Updated S/S

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Louise and Tabby

Louise and Tabby

Member Since 2015
Hi, am new to the group, not surei f this is the right place to post, but another member suggested I update my s/s with further info. I know his numbers are awful and yes I am worried/stressed. We are due to see the vet tomorrow. Any advice would be welcome. He was previously on caninsulin which brought his numbers right down for a good chunk of the day but since starting Lantus we have not seen much of a drop at all.
 
Can I ask why the vet reduced the dose on 4/25? It looks to me more like an increase was needed at that point. And with the nadirs he's getting in the mid-upper 300s he's definitely not getting enough insulin right now. I'd suggest increasing his dose by 0.25 of a unit at each shot for the next 6 cycles to see if that starts to reduce his numbers - there's almost always a lot of fine-tuning needed with insulin dosing for our kitties!
 
Hello Louise, and welcome to you and sweet Tabby to the Lantus/Levemir forum. My Neko also started on Caninsulin before we switched to Lantus. Can you tell me what his highest dose of Caninsulin was and what sort of numbers he was getting? Also, what is his ideal weight? Just wondering if he started on too low a dose when he switched to Lantus. We did. :rolleyes:

Here is your intro thread. As BJM mentioned previously, there are two methods for determining dosing here. One is the Tight Regulation (TR) Protocol and the other is the Start Low Go Slow (SLGS) method. Take a read of the Sticky Notes with the descriptions of the two, and depending on which you select, we can help you decide how to change his dose. You test enough for Tight Regulation but people have various reasons for choosing one or the other. Tabby definitely needs an increase, but the different dosing methods would give different increase amounts at this point.
 
Hi
His highest dose of Caninsulin was 3.5 which made him quite ill so we dropped it back to 3. His numbers were 24/432 before injection and the lowest was 7/126 4 hours after injection. His weight is 5.6kg which the vet says is ideal and he has maintained for the last few months. When he started Lantus on 1.5 he wasn't himself at all and looked quite depressed which was why it was reduced.
Sorry, am I supposed to post my post at the end of my intro thread as opposed to starting a new thread?
I think he may be better on the SLGS, he doesn't seem to handle changes in his insulin doses very well and high doses but am not sure which is best.
 
Caninsulin is a much harsher insulin which, as you found, drops the numbers quite a long way very quickly but often wears off before the next shot is due in cats. Lantus lasts longer and is more gentle on a cat's system. I wonder if him not seeming like himself when you first started him on Lantus might have been due more to the high numbers he was in all day than the dose itself - 1.5 isn't really that high of a dose and his numbers don't look as though they came down much at all on that dose.

The protocol you follow is really up to you - what you're comfortable with, how much you can monitor etc - but both do require dose adjustments to get him to a dose that gets him into good numbers.

And no, you don't need to just add on to your into thread - this is the right place to find out more about Lantus, though it does help if you can link your previous thread if it contains information that's relevant to your current question.
 
In this forum, we start a new thread each day, so what you did was good - I just added the link so people could go back and get more info from your first post.

With the TR protocol, we use a weight based formula for determining the staring dose, (#kg x .25) which would be around 1.5, but we also take into consideration the dose of the previous insulin if there is one. TR has you hold a dose for 3-5 days before increasing and cats earn reductions when they go below 2.8 (50). For TR, you need at least two tests per cycle, the preshot and one other, and that includes the evening cycle, when many kitties go lower. The SLGS protocol means slower changes, holding each dose for at least a week and then doing a curve. The starting dose would be .5 units if he's on entirely wet food and increments are only .25U. SLGS reductions are earned when kitty goes below 5.0 (90). Some people can only use SLGS, you should chose whatever suits your personal situation. Kitties who get some dry food are limited to SLGS. I'm quoting blood sugar numbers for using human meters, which I believe you are. You can switch protocols from one to the other if you decide you want to. We just ask that people put either TR or SLGS in their signature so we know how to help you.

I think the main reason Tabby isn't feeling so good is his high numbers. I'd like to see him get into better numbers sooner rather than later. It helps regulation and the possibility of eventual remission if you can get his numbers into normal blood sugar numbers sooner. If you were following TR, I'd suggest an immediate increase back to 1.5 units, with at least two tests per cycle, then evaluate the dose after 6 cycles. It's possible he'll need around the same about of Lantus as he did Caninsulin. Following SLGS, you would hold the dose for a total of 7 days, do a curve, then increase by 0.25U if the numbers warrant it, which I suspect they will by your spot checks.
 
Thanks for your advice everyone, sorry it has taken me so long to reply, my computer crashed, had to re boot.
I am slightly confused - so a cycle is from injection to injection? And am I right in assuming that TR is more likely to get him regulated quicker?
 
Gotta love computers some days...always when you're trying to find out something important! :rolleyes:

The answer to both of your questions is yes, though with either protocol it's impossible to know how long it will take to get an individual cat regulated. TR does tend to regulate a cat faster and gives a better overall chance of remission, but it is fairly intensive at times for the owner so isn't for everyone.
 
I know, was wanting to reply quickly and the computer just went bananas!

I think I am going to try and do TR then, as I think I need to get this sorted asap.

Thanks
 
As Wendy said, you're already testing at least enough for TR (more than the minimum for that too) so you're off to a good start already. I would agree that getting his numbers down into a healthier range sooner rather than later would be good. And there's loads of support here on the board for any questions you have about any aspect of the protocol. :)
 
I agree that his "not feeling like himself" is very likely because his blood sugar is so high.

If you're going to follow TR, I'd immediately increase the dose with his next shot. It doesn't look to me like 1.5u was high enough, but if you want to start there, we can look at his blood sugar tests after 2 days and even increase it at that point if he's not getting into better numbers. The 3 days that Wendy mentioned is typical, but for a cat starting out on Lantus if the #s are high and flat (over 300) there is the option of increasing sooner.

Another option - I would also think it would be ok to start a little higher, say at 2.0u if you are continuing to test like you have been. He's been in high numbers for quite a while now. If he were my cat, that's what I would do. With the 3u of Caninsulin only getting him into the 100's, it's likely his Lantus dose is going to need to be close to that - and if your goal is remission, you want to get him under 100 as soon as is safely possible.

In the meantime, I haven't seen anyone suggest that you test him for ketones twice a day. When a cat's being transitioned from one insulin to another and is not to a good dose yet, that's a risky time and ketones can develop. Add as much water to his food as he will tolerate and pick up some ketone sticks at any people pharmacy to test his urine.

You've found the diabetic cat mecca - we can give you a hand getting Tabby into better blood sugar control. Even if your vet doesn't really understand how Lantus works, you can learn here and even teach her.

Hang in there - things get easier!
 
Here is the information on starting out on Lantus, using the Tight Regulation Protocol:
General" Guidelines:
  • Each subsequent dose is held for a minimum of 3 days (6 consecutive 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.
We can increase his dose after 2 days if he stays constantly over 300.

edited to add: Did you get his insulin from a people pharmacy or from the vet? I'd encourage you to watch the video on "Taking Care of YOur Insulin" - one of the yellow stickies at the top of the main Lantus/Lev forum page - to make sure you're taking care of your insulin appropriately.
 
I will increase it 1.5. The only reason I cant go any higher at the moment is, I am nearly out of test strips, hopefully they will be arriving tomorrow, but yes it would be a good idea to check in a couple of days and look at increasing then as you suggested.
I haven't checked for ketones but have ordered some strips. it might be a little tricky to test as he toilets outside and doesn't have a tray but I understand it is important.
I got the insulin from the vet - very expensive! But have since been told I can get it more cheaply from a people pharmacy, so will be doing next time.
Yes I had a look at the video, thanks.
 
Was the Lantus in a sealed package when you bought it? Or opened?

The Lantus should never be repackaged - on that same sticky about taking care of your Lantus, there are photos of what the pens/vials should look like. We've had a few times where the vet (or Wedgewood Pharmacy) repackaged the insulin and it wasn't as effective as it should have been. Tabby's spreadsheet has a look about it - that basically looks like nothing is happening at 0.5u or at 1.5u. It could just be that the dose hasn't gotten high enough, but it raised my radar enough to question it. Look at those photos of the pens and the vial (the original vial, not repackaged can be seen in the video) and see if your insulin is in the original vial/pen or if it was repackaged.

Since your vet isn't that familiar with Lantus, I'm wondering if she repackaged it. From that same sticky:
Lantus and Levemir should NOT be repackaged and resold by the vet. If you are buying repackaged insulin from your vet, even if it was transferred into a sterile container, its efficacy and longevity is questionable.
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Sounds like you might need a blood ketone meter instead of trying to test urine. In the US, Novamax will give out a free meter, but the strips are expensive. You might do some looking to see what's available to you. the blood ketone strips measure both glucose and ketones in the same strip, I believe. Since he pees outside that might be a lot easier for you.
 
The Lantus wasn't repackaged, it was definitely a brand new bottle and not touched. I know what you mean though, it does look like it isn't having any effect on him.
 
How's Tabby feeling today? Did you new strips come?

ok, if the insulin was new and sealed, it's probably fine. So let's work on getting him to a good dose. Let's give this 1.5u 4 cycles and re-evaluate to see if he needs an increase at that point. So we should look at it on Wednesday sometime after his pm shot and evaluate it in case you need to increase for his Thursday morning dose. Would you make sure and flag your post - like put "dose advice?" in your subject line after your Wednesday pm shot so you don't get missed?

Go ahead and start a new thread tomorrow - starting a new one every day helps things remain manageable!
 
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