Switching to Lantus- looking for advice

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tommytn

Member Since 2011
Good morning everyone!

I posted on the main forum before and got many suggestions to take Tommy off Humulin N. I talked to my vet, he said the only insulin he's used to is the N, but that he'd call in whatever I'd like. I spent quite a bit of time looking up info and reading these message boards. I went and picked up 5 Lantus Solostar pens yesterday. I also have read about the ketones and testing his urine. (Still don't quite understand that whole process.) My pharmacist ordered them, they'll be here tomorrow. I thought about waiting to start the Lantus til I started testing his urine. Anyways, I'm not sure if that's the best idea or not? I am on spring break this week, so I want to make the switch while I know I can be home to watch him.

Here are his BG levels for the last week... (He was 2 units of N) Oh, and something I can't get out of my head... When Tommy was first diagnosed, his BG level was in the 300s. Is it possible the insulin could make it worse? Were there other tests that could have been done?

March 15- PS(6:15am) HI (600+) , (3:43pm) 406 , PS (6:45pm) 387, (9:08pm) 404
March 16- PS (6:10am) 485, PS (6:33pm) 396
March 17-PS (5:48am) 496, PS (5:33pm) 525
March 18-PS (6:00am) 435, PS (6:00pm) 452
March 19-PS (6:09am) 434, (10:09am) 215, PS (5:48pm) 508
March 20-PS (6:00am) 494, (3:36) 407 , PS (5:30pm) 408
March 21-PS (6:06am) 507, PS (6:00pm) 477
March 22-PS (6:18am) 530, (8:47am) 370, PS (5:35pm) 472
March 23-PS (6:03am) 483, +2: 339, +3: 344, +4: 386

Diet: Fancy Feast, Friskies, and 9-Lives- any variety on J&B's list that were low carb. Because of the other cats, he still has access to dry food. Right now he's only eating a little bit of it, but it was the IAMS multi-cat with 25 carbs (better than some of the others...) He eats canned food about 4 times a day. Only about 2-3 ounces each time (sometimes if that... he's starting to get finicky). I feed him 15 minutes or so before each shot, then around noon and 9pm. I have read several different ideas of when to feed, up to an hour before the shot. Is there a rule for feeding when using Lantus?

Other info: He's 7, kinda lazy, but doesn't seem to be acting weird. He still jumps on everything. Water intake... haven't mastered keeping track of that, but he does drink more than the other cats. Litter box... let's just say I should have taught them how to use a toilet! I have 3 boxes, all get changed daily.

Bottom line, I'm in this for Tommy. My vet wants us to keep him posted on everything. I don't mind paying for medicine, but I'm already charging that. I would prefer not to keep running to different vets just to be told something I've already researched myself. If something goes wrong, believe me, he'll get rushed in to the vet asap, but I feel like since I am home testing now, we might do ok. My vet suggested starting him at 1 unit. Should I continue with the humulin N today and start him on Lantus in the morning, or should I start him on the Lantus today sometime? Does 1 unit sound okay or should I start with .5? Is there a 'storage shed in Humulin N? Should I worry about an interaction if there is overlap?

Thanks in advance for the help, I know I have a million questions...
Christina and Tommy
 
Welcome, Christina!

you've come to the right place!

there's a wealth of information and support available here.
My only suggestion is to read the starred stickies at the top of the page to familiarize yourself with Lantus,
and the wise ones will weigh in presently...

celi & binks
 
New number is pretty high already... He's hating all the pricks it takes to get the blood from his ear. Wonder how much that has to do with the number....

March 23 (humulin N) -PS (6:03am) 483, +2: 339, +3: 344, +4: 386, + 5.75: 573
 
I'll second what celi said - no answers for you, but someone who knows more will be able to advise you. Those starred stickies at the top of this section are full of great information. i've had to read them all about a dozen times each!

Glad you're here! julie
 
If the insulin dose is too high, you may get the liver doing a protective thing which results in more glucose in the body. That will look worse and may result in a hypoglycemic attack when the liver becomes unable to keep up with the insulin.

A dose of 2 units b.i.d. (every 12 hours) isn't uncommon.

For the sore ear, pick up some antibiotic cream with topical anesthetic and apply it 10-15 minutes before testing to make him more comfortable with the process.
 
Hi Christine, welcome to LL!

I looked back at your previous threads on Health, and will link them here and here to allow others to get up to speed with you quickly.

Did the vet test for ketones? How was the diabetes diagnosed, from a BG test or fructosamine test? If the vet just tested BG level at the time of the visit, that's not as conclusive as a fructosamine test...which is an average of BG over a few weeks. Did he do any other blood tests...for example, for hyperthyroid?

Regarding the numbers being higher since you started him on insulin....it's likely that Tommy is bouncing from the fast drops or lower numbers he is seeing with the insulin. It's a normal reaction with diabetic cats that are used to high BG numbers...the BG drops due to the insulin, and the liver reacts by dumping stored glycogen and counterregulatory hormones to "protect" from him from hypoglycemia. This reaction happens even if he isn't seeing numbers that are too low....they are just lower than what he has become used to, or his BG dropped quickly. It's part of the sugar dance, frustrating but not unusual. Bounces can last up to 72 hours.

Humulin N is a quick and harsh insulin, so you need to feed before shooting. You will need to modify your routine a little with Lantus...you want to test, feed and shoot in that order, all within a short time (10 minutes or so). Lantus has a longer time before onset, usually 2-3 hours, so you don't need food on board ahead of time. You will want to test before feeding to make sure the PS tests are not inflated by food. Regarding the other feeding times, it's best to spread out the food over the cycle in small meals, similar to what you are doing...a lot will depend on how he responds to the insulin, so you can fine tune the feeding schedule after you get started. The only big thing to remember for now is to not feed for at least 2 hours before PS time, to avoid the food influencing the PS tests.

Humulin N does not have a shed, so it's fine to switch without a break between the shots. You can start Lantus 12 hours after the last Humulin N shot. There's no interaction between the two insulins as long as you aren't shooting them so they overlap, so no worries there...12 hours is long enough to avoid overlap.

How much does Tommy weigh? Is he overweight, underweight? Does he have any history of any other health problems?

As others have said already on the other threads, I would encourage you to eliminate all dry food. I would just switch all of your cats to the same LC wet food you are feeding Tommy. You would be surprised at the difference a little bit of dry food can make!

The 1u dose that your vet suggested is a typical starting dose for Lantus. I would prefer to see some more information before suggesting a starting dose.

Please do read the stickies at the top of the forum, there's tons of info there. Don't worry about asking a million questions...we like questions!
 
BJM said:
If the insulin dose is too high, you may get the liver doing a protective thing which results in more glucose in the body. That will look worse and may result in a hypoglycemic attack when the liver becomes unable to keep up with the insulin.

A dose of 2 units b.i.d. (every 12 hours) isn't uncommon.

For the sore ear, pick up some antibiotic cream with topical anesthetic and apply it 10-15 minutes before testing to make him more comfortable with the process.
Click to expand...
I'm glad BJ posted this...he is correct that if your dose is too high you will see high, flat numbers, puncuated with low numbers. This is why you need to get spot checks and nadir checks in addition to PS tests, to see what is happening after the insulin takes effect. If you only get PS tests, it's very easy to miss those low numbers that would show you that you are giving too much insulin.

Lantus dose is adjusted based on nadir, not PS, numbers. If you look at people's SS, you will see that most people get at least one spot check per cycle, every day, in addition to PS tests. Those spot checks are necessary to evaluate how a dose is working. A weekly curve is a much less useful way of evaluating a dose, although it does yield some information about onset, duration and nadir.

A dose of 2.0u is not a typical starting dose.
 
Hi Christine & Tommy and welcome! You will get lots of help here. As the others have said, start reading the "Sticky's", beginning with the one on "New to the Group". If you cut out all dry food you will be surprised at how Tommy's numbers will improve. Generally, the starting dose on Lantus is based on the cat's ideal weight. Most people start with 1 unit every 12 hours and work up according to the modified protocol we use.
Be sure to read the Sticky on how to handle Lantus. Keep it in the 'fridge. Don't shake or roll it; don't ever inject excess insulin back into the pen. We use syringes with the pens, treating the pen like a mini-vial. (Don't use the needles that come with the pens, because they only allow for measuring in 1-unit increments.) Get U-100 syringes with half-unit markings; most of us as we proceed up or down the dosing scale need to measure doses that are between the lines! When you draw out your dose, draw more insulin than needed, then slowly twist (more accurate than pushing) the plunger of the syringe while holding the syringe over a paper towel until you expell the excess insulin and reach your desired dose.

Good luck and ask any questions you need. Someone will always be along to help.

Ella & Rusty
 
Welcome to Lantus Land.

Laurie posted some great information to help you wrap your head around the difference between Lantus and N. They are very different in the way you need to think about dosing. I'm going to reiterate what others have said -- read the sticky notes!
  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal versions -- the Tilly Protocol developed by the counterpart of this group in Germany and the Queensland/Rand protocol developed by Jacqui Rand, DVM and published in one of the top vet journals.
  • New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
  • Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
  • Lantus depot/shed: This is an important concept for understanding how Lantus works.
  • Becoming Data Ready: What data you need in order to be able to work toward remission or tight regulation.
There's an overwhelming amount of information in these notes so please ask questions. The people here are very generous with their time and their knowledge. We're all here to help.
 
Hey Christina... welcome to lantus land :smile:

With regards to your kitty resenting ear pricks:

I use a super-warm light to heat simba's ear before pricking. This encourages the blood flow. You can actually see the veins rise! When I see that, I know he's ready for a prick.
I also use vaseline. A little dab smoothed over the area to be pricked ensures a nice bead will form - instead of seeing it leak into the fur where test strips can't retreive!
I also started using neo/polysporin with pain relief after a long day of ear pricks. It has lidocaine in it so it's uber soothing.

Best of luck,
Sarah.
 
Good morning!

Thanks for all the responses! I have read all the stickies. In fact, I have them all printed, highlighted, and started a notebook. It's so much information to take in. I think I have clicked on every link related to FD.... Most info repeats, but there are some discrepancies in info, so that's why I'm here! I figured no one knows unless they have been thru it themselves...

Did the vet test for ketones? How was the diabetes diagnosed, from a BG test or fructosamine test? If the vet just tested BG level at the time of the visit, that's not as conclusive as a fructosamine test...which is an average of BG over a few weeks. Did he do any other blood tests...for example, for hyperthyroid?
Click to expand...

Unfortunately he only did a BG test. His original number was in the 300s. Should I take him back to the vet to get a full panel blood test done to rule everything else out? The vet asked about his water intake and urine output before he did the BG test. As soon as I told him the litter boxes were being filled much faster than before, he said he thought it wasFD. He tested Tommy's blood twice, both numbers were in the 300 range.

Tommy's Medical History- I found Tommy on Thanksgiving 6 years ago. Like with all my animals, I immediately took him to the vet to be checked out, neutered, and vaccinated. Once a year he goes for his shots. He has never had any tests done. Tommy was a very large cat- not obese- he's very tall and very long. He was a stray, so I don't really know much else about his breed. In the summer he is usually 16 pounds. All 3 of my cats go outside during the day. I have land that they love to roam! When he was at the vet last December, he was 18 pounds. I noticed he was thinner around the beginning of February. When he was originally diagnosed with FD the end of Feb, he was down to 13 pounds.

If I can provide any other info on here, please let me know.

Recap of yesterdays PSnumbers: AMPS:483, PMPS:538
This mornings AMPS: 342. I gave him 1 unit of Lantus. So now every 12 hours, I will give him 1 unit. I have the Tight Regulation Protocol general guidelines as my guide. Is this ok?

I am picking up the ketostix later today. How often should I be testing that?
Should I BG test him hourly today since it's his first day on Lantus?

Thanks again everyone!
 
Be sure to read the Sticky on how to handle Lantus. Keep it in the 'fridge. Don't shake or roll it; don't ever inject excess insulin back into the pen.
Click to expand...

This is one of those things I read different things on. Most say to keep it in the fridge, but I read somewhere that the pen you are using should be kept out of the fridge. The pharmacist also told me not to keep the pen I'm using in the fridge, too. He said it would sting if I injected it cold. But, is the reason we keep it in the fridge so that it lasts longer? I know it says to throw away each pen after 28 days, but I've read that some people use the same pen up to 6 months...

Thoughts?

Christina and Tommy
 
Given Tommy's size, you are starting at a very conservative dose of Lantus. For the initial dose, you can use a weight-based formula: initial dose = 0.25 x ideal weight in kilograms. If we assume Tommy's ideal weight is 16 lbs, his starting dose would be approximately 1.75u. You can stick with the 1.0u. You should just know that it's probably not going to be enough. You need to hold this dose for 5 - 7 days to fill the shed.

Also, if you are forced to use any dry food, you may want to consider EVO. It's far less carbs than what you're feeding. Please look at Janet & Binky's list for something less than 25%. Transitioning all the kitties to canned will make life easier. The dry food is bad news. If you've not looked at Lisa Pierson, DVM's website on feline nutrition, you may want to read what she has to say.

The manufacturer does recommend that any unused Lantus be discarded after 28 days. Many people here do just that. Others will use their insulin longer. There are members of the German forum who have used their Lantus for up to 6 mos. but I don't believe anyone here has been able to use their Lantus that long.

The box of pens does say to not refrigerate after a pen is opened. Interestingly, my pharmacy put a "keep refrigerated" label on my new box. Here's my understanding of the discrepancy. When Lantus was put in pens, it solved a problem that human diabetics had struggled with -- how to travel and keep your insulin refrigerated. The pens didn't require refrigeration and were in a relatively safe container. I suspect that the issue is not one of whether to refrigerate or not but keeping the temperature consistent. Lantus is more fragile than insulin like Humulin N. Keeping it within a consistent temperature range seems to make sense. Likewise, cats use far less insulin than humans so in order to maximize the life of the insulin, refrigerating also seems to make sense. Someone mentioned that the mechanics of the pen may not work if the pen is refrigerated. Since we do not use the needles that come with the pens, this isn't an issue.
 
Thanks for the info! That clarifies that!

I will keep his shot consistent for the 5-7 days and keep posting my numbers. I am going to try and figure out the spreadsheet stuff. Someone sent me a few links to try. Thats prolly the best way for everyone to see Tommy's info.
 
Good morning! Great to hear that you have read the stickies and printed them out! One unit is fine as a starting dose. You may have been able to start higher, taking his weight and current dose of N into consideration, but I think 1u is ok.

It's great that you are getting the ketostix today, just get a test as soon as you can. As far as how often to test for ketones, there are no specific "rules"....if the intial test is negative, I would try to test every few days until his numbers are staying in the normal range (when he is regulated). Make sure you follow the directions on the bottle...if the strips are outdated or you wait too long to read the test, you may get a false positive test. If he has ketones, please post right away!

When you first start, we recommend that you test at PS, +3, +6, and +9 for the first 3 days. Most of the time, you won't see much reaction to the Lantus until the shed is filled (5-7 days), but some cats do respond right away. Hourly tests are not necessary unless you see a dramatic response and the numbers are low.

It wouldn't hurt to ask the vet to do a full panel, including a T4 to check his thyroid, just to catch any other issues. The fructosamine test is unneccessary if you are home testing, IMO....others may disagree, since it is the most accurate test for diagnosing diabetes. Since he clearly has elevated BG and has been treated for the last month or so, I think it's a fair assumption that he has FD and the fructosamine is a waste of money at this point.

I would store all of your insulin in the fridge. Lantus stings because it is acidic...the temperature contributes, but the main thing is the acidity. You can draw the insulin and warm it by rolling the syringe between your fingers if you want to make the injection more comfortable. I have read that the reason the manufacturer tells you to store opened pens at room temperature is because when humans use the pens, there are issues with leakage from the pen needles when the pen is subjected to temperature changes. Since we don't use the pen needles, this is not a concern for us. Your insulin will last longer if you keep it refrigerated. Some people use the pens past the 28 days, some people open a new pen at or around 28 days. I would use it until you see signs that it is losing potency.

It would be great if you can start a spreadsheet. While it isn't absolutely necessary, it does make it much easier for you to keep track of his BG, and for us to help you. The link is here

Sheesh, I'm wordy today...sorry about the length of this post!
 
just saying that while setting up the Spreadsheet takes a little bit of doing, i can't believe how helpful it is once you are getting some numbers into it. you can see how your cat responds to the insulin and it helps you understand the whole flow of it better. at least it did me.

Glad you're getting some good advice and getting it all figured out!
 
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