? Lantus once daily - thoughts?

So vegetable is still at the vet clinic but the Dr wants to switch her lantus to once a day instead of twice a day. I'm a little concerned about that idea. The reasoning behind it is it's better for cats to get the lantus once a day that way they don't go to low & then up to high to compensate.

Im not sure what to think of this idea. Right now vegetable is on .5 units twice a day but she's only been on lantus for less then a week. My instincts tell me to keep her at twice a day shots & monitor closely for a couple of weeks then when I have some data on how she reacts to it if need be I can switch to once a day.

Anyone have any ideas/suggestions? The Dr said lantus is long acting so it can last for 18 to 20 hours in a cat.

The vet wanted to do a fructosesmine test but o said no for two reasons. One I don't have the money & two it would be better to test it in another month or so when she's been on the lantus for awhile & a little more stabilized.

Vegetable had ketones in her urine & blood so they have her on IV fluids. In another thread on here it was suggested that I don't ever skip a dose of insulin because of the ketones but the vet said we are skipping tonight's dose cause she is at 4.4 so way to low for a dose of insulin tonight. I'm so frustrated! In a way I feel like I'm being told conflicting things & im not sure who to listen to!!

 

Cats have faster metabolisms than people, so it tends to be not as long lasting for cats. I know there have been a few cases where once a day dosing works, but not for the majority of cats and I wouldn't want to try it with a cat who has ketones. I think I would try twice a day until I saw that it wasn't working. It is too early to say that yet for Vegetable. With once a day, you can have one good cycle followed by one cycle of really high numbers. And it's harder to build the depot. If you find yourself skipping a lot, so effectively one dose a day, we usually suggest lowering the dose to something you can shoot twice a day.

I hope Vegetable can come home soon.

 

I think your vet's suggestion will have just the effect he's trying to avoid. You'll give a dose, numbers will drop and by the next day, numbers will be sky high. Pretty much anything you read about Lantus and cats recommends twice a day dosing.

I do think you need to give the insulin a chance to work. Making these kinds of decisions based on a week of data is premature. I also am worried about your vet's decision about withholding insulin. Was Vegetable showing minimal ketones or is the vet concerned about ketoacidosis. In most situations where a cat is in the vet hospital for ketones, the cat is on a dextrose (sugar solution) drip and short-acting insulin (e.g., Humulin R) is being used to offset the effect of ketones. Ketones occur due to the presence of an infection/inflammation, not enough food being consumed, and not enough insulin.

I don't want to undermine your confidence in your vet but are you sure this vet is knowledgeable about managing feline diabetes?

 

That's what I was thinking, once a day is not enough especially when I only have less then a weeks worth of data from being on lantus. I saw what happens when I skip a dose or in this case when i had a fur shot, her blood sugar spiked to 33!

I'm going to bring her home tonight, I'm not comfortable leaning her at the vet clinic any longer. I tried explaining to the Dr that she had only been on the lantus for less then a week but he was still insisting she start on one full unit a day. I'm a little freaked out with giving her one full unit, yesterday she had half a unit & by evening shot time her blood sugar was already low & probably partly because she just started eating a little bit yesterday after being force fed for a couple of days.

I think I'm going to see if I can find a new vet, I don't think I trust this one anymore. They called me at almost 11 o'clock at night to ask where her food is, that gave me heart failure!! And they couldn't find my new phone number in the file so they called my mother in law & freaked her out to & shes 84 years old, she doesn't need that stress!

So tonight would it be ok to give veg her evening dose of insulin? I'll check her blood sugar & make sure I get it up high enough to shoot but it would mean she would get 1.5 units today in total or should we start fresh at .5 units twice a day tomorrow?

 

As for tonight's dose, I would test her when she gets home and post here for advice when it is closer to shot time.

 

Why is Veg at the vet clinic in the first place?

 

From previous threads on Health, Veg wasn't eating and Jennifer found moderate to high ketones. Relevant threads from Health:
http://www.felinediabetes.com/FDMB/threads/unsure-if-i-should-shoot.142023/#post-1467691
http://www.felinediabetes.com/FDMB/threads/update-on-vegetable-question.142076/

 

Jennifer - I hope Vegetable is home and eating well. I agree with the others about the Lantus. If you're concerned about going low overnight, assuming she had the double shot this morning, I would skip tonight. Not sure what the experienced Lantus users suggest, but with ProZinc, if you split the dose, you would halve what the once-a-day dose was... assuming it was keeping in good numbers. I've used Levemir on 3 cats over the past 3+ yrs, and I typically shoot conservatively. With ketones, however, it's best to check (both BG and ketones) frequently and shoot as aggressively as you SAFELY can. Sometimes this is quite a balancing act... it may seem overwhelming, but it DOES get easier.

It is essential that Veg continue eating. This may require assisted feeding, and you can do that at home, probably with less stress than a stranger in the vet's office.

Do they have her on an antibiotic in case of infection? Have they checked her teeth? That's often the source of an infection that is a factor in ketones and even a diabetes diagnosis. You can also have your vet show you how to do fluids at home. I did 100 mL once or twice a day after Grayson threw moderate ketones (3 different times). The first night, we had a slumber party with the gang here, and I took him in at 7 am (4 hrs later) when my vet opened. He never stopped eating, so that was good. The local ER vet and the ER doc at the vet school told me that most of the DKA patients they see haven't eaten for several days, and the condition is much more severe; otherwise we would've gone at 3 am.

Hang in there. Let us know how things are progressing.

Lu-Ann

 

I'm happy to report vegetable is home! She's a little upset with me still but she will get over it soon enough. She is also walking around like she's a little drunk at times, I think this is due to being couoed up in a cage for a few days & just having the IV removed but I'll keep a close eye on her.

The vet checked her blood sugar at 4pm my time so two hours ago she was at 19.0 I'm going to check her blood sugar in an hour & then I'll be back to see if I should shoot tonight or not.

I'll be taking her to work with me tomorrow so I can keep a close eye on her & make sure she's eating and drinking.

 

Do you have any dose or blood sugar tests from the time at the vet that you could fill in the spreadsheet? That'll help with the decision on dosing.

 

@Wendy&Neko
I plugged in the numbers I know of for sure, the rest he just told me some numbers but I don't know what time they are from so I'm not sure where to put them in the sheet.

The vet did say she was at 9 around 11pm last night & then between 11pm & 2:30am she went to 13, 14, & then 16 by 2:30am but again I'm not sure of the times they took those readings other then the general time frame so I'm not sure where to put the info.

 

It's the doses that are more important if you have them. The rest of the info you can put into the remarks.

 

Ok, the doses I can put in no problem.

I just finished putting in the info for the doses. I'm going to go check her blood sugar now.

EDIT: I just checked her blood sugar & she's at 18.8 should I shoot .5 units tonight or start fresh in the morning? She's already an hour past her normal evening shot time.

 

I would give insulin. With ketones in the recent picture, you want to give as much insulin as you safely can. You can make up your schedule 1/2 hour once a day earlier, or 15 minutes a cycle.

 

If you are going to be able to monitor her for tonight I'd shoot 0.25U tonight at least, and start with 0.5U in the AM. If she starts to go lower on 0.5U try to get the sugars over 100 whatever way you can. Having a little padding with the sugars is a good thing in DKA, so goal is 150 to less than 200 with the sugars. Our goal is to try to increase over the 0.5U that the ketones developed at. It may take mixing sugars into the foods to keep her there.

Well see where she's at after 4 or so cycles and consider raising the dose quickly if appropriate.

 

Ok thanks for the advice, I'm going to shoot .25 units tonight & see how she does over the next few hours.