Have to start over with Lantus and any help with usused Lantus Pens?

Okay so this insulin that I got from a friend on here says that the insulin was purchased on Aug 29, 2014. I received the pens in just a box with no cold pack so not sure if he even had them refrigerated and if so why they weren't shipped with an ice pack? Either way, I had 2 unused pens from what I could see and its been approximately 8 months since he purchased these pens. I am beginning to wonder if despite that they pens appear to work somewhat to bringing his numbers down a bit if the efficacy has worn off? I wonder if I had a fresh batch of Lantus and started on 3 units if that would work better then? I have him on 5 units now and some may say that is too much. Let me remind that I do have a 21 pound cat and most people using Lantus probably deal with a 10-15lb cat so not sure if it requires me to use more insulin on him? When I went back to 3 units the other day it didn't seem to do much even if it was just for a day or two. So what should I do everyone? Do I get a new batch of Lantus and in the meantime resort back to 3 units/2 times a day or 2 units/2 times a day and let it readjust into his system for a week or so to find out if his body does better with the lower dosage? I just want to do whats best for him and I won't run this across my Vet because I am in the process of switching Vets since the one I have now doesn't seem to care much about him anyways. Does anyone on this forum have any unused Lantus Pens that they would like to give away? I'm on a very tight budget and will have to get more food and spent a lot trying to see what works. Just in a stressful time right now.

 

there are 3 possibilities for what's going on. One is that the insulin isn't as effective as it should be. The second is that Pooper needs that much or more insulin. A third possibility is that he is overdosed. What insulin was he started on? I can't find the name of whatever you used before PZI.

It looks to me like he might be overdosed. Notice how his blood sugar went out of control when you passed 0.75u? That's when the very high numbers began. Lantus isn't an insulin that can beat down high numbers. When a cat is overdosed, their body will put out hormones and stored sugars to increase the blood sugar. Then you get in a cycle of the cat's body trying to keep the cat alive by pumping out these hormones/stored sugars, causing high numbers, and you increase the dose because of the high numbers. The higher dose causes the cat's body to put out even more hormones/sugars and round and round you go. That happens with any insulin, not just Lantus.

I think this is a separate issue from the insulin, but that's what it looks like to me. The "cure" for this is to restart with a normal starting dose - and since you have dry food in the picture (assuming he's still eating Young Again?) your only option is to use the Start Low Go Slow protocol. It would have you start at 1.0u (because of the dry food) and hold it there for several days to see if the cat's body is the cause of the high numbers. They will usually clear out in about 3 days.

The risk of doing that is that if he truly needs a higher dose of insulin, it can put him at risk of ketones developing. If you decrease the dose, you would need to check for ketones 1-2 times per day during the trial of a lowered dose.

Most cats need between 0.25u and maybe 3-4u of insulin. My cat had acromegaly, a tumor on the pituitary gland that causes a need for high doses of insulin. He got to 15.5u per shot at his highest dose. Some cats go over 100u. So I'm very aware that there are circumstances when a cat needs more insulin.

Regarding the insulin -

If the insulin has been started most people can use it for 6 months. If it's kept cold in the fridge it'll last til it's expiration date on the package, or 6 months after you start using it.

So I would see if you can figure that out before you invest in more insulin. If you can't get that info, then you might want to get a new pen and see if it makes a difference in his blood sugar. There is some movement in Pooper's cycles, so it's not like it's completely dead.

Many people will go ahead and try a new pen, then if it changes the blood sugar significantly you would know that the old insulin was dead. If it doesn't, then they go back to the old insulin and finish it up.

One tip - it looks like you are changing doses based upon his preshot numbers. Lantus dosing is based upon how LOW a dose gets a cat, not the high points.

He likely needs to lose weight - that's very big for a cat. Would you say that his weight fits his frame - ie, is he a huge cat overall? Long? Endless appetite? The size of the cat isn't always related to the insulin dose. Just depends. But if he's a giant cat overall, not just fat, then it may be that he needs more insulin. Just one more piece of the puzzle.

Why don't you figure out what you want to do about the insulin and we can go from there. If you decide you want to reduce the dose, please promise that you will post daily here so we can help you figure out how to move ahead. You don't want to do this on your own.

 

By the way, I'm going to ask some other experienced members to take a look at his spreadsheet and see what they think.

Would you please check back in with answer to my zillion questions above before you shoot tonight?

 

I agree with Julie, I think he might be getting too much insulin. When Poopers was on a low dose you were either not giving a shot or they were sporadic. Then on January 30st you went from .75u to 1.5, to 2.0u in three cycles. those increase are just unheard of when using Lantus. And even into March dosing was a bit all over the place and it wasn't until the last couple of weeks that you have held the dose.

I don't know enough about dosing to tell you what to do from here, but I do think that the dose needs to be reduce, I just don't know where you go back to. I guess if I were in the same situation I might stop insulin for a day or two to allow the depot to clear and then see where Poopers is. Then I would probably start at .25u and follow the protocol more closely. But again I am not sure if this is the best approach. Hopefully some of the other experts can jump in and provide their advice.

 

I just saw your post from last Friday on Main Health. I can tell you that the folks helping you are all very experienced.

I also agree with them about the young again food. one of the problems with diabetics is that they are dehydrated. So giving dry food to a dehydrated cat, and cats don't have a strong thirst instinct, can really tax their kidneys. Even cats that are not diabetic can sometimes have trouble with their kidneys from eating dry food. Switching food to all low carb canned food is one of the very best things that you could do to help your kitty.

Reducing the carb load also reduces the stress on their pancreas.

If he's got bad breath he probably needs a dental. does his breath still smell?

 

I have never checked for ketones nor do I have the right stuff to check it or know how to do it.

 

I know that on the box the person bought it back in August 2014. It was sent to me unrefrigerated so given that it took 2 days to get to me that went unrefrigerated. It is beyond 6 months old obviously and I have kept it in the fridge since I got it and started Poopers on it.

 

Pooper's weight doesn't fit him. He has a Pop Belly and waddles when he walks. He doesn't want to eat all the time not with the YA. If I put down the FF wet food then he will scarf it right up but if it has carbs and a different texture that is probably why he scarfs it down. He is a big cat but because he is fat. Just felt like when I was giving him the BCP(Bovine) insulin at 3 units for several days it wasn't doing much for him. He was mostly staying in the 300s. When I made the switch to Lantus Pen I started out at 3 units and it pretty much did the same thing. When I went to 5 units and I know I increased it more than should have but when I did that is when it was dropping it into the 200s. So not sure if more insulin the better? I don't want to hurt him.

 

The thing with the lower numbers before was that he was on Novalin N and it was giving him lower numbers but not staying consistent. After 5 hours he would spike right back up.

 

He had dental work done recently if you see from my SS. The dry YA food is low carb and is meant to help with all those issues. They said that they have had alot of remission with the food and some people on here have even had their cats go into remission from using it.

 

For what it's worth... my 2 cents:

While the dose has been increased in whole units, the BG numbers are not dropping too low. Add in the fact that we're probably looking at some glucose toxicity as well as the fact that Poopers is being monitored often enough... I don't think I'd be do a rebound check at this point. We already know from years of experience that rebound checks usually don't work. More often than not, the best course of action is to continue forward using the suggested guidelines in the TR protocol (ditch the dry food). Monitoring carefully is imperative because as soon as there is a break through the trip back down the dosing scale could be very rapid.

Oh gosh! I guarantee we've seen many, many more remissions when kitties are on a low carb, high protein wet diet than anyone has ever seen from kitties on a dry food diet!

Like I said, just my 2 cents...

 

Here is a thing too that doesn't make much sense to me. Wouldn't a human and a cat if they do not eat for several hours see their glucose drop? However, with Pooper's his numbers climb if he doesn't eat. If I were to switch him to FF it wouldn't do much because I won't feed him anything with seafood/fish in it due to him being a male and according to Catinfo fish products not good regardless of where they fall in the list. Secondly, the Turkey and Giblets did not drop his numbers at all into the 100s. He always stayed above 240. So I do not know what to do. The YA Zero Carb is supposed to be for diabetic cats. If their foods were not accurate as some of you may think then they would be sued and out of business because I am sure most people have bought the food due to a diabetic cat or finding lowest possible carb food.

 

I understand Jill. But YA is the lowest dry cat food out there if you buy the original zero carb and not the mature formula. Either way 6% dry matter carbs is better than any other dry food out there. I know most people are on the wet food kick and despise dry food due to dehydration etc... I guess I'm stupid and don't understand but if a company created a cat food that said it wouldn't cause dehydration, kidney problems or urinary problems and people ended up buying the food and seeing their cats get worse then wouldn't you think they'd be sued? Everyone would send their food back for a refund. I feel like Pooper's is carb sensitive because for several weeks I have fed him the Turkey and Giblets FF classic and I have never seen his numbers drop into the 100s. So what could be the problem then? Too much insulin in him or not enough?

 

What food would you suggest I buy and try then that could help Poopers get lower numbers and help his pancreas heal? Friskies I seen were like 8-9% carbs.

 

I'm very aware and familiar with YAZC. I used to grind it and sprinkle it on Alex's food as an appetite enhancer when she was sick and wouldn't eat. YA is a new company. Who knows what will happen in the long run! I've been on this board since 2006 and I can tell you with utmost certainty that we've probably seen at most a dozen kitties come through here and go into remission on a YA dry food diet versus the 100s and 100s we've seen go into remission on a low carb wet food diet. Heck, this ISG alone has had over 300 kitties go into remission on a wet food diet just since 2008!

The dosing method you chose to use does not give us the luxury of coming to any conclusions as far as whether Poopers is getting too much or too little insulin... hence the suggestions I posted above.

As far as being carb sensitive... Alex could see her BG numbers rise from 50 - 100 points from a 1 inch piece of freeze-dried chicken! LOL!

I don't know what Poopers likes, but if you look at the Low carb-Lower phos foods tab on Alex's spreadsheet... those are the varieties she liked. I'd also suggest sticking with foods that are around 4% - 5% carbs as a starting point. Some kitties do better with foods that are have a littler higher percentage of carbs, but less than 10%.

BTW, re: switching foods...
Something that appears to be forgotten as of late: It can take around 2 weeks for kitty's system to adjust to being fed a new food. Alex's numbers went up for about 2 weeks before I began to see them come down again after introducing any new variety/flavor. I see so many caregivers proclaim kitty's numbers spiked too high after being fed a single serving of a newly introduced food. It's really a shame...

 

Not necessarily if his liver goes into 'starvation mode' and starts pumping out glucose - then you'd see a rise in BG even though he hasn't eaten. And if his pancreas is trying to work, then eating little and often takes the excess strain off it and allows it to work towards keeping his BG down.

I think you might be expecting a little too much of any food - wet or dry - in thinking that the food alone is going to be enough to bring his numbers down into the 100s at this point. All the food can really do is be the best diet possible to not give him so many carbs that a reasonable dose of insulin can't do it's job properly AND to give his pancreas the best chance of being able to deal with the carbs in his food if and when it starts to recover. While it's true that changing to low carb wet food from high carb dry can bring numbers down initially, now Poopers has been on low carb food for some time, I wouldn't necessarily expect to see much of a drop just from a change from one low carb food to another unless he's allergic to something in one of the foods you were already giving him (I'm not sure the 200-300 point drop you're looking for from food is possible even early on unless there's an allergy involved). Any low carb food will help support his system and allow the insulin you're giving him to work at its peak efficiency. Most of us like wet food because cats tend not to drink enough as they're adapted to getting most of their fluid intake from their food (a natural diet of mice etc would give them around 70% of their food intake as fluid). In the same way that many of us are wary of the prescription diets because they're often prescribed to us as the result of hard sell to our vets by the manufacturers, I think you're going to find that people here are wary of any claims made by any food manufacturer that haven't been extensively tried and tested. It's very easy for them to claim that their food is good for your cat and it would be extremely difficult for you to prove that the food had caused deterioration in an existing condition that tends to be progressive if not managed correctly if it ever came to filing a claim against them. That's not to say that their food has no benefits - if your cat absolutely won't eat wet food at all then it's surely going to be the best of the dry food options. Is there a reason other than the numbers you're getting why you don't want to feed wet food? If budget is an issue, even some of the 9 Lives varieties come in at under 10% carbs.

Just as an extra note - some cats actually do better on slightly higher carb percentages than others. Some cats really need to be kept under 5%, some do just fine on that 8-9% food. I can even get away with feeding the Friskies Mixed Grill flavor at 11% provided it's only one of the 4 or 5 flavors I put out each day without it having any noticeable effect at all on Rosa's BG.

 

There is no magic food and there is no magic insulin dosage unfortunately. Many cats will do just fine on YA because it is low carb and they'd do fine on any low carb. Same as if they'd have went to eating FF wet food. Other cats aren't going to be so lucky because they are going to be dry food sensitive regardless of the carb content. No one here has a crystal ball to know if Pooper is getting too high of a dose or if he hasn't reached it yet. That is one of the reasons protocol has us moving slowly up 0.25-0.5U after consistently dosing for 3-5 days so that we can fairly confidently say we haven't missed the optimal dose.

Some of the claims I am seeing people say YA spokepersons are making; I highly expect lawsuits in the future. No one can claim with certainty that a food can take a cat off of insulin in 3 days. That kind of claim WILL end up killing peoples' cats eventually. You also can't claim that feeding cats dry food will not cause dehrydration. It is scientifically impossible to remove the moisture from a food to make it dry, then claim it doesn't cause dehydration - the food is dehydrated and CANNOT provide any form of hydration to the cat!

As for where to go. I know many people support dry food. I am on my 4th sugar dance with foster Sly and every time removing dry food was a significant part. WIth Cecil (chart is linked in my profile) I removed his low carb dry food the night we brought him home into foster and he was off of insulin 3 weeks later (I don't cold turkey them the way YA recommends, I ween them off to give them healing support to help remission stick or he could have stopped insulin much sooner). You can see in Sly spreadsheet that removing his dry food has made significant changes, though his was also higher carb. He had low carb dry the first few days we had him.
Can you try Wellness Chicken? This is what I have used for all of my fosters with great success. I believe it is around 4% carbs. With ChrisFarley I did find his numbers stayed lower with the Turkey Wellness, but they all eat the Chicken better.
If you think he needs to lose weight to help with his numbers, I have ChrisFarley on Merrick Beef Wellington now. It is in the upper range of low carb, I think 8%, but it only has about 150 cals in a 5.5oz can where Wellness has 200-220. His BGs have stayed good since we switched him to this food. We add water and its like a gravy with chunks food.
I don't think either of these foods have fish in them other than salmon oil as a supplement.
For dose I think you could go either way. Pooper sure did look good at the beginning of the spreadsheet before the quick increases. But agree we don't see any peekthoughs of a too high of dose dropping him too low at points. If switching food, I myself would feel safer dropping the dose back down a little until the change in food settled into to the dose.

 

shortcut list

go back to the list and do some comparison shopping....
I would go back to using the special diets friskies .... simply because so many do fine with them. they are less calories, and lower phosphorus
...especially the turkey and giblets

fancy feast can be too high in phosphorus ... it just depends on if your cat likes it.


but Purina One's are 89c a can where I am.
eukanuba is 99c
authority is under a buck ( shadow won't eat it)

and the one I like best is nature's variety quality wise.....


most of the folks who continue with dry often have a cat that doesn't want to eat the wet.
If yours is willing to eat wet, you've got a plus right there....

 

I added to my spreadsheet at the very beginning the insulin he was on. I think some people thought he was on Lantus then. He was on N at the beginning and I changed it because it isn't lasting and wore off like after +5 hours.

 

Yeah my cats will eat wet. Pooper's enjoys the FF Turkey and Giblets and Chopped Grill classics but I know they are higher in phosphorus. They also don't seem to bring his numbers down either. ALways in the 300s. Even if he doesn't have kidney problems I'd want to go for one lower in that mineral and what will prevent urinary blockages.

 

I can't speak to feline diabetes as well as I can to human, but as a Type I diabetic, if I do not eat and take no insulin, my blood sugars will still rise, without fail. I don't really know why (after 30 odd years of living with it), but the body seems to need some insulin in it, regardless of food intake (which is why in the days before insulin, keeping Type I patients on a low carb diet still only helped them to live a little longer). And if Pooper's pancreas is still spitting out some insulin (just not as much or as reliably as it would in a non-diabetic), then getting a little bit of carb into him would trigger it to work a bit more. So that's one possibility.

Ultimately, managing diabetes is a balance of insulin, food and exercise (exercise makes the insulin on board work more efficiently, converting the carbs ingested into energy more readily: exercise is a little hard to manage in a cat, though, so insulin and food will be key ). A change in food alone might work for some, but certainly won't work for all. Back to the human diabetic analogy: Type I diabetics will always need to inject insulin: our pancreas's are effectively "dead"; Type II diabetics (those whose pancreas just don't make enough insulin, or their body does not use it properly, etc.) can be diet controlled, but for many, they still need to support this with medications and/or insulin injections.

 

In the true spirit of the FDMB, I prefer to keep things on the board... subject to peer review... rather than in private messages.
In response to your PM:

• You can find the link (blue font) to Alex's spreadsheets and other info in the signature block of this post. Please note: the foods found in her Low carb - Low phos tab are simply foods Alex liked to eat. Poopers might enjoy a wider variety of choices.
  
• Wet matter vs dry matter calculations -- which is more important? I have no idea. I've always used food charts calculated by persons I trust. Janet/Binky's charts are outdated now, but Dr Lisa Pierson's food charts are relatively new. From Dr. Lisa (same link): "I recommend that the reader ignore the Dry Matter Basis data and just focus on the Calorie values – the frst 4 columns. Most nutritionists prefer to consider nutrients on an energy (calorie) basis but dry matter fgures are included for those readers who prefer to evaluate foods on a DMB. Going forward in this document's dialog, I will be referring to calorie basis, not DMB."
• You'll have to experiment to see what carb % works out best for Poopers. Choose foods with about the same percentage of carbs when you start experimenting. I usually suggest starting with foods around 4% - 5% carbs. Give the experiment about 2 weeks to reach a solid conclusion about the food. You may or may not have to make adjustments from there.
• "If I have too much insulin in him, then would it help to feed him higher carbs to drain out the insulin so that I can restart to 2-3 units again?" Only time and reducing the dose will *drain out* the insulin (deplete the insulin depot)... if that's your choice for going forward.

Hope that helps...

 

I'm just lost for words on why you guys would recommend Wellness Chicken and Turkey when there are fruits and veggies listed in the food. From last I know, cats aren't supposed to have fruits and veggies and so why would I feed that to my diabetic cat? What makes it different seeing it in wet food than dry food?

 

I think it's all down to the amount of anything like that that's in the food. If it's a very small quantity then it's not going to have the same effect as if it was a large percentage of the food. Also, if you go back to thinking about a cat's natural diet, the cat is also eating everything that its prey has eaten, so if a mouse has eaten berries then the cat also gets the benefit of those but in small quantities. It's not about whether something like that appears in wet food or dry food, it's about the quantity of it in either.