Starting dose (glargine) for newly diagnosed cat?

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Missy & Jazz

Member Since 2013
Hi again everyone,

Thank you for your help before - will reply other posts later, limited time now, sorry!

I have read all the Lantus/glargine threads I could find here (and articles for dosing protocol by Rand & Roomp), but am getting a bit confused with correct starting dose.

My cat is 17 yo, newly diagnosed, due to start the insulin tonight. The vet has prescribed an initial dose of 1 IU of glargine twice a day (so 2 IU daily).
Jazz (cat) weighs 2.89 kg (= 6 lb). (SMALL! lol)

At the vet last Tues (9th April), her BG level was tested by vet at 31.3 mmol/L (I think this is 563.4 mg/dL).
I have a glucometer (Freestyle Optium) and have started testing yesterday.
7 pm yesterday she tested BG 19.3 mmol/L (347.4 mg/dl).
7 am today (it's now 4 pm) she tested BG 15.4 mmol/L (277.2 mg/dl). So she seems to be going down a bit, just with the switch from dry to wet food.
Note all those readings are WITHOUT insulin at all. Also, I have not adjusted the readings I took - they are just as read off the (human) machine. Not sure if I need to adjust with that meter to account for any differences b/t human/feline blood? I have a feeling the meter reads BG from whole blood, but converts results to blood plasma BG reading (apparently closer to lab results) - have to contact company to check that. Would that alter results? (yes I am really new at this!)

Vet has prescribed home BG checks before each meal (after which she will have insulin) and middle of the day (6-8 hrs after morning insulin shot). I intend to do that more often - esp. first few days (ideally every 1-2 hrs over next 1-2 days).
Vet has also noted that we shouldn't change initial starting dose in the first week, but may adjust appropriately later as required. That sounds ok to me, except I am worried that the starting dose is possibly too high?

I have tried to calculate correct recommended starting dose -
R&R suggest starting with 0.25 IU/kg of ideal weight BID which would = 0.25/about 3.5 - 4 kg = so 0.07 to 0.06 IU BID. Am I doing this wrong??? I think I must be, that sounds like an incredibly small dosage (not to mention no idea how to measure that out - our Aust syringes do not even half 0.5 IU markings!gah!).
I thought / is divided by, but is it x instead?? Sorry for daft questions.

If the calc is 0.25 IU x kg of ideal weight BID, that would equal 0.875 - 1 IU BID which makes more sense in terms of measuring dosage and sounds more in line with vet's dosage. However, she is obviously somewhat smaller than ideal weight - will that be an issue? Vet is well aware of her size, and I really don't think she would accidentally dose her too high, but obviously I want to make completely sure!

I have also read the start low, go slow protocol (http://felinediabetes.com/start-low-go-slow.htm) which suggests 1 - 2 IU BID - this also seems in line with vet's dosage, especially given Jazz's relatively high recent BGs.

I am going to call my vet shortly to ask something else about BG curves (I am making them to send her), not sure if I should query starting dose?
Does 1 IU BID sound reasonable to others as a starting dose, with Jazz's size?

Sorry if all that is rambly!
Thanks so much! Your opinions muchly appreciated :)
 
Thank you so much Rhiannon. That's kind of what I thought, given she's pretty little.

I have literally just tested her BG again before phoning vet and the reading is 15.9 mmol/L (286.2 mg/dl), if that is useful extra info.
Thanks guys and gals!
 
I sent a message to someone tonite who's advising so I hope she'll come along and tell you if that's a good starting dose....for such a tiny kitty.

I hope you will get a bg reading each time right before the shot. We tend to test then feed and shoot right at the same time... some cats are easier to shoot when they are distracted
with food.
And then a test or two or three during the cycle. ( a cycle is 12 hours... from one shot to the next shot so there are 2 cycles a day)

The other thing you will want to be testing is for ketones. You will need some ketostix to dip in the urine.... especially with the higher numbers...
 
Rhiannon asked me to pop in to help you.

I think 1u is a bit too high. The starting dose is usually .25u/kg of ideal weight. That comes out to roughly .75u. You could start at either .5u or .75u.
 
Thank you all so much.

Yes will def. be testing before each shot. No way I am giving her insulin without knowing exactly what her BG is doing!!
I will also test in between, as mentioned.
About to call vet now, so will ask her about a slightly lower start dose - I think partly she wanted to go with the 1 IU as our syringes here only measure full units and she thought would be too hard for me to measure 0.5, etc. consistently when I have no experience. However, i also don't think she would have suggested that only on that basis.I am definitely prepared to try get a smaller dosage! Would rather go too little than too much.

Thanks again. Sooo appreciated!
 
Hello and welcome. What country are you in? I noticed the mmol/l BG and that's what we use in Canada too. Some people here have started using digital calipers to measure doses consistently. My hubby bought me a pair for under $20 at his local hardware store, different brand but same idea. We have .5 unit syringes, but it makes the .25 doses much easier to be consistent. The other thing you can do for consistency is fill a used syringe with some coloured liquid like apple juice and use it as a template for measuring new doses.
 
Hi Wendy,

Thank you! :) I am in Australia, so we use kg and mmol/L here, rather than the US measurements. Didn't know Canada was the same as us!
Thanks for the tips - I will look into digital calipers, and the apple juice is a great idea! I will try that.

Update:
Have talked to the vet and she said to stick to 1 IU for first dose, monitor closely, and drop dosage (ph consultation with her before injecting) if needed, depending how she reacts. I explained my concerns about her size, recent drop in BG with diet switch, etc. and vet explained her calculations for start dose and said that it was on the lower side of the recommended start dose for her size.

Jazz did weigh 4.38 kg at her heaviest/fittest in Dec 2011 (I had to look for those numbers and just found them, so sorry for providing the wrong, slightly lower weights in my previous post), so even using 4 kg as an ideal weight, recommended start dosage is 1 IU BID.

So I am going to go on with measuring start dose on the 'lower side' of 1 IU atm, monitor really closely, and definitely re-appraise dosage for subsequent injections.

Thank you again for your help everyone - it has made me a lot clearer in my mind.
 
Keep in mind many vets don't tell anyone to dose in o.75u or .05 units....

I think they don't believe we can do it...

I think I remember someone else from Australia could not find 1/2 unit marked syringes so it is harder to estimate where the 0.75 is.
If you shoot on the underside of the 1 unit marking, you will be closer to it.
 
Good point - thanks Rhiannon. I will keep that in mind.

Yeah, apparently we can't get the 1/2 unit marked syringes here, but I do want to look into that further - will keep you all posted. Maybe I can get them imported from the USA or somewhere... not sure.

I have been shooting on the underside of the 1 unit marking, so as to err on the side of caution.
Did BGs every hour last night, and at least every 2 hrs since this morning's dose, and it's a bit up and down but lowest (since we've started insulin) is 15.7 mmol/L.

Still keeping a close on the BG and the cat of course! as I know it can change quite quickly.

Also, the 3 mg methylcobalamin cat capsules I ordered arrived today (yay!) so I will try start her on those today for her hind leg neuropathy, poor baby.
OT (sorry), but what's considered better - to dose as one capsule (ie. pill her and get her to swallow it) or break open capsule and sprinkle on food?

The chemist who made them said try get her to swallow it first, otherwise sprinkle on food if she won't take it.

Thanks again for all the help - I am overwhelmed and so grateful for the support on this board!
 
capsules are more likely to stick in the throat so if you go that route.... take a syringe with no needle ( may have to get one from your vet) and try to push some water down the throat
too.

I have capsules and I just sprinkle it on the food.... Mine turns the food a pinkish color.
It doesn't seem to have a taste... ( i guess I should check and taste it myself) :-D

the wonderful thing about the Methyl B12 is that is water soluble so you can't give too much, they just pee out what the body doesn't need.


Here are pictures of lesser doses ( of course they are 1/2 unit syringes) but it might help....
http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=18139
 
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