Too Hight of Does?

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Kitty mom

Member Since 2014
The vet put Dasher on 3 unit twice a day , this morning was his first shot. I thought the dose was high especially since I've changed his diet to all wet. The vet said he would prescribe 3 units even if his BG was 100 since it had been 446 when he was diagnosed . Another poster thought it was too much and now I'm not sure what to do. Should I just lower it or call the vet and question him again.
 
It would be helpful if you can get some tests in so we can see how Dasher reacts to the insulin throughout each cycle. 3 units is waaay too high to start, but it shouldn't be a factor today because Lantus is a depot drug and needs to build up in the system before it starts taking effect. I would lower the dose to 1 unit and work with the vet as it goes if needed. No way of really telling without regular testing, which is why we all do it. Honestly, if you can hometest and get some numbers to analyze, the people here can help you with dose changes. I see from another post you're planning to hometest, but until you can get some data, I would lower the dose.
 
Hi, Robin and welcome to Lantus Land!

One of the major vets who does research on Lantus recommends that you use a formula to calculate the starting dose of Lantus:
Initial Dose = 0.25 x ideal weight in kilograms​
If your kitty is underweight, plug that weight into the formula. For an average weight cat, the dose usually calculates out to somewhere in the neighborhood of 1.0u (give or take). For a dose of 3.0u, your kitty would need to be rather, ummmmm..... BIG.
 
He's 16.5 lbs. I put a call in to the vet, just waiting to hear back.
I will begin testing him tomorrow.
 
I do think sometimes you have to weigh up the dosing advice of the vet against what your gut is telling you and the advice of many members who live with this every day. The vets aren't the ones that have to live with the consequences of a hypo event.

If you have given your cat 3 units tonight I should strongly suggest getting blood glucose readings at various points in the cycle and making sure you are aware of how to deal with low readings ie high carb food, honey, etc
 
16.5lbs = 7.5kg x 0.25 = 1.875u per shot.

So if you want to go by the weight calculator, you would start with either 1.5u or 2.0u.

I'd probably go with the 1.5u because it is far less nerve-wracking to go UP in dose as you learn to hometest than it is to have a dose be too high and have to carb your kitty because you end up with low numbers when you're learning everything.
 
would you mind taking the 911 off now? you can edit the first post in this thread and remove it. That way if you test and have low numbers (less than 50 on a human glucometer or 68 on an AlphaTrak), you can put it back up and we'll know there is an emergency right now.
 
Yes, 3 units given twice a day is too high of a starting dose.

Print these out, familiarize yourself with them, and keep them handy:

SYMPTOMS OF & HOW TO TREAT HYPOGLYCEMIA - what to do if your kitty experiences a hypoglycemic event
Jojo's HYPO TOOLBOX - what to have on hand in case of an emergency

if your cat exhibits any of the symptoms listed in those links, rub some karo, syrup, or honey on kitty's gums and please take Dasher to your vet immediately!

how is Dasher acting?

how many hours has it been since you administered 3 units?

have you heard back from your vet yet?

has Dasher ever thrown ketones or been in DKA (diabetic ketoacidosis)?

just because this is only kitty's first shot it does not mean that 3 units cannot drop him like a rock. if you cannot test Dasher's blood glucose at home i would err on the side of caution and skip tonight's shot.


just my thoughts...


EDITED TO ADD: since you are not testing and gave that much insulin... please leave the 911 icon on your first post. it's good to know other members will see the 911 icon. they'll be more apt to check in with you in case you have a problem.
 
I'm thinking more and also realizing my error in the dose calculation. That formula is based upon the LEAN body weight of a cat. So even though your cat weighs 16.5lbs, that's likely going to include a lot of fat (sorry Dasher).

You may want to rerun the calculation based upon what you estimate his lean body mass to be for a better starting dose.

What help do you need to get started hometesting so you can monitor him today?
 
Ok so I talked with the other vet in the office who just so happens to specialize in feline diabetes. She said 3 units is what is recommended for his weight and his BG reading. She understood my concern about the diet change and told me to go out and get a meter and start testing. She wants numbers before he eats and two hours after he eats, she said if I want to go ahead and do a curve just so we can monitor his levels, She also said its not 0.25 but 0.50 due to his size...I don't know? I will give 3 units tonight and go buy his meter tomorrow morning and start testing. I like that she said if I'm that comfortable in BG testing to do the curves at home and she will work with me. She did give me guidelines if the BG is too low and not giving him a shot. She spent 20 min with me going over everything and I feel she knows what's she's doing. I will keep everyone up to date.

Dasher got his first shot this morning at 9:00 am Chicago time.
has Dasher ever thrown ketones He did have it spilling into his urine if I'm understanding ketones .Dasher is acting fine.

Thank all of you for the advise.
 
A couple of thoughts, Robin.

You can always go up in dose if it's not enough, but taking it out after it's been given is impossible.

Low numbers don't always show symptoms. By the time a cat is showing symptoms, they can be in real trouble. That's why we test at home rather than relying only on the cat's behavior.

Let us know how we can help you. :YMHUG:
 
Robin-S said:
She said 3 units is what is recommended for his weight and his BG reading. She understood my concern about the diet change and told me to go out and get a meter and start testing. She wants numbers before he eats and two hours after he eats, she said if I want to go ahead and do a curve just so we can monitor his levels, She also said its not 0.25 but 0.50 due to his size...I don't know? I will give 3 units tonight and go buy his meter tomorrow morning and start testing. I like that she said if I'm that comfortable in BG testing to do the curves at home and she will work with me. She did give me guidelines if the BG is too low and not giving him a shot. She spent 20 min with me going over everything and I feel she knows what's she's doing. I will keep everyone up to date.
Click to expand...
Your vet is using Dr. Rand's "old" dosing protocol. Rand scrapped that protocol because she based the initial starting dose on 0.5 unit per kg of actual weight. This formula proved to be too much for most cats... resulting in an over dose.

Dr. Rand has since revised her thinking about starting dose to 0.25 unit per kg of ideal weight. Her new protocol can be found here:
Dosing Protocol for Cats on Lantus/glargine or Levemir/detemir Using Daily Home Monitoring of Blood Glucose Concentrations to Adjust Insulin Dose

Please bring your vet up-to-date.
 
FYI: Rand's OLD protocol (based on 0.5 unit per kg of actual weight) also advised kitty be hospitalized for the first three days of treatment because of the increased risk of hypoglycemia!
 
So what in the heck is she talking about then...how frustrating !! I highlighted the one part below does this factor into it all? If you were me how much if any would you give him tonight?
I'm going out in the morning to get the Relion Prime meter is this one ok? Or is there another one that's better. I will be testing him throughout the day over the next few days. I'm now afraid is going to overdose and think I'll follow your lead .

Begin with 0.25 IU/kg of ideal weight BID
OR
If the cat received another insulin previously, increase or reduce
the starting dose taking this information into account. Glargine
has a lower potency than lente insulin and PZI in most cats.
 
Robin-S said:
So what in the heck is she talking about then...how frustrating !! I highlighted the one part below does this factor into it all? If you were me how much if any would you give him tonight?
I'm going out in the morning to get the Relion Prime meter is this one ok? Or is there another one that's better. I will be testing him throughout the day over the next few days. I'm now afraid is going to overdose and think I'll follow your lead .

Begin with 0.25 IU/kg of ideal weight BID
OR
If the cat received another insulin previously, increase or reduce
the starting dose taking this information into account. Glargine
has a lower potency than lente insulin and PZI in most cats.
Click to expand...
if i were in your shoes, i'd do this

--- go out and get a meter tonight
--- skip tonight's shot (unless Dasher has been throwing ketones or was in DKA recently --- talk to me about that)
--- familiarize myself with the new meter and practice taking Dasher's BG
--- start over tomorrow


that's what i would do. however, the decision is yours to make.


what is Dasher's ideal, not actual, weight?
 
I answered your other thread in the relaxed forum but I am so pleased that you are not going to go ahead and give the three units. Monitoring him isn't necessarily easy in the beginning and you will need to master that before you need to be worrying about preventing him from going low and the extra monitoring that requires.

As a newbie I would say skip the shot until you have your meter but other more experienced members may advise differently. Just make sure he eats his low carb food and get yourself all set up for tomorrow.
 
In the meantime I would also. Read through all the stickies at the top of this forum on how to handle lantus properly, how to handle low readings,etc.
 
Robin, I have to step away from the computer for awhile, but Libby is stepping in. Libby is another very experienced and seasoned member of this group.
I'd trust her with any one of my kitties.
 
Robin-S said:
If the cat received another insulin previously, increase or reduce
the starting dose taking this information into account. Glargine
has a lower potency than lente insulin and PZI in most cats.
Click to expand...
This basically means that if the cat was previously on a different insulin, you might find that their dose of Lantus or Levemir ends up being a bit higher than the previous insulin. The dosing protocol we're mentioning, though, is specifically for Lantus and Levemir, though, so if you're starting from scratch then you don't need to worry about that phrase.

A lot of people use the ReliOn Confirm or Micro.

I think Jill's plan makes sense, as long as Dasher is not ketone-prone. Better safe than sorry. I know I would be afraid to start at 3 units, especially if I couldn't test. If he does end up needing that dose, you can work up to it in a methodical manner.
 
Jill & Alex (GA) said:
if i were in your shoes, i'd do this

--- go out and get a meter tonight
--- skip tonight's shot (unless Dasher has been throwing ketones or was in DKA recently --- talk to me about that)
--- familiarize myself with the new meter and practice taking Dasher's BG
--- start over tomorrow


that's what i would do. however, the decision is yours to make.


what is Dasher's ideal, not actual, weight?
Click to expand...

Ketones? I have no idea, they said it was spilling into his urine so I'm thinking glucose in urine is what this means.
They didn't say what he should weigh so I have no idea.
Looks as if I need to make a list of question to ask her.
Thanks for everyone patiences with me as I have so much to learn. I will start fresh tomorrow after I buy the Meter and see where he's at.
 
If Dasher had ketones, especially as you were starting the diabetes management process, there's a very good chance the vet would have hospitalized him. Some cats, mine included as was Libby's kitty, began their experience with diabetic ketoacidosis (DKA). This makes for a very sick kitty. Not all cats end up in DKA, though. Some cats may produce ketones and get diagnosed in enough time that ketones do not progress to DKA. The bottom line is if Dasher is acting like himself -- or pretty much so -- and your vet didn't mention ketones, he's probably OK.

Usually when mention is made of "spilling" into urine, the vet is referring to glucose. (If a cat is having kidney problems, though, this could refer to protein.)

There is an overwhelming amount to learn. Please don't expect to absorb all of the information overnight. Many of us have been at this for quite some time and we're happy to answer questions and/or help you puzzle through the process.
 
Good, waiting until tomorrow is a good plan.

Do you think he is overweight at 16.5 pounds? 10-11 is kind of an average cat size, unless he is a larger breed.
 
Please do get either the ReliOn Confirm or ReliOn Micro meter rather than the Prime. Those 2 take half the blood of the Prime which is important when you first start testing. After his ears build additional capillaries and bleed easier, then you can change to the Prime.

Thoughts, prayers, HUGS and Dances!
 
you'll do fine, Robin. we've all been in your shoes. everyone one of us is overwhelmed at the beginning.
before you know it you'll be helping someone else.
hang in there!


ps --- how is dasher acting this evening?
 
Jill & Alex (GA) said:
you'll do fine, Robin. we've all been in your shoes. everyone one of us is overwhelmed at the beginning.
before you know it you'll be helping someone else.
hang in there!


ps --- how is dasher acting this evening?
Click to expand...
Dasher is just fine . He's loving all the rubbing of the ears , poor clueless baby . Lol.
Thanks everyone
 
Hi Robin,

I'm new too, and you're right that this is overwhelming. You'll be surprised by how much you'll learn in the first few weeks, though. You can do this! I really like my relion micro meter. It doesn't require much blood.
 
Hi Robin! Just adding a welcome. Everything will get much easier!! It is very overwhelming at first, but it will start to make sense.

You are definitely in the best hands here. I have found that even great vets don't know as much about diabetes as the experts on this forum - I think it's because the vets have to know about so many different conditions that they are a bit spread thin and don't have the time to dig in as deeply/stay current with the latest research.

Ask lots of questions, even if you find that you are asking the same questions multiple times.

Have a good night, and good luck tomorrow!
 
Libby and Lucy said:
Good, waiting until tomorrow is a good plan.

Do you think he is overweight at 16.5 pounds? 10-11 is kind of an average cat size, unless he is a larger breed.
Click to expand...

I have no doubt he's overweight and we nicknamed him Chumlee , thinking a good weight would be around 11 or 12 lbs.
I now feel guilty because we let this happen.
Our other cat is 17.5 I believe, he's just a big cat but think he could stand to loose maybe 2lbs, he is long and just big.
What's good is both are now on low carb and only wet food and are better off for it.
 
Hi Robin,

I just wanted to add my welcome to the group. Clare and I are new to the board this year; she was diagnosed in the spring. We've learned so much from the folks here and Clare's doing fine.

I know that Dasher will be fine, too. We have another "civvie" (not diabetic) cat, too, and she's been a lot healthier since we learned how to give them a better diet.

Lots of warm wishes to you and your four-leggeds,

Georgette and Clare
 
So I posted in another place that I did give Dashers his first BG test today 3 1/2 hours after eating and giving 2u of his Lantus. I did give him Lantus yesterday , it was our first day of meds. I gave him 3u in the morning yesterday and 12 hours later I lowered it to 2u as many here thought was better. This morning as he was eating I gave him 2u , I then went out and bought a meter and tested him at the 3 1/2 hour mark just to see where he was and he was at 162 . Now when he was first diagnosed he was at 448 , I then changed his diet. I really wished the vet would of taken another BG the day we went in for our teach on how to give him his shots, Is normal ranger 72-175 ? If so he's in range but is it due to the three shots of Lantus or his diet...maybe both.
Thoughts??
 
Robin-S said:
So I posted in another place that I did give Dashers his first BG test today 3 1/2 hours after eating and giving 2u of his Lantus. I did give him Lantus yesterday , it was our first day of meds. I gave him 3u in the morning yesterday and 12 hours later I lowered it to 2u as many here thought was better. This morning as he was eating I gave him 2u , I then went out and bought a meter and tested him at the 3 1/2 hour mark just to see where he was and he was at 162 . Now when he was first diagnosed he was at 448 , I then changed his diet. I really wished the vet would of taken another BG the day we went in for our teach on how to give him his shots, Is normal ranger 72-175 ? If so he's in range but is it due to the three shots of Lantus or his diet...maybe both.
Thoughts??
Click to expand...

new thread on Health (11/6/2014): Dasher 1st BG reading

hello Robin,

congrats on becoming a member of the Vampire's Club!

I'm very sorry to see you chose to ignore advice given to skip Dasher's shot last night and use the "ideal weight" based formula to determine a starting dose this morning, but that's you prerogative. FWIW, I am happy to see you've reduced his dose some. if i were in your shoes i would test sooner than later since we have no idea what Dasher will do with all this insulin on board. the effects of lantus are cumulative meaning each dose builds on the next. you've given 3 relatively high doses of insulin when you're first starting out to your cat. i don't mean to scare you, but you must test often to keep him safe!

Again, Print these out, familiarize yourself with them, and keep them handy:

SYMPTOMS OF & HOW TO TREAT HYPOGLYCEMIA - what to do if your kitty experiences a hypoglycemic event
Jojo's HYPO TOOLBOX - what to have on hand in case of an emergency


I'm putting the 911 icon back on your first post in this thread to alert others there's a potential problem here.

sorry, i have to get back to work. please test often today... not "when you get more used to it". i'm very concerned about Dasher.
 
Because there was no testing done between the diet change and the insulin starting, there is no way to know what kind of drop you can attribute to each. Likely both are dropping him.

I hope you have been testing more than the +3.5 test today. Lantus peek is often between +5 to +7 though some go longer or shorter than that. Dasher could have been just at the beginning of dropping when he tested at that 162. That is really great progress from the initial diagnosis, there just isn't enough data gathered from testing to know whether Dasher is safe with all that insulin on board. Diet change and a large starting dose can propel him down the BG scale pretty darn fast. Be prepared for him to possibly bounce around between lower numbers and high numbers. When cats drop low for the first time or really fast, their bodies can react with dumping glucose stores in response. DON'T respond to the first higher number you see by going back to 3U. Test and gather information on the 2U for at least 6 cycles (shots) before making any dose adjustments unless you need to decrease due to a low number.

When testing with a human meter, we look at the normal range being 60-120. The range is considered a little higher when tested on the pet meters/at the vet's.
 
So I just checked him again and it's at 219 at almost the 5 hour mark and will do so again right before his next shot.
 
good, I'm glad he has stopped dropping. We *do* want the numbers to come down, but we want them to come down in a safe, controlled manner. :smile: If his test at shot time is below or near the 219, please post for advice before shooting.

Personally I still think 2 units is too high for a starting dose, especially with a diet change at play (if his ideal weight is 11 pounds, then the starting dose would be 1.25 units), but he's your cat. Just please post and let us help watch for red flags.

For perspective, 162 is a good number, it's just that most cats don't get there so quickly. Lantus usually takes a few days to build up in the system, so for him to be at that number already could be a sign that this dose is going to take him quite low. Be very alert over the next 2-3 days especially.

Also, while 162 at +3.5 is good, because we don't know at what number he started his cycle, we don't know how fast he was dropping at that point. For example, if he was 200 when you gave his shot, and 162 after 3.5 hours, that's a pretty even slide downward and is probably safe. If he was 450 when you gave his shot, and 162 after 3.5 hours, that's actually pretty fast and sometimes they can just keep picking up speed and drop too far. It's like a puzzle, and as you start to fill in more pieces it will start to make more sense.
 
Libby & Lucy

I'll test hime again before tonight's shot to see where he's at. It will be right before 9:00 pm Chicago time and will post before I move ahead with the shot.
 
Hey, Robin? Is there a problem? Do you need help?
I noticed you put the 911 icon up again after I took it down.
We generally reserve the use of the 911 icon when there is a medical emergency. Is there something we can help you with?
 
I'm being told to keep it up by some and other to take it down?
Ok I just took his BG and its at 180 and he's due for his next shot in 45 min. so todays we had a 162 at the 3 1/2 hour mark after morning shot, then 5 hour mark he was at 219 and now 10 hours mark he's at 180.
I'm not going to does him until some one here can advise me on such.
 
Robin-S said:
I'm being told to keep it up by some and other to take it down?
Ok I just took his BG and its at 180 and he's due for his next shot in 45 min. so todays we had a 162 at the 3 1/2 hour mark after morning shot, then 5 hour mark he was at 219 and now 10 hours mark he's at 180.
I'm not going to does him until some one here can advise me on such.
Click to expand...
we use the 911 icon when there's a medical emergency. when the emergency has passed we take it down.
it doesn't appear to me there is any medical emergency at this time so there's no need to have it up now.

this is how you'd record what has happened so far today:

amps ? (2u) <------ the morning preshot number is unknown
+3.5 162
+5 219
+10 180

a lot can happen between +10 and pmps. you'll want to test before you shoot.
we usually do not feed between +10 and the next shot at +12.

have you thought about how much insulin you're planning on giving him tonight (assuming he's over 200)?
 
I was just going to take the advice here as I too believe I need to do smaller dose. I hate playing doctor but at this point I'm afraid to give him 2u .
 
Robin-S said:
I was just going to take the advice here as I too believe I need to do smaller dose. I hate playing doctor but at this point I'm afraid to give him 2u .
Click to expand...
ok, i'll tell you what... his shot is due in approximately 20 minutes, right?
i'll stay online. test his BG in 10 minutes and post the number. i'll suggest a dose. others will have the opportunity to offer their thoughts. you will then have 10 minutes to decide what you'd like to do.

how does that sound?

when is the last time dasher ate? did he eat low carb canned food? about how much did he eat?
 
Robin-S said:
It's 147
Click to expand...
amps ? (2u) <------ the morning preshot number is unknown
+3.5 162
+5 219
+10 180
+12 147

hmmm...
i really don't like to suggest skipping shots, but under these circumstances i would skip tonight's shot. you don't have enough data collected yet to shoot a dropping number. i wouldn't feel comfortable suggesting a shot tonight.

i'll write more in a minute, but wanted to post this info for you right away.
 
continued from above...

i'd test again right before you go to bed tonight. post the number if he continues to drop. if not, get a good night's sleep and start over in the morning at 1u BID if he's over 200. if he's less than 200, post the number and ask for help.

just my thoughts...
 
Test him before bed time if he's under 200 skip it , if over 200 I'll give him 1u.
I'm really feeling I'm not cut out to do this hopefully I'll get a good nights sleep and reboot
 
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