Recently diagnosed - hard time regulating with Lantus

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ajouteast

ajouteast

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Hi all,

My big guy... Bogey, was diagnosed about 5 months ago. The old vet slowly, very slowly, increased him from 1 unit of Lantus BID to 4 units BID. Unfortunately, this was not doing anything to curb the symptoms... ravenous appetitive, large water intake and unbelievable urination (we are talking he goes through a 40lb bag of clumping litter a week!). I moved him to a cat specialist vet who I had heard very good things about just this week. While in the clinic for curves testing, a urine test showed ketones, so we moved him to the 24hr hospital and got him stabilized. He's home and happy at the moment. We have now increased his dosage to 5 units BID. (The new vet said he's never treated a cat that has needed more than 3 units of Lantus BID.) We suspect that there is another underlying health problem and the new vet trying to work through some possibilities. The curves testing shows that the Lantus IS working, but not to the degree necessary. The new vet, along with the emergency vet, both recommend Bogey staying on the Lantus and to continue to increase the dose... and to watch his levels closely. I'm wondering if anyone out there has had a cat that has been insulin resistant at this level on Lantus? Or other thoughts? The last few days have been very scary and I'm trying to get a real handle on this.

Thanks so much for any advice or suggestions!

Amy
 
Amy,

Are you testing at home? Just wondering... Sometimes the readings at the vet's office can be much higher due to the stress of being at the vet's.

You can use a regular human blood glucose meter at home. Relion meters from Walmart are inexpensive for both the meter and the strips. There are videos to show you how to test.

There is a test for insulin resistance and there is a test for cats who have acromegaly. If you look in the Insulin Groups you will find a forum with information on the Hi Dose cats. Sorry, I don't have the link for you. The testing is only done at one lab in the country. It is not that expensive and your vet can do the blood draw and send it to the lab.

Good luck with your cat.

Claudia
 
Has your cat ever been tested for Cushing's or Acromegaly? Both these conditions can affect the diabetes and a huge dose of insulin may be needed to regulate the blood glucose levels. Here is info:http://felinediabetes.com/FDMB/viewtopic.php?f=12&t=375

Is your cat going to the vet's for blood glucose curves? Those are often inaccurate because some cats get so stresesd out that their blood glucose levels skyrocket. At home, the blood glucose levels are almost always much lower. Testing the blood glucose levels at home yourself is easy and highly recommended :smile: All you need is a Human diabetic blood glucose meter. You don't need an expensive pet specific meter such as the AlphaTrack. The Human meters work just fine, despite what your vet may say.

Are you using the 10 ml bottle of Lantus? Most people find that it loses effectiveness after a month or so. The Lantus SoloStar pens are much more cost effective and some people have been able to use it to the last drop.

Diet is an important part of managing blood glucose levels, Human or pet. What is your cat eating? Low carb canned and/or raw food is best. Dry foods keep blood glucose levels too high
 
Actually, the new vet just set me up to do home testing this weekend. He wants Bogey to be as stress-free as possible - given the last 3 days we've had. I'm going to give it my best shot! I've been using the Lantus bottle. The old vet said it should be good for up to 6 months. This is not true?? He hasn't shown any physical improvement signs in the 5 months of treatment. I guess in the beginning, the dose was low, and maybe at the end, eventhough the dose was higher, the Lantus wasn't working as well? I just bought a new bottle and now he's just been switched to 5 units BID - maybe this WILL make a difference.

And after his physical exam, one of the first things he mentioned was the acromegaly test. He said that was definitely a possibility with Bogey. You have confirmed that he at least knows his stuff. :)

Bogey is on a low carb, high protein diet. He's been on the Purina D/M for dry and Fancy Feast Classic for wet which he gets before his shots. The dry is left out for free-feeding because I have another cat, and because of his crazy appetite right now.

Amy
 
ajouteast said:
I guess in the beginning, the dose was low, and maybe at the end, eventhough the dose was higher, the Lantus wasn't working as well? I just bought a new bottle and now he's just been switched to 5 units BID - maybe this WILL make a difference

Amy
Click to expand...

Does your vet know how old your lantus bottle was? And do you know how to recognize hypoglycemia symptoms, and have supplies on hand to treat it?
 
While there are conditions that create insulin resistance, more often than not the problems with regulation are caused by a dry diet or too much insulin. Curves tend to be inaccurate at the vet because stress causes BG to go up, and you could have surpassed the dose he should be on. Another common problem with regulation is infection--Bandit needed a dental before I could get him regulated.

Purina DM isn't as awful as a lot of dry foods, but it could be still keeping his BG high. I would ditch it and just feed the Fancy Feast. You can free-feed wet food-- it can be left out for up to 12 hours or longer if you add water or freeze it. Or if your cat is like mine and will eat until he barfs if you let him, I have an auto-feeder that releases the food at a certain time if I can't be there to feed Bandit.

As for the Lantus, it's only guaranteed to work for up to 28 days. While some people can stretch it longer than that, I've never had it last longer than 45 days (about a month and a half). Usually it lasted about 30-35 days. You should have your vet write you a script for the pens...you get 5 3ml pens in a box, and you end up using most of the insulin before it goes bad because the pens are smaller. They're like mini-vials. And you use the same syringes with them that you would a vial.
 
If you've been using the same vial for 5 months, then my guess is that it's definitely not working anymore. I would go back down to the dose he was on about 2 months in when you get a new vial (or pens, they're a much better bargain) because if you shoot him with 5u of insulin that's working it'll most likely be way too high a dose and send him hypo.
 
You stated: "The curves testing shows that the Lantus IS working, but not to the degree necessary." Can you proved the BG values of these curve(s) together with the dose?
 
We had about a half day of curves done at the new vet when they found the ketones and he said that the Lantus was working but not as well as to be expected. Same report from the ER vet. This was at 4 units BID, with the old bottle at the new vet, and the ER vet had their own bottle so I'm not sure how old/new that was. I gave him 5 units of the new bottle last night and this morning. Seems fine. I have been instructed on what to do in case of hypoglycemia. I specifically called the old vet after I got the bottle because the pharmacy said it's only good for one month after opening. The old vet said "that's for human use... for cat use, it's fine up to 6 months." And no, I don't believe I told the new vet how old the bottle was. I'll give him a call and discuss that with him today. I'll ask him about going back down on the dosage too... that scares me though after the ketone episode.

All previous testing has been done with at the vet. I'm going to start home testing this weekend.

Amy
 
ajouteast said:
The old vet said "that's for human use... for cat use, it's fine up to 6 months."
Click to expand...

Boy, did you make the right decision switching vets. I don't know what kind of logic your old vet was using! The type of being you shoot the insulin in to has nothing to do with how long the insulin remains effective.

I didn't realize there were ketones present, or that you've started a new vial of insulin. If you can, I wouldn't wait until the weekend to start testing, because it's dangerous to lower the dose because of the ketones, but it's dangerous to keep him on the 5u if he got to that dose because of expired insulin. You said that your vet set you up for hometesting already--do you already have a glucose meter and strips, and lancets?
 
Are you home in the evening? Testing only takes a short time - longer at first, but even then, ten minutes is more than enough. To keep your kitty safe, give it a try this evening. It might end up being simple for you, and it definitely will increase your cat's safety.
 
Am I just checking to see where he's at? He gets his shot at around 8pm. I could actually probably test him when I get home, just before he eats, and 2 hours after. If all goes well, of course.
 
ajouteast said:
Am I just checking to see where he's at? He gets his shot at around 8pm. I could actually probably test him when I get home, just before he eats, and 2 hours after. If all goes well, of course.
Click to expand...

I would highly recommend that you test him daily...at the very least you should do a test before each shot, and then one 6 hours after one of the shots (since you work during the day this would be the evening shot), and a curve once a week on the weekend. However, you can test as often as you'd like and getting extra tests in the evening to see where his BG is at during his cycle will give you better information to adjust doses.

Tonight, I would test before his shot, and then get at least a test in 6 hours later. If it were me I would probably also test 2-4 hours into the cycle to make sure he wasn't going too low on that high a dose.
 
Basically that's what you're doing at this point. Test before giving the shot to be sure it is safe to give the shot. The usual recommendation, until you have more data on how the particular cat reacts to Lantus, is not to give the shot if the test is under 200. After you have data and can be more certain what is going on, then the "no shot" threshold will change. Additional tests will provide extra data, but they aren't crucial at this point, I don't believe.

A test before each shot, to make sure it is safe to give the shot, is the aim at first. Additional tests, if you are able to get them, add to the picture of how the Lantus is working in your cat. I'll let the people with direct experience with that insulin give you more detailed instructions about which tests would be most informative.
 
Just a little more info for you:

The reason for the tests before each shot is to prevent a hypoglycemic incident. If a cat is low and you can catch it before you shoot insulin, you can avoid this dangerous situation. The reason for the test 6 hours in is because Lantus dosing is determined by the nadir, or the lowest number in the cycle. This usually occurs at +6, but some cats hit their nadir at +4 or +8.
 
Ok, I just did my first home glucose test! Bogey didn't mind at all... it really is simple and no big deal. :) His reading was 305. He was just increased to 5 units of Lantus BID yesterday. What do you all think? I'm going to do a curve on Saturday or Sunday.
 
Doing great!!

Keep up the good work and keep posting your results and questions.

We can help with analyzing what is going on with Bogey -- and if he does turn out to be resistant to insulin -- we can help with that too.

There are some relatively rare conditions that cause insulin resistance - my first diabetic cat Norton had Acromegaly.

First let's see how Bogey is doing by getting more BG data at home (at the times suggested by others)

ps: since we are from all over the world -- saying 8 p.m. is kind of random -- so we report times as "AMPS" for morning preshot and PMPS for evening preshot and +1 +2 +3 for how many hours after the injection.

so... if you are in Eastern U.S. -- 8 p.m. would just be shot time in 15 minutes from now...


5u is a lot of insulin, but my Norton needed 13u BID at his highest dose because of his condition.

My adopted diabetic, Tiggy, is well-regulated on 0.5u BID -- he is a "traditional" diabetic.
 
Welcome.
Lantus is guaranteed for 28days, and sure it MAY still work, but you can't know for sure unless you are home testing to see the numbers. Now that you are testing, you will see how your cat is utilizing Lantus. By 30days, it's likely not worth continuing to use. Seriously, if it's not good enough for humans at 28days, how could it still be good for a cat?
Some info on Lantus for you to read:
Tight Regulation Protocol
Lantus & Levemir – Insulin Depot –AKA- Storage Shed
Lantus & Levemir – Data Ready to Shoot Low Numbers
Lantus & Levemir: Info, Proper Handling & Storage has picture of syringe and insulin pens.

You are feeding some dry foods, and dry food should be eliminated, but carefully.
The dose will drop when you cut out the dry food, so you have to coordinate with dose and diet changes.
You can find a good choice of foods, refer to Binky's list and pick some that are below 10% carbs.

Binky’s Food Lists
Feeding Your Cat: Know The Basics of Feline Nutrition

While that 5u BID dose is fairly high, you need to see how it's affecting your cat's BG numbers and adjust the diet before thinking about insulin resistance.
 
Gotcha! I am actually US Eastern time. :) Makes sense... I'll use the AMPS and the PMPS going forward. Thanks for the words of encouragement. :)
 
I used to have to do that with Bandit...I fed and shot at 7pm, so I would set the alarm for 1am to get his mid-cycle test every night. I think I did about half of them in my sleep! Thank goodness that meters save the recent readings, because I didn't even remember doing it half the time. :lol:
 
Not sure if I should give shot

Hi,

This morning I gave Bogey his increased dose of 5 units of Lantus (which he's been on for 2 days now). I tested him 2 hours ago which was +10 and his reading was 257. And I tested him again just now which is PMPS and it was 219. The vet said not to give him a 5 unit shot if his reading was under 250. I'm not sure what to do at this point. I can always page the vet - I'd rather not, but I can.

Amy
 
Hi -- since you are testing at home now --- we usually recommend a safe cutoff of 200 for "beginners" and as you build up data on how Bogey responds to insulin -- that cutoff can be adjusted lower.

For example -- I've been treating Tiggy for 3 years - he has been diabetic for about 8 years. Our safe cutoff is 80 assuming he is rising at shot time. Tiggy will probably never go totally off insulin, but he is well controlled on diet and a low dose of 0.5u BID.
 
Hi,

I'm a newbie who just joined this board on 4/18 after treating Junior since February. I've been so impressed by the passion, warmth, and wisdom of this board and just wanted to let you know you're really in good hands.

Like you, my vet had me slowly increase from 2u-5u and I kept telling my vet that Junior isn't getting better. He's thirsty all the time and peed like crazy. Mine went through 40lb of clumping litter in 2 weeks so I know how overwhelmed you must feel. The kitty litter would clump to his paws so I'd have to wash his paws twice a day. I've switched to non clumping and it's really worked out better than I thought. I don't know why I didn't do that before.

The biggest change was when I switched Junior from dry (Prescriptions DM and Evo Turkey and Chicken) to wet. Holy cow, I couldn't believe how fast Junior improved! His eyes cleared up, his congestion has improved and the biggest thing was his excessive drinking stopped almost immediately, over 2 days. Zombie Junior was gone and my old Junior was back. His BG is still high but his behavior is back to normal and now I can breathe a little easier.

BUT don't switch until you get more guidance from the folks here on the board and your vet (not a newbie like me). I'm still learning. The first night I gave Junior canned, I panicked. Was all excited about Junior's numbers until I saw Julie's post here. Then I ran and shoveled dry food into Junior as fast as I could.

Best of luck!!!
 
I'm a newbie here too, so I won't give advice, except to ask you over to the lantus support group. There are alot of experts overthere that are extreemly caring and thoughtfull. I'll post over there and see if an expert can pop over here.

Karisa
 
Thanks Karisa and MauiGuppy!

MauiGuppy: I'm having the same problem with Bogey... he's going through 40lbs of clumping litter a week! Another regular suggested trying the new litter box system which lets the urine pass through and collects on a pad. I might give that a try. But, mostly I'm excited to here that you were able to get such improvement from the switch to all wet food. I'm going to talk with my vet about that. I'm really hoping to get my big guy back to feeling like his old self. One of the weird things is that he used to always be cold. A big snuggler, to keep warm. Now he lies on the floor as wide spread as possible to keep cook. I find him in the bathroom on the tiles a lot. He used to sleep with me every night. Now he only comes on the bed to wake me in the morning for his breakfast. I miss that a lot.
 
hi amy,

i''m not an expert - i've been on this board for 2 months, but my punkin sounds a lot like your kitter. he's currently on a dose of 7u, he's 14 lbs, 13 years old. the vet, who isn't a pro on diabetes by any stretch, had us go up the dosing ladder and we ended up at over 8u twice a day because the vet also had us using the wrong syringes.

but how we got there isn't that important - one of the things i wanted to say is that if your kitter has any underlyin g infection it can be impossible to control their numbers. if you click on the bottom of my sig line where it says "punkin SS" you can see the results in the past 4 days. punkin had his teeth cleaned 3/29, had 2 teeth pulled and it turned out one was disconnected from its roots and was only held in place by tartar. ewww, i know.

we know that didn't happen overnight. punkin developed an infection and just in the past 4 days have we gotten him stabilized. he reacted to the antibiotics with vomiting and diarrhea, we switched antibiotics and he got on the "right" AB 6 days ago. the past 4 days his numbers have all dropped below 100 and the ONLY change was getting his teeth cleaned, pulled and infection on the road to recovery.

You have several things to immediately look into - and it will be a juggling act to change factors as well as insulin - so definitely if you have a good vet, work closely. don't change one factor too quickly and cause a crash in another one!

what i would look into -
...canned low carb food only - fancy feast is great.
...lantus that's not expired
...check for other health factors - does he need his teeth cleaned, does he have any infection elsewhere, feline leukemia, FIV - check for Bartonella's which comes from fleas and causes gingivitis if you live in a region that has a flea problem. did they check his thyroid and all the regular tests?
...definitely get hometesting - we'll help you get it figured out!

hang in there - people on here will help you through it too. don't these things always happen on Friday nights? several of us are west coast usa and are online late, too.
 
Yes, he just had $300+ worth of various blood tests on Tuesday while in the ER hospital. Everything looked really good. We are going to recheck his thyroid and the new vet wants to do the test for acromegaly. I didn't know that about the connection between body temp and thyroid. I don't think I mentioned that to the vet yet.

I did page the vet, but by the time he was able to get back to me I had already decided to give Bogey his insulin shot - I gave him 4 units instead of 5 to be safe. Unfortunately, the vet would have had me NOT give him a shot tonight at all. Now I'm worried. :(
 
This is where getting a blood sugar check in mid-cycle - like 6 hours post injection to check how low Bogey went during the day (or night)

We don't want our diabetic kitties to go below 50 at any point during the cycle.
 
If you ever have any questions on whether or not to shoot, just post your question. My first post here was similar to you. I missed and got the insulin all over his fur and my hand and emailed my vet. He didn't respond right away so I posted to this board in a panic. People were so responsive!

But OMG! Bogey lurking in the bathroom -- that's what Junior went through too! In fact, you can see a picture of him in the bathroom on Medical History link in my signature. That picture breaks my heart but it reminds me of how far Junior has come since 4/18.

Within 4 days of following the advice here, Junior stopped sleeping in the bathroom and is now on the couch. He hadn't done that since January. In fact, as I'm typing this, he's sleeping peacefully right next to me.

Every cat is different and I hope you'll experience some relief soon!
Bonnie
 
Welcome to FDMB!

You're getting a lot of very good guidance.

Now that you've started to home test, you may find it helpful to keep all of the test data in one place. Most of us keep our data on a spreadsheet that's color coded and linked to our signature. Here's the link to the spreadsheet template.

I've clearly been hanging around here too long! I don't think 5.0u is that big of a dose. If Bogey was throwing ketones, it's likely he needs more insulin. Just so you know, you can also test for ketones at home. You can pick up Ketostix at any pharmacy. A box of 100 strips costs about $15 and it will be the best form of prevention you can buy. You need to stalk Bogey to the litterbox and dip the ketostix in his urine stream. The pad at the end of the stick will turn color. After 15 seconds, you want to compare the color with the guide on the box. Anything above trace ketones is dangerous. I would also add water to Bogey's food. It will help to keep Bogey's system flushed of ketones.

Ketones can also arise if there's an infection present along with not enough insulin. Having your new vet check Bogey's teeth is wise.

Given the lower than anticipated pre-shot, I wouldn't wait until +6 to retest. You can test any time you want. How about grabbing a test at +2? If your +2 is lower than your pre-shot, you may want to get a test at +3. Also, do you have any low carb treats at home? Low carb treats have nothing except protein in them. If you don't have treats, giving Bogey some chicken or a bit of deli meat (as long as it's not honey or maple glazed!) is a good way to reward him for being so good with testing. One thing to remember -- as long as you can test and know how to control the cycle with food, you are in control. Get an early test. I'm assuming you have honey or Karo or other syrup in the house just in case you might need it.

If you are going to get Bogey tested for acromegaly, ask your vet to also get the test for insulin auto-antibodies (IAA) run. IAA causes insulin resistance. The tests are both run at the labs at Michigan State University. The cost for the IAA test is about $15 in addition to the acro (IGF) test. Alternatively, you may want to get some home testing data, especially once you eliminate the dry food from Bogey's diet, before getting these tests run. So far, Bogey's numbers don't seem like they are all that high.
 
you don't need to worry, amy. you can control his responses if he goes too low. you give a little bit of high carbs, either the gravy from canned food or a little bit of karo syrup, wait 15 minutes, test him again and if it's still low then you repeat until he comes up in numbers. in my signature line is the link to what to do if his numbers go low (below 50 is considered low).

if you test him during the night and his numbers are low and you get scared, you can post here and someone will help you through it. go to your first post in this thread and choose "edit" then change your subject line to "help now" or something like that. you can also change the post icon to "911" if you feel you have an urgent situation.

you're in the right spot now and will get help to get Bogey healthy again. the spreadsheet that Sienne referred you to is priceless for being able to see how Bogey responds to his insulin and his food. we've given you a lot of information - but knowledge is power. it also removes the fear of the diabetes when you learn how it all works.
 
Hi, I had the same problem with my Franky. I had worked him up to 8 units of Lantus and my Vet was suggesting more. I listened to this forum and stopped feeding him any dry food. Assuming your cat has no other problems, by taking him off dry food and feeding him only low carb wet food. Wellness, Evo, Fancy Feast to name a few, you will start seeing an improvement in a few days. Cats become addicted to the carbs in dry food. It has worked for my Franky. He is down to 1/4 to 1/2u per day. You can do this. Please give it a try. Good luck to you.
-Joe
 
Hi Amy,

I just wanted to pop in and say welcome. I am relatively new here as well, so all I am gonna say is that you are in excellent and knowledgeable hands. This board is a lifesaver, and not just for the FD kitties either!

Debbi and Saatz :-D
 
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