Starting Glargine Dose of 1U, Sound Ok?

Status
Not open for further replies.
Stache

Stache

Member Since 2023
My vet wrote me up for one unit of glargine every twelve hours. Is this conservative enough for a beginning dose? Hoping for a consensus, here.

There is a caveat though. See below. Has anyone heard of this before? It says not to refrigerate it, once opened. This goes against my intuition. Then again, these are the directions...

20230702_151321.jpg


20230702_151330.jpg
 

Attachments

  • 20230702_151321.jpg
    20230702_151321.jpg
    75.1 KB · Views: 385
  • 20230702_151330.jpg
    20230702_151330.jpg
    57.5 KB · Views: 523
yeah, many folks keep it on the fridge door to extend its life. That's what we did.

And yes my vet also started Hendrick on one unit of glargine/Lantus that is a pretty common starting dose. However, you are not starting, you are switching from Vetsulin to Glargine.

You previously posted that Stache was up to 4.5-5 IU of Vetsulin BID, as he was Dx on 5/9/23 and put on Vetsulin at that time. So, I am wondering if you should start at a higher dose of glargine. Let's see what some of the gurus have to say :)

@Marje and Gracie
@Sienne and Gabby (GA)
@Suzanne & Darcy
@Bandit's Mom
 
Stache said:
My vet wrote me up for one unit of glargine every twelve hours. Is this conservative enough for a beginning dose? Hoping for a consensus, here.

There is a caveat though. See below. Has anyone heard of this before? It says not to refrigerate it, once opened. This goes against my intuition. Then again, these are the directions...

View attachment 67137

View attachment 67138
Click to expand...

it is designed for humans to last 28 days and be carried in a purse or pocket. We keep it in the refrigerator so it will last much longer. You should be able to use it to the last drop if you store it correctly.

Hendrick Cuddleclaw said:
yeah, many folks keep it on the fridge door to extend its life. That's what we did.

And yes my vet also started Hendrick on one unit of glargine/Lantus that is a pretty common starting dose. However, you are not starting, you are switching from Vetsulin to Glargine.

You previously posted that Stache was up to 4.5-5 IU of Vetsulin BID, as he was Dx on 5/9/23 and put on Vetsulin at that time. So, I am wondering if you should start at a higher dose of glargine. Let's see what some of the gurus have to say :)

@Marje and Gracie
@Sienne and Gabby (GA)
@Suzanne & Darcy
@Bandit's Mom
Click to expand...
Welllll……sorry to say but it shouldn’t be stored in the refrigerator door because it’s more susceptible to temperature changes there. Best to put it in the inside cheese drawer :)

You are correct, Kyle. The vet has prescribed what most vets do for a starting dose but we would go based on what Stache’s BG is on his current dose. Where this becomes difficult is that without seeing the BGs on a spreadsheet, we are just guessing. For example, if the dose was raised 1u every week as many vets do, it’s possible 4-5u is too high. However, if at 4-5u, the BGs are all high, it would be counterproductive to Stache and set him back to start at 1u.

We definitely need to see what his BG is on the Vetsulin. My suggestion is to hold off on starting the Lantus a day until Stache’s parent can get a SS set up and the BGs entered. I offered to do this a couple days ago. The offer still stands and then data can be entered. This will allow us to determine a more accurate starting dose.
 
Stache said:
My Spreadsheet is set up. It was before anyone replied to this.
Click to expand...
I apologize. You are correct. I am sorry I somehow missed that. It needs data as Bron indicated. An empty SS doesn’t allow us to give you much in the way of solid advice :)

I believe you have data from the Libre but you said you weren’t sure if it was working correctly or not but anything helps. We will likely be able to determine if it’s valid or not. It’s difficult to glean anything from the graphs.

BTW, I just want to reiterate that we want to be careful about starting Stache on 1u of Lantus before we have some idea if that is an appropriate dose. If it’s too low, it leaves him at risk for DKA if he has any hidden infection. I would suggest you continue with the Vetsulin until the data is posted.

I would be happy to look at data today so you can start him on Lantus tonight or tomorrow morning. Although Lantus does take time to build a depot, I have seen two cats switching from a non-depot insulin who had a somewhat active first cycle of Lantus. It’s rare but best to be cautious and a morning shot would allow you to be awake and aware, able to test.

In the meantime, were you able to get a human meter & strips and have you had a chance to test him with it? Today would be a good day to do that if you could.

Also, it’s really admirable that you adopted an older , much less, diabetic cat. Not many would. Thank you for saving a life.

Thank you.

edited to add: please continue to give Vetsulin until Lantus is started. Once we help determine the Lantus starting dose, you will give the final dose of Vetsulin and the next cycle, start Lantus.
 
Last edited:
Marje and Gracie said:
I apologize. You are correct. I am sorry I somehow missed that. It needs data as Bron indicated. An empty SS doesn’t allow us to give you much in the way of solid advice :)

I believe you have data from the Libre but you said you weren’t sure if it was working correctly or not but anything helps. We will likely be able to determine if it’s valid or not. It’s difficult to glean anything from the graphs.

BTW, I just want to reiterate that we want to be careful about starting Stache on 1u of Lantus before we have some idea if that is an appropriate dose. If it’s too low, it leaves him at risk for DKA if he has any hidden infection. I would suggest you continue with the Vetsulin until the data is posted.

I would be happy to look at data today so you can start him on Lantus tonight or tomorrow morning. Although Lantus does take time to build a depot, I have seen two cats switching from a non-depot insulin who had a somewhat active first cycle of Lantus. It’s rare but best to be cautious and a morning shot would allow you to be awake and aware, able to test.

In the meantime, were you able to get a human meter & strips and have you had a chance to test him with it? Today would be a good day to do that if you could.

Also, it’s really admirable that you adopted an older , much less, diabetic cat. Not many would. Thank you for saving a life.

Thank you.

edited to add: please continue to give Vetsulin until Lantus is started. Once we help determine the Lantus starting dose, you will give the final dose of Vetsulin and the next cycle, start Lantus.
Click to expand...


he posted these screenshots of Libre data previously does this help? I can't really make it out, myself.

upload_2023-7-1_1-7-51-png.67119
 
Apology accepted! I would be happy to show data if I had it. I showed photos of the "curves" I got in the first trial in #21 of https://www.felinediabetes.com/FDMB/threads/hello-from-stache.279007/. I thought this would make it clear that it didn't work.

You seemed to imply elsewhere that the FL2 reader could talk to a computer via usb. I don't think so. I think its usb is for power, only.

I could painstakingly toggle the reader back a couple weeks to get data. Even if I can do this, you would have to help enter them into the SS; that's Japanese to me.

What's the point, here? As I said, my dose was 4.5-5U for the last couple weeks. The BG dropped steeply, stayed in a range you see on the photos, then rose steeply. Other times it didn't budge from its max reading of 400+ all day. That is probably either missed dosing or reader issues. (I always run my hand over him afterwards, checking for fluid.)

I'm supposed to get another sensor put on today, mixed feelings about that. The Freestyle Libre can blood test as well. I can get strips and a lancet today at rite aid. Someone said the FL2 tests low? How low? I guess that's better than high.

I got a courtesy call from the vet a while ago telling me I needed to bring the sensor; that's heads-up football on their part. This was news to me. I lucked out. Fred Meyer has them in stock. I'll be thinking about Stache as I walk towards that front entry.

We talked about trying the FL3 but my phone's too old for the ap. I did get the FL2 app, just now. I did not try that the first time; perhaps this could become a playmaker.

I want the vet to show me how to blood test. Watching a video ain't gonna cut it for me. This is the part that scares me most. It's supposed to be a minimum of four a day? I just don't see how that's going to happen. Even if I can learn how to do it, don't their ears ever get scarred? Mainly, I just don't see how you all can do that with cats as often as you do. But, I guess you're able somehow.

I'm out of vetsulin. He has gone without since 7/1/23. I gave him 1U of glargine last evening, none since. The initial vet visit found no ketosis, thyroid, etc., issues.

Stache was found closed in a suitcase in front of our Fred Meyer, here. I'd go visit him at the shelter for the next month, plus. Ironically, I miss those days. I'm not the only one who was wondering about his health. Eventually, the shelter mercifully sprang for the first vet visit since his check-in exam. Here, they found the diabetes.

The director began looking around for a place that could take him with his situation; the shelter couldn't have him anymore. She told me the places were all full. I asked what would happen if she couldn't place him. She said he would be euthanized; I sure hope she wasn't lying about any of her story. Suddenly, the weight of all of the burden I had been considering taking-on for days went POOF! I just didn't think I could live with that happening to him.

Then again, things haven't gotten much better. If I'd had a crystal ball telling me this would be the case into our eighth week, I don't know...I must say, I don't like where this is going.
 
Stache said:
Apology accepted! I would be happy to show data if I had it. I showed photos of the "curves" I got in the first trial in #21 of https://www.felinediabetes.com/FDMB/threads/hello-from-stache.279007/. I thought this would make it clear that it didn't work.

You seemed to imply elsewhere that the FL2 reader could talk to a computer via usb. I don't think so. I think its usb is for power, only.

I could painstakingly toggle the reader back a couple weeks to get data. Even if I can do this, you would have to help enter them into the SS; that's Japanese to me.

What's the point, here? As I said, my dose was 4.5-5U for the last couple weeks. The BG dropped steeply, stayed in a range you see on the photos, then rose steeply. Other times it didn't budge from its max reading of 400+ all day. That is probably either missed dosing or reader issues. (I always run my hand over him afterwards, checking for fluid.)

I'm supposed to get another sensor put on today, mixed feelings about that. The Freestyle Libre can blood test as well. I can get strips and a lancet today at rite aid. Someone said the FL2 tests low? How low? I guess that's better than high.

I got a courtesy call from the vet a while ago telling me I needed to bring the sensor; that's heads-up football on their part. This was news to me. I lucked out. Fred Meyer has them in stock. I'll be thinking about Stache as I walk towards that front entry.

We talked about trying the FL3 but my phone's too old for the ap. I did get the FL2 app, just now. I did not try that the first time; perhaps this could become a playmaker.

I want the vet to show me how to blood test. Watching a video ain't gonna cut it for me. This is the part that scares me most. It's supposed to be a minimum of four a day? I just don't see how that's going to happen. Even if I can learn how to do it, don't their ears ever get scarred? Mainly, I just don't see how you all can do that with cats as often as you do. But, I guess you're able somehow.

I'm out of vetsulin. He has gone without since 7/1/23. I gave him 1U of glargine last evening, none since. The initial vet visit found no ketosis, thyroid, etc., issues.

Stache was found closed in a suitcase in front of our Fred Meyer, here. I'd go visit him at the shelter for the next month, plus. Ironically, I miss those days. I'm not the only one who was wondering about his health. Eventually, the shelter mercifully sprang for the first vet visit since his check-in exam. Here, they found the diabetes.

The director began looking around for a place that could take him with his situation; the shelter couldn't have him anymore. She told me the places were all full. I asked what would happen if she couldn't place him. She said he would be euthanized; I sure hope she wasn't lying about any of her story. Suddenly, the weight of all of the burden I had been considering taking-on for days went POOF! I just didn't think I could live with that happening to him.

Then again, things haven't gotten much better. If I'd had a crystal ball telling me this would be the case into our eighth week, I don't know...I must say, I don't like where this is going.
Click to expand...
First, did you see the private message I sent you that deciphers the SS for you? The BG you get right before you give insulin goes in the AMPS or PMPS depending on whether it is morning or evening shot. The units of insulin you gave goes in the “U” column. The + numbers are hours since you gave insulin so if you gave it at 7 am, then 8 am is +1 and 11 am is +3, etc. Then you start over after the PM shot.

The FS Libre generates a BG in the form of a number at a specific time. So if it tells you his BG is 350 at 8 am and you gave his insulin at 7 am, then 350 is entered into the +1 column for the date. This is what the entries on a SS looks like for a cat on a FS Libre. You have to manually enter the data so you have a ton of data. Two weeks worth, as Bron said, is fine.

I do appreciate you adding the graphs but the data is really blurry and I can’t read the BGs. However, the pattern looks to me like he could potentially be dropping too low and then bouncing back up really hard because he dropped low, fast. Bounces can take up to six cycles to clear so if he dives low, pops back up, stays there flat, that’s an indication that it could be too much insulin. Again, without knowing what BG he dropped to, I can’t tell you for certain and I don’t guess when it comes to someone’s cat’s safety.

We have many, many posts to help you learn to test. The problem with the vet showing you is that, typically, they will use an 18g needle. We suggest 28g lancet starting out and then as the ears learn to bleed, you can move to 31g. The higher the number, the smaller the lancet so the smaller poke it makes. The cats get used to it especially if you are calm and give a treat or love on him. If you alternate ears, you will minimize the damage to them. After 5.5 years of many pokes a day, my kitty’s ears looked just like my nondiabetic’s ears. You will get there…everyone does. There are more resources on everything here.

It is best to not stop and start insulin if you can avoid it. Ketones can develop rapidly. The whole point on the dose is if it’s too high, he can die from hypoglycemia. If it’s too low, he can develop glucose toxicity or ketones/DKA. It’s very important to get the correct dose.
 
Last edited:
Marje, I must have been feeling optimistic the day I started our conversation. I soon thereafter realized I was in over my head. Anyway, I will try contacting you there, now.
 
Pete

Thanks for starting to enter data while Stache was on Vetsulin. It’s clear from what you entered that 5u is too much insulin for him. Similarly, for the data you have for him in Lantus, 1u is not enough even though he is still just filling the depot and the cycle count started over yesterday morning since you skipped a shot.

My gut tells me he needs at least 3u of Lantus bid but I want you to be able to adjust to using Lantus and let his depot fill a bit more. We can also increase the dose quickly if it becomes apparent that we need to. I’d like to suggest you give him 2u tonight and we will give him four cycles on that to see what happens.

Are you testing his urine ketones? Is he eating well and drinking?
 
Alright, four cycles of 2u BID starting tonight! So, that would take us through the morning feeding of July 9th, at least? He eats & drinks plenty.

I have some of those CheckUp strips but I think the ones I have are only for urine glucose. I notice they have a 10 parameter test strip that includes ketones. Of course, let me know if you suggest anything in particular.

Thank you so much, and thanks to everyone here! I suppose Stache & I are just getting started. I can't imagine though, being better informed anywhere else.
 
Stache said:
Alright, four cycles of 2u BID starting tonight! So, that would take us through the morning feeding of July 9th, at least? He eats & drinks plenty.

I have some of those CheckUp strips but I think the ones I have are only for urine glucose. I notice they have a 10 parameter test strip that includes ketones. Of course, let me know if you suggest anything in particular.

Thank you so much, and thanks to everyone here! I suppose Stache & I are just getting started. I can't imagine though, being better informed anywhere else.
Click to expand...
Please be sure you get a PS, +2 and before bed test tonight and a PS, +2, and midcyle test tomorrow at the least. If you see his +2 test is less than PS, please check at +4.

You can just buy urine ketone test strips at Walmart. Just free catch some urine or stick it in his stream as he pees but it must be read at exactly 15 secs after collection.

We are a close community here with lots of members anxious to help.m we are glad you all found us. Good luck with the dose increase.
 
Pete PMd me about changing his shot time from 8:30 to 8 and my response is:

With Lantus, you can’t change the shot time more than 30 mins a day until you are very experienced and know his curves, etc. That means you can shoot early by 30 mins one cycle or 15 min each cycle. If you moved his shot from 8:30 to 8 this morning, that’s fine, but that’s it for shooting early today.

@Stache We discussed holding the dose four cycles but since he saw some blue BGs last night, we need to hold it longer.

I’d like for you to go to the Lantus/Levemir/Biosimilars forum and read the stickys at the top as well as the posting guidelines because you will need to decide if you want to follow the Tight Regulation Protocol (which I strongly recommend) or Start Low Go as low.

I’m going to encourage you to start posting there daily so more “eyes” can be on your thread. Everyone there uses only depot insulins and the dosing advice is very specific. Please be sure you post following the posting guidelines.
 
Pete and Stache, Graduating to the LLB! Woohoo!! I second that recommendation for Tight Regulation. It can work wonders.

I spent six months posting daily threads over there (called 'condos' because the daily thread is where your cat lives). I still pop in there from time to time, so I'll see you over there Pete.
 
Status
Not open for further replies.
Back
Top