Intro and Starting Lantus

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Richard P, Mar 16, 2019.

  1. Richard P

    Richard P Member

    Joined:
    Dec 17, 2018
    Hello all,

    My boy Big is on Novolin now but he’s BG hasn’t changed much since on it.

    I spoke to the vet and we are going to try Lantus. He’s at (Novolin) 4 units 2/day right now. We are going to switch this Monday to Lantus 4 units 1/day for 2 weeks. Next Saturday I’m going to do my first curve and testing. Still haven’t pick out a monitor yet so any suggestions would be appreciated.

    I have to say something and I’m super stressed about this. My vet says one thing about dosage and then I get something different on this forum. Not really sure which way to jump. In the end I want to take care of my boy. With that said I don’t have all the money in the world or time. I see people testing all the time. I travel for work so this is very difficult but I have basically sacrificed my life. I need some practical advise. I can’t test all the time. And am concerned about dosage. Vet meters seem to be very accurate but the strips are stupid expensive. I’m getting insulin from Canada which is much better price wise.

    I also don’t really understand this fractions of unit dosage. I realize it’s a cat so dosage is smaller but to adjust by a quarter of a unit seems a little excessive. I mean a unit to begin with is almost nothing. On top of that I’m not really sure what to do with it once I have it. I’m reading but I seem to be missing something. Again, any info and advice will be helpful.

    Best,
    Richard
     
  2. Tom & Thomas (GA)

    Tom & Thomas (GA) Member

    Joined:
    Jun 23, 2018
    Wiser heads than mine will be chiming in but...

    - You should give the Lantus twice a day, once every twelve hours.
    - For our purposes a pet meter will be no more or less accurate than a human meter. And most of the guidelines here assume human meter.
    - You should start testing at least before every shot right away.
    - Fine dosing is easier with a syringe that has 1/2-unit markings. Here is the only one I know of with a 1/2" needle.

    The best approach is to read as much as you can of the yellow stickies at the head of this forum. The first two are a good place to start. It is an awful lot to absorb, I still have less than half of the basics even semi-straight in my head. Fortunately, great people are here to answer your questions as you go along.
     
    Last edited: Mar 16, 2019
  3. Olive & Paula

    Olive & Paula Well-Known Member

    Joined:
    Sep 6, 2015
    Richard, welcome. Lantus is a longer acting insulin than what you are use to. It's best given every 12 hrs and builds up a depot. The dose your vet wants to start at is to high. That being said, it does takes time to get the initial depot built up. I will let others chime in on starting dose , it is usually 0.5 units though. You would keep the dose for 7 days for the depot to establish, (could possibly see higher glucoses during this time) of course if glucose goes to low an immediate reduction is taken. Lantus is a U100 insulin so make sure of syringes you have are those. If you have a bunch of U40 syringes for can use a conversion chart to measure dosage. There is a difference so you need to make sure what you are using.

    There are many people here who work and travel. Just need to ask for suggestions on how do you......... And you will get lots of responses.
     
  4. LizzieInTexas

    LizzieInTexas Well-Known Member

    Joined:
    Jul 25, 2016
    Just to add to this... make sure the have 1/2 unit hash marks. They can be difficult to find. I always ordered mine on-line from ADW.

    You will want to get your (Big's) spreadsheet set up and linked in your signature. Those offering dosing advise rely heavily on the data in the SS.

    Read the stickies at the top of the forum.

    There are no stupid questions here :smuggrin:. Ask. Ask again. We have all been new at one time.:bighug:

    Lastly, welcome. I hope and wish you great success with Lantus.

    :cat:
     
  5. Richard P

    Richard P Member

    Joined:
    Dec 17, 2018
    Why would my vet say 4 units when others may think starting dosage is .5 units? That’s s huge difference. Also my cat is at 4 units with another insulin so is he still considered starting from scratch or is he just picking up where he left off? I’m assuming that if it’s too low then his BG would go to low. Would I then check again after? I’m not comfortable going against my vet wishes.
     
  6. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    I am going to counter what has been said on dose so far. Typically we take the dose of the existing insulin into consideration when people switch insulin types. The 0.5 units is only for people brand new to insulin and using the Start Low Go Slow method for dosing. However, and this is the big one, we can’t say if 4 units is a good dose to switch to, cause we don’t know how your kitty is responding to his current 4 unit dose. Get a human meter with cheap strip cost, and do some testing on his current insulin type first, before you switch. It’s possible 4 units will be fine, or not. The data will tell us, once you have it in a spreadsheet.
     
    Last edited: Mar 16, 2019
  7. Richard P

    Richard P Member

    Joined:
    Dec 17, 2018
    Thank you. That makes senses. I’m going to get a human meter and do that I think. How much data do I need? Every time he’s been tested he’s been in the 400’s. ie. 450, 418, 470.
     
  8. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Getting preshots is a good habit to get into. You want to make sure he’s safe to give insulin to. With Novolin, getting some test 3-6 hours after the shot will give us an idea what is happening. Insulin action takes the numbers down between shots. It’s important to know when you got those numbers in the 400’s, in other words, how long after the shot. Just preshot tests are not enough. My girl earned her first dose reduction (going under 50 if using Tight Regulation for dosing), when she started the day at 430. Without testing mid cycle, I would not have caught that.
     
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  9. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    I'm in agreement with Wendy. My only concern is your travel schedule. (You may want to take a look at the post on whether tight regulation is feasible if you work. While the post was developed if you're using Tight Regulation as your dosing method, there is good information for those who are using Start Low Go Slow as well.) Lantus works very differently than Novolin (also referred to as "N" -- we use a good deal of slang).
    • The first thing to know is that some cats to have a marked response to a change in insulin. However, we can't know how Big, or any other cat, will respond to a change and we don't have any test numbers to low where his numbers typically fall.
    • Lantus dosing is based on the lowest point in the cycle (the nadir) vs on pre-shot numbers. With shorter acting insulin, you base the dose on the pre-shot test data. Which makes me wonder how your vet was suggesting you adjust Big's dose. Were you bringing him in for curves at the vet's office? If this is the case, I'm hoping his blood glucose (BG) numbers weren't artificially high due to the stress of being at the vet's office.
    • Because dosing is based on the nadir, we encourage everyone to do their best to get at least 4 tests (pre-shot and one additional test per cycle) per day.
    • Doses are held for a minimum of 3 days with TR and a week with SLGS unless a dose reduction is indicated. Doses with shorter acting insulin like N can change daily.
    It may be worth considering starting on a dose that is a bit less than the 4u especially if you are going to be gone all day. This may give you a bit of a buffer until you have more data regarding how Big is responding to Lantus.

    Also, what kind of food are you giving Big? We strongly encourage our diabetic kitties to eat a low carbohydrate, canned food diet. There is wonderful information on this website on feline nutrition. Included in the links on this website is a chart of canned cat foods (see the links on the right side of the page). A good portion of the members here give their cats either Fancy Feast or Friskies pate style food which is both low in carbs and economical. If your vet has been selling you prescription food, it is typically high in carbs and pricey. (Vets don't get much education about nutrition during their training and what they get after vet school is courtesy of cat food manufacturers.)

    Please let us know if you have questions. There's a very steep learning curve at the beginning of this process. The people here are more than willing to share their knowledge.
     
  10. Richard P

    Richard P Member

    Joined:
    Dec 17, 2018
    We’ll, I started the Lantus at 2 times a day and doing 2 units instead of 4. Haven’t gotten to the testing yet. I have tried just haven’t gotten him to give up blood. Wanted to do a curve Sunday. We shall see.
     
  11. Ella & Rusty & Stu(GA)

    Ella & Rusty & Stu(GA) Well-Known Member

    Joined:
    Jan 11, 2010
    Hi Richard and welcome to you and "Big".

    Try the following to get a blood drop:
    1) warm the ear. Some people use a small cotton sock filled with uncooked rice and warm it in the microwave; I always preferred to use a damp baby washcloth put into a plastic baggie. Microwave for a short time and wrap it around the ear (test it to make sure it isn't too hot!).
    2) Put a little Vaseline on the edge of the ear that you plan to test. This helps the blood to bead up.
    3) Lancets come in different gauges. The higher the number, the finer the gauge. Some people start off using a relatively fat lancet (29g or lower) and switch to a finer gauge later (e.g., 31g or 33g--very fine). You can "freehand" the ear prick or use a lancet device. I always found that a lancet device was quicker--and therefore potentially less painful--than freehand, but this is a matter of practice and preference.
    4) After touching the test strip to the blood drop and recording it in the meter, be sure to praise Big and give him a treat (freeze-dried chicken treats are universally loved).

    Lots of tips and videos can be found in this link: http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

    Good luck!
     
    LizzieInTexas likes this.
  12. Judy and Boomer

    Judy and Boomer Well-Known Member

    Joined:
    May 23, 2014
    Hi Richard, welcome to you and Big!
    You've received some great advice above!
    Ask any questions you have! There is a steep learning curve but the people on this board are very knowledgable and are always willing to help! And, even if you don't ask questions, if you post daily we will steer you in the right direction!
     
  13. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

    Joined:
    Aug 5, 2016
    Good luck with your test tonight !!!
     
  14. Richard P

    Richard P Member

    Joined:
    Dec 17, 2018
    Test went badly. Trying again right now. Will follow up on how I do. Not looking good for the curve Sunday.
     
  15. Richard P

    Richard P Member

    Joined:
    Dec 17, 2018
    Well... that was just as horrible as the others but I got a reading. Cats under the bed. Problem is this is not a very mellow cat. He’s scared of everything. He’ll be there for hours. This curve is going to be super difficult. 12:41 pm alpatrack2 reading was 383. Started Lantus on Tuesday. Hoping it will be in his system long enough for the curve to be accurate. May do next Sunday instead. Not sure.
     
  16. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    If you're really having trouble, you may need to "back up" and kind of start over with getting him used to testing

    Here's something I wrote up for others for testing...maybe it'll help you too!

    It can be really helpful to establish a routine with testing. Pick one spot that you want your "testing spot" to be (I like the kitchen counter because it's got good light and it's at a good height....it also already blocked 2 escape routes due to the wall and the backsplash) It can be anywhere though...a rug on the floor, a table, a particular spot on the couch...wherever is good for you.

    Take him there as many times a day as you can and just give his ears a quick rub and then he gets a yummy (low carb) treat. Most cats aren't objecting so much with the poking ..it's the fooling with their ears they don't like, but once they're desensitized to it and learn to associate a certain place with the treats, they usually start to come when they're called! Or even when they hear us opening the test kit!

    You also have to remember...you're not poking him to hurt him...you're testing him to keep him safe and understand what's going on inside his body. There's just nothing better than truly understanding what's going on inside your kitty's body and with this disease, the more knowledge you have, the more power you have against it. The edges of the ears have very few pain receptors, so it really doesn't hurt them. Also, if you're nervous and tense, it's going to make your kitty nervous and tense too. As silly as it might seem, try singing! It forces you to use a different part of your brain!

    It's also important to make sure his ear is warm. A small sock filled with a little rice and microwaved or a small pill bottle filled with warm water (check temp against your wrist like you would a baby bottle) works well

    For new kitties, using a heavier gauge lancet is also really helpful. A 25-28 gauge lancet pokes a bigger "hole" than a 31-33 gauge lancet does, so look for "Alternate Site testing" lancets that are usually a lower number

    Finding the right "treat" will be a great help too! Freeze dried chicken, bonito flakes, little pieces of baked chicken...whatever low carb treat you can find that he really enjoys will help him to associate the testing with the treat! China's Achilles heel was baked chicken, so I'd bake a piece, chop it into bite sized pieces, put some in the refrigerator and freeze the rest to use as needed. It didn't take long for her to come any time I picked up the meter!
     
  17. Richard P

    Richard P Member

    Joined:
    Dec 17, 2018
    Okay, here’s a run down on the testing. I was able to get some tests in . As a matter of fact I was able to get a drop of blood pretty quickly this morning. The good thing is that he’s always starving in the morning so he doesn’t stray far. I have to do everything pretty close together though and I need the food to keep him focused. I test him as soon as I set down the food. I let him continue to eat and then give him his shot. Best I can hope to achieve at present time. The evening will be a little more problematic because he’ll run under the bed because he thinks we’re going to the vet. I can see I’m in for a long road of cat training. I’ll try for a curve next Sunday if this continues. I need some data on all this. I’ll be posting a spreadsheet soon. Best to all! Richard
     
  18. Sonia & Leo

    Sonia & Leo Well-Known Member

    Joined:
    May 24, 2018
  19. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

    Joined:
    Aug 5, 2016
    Congratulation on the testing and shooting and good luck tonight
     
  20. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Great news on your first successful tests! :) What sort of values were you seeing?
     
  21. Richard P

    Richard P Member

    Joined:
    Dec 17, 2018
    Ok. Here is what I have so far. He’s been hiding as soon as I walk in the door so for the most part I’ve only tested once a day. Hoping he will settle down but not counting on it. He’s always been a very frightened cat since I’ve gotten him. Scared of almost everything.

    383 - 12:41pm 3/23
    394 - 7:19 am 3/24
    336 - 6:40 pm 3/24
    413 - 6:05 am 3/25
    382 - 6:00 am 3/26
    378 - 5:56 am 3/27

    2 units 2x day. Was on Novolin at 4 units 2x day. Started Lantus on 3/19/2019 Tuesday
     
  22. Richard P

    Richard P Member

    Joined:
    Dec 17, 2018
    Also using AlphaTrak 2 meter. Tried human meter but just couldn’t get enough blood if any. Getting little drop now which is perfect for the AlphaTrak 2. I’m finally getting readings so will probably stick with this for now.
    Hoping to do a curve this Sunday. Not counting on it but I’ll give it a try. Hoping if I stay with him he won’t hide on me as much. We shall see.
     
  23. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

    Joined:
    Aug 5, 2016
    If you can get a mid day test and a test some time during the night every day trying to get them at different hours each time that could after a few days give you a good idea on how he's doing even if you can't do an actual curve
     
  24. Richard P

    Richard P Member

    Joined:
    Dec 17, 2018
    I wish I could. I work all day and it takes me an hour to get to work and sometimes more to get back. I’m right at the 12 hour mark. If he hides and won’t come out it’s longer.
     

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