TID dosing
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Monique & Spooky
Very Active Member
TID dosing is not usually needed with insulins like Lantus and Levemir. It is somewhat more common with PZI insulin and some people have had good results with it. It can be done with any insulin but only after exhausting all other alternatives and when certain problems in an individual cat are present. It is very time consuming and reqiures additional testing and monitoring. I would only recommend it for a very few individuals. Since there isn't much information available on the effectiveness it's sucess is unproven and it's uncharted territory. Are you just curious or are you wondering if it may be applicable to your situation?
Just curious mainly. I used tid dosing with BCP pzi several years ago. Definitely time consuming. Had pretty good results with the cats I had then (if you check my signature you'll see I've adopted a lot of diabetic kitties although they came in various stages of disease so some I didn't have very long while others were with me the longest at 4 years). Tried levemir off/on for several years but out of lev and had the lantus pens so really wanting to learn it. Having good results with 2 cats, so/so results with 2 cats, other 2 cats are new to household and just starting lantus.
I had just not seen tid dosing with lantus mentioned and wondered when you would consider doing it and why?
I had just not seen tid dosing with lantus mentioned and wondered when you would consider doing it and why?
Monique & Spooky
Very Active Member
Got your hands full eh? 
Lantus and Levemir are so much the same in how they work (biochemically quite different though) the only noticeable differnce is the color of the pen! I really don't know under what circumstances an attempt at TID would make sense, I know (as you probably do as well) people on PZI often try it when they aren't getting enough duration out of a shot shooting 12-12. Lantus has a typical duration of 12-16 hours with the nadir usually occuring between +6 and +12. With Lantus the main effects are in the 12 hour period when it lasts 16 hours the "overlap" simply keeps the cat in the lower range until the new insulin shot starts working (onset is at about +3) I guess TID might be a consideration if it is belived high preshot numbers are occuring because of a lack of duration or overlap. If the nadir is occuring at +6 regularly and after +10 the rise is generally steep until +12 and it takes until +3 before a drop begins then by shooting every 8 hours a smaller dose you could potentially create a 3 hour overlap.
Might look something like this
PS#1 450 (.5U)
+3 330
+6 120
+8 (PS#2) 280 (.5U)
+2 220
+6 80
+8 (PS#3) 150 (.5U)
+1 148
+4 65
+8 110 (.5U)
I think after a few cycles you may have a larger shed built up and a significant overlap so that either you will have numbers going to low (which could mean hours of HCing) and you would need to reduce the dose (perhaps just the middle one) or return to 12-12 dosing.
It's a "shot in the dark" but certainly not unthinkable. I personally wouldn't have the patients for it.
Lantus and Levemir are so much the same in how they work (biochemically quite different though) the only noticeable differnce is the color of the pen! I really don't know under what circumstances an attempt at TID would make sense, I know (as you probably do as well) people on PZI often try it when they aren't getting enough duration out of a shot shooting 12-12. Lantus has a typical duration of 12-16 hours with the nadir usually occuring between +6 and +12. With Lantus the main effects are in the 12 hour period when it lasts 16 hours the "overlap" simply keeps the cat in the lower range until the new insulin shot starts working (onset is at about +3) I guess TID might be a consideration if it is belived high preshot numbers are occuring because of a lack of duration or overlap. If the nadir is occuring at +6 regularly and after +10 the rise is generally steep until +12 and it takes until +3 before a drop begins then by shooting every 8 hours a smaller dose you could potentially create a 3 hour overlap.Might look something like this
PS#1 450 (.5U)
+3 330
+6 120
+8 (PS#2) 280 (.5U)
+2 220
+6 80
+8 (PS#3) 150 (.5U)
+1 148
+4 65
+8 110 (.5U)
I think after a few cycles you may have a larger shed built up and a significant overlap so that either you will have numbers going to low (which could mean hours of HCing) and you would need to reduce the dose (perhaps just the middle one) or return to 12-12 dosing.
It's a "shot in the dark" but certainly not unthinkable. I personally wouldn't have the patients for it.
chriscleo
Very Active Member
some use TID when they don't get enuf duration, for whatever reason. at one point i almost resorted to TID full time with lantus, because cleo is now on a steroid and we were thinking a tinier dose more often might keep her numbers more stable/consistent.
it's really rare for a cat on lantus to need it, tho. it gets significantly more duration than pzi or vetsulin (8 hrs for cleo on pzi but 13-14 hrs for cleo on lantus).
it's really rare for a cat on lantus to need it, tho. it gets significantly more duration than pzi or vetsulin (8 hrs for cleo on pzi but 13-14 hrs for cleo on lantus).
Why so many questions from me.
My friend, Samantha, has worked with her vet using BCP PZI for all their newly-diagnosed feline diabetics. I know she's had over 32 cats from two vet hospitals referred to her. Of that only 3-5 have remained on insulin, the others just either had a diet change putting them into remission or diet and a little insulin for remission to happen. But right now Samantha teaches tid, sliding scale at first and you are tied to her hip discussing dosage, what's happened, food fed before each shot. So...now some of the vets are going with Lantus. Samantha doesn't know lantus and, like me, is learning but she is not a person to use message boards much with pet sitting, old aunt to care for, family. She thinks lantus is harder to learn (I think it's fairly easy with the protocol list showing how much to start with, when to go up or down, etc) and she knows pzi and has had success with it. But she is being forced to take on some vet clients using lantus. When I saw the tid reference (and maybe I should have brought up my questions in that particular thread) I thought it might be something Samantha would be interested in and wanted to find out the particulars about it.
My two newest diabetics (Xena and BIg Red, a foster kitty) came from the same vet hospital. They use lantus. They also arbitrarily give a depomedrol shot to incoming cats !?! Crazy! But they each started out at 3 units, going up or down on dosage given, with the cats going from 400's down to 30 and then being given another 3 or 2 or even 1 unit. No rhyme nor reason as to dosing. Xena can't even handle .1 units of lantus causing her to drop in the 30's and then rebound up so I switched her to BCP at a low dose to see what happened. It has smoothed her out, and I believe she has a sputtering pancreas I'm having to deal with. (Therefore the questions on lc/mc/hc feeding.) Obviously tid isn't necessary for Xena but I know Samantha will want to know if it can be done since she's so used to tid when necessary, then going to bid. I printed out the Rand protocol linked on this board and took it to the vet. He practically grabbed it out of my hand trying to read it. It would be so great if he'd refer his newly-diagnosed clients to me or Samantha and we be able to work with the clinic and teach him how to use this insulin so that eventually he didn't have to refer his clients. Now you know why I'm asking so many questions here. I guess I could ask on the Health board, but not sure how many of you get over there to answer questions. I mean, everytime I see someone post on Health they are referred over here so I was trying to eliminate an unncessary step.
So...that's my story. I'll try to remember and follow the lantus board rules of posting.
My friend, Samantha, has worked with her vet using BCP PZI for all their newly-diagnosed feline diabetics. I know she's had over 32 cats from two vet hospitals referred to her. Of that only 3-5 have remained on insulin, the others just either had a diet change putting them into remission or diet and a little insulin for remission to happen. But right now Samantha teaches tid, sliding scale at first and you are tied to her hip discussing dosage, what's happened, food fed before each shot. So...now some of the vets are going with Lantus. Samantha doesn't know lantus and, like me, is learning but she is not a person to use message boards much with pet sitting, old aunt to care for, family. She thinks lantus is harder to learn (I think it's fairly easy with the protocol list showing how much to start with, when to go up or down, etc) and she knows pzi and has had success with it. But she is being forced to take on some vet clients using lantus. When I saw the tid reference (and maybe I should have brought up my questions in that particular thread) I thought it might be something Samantha would be interested in and wanted to find out the particulars about it.
My two newest diabetics (Xena and BIg Red, a foster kitty) came from the same vet hospital. They use lantus. They also arbitrarily give a depomedrol shot to incoming cats !?! Crazy! But they each started out at 3 units, going up or down on dosage given, with the cats going from 400's down to 30 and then being given another 3 or 2 or even 1 unit. No rhyme nor reason as to dosing. Xena can't even handle .1 units of lantus causing her to drop in the 30's and then rebound up so I switched her to BCP at a low dose to see what happened. It has smoothed her out, and I believe she has a sputtering pancreas I'm having to deal with. (Therefore the questions on lc/mc/hc feeding.) Obviously tid isn't necessary for Xena but I know Samantha will want to know if it can be done since she's so used to tid when necessary, then going to bid. I printed out the Rand protocol linked on this board and took it to the vet. He practically grabbed it out of my hand trying to read it. It would be so great if he'd refer his newly-diagnosed clients to me or Samantha and we be able to work with the clinic and teach him how to use this insulin so that eventually he didn't have to refer his clients. Now you know why I'm asking so many questions here. I guess I could ask on the Health board, but not sure how many of you get over there to answer questions. I mean, everytime I see someone post on Health they are referred over here so I was trying to eliminate an unncessary step.
So...that's my story. I'll try to remember and follow the lantus board rules of posting.
Jill & Alex (GA)
Very Active Member
shooting lantus or lev tid...
there have been several who have resorted to shooting tid. when i say "resorted to" i mean they tried shooting bid (put great effort into it) and it just didn't work for their cat. either they couldn't get enough duration or kitty dropped too low and then bounced to kingdom come. *most* kitties do well on lantus/lev with twice a day shots, but not every kitty fits the mold. we don't encourage shooting tid unless it's clear shooting bid is not working. shooting tid just puts a lot of stress on the bean because of life in general. imo, dosing bid is just easier.
michelle and doodle's spreadsheet: http://spreadsheets.google.com/pub?key=p0A4zW1EuYESgCldcEJIkTQ.
michelle started out shooting doodle bid before she started dosing tid. there have been times when she's been able to extend shooting times to +10 or +12, but has often returned to shooting on the 8s.
there have been several who have resorted to shooting tid. when i say "resorted to" i mean they tried shooting bid (put great effort into it) and it just didn't work for their cat. either they couldn't get enough duration or kitty dropped too low and then bounced to kingdom come. *most* kitties do well on lantus/lev with twice a day shots, but not every kitty fits the mold. we don't encourage shooting tid unless it's clear shooting bid is not working. shooting tid just puts a lot of stress on the bean because of life in general. imo, dosing bid is just easier.
michelle and doodle's spreadsheet: http://spreadsheets.google.com/pub?key=p0A4zW1EuYESgCldcEJIkTQ.
michelle started out shooting doodle bid before she started dosing tid. there have been times when she's been able to extend shooting times to +10 or +12, but has often returned to shooting on the 8s.
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