start taking effect.
Deb & Wink
Member Since 2013
Re: Newbie- 6/7 Oliver +7 403 +8 421 +9 419 Need doseage hel
The Relion Confirm reads high when it is over 600 something. HI is high, so note it on your spreadsheet and try to get it lower another day.
I would be testing for ketones daily when the numbers are high like that.
So even though you are back for a second round in treating the diabetes with insulin, you probably still need a lot of advice in managing this. Only one week was not a lot of time for you to gain experience.
What do you want to know?
The Relion Confirm reads high when it is over 600 something. HI is high, so note it on your spreadsheet and try to get it lower another day.
I would be testing for ketones daily when the numbers are high like that.
So even though you are back for a second round in treating the diabetes with insulin, you probably still need a lot of advice in managing this. Only one week was not a lot of time for you to gain experience.
What do you want to know?
I always add extra water to the wet food. Keeps my cat Wink from getting frequent UTI's.
Re: Newbie- 6/7 Oliver +7 403 +8 421 +9 419 Need doseage hel
That's great that you had labs run. I'm assuming that Oliver's hyper-T was under good control when the labs were drawn. Hyper-T can effect BG levels.
I would talk to your vet about a dental. At 16.5 yrs young, it's quite possible that Oliver has tarter on his teeth. Tarter deposits can cause the gums to be inflamed and the inflammation stresses the cat's system. Any sort of stress can cause a food controlled diabetic to lose regulation. Although his blood work didn't indicate that there's an infection, there can still be an inflammation.
I would strongly encourage you to pick up Ketostix at a pharmacy. This is a method to test for urinary ketones. (You dip the paper end of the strip into Oliver's urine and it will change color to let you know if ketones are present and if so, how much.) Until there's improvement in Oliver's numbers, given that the vet noted the presence of ketones, testing is your best way of avoiding what can be a life threatening situation. Ketones develop if there's not enough insulin, an infection/inflammation is present, and a cat isn't eating. Ketones can go from a level that's manageable at home to a critical situation so testing can save you a great deal of anxiety and money! Adding water to Oliver's food is an excellent strategy. Fluids help to flush out ketones.
Ordinarily, I wouldn't suggest that someone who's relatively new to managing their kitty's diabetes shoot early. (And early shot acts like a dose increase.) However, given where Oliver's numbers are, it's not a bad idea! Just remember that your shot tomorrow AM is 12 hours from when you shot tonight.
Given the ketones, I would have suggested dropping Oliver's dose just a little -- to 0.75u. It's up to you if you want to stick with the 0.5u. If you do, it's very important that you pick up a box of Ketostix. They are available at pretty much any pharmacy and you use the same ones for Oliver that you'd use for a human.
That's great that you had labs run. I'm assuming that Oliver's hyper-T was under good control when the labs were drawn. Hyper-T can effect BG levels.
I would talk to your vet about a dental. At 16.5 yrs young, it's quite possible that Oliver has tarter on his teeth. Tarter deposits can cause the gums to be inflamed and the inflammation stresses the cat's system. Any sort of stress can cause a food controlled diabetic to lose regulation. Although his blood work didn't indicate that there's an infection, there can still be an inflammation.
I would strongly encourage you to pick up Ketostix at a pharmacy. This is a method to test for urinary ketones. (You dip the paper end of the strip into Oliver's urine and it will change color to let you know if ketones are present and if so, how much.) Until there's improvement in Oliver's numbers, given that the vet noted the presence of ketones, testing is your best way of avoiding what can be a life threatening situation. Ketones develop if there's not enough insulin, an infection/inflammation is present, and a cat isn't eating. Ketones can go from a level that's manageable at home to a critical situation so testing can save you a great deal of anxiety and money! Adding water to Oliver's food is an excellent strategy. Fluids help to flush out ketones.
Ordinarily, I wouldn't suggest that someone who's relatively new to managing their kitty's diabetes shoot early. (And early shot acts like a dose increase.) However, given where Oliver's numbers are, it's not a bad idea! Just remember that your shot tomorrow AM is 12 hours from when you shot tonight.
Given the ketones, I would have suggested dropping Oliver's dose just a little -- to 0.75u. It's up to you if you want to stick with the 0.5u. If you do, it's very important that you pick up a box of Ketostix. They are available at pretty much any pharmacy and you use the same ones for Oliver that you'd use for a human.
Wendy&Tiggy(GA)
Member Since 2011
Hey there
How is Oliver doing? Long time no see.. hope all is well?
Wendy
How is Oliver doing? Long time no see.. hope all is well?
Wendy
Welcome to Lantus Land!
I think it is a good idea to mix water in his food. I always do that with all my cats. I also agree that if his numbers are still high, I would increase his dose to .75u tomorrow provided you can monitor. If you shot early tonight, you should know that shooting early can act like a dose increase. And if you increase in the morning, you just need to stay vigilant.
Please ask questions....we are here to help.
I think it is a good idea to mix water in his food. I always do that with all my cats. I also agree that if his numbers are still high, I would increase his dose to .75u tomorrow provided you can monitor. If you shot early tonight, you should know that shooting early can act like a dose increase. And if you increase in the morning, you just need to stay vigilant.
Please ask questions....we are here to help.
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