Question on dosing??

[Maresydotes]

Has anyone heard of dosing a cat on Lantus 3 times a day? Say the cat was on 12 units BID (this is hypothetical and I chose those numbers for ease of math :roll: ) you would divide those 12 units and give 4 units three times a day.

My vet was mentioning this to try on Miss, but I thought I would put it out here, for opinions/input.

I may call the people at Lantus and see if they will give me an opinion on this type of dosing, but doubt they would like to comment, since it is not 'approved' for use in felines. Maybe I will tell them I am the patient.

Any thoughts would be welcome. I will get her SS updated shortly.

Prayers to Thelma and Ray..

 

[Sienne and Gabby (GA)]

The people at Sanofi will not comment. Lantus does not have a veterinary indication and they could get sued for commenting.

There are people that dose TID. This means giving insulin and monitoring every 8 hours. It is not for the faint of heart. However, this is only recommended if there is some indication that there is insufficient duration of the insulin. I don't know that I see with on your SS.

What I do see is that you are holding doses overly long. Doing so can cause glucose toxicity. What this means is that Missy gets used to being in higher numbers and it gets harder to bring her numbers down. I'd encourage you to follow the protocol and evaluate her dose every 3 days/6 cycles.

 

[Maresydotes]

Thanks for the input, Sienne.
I updated her SS with todays numbers, but also I had forgotten to enter the last increase I did to 5.5 units. I started that on 11/05. (have it in my notebook, just had not updated on line :sad: )
I will take your advice on increasing her on the 3 day/6 cycle time span.
When you said the 8 hour shooting is not for the faint of heart, were you referring to hypos? My vet warned me I would have to be vigilant about that and actually talked about me waiting until she comes back from her vacation, in case I have problems. (hers is a one vet office) I have not made up my mind about doing it, since I have enough problems with PM testing, as it is.
Has anyone else had any experience with this dosing?

 

[mybuddybinks]

stopping by to say hello!

 

[julie & punkin (ga)]

i've seen a couple of discussions on this and much of the concern seems to be regarding the overlap of the cycles - so it's not just on the timing of the shooting and the monitoring, but it's also on the build-up of lantus in the body and the slow-release causing too much in the overlap.

personally, i'd give the 2x/day a really great effort before trying something else. i think there have been maybe 35 cats go OTJ following the protocol.

what's your vet's reasoning for suggesting that?

 

[Maresydotes]

Julie,
I think she was mentioning it because of her high, flat 'curves'. And, also because of the ever-increase dose with not much change in numbers.
I did increase her again and she seems to be showing some effects at this dose. She was 224 at PMPS. She bounced today, but I will hold it for another day or two, I guess. I can understand Sienne's concern about holding her dose too long....but what do you do when you suspect a bounce, if it takes place at the 6th cycle of the new dose and takes up to 72 hours to clear? Hold or increase at 6 cycles?
Thanks for looking at her.....
Punkin sure seems to be doing awesome. I am sure it is nerve-wracking for you....but definitely looks like steps in the right direction!

 

[Linda for Weezer]

Hi Marse,
Those lower yellows sprinkled in are sure looking nice!

Of course I don't have any advice, except that for Weezer I'm always comfortable following Sienne's advice. I would be interested in hearing more from the experienced people about the relative importance of the flatness of the curve as opposed to the range of numbers involvled.

 

[Sienne and Gabby (GA)]

There is definitely concern about hypos for the reason Julie noted. However, think about your quality of life. I could not manage TID dosing. You have to be home to monitor pretty much around the clock.

I would also want to rule out a high dose condition prior to trying TID dosing. IMHO, it would be foolish to try a difficult dose schedule only to find out later that you cat is insulin resistant.

 

[Sandy and Black Kitty]

I can understand Sienne's concern about holding her dose too long....but what do you do when you suspect a bounce, if it takes place at the 6th cycle of the new dose and takes up to 72 hours to clear? Hold or increase at 6 cycles?

To answer you question - yes - hold the dose if Missy is in a bounce. The combination of a higher dose and clearing bounce could spell trouble.
The problem here is, you are "suspecting" a bounce - you need to know if it's a bounce. Otherwise you are waiting for a bounce that doesn't exist to clear - and glucose toxicity is gaining ground.

I agree with Sienne regarding your quality of life.
TID It's extremely demanding, physically and emotionally. It's not for those of us who suffer from fatigue.

 

[Maresydotes]

Sandy,
Thanks for weighing in on that. I probably won't do the TID dosing. Will wait to see if I can gain back some of the ground I have lost the last couple weeks. I also don't want to introduce too may things all at once with the risk of not being able to tell what caused what.
Miss was on clavamox for 6 weeks (hoping to clear up her acne) from Sept to mid Oct. I gave her probiotics during that time, but she had diarrhea and it never went away, completely. So, I took her in and had some blood work done. She had mildly elevated liver enzymes, so they had me start her on Denamarin for that. Put her on metronidazole for the diarrhea. Ugh, she hates that! I have had it myself, so I can't say as I blame her...it gags me. It hasn't helped with the diarrhea, yet, in fact seems to have made it a bit worse. She had partly formed stools before, now not so much.
Now, the vet is mentioning de-worming, although Missy isn't much of a hunter...mostly dragonflies. I certainly don't want to de-worm her if she doesn't have worms, but vet seems to think a stool sample is not necessary. I am a bit hesitant about that. I don't want to introduce unnecessary drugs into her system, esp. if her liver is acting up, albeit, midly.
Anyway, I think I will let the metronidazole run it's course and see the outcome before I introduce anything else in to the mix. I would love to see her have normal stools, though. I am giving her FortiFlora hoping that will help, too.

To answer you question - yes - hold the dose if Missy is in a bounce. The combination of a higher dose and clearing bounce could spell trouble.
The problem here is, you are "suspecting" a bounce - you need to know if it's a bounce. Otherwise you are waiting for a bounce that doesn't exist to clear - and glucose toxicity is gaining ground.

How do I KNOW it is a bounce?
She was 224 PMPS and 326 AMPSthe next morning. I couldn't test during the night...had some reactions to my own meds and was sicker than a dog, even tho I know it would have been good to get a couple checks in. I am assuming, from what I have read, that she bounced...but how do I know for sure? Besides the tests I didnt get? :roll: I know I missed a golden opportunity, but my side effects are the same as having the flu. (interferons) I could not drag myself out of bed but for the bare necessities. I don't get them often, only when I am run down so the timing sucked for Miss and I both. Am I doomed not to know? Should I increase or stand pat for a couple days based on what info I do have?
Thanks so much