Rx for Lantus

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dustyboy4

dustyboy4

Member Since 2010
Hi everyone,
I picked up the Rx this afternoon after work and will have it filled tomorrow. His vets left the Rx at the front desk with a note (I didn't get to speak with either of them ). The note tells me to check Dusty's weight before beginning the insulin switch over and keep track of it and also to check Dusty's BG pre shot (I always do that anyway but I guess the reminder is good). Then it goes on to tell me to make sure to get the correct syringes, that I can't use the ones I used for the Prozinc (I used U-40 syringes). I know I need to get U-100's and to ask for 3/10cc with half units marked on the barrel for the fine dosing from one of the articles I've read on this message board. Can anyone tell me what gauge the needle should be and how long the needle should be? I've been using 29g 1/2-inch with the U-40's. Also, what if the pharmacist doesn't carry what I need? Does anyone know where I can purchase them quickly? Is there a favorite name brand? I've been using the brand Ulticare and I've been purchasing them from the ADW American Diabetes Wholesale website because I can also get my meter supplies there and because they are cheaper than what the vets sale them for. I see the U-100 3/10cc with half units marked on the syringes listed on there but they are 31g with a 5/16 inch needle. I can't remember how the gauges go, is 29g larger or smaller than 31g -or- is it the other way around where 31g is smaller than 29g? What do you all suggest? Also ***** the Rx tells me to start Dusty off at 1u every 12 hours ***** I truly want y'alls opinion on this. Is this too much or too little for a 9 lb under weight cat (he's bony) that is switching over from Prozinc to Lantus? I use an iPet meter. I don't have to convert the BG readings from a human meter to animal it does all the work. His readings right now for BG are 500+. This evening his BG registered Hi which means his BG is over 600. I keep thinking he should be in a coma or something but he acts as if nothing is different about him. He still drinks alot and urinates a lot just as always because he has never stayed regulated but nothing different on the outside but I know his insides can't be doing good, at all. This is the absolute highest I have ever seen his levels, hence the insulin change. I'm trying not to stress too much over this change and I may be making it a bigger deal than what it is, but I just can't help it. I want very much to do this right with the retraining of myself to use Lantus correctly. HELP and thank you all. You are all so kind.
 
Formula for starting dose is lean weight in kilograms * 0.25
9 lbs / 2.2 * 0.25 = 1.02 units, round down to 1 unit.
Edited to add - he's underweight & did not say what dose he had been getting. It may need upping based on his prior insulin dose.

If you wanted to be cautious, you could start at 0.5 units, though with glucose over 600 on an iPet, I'd be inclined to start with 1 unit.

The higher the gauge, the thinner the needle 30 gauge needles work well for a lot of us. If you are OK with WalMart, they do have 3/10 cc, U-100, 30 gauge syringes marked with half units. I liked the 5/16 length needles; some like the 1/2" needles.

Remember to breathe ... and maybe put in some hard returns so we can read your post more easily?
 
Press <Enter> or the left-pointing right angled arrow on the right side of the keyboard of a smart phone

Basicallly, more white space to make it easier to see.
 
Terumo's are good. I use Monoject syringes -- 1/2 inch, 31 gauge and I get them through ADW.

You can get Relion syringes in half units at Walmart.

The information that BJ provided regarding dose is for a cat that is newly starting out on insulin. What's Dusty's current Prozinc dose? Starting dose should take your current dose into consideration. Also, is Dusty's weight good (vs. over or underweight)?
 
Some cats tolerate high numbers for long periods before being treated. Not optimal, so checking for ketones is a good idea. There are some tips for urine testing in my signature link Secondary Monitoring Tools.

Ina 2010 post, you noted 2 units of ProZinc twice a day.
 
Dusty is on 10u of Prozinc twice a day so that's 20u total. He seems to have always been a big gulper for about a year and a half he was on 9u twice a day until December 2012 where he had an episode where his numbers went down to 26, 36. Scarred me really bad.
Dusty doesn't show much when his numbers are down or up for that matter other than when low he also urinates a lot and is a little slower getting up. Since Dec. the vets had me start all over with his injections with 2u and increasing about every 10 days.
His best numbers ever were for about a 3 week time period where he was receiving 3u twice a day and read >125 but <300.
Since then his numbers have increased and increased and his insulin has increased and increased. Dusty is taking 10u twice a day and it just doesn't help. His numbers have not registered below 395 in 16 days.
I questioned his vets about the Smogyi phenomenon. I haven't done a curve but no matter when I test Dusty, sometimes 6 to 8 times in a 16 hr time period, his numbers are always extreemly high. The vets seem to think there has to be an underlying condition, but after testing still can't figure out what it could be.
If it is Smogyi like wonder I can't get much direction about how to reverse it. By them all of a sudden agreeing to change to Lantus I can only think that Dusty is insulin resistant.
I talked to my sister who is a pediatric nurse with oncology patients. She said that a lot of the children who are given Zinc have a problem where the Zinc doesn't let certain medications absorbe into their bodies and they have to quit giving the Zinc.
I have to wonder about this and even though Dusty is a feline if after several years of taking Prozinc that this could be what is going on with him.
If it is Smogyi and Dusty is producing other hormones from his liver into his blood stream making him show high BG readings do you all think starting with 1u of Lantus could reverse this? I don't think the vets know what to do with Dusty.
Anyway here we are changing insulin today and hoping for the best outcome.
 
Elaine:

Sorry to plague you with more questions. The numbers in the high 300s, are those pre-shot numbers? Do you have any test data from other times during the cycle?

Given that you've described Dusty as a "big gulper," has anyone suggested that you get your kitty tested for a high dose condition, such as acromegaly or insulin resistance? Usually when we hear about a kitty that is requiring more than 6u of Lantus, we encourage getting the tests run to determine whether or not either of these conditions is contributing to the high insulin need.
 
BJM that was very helpful what you posted regarding Sienne's previous post. I guess that could be why the vets kind of brushed this off and decided to change insulin. Initially they had told me they were going to call in another consult but have not done so.

Just so you know Dusty has not been tested for IAA or Acromegaly. I'll have to ask his vets for the tests. After reading about them I guess it could be one of them. Although Dusty's head has not grown in size what I've read says that if tested he could test positive and not show this outward sign.
The vets have only asked to test for one thing which (I can't remember the name of the test now) they wanted about $120 for this blood test and all it does is check the pancreas functions and from what I've read, the results are inconclusive. So when they asked my decision about giving him this test, I told them NO. I didn't want to pay for something, again, that is just money running out of my pocket if it can read + or - and not really give an answer for treatment. I really wish I could tell you all what that test was now. It's been a few months.

When Dusty was first diagnosed, the vets had me coming in for fructosamine testing which, of course, kept telling them that he was not regulated. I was telling them that he was not regulated and giving them documentation of his BG numbers. I was also giving them curve results about once a month and letting them know that the insulin dose he was being given was not responding to bring down his BG.

Please don't get me wrong, I respect both of his vets, I just don't think they know to much about managing feline diabetes. Not that I do, but just saying.

Sienne, when I get home from work this evening, I WILL find the time to insert his numbers from the past 2 weeks for all of you so you can check them out. I have been freaking out about them and hoping that Dusty doesn't stroke out or something before I can try to get him some help with the Lantus. I'm trying not to think of Lantus as being THE miracle drug for him, but I'm really at my last resort until I can have him tested for IAA or Acromegaly.
 
Oh yeah, Sienne most of those numbers are from pre shot. The ones taken inbetween are just as high or higher. Until this evening.
 
hi Elaine,

looking forward to seeing some numbers when you have a chance to input them. That will help in determining whether starting over at 1u is a good idea or not.

Welcome to LL!
 
Dusty's SS is now up for review. I apologise for the delay. Any feedback on this will be greatly appreciated.
I just don't know if 1u is enough of the Lantus for him when trying to make this switch.
As you will see, so far I have only had HI readings since giving it to him.

Dusty had other plans for me when I arrived home this evening.
My husband said everything was normal when he arrived home. He told me there was a small stool in one of his boxes (he has 2 litter boxes)
and 3 large pee's that he scooped up. When I arrived home an hour and a half after he did, Dusty had peed outside of
his litter boxes and began frequenting them for very small pees as if he had developed cystitis.
He has done this before when coming off of an antibiotic and is constipated.
It usually clears up with in an hour or 2 because he goes and poos but not this time.
The small pees have tapered off thank goodness. I know he was tired of climbing in and out continuously,
but he is still having trouble pooing. He squeezed out one little nugget and that has been it and he's still peeing outside his boxes.
I've been going behind him cleaning up since I arrived home.
Dusty's belly is soft but I can also feel the poo in his intestines. Does anyone have any suggestions for constipation?
I've been getting him to drink extra water this evening by filling a large needless syringe and he's licking it as I slowly squirt it into his mouth.
He seems to think this is fun because he licks it right up. He's also drinking out of his water bowl, so I know he's trying to hyrate.
If he hasn't stopped this by 8:00 am this morning I will be take him to his vets and getting something for constipation
as well as making sure he doesn't have a bladder infection.
He's never tested positive for one but with all the HI BG numbers I've been getting I could see it happening. Well, I'm going to try to get some rest. We'll talk again soon.
 
First off, sorry if you already know this since you aren't new to the process...

Do you know how to check for dehydration by "scruffing" to see how quickly the skin and fur return to place?
Has he ever had ketones that you are aware of?
Can you detect an odor on his breath that smells like nail polish remover?

If you don't see any improvement when you wake, I think a quick trip to the is a great plan.

And first impression is that 1u is not cutting it, but first cycles on Lantus won't necessarily show instant effect.

I'm on my way out the door to work but will check back soon.
 
Carl, I really didn't sleep at all last night, just stayed up checking on Dusty and cleaning up after his urine deviation problem.
I took Dusty to the vet this morning and told his primary care Dr. what was going on. She checked his belly and bladder.
Dusty proceeded to pee on the table and I asked her if she could get a sample.
She quickly ran and got a container and collected a sample in the container before he quit peeing. :smile:
Back in March when Dusty did this same similar deviation action, they couldn't get a sample because he emptied his bladder before I took him.
So this time I made sure he had water before we left for the vet.
I was hoping he wouldn't do that but by her squeezing his bladder he let it all go. lol
She is sending the sample for testing for a UTI. She tested his BG and her meter read 735. Yikes! She decided to take an x-ray of his lungs and intestines.
His lungs because he is breathing hard. She tells me he doesn't feel constipated the x-ray shows he has poop in his intestines but mostly that he's full of gas.
She believes the Hill's WD could be doing this because of the higher fiber and carb levels.
I don't disagree with her but he's been eating this way since March and hasn't been having gas or a urine deviation problem lately.
In fact feeding him (he's a really big eater) 2 cans of Purina DM & 1 can of Hill's WD per day has cut down on his gasiousness.
That's why I had him in to see her in March. He has been extreemly gasseous the past couple of years and ends up with
cow pattie type stools. She wants me to go back to a stricktly Purina DM diet.
Just as soon as they can get the DM back in stock (because I'm almost out of it myself) I will be switching him back to only feeding him the DM.
In the past the Purina DM has made him so gasseous that you can hear his bowel sounds from the other room.
He's never been a flatulator though, but still, it can't feel good. I still believe that his water intake is mainly going to his kidneys to flush out the sugar
and leaving his bowel somewhat parched all due to his high BG levels. His stools have not exactly been soft lately.
She gave him a bowlus (not sure how to spell) of fluid under the skin for dehydration. I was very glad with this.
She also felt it necessary to go ahead and give him an antibiotic for if he actually does have a UTI since they won't be back in the office
until Monday. I'm very glad she thinks ahead but still not very happy with her selection of antibiotic.
She is real big on giving Convenia. I've heard such bad things about this drug. This is his 5th round with it.
He seems to do good on it, but they give it to him never knowing if he has an infection or not. Her only other suggestion is Amoxicillian (sorry spelling).
What they give has potassium in it and it smells like bananas. I also am fairly certain that it has sugar in it because Dusty loves the stuff.
I keep telling her that I don't mind giving the amoxicillian but she likes the convenia. I know I could just tell her NO, but I try to put my trust in her
education. She couldn't offer me anything for his gas. She says she doesn't know of anything that can be given for that. Do any of you?
I asked her bout testing for IAA or Acromegaly. She told me she has no idea what IAA is (I told her it has to do with insulin resisitance) and she says
that she would have to read up on Acromegaly because she has never had to treat a case of it. She is going to call in a consult and talk with them
about all of this and get back with me the first of next week. She did decide that after he registered 735 on her meter and even though only having had 1 cycle of the Lantus
that instead of 1u twice a day that it would probably be ok to give him 2u twice a day based on his levels. He also weighed in at 10.3 lbs today. That could mean
he has actually gained some weight or that his poop retention of (3 cans and holding) is where the weight is coming from. The vet thinks the weight is
great, but I can tell you every time I weigh him he fluctuates from 9 to 9.5 to 10 lbs and it's all according to when he poops.
Right now, Mr. Dusty is sitting in my lap getting his purrrrr on. :-D
Carl, to answer your question about the Keytones. I have never detected his breath smelling like nail polish remover or having a fruity odor.
He has always smelled like cat food to me. It could be that he is throwing Keytones, but I don't have any way to test him and it could be my smeller is off too.
In April of 2012 I had his teeth cleaned for the 2nd time in his 14 years. They were smelling rank. 3 teeth had to be pulled.
His teeth were pearly white when I got him back but now they have stained to a yellow. I've asked her about cleaning but she doesn't want to do that because of his age, she says. My sister says it's probably because of how high is BG is and it would probably be very hard to manage under anesthesia.
Well, I do believe I'm going to try to take a little rest. Thanks for listening.
 
Elaine:

There's a huge elephant in the room. The WD that you've been feeding is well over 20% carb. That's VERY high in carbs. The carb level may be a big contributing factor to why Dusty is on such a high dose of insulin. The DM is 7%. One possible reason that Dusty is experiencing gas is that DM (and WD, for that matter) while expensive foods because they are prescription, are truly poor quality.
  • WD - Brewers Rice, Corn Gluten Meal, Chicken By-Product Meal, Powdered Cellulose, Chicken, Chicken Liver Flavor, Soybean Oil,
  • DM - Liver, poultry by-products, meat by-products, water sufficient for processing, chicken, salmon, oat fiber, salmon meal
The primary ingredients are animal by-products or liver. Organ meat should not be the primary protein for cats -- they need muscle meat. The brewer's rice in the WD may be causing the gas. You could easily be feeding a human grade cat food for less money than what you're spending on poor quality, prescription foods. Have you given any consideration to trying another, lower carb food? I'd also note that fish is a common allergen for cats and it may be that the fish in the DM doesn't agree with Dusty.

If you are going to stop feeding the WD, I would definitely reduce Dusty's dose.

Regarding the Convenia, if Dusty tolerates it, that's fine. The issue is that since it lasts for 2 weeks, if your cat is allergic, there's nothing you can do once the shot has been given. Just so you are aware, they only pharmacological indication for using Convenia is for skin infections. Vet's like using it because it means that people don't have to pill their cat.

IAA = insulin auto-antibodies. It's those antibodies that cause insulin resistance. However, right now, there's no way to know if Dusty has a high dose condition or if his insulin needs are the result of a high carb diet.
 
I had Lucky on what the vet said,Lucky is very high sensitive to a lot of foods he can spike so high in just a half hour Friskies Pete' has been so much better,he still gets his bounces but nothing like he was so grateful for the knowledge I get here.
 
Sienne
Sienne and Gabby said:
Have you given any consideration to trying another, lower carb food?
Click to expand...
In February of this year for the whole month I (not the vet) took Dusty off the Purina DM and switched Dusty to Fancy Feast.
I put him on the gluten free wondering if he could be gluten intollerant due to the way his stools were coming out and all the loud bowel
sounds he has had since he began eating the Purina DM when he was diagnosed with diabetes.
I can't tell you how often I questioned his vets about his bowel probliem and the DM possibly being the culpret. At one time we even discussed the topic of Cushing's Disease.
He has never been tested for this because the vets tell me that the test is expensive and can be inconclusive. For a while he was even put on Pancrea
"which did nothing for him" to see if he might be having problems with his pancreatic enzymes.
When Dusty was eating the gluten free (I ONLY purchased the chicken version) it raised his BG to a high level and gave him super dark stools and they were pretty large around.
My sister thinks he may have something called Megacolon. It's some term they use in pediatrics.
I promise Dusty can poop one as big around as a human. [Hope this isn't too much information]
I used a chart on this website to find the lowest carb variety gluten free Fancy Feast I could find, but after 1 month that's when Dusty had one of the urinating outside the box episodes where when tested they didn't find an infection and the vet put him on the Hill's WD after me complaining about the DM causing him to have rolling gas in his intestines. I gave the Fancy Feast a whole month and he just didn't do very well on it. Do you think I didn't try long enough or that I had him on the wrong kind of Fancy Feast?
When his vet put him strictly on the Hill's WD, I think his vet initially put him on the Hill's WD because it had the "low fat, diabetic, gastrointestinal" statement on the side of the can that she liked, she asked me to watch his weight closely. Dusty had the best stools he has every had on that food but low and behold he lost a pound,
which he really couldn't afford to lose. His vet, not liking the weight loss, had me put him back on the Purina DM. But because Dusty had really good stools
during the Hill's period of time she let me keep purchasing the Hill's WD and until today he has been eating 2 cans of the DM (one in the morning, one in the evening)
and 1 can of the WD daily. This 3rd can I let him tell me when he wants it and I break it up into small feedings.
I know this is a lot of food. Every time I feed Dusty he eats a whole can at one sitting. He is not a nibbler. The vet would like to see me free feed him. :roll:
Her suggestion is to give him his canned food and put down dry that he could nibble on if he gets hungry. I tell her I can't do this, that
if I put down any dry food at all he will gobble it up even if he is full from the canned food. He lets no food sit. He has no competition with another animal either.
Well to move on with my story, the Purina DM I was giving him was the pate' version and at some point they accidently sold me a sliced select version (which I didn't know existed until I opened the can and looked at it and said What The???). I initially though Purina had packed the wrong product in the can until I got to reading the label, lol.
I guess it's fairly new but once Dusty had the sliced select version, he will not eat the pate' version anymore. I can't believe he will actually turn his nose up at it because if you know Dusty he don't usually care what kind of food it is (Human food, cat food, when we had a dog, he even got into the dog food) he will usually eat anything he can get his mouth on.
If we have a spider or moth in the house, he supplements his food intake with injesting those too.
I haven't seen the stats on this new version of Purina DM but it has a gravy so who knows, it may actually be higher in carbs than the pate' version.
Anyway, his vet really wants him on only the Purina DM (either version) and not on the Hill's WD.
I was still giving him 1 can of the Hill's WD only because it truely has seemed to help his bowel sounds to not roar. Oh well, out with the WD.
Is there a particular food you would suggest that could satisfy Dusty and help me get his BG under control?Just so everyone knows, I did go ahead and give Dusty 2u of insulin this evening. After reading about giving Lantus, I don't really think I should go higher than this until several days have past and I can truely tell if he is responding or not. What do you all think? His vet also would like to see me go back to the 2 cans a day and free feed some dry cat food. I am so opposed to the dry. I believe this was one of the main culprits that put him in this situation, the other is Genetics (he has a sister from his same litter that also has Diabetes).
What to do, what to do, what to do. I want so badly to get Dusty on a good diet that will be low carbs, curb his intake of food enough to get him to let me sleep and not jump up asking for food every move I make in my house and get his BG regulated with insulin. Good diet + proper dose of insulin = normal hunger, gain to a healthy weight and a happy cat.
 
The Purina DM pate style is a nice low 3% carbs. The Purina DM Savory Selects (slices) is a higher 10% carb - too high. This is per Dr. Lisa Pierson's food chart.

The Hill's W/d is meant to be a weight loss formula. Lots more fiber to bulk up the stool and not have as much nutrients to provide energy for your cat.

Of your current choices, the Purina DM pate style is the lowest carb and the best choice for a diabetic. Not very good ingredients though. And expensive.

What were you feeding before the diabetes diagnosis?

Which of the Fancy Feasts were you feeding? You said the chicken, But what style? flaked? sliced? pate? other? Any other flavors besides the chicken?
 
There are a ton of possible low carb foods. Lisa Pierson, DVM has put together an extensive list of canned cat foods. If you look down the "C" column for foods with under 10% carb (most of us feed under 7%), you'll get a number of possibilities. There are high quality foods which are more expensive as well as Friskies and Fancy Feast which are less expensive. There's a choice for every pocket book! I feed Gabby and my civvie (nondiabetic) cat Wellness chicken or turkey.

The advantage of WD is the fiber. There are lots of ways to add fiber to a cat's diet -- canned pumpkin (plain pumpkin, not pumpkin pie style which contains sugar) or adding baby food squash -- are sources of fiber. Another possibility to consider is a raw diet. Many cats who have had bowel problems seem to have a very positive response to raw food.

You may want to read this link on megacolon. You didn't mention whether Dusty has problems with constipation which seems to be a primary symptom of megacolon. There are a number of cats here who have issues with constipation and their caregivers use Miralax on a regular basis to help offset the problem.

One thing to be aware of is that any change in diet can effect both BG and a kitty's GI system for several days or longer.
 
I gave the Fancy Feast a whole month and he just didn't do very well on it. Do you think I didn't try long enough or that I had him on the wrong kind of Fancy Feast?
Click to expand...

That's perplexing to me. If it was the Classic pate style, IIRC that is 3% carbs, which would be the same as the DM. So while it still might have some ingredient that disagrees with Dusty's system, it shouldn't be the cause of higher BG numbers.
 
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