Finnish 10-year-old cat, diagnosis 1,5 months ago. No real response to Lantus?

Hi everyone,

I'm Ville and a servant to a 10-year-old cat called Sulo. I posted a full introduction earlier in the main forum, outlining the background and some questions that were troubling me. While I got advice on nutritional aspects, I was also kindly adviced to repeat the part specifically concerned with Lantus here.

This is my problem: There didn't seem to be big enough response to 1 unit of Lantus (administered from the pen) and the dose was increased to 2 unites by the vet. Despite the higher dosage, Sulo's results are higher than they were before. In fact, they're about as high as they were for the first time before starting the insulin injections, and as high as they are at the vet's with all the stress involved. Also the hind legs (diabetic neuropathy specifically) have not really improved at all.

In your experience, am I panicing too early? Is it normal that it takes longer for the blood glucose levels to decrease? Is the curve spiking even higher a random occurence that could happen with Lantus (or injections in general) or something else. Is this a question of dosage - or more than anything about fixing the diet? Or perhaps another disease or condition that has remained hidden so far but interferes with the treatment?

I've got a busy day tomorrow with work and everything but I'll do another test before giving the morning injection (and perhaps another one in the evening). Hopefully the vet gets back to me soon too. There are two vets at the clinic who've now looked at Sulo's condition, and I don't know when they're working next time and how much do they communicate with each other (it's a 24/7 clinic so they don't work in regular 8 am to 4 pm shifts).

 

Welcome. It will really help you understand how lantus works if you read the yellow stickies at the top of the board. Lantus is dosed based upon the nadir, the lowest point in the cycle. That usually occurs mid cycle but for some it’s earlier and for others later. It’s best to get 100u syringe goes for dosing because usually we increase by .25 rather than whole units. Also every time you increase it takes time for the depot to build and thus to see how well a dose is working. Can you get some tests between +4-7? Sounds like it might be possible at night which is good because many cats go lower at night. Mine did. Onset is usually at +2-3 so a test at that point will sort of predict how the rest of the cycle will go. Getting a test around +6 will help see the lowest point. That being said tests before injecting are important to make sure it’s safe to shoot. There’s no reason at this point to think your cat has any other disease. This is usually a marathon rather than a race. What you are seeing is quite normal.

Based on your schedule I’d have a look at SLGS first.

 

If you have the time, you may want to look at several of our spreadsheets. We test every day and multiple times a day. If you are basing your concerns over 2 days of tests that are about a month apart, I think it's very premature to draw any conclusions. You have no idea where Sulo's numbers have been in between the days that you tested -- the numbers may be high or they could have dropped much lower and what you're seeing is what we call a "bounce."

If you can start to collect more test data, that would be ideal. You would need to test before you give a shot and get at least one test per cycle (AM and PM cycles) every day.

 

Hello, Ville, and welcome!

 

Thanks! That's reassuring. Yeah, it seems like it will be a marathon to get Sulo better - equally a marathon for me in terms of learning about the condition and the practicalities of treatment. Now that I finally have plenty of lancets I can keep on testing even a couple of times every day, that should put things in perspective. You can't browse syringes at the online shops of pharmacies here (the best I could find was a Lantus pen with .5 unit increases) so I'm going to have to walk in and see what they're carrying.

I'm also using a blood glucose meter intended for animals with a specific calibration for cats (Wellion Gluco Calea), which the vets will use as well. As far as results of different users being comparable is concerned, I'm not sure how many people use equipment calibrated for humans? I see for example the SLGS method discourages the use of pet-specific meters.

 

I'm not sure if you'll be able to find syringes with half unit markings, but I know that the BD syringes like these are popular and there's an insulin ruler that you can use with them to get the smaller doses

 

Most of us use human meters because the strips for the pet meters are so crazy expensive, but you can use the pet meter too on either dosing method (TR or SLGS)

The main difference that counts is the "take action" point....On a human meter it's when they drop below 50 (2.8)…..on a pet meter, it's when they drop below 68 (3.8)

If they drop below that point, you want to intervene by feeding something high carb or adding a few drops of something like corn syrup, honey or maple syrup

 

I always keep on forgetting about an online shop for diabetes related products, which does indeed carry Lantus in a bottle and those BD syringes now that I looked into it again. I also get your point about the strips being expensive, 74 euros for a pack of 50... So far managing on the ones that came with the meter.

 

You might want to see if you can find some oral B-12 (methylcobalamin is better than cyanocobalamin)

Here in the states, we suggest a supplement called Zobaline for Cats (methylcobalamin 3mg + 200mcg folic acid) but you probably can't get that in Finland.

It can make a world of difference in diabetic neuropathy

 

I'd stay away from the vials of Lantus......each vial holds 1000 units and the vast majority of cats end up on less than 2U twice a day so you end up paying for a lot of insulin that you just throw away when it loses efficacy. A vial that's properly cared for will generally last 4-6 months and then you end up throwing half of it away.

The pens are the better buy because each one only holds 300 units. You just buy the regular insulin syringes and pull the insulin out of the pen instead of using the special pen needles and the "dial-a-dose" mechanism. You can usually use every drop of each pen since they hold less.

If you pull the cap off the pen, there's a rubber stopper just like on a vial...you just insert a regular insulin syringe into the pen and pull a little more than you want out of the pen and then "waste" just a little to get to the right dose

 

Thanks Chris for the help! And looking at Tootsie's video, that's exactly how Sulo walks now. So we have a long way to go, but there's still hope he might walk somewhat normally again!