? OMG..Switched from NPH to Lantus Today. What to do/expect?

Status
Not open for further replies.
ELLIOTT & Fran Munschauer

ELLIOTT & Fran Munschauer

Member Since 2016
I have spent a great deal of time on the introduction page going crazy, worrying about Elliott but thanks to all of your great cat people, I was beginning to feel a tiny bit of peace, I think. NOW, It is starting all over because Elliott's BG are awful and so, I consulted our DVM switching to Lantus that started at 6 AM today. I believe that his weight of 14.8 ( 20 lbs prior to diagnosis) called for 1.78 u Lantus but was instructed to give 2 u BID with only a 6 hour peak check? I replied wondering why the nadir would be the same, since I performed the 6 hr NPH peak at 6 hours. Also, as a HCP with humans, I expressed that I was not comfortable NOT performing a BG prior to the am and pm meal and insulin injections. In the ER, I have never used Lantus, only Regular Insulin, so, called my daughter. She claims "It does not matter what the BG is prior to administering it, since Lantus does not kick in for many hours." Is she correct..I do not read this anywhere.??? Also, the DVM said that Elliott's BG would probably be high for first 3+ days. There was no mention of changing dosage and I should call him in 7 days..He sent off a Fructosamine level. Any advice on anything would be greatly appreciated. Also, I read that well regulated cats should maintain 60-150 BG levels at some point. I thought 60 was considered too low esp. since we're using home meters (AlphaTrak).Thanks for reading!!!!

POOR ELLIOTT'S DIABETES SPREADSHEET:
https://docs.google.com/spreadsheet...2rAeC4FxEqoeAUlnBPqganucis/edit#gid=361360320
 
N/NPH typically has maximum effectiveness in cats at 4-5 hours and you usually get relatively fast drop.
The depot insulin like Lantus and Levemir build up over days to reach maximum effectiveness. For most cats they is not that much of form before shot to max effectiveness which can be 5-7 hours.
Usually the starting does of insulin 1 unit twice daily but with data for other insulins it can be higher (or lower). Based on your N/NPH data 2 units of Lantus might be right. However, I would have started with 1 units to be on the safe side.
Most of use here test before each shot and then periodically between shots.
 
Most important thing will be patience! As Larry notes, it can take 5-7 days on the first dose level and 3-5 days after that, to fully see how successful a given dose may be.
You'll want to read over the sticky posts at the top of the Lantus forum to optimize your use of it.
 
Hi Fran,

According to Tight Regulation Protocol starting dose of Lantus is worked out at 0.25 IU per kg (2.2lb) of cat's current weight (if underweight) or 0.25 per kg of ideal weight for newly diagnosed cats who have not received any other insulin. If, as is the case with Elliot, there has been prior insulin treatment then the response to the previous insulin may be taken into consideration. Elliot's dose at 14.8lb/6.73kg would work out at 1.68IU Lantus. Maybe the vet has factored in the data you've already gathered for Elliot when setting the starting dose.

As BJ has already suggested, if you read through all the stickies at the top of the L&L support group board they will give you a great introduction to Elliot's new insulin. In particular, I recommend you read about the insulin depot to get a feel for how differently Lantus works compared to NPH.

Word of caution: The blood glucose reference ranges and thresholds in the Lantus board stickies are written for human meter users. The only Alphatrak guidance for which FDMB has a reputable reference source is the low number hypo boundary of 68mg/dL/3.8mmol/L. You need to consult your vet about the correct blood glucose reference range to use with your Alphatrak meter. There is some guidance on pet meter numbers and dose adjustments in the published Roomp-Rand Tight Regulation Protocol guidelines.

On testing, as you have already remarked the start-over with Lantus makes everything 'new' again - especially because of its different mode of action. With Saoirse I always get preshot tests and mid-cycle tests, even while a dose is settling. It gives me a little more peace of mind and also helps with making dosing decisions. I'd suggest getting AMPS, AM+4, AM+7, PMPS and a 'before bed' test each day for the first while. Once you get a feel for Elliot's response to his Lantus, the two preshots plus a AM mid-cycle spot check and a 'before bed' test should give you a good idea of Elliot's response. (Note: if you vary the times of day for the mid-cycle checks it can help you build up a bigger picture without the need to test excessively each day.)

Fingers and paws crossed that Lantus will work really well for little Elliot. :)



Mogs
.
 
OHHH...So much to respond to...I thought the "sticky" said that this area should be the second (or first) area to discuss my Cat's Health issue.

The DVM told me to give 2 u Lantus but if I was not comfortable with 2u, I could give 1.5u, since 1.7 or(1.68) would not be easy to measure. He speculated that Elliott will probably end up on 2.5 u Lantus?I told him of this forum and members' understanding, experience, and patience for others just beginning to deal with DM..adding that "They told me everything that you just planned. These people are really vested in Cat health..". I told him about the cat people who (apparently) were caring and watching my thread closely. "She (Mr Worfman's Mom) posted a message to another member, that she needed to go to the store asking another member to keep an eye on Elliott' low BG" REALLY??? I did not expect such "caring" from anyone.

I have used 3 meters but am charting the Alphatrak . I ran out of strips so used Relion and Bayer and used them before the AlphaTrak monitor arrived after diagnosis. I continued to test the blood gtt. with all 3 meters tracking differences in case AphaTrak broke or I ran out of strips. I am going to read the Lantus support group and about depot insulin right now ..after I go chase Elliott to perform another BG. Thank You!!! ONE MORE THING: After dx, I think we were starving Elliott because the cans of FF Classic are 3 oz, giving him 2/day=160-180 cal. Now, we give him 1.5 cans FF in AM and 1.5 cans in PM= 240-270 cal. When his BG has been low at NPH peak, I have given him .5-1 can FF (with faster acting substances close by if needed) Also, we boiled chicken breasts, cut in small pieces, and freeze most of it.. to give Elliott and brother treats, esp around BG test time. Elliott seems hungry all of the time..Elliott has gained no wgt since 12/31/2015. I have read that some cat people still free feed and others feed strictly...I am utilizing the strict feeding unless BG is low.. Thanks for all of your suggestions and experiences.
 
FRAN MUNSCHAUER said:
I thought 60 was considered too low esp. since we're using home meters (AlphaTrak).
Click to expand...

Noticed this hadn't been answered....and you're totally correct!! Using the AT meter, 68 is the lowest we want them going. If he drops below 68, you'd want to intervene and feed a little high carb "gravy-type" food to get him back above there

If you do 1000 searches for "normal cat blood glucose" you'll get about 1000 different answers, but here we say on a human meter, 50-120 is what we're shooting for....On the AlphaTrak, there is no official "upper register" number, but generally, you're trying for 68-about 150
 
I DON'T KNOW WHAT TO DO or what to expect next....When starting Lantus today, I did not expect the following
BG- 6am-406 Lantus 2u +meal
12n-283
6pm-113 Lantus 1.5u+ meal
7pm- 74 when starting on Lantus this AM..Is this normal? I am allowing him to eat right now.
 
Scotty was on 13 units of ProZinc twice a day and his blood sugar would not come below 350, the first day the vet started him on Levemir at his office he started him on 4 units and by +6 he was at 60, it scared me and the vet. Because he will not eat at the vets he had me bring him home and give him some high cal food and he came up fast but just wanted to warn you that even though sometimes it takes a few days you might see an immediate response. That 74 you saw at 7PM is pretty much the way Scotty responds to Levemir, he does not seem to wait on the insulin building up in his body.
 
Nancy and Scotty said:
Scotty was on 13 units of ProZinc twice a day and his blood sugar would not come below 350, the first day the vet started him on Levemir at his office he started him on 4 units and by +6 he was at 60, it scared me and the vet. Because he will not eat at the vets he had me bring him home and give him some high cal food and he came up fast but just wanted to warn you that even though sometimes it takes a few days you might see an immediate response. That 74 you saw at 7PM is pretty much the way Scotty responds to Levemir, he does not seem to wait on the insulin building up in his body.
Click to expand...
Thank You..I guess I should just carryon as ordered???
 
Have you got some Fancy Feast Gravy Lovers in the house? He's still safe, but he's getting close

If he's a good eater and you're sure you can get him to continue to eat, I'd give him another teaspoon of his regular food and recheck in 30 minutes (we don't want to fill him up now in case we need him to eat later)
 
I just realized you are using an alpha trak, you are going to have to test all night and may even want to give him Karo Syrup through the night, do you have any high cal gravy food, if so you need to feed him that, as much of the gravy as possible, I will be up all night and will check in hourly, you also need to decrease on your next dose.
 
Chris & China said:
Have you got some Fancy Feast Gravy Lovers in the house? He's still safe, but he's getting close

If he's a good eater and you're sure you can get him to continue to eat, I'd give him another teaspoon of his regular food and recheck in 30 minutes (we don't want to fill him up now in case we need him to eat later)
Click to expand...
I am so glad you jumped in on this too, I did not realize at first she was using an alpha trak.
 
Wow! That's quite the response (good) Elliott's having to the Lantus. Looks like the Lantus will be a much better "fit" for him.

You're in good hands and as you can see, you don't have to deal with this all on your own. I'll check in too to for awhile to see how things are going.
 
WELL.Elliott had perfect blood values except for the BG=DM..and so...if something happens to him because I don't know what I am going to do!!!! My DVM told me that his BG would be high for next few days. I should have done that go slow method? He told me to start at 2U. First, I read the Lantus/levemir "depot" article that said "DON'T FEED" after a low BG right away because then, I won't know what is really going on= I won't know the process of how the Lantus is working..but I did feed him twice after both low BG's. And so, if his BG is increased, what does that really tell me? Apparently those depots hold little pouches of Insulin and release them whenever. And so, I should perform hourly BG for the next 12 hours? I wish I had a BG curve to see how Lantus works when switching insulins..but can't find one. If this is normal, I am sorry for bothering all of you!!! I am sorry but did not know where else to turn. My DVM was not worried.
 
Relion read 54..I always check with 2-3 meters. I was trying to stop doing that. Relion, Bayer and Alphatrak. However, Alphatrak is what is recorded (note inserted may read Relion)
 
Last edited:
First....breathe.....as long as you're home testing, you're pretty much in control of his blood glucose

As long as he's above 68 on the AT (don't try switching back and forth with meters....it'll only confuse you right now) he's perfectly safe
 
You don't need to test every hour usually..EXCEPT right now, with him running so close to 68, we want you to keep a close eye on him so keep testing every 30 minutes until he's coming up at least a little

Since we don't have any data on him with Lantus, right now the important thing is keeping him safe
 
Re: Relion 54, need to keep feeding him gravy cat food and testing every 30 minutes to hour, he can keep going lower all night. Is he a good eater?
 
As far as the 54 on the Relion....that's still a safe number too...we don't feed high carb until they drop below 50 on a human meter, 68 on the AT
 
FRAN MUNSCHAUER said:
I should have done that go slow method?
Click to expand...

As far as this goes, both using TR and SLGS, you have to start "somewhere" on the dose....the numbers will tell us if the dose is too high or not. The main difference between the two protocols is how often you adjust the dose and at what point you reduce. TR is a more "aggressive" protocol, but it also has better results
 
Example of an ACTIVE, but NOT necessarily typical Lantus cycle:
NOTE: Until kitty is pretty well regulated, the description below is NOT not what you'd consider a "typical" Lantus cycle. It takes time and patience for kitty to achieve a "typical" cycle! The example below is what you're working towards (a nice shallow curve). A relatively flat cycle is the ultimate goal.

+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number. You'll probably see an active cycle if the +2 is the same/similar or lower than the preshot number.Continue testing!
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle. NOTE: ECID. Not every cat has a mid-cycle nadir. Adjust the hours on this example to fit your cat.)
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (one of the quirks of Lantus/Levemir: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.
 
If it were me knowing how Scotty reacts to Levemir I would keep feeding a little high cal food and testing every hour at least until I saw his numbers climbing a little. Scotty's nadir on Levemir is usually about +8 and he always lets me know by wanting to be fed then but I have had him drop really low (like 30 on Relion) at +4.
 
How's his appetite? Is he still willing to eat?

If you can give him another teaspoon of his regular food, I'd do that....he's surfing now and we just don't want him dropping any more
 
Elliott acts like I have starved him-eats- just finished another 1/2 can off F flaked+sauce. He is running from me when I try to get him..like he used to before diag with DM. Also, I am using the laser pointer and he is chasing it...will keep checking him a, behavior and BG..and then decide what to do in AM...I guess. will check BG at 9 pm. I do not expect all of you to stay awake. If Elliott gets worse, I guess I will get that Karo and start rubbing it in his mouth on the way to the DVM..I appreciate each and every one of you.I hope that I can help you all someday... I will keep posting...but You all need to sleep to care for your own cats tomorrow!!!!
 
I am so glad Elliott has come up a little, I work from home and will be on duty until 0500 CST so I am up all night anyway. I always know when Scotty is going low because he gets very rowdy and aggressive and he is always starving when he is low. Normally he is just a big lazy blob that wants to pile up in my lap. If he beats up one of the civies I am running for the testing kit.
 
You are doing great! The fact that Elliott is playing like you say, reminds me of my Jake when I switched him to Lantus. I was amazed at how well it was working. Jake was on 1.5 units of insulin in March of last year. I did just switch to Levemir a few weeks ago and he is now at 1 drop twice a day. Fingers crossed that this is just the beginning of beautiful, steady numbers for Elliott. :)
 
OK....time to break out a little high carb food....If you have some Fancy Feast Gravy Lovers, pop the top on one, put it back on and "squeeze" the gravy into another bowl and give him a couple teaspoons of the gravy

If you don't, add a few drops of Karo, honey or syrup to a little of his regular food and give that to him

Retest in 30
 
Do cats like Karo? I just gave him the last gravy one..He is running from me now so will I shove Karo in his mouth? I will look to see if any gravy food can be found...I found one more and squeezed gravy into bowl and added 1 tsp Karo to side in case he won't eat the karo!!!
He ate all + Karo+the food left in can by 11:15pm
 
Last edited:
Hang in there! You're doing great!

A few drops of Karo on a teaspoon of food may not be noticeable and he may just eat it.

If you have any flour, you could make a quick roux and add some to the regular food. (A teaspoon of flour, a few drops of water or broth from the canned food stirred in, heated to help it mix into a gravy.)
 
Last edited:
What were you feeding all this time? Brand and variety?

Some cats will willingly lap up Karo/honey/maple syrup...others won't....if he won't and you don't have something with gravy, you can try a little yogurt or ice cream (if he's ok with dairy) or rub it directly on his gums
 
He began eating only FF Classic (lowest carbs)since diagnosis..Prior he ate all the FF meals with gravy etc + dry Iams. I had a few cans of left hidden in cupboard. 1 is grilled tuna in gravy.
11:25pm-1/3 left of can FF with Karo dripped over-ate all again.
Elliott is not a happy boy...He is hiding when I approach because he knows what is going to happen. I will test his BG at 12 MN...This cat has been eating since 6pm!!!! Elliott and his brother will not eat anything but their cat food (and boiled chicken breast cut i to treats) BUT he must like the karo..since he licked it all up..If his BG doesn't increase at MN ???
 
Last edited:
Don't go overboard...we want him to be safe, but we don't want to send him to the moon

A couple of teaspoons of just the gravy OR a few drops of Karo is enough...we just want to support him and get him up a little
 
It'll help me know better about what's been going on if you could tell me exactly what kind of food you were feeding earlier (from +1 to +4)

If it was Fancy Feast, was it flaked tuna? Tuna Florentine? Tuna Tuscany?
 
Oh....and don't feel bad about "overdoing" it....the first time China went below 50 I knew to give her some syrup, but didn't know how much so I dumped about a cupful into a bowl and let her at it (was surprised that she liked it!!)

Only later did I learn I was only supposed to give her a drop or two at a time....needless to say she went high!!

We ALL do it the first time!!
 
Status
Not open for further replies.
Back
Top