Newbie switching insulins - dose question

[heidi]

After reading many of your posts here and consulting with my vet, we have decided to move my kitty, Frodo, from Humulin N to Lantus. I filled the prescription today . . . But I am not comfortable with my vet's dosing recommendation. Frodo was diagnosed about four weeks ago. I immediately switched him to a canned, low carb food on the advice of a good friend and reduced the recommended starting dose of Humulin N from 2.5 units to 1.0 units. Other than that I followed my vet's instructions. Unfortunately, I didn't get the every 12 hours message, so we've been doing them at wonky weird times -anywhere from 8 - 16 hours apart.

I had a curve done at the vets office on Thursday - was not satisfied with what I was hearing and found you guys that night . . . Anyway, he tested at somewhere in the high 300's after 2 hours (sorry wasn't given exact numbers--just a hand-drawn graph), dropped to somewhere around 220 after four hours and was back up in the low 400's after six hours. (He had a 1.0 unit dose at about 11:00 the previous night and 8:00 that morning). My vet told me I could either try it again with Humulin N at 2.5 units or switch to Lantus at 2.5 units. I am switching to Lantus, but 2.5 seems awfully high. I do not yet have my glucose meter. It is in the mail and will be here when the post offices open back up on Tuesday. Until then what do you think is the best course of action?

I will continue low carb food. I will dose close to 12 hours apart. I will switch to Lantus. DOSE recs???? Anything else I'm missing until I can add the blood testing? Oh, do you dose with food with Lantus or after they eat?

Thanks!

 

[BJM]

What I'd suggest:

Stick with the low carb foods.

Pop over to a pharmacy and pick up urine ketone testing strips to monitor for ketones, and if they monitor for glucose too, so much the better. Ketodiastix is one brand.

If you start Lantus, insulin, I would print out this sticky How to treat HYPOS - THEY CAN KILL! Print this Out!! and make appropriate preparations.

If and only if, you detect ketones or glucose in the urine (which you probably will, based on the vet results so far), you might be very conservative and start with 1/2 to 1 unit every 12 hours ... preferably if you are at home to take action if hypo symptoms arise. It does acts more gently than the Humulin does. Tip: aquarium gravel is non-absorbent, so you if you put down a fresh litterbox with it, you can slide the gravel over, tip the pan, and test. Fresh is best ;-)

It takes 3-5 days for Lantus to build up to a stable level, since it works with a 'depo' process - when it is injected, it slowly breaks down, and the next dose 12 hours later occurs before all the previous dose has been used, so little by little it builds up in the system. While you are waiting for your meter, read and re-read the Lantus stickies, a bit at a time, to help familiarize yourself with how it works and how it should be used.

Once you get your meter, and get the hang of testing, you'll be able to follow the rules for gradual dose adjustment.

 

[julie & punkin (ga)]

the formula for starting lantus is based upon the kitty's weight - .25u/kg

Using a weight based formula for determining a starting dose of Lantus or Levemir:
the formula is 0.25 unit per kg of the cat's ideal weight
if kitty is underweight, the formula frequently used is 0.25 unit per kg of kitty's actual weight
if the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration Online Calculator for Converting Pounds to Kilograms

there is consideration given to a cat who was on another insulin. if you were having good numbers on the humulin and had been following the 12 hr dosing, it would play into the decision. i don't know much about humulin, but if it's supposed to be given every 12 hours and wasn't, we probably don't know much about how that impacts this dose.

given all of that, and not having the testing equipment at home, i think BJ's given you some good advice. it's actually considered 5-7 days before lantus is fully up to speed and you can see what the dose does. but i am a huge fan of testing to make sure kitty is safe, so given that you'll be able to start testing on tuesday, i think going with 1unit would be ok, or even .5u to be more conservative, every 12 hours is a fine option. we'll be able to help you adjust the dose after a few days when we have some numbers to look at and the depot, or shed, has accumulated.

BUT, i should add - whatever dose you pick, stick with it every 12 hours. don't shift back and forth between the doses. lantus likes consistency - same dose every 12 hours. give a majority of the food within the first 4ish hours after the shot to help the carbs be there while the lantus is working best.

Here is the link to the Lantus forum that has all the information on how Lantus works. look for the posts with a yellow starred "sticky" on the left side. it's complicated - which is why people post daily to learn about it. we'll be glad to teach you. Lantus Tight Reg Insulin Support Group
glad that you found us! welcome!