I'm confused

Just started Rusti on Lantus yesterday morning. Her AMP was HI, gave her 1U. Tested 2 hrs later and it was still reading HI so gave her 0.5U. Tested again 2 hours later and it was still reading HI and I gave another 0.5U. It's now 12 hrs and her reading is 224. Do I give her a shot now or hold off?

 

question: I'm I right in reading that you have given Rusti multiple shots of lantus within a 12hr time frame?

 

whoa! you CANNOT shoot lantus willy nilly like you have been doing. i know i'm coming across very harsh here but i've seen at least one cat killed by shooting lantus too often. and i'd like to not see another one.

i have to ask where did you get the idea to shoot lantus every two hours?

let me see who's around as far as lantus goes to see if you should shoot anything now or wait and let all that lantus clear her system so she doesn't OD

 

How many hours ago was the last shot?

Cindy is correct in that you cannot shot lantus like that. You shoot it only twice a day 12hrs a part, like 7am and 7pm...does that make sense?

 

I hope you read this before shooting...

It looks as though the last shot you gave was at +4, meaning 4 hours after the AMP shot. Because you are only suppose to shoot lantus every 12 hours, if it were my cat, i wouldn't shoot right now. If it were my cat I would wait another 4 hours before shooting again depending on what you get as a pre-shot reading...If you shoot now you risk over dosing your cat and you could potentially kill them...

I'm not sure what your normal shooting time is but if you decided to shoot 4 hours from now you would have to gradually get back to your normal shooting time over the next few days...

I hope someone else chimes in on the topic...

 

ok, i've done some searching and came up with some of your prior posts. it appears Rusti is a very sick girl.

summary of stuff i've found:

no ketones recorded yet
just switched from humulin to lantus
lethargic kitty and being syringe fed
but seemingly better today behavior wise?

 

whoa! you CANNOT shoot lantus willy nilly like you have been doing. i know i'm coming across very harsh here but i've seen at least one cat killed by shooting lantus too often. and i'd like to not see another one.

i have to ask where did you get the idea to shoot lantus every two hours?

My vet started me off with Humulin and when she was still reading HI (off the meter) after 2 hrs I was told to give another injection but only 1/2 U. I honestly thought I had to do this with Lantus also. You may be as harsh as necessary - i'll even hand you the 2 x 4.

Margie

 

it's ok Margie. we'll help you figure this out.

the problem with shooting lantus that way is that it has a build up effect so in a few hours after shooting that way, you're gonna have a heck of a lot of insulin all working at the same time, and most likely dropping kitty way too low.

in the kitty i mentioned above, it all hit and kitty hypo'd badly, and there was no bringing kitty back up to safe numbers before their body gave out on them.

the one plus i see to this is that it's your first day on lantus right?

may i ask what led to Rusti's current weak inappetant condition? did she have a bad hypo on the humulin? in the prior posts i found it says there's no signs of ketones correct?

 

hi, treyspot? how long ago did you shoot lantus last?

problem is that lantus lasts about 12-14 hours in most cats, so shooting early intensifies its effect in the system. if you take a look on the lantus forum or in my signature, you'll see a link to the Tilly Protocol, which has been very useful to lantus kitty owners. in a nutshell, under the protocol we shoot the same dose every 12 hours, increasing the dose in tiny increments every 3 to 10 days if we can't get the numbers down decently by nadir, which in most kitties seems to be between 4.5 and 6.5 hours after the shot.

we really need to see how your cat is doing on one dose for about a week to 10 days after he first starts on insulin. does he have any other health issues we should know about, like diabetic ketoacidosis? that would affect how we approach dosing. i'm concerned that multiple shots today have created an overlap situation that may intensify the next shot even further, so at 12 hrs after your previous shot it will be time to shoot again unless his number is too low at that point. after that shot, it would be a good idea to start testing hourly for a few hours to make sure he's okay. if he's running too low, you may need to intercede with food. do you have any canned cat food with gravy that you can get him to lick? some cats will lick that off your finger even if they won't eat normally, and it's what we give them when their numbers are too low.

welcome aboard and hope to hear from you soon re when you last actually injected the lantus into your cat. we'll keep an eye on you two to make sure he's okay.


[ok, based on your discription of his current condition and immediate history, can you make it to the drugstore for some ketone test strips? highly recommend you test for ketones as soon as possible. it involves putting a test strip in the litter right after he pees and before he covers it up, or getting the strip in his urine either collected via ladle or put directly in the urine stream. inappetance and high numbers can lead to ketones, which can be deadly. if we can keep on top of them we'll be ahead of the game.]

 

Lantus is a slow starting long lasting insulin. You usually see no effect until about 2 to 3 hours after shooting. You only shoot every 12 hours and even then there is an overlap Come to the Lantus Forum to get a lot more info. http://www.felinediabetes.com/FDMB/viewforum.php?f=9
It's pretty late now and a lot of peeps are east coast and in bed. There are a lot of general info posts on the top of the page to help you understand how Lantus works and in the morning people will be there to advise you.

This is an example of what to expect to see during a 12 hour cycle.

• +0 - PreShot number.
  +1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
  +2 - Often similar to the PreShot number.
  +3 - Lower than the PreShot number, onset has started.
  +4 - Lower.
  +5 - Lower.
  +6 - Nadir/Peak (the lowest number of cycle).
  +7 - Surf (hang around the nadir number).
  +8 - Slight rise.
  +9 - Slight rise.
  +10 - Rising.
  +11 - Rising (may dip around +10 or +11).
  +12 - PreShot number.

In addition Lantus has a cumulative effect in the system, so it usually takes several days for the "shed to fill." So you will not see the full effect of the dose for several days.

Lantus is very effective but you must understand how it works and have patience.

Definitely do not shoot again for 12 hours after last dose! There are several members on the Lantus board who can help you establish the proper amount to shoot.

 

I'm gonna second the others that Lantus does not work this way and you run the risk of a crisis situation down the road. Lantus is a long acting insulin and you won't see immediate results after giving a shot (the first "action" begins not before 3 hours post shot) and the maximum working can happen anywhere from 6 to 12 hours after a dose is given. Lantus takes time before you will start seeing it's effectiveness (usually 3-5 days) of steady regular shots. You cannot "shoot down" a high blood glucose by simply giving more and frequent insulin.

I suggest you continue to monitor the BG regularly and plan to give a steady dose of 1 or 1.5U every 12 hours. I would depending on what the BG does today with all those shots, plan to give your next dose at least 12 hours from the the last shot you have given. If the last .5U you shot was at noon you will not be able to give insulin before 12 midnight.

High BG is not seriously dangerous (if no ketones were present) then there is no need to panic it may take several days of steady 12/12 dosing before you see a nice drop. Keep checking BG and ketones and report your readings here. When you have low numbers or are ready for the next shot, come here and post first for advice.

 

BTW, we don't hit with 2x4's here, but do throw "wet noodles" so be prepared

 

Thank you all for the information. I have a lot of learning to do. At 10:30 PM her BG was 224. Now a12:45 it's at 208. Should I make this an all-nighter and check her every 2 hours, or do you think she will not drop too far off the scale?

 

how many hours after her AMP shot was the 10:30pm BG reading?

 

Her last shot was at 2:15 PM, so that was 8 hours.

 

ok, let me sure i have this right...

the first shot was at 10:15am, the second shot was at 12:15pm and the 3rd shot was at 2:15pm...is that about right?

 

ok, so you're looking to shoot her at 2:15am. after that it would be good to test hourly for the first few hours to see how she's doing.

at 2:15a.m., if her number is still dropping, i'd suggest you do not shoot until it starts going up again, just because of the accumulated overlap from today. you'd be testing every 15 to 20 minutes after what should have been her shot time, to determine when the number starts going back up.

 

As you can see she is still dropping and may continue to until morning (at least 12 hours from the last shot) I would test as much as you can, once you see the numbers starting to rise (>200) you can take longer breaks. As long as the numbers keep going down you will have to test more often and do not give any insulin until they have started going up. Regaurdless of what the morning AMPS is I would not give more than 1 to 1.5U (what dose were you at on Humalin?)

 

I was giving 1/5U with the humulin (12/12)and boy were the readings all over the map, most of the time she was still falling at 12 hrs so I couldn't even get a schedule worked out as I wasn't going to give anything when the numbers were on the way down or hit super LO.

 

now I'm confused :lol: is that 1 to 5 units or one fifth of a unit? Were you shooting just 1x every 12 hours or shooting additional after 2 hours when the BG remained high? Humalin usually has it's peak/nadir at about 4 hours so when you shoot every 2 hours you will be getting overlaps and multiple peaks within the 12 hours (curves within curves). Anyway you can forget all that stuff cause Lantus is whole new game and has very few simularities with other insulins. Starting with Lantus you can consider this your first real insulin attempt. A typical starting dose for newly diagnosed cats or cats that were not regulated or only breifly on another insulin is about 1 to 2U. Most people start on 1U, if BG is quite high or the cat has danger of ketones or is very large (not fat but a large breed with a larger ideal weight) the dose can be a little higher (1.5 or 2U). We follow the protocol in the Lantus Group and keep doses steady for several days before incresing if needed. Little importance is given to the preshot we adjust the dose as needed according to the protocol in small increments based upon the nadir (lowest BG readings in the 12 hour cycle).

I'm sure Humalin was like being on a roller coaster (it's a poor insulin choice for most cats) I have never used it, but I messed around with Caninsulin (an insulin made for animals which is simular to Humalin) and tortured myself and my cat for several months before I made the switch to a long acting insulin (Levemir) I never regretted it and never looked back!

 

Hi and welcome

loks like you've got through last nights drama.
I clicked on your spreadsheet but no numbers?

You say your hometesting. My suggestion would be to start over.To not have a complication I would give the next shot 12 hours after the last shot you gave (1/2u I believe).

Test before shot. If your not sure about number, post here first. Musn't feed until you are going ahead with shot.
Get a +1 and 2.
Again depending on what number you have you would get further spot checks at either +4 or +5 and +6.

You need to find Nadir-this is where the insulin is working it's hardest and thus the lowest bg number you will see in the cycle.

Because of the way Lantus works, you hold this initial dose (1u) for the next 5-7 days. If numbers aren't shifting down by day 5 you would increase by .25u (this requires some eyeballing on your part and using 1/2 unit syringes). If numbers have moved some, you would wait till day 7. This is so you can see exactly what impact 1u is having on kitty's bg's.

Have you swapped to low carb food?
I know you said your syringe feeding.
This is another reason for you to tread cautiously as food raises bg's and I'm guessing kitty doesn't eat much?


We'll help you every step of the way, so take your time and ask as many q's as you need.
Good luck :mrgreen:

ps-if you have got your spread sheet up and running, post in the Lantus isg and highlight that your a newbie.

 

Good morning :smile: Just dropping in to see what was going on and after reading your post I see you got some great folks looking out for you. I have to run...work is calling...but when I can, I'll be back to see how everything is going.

 

Good morning.

Today is a new day, so we are going to help you to learn to use Lantus properly. Here are some things to help you:

1) Lantus is a long acting insulin. It is only given once every 12 hours.
2) You should test before every shot. Since it looks like you are hometesting, kudos for you!!!! :thumbup
3) Start low and go slow. 1 unit is a great starting dose. More kudos :thumbup
4) You must give each new dose of Lantus at least a week before raising the dose. If you do need to raise it, only raise it by 1/2 unit. Again, wait at least a week, before adjusting again.
5) ECID (Every cat is different). NADIR usually occurs anywhere between +6 to +10 hours after the dose. By doing your own curves, you should be able to determine when it usually occurs for your cats.


You are going to do a great job caring for Rusti and we are here to help you.

 

Hi Margie,

You got excellent advice earlier, I won't wet noodle you or anything. Rather, I would like to direct you to some lantus links that when you have a moment to breathe that I highly suggest you read:

New to Lantus Group
Info, proper handling and storage
Storage Shed
Tight Regulation/protocols

All of these links and a few more are found on the lantus ISG viewforum.php?f=9

Please read this to help you get started -

Lantus works VERY differently from N that you are familiar with. For example - always keep lantus in the fridge (opened and unopened containers), NEVER shake or roll the container, only shoot twice a day (BID) in 12 hour increments, if you think you gave a fur shot or missed - NEVER shoot again, instead note it on your chart and wait until the next 12 hour to shoot.


When in doubt - SHOUT out your questions either on health like you did or the lantus board!

I hope you and kitty are doing well this morning and welcome to the group.

 

Margie:

It would be beneficial if you read your previous threads, like the ones from yesterday. Several of us responded there with links to the Lantus board, our dosing protocol and much of the same advice that has been provided today.

Do you have blood glucose levels from throughout yesterday and today? Depending on what Trey's numbers were will dictate whether a shot needs to be given today. If your cat had very low numbers for a long period, this morning's dose is best skipped. However, it is necessary to see what the numbers were.

 

Hi Marty,

I thought you might have an exciting evening. The 224 at +8 from the last shot you gave yesterday was very nice, and so much better than the wild swings Rusti was getting from N.

I bet you are pooped today, but you are doing a great job with Rusti.

You do need to get Rusti on a 12/12/ schedule, but I'm sure that 2pm,2am isn't your choice for shot time. You can move her back to 10am/10pm over the next couple of days by shooting at +11 or +11.5, depending on her number.

Another caution about the Lantus. If you pull more than you need into the syringe, do not inject it back into the pen. Discard it over the sink. Syringes have a silicon lining that can contaminate Lantus. For the same reason, you cannot preload Lantus into syringes, for example, if you want to leave prefilled syringes for a petsitter.

You're doing great Marty!!!

How is Rusti doing today in the lethargy department? Just so folks are aware, Rusti is lying on puppy pads and doing her business where she lays. She has a vet appointment tomorrow for a potassium test.