Soon to be Lantus kitty - intro/questions

[Kim&Buddy]

Hi everyone,

I'd like to introduce myself (warning - long winded!) and my little man Buddy and apologize in advance for what I'm sure will be an avalanche of questions. I've read the stickies which have great information and have follow-up questions. Even though tight regulation seems to be the more challenging option, I think it may be the way I'd like to go. Just not sure if it's an appropriate approach for newbies.

HISTORY
My 12 year old Buddy will begin a much anticipated switch from oral glipizide to Lantus. He was diagnosed at the end of February by a doctor that, at the time, I thought knew what she was doing. Buddy's symptoms started immediately after a steroid injection (literally the next day) that was a last course treatment option as he tried to recover from a severe URI and allergies. Poor little guy.

I trusted my old vet implicitly. It was only after I joined the FDMB that I realized just how much I - and apparently she - didn't know. She never once suggested home testing. I learned about it from you all and taught myself how to do it. Also without any guidance from her, I switched to a low carb, all wet food diet. Again thanks to you all. Newly informed, I approached my old vet. She was visibly disturbed that I was home testing, upset that I was using a Relion Confirm instead of AlphaTrak, and challenged my request to put him on Lantus. Her argument? Her concern was that the diabetes is transient and that glipize will minimize the chance of a hypoglycemic reaction seeing as his numbers are decreasing.

I recently started seeing a new vet here in Orlando recommended by a local FDMB member. This is a feline-only practice and while I didn't get the warm and fuzzies I get with my old vet hospital, I did see someone who seems to be a competent, caring doctor. She starts Buddy on Lantus this Thursday afternoon.

My new vet has said to keep his weight at a good 14 pounds so he needs to eat 3/4 can twice a day. At this point I feed him at 6:00 am (3/4 can and he grazes throughout the day while I'm at work); 6:00 pm (1/4 can) and 9:00 pm (1/2 can).

Below is something I posted in the general health forum and it was suggested that I ask for advice in this forum seeing as you've got the specialized experience. Thank you in advance for any help you can give.

Kim

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GENERAL HEALTH FORUM POST (slightly edited)
Buddy will receive his first dose at the vet Thursday and I'm on from there. My plan is to work from home Friday and not budge Saturday or Sunday. My question is this: how often should I check his BG Thursday night and during the day on Friday, Saturday and Sunday?

If I understand what I'm reading throughout the forum, Buddy's dose should be based on nadir and not pre-shot levels. I don't have a real baseline because all my tests have been on the glipizide (see his spreadsheet). Well, on 4/15 I didn't give any glip to him in the morning because his pre-dose number was low, but I learned when I switched out strips that it wasn't as low as I thought. The +9 read on 4/15 (3:00 pm) marks the use of the new strips. I do believe them to be accurate after multiple tests on me. Calling for a control solution today.

Besides the concern of learning the mechanics of the injection itself, I'm concerned about dosage and his low levels at the outset. He's holding steady around 150 on a reduced dose of the glipizide. I can do a BG test Thursday afternoon before I leave and see where he's at. That read will be interesting seeing as he will not have been given any medicine that morning. Should I ask my vet to start him out at .5u seeing as his numbers aren't high to begin with? What if the PMPS I take before the vet is 150'ish? From one of the sticky entries, it looks like 150 is the beginning of a gray area. What if it is significantly lower than 150?

The last thing I want is to induce hypo on his first night. I'm even more concerned because his pre-dose this morning was 124 - which could mark a similar declining trend I saw last week.

I'd greatly appreciate any advice you can give.

 

[Sienne and Gabby (GA)]

Welcome to Lantus Land!!

You have done your homework!! Congrats on getting your spreadsheet up and running. You may also want to put together a Profile on Buddy so we don't plague you with the same questions.

Your first vet may have had a point in that steroid induced diabetes may be transient. However, I'm not a bit fan of glipizide.

The initial dose of Lantus can be based on a cat's ideal weight (initial dose = ideal weight in kilograms x 0.25). Based on his 14 lbs, this would work out to 1.5u. Many people here will start out at a lower dose (e.g., 1.0u). Given that Buddy is having a good response to glipizide, you may want to start Buddy at the same dose. Most of us, myself included, are not terribly familiar with glipizide so I don't know how equivalent the dosing may be. I'd discuss starting dose with your vet but from the standpoint of safety, I'd think of starting Buddy at his current dose of 0.25u or lower. Given the concerns you noted, you can start at a lower dose. If you look at the New to the Group sticky, there are photos of microdoses.

You'll note in the Tight Regulation Protocol sticky, we suggest getting frequent tests when starting out. Doing a mini-curve (i.e., testing every 3 hours) should be fine unless numbers are dictating more frequent testing.

Please keep asking questions. People here are very generous with their time and information!

 

[Kim&Buddy]

Thanks for your thoughts about the .25 start. I'm terrified of starting out too high.

I'm going to do his profile this weekend once he's started and I have a dose to work with. I definitely can see where it's a benefit to have it!

Would you suggest I do any testing overnight Thursday (perhaps midnight) seeing as it will be his first dose ever? He'll be getting his shot around 6:00 pm. I'm thinking of doing curves Friday, Saturday and Sunday during the day if his poor ears can handle it.

 

[julie & punkin (ga)]

for most of us, it's easier to start too low and work up instead of starting higher and seeing low numbers that can be scary when you're new.

i agree with sienne, i think .25u is a nice starting dose.

here's the guidelines from the Tight Regulation Protocol for starting out:

REQUISITES WHEN FOLLOWING A TIGHT REGULATION PROTOCOL WITH LANTUS OR LEVEMIR:

Kitty should be monitored closely the first three days when starting Lantus or Levemir.
Blood glucose levels should at least be checked at pre-shot, +3, +6, and +9.
More monitoring may be needed.
It will be necessary to test kitty's blood glucose levels multiple times per day.
Learn the signs of and how to treat HYPOGLYCEMIA and prepare a HYPO TOOLBOX.
Test regularly for ketones and know about DIABETIC KETOACIDOSIS (DKA).
Use U-100 3/10cc syringes with half units marked on the barrel for fine dosing.
Feed a high quality low carb canned or raw food diet.
Feed small meals throughout the day. Some kitties adapt well to free feeding.


Many Lantus and Levemir users in this forum have been successful following a somewhat modified version of this Tight Regulation Protocol for the last few years. These "general" guidelines are based on anecdotal evidence and personal experiences of laypersons frequenting the forum.

"General" Guidelines:
Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

if you post here, people will watch for you and give you feedback to let you know if you need to test more or less often.

we encourage everyone to just keep posting everything in one thread per day - because there are about 50 people who post most days, that keeps everyone on the front page and no one gets missed. we also encourage you to keep updating your subject line as you add tests - that lets eyes be on your progress really at all times. we're peepers, apparently! :lol:

you're making a great choice - this protocol is proven for good results in getting cats off of insulin and with the situation you're describing, a little bit of time invested now will likely pay off for you!

feel free to ask away, and if you're not getting answers, also feel free to add your question to the subject line, or add a ? icon so people know you need a hand.

great to have you here! welcome!

edited to clarify information