Starting dose for Lantus?

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JenM

JenM

Member Since 2013
Hi all,

My Tink was diagnosed last October and had a rough start with FD (DKA, hepatic lipidosis, 11 days hospitalized) but went OTJ quite quickly on ProZinc. Unfortunately, in June his numbers began rising and we're back on insulin. I went with ProZinc because it worked so well the first time, but we're just not seeing great results. We're up to TID dosing now and although his numbers are better (usually) he's still really unpredictable and nowhere near regulated.

I just had a full blood panel done and am awaiting results today, to rule out pancreatitis or any other issue that could have caused his relapse (we already had a full exam and UA done just before going back on insulin). If that shows a REASON (hopefully a treatable one) then we might stay the course, but if not, we'll be trying Lantus to see if that works better for him (and me... this TID thing is NOT enhancing my social life or my sanity).

Anyway, I already heard from Jen&Eddie but would love to hear from any of you who've had better results with Lantus (or those who had poor results, but then I guess you wouldn't be on this board then, huh?).

I've read through the protocol and several posts & SS's here in Lantus Land and the only thing that really concerns me is the "shoot low to stay low". I know it's proven, and I see that it works... but coming from ProZinc, the thought of shooting even a 105 or something scares the bajeezes out of me!!! That will definitely take some getting used to. I LIKE the "shoot the number" method of ProZinc and it's going to take some serious effort to retrain my brain to largely ignore those PS numbers that have run my life for the past months.

My Costco sells individual pens, so at least the cost wont be too horrible to switch.

The biggest obstacle I face is that I am not home from 7am-4pm during the week. I COULD run home in an emergency or very short term, but it's not feasible to do so regularly. I live about 20min from work... so if I do go home, I have about 10-15min to spend there before I'm late for work. That said, my work IS very understanding and I have tons of time off accrued... but I'm also a manager and I really need to be present as much as possible. My daughter also works usually the same schedule, so she can't help. Obviously I'll make the switch on a Friday so I can be home to monitor for the first few days. May even take that following Monday off. Time off is easy to take in advance... it's just that "sorry, can't come in today because my kitty's blood sugar is low" thing that may not be tolerated on a regular basis. :roll:

Anyway... appreciate anything anyone has to offer.
 
Re: Likely switching to Lantus from ProZinc - insight?

The biggest difference between Lantus and ProZinc is that Lantus dosing is NOT based on the pre-shot number. Pre-shot numbers are given consideration -- obviously, we don't suggest that you shoot if your kitty is below 50 at shot time. What you base the dose on is the nadir value. If you look at the majority of SSs, when you are shooting lower numbers, you hope to see a flat cycle. This is the basis of the "shoot low to stay low" approach. This is also the hardest perspective for people who have used an insulin that has a shorter duration than Lantus or Levemir to wrap their head around. Lantus duration is longer and the nadir may (or may not) be later than with ProZinc.

Also, remember that you need U100 syringes for Lantus. You do not want to use your ProZinc (U40) syringes. The concentration of the two types of insulin is different.

If you don't already have one, you may want to get a timed feeder. I'm out of the house between 7:30 - 8:00 and not back until about 4:30. It's rare that I can run home in the middle of the day. While I'm not convinced that Gabby eats if I'm not home (I have another cat and I suspect he is the one eating from the feeder), food is available if her numbers are dropping.
 
Re: Likely switching to Lantus from ProZinc - insight?

Thanks. Yes, I already have u100 syringes. I was microdosing and using the conversion chart before he started needing larger doses of ProZinc.

I also have the PetSafe5 feeder. Tink currently eats 5 times per day (my other cats eat 3 times). Tink is a PIG though and will immediately eat any food provided. He's never been able to be a "free feeder" (and that wouldn't work with the other cats either). Even if I locked him in my room, he'd eat as much food as I put out right away.

He's also always struggled with being um... fluffy. :-D He's spent most of his years as a 14+ pound cat (way more than he should be, he's a fairly small guy, lenth/height-wise). He lost a ton of weight when diagnosed (down to just over 10lb), but slowly got back up to a healthy 12lbs. Then 13lbs. Then we lost remission and he's back down to 12 currently. While he was in remission, he was managing to gain weight on just 6oz of Wellness GF per day. So, leaving food available isn't really an option with him - but the timed feeder certainly is, and I can isolate him if I have to, to make sure nobody else eats his food.
 
Re: Likely switching to Lantus from ProZinc - insight?

Hi Jen!

China went from being a walking skeleton before we started insulin to being a little too uh..."fluffy" too! :lol:

What's working for her is extra exercise using Da Bird. She goes absolutely crazy over it (so do my other cats) and I'd tried a bunch of other toys to get her off her rear end and this is the only one that's worked!

She'll chase it as long as my arms will last! Only once has she gotten so tired that she quit, and at that time, she was still a lot "fluffier" than she is right now.

Exercise also helps the cells be more receptive to insulin (which is a good thing) since it actually lowers BGs...but go slow when you first start so you can see how it's affecting Tink's numbers
 
Re: Likely switching to Lantus from ProZinc - insight?

Hmm... might have to look into that. We have a few similar things that Tarzan loves, but Tink thinks he's above "toys". He WAS always very amused by "Red Dot" though (the laser pointer)... I totally forgot I was going to get one of those! Not sure what happened to the two we used to have.

When he was OTJ, he had resumed playing with the other cats... or I should say "racing" with the other cats. They rarely touched each other, but would tear through the house at roughly the speed of light. :lol: Usually three or four laps, then naps. He's been wrestling a little bit lately, but not as much as he had been. Of course this extra hot weather has everyone a bit more lethargic and content to nap in open windowsills.

I'm looking forward to seeing how Lantus works on him.

OH... and update to my initial post... bloodwork shows pancreatitis. I'm assuming it's a mild case since he's showing no symptoms. Vet is prescribing pain meds for a few days and switching us to Lantus. Will start the Lantus Friday, hoping to pick up the pain meds at lunch tomorrow. Already working longer than normal today and need to go straight home to shoot.
 
So, I'll be starting Lantus tomorrow afternoon. He's been getting usually 5.5 or 6u of ProZinc daily (TID dosing) and still only seeing nadirs in the mid 100s, as low as 130ish usually. Though he did see an 80 or two a few days back.

The vet is going to "calculate" a starting dosage (based on weight I assume, which is 12lb) - and while I mostly trust this vet, I trust ya'll more. :-D I will be home most of the time for his first 7 cycles, and even when I'm not home - I'll be nearby enough to stop in if I feel I need a test at a given time.

Appreciate any suggestions. I know Lantus works way differently than ProZinc - but no idea how the ProZinc dose and Lantus dose would compare to each other. He does have a tendency to bounce easily (he doesn't seem to like GOOD numbers currently), so I'm leaning on the conservative side - hoping to gradually get his nadirs down where they belong - I think if we go slow enough we might avoid bouncing.
 
when a cat is first diagnosed, and begins with lantus, the protocol suggests a weight based formula of 0.25u per kg. If Tink weighs 12 lbs, that equals 5.5kg. That would be a starting dose of 1.375u per shot, or a daily total of 2.7u.

When a cat has been on another insulin, we consider that dose when suggesting a starting dose. You're giving him 4.5-6ish units per day of ProZinc. Starting too low can mean an unnecessary length of time in high numbers. Starting too high can mean you're dealing with low numbers fairly quickly.

Let me run it by a couple of other experienced users and see what we can suggest for you before tomorrow's shot. My first thought is to start somewhere around 2u per shot and adjust as you get test results, depending on the numbers. In the meantime, consider what direction you might want to go. One of us will get back to you with a suggested dose or range. I'll be curious to see what your vet suggests as well.

And welcome to LL! we're glad you and Tink are here - looks like you've had an intensive time with the TID! Hopefully he'll respond well to the Lantus and it'll be a little easier for you.

Does Tink have any other issues going on - hyperthyroid, pancreatitis, bad teeth? has he ever had a dental?
 
Tink was just confirmed yesterday to have pancreatitis. The vet didn't elaborate too much on whether it was acute or chronic - but since he's asymptomatic, I'm assuming we're dealing with chronic. Will pancreatitis still show in bloodwork if it's not during a flare-up? I'm curious why he's symptom-free (NOT complaining, just curious!!), since it sounds like this can be a pretty big deal.

Only other thing the blood panel showed was a somewhat LOW thyroid level (which the vet pretty much dismissed as a result of the pancreatitis/diabetes) and some number indicating possible blood loss in stool - asked if he'd had bloody stool or diarrhea, but he has not. Not sure what that's about... but the vet didn't seem concerned.

Other than that, he's in perfect health. We had a UA done right before starting back on insulin - hoping maybe a bladder infection or something was causing his higher numbers. UA was clean, in fact at the time he had no glucose in his urine, which the vet said was unusual for a diabetic. Granted, at that time, his BG had only gone over 200 once or twice, but he had been spending almost all of his time betwen 110 & 150 or so for a couple weeks. The vet said "as long as he's not going over 200 I'm not really concerned"... then the next day we started seeing mostly yellow. He jinxed us! :evil: :lol:

The vet also said his teeth were in perfect shape - he was pretty shocked about it too since Tink has never had a dental and is 11yrs old. I guess a life on kibble did at least one good thing for him. :roll:
 
The vet wrote the rx for 1u BID. Of course he knows I'm not necessarily going to pay attention to that and he trusts me to make dosing decisions, at least with the ProZinc.

I'm thinking more might be better. While I'm ok with being conservative to avoid bounces... I dont want him hanging out in the pink/red - which I'm afraid he'd do on 1u. Knowing we want to hold a dose before increasing... I'd rather start higher and be able to decrease if we run into trouble. I dont work weekends and I took Monday off, but I dont want to waste all my monitoring days shooting a low dose and then have to increase when I CANT monitor. So, whatever dose you guys think is safe is what I'll go with. 1u BID is less than would be recommended following JUST the protocol, without the current insulin being put into consideration.
 
How was the pancreatitis diagnosed?

There is a good post that marge wrote on pancreatitis.

Look on the New to the Group yellow starred sticky at the top of this forum page. On that sticky, scroll to the bottom and there are several single topic posts. If you can't find it, remind me tomorrow and I can get the link for you when I am at my regular computer.
 
The pancreatitis was diagnosed with a full blood panel (no exam at this time, just a blood draw by a tech), which I did just as a "because I wanna know" thing. He'd been in remission for awhile and I wanted to make sure something hadn't caused the loss of it. Wish I would have done it when we first lost remission, but I tend to procrastinate (especially when things are gonna cost a couple hundred bucks).

I picked up the pain meds yesterday but haven't given him any yet. Wanted to be there to watch him in case it did anything to his already unpredictable BGs - or any other side effect, since he's never taken pain meds before. So I'll likely start that tonight as well - the vet gave me 4 days worth to be administered on the gums, BID. I'm almost wondering if I shouldn't save it till I NEED it though. He doesn't seem to be in any pain, is eating fine, etc. I know pain meds can sometimes cause lack of appetite and I DONT want to do that if he's not IN pain. The ONLY thing that would make me think he's experiencing ANY pain is that he hasn't really been running or trotting much, just walking. But he lays all sprawled out still, is still usually talkative, excellent appetite (and then some!), etc. He tends to get clingy when he isn't feeling well and he hasn't been overly affectionate (he still asks for his "loves" but no more or less than usual). Any suggestions there?

Also... re: starting dosage... He's been on an odd trend the last couple days (see SS). I believe we had a bounce yesterday (cycle 2 preshot) but it looks to have cleared in one cycle. This morning was a no-shoot as he was only at 99 (and we're still on ProZinc). I'd like to make the switch tonight still... but I'm guessing he's going to be rather high by 6pm when I plan to shoot, since he didn't get a shot this morning and would normally get his next one at 4pm. Not sure how this might affect his starting dose for Lantus... Mind you, I typically call it a night around 10pm... so I'll only really be actively monitoring his first dose for the first 4 hours - but I will probably set my alarm and check throughout the night as well. So much for extra sleep this weekend. :lol:

Lastly, when figuring out my Lantus schedule - I can do either 6am/6pm or 7am/7pm. During the week, I get up at 6 and leave at 7. Would it be better to be able to get up at 6 and test, shoot, feed and then test at +1 before I leave, OR better to get up, test (and maybe feed?), and then feed/shoot at 7am, but then have to leave? Granted, this will all be AFTER the first 3 full days in which I can monitor him. Just want to set myself up on the right schedule from the start.
 
I'd probably start at 6am with the test/feed/shoot schedule. it's very easy to move it later if you need to. getting a +1 might/might not be helpful. for many cats it will show a spike in BGs from the carbs they've just eaten. the +2 is probably the most helpful test in predicting what might happen for the rest of that day's cycle.

pain can drive up blood sugar, so i think i'd be inclined to go ahead and give the pain meds now, even if you don't see evidence of pain. pancreatitis can be painful, and cats often won't show it, but they are feeling it. i suspect that's why you're not seeing symptoms. i haven't seen any reduction in appy when i had to give punkin pain meds, but he had acro and that includes a big appetite. so he might not be the best to compare to. punkin was on bupe twice a day for months to help with acro/arthritis pain.

I'd go ahead with them.
 
Ok, sound like a plan. I'll start the bupe when I get home and the Lantus at 6pm.

Hopefully I'll have some dosage suggestions by then - otherwise I'll probably just go with the vet's 1u (or maybe 1.5u, since he's been getting 1.5-2u of ProZinc, TID) and see how it goes. Given that I have 3 days off, I'd like to be semi-aggressive... but then given that his last shot seems to be having a better duration that we've seen... I'm afraid to be TOO aggressive. nailbite_smile

I wonder if Feline Diabetes has ever killed the caregiver??? @-)
 
i mentioned above, i'd lean towards 2u, especially since you're not afraid of having lower numbers and you've got the next few days off. Lantus does take a few days to build up a depot in the body - it sort of slow releases. but even in the first few days on Lantus we may be able to tell if the dose is about right.

from the Tight Regulation Protocol yellow starred sticky:

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.

"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).
Click to expand...
 
i'm wondering about the low thyroid. Many of us put tabs on the spreadsheet for labs, so they can be updated when you get new bloodwork and you can compare readily to previous tests.

that one in particular, though . . . low thyroid in a cat that hasn't been radiated (punkin and neko both had radiation for their acromegaly) is unusual. what was the number on that, and what was your lab's reference ranges for normal? low thyroid can really throw the whole body off - as can high thyroid. hyper (high) thyroid is pretty common.

if you don't have copies of the labs, you might want to get them. at least ask those numbers. i haven't heard of low thyroid because caused by pancreatitis or diabetes, but think it's worth following up on to see if it's significantly low or just on the lower end of the normal range.

if you want to do the labs on the ss, you can copy punkin's vertical columns for the names and maybe the reference ranges, if they are the same, and that will save you a little effort.

when you switch tonight to Lantus, would you make a significant line across his spreadsheet and note the switch to Lantus so it's obvious. I wouldn't make a new ss - it's helpful to us to see the previous numbers, but just make it obvious that it's a new insulin type.
 
I did get the lab results, but I think they only gave me one of the two. I dont see anything about the pancreatitis, nor thyroid - though I guess they may not be listed as such. It SOUNDED like the thyroid was low-normal, but he wasn't terribly specific. The only thing on the lab I have that is completely outside of normal range is glucose, which was obviously high.

I'll work on adding the lab I have to his SS and will request the other one.

There were some low normal and high normals:

CHOL = 206 mg/dL (ref range 65-225)
GGT < <0 u/l (ref range 0-1)
Potassium = 3.8mmol/L (ref range 3.5-5.8)

Everything else is well within normal range. I'm curious about the low potassium. Is that something I should be supplementing? I believe Wellness has some added - but apparently not enough?
 
Hi there :cool:

I have no personal experience with switching from a fast acting to slow acting insulin however a few things popped out at me in reading this post, so I'll throw in my $0.02.
JenM said:
I'll start the bupe when I get home and the Lantus at 6pm.
Click to expand...
I wonder how much his pain is contributing to his high BGs. Since pain relief may bring down BGs, if you can, check his BG before you give him bupe and after it kicks in (I'm not sure how long it takes, maybe 30mins?) The result should be considered in deciding Lantus dose, especially if you will be giving bupe regularly.

JenM said:
I wonder if Feline Diabetes has ever killed the caregiver??? @-)
Click to expand...
There are not any CG deaths on record. Theh bigger risk is that It can quickly turn a you into a zombie :lol:
 
I managed to copy/paste the couple weeks of TID dosing data into the regular spreadsheet. It's not pretty, but it's there and mostly readable (one of the late columns is wonky because it's the comments box in the BID sheet, but whatever).

Please let me know if you think I should alter anything - but I think this works. SO glad to be back to BID tonight!!!

Still working on the lab part.

ETA: Lab up now. Will update if the vet has more info that I didn't get. Also have UA results at home and will update with that soon.
 
FWIW, apparently the pancreatitis dx was based on the SNAP fPL, not the Spec. Annoyed, since it cost $200 for this blood panel (which did not include an exam, just blood draw/lab)... I dont see a lot of answers for this price. :-x
 
So sorry they ran the SNAPP. The fPL shouldn't cost any more and has to be sent out. However no need to run it now. Treat the symptoms with nausea meds, pain med, and perhaps sub-q fluids. I didn't need the fluids for Max. Yes the potassium would need to be supplemented but this is just one test and when not feeling well. Once the p'itis has cleared up and blood tests run you will see if it is necessary or not. Lots of vets treat if under 4.2 but mine feels the 4.0 Max runs is just fine. I've thought about supplementing anyhow but then there would need to be rechecks but too how is dangerous as well. Hang in there. Sorry but no advice here on dosing. I'm waiting to hear what to do myself. Hugs.
 
Sandy and Black Kitty said:
Hi there :cool:

I have no personal experience with switching from a fast acting to slow acting insulin however a few things popped out at me in reading this post, so I'll throw in my $0.02.
JenM said:
I'll start the bupe when I get home and the Lantus at 6pm.
Click to expand...
I wonder how much his pain is contributing to his high BGs. Since pain relief may bring down BGs, if you can, check his BG before you give him bupe and after it kicks in (I'm not sure how long it takes, maybe 30mins?) The result should be considered in deciding Lantus dose, especially if you will be giving bupe regularly.

JenM said:
I wonder if Feline Diabetes has ever killed the caregiver??? @-)
Click to expand...
There are not any CG deaths on record. Theh bigger risk is that It can quickly turn a you into a zombie :lol:
Click to expand...

I'll give the bupe when I get home at 3 or 4 and test before/after. Not giving Lantus till 6pm... so should see an effect by then, if any.

And funny you should mention zombies... my 18yr old has had zombie nightmares 2 nights in a row (no movies involved)... so maybe she's having some sort of intuition... :lol:
 
it might not be that instant. it might - and it would be good info to test before/after the bupe. what i found with punkin is that it could begin to bring his numbers down and that it might continue for several hours.

after looking at his first spreadsheet - i'd been looking at the past few weeks with the TID dosing - it does look like the pain might be driving up his numbers. it might be better to start at the 1unit as sandy is suggesting. if you're addressing the cause of the high numbers, ie, the pancreatitis, with bupe, fluids and anti-nausea, his BGs might come down in response.

you can always go up. because of the way Lantus builds in the body and releases, it will take a few days to see the full effect of what the dose will do.

if you haven't read Marje's post on http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=79693 pancreatitis yet, it is worth your time.
 
I've read all the pancreatitis links. I'm not finding anything particularly helpful though since he's not showing ANY symptoms. There's no need for anti-nausea meds or appetite stimulants - his appetitie is insatiable. He eats anything he can get his hands on (which has been a bit of a problem). We have to be diligent in keeping human food out of reach - he found leftover couscous in a pan on the stove at one point a few weeks ago... he was caught gnawing the stem off a fresh picked zucchini that I'd set on the stove for a few minutes... nope, appetite is NOT an issue. :lol:

Granted, it's great to know what the symptoms ARE, in case it becomes more severe. I can only assume at this point that it's a very mild case. Would the SNAP fPL still show "abnormal" if he has chronic pancreatitis which is not currently flaring up? Or does that only show the p-itis if it's active at that time??

But yes, if the pancreatitis has been lingering for awhile, it would possibly explain the loss of remission. His numbers had been pretty stable while OTJ. They started creeping up slowly (maybe as pain started and increased?) until he got to the point of needing insulin. Since then, it's been a roller coaster with no clear patterns and it's been really hard to find the right dosage. Which makes sense if he's experiencing varying levels of pain.

Still, I wonder if a few days of bupe is going to do anything. I mean, obviously while he's taking it... but what about after that? Since I can't tell if he's even IN pain to begin with, I'm certainly not going to be able to tell whether he's STILL in pain or not, once we use all the bupe.
 
Sorry, one more question. So... for the buprenex... the vet gave me 8 doses of .2ml to be administered every 12 hours on the gums. However, .2ml looks like a lot of fluid to try to get on just the gums. I can't imagine he's gonna be too keen on me putting ANYTHING on his gums. I know .2ml isn't much... but looking at the syringes, it still seems like a lot to try to get onto such a small area. Does that dosage sound right?

Any tips on how to do this? I've never applied anything to the gums before.
 
With Max at the beginning his appetite decreased until he stopped eating. His fPL returned to normal when he recovered. I would think the same would be true of the SNAPP test. If the test was not done on a fast it is basically useless since all you get is positive or negative and it can be off by 10-15% without fasting so if it was in the gray zone he might not even have it.
 
all you have to do with the bupe is slip the oral syringe under his upper lip and squirt it on his gums. i usually did half on one side and half on the other, more to give punkin a break and to increase the chance it absorbed ok than for any other reason. he got the same 0.2ml dose as Tink.

my kittens (1.5yrs old) are insatiable like that. i have to put every bit of food away or they get into it.
 
Ok, that's what I did with the bupe. Just seemed like he swallowed a lot of it... but maybe that was mostly saliva?

Yesterday the bupe seemed to drop him by about 50pts, but he was very high because of our skipped AM shot. Today it didn't seem to drop it at all - in fact 2hrs later it was 50pts higher. :YMSIGH: I have the SS updated. Today's AMPS was better, but I'm not seeing much of a dip. I started him on 1.5u, since he was SO high yesterday.

Overall though, it seems the Lantus is working much better than the ProZinc... it seemed to last the whole cycle and isn't causing those deep dips like the ProZinc did. He's much flatter, but so far at least appears to be on a slightly downward trend (other than I dont know why today's +5 is higher than +3... but whatever. :roll:

That's interesting about the fPL... they didn't say anything about fasting. He'd last eaten at 11am and had the blood draw at 4:30pm. He had just had his insulin at 4pm. I asked them and they said to just give it on schedule. I was talking to a tech, but she asked a vet about it when I asked.
 
Hi there :cool:

Quick housekeeping item, from the 'New To The Group' sticky:
*** Daily Threads & Posting Instructions ***
Please start one new thread each day. This will keep all your questions, comments, and replies in one place.
Start your daily thread with the date, kitty's name, and AMPS
Your thread will be bumped to the top of the list when you or anyone else posts on your thread.
Click to expand...

JenM said:
Today it didn't seem to drop it at all - in fact 2hrs later it was 50pts higher.
Click to expand...
It is going to take a few cycles for the depot to form and fill. A dose needs a little time to settle in and show what it can or can not do.
Hang in there :cool:
 
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