Ready to start back on lantus *updated* need help :)

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Theresa6

Member Since 2011
I posted about this in the main forum, but as a quick recap my cat Stella was diagnosed in Dec. with FD and hyperthyroidism. We started meds for both at the same time. She was diagnosed with bg at around 450, and after more than a month on lantus showed absolutely no change in her numbers. Her starting dose was 2u and we went up to 2.5u and still no change. She was ranging from 350-450+. So, we stopped. I also stopped her dry food cold turkey and went to canned, staying under less than 5% carb content. Her numbers dropped drastically to in the ballpark of 200-250, give or take some depending on the day, but still it was a huge change. She has been off dry and off lantus for 2.5 weeks now.

I am planning on taking her to the vet to get her thyroid rechecked, and her bg (fructosamine?) checked, which our vet recommended. Assuming her thyroid is under control, we will be restarting her on the insulin again.

That is why I am coming here. I need good instructions for starting her. I am worried that it will simply do nothing again, but I am willing to give it another try. I am not comfortable with dosing smaller than .5u, because it is hard to measure and will be inconsistent. I also cannot afford multiple vet visits or more than 2 (maybe 3 for a short while) home tests daily.

I would really appreciate some help in getting started again!
 
Re: Ready to start back on lantus after 2.5 weeks. Need help

Hi, Theresa and Stella!

sorry she has to go back on lantus, but I'm sure you'll get some knowledgeable eyes and input
here momentarily...

celi & binks
 
Re: Ready to start back on lantus after 2.5 weeks. Need help

Welcome, Theresa and Stella!

If you are planning to follow the Tight Regulation Protocol, we usually suggest a starting dose of 0.25u per kg of the cat's ideal weight (or 0.25u/kg of the cat's actual weight if they are underweight). Using the Tight Regulation protocol, we work up to a good dose methodically, so there is no question whether the dose is too much, too little, or just right.

If you are planning to follow the Start Low Go Slow approach, then you would probably want to start lower, maybe 0.5u or 1u. Again, dose changes are done methodically so you don't miss a good dose.

I'm glad you are looking at resuming insulin, since Stella is still running in diabetic numbers. Hyperthyroidism does sometimes make BGs a little wonky, but you have to treat the diabetes so sometimes you just have to deal with the wonkiness.
 
Re: Ready to start back on lantus after 2.5 weeks. Need help

I'd suggest taking a look at the two protocols Libby provided. Once you've digested them, let us know what you want to do and we'll do our best to lend you a hand.
 
Re: Ready to start back on lantus after 2.5 weeks. Need help

can someone tell me why someone would choose one over the other? What are the benefits/drawbacks of each? Just not sure which route to go and why.
 
Re: Ready to start back on lantus after 2.5 weeks. Need help

The TR protocol, while safe if you are following the guidelines, is meant to get a cat's numbers into the normal range as quickly as possible. This means a minimum of 4 tests per day, monitoring, no dry food, and dose changes in the amount of 0.25u. Doses are evaluated every 3 - 5 days. It also has published research to support it's use and a strong track record of getting cats within a year of diagnosis into remission.

SLGS is what it states. It does not move as quickly. You still need to be able to monitor to insure your cat is safe. Dose changes are done much more slowly but still in small increments.

I will point out that all of us struggle with micro dosing. Many people use a magnifying lens in order to be as consistent as possible with doses. Others can suggest what they use to better see the lines (or between the lines) on the syringe. Changing doses in larger than 0.25u increments could put your cat in a risky situation and could easily put you over dose. There is a reason that these protocols recommend dose changes in 0.25u increments.
 
Re: Ready to start back on lantus after 2.5 weeks. Need help

Hi there and Welcome!
Theresa6 said:
I am worried that it will simply do nothing again, but I am willing to give it another try.
Click to expand...
Following one of the protocols will help you get results.
That and a helping of patience :cool:
Theresa6 said:
I also cannot afford multiple vet visits or more than 2 (maybe 3 for a short while) home tests daily.
Click to expand...
Is it the price of strips? What kind of meter are you using?
I and many others here have found fabulous deals for test strips on ebay
 
Re: Ready to start back on lantus after 2.5 weeks. Need help

Hi everyone :)


I finally got Stella's follow up bloodwork done and results back. Her thyroid is under control and they did a glucosamine test as well, and she came back at 517... the vet said we wanted her under 450. Her home tests have been showing her BG around the 250 (plus or minus 20ish points) steadily since the diet change to all canned.

Her current weight is 10.19 and her ideal would be somewhere around 9.5-9 3/4.

Her clinical signs are better but not 100%, obviously, since she is still higher than she should be in her BG. So, we are ready to start back on insulin again.

The vet suggested we start at 1u 2x per day, but my guess is you guys will say go lower :mrgreen: In a perfect world I would like to do the tight regulation but honestly I just don't think I have it in me to test her 4-5 times per day. I have a very busy home with 3 kids and other pets... I am pretty sure I am going to slack on it. So, while I would love to have higher chances of her going into remission, I will probably be more successful with the low/slow approach.

Can someone help me get started again? Thank you!
 
hi theresa! good morning and welcome back!

sure, we can help you get started. have you given a shot yet since you made that decision? if so, what dose?

you want to pick a time for shots that you can most of the time give 12 hrs apart. i use 7am/7pm - doesn't matter what time you choose, just something that works with your life. with little kids you may want to avoid their bedtime hour.

what is the brand of the glucometer you are using?
 
~O) ~O) ~O)

Good to see you again .

here are the basics of SLGS:
Starting Dose
1u – 2u twice per day if kitty’s glucose was higher than 400mg/dL at diagnosis OR if cat is not on a wet low carb diet
0.5u – 1u twice per day if kitty’s glucose was less than 400mg/dL at diagnosis OR if the cat has been switched to a wet low carb diet

Hold the dose for at least a week
unless your cat won’t eat or you suspect hypoglycemia
test often for ketones
be consistent in timing and type of food
shoot every 12 hours

After 1 – 2 weeks at a given dose perform a 12 hour curve, testing every 2 hours
if nadirs are more than 150, increase by 0.25 unit
if nadirs are between 90 and 149, maintain the same dose
if nadirs are below 90, decrease the dose by 0.25 unit

Lather, Rinse, and Repeat!
Click to expand...

I think starting at .5u would be good, based on the BG test numbers you stated. (Fructosamine numbers are different - they are a measure of BG over time).
 
julie & punkin said:
hi theresa! good morning and welcome back!

sure, we can help you get started. have you given a shot yet since you made that decision? if so, what dose?

you want to pick a time for shots that you can most of the time give 12 hrs apart. i use 7am/7pm - doesn't matter what time you choose, just something that works with your life. with little kids you may want to avoid their bedtime hour.

what is the brand of the glucometer you are using?
Click to expand...


No, she has not had any insulin at all since 1/11/12, so over a month. I was giving her shots around 7/7 and that worked pretty well. We just got her blood test results this morning, so as soon as I got off the phone with the vet I came here right away :) Right now I have a bayer contour, but when I run out of test strips this time I will be buying something that is much less expensive to refill.

What dose do you think I should start with? .5u? I was going to start her tomorrow morning since I am going to be out to dinner with family tonight and won't be home to watch her.
 
That sounds like a good plan, since you won't be home tonight. I'm glad you're starting back on the insulin.
I hope to see you opening daily condos, so that we can keep track of how she's doing and help you to help her.
 
I think you meant that the vet did a fructosamine test. This is a blood test that gives you an average BG over a 2 - 3 week period. Once you start home testing on a regular basis, you shouldn't need this test since you'll have your spreadsheet.

Are you planning on following Tight Regulation or the SLGS (Start Low Go Slow) protocol?

The Contour is a good meter. If there's a Walmart near you, many people use the Relion meter. ADW also sells the Arkay meter which is the same as the Relion. Strips for either are inexpensive.
 
i like Sandy's suggestion of .5u to start with. it's far less hairy/scary to go up the dosing scale than to try to manage constant low numbers and have to go down the dosing scale. if .5u isn't enough after you've waited a week or two, you'll be able to increase it then.

Good online sources for diabetic supplies are http://www.hocks.com, http://www.americandiabeteswholesale.com and ebay (reputable seller, check expiration dates). there's a link at the top of the page for ADW - a percentage of each sale supports this website if you go through that button. buying supplies online will save you 1/3-1/2 in cost.

the cheapest reliable meter seems to be the Relion from Walmart. A lot of people have those and buy generic Arkray strips to go with them from online. The Bayer Contour is considered a very reliable, accurate meter (consumer reports). Just stay away from the meters with True in the name - i don't think any of them were rated very accurate.
 
Dyana said:
That sounds like a good plan, since you won't be home tonight. I'm glad you're starting back on the insulin.
I hope to see you opening daily condos, so that we can keep track of how she's doing and help you to help her.
Click to expand...

Ya, I didn't want to go back to insulin after more than a month off and not be home to monitor her. I am much more comfortable waiting until tomorrow when I will be home all day to watch her!

What is a daily condo?
 
Sienne and Gabby said:
I think you meant that the vet did a fructosamine test. This is a blood test that gives you an average BG over a 2 - 3 week period. Once you start home testing on a regular basis, you shouldn't need this test since you'll have your spreadsheet.

Are you planning on following Tight Regulation or the SLGS (Start Low Go Slow) protocol?
quote]

Yes, the vet did a fructosamine test. I had been doing home monitoring while she was getting insulin and then for a while when she was off. I stopped regular testing after she had been off the insulin for about 2 weeks and her numbers were not chaning much.

I plan to do the SLGS because, while I would (in a perfect world) like to do the TR, I don't think I can manage the commitment needed at this point. I think we will be much more successful with the SLGS :)
Click to expand...
 
I guess I shouldn't have called it a condo. It's a daily thread. Each day, we start a new thread for our kitty. Using the NEWTOPIC* button. Each day we post our cat's AMPS numbers, and a WCR (whole cat report) writing about how our cat seems to be doing, acting, feeling, whether all 5 Ps (purring, playing, peeing, pooping, preening) are present, and then any questions or concerns you might want feed back on. That way all the information for one day for one cat is contained in one thread with all the opinions and well wishes in one place. We also add a link to our last (or yesterday's) thread into the first post of the day, which makes it easier for advice givers to go back in time, day by day, if they need to.

As far as choosing to use the SLGS approach, that's perfectly fine. It would be helpful if you could add SLGS or something like that to your signature line, so we can tell quickly if needed, which approach you are going with.

Keep asking any questions you have, or letting us know about any concerns you have. We're here to help.
 
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