Sticky The Basics: New to the Group? Start here!

Discussion in 'Lantus / Levemir / Biosimilars' started by Jill & Alex (GA), Jun 25, 2010.

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  1. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Dec 28, 2009
    If you're new to the FDMB, please start on FELINE HEALTH: The Main Forum where you'll learn all about hometesting, the basics of feline nutrition, and feline diabetes.



    Symptoms of & how to treat HYPOGLYCEMIA - what to do if your kitty experiences hypoglycemia
    Jojo's Hypo Tool box - be prepared, what to have on hand in case of an emergency
    Don't Panic! or How to Handle Low Numbers

    Welcome to the Lantus, Levemir and Biosimilars Group!

    We've put together information we think will be helpful. Most Stickys and Info posts have links (clickable, in blue font) to provide answers to many of your questions. Although, one of the first things you'll probably want to do is check out the Syringe & Insulin Info: Handling, Drawing, & Fine doses sticky to learn how to properly care for your insulin so it'll last as long as possible.

    Confused about our jargon? Don't let it scare you off! You'll catch on in no time.
    Until then, here's some help:

    Daily Threads & Posting Instructions for this forum:
    • Please use one thread for all your comments and questions you have that day since this forum is so busy. This will keep all pertaining to your cat together everyday.
    • Start your thread with the date, kitty's name, and AMPS
    • Your thread will be bumped to the top of the list when you or anyone else posts on your thread.
    • The 911 prefix in the subject line should only be used for emergencies such as symptomatic hypos, very low numbers (below 30 on a human meter), and/or very sick cats potentially needing ER care. Please remove the 911 as soon as someone has responded and you have received help.
    • Making the Most of Your Lantus, Levemir, & Biosimilars ISG Experience
    How to Create a Spreadsheet:
    • Please set up a Google Spreadsheet as soon as possible. Always keep spreadsheets up-to-date! Valuable time may be lost looking for information when a spreadsheet is not up to the minute.
    • If you have not been able to transition your kitty off of DRY food yet, please note it on your spreadsheet and in your signature. A dry food diet will often require higher doses of insulin to bring numbers down. Having this information plainly visible will help us help you.
    How to Use the Spreadsheet

    Creating a FDMB Profile

    Blood Glucose Converter Calculator (1 mmol/L = 18 mg/dL)

    Index: Health Links/FAQs

    Food and feeding:

    Why do spot checks or curves?

    Example of a prolonged hypo: Baby begins Lantus (first day, first shot).

    Meowzi surprised her caretakers one night! Luckily, they caught the low by doing a simple spot check.
    PMPS 241; +4~132; +7~20; +7.25~31; +7.5~47; +8~89; +9~93

    Reference numbers given are for blood glucose meters calibrated for humans, not pet-specific meters.

    Blood Glucose Meter Ratings, Comparisons, & Recommendations

    Pet-calibrated AlphaTRAK meters and AlphaTRAK test strips:
    The pet-calibrated AlphaTrak (AT) (current version) is widely considered by vets to be the “gold standard” for testing blood glucose for cats because the results are closer to that of veterinary lab equipment. An AT meter must be purchased either from a vet clinic or online. Most vets don’t carry the test strips. They are much more expensive than human meter strips. Some additional info: Alpha Trak

    Learn how YOUR kitty is responding to insulin:

    • Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
    • Peak/Nadir - the lowest point in the cycle
    • Duration - the length of time insulin continues to lower blood glucose
    • How to do a Curve - a simple explanation

    Example of an ACTIVE, but NOT necessarily typical Lantus and glargine biosimilars cycle:
    NOTE: Until kitty is pretty well regulated, the description below is NOT not what you'd consider a "typical" Lantus/Basaglar/Semglee cycle. It takes time and patience for kitty to achieve a "typical" cycle! The example below is what you're working towards (a nice shallow curve). A relatively flat cycle is the ultimate goal.

    +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. Onset begins around +2 for most cats. You'll probably see an active cycle if the +2 is the same/similar OR lower than the preshot number. Continue testing!
    +3 - Often lower than the PreShot number.
    +4 - Lower.
    +5 - Lower.
    +6 - Nadir/Peak (the lowest number of cycle. NOTE: ECID. Not every cat has a mid-cycle nadir. Adjust the hours on this example to fit your cat.)
    +7 - Surf (hang around the nadir number).
    +8 - Slight rise.
    +9 - Slight rise.
    +10 - Rising.
    +11 - Rising (one of the quirks of Lantus/Levemir/Biosimilars: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
    +12 - PreShot number.

    An active Levemir cycle will have an onset at approximately +4 and a nadir around +8 - +10. However, please keep in mind every cat is different (ECID). Data collection will offer you a better picture of YOUR cat's response to either of these insulins.

    Initially, don't expect to see "active" cycles after every single shot whether you're using Lantus, Levemir or Biosimilars. Chances are, your kitty had diabetes for some time before diagnosis. It requires time for kitty's body to become used to dropping into lower numbers than their bodies have become accustomed. Don't expect immediate results! Regulation takes time and patience:

    • Also worth noting: "Many cats will occasionally react to an increased dose with increased BGs - within the first 2 to 3 days after an increase, usually lasting for less than 24 hours. Nobody really knows what the reason for this phenomenon is (perhaps a "panicky liver"?) - hold the dose and ignore the fluctuations." Here in the Lantus, Levemir, and Biosimilars Insulin Support Group (ISG), we've affectionately dubbed this unexplained phenomenon "New Dose Wonkiness" (NDW).
    A full understanding of the following concepts will go a long way in helping you regulate your kitty's blood glucose when using Lantus or Levemir or Biosimilars:
    • Carryover - insulin effects lasting past the insulin's official duration
    • Overlap - the period of time when the effect of one insulin shot is diminishing and the next insulin shot is taking effect
    • Insulin Depot - a "spare tank" of insulin, which has yet to be used by the body
    • Lantus, Levemir, Biosimilars: What is the Insulin Depot?
    • Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

    'What is Regulation?':

    There are different definitions of regulation. As hometesting becomes more common, we've been getting a better understanding of what cats and their humans might be capable of. Janet & Fitzgerald propose the following "regulation continuum":

    • Not treated - blood glucose typically above 300 mg/dl (16.7 mmol/L), poor clinical signs
    • Treated, but not regulated - often above 300 (16.7) and rarely near 100 (5.6), poor clinical signs
    • Regulated - generally below 300 (16.7) with glucose nadir near 100 (5.6), good clinical signs, no hypoglycemia
    • Well regulated - generally below 200-250 (11.1-13.9) and often near 100 (5.6), no hypoglycemia
    • Tightly regulated - generally below 150 (8.3) and usually in the 60-120 (3.3-6.7) range, no hypoglycemia, still receiving insulin
    • Normalized - 60-120 (3.3-6.7) except perhaps directly after meals -- usually not receiving insulin
    There may also be an extra category of "mostly above 300 (16.7) but with good clinical signs" which occurs with some cats who are getting insulin. We don't know why it happens, but such a cat probably should not be considered to be regulated. On the other end of the spectrum, it is possible for a cat who is not getting insulin to have blood glucose as low as 40 mg/dl (2.2 mmol/L) on a glucometer calibrated for humans. If you have a non-diabetic cat, try testing her with the same meter to get a safe comparison figure.

    Approaches to Regulation:

    Many here choose one of two methods to hopefully achieve regulation: Tight Regulation Protocol with Lantus or Levemir or a less intense method with fewer blood glucose tests required called Start Low, Go Slow (SLGS).
    Note: Lantus, Basaglar, and Semglee are brand names for insulin glargine, also called Biosimilars.

    Both approaches were created and developed by laypersons using human meters. Reference numbers given for blood glucose numbers are from blood glucose meters calibrated for human use.

    As of this writing, the Tight Regulation Protocol with Lantus or Levemir for Diabetic Cats is the only published protocol we know of for use with glargine or detemir. This approach was created by laypersons from the German-Katzen Group and was eventually published several years later.

    The TR protocol is the same, but presented in different formats here:

    Many glargine and detemir users in this forum have been successful following a somewhat modified version of the Tight Regulation Protocol for years. These "general" guidelines are based on anecdotal evidence and personal experiences of laypersons frequenting this Insulin Support Group.

    If the Tight Regulation Protocol isn't the right fit for you, the FDMB's Start Low, Go Slow Method (SLGS) offers an alternative method for regulation. SLGS offers caregivers a less intensive approach to managing their cat's glucose levels.

    Guidelines listed for each of these approaches are not intended to portray the ONLY way you can use Lantus, Levemir, and Biosimilar insulins. The guidelines on this website suggest how to best use Lantus, Levemir, or Biosimilars when following one or the other of the protocols mentioned above. Be aware there are other feline diabetes message boards on the web using different dosing methods/protocols successfully.

    Once you have learned the onset, peak/nadir, and duration of the insulin in your cat by collecting data from spot checks and curves you'll want to be sure to read Shooting & Handling Low Numbers if you're following the Tight Regulation Protocol.

    Links to more information and discussion:

    Please be aware: There are not any "dose advisers" or "experts" on the FDMB. The FDMB is an open board subject to peer review where laypersons with varied degrees of knowledge and experience are free to share their own thoughts and opinions through explanation and by making suggestions.

    We are not veterinarians. It is not our intention to take the place of your veterinarian. Please discuss dosing, methods, medications, and care for your cat with your veterinarian.

    Hope this information helps ease your way through this journey...


    WELCOME to the LANTUS, LEVEMI, and Biosimilars

    This document was written by FDMB members Jill & Alex (GA) and jojo and bunny
    with contributions from Libby and Lucy and wcf and meowzi.

    Attached Files:

    Last edited by a moderator: Jun 1, 2024
    Reason for edit: Glucometer discontinued
  2. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Dec 28, 2009
  3. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Dec 28, 2009
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