New to Lantus/Lantus Group (sadly, not new to feline Diabetes)

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Abbey Erwin, Sep 13, 2018.

  1. Abbey Erwin

    Abbey Erwin Member

    Joined:
    May 25, 2018
    Hello!

    First off! Warm greetings to you - and thank you for being part of this awesome community! I do not know what so many of us would have done without it!

    Second, I’m new to the group of course! We have previously had our male 12 year or so old cat on Prozinc. You may check his chart below. His first Lantus shot will be tonight with the pen (although I hear you can just take your syringe and pull from the barrel of the pen). We got a 2nd opinion from our Cat Clinic (rather than our regular vet - just to go to a specialist) and they suggested we start up on Lantus after having a not so good curve done at the end of August). He recommended 2 units 12 hours apart.

    We will do our best to make sure that he hits those 12 hour marks at close as possible because I am to understand this insulin can do more overlapping one way or the other/or you have to keep that in mind at all times. I did read over the starting forum stickys... but it was a LOT of info.

    To start out I know we will want to get at least one mid when we can in the middle of checking. He’s on B.F.F. We’re a canned food. He gets the occasional tuna/mackerel treats along with dried chicken treats. :)

    Ketones: We check him periodically but I’ll be sure to check him a few days into Lantus as well!

    Sorry about being all over the place! (Getting hopefully close to being over a head cold! :) ).

    If anyone has anything to shout out in general, please feel free!

    Take care,
    Abbey
     
  2. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Hello Abbey - a welcome to you and sweet Cosmos. I'm glad you've started reading the sticky notes. There is a lot of information, so keep asking questions. We love to help here. At some point you should read again the Tight Regution protocol and Start Low Go Slow method sticky notes. People here use one or the other to guide how they make dosing changes.

    First, we typically start the Lantus dose keeping in mind the Prozinc dose, so likely would have started him a little higher, maybe 2.5 units. However, 2.0 is OK, as long as you check regularly for ketones. It may take several days for the depot to build and you to start seeing results, so you'll need to learn to be patient (not my strongest suit!). I would also look at getting 1/2 unit marked U-100 syringes for dosing. We make changes here most of the time by 0.25 units at a time. Even those small changes can make a difference.

    Getting tests, beside preshots, each cycle, is ideal if possible. That includes the night cycle. You will want to do spot checks at different times of the cycle, to try to figure out when Cosmos' onset and nadir tend to be on Lantus.

    As for timing of dosing, you can move things around 15 minutes per cycle, or 1/2 hour once per day without much consequence.

    And one last housekeeping thing, it'll help to have a blank line on the spreadsheet between the day you start Lantus and last day of Prozinc. Maybe put "start Lantus" or something like that on that line. Just so it's easy to spot.
     
  3. Abbey Erwin

    Abbey Erwin Member

    Joined:
    May 25, 2018
    I would also look at getting 1/2 unit marked U-100 syringes for dosing. We make changes here most of the time by 0.25 units at a time. Even those small changes can make a difference.

    -Currently we have 1 unit syringes.... and a lot of them.. so we'll probably try and burn through those first? OR I'm not familiar enough with the pen. BUT I do have a bunch of pen needles for the Lantus Pen? Are either of these just a terrible idea? OR any way to use them?

    Getting tests, beside preshots, each cycle, is ideal if possible. That includes the night cycle. You will want to do spot checks at different times of the cycle, to try to figure out when Cosmos' onset and nadir tend to be on Lantus.
    -So, at the very least one mid but random spot checks would be ok?

    As for timing of dosing, you can move things around 15 minutes per cycle, or 1/2 hour once per day without much consequence.

    And one last housekeeping thing, it'll help to have a blank line on the spreadsheet between the day you start Lantus and last day of Prozinc. Maybe put "start Lantus" or something like that on that line. Just so it's easy to spot.
    -Done! :)

    -Can't decide which approach to go with. ( I like how the doctor only says "2 units twice a day". And gives no other info... to be fair - he probably wants to see how he does in the next week or two! ) I'll have to think on the approach but for now we can get him started! Hopefully that one day he has to miss his shot in the AM won't screw things up too badly!)

    Thank you so much Wendy! :)

    ~ Abbey
     
    Sue and Luci likes this.
  4. Tricia Cinco(GA) & Harvey

    Tricia Cinco(GA) & Harvey Well-Known Member

    Joined:
    Jul 18, 2011
    Welcome to Lantus & Levemir Land - the nicest place you never wanted to be.

    It'd be better to use the syringes than the pen needles. As I understand the pen needles, 1 unit increments are your only option. With the syringes, you can at least eyeball smaller doses. I would recommend getting the 1/2 unit syringes as soon as possible - not sure where you live (would be helpful to at least include the time zone in your signature), but Walmart sells them pretty cheaply. You'd be amazed at the difference a very small amount of insulin can make.

    The stickies DO have a ton of info, and it can be quite overwhelming. Don't hesitate to go back and re-read stuff - we all do it. Ask lots of questions - the only dumb question is the one you don't ask.

    Here is a post we put together to help new members get comfortable in L & L Land: http://www.felinediabetes.com/FDMB/threads/updated-tips-for-new-members.173572/

    We're glad to have you and Cosmo with us!
     
  5. Sue and Luci

    Sue and Luci Well-Known Member

    Joined:
    Nov 3, 2017
    Welcome to the group Abbey! Tell Cosmos 'hey'! We have a lot of fun on this group - have to laugh every now and then otherwise we'd all be crying all the time...serious stuff this FD...but we'll get through it together. Lots of fun 'parties' with the kitties...:bighug::bighug:
     
  6. Sonia & Leo

    Sonia & Leo Member

    Joined:
    May 24, 2018
    Welcome Abbey and Cosmos! :bighug:
     
    Abbey Erwin and Sue and Luci like this.
  7. Abbey Erwin

    Abbey Erwin Member

    Joined:
    May 25, 2018

    Thank you so much for being around! I'm lucky to have you all! :) Cosmos says Hi back! :)

    ~ Abbey
     
  8. Abbey Erwin

    Abbey Erwin Member

    Joined:
    May 25, 2018
    Thank you Sonia AND Leo! :)
     
  9. Abbey Erwin

    Abbey Erwin Member

    Joined:
    May 25, 2018

    <3 SO MANY THANK YOUs! Tricia!!! :)
     
  10. Abbey Erwin

    Abbey Erwin Member

    Joined:
    May 25, 2018
    Looks like Cosmos had 152 this AM and tonight just before bed (going to bed now!), he was 63. That seems to be a good thing - BUT maybe something that's common with Lantus OR changing insulin? We gave him his food, his shot tonight! We will see what tomorrow brings! (We'll miss the AM shot as literally no one is home (class for me, job for the hubby, and a family visiting from England for our roomie!)) I plan on getting some mids when I can! :) Just wanted to update AND check in that 63 is alright/normal Lantus stuff. (probably depends on the kitty!)

    ~ Abbey
     
  11. Chris & China

    Chris & China Well-Known Member

    Joined:
    May 10, 2013
    I'd be sure to get a +1 and +2 tonight

    Yes, we do shoot those lower pre-shots, but only after we have a lot of data on how our cats respond.

    I would have suggested that you not shoot that 63 but instead, Stall, don't feed and test again in 20-30 minutes to see if he was coming up without the influence of food, but it's too late now since you already shot.

    PLEASE get some more tests in tonight!!
     
  12. Abbey Erwin

    Abbey Erwin Member

    Joined:
    May 25, 2018
    I can get one in at 6pm so... +7 but he won't get that shot this AM... but I can still check it than and just before his food tonight at 11pm! It's just a crazy packed weekend (not normal for us!)

    <3 Thank you for the help! :) AND good to know about the 63!
     
  13. Abbey Erwin

    Abbey Erwin Member

    Joined:
    May 25, 2018
    Soooo far he has been doing pretty good - I wanted to see how he'd do for the next couple weeks with the Lantus and than go from there in terms of method etc. Also, of course, check in with the doctor.... but things seem to be getting better - IF we can keep it regulated - we can maybe do something about his supreme hunger needs - his peeing is still continuing (4 times today) :(. But... we clean it up with enzyme cleaner and sometimes water/tiny bit of bleach mix on the fake wood floors we have. :) I will keep you guys posted! Even had a 47 this AM. (I have plans to get some mids in - between work, school, and life. :) Glucose tests before food/insulin are number one to make sure we don't make him go the other way!
     
  14. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

    Joined:
    Jun 15, 2015
    Abbey, PLEASE do not shot a 47! That is a number that would deserve a reduction and yet it looks like you shot it and no other test done until PM and then shot it again. When presented with a number that low, you would stall and not feed until the number comes up over 50, but that said, that is for caregivers that have a lot of data to know how kitty is responding to shooting lower numbers. At this stage in the Lantus game, you would not shoot anything over 150. Your SS indicates that you are shooting any number with out any more test. I am so afraid for the safety of your cat. Please don't be complacent with testing.

    A great test to get in is the +2. If it is the same as the pre shot number or lower, it could indicate an active cycle which would require more tests to make sure Cosmo is safe. It will be very important for you to get more test in to determine when Cosmos nadirs and so that you will know when a reduction is in order

    I also would suggest you getting U100 syringes with 1/2 unit markings ASAP so that you will be able to better shoot 1.75 which is the new dose for Cosmo. You can get the Walmart brand Relion, a box of 100 are around $ 13.88. Until then, you can eye ball it the best you can and make a sample syringe to be your guide. Consistency is more important.
     
    Last edited: Sep 20, 2018
    Sue and Luci and Abbey Erwin like this.
  15. Abbey Erwin

    Abbey Erwin Member

    Joined:
    May 25, 2018
    When getting a test at 2 hours after the insulin shot, what if no one is home to take it? :( Also, he is endlessly hungry in general - he has been that way forever - so, for him and our sanity he gets fed whenever he tells us he's hungry. If we do not give him food, he will meow and follow you incessantly and there is no peace. In small doses, no big deal - but many days of that is emotionally taxing. There is peace if he gets food. :) Trying to do what's best for him first and than also for everyone in the household. This has been taxing and I feel our family is exhausted - so we are trying to look at things different ways, be patient and loving with the process, and do all we can to help him. I am working on getting the syringes now with the half marks.

    When you said, "you would not shoot anything over 150"... I'm not familiar enough to know what you mean by that. I figured over the next two weeks we would be just getting him kind of stablized as before with Prozinc he was up and down and all over the place - there was no smaller pocket he stayed in (in terms of numbers).

    Thank you for your help!!!! (if it helps any as well, there are no signs of any hypoglycemia or anything like that - in fact, he's been acting so much more clearer since we changed from Prozinc! His body must not have liked that stuff!)
     
  16. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

    Joined:
    Jun 15, 2015
    Yikes, I meant UNDER 150. Sorry, I had not had my coffee yet and was posting at 6:30 AM.

    The incessant hunger and crying for food is very draining and should get better as he stays in better numbers. It does appear that he is responding well to the Lantus.

    About getting the +2 test in, that can be difficult if you shoot and leave. Is it possible for you to change up the shot times so that you would be able to get a test in before leaving? If you can do that you can shoot earlier by 30 minutes a day or 15 minutes a cycle. But, you would not want to make the shot time earlier if he is all ready in a low number. Some peeps here get a PM + 11 so that you will know if the AMBG is rising or falling and can help in your decision to shoot or stall.
     
    Abbey Erwin likes this.
  17. Abbey Erwin

    Abbey Erwin Member

    Joined:
    May 25, 2018
    And this 150 is on a human glucometer - so really... 130 or below? We found there was roughly a difference of 30 with the vet glucomter for cats and the human one. (ie... the number is higher than it appears on the human glucomter) " .."
    (although 150/130 seems high to me - but than again - it might just feel high - I thought regulation was 50-99 which is where we want to keep him IF he doesn't "honeymoon" or actually just maybe - go into "remission"... which honestly isn't too likely since he's might have had diabetes a bit before January of this year - 9+ months is a while to have diabetes - I imagine especially for a kitteh)

    SO.... it may not hurt to get a shot a within an hour or so before the official morning feed/glocose checke BEFORE the feed.. so see if the BG is less or more than the PMBG the night before? Mids would help with that for sure too........ they are hard to get in!

    ALSO, awesome numbers for Bubba! (AND you must be able to be home with him to be able to check him so much! - that's a super awesome treasure!)!

    We'll get a flow - <3
     
  18. Abbey Erwin

    Abbey Erwin Member

    Joined:
    May 25, 2018
    ALSO... I might add, vet just got back to me - he felt 47 is too low as well - suggested we shoot at 1. Just noting it here. Not sure what everyone thinks of that - seems to me - like a dose of 1 wouldn't be good for a glucose test results of say, 193. (taking a number off Cosmos' spreadsheet recently as an example).
     
  19. Abbey Erwin

    Abbey Erwin Member

    Joined:
    May 25, 2018
    He got 128 this morning 11+. So maybe I'll just do the 1U at 11. I will also check glucose before doing the shot and feeding him too! What I DO NOT want to do - is hold off on a shot - and than we have to give him a shot 12 hours later and it changes when he gets his shots so that they are 12 hours apart - because of overlap of dosing - say he needs a dose at 1pm this afternoon because I held off on giving it to him at his normal 11. Now someone has to give him his next insulin shot at 1AM - which over time would just be not regular enough for US to function.... any advice on that prospect? We'd like to try and keep it at one time and one time for Insulin. ? Not sure how all that works. Before with prozinc, we just gave him a shot and tried to get him stablized for a while. It might be better to just alter the shot every time based on his glucose results just before - but I didn't want to mess anything up in that regard - THAN there's the whole - how much more or less based on numbers! (I am reading/re-reading over the main Lantus page today).
     
  20. Chris & China

    Chris & China Well-Known Member

    Joined:
    May 10, 2013
    The constant hunger could also be because you're shooting so low....it's driving his BG even lower and the only thing he can do to try to "save himself" is eat more food. Most cats who's BG is low will look for food....just like a human diabetic will crave food when their BG goes too low.

    You're not understanding how Lantus works...It's totally different from ProZinc…..It's a depot insulin which means every shot "builds" upon the last ones. ProZinc is an "in and out" insulin …..you shoot and 12 hours later it's all out of the body. With Lantus, there's a depot that's formed that slowly releases insulin back into the bloodstream

    Insulin needs constantly change.....just because "A" happened the last time you tried it doesn't mean it'll happen again. "A" may have not been enough the first time you tried it, but as the pancreas has done a little healing, it might be perfect.

    I'd seriously consider dropping back to 1U for now and get more tests when you can.....If you can't get them on the AM cycle due to work, make sure to get them on the PM cycle!!

    I've been treating China for over 5 years and I wouldn't give her insulin with a BG of 47....We're all just really worried about your Cosmos!
     
  21. Abbey Erwin

    Abbey Erwin Member

    Joined:
    May 25, 2018
    Thank you! I knew Lantus can overlap and that kind of thing.. which is different than Prozinc. I'm more so not in a comfortable place in terms of knowing when I can alter things or not because I do not want to mess things up! The good news is.. I'm learning! (it's only been a week or so on the Lantus) AND we did only shoot for 1U this morning at 11am (he had a 144 reading) as directed by the vet as well. So the cat specialist and you guys are saying the same thing! We'll listen! We do not want to do anything dangerous or not make sure to take care of him. Next time if we have a read of 47 or so... we'll plan to just skip it if we can not check him again in a few hours to feed. AND we don't want to change his insulin time to 1pm and 1am for example as a result - at least - that's the plan. Early 100s may mean .5 dose or so.... 150s... 1 unit? (We'll know more if I can get more mids in... which is the plan when we can get them in!) We are all on Team Cosmos! Thank you for helping me treat him better and be more proactive! :)
     
  22. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

    Joined:
    Jun 15, 2015
    The protocol is written for human meters and has safety nets built into the protocol. All meters can have a 20% + or - variance to them.

    I am glad your vet guided you to do 1 unit. 2 units is definitely too much for Cosmo.

    Looks like Cosmo bounced today from being under 50. Keep in mind that it takes 6 cycles or 3 days for a bounce to clear. So, while he will be in higher numbers until it clears, you will have to be patient and not raise the dose until the bounce clears. Also, it can take 4-6 cycles for the depot for 1 unit to fill and to know what that dose is doing for him. So, testing in the middle of the cycle will be helpful to determine how low the Lantus is taking him. Remember, the Lantus dose is based on the nadir with consideration to the pre shot number which is the opposite of ProZinc which is based on the pre shot with consideration to the nadir. When I first came over to Lantus from ProZinc, I had to take off my ProZinc thinking cap .
     
    Last edited: Sep 20, 2018
    Chris & China likes this.

Share This Page