Lantus and BG Readings

Tiger (an overweight cat) was diagnosed diabetic in late October. He started on insulin on 10th November (Lantus)
Sometimes he seems to be doing fine, then his general well being seems to take a dive and very quickly. He becomes withdrawn and lethargic. His BG readings are all over the place and never really satisfactory. I don't know whether the insulin is not good for him or if I have the dosage wrong.
I started off on 1 unit for a week and have worked up to 3 units morning and 2 units in the evening. Trouble is that sometimes it just doesn't seem to bring his BG down. It certainly doesn't bring it down enough. Giving him more units doesn't help.
When he is not feeling too well I take his readings, but they are not usually way off the mark, neither crazy high or too low.

It is so confusing and frustrating. Help please.

 

Hi there,

assuming you are home testing yes?
what food does Tiger eat?

Giving him more insulin isn't going to help, until you have established data collecting to see how each dose is working for him.
Lantus likes consistency.
Do u have any numbers to share?
You may want to put some more info together so that others can help out.

There is a Insulin Support Group here too for Lantus users:
viewforum.php?f=9

The Lantus forum follows the Tilly Protocol:
viewtopic.php?f=9&t=1581

which has helped many cats go off insulin, including my own after 3 months on Lantus, just last week.


But in the meantime, put together some info, numbers you have tracked, the more recent the better, and confirm please, if you are home testing, and what food Tiger is eating.

 

Quite possibly this is due to too much insulin causing a hypoglycemic episode.

It appears there quite likely an issue with rebound. Too much insulin causes the liver to dump sugar which causes the blood glucose to increase. Lantus likes to be maintened slow and steady. And you only want to increase by .25u at a time - unless there are other health issues.

Do you mean that's the only time you test his BG? You should test before every shot, and also try to test around the +3 and +6 (hours after shot) to get a really good idea of how the insulin is affecting your kitty. For some reason Lantus kitties have a tendency to go a tad bit lower in the evening cycle.

And, finally, you've been using your Lantus since November. Is that the 10ml vial, or the 3ml cartridge? We were able to use our first Lantus SoloStar cartridge almost two full months. I don't believe the vial lasts as long. Read up on the Lantus handling instructions at the top of the Lantus forum.

 

Re: Lantus and BG Readings - answers

Ok, I'll see if I can give you some more information.
I first took Tiger to the vet in November 2009. Then he was being fed on dry kibble (Purina cat chow) and fancy feast. After the diagnosis my vet said that we should change his diet to low carb and suggested Purina DM dry and Fancy Feast (accepted varieties)
She gave us Lantus and said to put him on 4 units (based on weight) in the morning only.
Not knowing any different I followed these instructions. It soon became apparent that this was not right.
After discussion with the vet I went right back to a low dose. 1 unit morning and evening and built it up to 3 units morning and 2 units evening.
Sometimes this seemed to be ok, but at others his readings were all over the place as was his behaviour.
I do test at home, but not all the time. Have done a couple small glucose curves, but mostly do spot checks.
Current position is that he has 2 units morning (8 am) and 2 units evening (8 pm)
Still doing spot checks of BG.
Feeding Fancy Feast (accepted varieties) and a small amount of DM. Now I know DM is scorned, but he loves kibble and he only has a small amount.

Right, readings.

The small curve I did (now I know this is not correct procedures but here it is. It was on 17th January.
8.00 (pre jab) 275.4
10.00 255.6
12.00 221.4
3.30 158.4
8.00 286.2
This was when he was on 3 units morning and 2 at evening.

More recently on 27th Jan.

8.00 271.8
11.00 219.6
2.00 255.6
7.00 275.4
10.00 (after his evening shot) 214.2

This was when he was on 2.25 units morning and 2.25 evening.

Ok, I know there's no consistency here. I'm frustrated and confused. Don't know whether to increase or decrease dosages.
What I need is a step by step right from the beginning - diagnosis to finding the right dose.

I am so confused that I am taking him to another vet that specializes in small animals on Monday, to see if I can get better help there.
Please help.
Thanks

 

if ur looking for an excellent step by step process and protocol that has helped and is helping many kitties on lantus insulin
(my kitty included - 3 months on lantus and he is off the juice)

I would recommend you open a thread in the ISG forum for lantus users.

Many of us have come from vet offices in sheer frustration mode due to the lack of knowledge of feline diabetes.
And many of us have educated our own vets with things from home testing, to starting low and go slow approach, to feeding a low carb wet food diet

I hope u find the answers u are looking for, but do know, this board and its experienced members on insulin usage are always here to lend a helping hand!

 

I can confirm diet can change everything. My diabetic has been on Lantus for 4 years until recently. I have been feeding him a Low carb/High protein diet but it was dry food, and his values were all over the place (150-300). Recently I moved and got a new vet. He recommend the Purina DM stuff as well (Which everyone with diabetic cats agree is not good food). I had just purchased some EVO 95% Chicken & Turkey Canned food and decided to try him exclusively on that instead. I can proudly say that at this point in time he is consistently testing between 80-100 and is not on insulin for the time being. I need to keep testing before I can confidently say he is in "remission" but as you will discover, Dry food is never going to help your diabetic. If it hasn't been posted, I will post this link anyway, as it is one of the best sources on the web regarding the topic:

http://catinfo.org/felinediabetes.htm

http://binkyspage.tripod.com/index.html

 

Hi, sorry you are having such a difficult time of it.

I think it may be best to take a step back and if you are willing, to start over from the beginning.

First thing to do, visit the lantus forum and read the starred posts at the top. It will tell you everything you need to know about the handling, usage, dosage and protocols of using lantus.

Second, you are changing the dose too frequently, lantus protocol recommends holding the dose for 3-5-7 days Depending. By giving 2 units in the morning and 3 units at night, you are dose hopping and that is not the best way for using lantus.

Third, I think the vet was wrong telling you start at 2 units. While there is a way to dose based on weight, most of start off with 0.50 or 1 unit of Lantus and over the course of several days, even weeks work ourselves up or down the dosing scale and do it in very small increments - like 0.25.

It's very possible by following the vet advice and dosing the way you have been that you have missed the optimal dose for your cat. Now, don't get me wrong, you may need to give 3 units, BUT that is only after a lot of time, testing and monitoring. and it's done slowly over time.

Also, home testing is vital, not just when you think the kitty feels bad. You must home test at a minimum before every shot, and during the day/night as often as you can and are comfortable with.

Food is another area of concern. Vets, sadly don't get the correlation between nutrition/food and cats' health. all they know is what the pet food companies tell them - use the prescription food - it will fix everything.

We highly recommend feeding canned or raw food only - NO dry food.

So, if you are willing, let's start this entire process over and pretend it's day one. Are you willing? And by this, I mean, set up a spreadsheet (instructions are on the tech forum), reduce the dose to 1 unit every 12 hours and test frequently to see how this dose works and put the results on the spreadsheet.

Come to the lantus forum, post there and you will get further guidance on how best to tweak from the starting point.

I'm also going to include my typical welcome speech that includes a lot of good basic information and links that I highly recommend you read.


There are three key factors to managing diabetes: food/nutrition, home testing and insulin

1) Feline Nutrition: Now, as far as diet - definitely dump the dry food (if you are feeding any) and if the vet recommends purchasing prescription food like DM just say "no thank you". ALL cats, and especially those with diabetes, do best on a species appropriate diet that is high in protein and low in carbs. Dry food DOES NOT fit that bill and DM food, even canned, just really isn't that great as far as quality. Most here on FDMB feed low carb/high protein canned, raw bought from a pet store or they make there own.

Here great links, one is to a food chart put together by one of our board members that breaks down the carb % and protein % of most of the commercial brand foods. You want to keep the carb % below 10% and around 7% is great. The other link is to a site by a vet "Dr. Lisa DVM" ... who also posts on this board from time to time ... there is in-depth info. there about many things, including nutrition and how to make raw food.
Nutrition/food info

The good thing with feeding your diabetic cat this way, is that it is ALSO good for any non-diabetic cat too. All your cats can safely eat the same food without worry and it may save you some costs and headaches of having to do separate feedings and keeping track of what they are eating.


2. Home testing: It is impossible to convey the value of testing your cat's BG (blood glucose) level at home. Some vets will "suggest" this, but most won't even mention it. They will send you home with insulin and an amount to shoot and maybe some instructions about hypoglycemia (blood sugar dropping to a dangerously low level).

Well, the thing is, human diabetics don't EVER give themselves insulin without checking there BG to make sure it is safe to do so, so why shouldn't it be the same for our kitties. Here on FDMB it is. You will notice that the vast majority of people here test their cat's BG at least 2x/day (before giving each shot to make sure the level is safe enough) and periodically at other times to see how the cat is responding to the current dose. We use a human glucometer, test strips and lancets - which are all very readily available and easy to use.

Our kitties get lots of love and treats for "putting up" with this and most of them actually come out to be tested on their own 'cause they want those treats . Here is a collection of great links that "Carolyn and Spot" pulled together about hometesting. See what you think ... it truly is the best way to not only keep Your cat safe but also really get a handle on this disease and help him to live a healthy life with FD (feline diabetes).

Home testing Links

3. Insulin: There are several types of insulin available. Many people, myself included use Lantus or Levimer both of which are great insulins. They are gentle insulin and given twice (BID) per day in 12 hour increments.

Please read up on the insulins available, here is a link to the Insulin Support Groups:

Insulin Support Groups

However, one caveat and again this shows how these three things are inter-related:

If you are feeding dry food or even a high carb food, BEFORE removing these foods, please make sure of your insulin dose as it will most likely need to be reduced, so as to avoid a possible hypoglycemic situation due to the removal of the dry/high carb foods that will lower the BG’s and reduce the amount of insulin required. Again, another reason why home testing is important.

I know this all seems like a lot, and that's because it is ... there is a learning curve here. But as long as you are determined and keep at it, you will have it down before you know it and you'll be seeing the results in Your cat' overall health and happiness. Ask all the questions you can think of - that's why we are here!

Also, if you haven't done it yet, take the time and fill out your profile. It will help when others come on and read this. Also, let us know where you live - city/state as there are probably people in your area who can provide on the ground support and help you to learn home testing, etc.

 

I am either very dumb or confused.
There seems to be too much conflicting information around or it's too complex.
The general advice seems to be start ow and go slow, yet the German strict regulation method recommended say to start with .25 units per KG ideal body weight. This is a lot to start with isn't it?

So, if I go back to square 1, which I am happy to do and give just 1 unit every 12 hours, where do I go from there.
I measure the BG and how do I decide to increase/reduce the dose. This is where I'm stuck.
Sorry to be so dumb.

 

Not dumb - so lose that thought, overwhelmed? Prob.

Someone crossed posted in the Lantus forum to get you some feedback over here, so if u can - check in, keep posting and hopefully get your concerns sorted out ok?
Cheer up! You're here and thats a good place to be!!

 

Calliope lived for kibble too, but as soon as she started eating low carb wet foods, I never let her have it again. It made a HUGE difference in her BG. We were fortunate in that we weren't even on lantus for 3 weeks. I give her Halo Liv a Little treats. I order it over the net and she loves it. Do price shop for it, though. I can find it for about $6.50 a jar, usually.

I think if you move over the lantus forum and open threads there each day, you can get some suggestions from folks who are testing and keep close tabs on their kitty's bg readings, daily, before and after doses. Lots of support there and you'll get a good feel on how lantus works and how to adjust doses based on the collection of data that you get.

Sometimes, high numbers can result from rebounds when kittys goes low, during the day, for example. The only way to figure that out is by testing and keeping track of the numbers.

Hope things get better.