Starting Lantus insulin dose (Choco)

Discussion in 'Feline Health - (The Main Forum)' started by Robert and Echo, Feb 7, 2011.

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  1. Robert and Echo

    Robert and Echo Administrator Staff Member Moderator

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    Dec 18, 2008
    So glad that Choco is doing well! What a scare!

    In a 2005 veterinary paper on glargine/lantus and low-carb diet inducing remission http://www.felinediabetes.com/glargine.htm, the initial dose of glargine was 0.5U/kg BID (twice a day), rounded to the nearest unit. So, figure out Choco's weight in Kg, then multiply by 0.5 and that will be the starting dose used in this study. Choco weighs 17 lbs, which is about 7.7 kg. Mulitply 7.7 kg x 0.5 U/kg and you get 3.85 U, or rounded to the nearest unit, 4.0 U. Keep in mind this dose was used for cats who were just diagnosed, had pretty high blood sugar levels and were ketotic or acidotic. AND the cats were monitored. 2.0 U twice a day would be 0.25 U/kg.

    Someone help me out here. Where does that .25 U/kg recommendation come from?

    Also, keep in mind that I am citing a 2005 paper and a newer reference most likely has a revised starting dose.

    IMO, 2.0 U is not unreasonable but after what you've just been through with Choco and if you are feeling pretty cautious, I wouldn't give him more than 1.0 U twice a day. And MONITOR!!!! You don't want him hyperglycemic too high too long.

    -Rebecca
     
  2. marleesan71

    marleesan71 Member

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    Feb 3, 2011
    Oooh, I'm so confused. I'm going to take his BG again in about a half hour. That will have been 2 hours since I tested him at 393 and before I gave him his 2 units of insulin. I feel like I'm not doing things right and I'm going to end up killing him. :O( Thank you for starting a new thread and also thank you for your input.
     
  3. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    Dec 28, 2009
    You are doing fine. Testing will let you see just how the insulin is working. You are doing the ketone tests so you can head off any possible ketone problems.

    Take another test and post your results.
     
  4. tuckers mom

    tuckers mom Well-Known Member

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    Dec 28, 2009
    (((Maria))) You are doing everything right, please don't beat yourself up and do not think you are doing anything wrong.

    You started hometesting faster than most of the people I've ever seen, that has got to be one of the biggest obstacles out there. You also changed his diet immediately, probably the second biggest obstacle, at least for Tucker it was, he fought me for months on switching food.

    Please do test Choco a lot in the beginning, the more information we can gather now the better you'll be able to see how he is responding and make notes when you log his numbers, note things like how he was feeling, did he eat well, did he seem tired, did he seem happy and content. These things along with the BGs will be your guide in the future.

    Do you have subq fluids at home in case you need them? I know you are super amazng foster mom for KA and others and I've seen you with those sick kitties, so I'm sure you know signs of dehydration, but for a big furry guy like Choco, I'd touch his gums and check for stickiness since pinching the skin wont tell you much with all that beautiful fur.

    You have the hypo instructions, but just in case, here they are again: viewtopic.php?f=14&t=1122

    The smell of his breath that you mentioned on the other thread, was it like nail polish remover or more like he has the bad tooth. I believe Venita asked that. If it's acetone, like nail polish remover, that would be an indicator of ketones. You have your strips to check ketones. If you can't catch him mid stream, sometimes I put plastic wrap over the litter and Tucker pees right on that, then I dip the stick in that.

    How's Choco's appetite, is he eating well?
     
  5. marleesan71

    marleesan71 Member

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    Feb 3, 2011
    Okay so, at 6:00pm before he ate or had insulin he tested at 393. I rechecked him at 8:00 and he was at 269. He ate some Fancy Feast but sure wasn't as interested in it as he was last night at the ER. I just got him to eat 3 slices of chicken sandwich meat. I looked at the carbs on the package and it said there were 2 carbs for 6 slices so I didn't think that was too bad. I just wanted him to eat something more then the little bit he ate earlier. I did catch him going to the bathroom earlier which I posted saying that it showed no signs of keytones so that was good. The smell is the acid smell because it is the same smell that my kitty's who were in kidney failure had when their little bodies started producing acid. It definitely doesn't smell as strong as it did the past couple of days so that's a good sign. I do have fluids and I will take Jennifer's advice on feeling his gums.

    I think my biggest confusion is whether or not I'm giving him the right amount of insulin. It looks like giving him 2 units was okay and his BG went down. It is what my vet told me to do and I really trust her but since she doesn't have any experience with Lantus, it worries me. I do need help on putting together this spread sheet. I'm having a hard enough time trying to figure out this message board so PLEASE someone help me. :O)

    Choco looks like he's ready for bed so I guess I'm going to go tuck him in. :O)
     
  6. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

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    Dec 28, 2009
    I can help with your spreadsheet. check your pms- upper corner of the page "You have 1 message"
     
  7. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

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    Dec 28, 2009
    Rebecca:

    That is old information. The Rand/Queensland/Tilly protocol has been updated. Please see the info in the Tight Regulation sticky on the Lantus board which include the link to the formal versions of the Lantus dosing protocol. The weight based formula is:
    initial dose = 0.25 x ideal weight in kilograms
     
  8. Robert and Echo

    Robert and Echo Administrator Staff Member Moderator

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    Dec 18, 2008
    Thank you, Sienne! And it is important to note that the formula is now for IDEAL weight not for current weight. Now, how the heck are they determining ideal weight? I asked my vet and got, "Use 10 lbs, the average weight of a cat." Huh? What about a Maine Coon? What about my tiny little Willow who weighs only 5 lbs but is NOT underweight, just tiny.

    _Rebecca
     
  9. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

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    Dec 28, 2009
    I agree about what "ideal" is. I suspect as long as your cat isn't obviously under or overweight, current weight is a reasonable approximation. It should also be noted that if a cat is switching from another insulin to Lantus (or Lev) that previous dose should be taken into consideration. Likewise, other medications (e.g., steroids) or a history of DKA are important to consider.
     
  10. MommaOfMuse

    MommaOfMuse Well-Known Member

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    May 26, 2010
    Not real sure on how to get an exact "number" for what the "Ideal" weight but this chart might be helpful on determining if a cat needs to gain or lose weight. I guess the rest is just kind of guess work. If they weigh 11 lbs currently and look like a cat considered thin then add a pound or two to current weight for ideal, if they look like one that is considered obese, then subtract a few pounds for ideal.

    http://vet.osu.edu/vmc/body-condition-scoring-chart

    That was about the only real information I got when asking my vet on what Max should ideally weigh, when we first got him and were trying to figure out how much he should weigh. That and the fact the most domestic mixed breeds average about 10 lbs.

    But I also know that max was a walking rack of bones at 10.5 when we got him, and yet our Tre'Vona barely tips the scales at 6 lbs, which is perfect for her, and 10 lbs she would be a butterball.

    Mel, Max & The Fur Gang
     
  11. housecats4

    housecats4 Well-Known Member

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    May 31, 2010
    Wow there is some much info here that I did not have to deal with for Trey .You guys are great keep up the good work. Choco you are in the best hands your momma and these angels will get you through it all Sending more angels and tons of healing green light to you and your mom of course everyone on this awesome board.

    Hugssssssssssssssss Kath& Trey
     
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