Trouble with Lantus need advice

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constantina

Member Since 2014
Hi,

My kitty Pancake was diagnosed with Diabetes almost a year ago. We switched her to low carb wet food and started Lantus but have had spotty results. At one point she had a UTI, cleared it up with antibiotics, she sort of responded but not consistently. Found out she had dental issues, cleared them up, then she was sort of responding to the lantus sometimes but not consistently. We were thinking we were shooting poorly at first but now have ruled that out with lots of practice. The problem is, she'll just go hypo (48, 50, 63) out of nowhere. We shoot the same amount (0.5 units), feed her the exact same amount at the same time of day, shoot at the same time of day. We test her twice a day pre shot, and at nadir just to be safe. My vets can't believe she's going hypo at 0.5 units and have tested for hyperthyroidism (negative). She has an appointment Tuesday for a GI panel and X-ray in case there's underlying disease but here's my new problem: She's not responding at all to the Lantus now, just stuck in the 350-450 range all the time. It happened ten days ago, we suspended shots for 24 hrs, then shot her, 400 at pre shot and nadir, then the second shot sent her down into the low 70s and possible lower (we fed a lot but didn't want to test a bunch). After that, just 350-480 all the time no matter when we tested. Has anyone else had this problem with Lantus? Should I beg to switch insulins? My one vet seems to think it's not realistic to expect consistent results and that I'm testing too much. Any advice would be appreciated. What I really want to know is if anyone else has this difficulty with Lantus and if so, what helped.

Thanks,

tina
 
Were that last two shots 1/2 unit?
You said "then shot her, 400 at pre shot and nadir, then the second shot sent her down into the low 70s and possible lower"
How long after shot was the 70?
How many tests did y do after the first shot?
 
Hi, Tina, and welcome to FDMB.

Gabby has been on Lantus for 5 years. I'm wondering if your vets have helped you to understand how Lantus works. If you look at Gabby's spreadsheet (the link is in my signature) you'll see that I change Gabby's dose as I need to. You'll also see that I test way more than at pre-shot and nadir. Lantus dosing takes a certain amount of adjustment on a regular basis. When you see numbers below 50, the dose is reduced. If you're not seeing numbers in the normal range (50 - 120), the dose is increased. Sticking with the same dose may not yield consistent results. This is because cats who have diabetes, unlike humans, can go into remission. Thus, their pancreas can "sputter" and produce it's own insulin -- in addition to the insulin you're injecting -- which means that numbers may drop.

You may want to take a look at the starred, sticky notes on the Lantus board, In particular, you may want to read the note regarding the Tight Regulation Protocol. There are also several links in that note that are worth looking at. This is the dosing protocol that most of the people here use if they are using Lantus. The links to the information on the Lantus board are below.
  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal version -- the “Tilly” Protocol developed by the counterpart of this group in Germany, which was also published by Kirsten Roomp & Jacqui Rand, DVM 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: 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.
 
The body is always in a state of constant flux. It does not operate exactly.

Even if you dose the same amount, feed the same amount of the same food at the same time, have the exact same activity levels every day, things change.

Batches of syringes may vary slightly in the markings.

Batches of food may differ in composition - notice that the can labels say 'at least' and 'at most'. The manufacturer can change ingredients so long long as the minimums and maximums are met. Values for % calories of carbohydrates is a snapshot of 1 batch; it can change.

Also, there are some medical conditions which can interact with diabetes - infection, an intermittently functioning pancreas, insulinomas (tumore that produces insulin) and more.

Something that may help us is to see a chart of your doses and test results in a Google Drive shared spreadsheet grid. Instructions are here
 
Larry and Kitties said:
Were that last two shots 1/2 unit?
You said "then shot her, 400 at pre shot and nadir, then the second shot sent her down into the low 70s and possible lower"
How long after shot was the 70?
How many tests did y do after the first shot?
Click to expand...

all of the shots have been 0.5u since we suspected she was rebounding, took her off the insulin for a few days, and resumed. before that i had her up to 1.5 units and we had basically the same numbers. i just test before the shot and at the +6 or +7 hours and then again at 12 hrs (before the pm shot). the 70 was at +5 hrs, just happened to test her early and catch it.
 
Sienne and Gabby: Thank you for the links. I have read through these before and am familiar with the tight regulation protocol (and the sliding scale dosing) however my vet has advised me against this so I was trying to follow orders. My cat's numbers never lowered as consistently as your charts show, it was just a shot in the dark whether the insulin would even have any effect at all. We really thought we were just terrible shot givers but that doesn't seem to be the case. and then the weird dips out of nowhere, followed by what looks like rebound but could be the cat not responding to the insulin? I guess I'm desperate enough to try something drastic now (like ignoring vet instructions) but I really wanted to just see if anyone piped in with an "oh that happened to me too" story in case they had some advice. I'm sorry I don't have time to upload some past glucose results in a google doc yet, but this is what I have just typed up (am is pre shot, pk is +6 or +7, pm is pre shot, dose is 0.5 units am and pm):
[also thanks everyone who replied so far]
June 26
am 236
pk 370
pm 68

5/27
am 391
pk 418
pm 431

5/28
am 92 (no shot)
pk no data
pm 335

5/29
am408
pk 148
pm 131
late pm 179 (no shot)

5/30
am 382
pk 438
pm 397

5/31
284
195
409

6/01
387
364
446

6/02
325
444
484

6/03
398
348
409

6/04
390
456
448

6/05
385
409
 
I'm wondering about some of the odder conditions given those test results.
Insulin resistance can happen for a number of reasons and test values can be very erratic when those conditions happen.

1) what insulins have you used so far? Sometimes a cat can become insensitive to a specific insulin &/or have reactions to them.

2) has your vet ruled out infections, esp dental infections.

3) how big is your cat? An intermittently sputtering tumor (acromegaly) can alter glucose levels.

4) any evidence of thin skin, easily torn or bruised (Cushings)?

The last 2 are covered in more detail here.
 
BJM said:
I'm wondering about some of the odder conditions given those test results.
Insulin resistance can happen for a number of reasons and test values can be very erratic when those conditions happen.

1) what insulins have you used so far? Sometimes a cat can become insensitive to a specific insulin &/or have reactions to them.

2) has your vet ruled out infections, esp dental infections.

3) how big is your cat? An intermittently sputtering tumor (acromegaly) can alter glucose levels.

4) any evidence of thin skin, easily torn or bruised (Cushings)?

The last 2 are covered in more detail here.
Click to expand...
1. only lantus
2. she had a dental infection 4 months ago, pulled teeth full cleaning, antibiotics. she had her best results in the two weeks after that and then they went all wonky again.
3. 4.5 pounds, she keeps losing weight when she goes unregulated like this.
4. no evidence of thin skin.
 
I have read through these before and am familiar with the tight regulation protocol (and the sliding scale dosing) however my vet has advised me against this so I was trying to follow orders.
Click to expand...
Your vet actually advised you to not use the only scientifically proven, vet journal published protocol for using Lantus insulin?
 
Deb & Wink said:
I have read through these before and am familiar with the tight regulation protocol (and the sliding scale dosing) however my vet has advised me against this so I was trying to follow orders.
Click to expand...
Your vet actually advised you to not use the only scientifically proven, vet journal published protocol for using Lantus insulin?
Click to expand...
She told me to hold the dose no matter what and not to test her because she was on such a low dose (0.5 units, which I know from this message board is actually not even that low for Lantus). I was originally instructed to increase by .5u after 10 days if her numbers were still high, but since we had these dips I was told to leave it low. I didn't like some of what she was saying (or her, really) but I went along with it. I did cheat and continue testing her because she went hypo exactly one day after the vet told me I was testing too much, but I followed the dosing instructions.
But I saw a new vet on Monday and she was really great. She ran a GI panel and some other tests. We only have partial results back so far but she saw indications of a really inflamed pancreas. So we need to do an ultrasound to make sure she doesn't have a mass in there causing it, and we wait for the other results to come back.
You may or may not be pleased to hear that the new vet actually did tell me to increase the dose by .25u if she's high (above 400), but she said to just not shoot if she's below 150, and to shoot .5u if she's btwn 150 and 400. Does this sound like a good plan to you guys or is varying the shot in response to pre shot values a no no?
 
If you follow those instructions, the cummulative effect of Lantus, which can keep a cat very stable may have erratic delatedresults. However, you may be dealing with another condition which is erratic and interacting with the glucose levels.

It may actually work better to switch to an in and out insulin such as ProZinc due its flexibility in adjusting the dose based on pre-shots with no carry-over to cause a problem. Or, you could keep a low constant Lantus dose and use an as needed bolus of an in and out insulin such as Humulin/Novolin N (inexpensive and OTC in the US).
 
Lantus dosing is not based on the pre-shot values. In fact, very little weight should be given to those pre-shot values. Mainly you test at pre-shot to see how low the BG is and to know if it is safe to shoot. Also, those pre-shot tests allow you to put the mid-cycle tests into context.

Lantus dosing changes are based on the nadirs or lowest point in the cycle.

Lantus is an insulin that has a depot effect. By constantly changing the dose, you are draining and refilling the depot and never able to see the actual effects of any particular dose you are using.

Bottom line, no we do not recommend you constantly change the dose of Lantus or base the dose on the pre-shot test.
 
Hi,

I guess its no help but just to say - sounds exactly like my cat & her experience on Lantus, so erratic and impossible to stabilise. She also has pancreatitis so it may be something to do with that. She can go low on an extremely low dose (less than 0.25). She seemed to need less & less insulin but was still bouncing very high despite needing less :? Now I am just beginning to increase the dose again, so far it hasn't built up the depot I suppose to see the outcome but her numbers haven't dipped much as yet. Like you, I thought I was hopeless at injecting but I now know it has gone in (since cutting fur back!).

I do have a good vet but don't always agree with her on the dosing (she would have had her hypo many times!). I am hoping she will agree to a change to Hypurin Bovine PZI now.

All the best to you
Julie
 
Julie and Alice--
I'm sorry you're going through the same thing as I am. And it is helpful to hear that you're having the same experience with the Lantus as I am. What treatment are they giving your kitty for the pancreatitis? We're still waiting on test results so they haven't really done anything for my cat yet in terms of treatment. I'm just curious if anything has worked for your cat. Oh and please do let me know if switching insulins helps you! I have been thinking about the switch but then I wondered if it was even worth trying.
Thanks for replying to my post, Julie and Alice, and also everyone who gave advice on the dosing.
 
Hi again,

Boy do I understand your frustration & difficulty! Alice seems to have done a Uturn on the Lantus. She had become so sensitive to the insulin I had to decrease until giving nearly nothing, a hairline more or less would put her into too low or too high numbers. confused_cat Suddenly, after a few days of too high, she has gone to little response to the Lantus. It is doing very little despite increasing it, granted only to 0.5 at the moment but a couple of weeks ago she would have been far to low on that & I would definitely be giving the glucose! Today I am wondering if the Lantus suddenly expired before time or if Alice has become suddenly resistant to insulin! She is staying far too high nailbite_smile

Unfortunately re the pancreatitis, her vet says there is no cure. Although I know she should know, I still live in hope. She said there is no treatment. I would be interested to hear what your vet has to say. It may be connected to inflammatory bowel??

I sent an email (another!) to my vet today asking (pleading!) for the Hypurin Bovine PZI. It might not be any different but I understand that it doesn't have a depot, so when its gone, its gone, this makes it easier to dose according to blood glucose. I also read somewhere on this group that more cats were going into remission on PZI than they were on Lantus but I don't know how accurate that is.

I wish you well and hope to hear good news for poor Pancake, lets hope we can get our kitties into healthier healing numbers soon.

Juliex
 
Not sure if this will help or is even related to the issues you might be having but Michelangelo spent a year and a half on Lantus without ever getting "regulated." I finally switched to Levemir back in March and if you check out his spreadsheet (in my signature below) you can see what a world of difference it's made for us! I haven't changed anything; food is the same, dose increases/decreases are the same, etc.... And now it's finally working for us! Such a huge, positive difference it has made and no more frustration as to why he isn't "regulated" yet after all the time and energy I had been putting in.
 
Maybe you need to check if she needs the insulin at all. The swings could be due to compensatory hormones kicking in to combat the insulin effects by releasing glycogen which is converted to glucose.

Pick up some brand or generic KetoDiaStix or KetoStix to test the urine. Stop the insulin. And test both blood glucose and urine ketones. Give it about 3 days to see if the glucose settles down, UNLESS ketones are detected. Then you'll definitely need some form of insulin.

Has anyone explained the drop method of dosing? First, you practice with a colored liquid (to see it better) and a syringe. Fill to 0.5 units. Carefully push out 1 drop at a time, of equal sized drops. Repeat until you are able to consistently obtain the same number of same sized drops every time. It may help to gently twist the plunger as you push. Once you can do that, you can adjust the dose further downward by discharging drops before you shoot - ex 0.5 - 2 drops, and so on.
 
BJM said:
Maybe you need to check if she needs the insulin at all. The swings could be due to compensatory hormones kicking in to combat the insulin effects by releasing glycogen which is converted to glucose.

Pick up some brand or generic KetoDiaStix or KetoStix to test the urine. Stop the insulin. And test both blood glucose and urine ketones. Give it about 3 days to see if the glucose settles down, UNLESS ketones are detected. Then you'll definitely need some form of insulin.

Has anyone explained the drop method of dosing? First, you practice with a colored liquid (to see it better) and a syringe. Fill to 0.5 units. Carefully push out 1 drop at a time, of equal sized drops. Repeat until you are able to consistently obtain the same number of same sized drops every time. It may help to gently twist the plunger as you push. Once you can do that, you can adjust the dose further downward by discharging drops before you shoot - ex 0.5 - 2 drops, and so on.
Click to expand...

We took her off the insulin for a week to make sure she needed it and also that it wasn't rebound. I've used the drop method too but I'm glad you mentioned it here for others, it took me quite awhile to find it when i was desperate before! thanks so much for responding :)
 
julie and alice--

we took pancake in for an ultrasound and they detected a thickening in the intestinal wall (just like your kitty) so they did an endoscopy to figure out if it's ibd or lymphoma. fingers crossed that it's not lymphoma. they told us that the pancreatic swelling was likely just secondary to whatever's going on in the intestines and that it had actually subsided a lot by then.

the other thing two separate vets have told me (this may help you to know) is that no matter what's causing it, inflammation like that makes it impossible to regulate your cat, so that is what's wrong and probably not the insulin. the things we're supposed to try if it isn't cancer are metronidazole (her folate is high, also bacteria detected i think), a novel protein diet, and possibly if nothing else helps a steroid with low systemic absorption called budesonide. Probiotics are also important and sometimes b12 shots are given, too. You may want to ask your vets about some of these. if you have any luck with an insulin switch (maybe try levemir like kpassa suggests? it is supposed to be excellent) please do let me know, it can only help if we share notes on this.

kpassa--thank you for letting me know about your experience with levemir. I can't help wondering if the inflammation may be caused by unregulated diabetes and not the other way around. If nothing else works, i may ask for levemir just to see if it helps. my vet says that scenario looks unlikely now, but it's not impossible.
 
Hi Constantina & Pancake,
Thanks for info. I did mention it to my vet this evening. She listened but made no comment. She said that her pancreatitis cant too acute at the moment as she doesn't seem to be in pain. She did say to keep a high protein, low fat diet and stick to one low carb food only.

I am using Catzfine lamb & buffalo which she tolerates but not her favourite.
I have some probiotics for Alice as I requested them when she had antibiotics for a urine test but I didn't use them incase they actually upset her gut at the time. Perhaps i should give them a go.

Finally - I can collect the Bovine Hypurin PZI insulin tomorrow! Life has been very difficult trying to guesstimate how much Lantus insulin to give Alice as it varies from day to day & I seldom get it right! I am hoping that as there is no depot with the PZI that it will be easier to control, I really hope so!

All the best, I hope to hear good things of Pancake

Juliex
 
Julie and Alice

How's the new insulin working? Pancake has been on budesonide for about 2 days now but it hasn't had a chance to work yet . I'm still thinking we need to switch away from Lantus, but I'm giving the budesonide a shot first since my vet recommended that. Will keep you posted if anything happens with either the budesonide or a new insulin in the future.
 
Hi,

Hope the budesonide helps pancake. I'll be interested to know how it goes. I have actually sent you message so wont duplicate here! I'm presuming budesonide is a pill and not another injection? Alice's vet wants her in again soon to do another ultrasound scan and see if the patch in her intestine has grown or not - to see if it is lymphoma or IBD. I cant face taking her yet so has given us a short reprieve! I will have more time & hopefully energy soon as I am giving up work - its a choice I had to make. It was easy in the end, Alice stays as long as I can keep her, she's a great little friend, hard for some folk to understand. Still working my notice at mo! :smile: I get an NHS pension next Feb so sure will survive but hope vets bills not too much meanwhile!

All the best to you and Pancake
 
Julie-- I just checked and never got a message from you. Let me know what it said, please, or resend maybe? I checked and my settings allow me to receive messages.. thanks and hope your kitty is doing ok
 
Hi,
I've copied and pasted my previous message to you on the PMs forum here. Let me know if it still hasn't come through.
All the best
Juliex
 
Our cat Jinglebells had BG's similar to you and plummeted like your Kitty, BUT she was on .5 of PZI. She actually almost died because her Pancreas started working. She went into remission for like 3 months--it was Heaven--but then the diabetes came back. We tried PZI again, but she went hypo so fast and without warning even on .25, that we gave UP the PZI.

Like your Kitty, ours they say has Pancreatitis. We tested our kitty for EPI, which you might want to do if you haven't already. There is also an EPI site for cats with support like this forum.

We eventually had to start Lantus because she lost so much weight yet remained ravenous--we have to feed every 2 hours, so I understand the multiple issue thing going on. We are having problems with Lantus right now since we started the 2nd dose--her BG's are higher than ever. These worries are so draining. Keep us informed.
 
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