The strange effect of Lantus

I am posting here so more people will read it.

My cat was diagnosed six months ago and is on Lantus.

I will put her on 1.o units BID and her numbers climb so I increase it in .25 unit increments for ten days at a time. ( I don't test every day )

Then I get up to around 2.0 units BID and her numbers at 5/6 hours are in the 80s/90s range. Today she just tested to 94, 1.5 hours before shot time and she has been getting 1.75 U BID. The doc says don't shoot below a hundred, but I am willing to bet the number has been in the 90s zone for a week.

Any thoughts?

 

I have a couple of thoughts.

1) It sure would be nice to see a spreadsheet. Do you know how to create one?
When you ask for input, folks tend to want to see the numbers.

2) From the little info you are provding, it is possible you've had similar numbers for a week but without knowing that, you could also be risking a hypo.
I would decrease by a tiny bit. Since you are at 1.75, and the bg numbers are good, I would drop to 1.65 , or 1.6 as long as you are going to be around
to observe the reaction. The small decrease won't cause you to lose ground and you don't want to depelte the shed ( insulin depot ) if you can avoid it.
It is possible you are about to discover your optimal dosage in these next few days.

And then another thought is to post with the date, cats name, amps , etc. and Need opinions...... No one seems to have noticed the title of this posting except me. ( thus far)
Now they will probably all show up.

 

I suspect that people have not responded because they don't know what to say. At least on this Board, we are very numbers driven. It would be unfair to you and your cat (I'm not sure if George or Burt is the cat -- sorry!) to attempt to draw any conclusions based on very limited information. We base our dosing decisions on data -- pre-shot numbers and at least one spot check per cycle.

It's not uncommon for vets to discourage people to not shoot lower numbers. Because we highly encourage monitoring, the goal of tight regulation is to 'shoot low to stay low.' However, if you are not going to monitor closely, using a Tight Regulation approach, where you do shoot low, is not recommended. It's too risky.

We look to see cats in a normal blood glucose range (50 - 120). The longer a cat stays in that range, the more the pancreas has a chance to heal. That your cat is spending time in that range is good. The issue is how low did the numbers get? If your cat is tested at 94 and it's 1.5 hrs before shot time, there's a reasonable chance that the numbers will have come up by shot time.

If you are not going to test and can't give us more definitive data, you might want to consider posting in the Relaxed Lantus forum. They are a bit looser when it comes to testing and are less numbers driven.

 

duplicate

 

Hi George,

It's really impossible to give you a better suggestion than you just got with no data. Most people won't want to advise with no info. Why are you not testing? It really is not safe to shoot without knowing what the current bg is. At the very least, you should be testing before shots and at the nadir so you know you are not giving Bert a hypo by shooting and you know how low he is going and have something to base dosing on.

What strange effect were you referring to?

Melanie & Racci

 

I work two jobs, have two sugar cats and 18 civies ( lost three this year to various causes). I am just not home or have the time to do more than I am so I am doing what I can.

Randomly I test with no particular schedule in mind and test when I think I should and it's always the same. I get a number from 60 to 90 and so I back off on the dose a lot. Then I start low and continue testing periodically until I reach around 2.0 u BID and test to make sure.

Today 20 hours later her number is 160. I am guessing she needs the dose she is on to stay level.

I'll re-post this elsewhere.

 

I understand being busy - I am a retail manager AND wait tables on the side. In addition to Kazi I have a dog with Glaucoma who also requires extra work. If you have time to feed and time to shoot you have time to test. I keep Kazi's testing pack and a tupperware on the nightstand next to my bed. I test her sugar before we even roll out of bed in the morning, and it's the last thing I do before we knock out for the night. The tupperware makes it easy to toss in used lancets/strips. I just empty it once every couple of weeks into the big container with her used syringes in my pantry.

 

hi george!

i remember your situation with lots of kitters that you've rescued from your previous posts. i know you're feeling like you can't do more. the tricky thing is that i think lantus seems like it works "strangely" to you just because you don't have enough data from testing to be able to know what's going on. its action isn't strange at all, it's very predictable. but each cat is a little bit different and without knowing more about its action in an individual cat, it's impossible to say much.

that's not much help to you because you've got a difficult situation, but i just wanted to mention it. it's not really about the lantus, it's just about not having enough information to be able to see the picture.

i think of a spreadsheet with BG numbers plugged into it like it's a jigsaw puzzle. the more pieces in the puzzle (ie, the more data from tests) the clearer the picture is. one doesn't have to test every hour to get enough data to tell what's going on - we can get a pretty good idea from having preshot numbers and one mid-cycle test every cycle - so 3 or 4 tests in each 24 hr day. but with less data than that, it's like you've got a jigsaw puzzle with only a couple of pieces. you can't hardly even get an idea of what the picture is supposed to look like. that's where you are now and why it all seems like the lantus effect is strange.

 

Hi Julie

The "strange" I elude to is the apparent really flat curve that does not exhibit a perfect Nadir nor top/bottom end. I test more than I am letting on. I was not asking for advice per se'. I just wanted to know if others got such flat curves.

The numbers seem to stay in the zone for days on end with the same dose. It is a bit unnerving as it is difficult to pick as shot size.

One reason i don't believe in all the testing is the numbers shift. One day it's this the next day it's that and a person starts chasing numbers.

I believe in testing every ten days. Once +6 and once +12 and it tells me all I need to know.

Remember, not too many years ago "Tight Regulationists" were the "Minority" and on the "Fringe".

It's not that I can't do more, I simply find it unnecessary to do all that when I have so many things that need attention like keeping all the guys fed and safe.

 

again, if you had more data, laid out on a spreadsheet, you would see where a high flat "curve" fits into the overall picture of a cat using lantus. the simple answer to your question is that absolutely yes, every cat has days where the cat is flat and exhibits no clear nadir. the question is how that fits into the whole picture.

this is not about tight regulation. it's about understanding your particular cat's response to the use of insulin. if you want to understand more i will show you some examples.

click on punkin's ss in my signature line.

on 7/18 his amps was 150. +7 124 pmps 160. looks pretty flat and quite uneventful.

that however, was the beginning of a 3 day bounce for him. the night before he'd gotten to 68 at +4, which was apparently lower than he had become used to and his liver responding to what it perceived as danger by letting loose hormones and sugars to "save" the cat's life from hypoglycemia. remember that a non-diabetic cat's BG will be 40-120, so this is not a hypo situation, it merely comes about because the cat's body has become accustomed to a higher range. this happens to punkin very quickly - his body gets unaccustomed to normal numbers very quickly.

his numbers continued high the next day, 7/19.

7/19 amps 155, +5.5=215, pmps 225 (i had used R which held down the pmps, punkin has acro so his situation is a little different, although these responses are found in many of our cats whether or not they have acro. just explaining my use of R.)

7/20 amps 314 - the final giant inhale before the bounce broke. at +6.25 he was 46.

if i had only checked his BG on 7/18 or 7/19 i would've thought the same thing you are thinking. "why is he so flat?" but because i had the other data, the other pieces in the puzzle to fill out the picture, i know exactly what was happening. his body was responding to the 68 on night of 7/17. every single bit of the data on 7/18, 7/19 and the morning of 7/20 was a result of the 68.

nobody is suggesting that you have to test as often as i test to be able to use Lantus on your cat. you can test as often as you want. but the bottom line is without preshot tests and a mid-cycle test - you will continue to be scratching your head and wondering why the tests you do get don't make sense to you.

 

hi george. when used properly, lantus and levemir have the ability to produce long flat curves. alex is on levemir, but the use of lantus and levemir is very similar. last week she had an amps of 71, 71 at +6, and 71 at pmps. lol! how's THAT for flat!

we've both been around long enough to remember when "tight regulationists" were in the minority and on the "fringe", but just like in human medicine, our knowledge base has expanded and we've found more efficient ways to use lantus and levemir for our kitties. most, if not all the responses you've received reflect changes that have taken place over the last few years.

having said that, you might want to take a look at the info in this link: http://www.uq.edu.au/ccah/docs/diabetesinfo/link3.pdf.
it's a dosing protocol for for cats on lantus or levemir when monitoring every one - two weeks. it may be of some help to you...

 

Hi George! Long time, no see!

Lantus and Levemir have very lovely flat curves -- Read the sticky post about learning to shoot lower numbers. The old cutoff of don't shoot below 200 or 175 is out the window - but you do need to test and observe when shooting these nice lower numbers in order to build up data.
viewtopic.php?f=9&t=147

I've been caring for Tiggy for over 3 years now - using Levemir, which is pretty similar in action to Lantus but more cost effective (the "shelf" life is longer and it is not acidic, so it doesn't sting when injected).

Anyway - Tiggy is quite well regulated on a tiny dose of 0.5u BID. After 3 years of testing - we know that it is safe to give Tiggy his whole dose when his BG at shot time is as low as 100. If below 100, we'll shave a little bit off his dose and give 0.25u. If below 75, we wait and check later (in an hour or so).

Sorry I don't have a spreadsheet that you can look at - we keep our records in a book and I haven't typed them into the computer in a long time.

((((((hugs)))))) and bless you for taking in more diabetics after losing Bert, who will always be your most special boy.
phoebe

 

George, I'm so sorry you lost little Bert. Please accept my condolences. I didn't realize. How wonderful of you to take another one on on top of all the cats you have already. What is your new diabetic kitty's name?

I didn't mean to come off as scolding so if I did, I apologize. It's just that I knew you had started testing Bert and didn't understand why you were no longer testing. It only takes a few minutes before shots and nadir testing can be done on your days off.

Again, I'm so sorry about Bert.

Melanie & Racci

 

The not so strange effect of Lantus?

Hi everyone and thanks for your input.

My sugar kitty Bert passed two years ago from complications due to cancer and not diabetes. He was doing well on PZI, but I had intended to change him to Lev just before he was called up. You're right Phoebe in that he will always be my special boy.

My two new sugar cats are Andre a former feral wild boy who has made a complete transition to a real lover, but hates his blood taken after vet techs brutalized him during testing. Now I can't test him without a big fight. Before that I tested him routinely. He became diabetic from a very serious, almost deadly infection.
He pulled through, but with a damaged pancreas. I have been shooting him with 2.0 units BID for months and he continues to look and act perfect and has even put on two pounds. He does not drink much and the boxes are fairly dry. No sign of back leg weakness and you would never know he had a problem.

My other is Matilda , a Maine coon fuzz ball also a feral who became friendly very quickly and is adorable. She is the most week behaved cat I have ever had. She seems to like the shots as she purrs the minute I set her on the table. She never budges when I say "Sit still". No matter when I test her or the dose his numbers are the same. I will give her 2.0 BID for ten days and test her mid or end and she'll show 98. The I'll shoot her less at 1.25 BID for five days and like just now she tested at 90!

Now, what do I do? Geeeez!

Ps In the past six months I have lost four of my guys from different ailments..none were diabetic. One "Baby" the vet killed with bad treatment and gave her a heart attack ( She's the orange and white one in the pic) and another "Electra" a vet over dosed. The other two died unexpectedly. Bert is the Tuxedo in the lower pic.