the first dosis of lantus

Status
Not open for further replies.
L

lybia palermo

New Member
Hello! Teofilo, my cat , has started to use Lantus today. 1UI. He had it in the morning, around 11 o' clock. At this moment his glicosis was 295. After 6 hours it was 245. I was motivated, but I did the controll after 12 hours again because it is half the period of action of lantus. His glicosis is the same as it was in the morning. Is it ok for the first day? His doctor called me up to get informed about his first experience with lantus. She said that day by day the body gets used more and more and the resoults can be better with the same dosis. Do you agree? She also said that sometimes it is necessary to give more than 1 UI. I've already introduced myself and my cats and I've got lots of wellcome . I'm Brazilian from Rio de Janeiro.
I hope you can answer this question.
Thank you
lybia
 
I'm new at this too, but from what I understand, it takes a while for the insulin to build up in the body and then begin to lower the cat's glucose. My cat has been on Lantus for four days, and her blood sugar is dropping slowly. I think that's normal.
 
grapey said:
I'm new at this too, but from what I understand, it takes a while for the insulin to build up in the body and then begin to lower the cat's glucose. My cat has been on Lantus for four days, and her blood sugar is dropping slowly. I think that's normal.
Click to expand...

I'm so glad to read it! So I have hope. If I compare the index of other nights I'm compelled to believe that it's going to wor. Yesterday night it was 355, so...
My frustation concerns the index of this morning 295 and the resoult, today after 12 hours 297...
Your experience is important for me.
Tchau
Lybia
 
grapey said:
I'm new at this too, but from what I understand, it takes a while for the insulin to build up in the body and then begin to lower the cat's glucose. My cat has been on Lantus for four days, and her blood sugar is dropping slowly. I think that's normal.
Click to expand...

If you don't mind ,could you tell me the dosis prescribed for your cat and his numbers of glucose? It's also importante for me to have an idea.
Tchau
Lybia
 
It does take time for Lantus to build up in their systems. You should come over to the Lantus board. There is a huge amount of info there.
 
Hey, Lybia -

Don't know if you saw my response to your PM, so I'm copying it here.

"From all I read about Glipizide, I'm really glad you're no longer using it and have started Lantus. My kitty uses ProZinc, so I'm really not familiar with Lantus. I have sent out a note trying to find someone who knows more about the way Lantus works. I can tell you that we recommend starting with a low dosing and increasing in small amounts. My kitty takes several days to 'adjust' to a new dose and it takes all of the patience I can find not to 'get ahead of myself.'

Feline diabetes is very manageable, but it doesn't happen overnight, unfortunately. There are some days that I think I'm getting close to understanding what dose Hershey needs, and other days that I feel completely confused! (295) or (297) for the Pre-Shot (PS) is higher than you may want to see, but it's not dangerously high, especially since you're just starting out.

So, you're hometesting, right? Are you feeding lower carb canned food entirely? That's one of the variables we can control in this 'dance' - wish we could control more.

I can't advise you on dosing, but I can tell you that you're doing great and that this DOES get easier. You have found a wonderful resource in this forum, this group of people. We all love our furry friends and want to do our best to help each other out.

I'll let you know as soon as I hear from someone who uses Lantus.

Take care -"

I see you've posted here and have already been receiving some help from other Lantus users. I'm sure they'll be able to guide you in the right direction.

Libby (and Hershey, too!)
 
Hi Lybia

Deep breaths, all is well. Lantus takes a little time to build up a shed so you generally won't see any real action for the first day or two. 1 unit is an appropriate starting dose and you don't want to tinker with that (unless you get a low number - how low depends on which protocol you're following - more about that later) for at least 5-7 days while you give the dose time to settle in.

It is great that you are home testing, this is very important for keeping Teofilo safe.

There are two main protocols that are followed here using lantus. There is tight regulation (TR) which gives Teofilo the greatest chance of remission and also the start low go slow protocol (SLGS) which you must use if you are not feeding low carb wet food and/or are unable to get sufficient tests to use the TR protocol.

I will just go and find the links for the protocols for you - be right back.

Serryn
 
lybia palermo said:
Hello! Teofilo, my cat , has started to use Lantus today. 1UI. He had it in the morning, around 11 o' clock. At this moment his glicosis was 295. After 6 hours it was 245. I was motivated, but I did the controll after 12 hours again because it is half the period of action of lantus. His glicosis is the same as it was in the morning. Is it ok for the first day? His doctor called me up to get informed about his first experience with lantus. She said that day by day the body gets used more and more and the resoults can be better with the same dosis. Do you agree? She also said that sometimes it is necessary to give more than 1 UI. I've already introduced myself and my cats and I've got lots of wellcome . I'm Brazilian from Rio de Janeiro.
I hope you can answer this question.
Thank you
lybia
Click to expand...

Hi Lybia,
Yes, that number is fine for the first day.. it normally takes about 5 days to let the insulin settle and show how well it's working for Teofilo.

Here are some notes on the protocol followed on this board for Lantus:
"General" Guidelines:
--- Hold the initial starting dose for 5 - 7 days (10 - 14 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 cycles).
--- Each subsequent dose is held for a minimum of 3 days (6 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.

Increasing the dose...
--- Hold the dose for 3 - 5 days (6 - 10 cycles) if nadirs are less than 200 before increasing the dose.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Reducing the dose...
--- If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

--- If an attempted reduction fails, go right back up to the last good dose.
--- Try to go from 0.25u to 0.1u before stopping insulin completely.

Random Notes...
Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.

A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.




How to do a Curve
Example of a typical curve:
+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 (may dip around +10 or +11).
+12 - PreShot number.
 
Here is the link to the TR protocol, that page also contains a link to the SLGS protocol. As I said earlier the TR protocol has the highest chance of remission but remissions can also be achieved using SLGS.

http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

Have a read through and see which you think is best for you. Then I would recommend you post any lantus related questions in the insulin support groups - lantus (glargine) tight regulation forum. This is the busiest forum for lantus users and you will find people there are very experienced using lantus and very happy to help you with Teofilo.

To help us help you it would be great if you could set up a spreadsheet for Teofilo's BG results. Here is the link to help you to do that http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=50130

I saw mention of glipizide use earlier, can you advise how long the glipizide was administered please and also what you are currently feeding Teofilo and how you are feeding it, e.g. free feeding or a certain number of meals per day and whether or not he is overweight and has any other recent medical issues.

Welcome aboard Lybia, if diabetes had to happen to Teofilo this is the place you want to be to make it try and unhappen :smile:

Note - the guidelines provided by Gayle are for the TR protocol. It is not safe to use this protocol if you do not have Teofilo on a low carb canned food diet and/or are unable to test sufficiently often.

Also we do not do a curve by testing every hour, a curve is done by testing every two hours (you need to be able to do this a minimum of once a week using the TR protocol). The e.g. provided by Gayle just shows how lantus typically works over the whole of the cycle on an hour by hour basis.
 
Hi Lybia, welcome to Lantus.
You want to hold the initial dose for 3 - 5 days.
Lantus builds a shed which has to fill first. I think that's why it takes a few days to notice a difference.
When I first switched DC to Lantus, it took around 6 days to notice a significant change.
Although every cat is different. I'm sure you'll like the switch.
Lantus likes consistency so you want to shoot as close to the same time as possible 12 hours apart twice a day.
I shoot at 10am and 10pm.
I would post to the Lantus board, you will get many more eyes and much more response that way.
 
Hi Libia. Welcome :-D
I think you'll get good results using Lantus. But it does take patience, and lots of it.
Keep posting with your test results and let us know how Teofilo is doing daily with the 5 Ps of Playing, Purring, Preening, Pooping, Peeing (that's part of what we call the WCR or Whole Cat Report, as a cat is more than just numbers :-D )
I hope to see you around.
 
No matter what kind of protocol you follow, you can still use the general guidelines in determining dose adjustments.

Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.
Click to expand...
You can be on either protocol or some other that is modified by you and your vet, you will still use the nadirs, the lowest point in cycles as your dosing guide.

if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
Click to expand...
if you are testing in the middle of cycles and getting numbers over 200 and under 300, and you have given that dose for at least 6 cycles/3 days, increase your dose by .25 units.

if nadirs are greater than 300 increase the dose by 0.5 unit.
Click to expand...
if you are testing and the low points are above 300, then increase your dose by .5 units after holding the dose for 6 cycles/3days.

He had it in the morning, around 11 o' clock. At this moment his glicosis was 295. After 6 hours it was 245.
Click to expand...

Now looking at the numbers you gave in your post, if you kept giving the 1 unit twice a day for 5 days, and you were still getting BG above 200 at that 6hours mark, you could increase Teofilo's dose to 1.5 units twice a day.

Just be sure to hold the 1unit twice a day for 5days as the insulin shed fills.
If you can test before each shot, and again at 6hours after each shot, you will have the info you need to be decide on Teofilo's dose.

Now remember that the more important numbers are the ones around 6hours after shot, as that number should be lower than the test number at the time you gave the shot.

And day by day, you should see some improvements and some lower numbers. If not, then you can increase the insulin according to above...

If she is having all her numbers at 6hours after the shot above 300, then increase your dose by .5units.

If she continues to have all her numbers at 6hours after the shot like yesterday, above 200 but below 300, then increase your dose by only .25units.

Do you have syringes with 1/2 unit markings?
 
Welcome, Libia.

I just want to clarify -- how many times per day are you giving an injection of Lantus/glargine? You stated,
I was motivated, but I did the controll after 12 hours again because it is half the period of action of lantus.
Click to expand...
. Unless I'm not understanding, this statement is not correct for felines. In humans, Lantus is given once a day. Because cats have a faster metabolism than humans, Lantus is given twice a day so it's mid-point is 6 hours, not 12 hours.
 
From the SLGS protocol gudielines:

Step 2. Don’t increase the dose until your cat has been on it for at least a week. If you have reason to be concerned about hypoglycemia, or if your cat won’t eat, do decrease the dose and contact your vet. Do test your cat’s urine frequently during the regulation process using Ketostix or Ketodiastix, and contact your vet immediately if the cat tests positive for ketones. Do be consistent in the timing and type of food. Do give the shots at about the same time every day.

Step 3. After 1-2 weeks at a given dose, you or your vet should perform a serial blood glucose curve (blood glucose tests every 2 hours, starting at shot time and continuing until the next shot). Follow the cat’s normal feeding schedule during the curve. The curve should be evaluated by someone experienced at interpreting feline blood glucose curves, in order to check for signs of rebound and other possible problems. If no rebound is present, follow these guidelines for dose adjustment (smaller adjustments may be appropriate for cats on PZI or Lantus):

a) If the lowest point of the curve is above 150 mg/dl (8.3 mmol/L), increase the dose by 0.5 unit.
b) If the lowest point of the curve is between 90 and 149 mg/dl (5.0 and 8.2 mmol/L), keep the dose the same.
c) If the lowest point of the curve is below 90 mg/dl (5.0 mmol/L), decrease the dose by 0.5 unit.
Step 4. Repeat the cycle of curving and waiting 1-2 weeks. As your cat’s blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases. If you decide to change another factor (e.g., diet or other medications), don’t increase the insulin dose until the other change is complete (but do decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change). Don’t be tempted to rush the process along by increasing the dose more quickly or in larger increments-- no matter how high your cat’s blood glucose is! Rushing towards regulation will cost you time in the long run, because you may shoot past the right dose.
Click to expand...

Quite different from the TR guidelines for that protocol. In particular you do not want to be waiting to catch a nadir under 50 for a decrease if you are not feeding a LC canned diet and testing sufficiently. As per the notes about smaller adjustments being appropriate for Lantus users we would generally make adjustments by only 0.25. An exception to this is when an increase is called for and the cat is having nadirs above 300 in this case you would increase by 0.5 but I highly recommend you post in the lantus TR forum (even if you elect to follow SLGS because people there are knowledgeable about both protocols) for advice about changing doses (not because the relaxed forum doesn't have experienced users too but because the TR forum is a lot busier) :smile:
 
lybia palermo said:
Hello! Teofilo, my cat , has started to use Lantus today. 1UI. He had it in the morning, around 11 o' clock. At this moment his glicosis was 295. After 6 hours it was 245. I was motivated, but I did the controll after 12 hours again because it is half the period of action of lantus.
lybia
Click to expand...
I would like to be clear on your dose. Are you giveing Teofilo 1 unit once a day or twice?
 
Status
Not open for further replies.
Back
Top