Starting Lantus today 11/2/13...

Status
Not open for further replies.
Mocha'sMom

Mocha'sMom

Member Since 2013
So today is Mocha's first day on Lantus. We had him on Humulin N and decided to switch for a number of reasons. We skipped insulin all together yesterday 11/1/13 per vets orders. We started him off today with .5 unit of Lantus at 7:00 am and took his BG at 1:00 pm and it was 477. After reading that the peak with Lantus should be in the hour before the next shot we took his BG again at 6:00 pm and it was 580. It seems to me like the insulin did hardly anything. Does this just mean that we need to up his dosage? And if I should increase his dosage, should I wait the customary week before upping his dosage? Thoughts?
 
Typically the starting dose is 1 unit. Why did you start with 1/2 unit?
What dose N were you using and how were the BGs?
Lantus is a depot insulin and it takes three days or so for the deot to fill before yu see a good effect of the Lantus.
 
The formula to calculate a starting Lantus dose is:

Weight
In kilograms (divide pounds by 2.2)
Multiplied by 0.25
Rounded down for safety.

Ex
an 5.5 lb cat is 2.5 kg * 0.25 =.625 units. -> 0.5 units
an 11 lb cat is 5 kg * 0.25 =1.25 units
 
I went with a full unit for his PM dose. He was on a full unit x2 day on the N and he weighs about 8.5 lbs right now. He is eating Purina DM dry (free feeding) and a variety of wet foods (breakfast and dinner w/ his shot) depends on what he feels like eating that day. Typically a Weruva or FF, sometimes Wellness Core Chicken. Yes, I realize this isn't an ideal diet, but It's a work in progress. Working on finding a few brands/flavors that he will eat and sticking to them, of course aiming for similar protein/fat/carb ratios.

He also got a full unit this AM and his +6 was 361. Which is much better than the 400 & 500's he was reading yesterday.
 
Sounds like a good plan. here are some food transitioning tips: http://www.catinfo.org/docs/TipsForTransitioning1-14-11.pdf

Als you might want to set up a spreadsheet to track his results and trends - you can also share it with us and your vet if you want more eyes on it?: http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207. Let us know if you need help with it.

Also I usually recommend 3-4 tests a day

- always before the shot - this is mandatory as you don't want to shoot when too low. As a newbie this too low number is 200 but is reduced over time once you have the data to know if its safe.
- mid cycle - 5-7 hours after morning shot depending on your schedule. This is to see how low he is going. The low point "nadir" is what you base dose changes on since you don't want him dropping too low (under 50).
- before bed (2-3hours after Pm shot) to get an idea of what his overnight plans are. If this number is less than the pre shot test number you may want to set the alarm for a test a few hours later as this implies an active cycle.

Wendy
 
I do have a spreadsheet, but most of my work is done on an IPad and the spreadsheet in that post doesn't seem to play well with the IPad, so I have created my own, but I'm still trying to figure out how to get it in my signature. I did have one question about that spreadsheet though. There are the BG's listed at the top of the spreadsheet, are those what his number should be at the different test times? For example, should his BG be between 499-400 between the +1 & +5 test after the AM shot? Does that make sense? I'm not sure if I'm phrasing my question well. Basically, I thought there were 2 peaks in 24 hrs. Instead of a steady decline in BG over 24 hrs. Also I am *assuming* that AMPS = AM Pre Shot and PMPS = PM Pre Shot, but I couldn't find confirmation of that anywhere. I could have been looking in the wrong place though.
 
I have an iPad and I use the Google docs app (free) and the spreadsheet works fine

The BGS at the top is just the key to the colours. It doesn't correspond to testing times. A typical Lantus curve looks like this :

+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (one of the quirks of Lantus/Levemir: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.

And yes AMPS = a.m. Pre Shot. And PMPS = p.m.Pre Shot

Wendy
 
Here's a "cheat sheet" on how to use the spreadsheet that might be of help.

KPassa said:
Questions on understanding how to use the spreadsheet get asked a lot, so I thought I'd share a quick run-down of spreadsheet-specific terminology:
  • Fur shot: when the syringe needle pokes through almost like a sewing needle through fabric and it is unknown how much, if any, insulin actually made it inside the cat. Usually detected by wet fur or the smell of insulin (it smells like band-aids or scotch or antiseptic). IT IS ALWAYS ASSUMED THAT THE CAT GOT THE INSULIN AND YOU NEVER GIVE ANOTHER SHOT. It is always better to miss a shot than to give too much insulin.
  • AMS/PMS: morning (AM)/evening (PM) shot
  • AMPS/PMPS: morning pre-shot test/evening pre-shot test (it's assumed the shot is given within 15 minutes or less of this test).
  • +1, +2, +3...: How many hours after a shot, i.e. +1 would be one hour after their last PS (pre-shot) test
  • BG/BS: Blood Glucose or Blood Sugar (numbers). Usually used in relation to testing and dosing and what "level" or "point" the cat is at. Used in a sentence: "Michelangelo's BGs have been high so I've been increasing his dose."
  • AMBG/PMBG: morning/evening Blood Glucose. Used when no shot has been given at the regular shot time.
Click to expand...
 
Thank you KPassa. That is helpful too!

Mocha's numbers are starting to normalize. They are still too high, but at least they are consistent. I think we will be able to increase his dose this weekend by .50

I was reading the "handling" instructions for Lantus and this is the most complicated handling instructions I have heard of for insulin. None of my vets ever said anything more than "keep it refrigerated". Must you REALLY use a new needle every time? My vets have always said it was okay to reuse needles. With how expensive everything is getting, it's hard for me to hear.
 
With Lantus, you want to keep it refrigerated. Most all of the other instructions, I kinda lump together under a general "be careful" umbrella and don't worry too much. I shoot insulin back into the pen/vial and have never shoot it into a paper towel or the sink, I keep it in the door of the refrigerator, I suck air out of the pen to re-stabilize the vacuum when the air bubble starts getting big enough to be in my way.... Many people on here might scream bloody murder about me doing all this, but my vial lasted me around 5-6 months and each of my pens have lasted me to the last drop. YMMV.

As to re-using syringes, this is not advisable at all and can be particularly painful for the cat and can produce red spots, bumps, and infections. They're cheap enough that this is one area you don't want to scrimp on.
images


Lancets, on the other hand...I change out the lancet in his lancet pen maybe once every couple of weeks, if I even remember. Usually I only remember to change it when I suddenly have to start poking more than once to get blood because the lancet has gone dull.

Here's something I wrote up a while back about breaking down the cost of things.
 
@KPassa: Syringe vs. lancets. I would expect to change the lancets more often being they come in contact with blood vs. syringes that are only going sub dermal. That is interesting to me. I do understand syringes dull though.

Anyways, good news, Mocha is rejecting dry food. All on his own too! It seems the better he feels, the more canned food he wants. I like that the difference between his hi numbers and lo numbers on Lantus is a much smaller gap than we had on N. I hope his check up on the 18th will reflect all of our hard work, and things will look good (getting a blood panel done). Weighed him today and he is 8.8 lbs roughly. To think he once was over 10 lbs is crazy to me. And to think my old vet had me thinking of putting him down. :sad: I wish I could get some pictures up. How do people do the kitty profiles I see in signatures?
 
Mocha'sMom said:
@KPassa: Syringe vs. lancets. I would expect to change the lancets more often being they come in contact with blood vs. syringes that are only going sub dermal. That is interesting to me. I do understand syringes dull though.
Click to expand...

With syringes, you also have the problem of cross-contamination with the insulin vial and it goes under the skin instead of into the skin. With lancets, I use a lancing device so the lancet goes back up into it and isn't exposed to air and isn't easily contaminated. The blood also doesn't really "stick" to the lancet so not many worries about old blood causing a problem with the test results. The lancet is supposed to create blood, so again, it doesn't matter about the degradation of the needle since all that means is it makes it easier to get blood the more often it's used...until it's used too often and becomes dull. Again, I'm sure there will be a few people screaming bloody murder at me for saying all that, but I've been at this for a year without any adverse side-effects from re-using lancets. Besides, when in doubt, I simply retest. ;-)

Mocha'sMom said:
I wish I could get some pictures up. How do people do the kitty profiles I see in signatures?
Click to expand...

Here's some help on creating an Avatar and on creating a profile.
 
Hello there

I saw you are having issues with blood pooling -you can apply a small smear of neosporin before you poke as that should help the blood well up.

Also you are doing great on testing. Is he totally off the dry now? I am wondering if its time for a dose change since its now been a week - see the protocol you would increase by 0.25 but if he just stopped eating dry then you might want to wait a couple days : http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

Wendy
 
I have not completely transitioned him off of dry since it is a prescription diet and is the easiest way for the family to free feed him during the day. With the RF cat in the house we have two dry food bowls that get uncovered when the respective cat is hungry and re-covered when they are done eating. The frozen wet food idea needs some work for our set up, and some co-operation from the people involved. It's not impossible but I need to talk it thru with them first.

We did up the dose to a plump 1.00U since we don't currently have syringes with .50U markings on them to accurately up the dose by .25U

Wendy&Tiggy said:
Hello there

I saw you are having issues with blood pooling -you can apply a small smear of neosporin before you poke as that should help the blood well up.
Click to expand...

I have cream Neosporin, but I'm guessing you are suggesting the petroleum based Neosporin?
 
Yes, the Neosporin ointment, not cream, will help the blood bead up. Wipe off the excess before testing.
 
Thank you! It helped. His blood is still watery and he doesn't bleed much, but it was better than doing it without the Neosporin.

* PM +4 was much easier to test and it was the lowest number we have seen yet on Lantus(170). I'm excited but nervous too. I'm worried he might go hypo. I think I will retest at +6. I just gave him some DM dry food to be on the safe side.
 
Mocha'sMom said:
I'm excited but nervous too. I'm worried he might go hypo. I think I will retest at +6. I just gave him some DM dry food to be on the safe side.
Click to expand...

Just to give a little background on my shyness towards low numbers, we had a bad hypo experience this summer. Mocha was on Novolin N at the time, and we noticed him acting funny one night. As the night progressed he started shaking, staring at the wall, vomiting (with blood in it), and finally diahrea with blood in it. We took him to the ER and they said it was hypoglycemia with possibly an underlying cause. We got him stable and took him to our regular vet a couple days later, and yes, he was diagnosed as hyperthyroid. Did the uncontrolled thyroid cause the hypo? I don't know, I'm not sure if there is a connection. But I just can't forget the pained cry he made and that blank stare, and I really don't want to let that happen to him again.
 
Well, now you're home-testing so you'll be able to catch a potential hypo and stave it off before it comes to that again. ;-) You're also now using a much better insulin for cats, so it decreases the chances even further.
 
Thank you for the reassurance KPassa. I know I shouldn't be shy of low numbers, it is the goal after all.
 
As long as he is getting any dry , he will be harder to regulate and lower numbers will probably need a higher dose. Also remission will be unlikely... many cats go into remission with a low carb wet food but dry food will prevent this.

Many of us here free feed wet food. Some people use a timed feeder. Others leave it out (like me) and refresh it twice a day. Some people make cat foodsiscles where they freeze the food and leave it out to defrost.

Wendy
 
The foodsiscles are probably the way we will go. The daytime caregiver is a very hands-off kind of person, the simpler the better. We just need to figure out the food dish situation to keep the RF cat out of the hi protein food.

Wendy&Tiggy said:
As long as he is getting any dry , he will be harder to regulate and lower numbers will probably need a higher dose. Also remission will be unlikely... many cats go into remission with a low carb wet food but dry food will prevent this.
Click to expand...

As for remission, I didn't think it was possible for him since he has been on the juice for so long (and the bad kind at that), we never really got a good handle on his diabetes and with his thyroid complication...it just seems impossible. Do you think that's wrong? Is remission possible despite all that?
 
I would never give up on remission. The dry food could have been keeping him high and taking him off that could be all he needs.

Wendy
 
Since the Novolin N has a much faster onset and steeper, quicker dives it seems to be "easier", more prone for kitties to hypo on that insulin. A hypo can happen with any insulin, but studies have shown that Lantus and clinical signs of hypo are extremely rare.

Best way to stave off those hypos, and relieve some of your concerns, is to home test. The most important test is the one before the isnulin shots and we highly recommend a test before every shot.

Tricky food/feeding situation with the RF kitty in your home as well as the diabetic cat. There may be some foods both low carb/low phosphorus, such as the Friskies Special Diet canned food that the RF (renal failure) kitty could eat and that would still be good for the diabetic.

What stage renal failure/kidney disease are we talking about here?
 
Deb & Wink said:
Tricky food/feeding situation with the RF kitty in your home as well as the diabetic cat. There may be some foods both low carb/low phosphorus, such as the Friskies Special Diet canned food that the RF (renal failure) kitty could eat and that would still be good for the diabetic.

What stage renal failure/kidney disease are we talking about here?
Click to expand...

She was early stages the last time we tested her. She had a blood work up done today to check on how she is progressing, they will be calling me tomorrow. She is on a low protein food though, 7% or less. And her dry food is only 25% protein. The lo phosphorus thing is new news to me. I read a little bit about it on Tanya's page.
 
I do home test, I get nervous sometimes though since I am not home for his nadir, and the person who is I'm not sure would notice if he started acting weird. If his pre shot number is low though, I try to get a +2 before I go to work. So far, so good. Today is a trial run of free feeding wet food. His numbers are high, maybe because he is sick (possible UTI) and on antibiotics so I am going to try to avoid the dry food today and see what we get tonight. The vet should be calling me today with the full urine analysis (for Mocha) and the RF cat's status update. I noticed diarrhea last night, but didn't see anymore blood in the urine. Poor baby, of course it would be him that gets the UTI, he has all the luck.
 
Keeping our fingers and paws crossed for your RF kitty test results to be positive. What's her name? Is that Pepper, that I see you mention in Mocha's profile?
 
Yes, Pepper is my RF cat. My crazy mother/son combo I have here. We couldn't get anyone to adopt her, everyone wanted the kittens. So we finally said, oh what the heck, and kept her. I'm really glad we did though, she has added a lot to our family, and she would have been so depressed if she had to give up all of her kittens. You can tell by how she treats Mocha. The vet says her levels are slightly more elevated than they were before, but didn't say anything else in her message. I will have to call tomorrow for more details.

As for Mr. Mocha, his numbers were still high today, I'm assuming because of the UTI/antibiotic/vet visit combo. We only free fed wet food today as a trial run. The daytime care taker found it easy enough, so I think we will continue. The automated feeders that people use for free feeding, what brands do people use? And do you put wet food in them? I'm assuming so...
 
Status
Not open for further replies.
Back
Top