Any expert on the board: Is 20u BID Lantus a crazy dose?

I am very distressed because I think I might be giving Spanker (12YO 22 pound male tabby) too much Lantus. Currently 20u BID. The vet had me start him at 2u and I kept sending curves over the last 6 months or so and the vet keeps increasing by 1u. He really has not ever gotten even close to regulated - typically BG above 350-500 at any give time. He only eats Wellness Core High Protein Low Carb canned food.

Any expert on the board: Is 20u BID Lantus a crazy dose?

Should I start over with 1 or 2 u and see how he does?
I am driving myself crazy thinking I might be giving him way too much...
Or that my vet is crazy for prescribing this much...

Thanks for your kind advice...

Andrew

 

Re: Any expert on the board: Is 20u BID Lantus a crazy dose

There are conditions in diabetic cats that require a lot of insulin. Here is some information-
http://www.felinediabetes.com/FDMB/viewtopic.php?f=12&t=375

In normal cat, yes, 20 units is a lot of insulin. I'll see if I can get a Lantus user to give more advice

 

Re: Any expert on the board: Is 20u BID Lantus a crazy dose

That is a crazy huge dose for a typical diabetic cat :shock:

But some diabetic cats who have Acromgaly or Cushings may need that much insulin. Has your cat ever been tested for these?

What are you feeding your cat? Dry food, even the prescription stuff, can keep blood glucose levels way too high. Diet is an important part of managing your cat's diabetes.

I take it you are testing blood gluocse levels at home? How often are you testing? Can you post some recent numbers?

 

Re: Any expert on the board: Is 20u BID Lantus a crazy dose

I'm not an expert, but 20u is a crazy high dose unless Spanker has been diagnosed with a "high dose" condition like Acromegaly. I'll try to find someone with Lantus experience to chip in here, as well as someone with an Acro cat.
Do you test his BG at home, or are all those numbers from tests run at the vet?

Carl

 

Re: Any expert on the board: Is 20u BID Lantus a crazy dose

Hi Andrew,
If you cat has acro or IAA, not that is not a crazy dose. Has you kitty ever been tested for either of those conditions. I would have the tests done just to make sure.

pattie

 

Re: Any expert on the board: Is 20u BID Lantus a crazy dose

Before I go back to 1-2u, I would have the tests done (IGF-1 and IAA). I always worry about ketones when a dose is reduced drastically. Would your vet be willing to run the tests, If not, I would find one that would

Pat

 

Re: Any expert on the board: Is 20u BID Lantus a crazy dose

Orange and white tabby Spanker only eats canned Wellness Core now. He used to free graze dry food. No more only canned high protein low carb.
I do not think he has been tested for a high dose condition. My vet never mentioned these test.

I test regularly at home

Original Curve at 2u BID in December:
8AM 425
12PM 382
4PM 358
8PM 396

Most recent numbers at 20u BID in July:
8AM 415
12PM 330
4PM 394
8PM 484

I am thinking like about starting over at 1.5u BID tight regulation model instead of 2+u BID and see what happens.

PS does anyone know of a fantastic kitty vet in Orlando or Tampa Florida?

Bless you...

Andrew

 

Re: Any expert on the board: Is 20u BID Lantus a crazy dose

The Wellness Core canned chicken/turkey one is good and low carb. The salmon one is just over the ideal 10% carb limit for diabetics. There are other brands of canned fodos you can feed, if you didn't already know :smile:

Binky's canned food charts
Pet Food Nutritional Values list
Hobo's Guide To Nutritional Values
Dr. Lynne's Wet Food list
List of low carb gluten free Fancy Feast

On Binky's charts, stick with foods that have a number 10 or less in the carbs colum. On the Pet Food Nutritional Values Chart and Hobo's Guide, look at the %kcal from carbs column and choose foods that have a number 10 or less.

Here's a thread with Orlando vet suggestions: http://www.felinediabetes.com/FDMB/viewtopic.php?p=738339

Edit: Somogyi effect link removed because apparently the info on that web site is not correct and some people feel that it is a myth.

 

Re: Any expert on the board: Is 20u BID Lantus a crazy dose

Well, I think it's time to have your cat tested for acromegaly and IAA as your cat very likely has an insulin resistance condition.
Here are the links for the 2 tests you may need to have done.
IAA Test
IGF-1 (Acro) Test

Now, you are already feeding a decent food, so I am ruling out food as a reason for the high dose.
The numbers you mention are high, and more along the lines of an acro cat who is not yet regulated, so no, the dose is not crazy.
It is good you are home testing, can you post some of your curve numbers? A great deal of numbers that are high at the vet are due to stress, but at home, numbers are pretty true, depending on the meter you are using.
Both of my acro cats had numbers that were untrue at the vet office but then they returned to normal 30min after getting home.
One acro always tested much higher at the vet, and the other was often lower.

If you doing curves at home, you would see exactly how the insulin dose is working and DO NOT drop back to a 1u or 2u dose as it would be too hard on the cat's body, especially if the current dose of 20u BID is not causing hypos.

I guess it would be a good idea to talk to your vet about taking your cat in for a blood draw and have the draw sent off to test.
For acromegaly, 12-92 is normal and above would be positive.
For IAA, a positive is above 20%

If you have any questions, please ask.

 

Re: Any expert on the board: Is 20u BID Lantus a crazy dose

If you go back to 1u or 2u, be prepared for a very sick cat and you will see BG numbers in the 500s and 600s.
Your cat will be lethargic and you may well end up in the ER.

As was mentioned earlier, are you testing Spanker's urine for ketones? If not, you can pick up a container of KETOSTIX at the pharmacy.
There are many acro cats whose insulin doses are above 20units, so before any drastic decrease, you may want to talk to your vet about getting the tests done.

I know of one other owner whose cat's dose was 20u and still not regulated, so she cut back to 11u, despite the fact that her cat had tested positive for acromegaly. The results were horrific with all BG numbers in the 500s and her cat acting extremely sick.

 

Re: Any expert on the board: Is 20u BID Lantus a crazy dose

How long did you hold each dose before increasing?

And did you increase by 1u at a time? (so 5u a.m., 5u p.m. to 5u a.m., 6u p.m.= 1u per day increase OR 5u / 5u to 6u / 6u = 2u per day increase)

My first diabetic cat, Norton, had a high dose condition - Acromegaly. We reached a high of 13u BID with 1u per day increase per week (took about 6 months to go from 1u BID to 13u BID in gradual increases - changing once per week)

The only lab in North America that performs the IGF-1 (Acromegaly) and IAA (insulin autoimmune antibodies) tests is in Michigan (the links that Gayle posted above). Save time and money by having your vet contact them directly.

The lab charges $49 and $15 for the two tests - your vet will charge for office visit, blood draw and shipping plus some profit / fee. There are special shipping instructions to make sure the blood is cold when it arrives and doesn't sit in some random university mailroom and spoil.

These are the two most common causes for insulin resistance in cats -- and there are some additional tips / tricks if you know you are dealing with either. For example - a cat with Acromegaly has a healthy pancreas, so treatment and goals are different than for a "traditional" diabetic.

Hopefully some folks from Florida will post vet recommendations soon -- Gayle is inquiring in another webpage.

By the way - when I first arrived here at FDMB, and got the reaction of OMG, that is a high dose --- I did a dose reduction test. Norton got sick within the 24 hours of the reduced dose, so I immediately went back to his previous dose -- thankfully he recovered quickly.

 

Re: Any expert on the board: Is 20u BID Lantus a crazy dose

Checking with someone in your area for a vet.

 

Re: Any expert on the board: Is 20u BID Lantus a crazy dose

Quick reality check here:

1) where are you getting your insulin? Is it from a human pharmacy, the vet, or an online source?

2) is the insulin in its original packaging? If yes, which is it -- a vial or a pen?
If no, what is the packaging? (some vets try to repackage and/or dilute Lantus, which you can't do)

3) how old is the insulin? Where are you storing it? (in refrigerator?)

4) are you rolling the container before use and/or injecting air or excess insulin back into the container? (both no-no's)

4) what syringes are you using?

A dose of 20u is crazy high without an underlying condition, as others have mentioned. Barring one of those conditions, I'm wondering whether there's another variable at play -- like perhaps the insulin has lost its efficacy or you're not actually shooting 20u (insulin is being diluted or some other factor you're not aware of). The big risk with the former is that you could have a crisis situation when you start a new vial.

Just want to rule out external factors, such as the insulin, before focusing on the 20u. But if there's any doubt about the efficacy of the current insulin, DO NOT start a new vial at the 20u dose.