? No significant change after 4u of Lantus

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Ana-Maria, Oct 11, 2018.

  1. Ana-Maria

    Ana-Maria Member

    Joined:
    Oct 11, 2018
    Hello everyone!

    I will start by saying that I'm new to the feline diabetes community and I am a bit overwhelmed by the situation. Also been reading some topics here and I have to say everyone here helped me understand a bit of what my cat is going through.

    A little background: i have a 10 year old diabetic cat that we diagnosed almost 2 months ago but only started him on insulin last evening as we hoped the diet management would help him (turns out not enough).

    So my vet administered 3 units of Lantus last evening (7:30 pm).
    Pre-shot BG: 321
    20 mins after shot: 372
    +1: 351
    Gave him 60 grams of Purina DM canned
    +3: 182
    +5: 169
    +8: 280
    +13: 349

    Today I took him to the vet again to give him another dose of insulin. He decided to increase it to 4 units. Pre-shot BG was 325. And this is where the strange thing ocurred. I decided to test his BG two hours after the shot and it was 315. Three hours after Lantus his BG was 314. After that I fed him the same amount of Purina DM canned and one hour later his BG was 327 and has increased to 356 an hour later.

    I literally don't know what happened here. I wanted to remain on the 3units of Lantus spread between 12 hours as he responded really well to that but my vet said that we're trying to see what dose will get him to 100 and then stick to that by dividing it into 2 so we can give him half of it every 12 hours.

    I am going to discuss the numbers with him tonight but I fear he will increase the dose even more to 5 units and I really don't want to give him 5 units tomorrow morning and then leave him alone all afternoon.
    Can you please share some opinions regarding what might have happened with these 4 units that apparently did not work?

    Thank you so much!

    Ana
     
  2. Olive & Paula

    Olive & Paula Well-Known Member

    Joined:
    Sep 6, 2015
    Ana,

    DO NOT let vet increase anymore. Lantus is a depot insulin and needs minimum 3 days to fill on initial starting dose.

    Please pick a meter and start testing immediately. Go the lantus main thread and read the stickie on how lantus works, you vet doesn't know.

    Make sure you have karo syrup or honey in house. I'm afraid your vet is going to overdose your kitty. Starting dose is usually 0.5 units every 12 hrs for 1 week.

    The way your vet is doing it this way is so wrong. You don't willing overdose to find out if it's to much.

    PLEASE PLEASE, don't let them give him more. Is there a reason you are not giving the insulin?
     
    Sue and Luci likes this.
  3. Ana-Maria

    Ana-Maria Member

    Joined:
    Oct 11, 2018
    Heey,

    Thank you for your reply! I have been testing him like crazy last night (as it was his first shot of insulin ever and was afraid of hypo) and today as well. I do have honey on hand in case of hypo but I hope it will not be the case.
    I am also afraid that he's overdosing him and this is why I will tell him tonight that I think the dose is way too high. I was actually relieved that he responded well to 3 units and was thinking to not shoot him tonight and start all over again tomorrow morning with only 1 unit every 12 hours.

    The reason I did not give him insulin up until now was that I was hoping to get him on a lower BG level through diet. He was also overweight when we diagnosed him. He was like 7 kg and now he's lost almost 2 kilos since august. However, the past few days he started having weird BG fluctuations going from 319 to up to 460 (the highest he's ever been) and thus, I decided it's time to start him on insulin in order to regulate him.

    I'll keep updating this post.
    Thank you once again!
     
  4. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Hi, Ana and welcome to the group.

    As Paula noted, Lantus (and Levemir) differ from other types of insulin. Lantus/Basaglar and Levemir are depot-types of insulin vs. "in and out" types of insulin. It sounds like your vet is more familiar with the latter, shorter acting types of insulin. What this means is that your cat needs to establish an insulin depot so there's a steady state of insulin in your kitty's body. With every shot, a little bit of Lantus is deposited in the fat tissue in the form of microcrystals which then gradually dissolve. This is what causes Lantus to have a gentle, long acting respond rather that slamming blood glucose (BG) numbers into the ground. For the initial period, it takes 5 - 7 days for the depot to become established and for you to begin to see how well the dose is working.

    The initial dose of Lantus is based on your cat's weight (if you are opting to follow the Tight Regulation Protocol). Initial dose = 0.25 x cat's ideal weight (in kilograms). For most cats, this is about 1.0u, give or take. An initial dose of 3.0u, would be appropriate for a cat that weighs about 26.5 lbs (12 kg). I somehow doubt that your kitty is that big! This is why Paula is concerned that you have supplies on hand in case your cat's numbers drop like a rock. From your note, if your cat is 5 kg and this is a good weight for your cat, the dose should be 1.25u. (If you opt to use the Start Low Go Slow approach, the starting dose is much less.

    You may want to take a look at the sticky notes at the top of the board. They will give you more perspective on what we're posting. There's a huge amount of information there so don't be alarmed if you feel overwhelmed. We've all been there.

    Please take a minute (or several) to set up a spreadsheet for your cat. It's the best way that you can monitor your kitty's progress and for us to help you. Please let us know if you have questions. The members here are very generous with their time and knowledge. We're here to help.
     
  5. Olive & Paula

    Olive & Paula Well-Known Member

    Joined:
    Sep 6, 2015
    Trying diet change first is always good. I think most of us did. The weird fluctuations are referred to as bounces. It is actually normal occurrence as most kitty experience it. The insulin brings down the blood sugar the cat isn't use to, the liver panics and release stored up glycogen which causes the blood glucose to rise high. Overtime kitty starts to get use to lower numbers and the "bouncing" gets shorter. My kitty still bounces from a glucose in the 200s. They refer to this as somji (sp???). Regulating does not happen in a week or a few weeks as most vets believe.

    Lantus is dosed on the nadir (lowest number in a 12 hr cycle). Depending on the protocol you decide on, the dose will change every 3 days for TR method or 7 days for SLGS method. Lantus works best with consistent dosing.
     
  6. Ana-Maria

    Ana-Maria Member

    Joined:
    Oct 11, 2018

    Hi Sienne,

    Thank you very much for your response! I don't know why he decided to start him on 3u and because I feared it was too high a dose I stayed up until 3:30 am to test his BG every 1 or 2 hours. However, he responded well to the dose having the lowest (at least what I caught to be the lowest) at 169, 5 hours after the shot. I hoped he would stick to this 3u for at least 3 or 4 days in order to see an overview of his BG but this morning he decided to raise it to 4u and as the title of this thread says, his BG remained roughly the same as the pre-shot level. And I tested almost hourly.

    I will start a spreadsheet soon! Thanks!

    I do have a question related to how much food to give him. He's been a grazer all of his life and I am trying to let him eat when he wants it but in order to do so I need to know what is the amount of food to give him. I have been giving him 160 grams of canned food a day but I don't know whether or not this is good or bad. And I also don't want to starve him. My vet told me to feed him twice a day.
     
  7. Ana-Maria

    Ana-Maria Member

    Joined:
    Oct 11, 2018
    I read about them and I was wondering whether or not this bouncing thing happened today with the 4u of Lantus. Those fluctuations started before we started giving insulin. That's why I kind of freaked out.

    Went to the vet tonight and told him those 4u changed nothing to his BG. He told me to give him 3u tonight and another 3u tomorrow morning. However, I refuse to do so because I think it is waaaay too much insulin and also because tomorrow I will be leaving him alone from 11 am to 7 pm and most certainly don't want to inject high doses of insulin when I am not around to check and intervene if something happens. I was thinking to not give him insulin at all tonight and tomorrow morning and get him back on 3u tomorrow night again. What do you think?
     
  8. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    That's a second clue that your vet isn't familiar with the slow acting depot insulins like Lantus or Levemir. Most people here give their kitties several small meals a day, with most of the food given in the first 6 hours after the shot, when the Lantus is the strongest. What brand food are you feeding your kitty? You should go by the appropriate number of calories, not by grams.
    Your vet doesn't hold the syringe, you do. If you don't give insulin tonight, he will likely be high tomorrow and two cycles without insulin might be a bit much. Have you been testing your cat (his name?) for urinary ketones? Any infection/inflammation in the picture? A better strategy might be to start on a much lower dose like 1.0 unit each shot and let that depot build.

    ETA: Any ketones in the picture would change what you do with dose.
     
    Last edited: Oct 11, 2018
    Reason for edit: added ETA
  9. Olive & Paula

    Olive & Paula Well-Known Member

    Joined:
    Sep 6, 2015
    He can continue to free feed. Just no food 2 hrs prior to insulin as you don't want the test to be food influcenced.

    As far as dose see what others say. There isn't any data to go on and I'm fairly conservative. But let others weigh in.
     
  10. Ana-Maria

    Ana-Maria Member

    Joined:
    Oct 11, 2018
    I am feeding Purina DM canned. He has been high today as well, even on 4u. However, he was kind of constant all day. I tested him every 1 or 2 hours and he remained between 320 and 350 all day. And this is a cat that had a BG of 350 even without insulin and the highest BG level 460. His name is Mimo and at the last urine analysis at the vet he had no ketones. No infection/inflammation that I know of. I will wait until tomorrow morning see what his BG level is and then decide whether or not to give him a 1u shot. Tomorrow evening I am going to the vet again and I will tell him that maybe it's better to start him on 1 or 2u every 12 hours and see how he responds.
     
  11. Ana-Maria

    Ana-Maria Member

    Joined:
    Oct 11, 2018
    Thank you! I will keep that in mind.
     
  12. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    When Mimo is in high numbers, it's good to test frequently for ketones at home. You can buy Ketostix at most pharmacies. The level of ketones can change quickly.
     
  13. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    If you don't mind a dumb question, why are you going to the vet daily? If you're testing at home, it's highly likely you're getting more accurate BG readings than the vet. Most cats have higher numbers at the vet's office due to stress. Again, this is another reason to go slowly with insulin.

    I think several of us are concerned that once Mimo's depot fills, you may seem a truly dramatic drop in numbers due to the rapid increase in dose. With Lantus, more often than note, even with a cat who'd depot is full, every time you raise or lower the dose, it can take the depot several days to get caught up with the change.
     
  14. Ana-Maria

    Ana-Maria Member

    Joined:
    Oct 11, 2018
    Not dumb at all. I'm going to the vet daily for him to teach me how to administer the insulin myself. I am really panicked about not being able to give him the shots myself and I wanted him to show me how to do it. So you're saying that say even though I won't give him insulin today his BG may still decrease thanks to the depot formed from the 3 and 4 units?
     
  15. Ana-Maria

    Ana-Maria Member

    Joined:
    Oct 11, 2018
    Thank you! I will look for the tests
     
  16. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    It's possible but the depot really hasn't been fully formed. It takes 5 - 7 days for the depot to form when you first start shooting.

    I'm assuming you're giving an AM shot. If you're already giving a shot once a day, you are likely doing just fine. To be honest, Gabby was in the kitty ICU when she was diagnosed. I do medical-speak really well and everyone assumed I was an MD and didn't need instructions on how to give an injection. I was so rattled with how sick Gabby was and so glad to spring her from the hospital, I forgot to ask for a demonstration. I watched a couple of YouTube videos and learned how to shoot from the videos. I think you are likely to know what you're doing!
     
  17. Ana-Maria

    Ana-Maria Member

    Joined:
    Oct 11, 2018
    I have some good news and a question as well! Firstly, I started Mimo on 2 units twice a day and his first shot was last night and his second this morning with an AMPS of 437. He is now within the normal range: his BG is 109 +9 and i think he might still decrease. Now, do I give him the second shot tonight or i can skip it? Not sure what to do. I want to obviously avoid a hypo but not send him back to the 400s.
     
  18. JoyBee&Ravan

    JoyBee&Ravan Well-Known Member

    Joined:
    Feb 17, 2018
    Sounds like you're doing a really good job! But it's important you set up a spreadsheet . There are people here that can help you with it. Just put ." ? mark & Need help with Spreadsheet. "

    Hang in there. There more you understand how the insulin works & can refer to the Spreadsheet it will get EASIER! :):bighug:
     
  19. Ana-Maria

    Ana-Maria Member

    Joined:
    Oct 11, 2018
    Hey there! I'm trying my best to cope with his diabetes and to make him feel good. I did keep track of all of his BG levels as i tested him thoroughly to see the effects of the insulin but i have yet to put them all in a spreadsheet. I'll post it here when i manage to start it. I decreased his dose tonight however, as his nadir happened at +10 and was 103 and his PMPS was 115. I only gave him 1u because I fear he might go too low and I also have to go out tonight for 3 hours and won't be able to test him.
     

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