Starting Lantus tomorrow!

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Jenn

Jenn

Member Since 2015
Tomorrow my foster cat, Sampson, whom I've had for 2 weeks, is starting Lantus. He is eating ground raw and doing pretty well on it. I'm sure I will be back with plenty of questions!
 
Welcome, Jenn!

It's great that you've got Sampson started on low carb (LC) food. Have you started to home test? If not, we can help you here or you may want to also post on the Health board if you need a hand. Likewise, you'll want to get a spreadsheet started. The information on setting up a spreadsheet is in this link.

There is also an overwhelming amount of information in the sticky notes at the top of the board. The information will help to get you acclimated to this message board as well as provide a great deal of information about Lantus/Levemir and it's use.

Please let us know if you have questions and how we can be of help. The people here are very generous with their time and their knowledge. And again, welcome!
 
I'm not sure yet which protocol we will be using. I'll find out tomorrow when I take him to work. (I am a vet assistant at the shelter.) I am doing at home testing and his BG is at about 300. I'll work on a spreadsheet tomorrow
 
Welcome to the FDMB Jenn!! Sampson is a lucky kitty to have a foster mom and getting him out of the shelter environment will increase his chances of remission too!

Which protocol you use is really your decision, not the vets. It depends on how often you're able to test (to some degree) , your goals (possible remission or just regulation?) and how comfortable you are with making dose changes (more frequent which can mean more testing or slower with at least weekly curves?)
 
Just wanted to add my welcome, Jenn. It can be overwhelming to begin this sugar dance. We've all been in your shoes and we understand - so please feel free to ask any questions you might have.
 
Oh, I didn't realize that I choose the protocol. I'm willing to test as much as necessary, however I work an hour away from home and the fiance and I share a car causing us to be away for 11 hours. My plan was to do insulin at 6am just before I leave and at 6pm as soon as I get home. I can bring him in for curves as often as I need to but he won't like the stress of being back and forth more than necessary so I can't plan to bring him back and forth until he is adopted. In a few months when we get another car I will have more freedom and not have to leave the house until 7:30. I'll read up on both protocols and try to figure out which would be best for us.
 
Also, I'm comfortable making changes but would prefer to make them on weekends. Remission would be best but we aren't sure how long he's been diabetic so not sure if that will be attainable. If not, regulation is the goal.
 
After reading, I think I would prefer Start Low, Go Slow. I'm terrified of hypoglycemia, I know its irrational since I already have high carb canned food, dextrose in the fridge, and a fluid bag hanging on the wall haha. I just worry it will happen when I'm not home.
 
Welcome, Jenn! What a lucky kitty Sampson is to have you taking care of him.

Hypos are always lurking there in the back of our minds. One thing to keep in mind in Lantus is that dose changes don't show up immediately, for increases it can take up to 6 cycles for the shed to rebalance and for decreases it take a few cycles for the excess in the shed to drain. Keep that in mind when you are planning when to adjust doses.
 
With Start Low Go Slow, and a raw diet, the suggestion is to start his dose at 0.5u.

One thing that can be a huge help for people who are gone much of the day (and even for people who are home), would be to get a timed feeder. If a cat's blood sugar goes low, we use food carbs to bring them up. A timed feeder can do that while you are at work.

As you navigate your way around the Lantus/Lev support group, there is a post you may want to bookmark that somewhat serves as an index within the group: Where Can I Find? There is a thread in the lower part that has a discussion on timed feeders that might be helpful to you. Also, at the top of this page there is another thread about how people who work full-time adjust things so they can manage to follow Tight Regulation.
 
He is 10 pounds.
His AMPS was 324
3 hours later we fed and shot him with 2u
+3 was 318
+7 was 314

I need to give his shot 3 hours earlier than we gave it this morning (I need to give it at 6 and we gave it at 9) vet told me to give it tonight at 8 then do 6 tomorrow morning. I will test before I shoot each time, of course, but tomorrow he will be home pretty much alone. I can have my brother check in on him and have him check his levels if I absolutely need to. Thoughts?
 
On the Tight Regulation Protocol, his dose would be (0.25u x 4.5kg) = 1.25u
Using a weight based formula for determining a starting dose of Lantus or Levemir when following the Tight Regulation Protocol:
  • the formula is 0.25 unit per kg of the cat's ideal weight
  • if kitty is underweight, the formula frequently used is 0.25 unit per kg of kitty's actual weight
  • if the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration
There are circumstances such as ketones present, an unusually low preshot number, a caregiver leaving the cat with a sitter, relatively high flat curves, loss of appetite, infection, a schedule change, ability to monitor, etc. which may call for adjustments to these guidelines.

"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.

​
On the SLGS dosing method, his starting dose would by 0.5u.
Starting Dose
  • 1u BID if kitty is not on a wet/canned low carb diet
  • 0.5u BID if kitty has been switched to a wet/canned low carb diet
  • If the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration
  • Generally, shots are to be given 12 hours apart.
He's being started at a fairly high dose - more than either of our guidelines would suggest. If you want to follow SLGS, you'd want to decrease that starting dose to 0.5u.

Shooting earlier than 12 hrs acts like a dose increase. One shot is still in effect and the next shot can be starting to take effect, causing a potential overlap of the two doses.

It would be better to just skip the shot tonight and shoot at 6am tomorrow, rather than shooting early tonight and early in the morning.

A depot insulin means that the insulin builds up in the body and then slow releases - so it's dosed differently than a quick in and out insulin, like the older insulins were. I would not shoot a cat several hours early until I was experienced, and I would only do it if I could test afterwards to make sure the cat stayed safe. It's important to understand how the depot works - there's a good post on it here - and reading the link on the difference between Levemir and Lantus will help you understand a lot.
 
That's not the best plan. With Lantus, an early shot acts like a dose increase. (A late shot acts like a dose reduction.) IMHO, you would probably be getter off skipping tonight's shot and starting tomorrow.

I don't know if you saw Julie's note that with SLGS, you would want to start at no more than 1.0u -- Julie suggested 0.5u given the raw diet. Even with the Tight Regulation Protocol, 2u is probably too large of a dose. With TR, the initial dose is calculated with a formula: initial dose = 0.25 x ideal weight in kilograms​
That would calculate out to approx. 1.0u.
 
Ok so I'll skip the dose tonight and give it again tomorrow morning, will feeding him effect it? Should I wait until +12 (9am) to feed him tonight? I'm torn on what dose to give him, on one hand I obviously don't want to send him in to hypo but on the other had he truly isn't my cat. Maybe I can do 1u from now on and see how it goes? I was told to bring him back next Tuesday for a curve, but truthfully I could do it at home on Sunday and I may suggest that to the vet because having to interrupt everything else we do during the day to do a curve is difficult at times. Should I test him more tonight to see what his levels are?
 
You want to have a non food influenced test for the preshot number. Food will rase the BG in about 15 to 20 minutes and when we do the preshot test we do it to make sure he isn't too low to safely test. So you don't want that test to be food influenced, we usually don't feed for 2 hours before the preshot. The normal routine is to test (as close to the shot time as you can get every thing done), feed and shoot. All within 10 to 15 minutes if possible. My routine is to get Tess's raw food ready and warming in a bowl of warm water, test, draw the dose, give her the food and shoot while she is eating. She barely notices the shot. Mostly she is just annoyed that I am bothering her while she is eating finally!!!!
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Right after shooting I sniff the fur to make sure the insulin went in and wasn't a furshot. Insulin has a strong smell. I also give a little kiss to make up for the pokie.;)

By Sunday you may not be seeing the full effect of the Lantus dose yet, that would only be 4 full days on Lantus. It wouldn't hurt, but things could still be changing.

BTW Lantus doses are adjusted by the lowest BG the dose will cause, the nadir, not on the preshot number like other insulins. Usually for Lantus the nadir is about 6 hours after the shot, but it can vary from cat to cat and even from shot to shot. We like to test at least 4 times a day, preshot and somewhere mid-cycle to try to catch the nadir. When you are working that isn't always possible, but at least try to get a before bed test. There are other times it helps to get some test, but theses are good starting points.
 
This morning his preshot number was 3 hours before we shot him because I wanted to get a reading before I brought him to work and stressed him out. Maybe I will suggest we wait until the next weekend, so that would be about 11 days then I can curve on the weekend and consult her on Monday. I can do the test, feed shoot easily. He is a prince for testing and was great for the shot. Normally when giving sub q's I pull back on the plunger and if there is suction I know I'm in the skin. Is it okay to do that with the insulin?

Also, if the dose is adjusted by the nadir, what exactly is the preshot telling me? Do I still wait to shoot if the preshot number is low?
 
The pre-shot test is to make sure it is safe to give the insulin. Starting out, we suggest you not shoot below 200 mg/dL. Once you have a spreadsheet up, are testing regularly, and have test data in the middle of the cycle to show how low he goes, that can be adjusted downward.

Can we get you started using our grid to record your glucose tests? It will help us give you better feedback. Instructions are here.

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.
 
If you're posting in Main Health, the suggestion is not to shoot under 200.

On the Lantus/Lev group, For new members that have a preshot number under 150, we suggest that you post and ask for guidance on how to proceed.

An experienced Lantus user would look at your spreadsheet to see what all is going on and help you figure out if it's safe to shoot. You'd be asked if you are able to monitor after the shot in case the cat goes into lower numbers, if you have high carb cat food, karo, honey, or maple syrup and plenty of test strips if you need them.

And the tradition here is that if a person suggests you shoot a lower number, they will also stay with you to teach you how to deal with low numbers if you get them.

The interesting thing about Lantus is that it works very well at lower numbers, and you'll see by people's subject lines that with a preshot that's in normal numbers, say under 100 or so, the hours after the shot might just be a flat "surf." When a cat spends time in normal numbers (50-120), the opportunity exists for the cat's pancreas to heal, if that is at all possible, and for the cat to become diet-controlled. We don't know what cats will be able to do that, but some can.

Sienne corrected my math error - 0.25u x 4.5 = 1.125, which would suggest starting at 1.0u if you were following Tight Reg, or the 0.5u if you want to follow SLGS.

As far as the dose for tomorrow morning goes, it's pretty important not to start too high for a couple of reasons. One is that it's less nerve-wracking to not see low numbers immediately! Another reason is that too much insulin can cause the cat's body to have high numbers. If the cat's body perceives that it's going into low numbers - the body will release sugars and hormones to send the blood sugar high. That's called a bounce. There's a more descriptive post here - the second one in the thread - if it would be helpful.

Increases are done slowly and in small increments, with those decisions made by the tests you get, so that the cat doesn't become overdosed and miss the right dose.
 
I'll make a spreadsheet tomorrow. His +12 before his meal was 210, I did not give him insulin. Tomorrow at 6am, which will be 21 hours after the first dose will be 1u.
 
Tight reg requires testing throughout the day whereas SLGS doesn't as much, is that correct? I can get more of an idea of everything this weekend when I am home and can test him throughout the day.
 
Tight reg requires at least 3 tests per day - both preshots and at least one mid-cycle (most people get a right before bed test.) Most people do more than that, but it's not required. Once you get the hang of testing it can become very easy to become a "test-a-holic". :rolleyes:

Start Low Go Slow requires preshots and then running a curve - either every 2 hours for 12 hours or every 3 hours for 18 hours - once a week before adjusting the dose.

Because the dosing decisions for both are based upon how LOW the dose will take the cat, mid-cycle tests are pretty important, regardless of which one you choose.
 
I will admit, I am a testaholic but I try not to be because when the vet went to buy the strips for the meter we have (Freestyle Lite) and said 50 were $100. I do want to get him a reader with cheaper strips soon. Figure I can use both for a few days to get a feel for the difference.

I think I will test before each shot twice daily then I will do a curve on a weekend day to see where we're at. Once I start figuring out what is normal for him I can start doing a bed time test, which would be +4 from the second shot, and make sure we are on track.

This morning his AMPS was 354, higher than it has been since he's been on raw. Thought that maybe from the liver being confused. Is there a medical term for that? Lol I gave him 1u. I'll have my brother check in on him later today, though he can't test, and I'll test him again when I get home for his preshot. Will work on the spreadsheet tonight, don't think I can make it from my phone.
 
Please remind me in a month to figure out how to get this info on VIN! That's where the vet turns for research on things she isn't quite sure about and I think having more, better info on there could help a lot more cats! Or of someone already has links to info on VIN that I can hand her, please forward.
 
My understanding is that unless you're a veterinary professional, you can't join VIN.

You might want to share this article with your vet. It is the journal publication of the tight regulation protocol for Lantus.

If the vet is buying strips at a pharmacy, it's going to cost a fortune. Here's a link to American Diabetes Warehouse. The strips are about half of what the vet paid. I'd also check on Amazon and EBay. You can sometimes find as good or better deals there.
 

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Hi Jenn and welcome to you and Samson,

You may want to get a different meter. Many of us here were stung by the Freestyle Lite several years ago: its readings at the higher end of the scale are deceptively low. For example, people were getting readings in the 200s when their cats' glucose on all the other meters was in the 300s. The average was about 100 points lower for the Freestyle Lite. It was quite a jolt to find that your cat was doing much worse than you thought! In the lower numbers (below 100) there was no appreciable difference between the Freestyle Lite and the other brands of human meters.

If you shop online at ADW (Sienne provided the link above), you will find nice buys on the Arkray Glucocard 01 and the Arkray Glucocard 01 Mini. Both of these meters use the Arkray 01 Sensor Plus strips and ADW always has these strips on sale at 250 strips for $69 (buy 4 boxes and get 1 free). The Walmart Relion Confirm and Relion Micro meters are Walmart's branding of the two Arkray meters mentioned above. So if you happen to run out of strips for your Arkray, you can buy the Relion strips at Walmart.
There are lots of good meters on the market, but I have been very happy with my Arkray Glucocard 01 Mini. It is reliable, takes a very small blood drop, and is easy to use.

Best of luck,

Ella & Rusty
 
You can get the Agamatrix Presto at ADW too. You can get the meter, 100 strips and 100 lancets for $23.25! Strips are $10.69 a box, even a little cheaper if you buy several boxes. In it's rebranding at Target it is called the Up & Up and was given a Top Picks Consumer Reports rating. Another good meter is the Relion Confirm or Mini from Walmart, many here use that.
 
I just saw Ella's post, the Relion (Arkray) was also given a top rating from CR. Especially for a shelter one of theses meters would be the way to go. Nice the hear the vet isn't wedded to the idea of the "pet" meter. All of the ranges we use here are w/ human meters, the pet meters are just calibrated differently. I talked to a company rep whose company also made meters for a "pet' meter brand. He said there was no basic difference. And they cost way more! The clinical research was done w/ human meters as well.
 
Another hiccup. Sampson's PMPS was 405, he hasn't been that high since he was diagnosed a few weeks ago pre-diet change. I gave him his food and shot him with 1u12 hours after his previous dose. This was about an hour minutes ago. About 15 minutes ago he vomited all of his food. I am 100% it was him since no other cat has eaten yet and it was ground raw. Three possible unrelated causes are: 1) one of the three cats ate some fish food, it was on the counter, however, and Sampson can't jump that high; 2) the food was cold (not frozen), but this has never been an issue for him before; 3) I started vacuuming the cat room in an attempt to hurry and do the chores so I could make the spreadsheet! He is behaving normally (still hungry as usual, hydrated, pink, etc) and I will be home for the rest of the night. Short term question: should I re-feed him and see how that goes? Long term questions: Should I test him periodically throughout the night? What, aside from ketones, could cause this? Can a test for ketones wait until tomorrow evening (I can bring home test strips tomorrow) or should I bring him in tomorrow? I knew this wouldn't be easy but DANG!!! LoL
 
I'd wait about a half hour to try to give him more food so if his tummy is upset, it has a chance to settle down. I'd also just dole out the food a little at a time so he hopefully won't vomit it all back up again.

Cats can vomit even from hairballs. One vomiting episode as long as he's behaving normally, wouldn't make me worry too much. I'd see if he'll eat later and go from there.

Just because he's in high numbers doesn't mean he'll develop ketones. That "recipe" includes infection or inflammation + not enough food + not enough insulin. Did he have ketones before, or DKA? That's an important question.

He might be higher because you've started insulin and it's brought him into a range lower than he's used to. If he's been sitting at 300 for the past 2 or more weeks, his body now would think that's normal. So when he gets into 100's, or possibly even 200's, his body may perceive that as a hypo and bounce from it - sending him back higher to "save" him from that perceived hypo. A bounce can last as long as 3 days - so don't let yourself succomb to the desire to increase his dose because he's in higher numbers. Resist. :D It's also possible that he's experiencing New Dose Wonkiness - and you just have to wait that out as well. If you look at the post I linked above it talks about both NDW and bouncing.

I would never not test before going to bed - but that's how I learned to treat Punkin. We didn't have the SLGS option and everyone at that time used Tight Reg, so that's where I learned and what I practiced with him.
 
Whew! Thank you!! Any other animal and I wouldn't care about the vomiting just figured since I already gave the insulin that the boy needs to eat! Haha The vet said the same thing, to try feeding again. I have it warming to room temp. and will give him a little at a time. I've heard cats just vomit if you look at them weird but aside from sickly little kittens he's only the third adult cat that's come to my house! LoL He hasn't had ketones or DKA, The day we started him on insulin I ran a stick and it was clear. I will have to remember to bring some home with me for times when I am feeling especially paranoid. Ha! I first thought the higher BG could be from him bouncing but then I second guessed myself because that's what I like to do. He was indeed at about 350 for about three weeks between diagnosis and now while we changed foods, I went on a minivacation, and we had some major happenings around the shelter that prevented us starting insulin. Plus before that he was 400 and we have no idea how long he was that high.
 
Also, I just purchased a ReliOn Prime and just need to find a Walmart that has strips so I can switch him.
 
He looks adorable! In the beginning it is so hard not to second guess yourself....I did it all the time and who am I kidding, I still do it, just not as much (or at least I like to think not as much)......All of the stuff will start making sense soon, just remember to ask as many questions as you want!
Jenn said:
I've heard cats just vomit if you look at them weird
Click to expand...
That is pretty much all you need to know about cats.....LOL.....I have learned to stop asking why as much, because normally the answer is, because he is a cat :)
 
Sampson is a cutie!

Has he been on raw food long? When I switched my two, my non diabetic cat would occasionally vomit up after his meal. I learned to give him smaller amounts more often and I put lots of warm water on it to warm it up. Cold raw can cause vomiting in some cats and extra water for a diabetic cat is a good thing.
 
He's been on raw food for 7 days but has been getting chunks since I got him about a week and a half before that. I did smaller, room temp meals and so far he's kept it down just fine! +3 was 400
 
Hi Jenn. Just wanted to add my welcome to you and Sampson. I see you've had lots of help from a variety of people. You've come to the right place. The knowledge pool here is deep, and everyone wants to help.

I just have one suggestion I don't think anyone else has made. Can you please start a new thread each day? You can link the old one by copying the URL, then typing a name (like "Yesterday") in the new thread (or condo as we call it). Highlight the name, then click on the link symbol in the toolbar at the top of your post (third box in). Paste the URL in the dialog box that appears and click Insert. We usually put the date, the kitty's name, and pertinent info, like latest test numbers, or a question, like "dose advice?" in the subject line. If you do a new one every day and link the old one, it make is easier for people to keep up with what's going on.

It looks to me like Sampson lucked out when he got you as a foster mom. :)
 
Sure I can do a new thread each day. Is it beneficial if I am just posting his measurements for the day or only if I am asking about increase or whether or not to shoot?
 
We all do a new thread each day, even if it's just to report numbers, but remember, Sampson isn't just a sum of his numbers...we also want to hear how he's feeling otherwise too!
 
Yes, it's fine/great to start a new thread each day, even if you're just reporting tests. Most people give a "whole cat report" in the first post of the day. Behaviors can tell a lot about how a kitty is feeling, so we look at the "5 P's": Is my kitty purring, preening, playing, pooping & peeing normally? If those things change, then that can indicate something's going on.

Way to go on getting the spreadsheet started! Yay!

In the comments section it's helpful to write any notes - like on yours, I'd add on the top row that you've had Sampson for 2 weeks. That tells us that he's been in these high numbers for at least that long. It's also good to note when you start a new pen/vial, because sometimes you'll need to know how long you've been using one, or once in a while (not often) a new vial/pen will be bad and if BGs go up at the same time as new insulin is started, and it's noted on the spreadsheet, that can help figure out what's going on.
 
I didn't even see the comment section! Excellent! I will start a new thread now.
 
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