twice daily vs once daily lantus?

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kidsandliz

kidsandliz

Member Since 2015
My vet is telling me 3 units one a day (weight of cat 13.9 pounds so this seems about right based on dose per pound) rather than 1.5 twice a day. I read a pubmed article that twice a day is more likely to put a cat in remission but that either will control diabetes. So far my cat has only been on Lantus since Saturday (I had another diabetic cat who died 17 years ago so not totally new to this).

To what extent should I try to convince my vet we need to do this twice a day?

Also she is not checking him until 11 days into this (she has said 7-10 days and the vet tech who is doing it said she won't be in on day 10 (Monday) or the previous two days they are open. I am going to try to get him tested on Friday as I feel uncomfortable having him wait that long.

Thanks
 
Hi and Welcome to L&L Land. Humans usually use Lantus once a day, but a cat has a faster metabolism and the insulin is used up long before then. Lantus is a slow acting insulin which has a carryover into the next cycle. If you only dose once a day there is a big gap in the availability of insulin. Lantus also builds up a reserve in the body (we call it the "shed"). It takes 5 to 7 days when starting insulin to establish the shed. When the insulin in the blood stream is used up the shed starts to be depleted. Every time insulin is used up from the shed, more insulin is used to refill the shed. By constantly depleting the shed by once daily dosing the full effect of a dose is not seen.

Also she is not checking him until 11 days into this (she has said 7-10 days and the vet tech who is doing it said she won't be in on day 10 (Monday) or the previous two days they are open. I am going to try to get him tested on Friday as I feel uncomfortable having him wait that long.
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Are you home testing? It isn't safe to give insulin to a cat when you don't know what the BG is before the shot. Most of us use human BG meters that you can get at the drug store. The Up & Up from Target and the Relion Confirm from Walmart are very good (Consumer Reports "Best Buy") and quite economical. BG testing can be off at the vet too. Stress often raises the BG in a cat and few cats are not stressed when they go to the vet. We can help you learn to do the testing yourself.
 
Welcome to Lantus and Lev Forum - we're glad you found us! Ann has given you some great information about why it is better to shoot insulin twice a day instead of once a day.

Home testing is very important when treating cats with insulin. Every cat responds differently, so it is important to know how your cat handles insulin. testing seems daunting at first, but we've seen many kitties adapt to it very quickly - give a few treats and extra love at testing time, and before you know it your kitty will be reminding YOU that it's time for a test!

I agree with your feeling of discomfort about waiting so long to tests. Any of the meters Ann mentioned are great, and as she said, we will be more than happy to help you get started. There are two things that are very important to us here in these forums: Keeping cats healthy, and keep cats safe. Insulin is powerful stuff, and home testing will keep your kitty both healthy and safe!

We're looking forward to hearing more from you!

PS - what is your name, and your kittiy's name, so we can address you "properly" :smuggrin::cat:?
 
Thank you all for your answers. My cat's name is Max. He is 14.

So when they dose twice a day they just split the dose or is it done differently? I will print out the article I found on pubmed to show my vet (she is kind of touchy about being questioned about some things I am discovering so I will need to do this carefully) where twice a day results in more remissions than once a day although there was no significant difference overall with diabetes control so see if I can get her to switch Max to twice a day.

I still have to by a glucose meter. My finances are extremely stretched as I was fired for cancer and this state did not expand medicaid so health insurance is $798/mo and I have just spent nearly $700 on Max in the last week. At the moment I am only adjuncting and I still get food stamps. What I am doing is checking him for activity level, cold ears, etc. to make sure that this dose isn't too much. Today was only his second shot. I had a cat who died 17 years ago who I managed for several years until he died of complications (he had hyperthyroid and diabetes; Max has kidney stage 2 issues, diabetes glucose 480 and heart issues - grade 1 murmur, inflammation and it is too small; I have a different cat with hyperthyroid).
 
See my signature link Secondary Monitoring Tools for some assessments to help you evaluate his condition.
 
Yes, vets can definitely be touchy on this subject, but unfortunately many of them are just not well-versed in diabetes or how Lantus works. It's not their fault; they have to know about a lot of illnesses for a variety of species, and most of them can't their energy on one specific condition the way the folks here in the forums have. Honestly, some folks do just smile in agreement with their vet but then take matters into their own hands. Not everyone is comfortable doing that, though. Fortunately my vet is willing to work with me.

There is also a lot of very good information contained in the stickies at the top of the forum. It is a lot of info and can be very overwhelming, but ask as many questions as you need too.

Chances are yes, Max's dose would be split (or at the very least lowered) and then administered twice a day instead of once a day. The protocols we follow here use very safe, systematic measures for increasing and decreasing dose, which is another reason why home testing is so important.

The meters Ann mentioned are very inexpensive. Many vets will say you HAVE to use meters for animals, but that is not the case. Meters for animals are calibrated differently than human meters, but that is taken into account in the protocols. No doubt animal meters are very good, but they are VERY expensive, and you can't just run out to the local store for test strips if you need them in an emergency. \

Additionally, home testing will be far more cost-effective than taking Max to the vet for testing, and it will be far more accurate, as vet stress causes BGs to rise in many kitties.
 
My vet originally prescribed Lantus once a day. After discovering this board, I injected twice a day. I love my vet, but use this board to manage Lulu`s diabetes. Also, I do home testing, as Amy mentioned, it is more cost-effective. I am currently unemployed, so have to watch my finances as well. Another thing I learned on this board is that the expensive Rx food is not necessary; I`ve always fed them Rx food, which is so expensive. I`m happy to have switched them to more affordable canned food and they all seem to be doing just fine.

P.S. Did I read that right -- that you were fired for having cancer??? That is not legal in Canada, I'd check into that with your state labour laws, that is so wrong!!!
 
Amy&TrixieCat said:
Yes, vets can definitely be touchy on this subject, but unfortunately many of them are just not well-versed in diabetes or how Lantus works. It's not their fault; they have to know about a lot of illnesses for a variety of species, and most of them can't their energy on one specific condition the way the folks here in the forums have. Honestly, some folks do just smile in agreement with their vet but then take matters into their own hands. Not everyone is comfortable doing that, though. Fortunately my vet is willing to work with me.
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I have read the stickies.

I was planning to take matters into my own hands if she didn't agree once I had a meter I could afford and put him on twice a day. I am more willing to believe NIH Pub med peer reviewed articles over my vet when it comes to something she doesn't deal with all that frequently - especially since she wouldn't share that you could use this stuff far longer than 28 days and was upset with me that I was talking about being unable to afford to treat Max if I was having to pay $257 for Lantus plus needles a month as that was just so out of my budget (I have food stamps). It was the vet tech that told me she (tech) called another clinic where they had an in house cat with diabetes and they used it for 3 months. Told me that they were not so up on some of this (I had read it online and called the vet to see what she would say since I wasn't sure of the credibility of the site I was looking at when I saw that on Saturday morning.). That is why I asked about how doses were usually split.
 
Kept in a refrigerator on a stationary shelf, Lantus may last up to 6 months before it peters out in effectiveness.

See the Lantus sticky posts in the Lantus forum here.
 
BJM said:
Kept in a refrigerator on a stationary shelf, Lantus may last up to 6 months before it peters out in effectiveness.

See the Lantus sticky posts in the Lantus forum here.
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Yes have it in the fridge… hopefully cold enough (is a small dorm fridge) to last that long and still be effective.
 
P.S. Did I read that right -- that you were fired for having cancer??? That is not legal in Canada said:
.
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Yes I was. It is not legal in the USA either. Have had a complaint "pending" for over 2 years at this point. That federal office is slower than slow.
 
Excellent...you are already making huge strides in helping Max!

My only thought on the dorm fridges is just be careful it doesn't freeze. We have a dorm fridge at my store, and sometimes things get a little too cold in there.

I'm trying to round up a few more eyes to help you out. I'm at work at the moment so I have to pop in and out a fair amount.
 
Amy&TrixieCat said:
Excellent...you are already making huge strides in helping Max!

My only thought on the dorm fridges is just be careful it doesn't freeze. We have a dorm fridge at my store, and sometimes things get a little too cold in there.

I'm trying to round up a few more eyes to help you out. I'm at work at the moment so I have to pop in and out a fair amount.
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I am headed out the door, gone all afternoon so won't see much of anything until this evening. Thanks.
 
I'm one of the other set of eyes Amy rounded up ;)

I applaud you doing so much reading and taking Max's care into your own hands. I would also highly recommend shooting a consistent dose every 12 hours as closely as possible. And yes, the starting dose for Max's weight, if 13.9 lbs is his ideal weight and he's not underweight, would be 1.5u every 12 hours (aka "bid").

Very many of us use the Relion Micro or the Target Up and Up human glucometers. They are very inexpensive. I use the Micro and buy my strips on eBay; I am very careful to only buy from top rated sellers and make sure the expiration date is a few months in the future. I usually pay about $.20/strip instead of buying them at Walmart and paying $.35/strip.

Most of us also buy the insulin in packages of five 3-ml pens. It is more cost effective than the vial unless the kitty is a really high dose cat (upwards of 6u bid). I typically use my pens until they are empty and I store them in the cheese drawer so they aren't exposed to so much temperature change with opening and closing the door...and I have a refrigerator thermometer sitting right by them. A dorm frig is not likely to have a cheese drawer so if you can get a refrigerator thermometer at Walmart or the dollar store, I'd put it next to the insulin so you can keep tabs on the temp which should stay between 36-46 degrees F.

There are a few here who have great vets who understand the TR protocol and are supportive; mine is one as is Amy's. But, for the most part, it's a struggle and if your vet isn't open to being educated and learning, you may have to do what many here do.....rely on the experienced members here for assistance and don't get too involved with the vet on dosing. Many here just nod at the vet but don't follow the dosing instructions. It will just depend on your relationship with her but I'd make every effort to educate her and get her on board if you like her. If you don't, maybe it's time to find a new vet.

We can better help you if you have a Spreadsheet for Max. If you need any help with it, please let me know. It only takes me a minute to do it.
 
I have an extra Agamatrix Presto meter (it's the same as the Target Up and Up, that's just the name the store puts on it). Contact me directly and send me your address. Just click on Tess's avatar, you'll see some options in the pop up box, click on "Start a Conversation."
 
My Cootie just passed away last month. I have a ReliOn Confirm meter and unopened package of 50 test strips (from WalMart) that I would be happy to send you. You can contact me directly as noted above to send me your address.
 
Just want to say hi and welcome. I have a Max as well. You have come to the right place. My vet is wonderful but wanted me to give different doses for the morning and night cycles because he thought it would be too difficult to dose .25 or less increments. I never did that but explained how I do it. He's a believer now and says I manage Max as well as anyone gets ever seen.
 
Nancy & Cootie (GA) said:
My Cootie just passed away last month. I have a ReliOn Confirm meter and unopened package of 50 test strips (from WalMart) that I would be happy to send you. You can contact me directly as noted above to send me your address.
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Hi

I am so sorry to hear that your Cootie passed away. That is sad and you must miss him. Thanks for your offer but someone else offered me their, unfortunately, now no longer used glucose meter.
 
PS
Ann & Tess said:
I have an extra Agamatrix Presto meter (it's the same as the Target Up and Up, that's just the name the store puts on it). Contact me directly and send me your address. Just click on Tess's avatar, you'll see some options in the pop up box, click on "Start a Conversation."
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Thank you for your offer. People on this forum are so generous. Someone is already sending me hers.
 
Welcome Max's mom? We'd love to have your name too!!

Something to remember for the future is if you live in the US, a lot of us are buying our Lantus from Canada because it's 1/3rd the price it is here! The last post in the Insulin from Canadian Pharmacies thread will give you all the information, so if you need to get more in the future, keep it in mind!

I paid $144.99 for a 5 pack of the Lantus pens....the pharmacies around here are charging over $460 for the same thing. With the pens, you can use every last drop where with the vials, although if they're cared for properly, they can last up to 6 months, unless Max ends up on a pretty high dose, it's going to poop out before you use it all. The pens are good until the expiration date on the box..usually at least 2 years
 
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