Target Blood Sugar Levels

[JenniferG]

Hi Everyone,
One of our cats (Robinton, but we call him Boo, long story) was diagnosed with diabetes last week. He's also suffering from neuropathy in his hind legs, so his blood sugar must have been elevated for some time.
His blood sugar was over 400 when the vet tested him and the first time we tested at home before giving him insulin was 263. Our vet prescribed 3 units of Lantus bid. We weren't vigilant about testing him initially. Our vet was most concerned with his BG halfway between his shots, so we didn't test him again until +6 hours after his second dose and his BG had dropped to 47. That made us concerned about hypo. We got him to eat more and gave him a bit of honey. Over the next couple hours, his BG had dropped even further to 40, but he didn't have any hypo systems. We were in contact with the vet who told us to hold off on any further insulin and to keep checking his BG levels. We even went down to the vet and tested our meter against theirs. It's been 3 days with no more Lantus. He's doing well and BG has stayed from 150 to 200. I'm very nervous about giving him more Lantus during the week. My husband and I both work. We want to be home to monitor him closely when we try again with a lower dose.
Here's my question. What BG levels should we be aiming for when we start Lantus again? I'm nervous about hypo, so I don't want to be too aggressive.

 

[Anne & Zener GA]

Hi Jennifer, you're in the right place to get dosing advice for Lantus. Thank goodness you tested him and gave him honey! What does Boo weigh? What should he weigh?
Liz, Zener's other mom

 

[Sienne and Gabby (GA)]

Welcome to FDMB!

It sounds like you have very good instincts! It's also a huge benefit that you have started home testing.

What are you feeding Boo? If you have switched him to a low carbohydrate (LC) diet -- preferably one that is based on canned food -- there is a good chance that Boo's numbers dropped due to the diet change and insulin. If Boo has always been on a LC diet, then it's very likely that 3.0u is too much insulin.

There is actually a formula for calculating the initial dose of Lantus: initial dose = 0.25 x ideal weight in kilograms. This formula usually yields a dose that's in the neighborhood of 1.0u. Most people find it easier to start at a lower dose and increase as they need to rather than starting at a higher dose and needing to reduce.

There is a great deal of information about Lantus in the starred sticky notes at the top of the Lantus Tight Regulation board. Below is an overview of the information in those 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.
• Lantus & Levemir: Shooting & Handling Low Numbers: What data you need in order to be able to work toward remission or tight regulation as well as information if you have a low pre-shot number or a drop into low numbers during the cycle.

 

[JenniferG]

Boo is 13.6 pounds. He's probably about the right weight now. At one time, he was over 20 pounds, but nothing we did made him lose weight. I should have known something was wrong when he started losing, but it happened pretty slowly. We're feeding him FF classics based on the suggestions here, but we also have EVO dry out out for one of our other cats that refuses to eat anything that resembles meat. That one has no idea he's a carnivore. I see Boo munch a few kibbles here and there but he prefers the wet food.

Thank you for the links. I will read over all of that. I wasn't sure if our work schedules would make it possible to follow a tight protocol safely, but I would like to do everything we can to get his back legs to improve. Our vet has given him a couple of B-12 shots and we've discussed doing it once a week for a few more weeks.

 

[Anne & Zener GA]

Zener had peripheral neuropathy (walking on his hocks) and we started giving him a 3 mg pill of zobaline every day. It took a few weeks but he slowly got better and we do not see any evidence of it now. That's a lot cheaper and easier than shots at the vet.

You could probably start Boo at 1.5U BID, or a little less if you feel more comfortable there. Quite frankly, 3U BID is way too high. I know vets mean well but we see this quite often, where the vets do not know a good protocol for Lantus or how to deal with feline diabetes in general. Zener wouldn't be alive, let alone thriving, if we hadn't this place.

I invite you to post on the Lantus - Tight Regulation forum. This is the tight regulation protocol but several people also follow the Start Low Go Slow protocol. Either is fine. There is a lot of activity on the Lantus forum and you will get quick responses to your questions, especially if you have an emergency.
Liz