vet wants daily lantus- Updated +5 54....

Not sure what to do. The vet Shadow sees is thinking about switching him to once a day lantus. I think I've read on here that that is not recommended.

Sugars are still high. If he's bouncing from his lower numbers on 5/26, I would think that would be cleared by now?

 

Re: vet wants to swtich to once daily lantus

Once a day is not recommended. Twice daily is the best way to dose lantus.

You are of course assuming that he didnt have a low green last night. He may well have gone green since he seems to go black after every green. Which means he is bouncing again.

I am hoping an experienced doser will pop in and advise

Wendy

 

Re: vet wants to swtich to once daily lantus

Did the vet explain his reasoning behind once a day dosing? I don't see anything to indicate that once a day dosing would improve Shadow's numbes.

 

Re: vet wants to swtich to once daily lantus

Just had this discussion again with the vet. She really wants to try once a day dosing. She thinks because he's still having the low numbers (40s) the other day that he is getting too much insulin and would do better with once a day....

 

Re: vet wants to swtich to once daily lantus

Cats metabolize insulin differently than people. Dosing once a day is likely to give you very wonky numbers. We've seen it quite often.

I think your vet does not understand how the insulin works.

 

Re: vet wants to swtich to once daily lantus

Lantus only lasts 12 hours in a cats system. Doesnt make sense to move to once a day dosing. Plus he is seeing great numbers right now - he even had a dose decrease the other day to 2.5! I would stick with the plan for now and see how it goes.

If (later) it stops working then maybe you can move to try it your vets way to prove them wrong .. but I would hate for the vet to mess up what looks like a good trend right now!!


Wendy

 

Re: vet wants to swtich to once daily lantus

Can your vet show you where it is proven that Lantus lasts a full 24 hours in a cat? I bet not.
The dose you are giving may be too high but how is it going to be better to give a 2.5u shot in the morn and then have it run out by dinner, then have your cat bounce and be high for 12 hrs.... and then repeat the next day?
Sorry, no logic there at all.

There are TONS of cats who never need as much insulin as you are giving, so if you and your vet think you are giving too much insulin, decrease the dose, but still give shots every 12 hrs.
What's wrong with your giving a 1.25u dose every 12 hrs, instead of 2.5u once a day?

I am sorry, but I think you should tell your vet to find another guinea pig for once a day dosing because you are not going to inflict that kind of discomfort on YOUR cat.

Gayle

 

Re: vet wants to swtich to once daily lantus

Just did a little reading. Looks like there is research out there that supports once a day dosing of Lantus. I'm not saying that the vet is right. I would be more than happy to continue as we are and chip away at the dose by 0.25 when I get lows. I'm just wondering if I should "play nice" and give her idea a try? I've gone against a lot of what she has said over the last 2 months... she does spend a lot of time with me talking about what we're seeing. I emailed her the link to Shadows SS today so she can continue to look at it. Would it hurt him to try her way for a week- see that it doesn't work and then go back to what we're doing?

"In general, the duration of effect of insulin glargine appears quite variable, with the glucose nadir occurring as soon as 4-6 hours and as late as 18-22 hours after administration. Insulin glargine works well when given once or twice a day in some diabetic cats and does not work very well in other cats. As with other insulin preparations, the glycemic response to glargine is always unpredictable, and each cat treated with this insulin, as with any insulin, must be carefully monitored and evaluated to judge the cat's response."

"Insulin glargine is the longest acting commercially available insulin for treatment of diabetes in humans and is currently a popular initial choice by veterinarians for the treatment of diabetes in cats. A preliminary study identified better glycemic control and a higher diabetes remission rate in newly-diagnosed diabetic cats treated with glargine twice a day, compared with lente or PZI administered twice a day.16 Another study found no difference in glycemic control in diabetic cats treated with insulin glargine once a day versus diabetic cats treated with recombinant human lente insulin twice a day, and a higher diabetes remission rate in diabetic cats treated with recombinant human lente insulin.17 In my experience, the duration of effect of insulin glargine is quite variable, with the glucose nadir occurring as soon as 4 hours and as late as 20 hours after administration. Insulin glargine works well when given once or twice a day in some diabetic cats and does not work very well in others. Problems are usually related to duration of effect."

"The goals of this study were to compare the efficacy of once-daily administered Glargine insulin to twice-daily administered Lente insulin in cats with diabetes mellitus and to describe the use of a high-protein, low-carbohydrate diet designed for the management of diabetes mellitus in cats. All cats with naturally occurring diabetes mellitus were eligible for inclusion. Baseline testing included a physical examination, serum biochemistry, urinalysis and urine culture, serum thyroxine concentration, and serum fructosamine concentration. All cats were fed the high-protein, low-carbohydrate diet exclusively. Cats were randomized to receive either 0.5 U/kg Lente insulin q12h or 0.5 U/kg Glargine insulin q24h. Re-evaluations were performed on all cats at weeks 1, 2, 4, 8, and 12, and included an assessment of clinical signs, physical examination, 16-hour blood glucose curve, and serum fructosamine concentrations. Thirteen cats completed the study (Lente, n = 7, Glargine, n = 6). There was significant improvement in serum fructosamine and glucose concentrations in all cats but there was no significant difference between the 2 insulin groups. Four of the 13 cats were in complete remission by the end of the study period (Lente, n = 3; Glargine, n = 1). The results of the study support the use of once-daily insulin Glargine or twice-daily Lente insulin in combination with a high-protein, low-carbohydrate diet for treatment of feline diabetes mellitus."

 

Re: vet wants to swtich to once daily lantus

OK can someone show me proof in numbers on a spreadsheet that their cat is at a dose around 2.5u and is getting nice numbers for 18-22 hrs? I would bet money nobody can.

So, a cat can be fine on one shot for 18 hours.... what about the other 6? Does the cat stay high until the next shot?

You can choose to play nice with this vet at the expense of your cat's feeling good, but why? Everywhere you look around here, on the spreadsheets, you can SEE that no dose lasts that long..... look at the cycles.... numbers drop for half the cycle and then start rising. Just look at your OWN cat.... do you see anyplace where that 2.5u is coasting nicely for 18-22 hrs? Nope.

Like I said before.... many cats never need a dose as high as 2.5u, so cut it down. From your ss, it looks like you started at 3u - that alone tells me that your vet is not familiar with Lantus with cats.... maybe your vet deals with more dogs? And I don't want to hear that the vet said something like 'Well, lots of my cat clients are doing very well on once a day shots' .... I would say show me their numbers; I want to see their full curves with tests done every 2 hrs. Oh, you don't have that data? Well then, how do you know they are doing well? Oh, because the cats act better?

Nope, stick to your every 12hrs dosing and cut down the dose if needed. YOU know more about Lantus than your vet.

Gayle

 

Re: vet wants to swtich to once daily lantus

There have been a small number of cats who did well on once a day dosing. To the best I can recollect, these were cats that were already on a micro-dose of insulin and were close to OTJ or where they had a "sputtering" pancreas. I can't recall anyone on a dose that was more than 1.0u on a once a day dose. Maybe Jill or Libby, both of whom have been around longer than me, can think of someone where this strategy has been effective. While once a day dosing is the exception to the rule, that doesn't mean it will or won't work for Shadow. I just don't see what your vet is seeing.

If your vet is seeing the 40s on your SS and using this as a rationale for once a day dosing, that wouldn't be the criteria I would use. A drop in numbers below 50s is a signal that a dose reduction is needed. You'll see this in the Tight Regulation Protocol. I'm attaching a copy of the journal article with the protocol for you to share with your vet. Frankly, lots of vets overreact to numbers that we consider to be in a healing range. Most of a vet's clients do not home test and do not know how to steer lower numbers with food. Because most people don't home test, vets want to give them a very wide margin of safety and will suggest that numbers between 100 - 250 are "normal." We don't regard those numbers as normal, especially at the upper end of that range.

It's up to you whether you follow your vet's instructions. All we're doing is our best to give you our impressions so you can make an informed decision. You shouldn't feel pressured by us or by your vet. Shadow relies on you for the best possible care and to act in his best interest. We'll support your decision no matter what you do.

Can I ask where you found the quotes you included?

 

Re: vet wants to swtich to once daily lantus

Peterson, M. E., & Kintzer, P. P. Progress in Choosing the Right Insulin in Dogs and Cats.

Weaver, K. E., Rozanski, E. A., Mahony, O. M., Chan, D. L. and Freeman, L. M. (2006), Use of Glargine and Lente Insulins in Cats with Diabetes Mellitus. Journal of Veterinary Internal Medicine, 20: 234–238. doi: 10.1111/j.1939-1676.2006.tb02851.x

Here are the references for two of the articles.

 

Re: vet wants to swtich to once daily lantus

I just noticed the dose in that study..... it was 0.5u.

How about if you tell your vet that once Shadow gets down to that low of a dose, you will try the once a day dosing.

Gayle

 

Re: vet wants to swtich to once daily lantus

Thanks for the citations. There is an editorial in the same issue of JVIM as the Weaver article. The editorial is by Jacqui Rand -- the vet who is one of the authors of the Tight Regulation Protocol. She makes several points about the Weaver study and its use of once a day dosing. One thing to note is that the comparison insulin, Lente, was given twice a day. This was the only way to compare the two insulins. Rand et al.'s research uses twice a day dosing and she has found a far greater rate of remission than what was found in the Weaver article. She has an issue with their results. Here's the editorial if you want to take a look:


I can send you the full Weaver article, as well. (I have access to medical and vet libraries. Science nerd!)

Like I said earlier, please don't feel pressured. Any research can be picked apart. Just do what you think is best for Shadow.

 

Re: vet wants to swtich to once daily lantus

Sienne,
Thanks for the article. I'm going to try to do some more research tomorrow.

Just checked shadow, he's 71 at +4...

Time to decrease again in the morning. What would you think of a 0.5 decrease to 2 instead of dropping 0.25

I think some of what the vet may be thinking is that shadow seems to go low at night. Is this because he's getting that second dose of insulin and the added effect of the pm dose with the am dose is to much. She has talked about dosing every 18hrs, but it's almost impossible to make that schedule work.

 

Re: vet wants to swtich to once daily lantus

See? He is doing great.. Don't fix it if it ain't broken!!

He needs to go under 50 for another decrease..(u aren't using the AT any more right?) Can you get another test in an hour?

 

Re: vet wants to swtich to once daily lantus

Oh right- the numbers changed when I switched meters. We are using the relion. So, under 50 for a decrease. Yes, I will check him in an hour.

 

Re: vet wants to swtich to once daily lantus

Paws crossed he goes under 50 (but not too low!!) and gets another decrease! Down to 2.25.. We don't want to skip the best dose., and he will get to 2 soon enough if he keeps this up!

 

Re: vet wants to swtich to once daily lantus

Shadow is looking great tonight. :mrgreen: :mrgreen:

Interesting discussion on the single vs twice a day dosing. I see that Shadow has gone low during the day as well as the night. My Neko is on a month and a half stretch where she only goes low at night. Before that she used to go low both at night and during the day. I have no idea what started the trend, cause if I did, I'd change it. I think it's because she's a cat. :lol: Cats are by nature more nocturnal animals so that could be why we see them go low more at night.

 

Re: vet wants to swtich to once daily lantus

54..... What should I do? I can't stay up much longer...

 

Re: vet wants to swtich to once daily lantus

Feed a couple of tsp of regular low carb food and test again 30 minutes after Shadow has eaten.

Could you change the subject line of your first post to include this latest number? (+5 54 I think?) That'll help people know to pay attention to the condo.

 

Just fed- will retest at 11:30 (30 minutes)

 

Re: vet wants to swtich to once daily lantus

You don't have the test on your SS. What +time did you get the 54?

You can always feed HC. It may abort the cycle, though. The trade off is bumping the numbers up or seeing if Shadow is telling you he needs a dose reduction.

I want to emphasize how important it is for you to get a before bed test every night. It's possible that Shadow went low last night given the blue AMPS this morning.

 

Sorry, just updated the SS. Got the 55 at 11pm.

I will start getting a bedtime test, but that is usually 9pm or +3- doesn't necessarily give me all the much info- except if he is low then I can expect he will continue to drop.

I'm feeling a little stressed because I can't stay up with him this late every night. But I also know I can't leave him if he's dropping. It's making me worried... I have to sleep though to be able to function at work. I get up at 5am- work 12 hour days. When I check him at 11:30 which will be +5.5 if he's still low, what will I do?

At that point can I feed with karo and go to bed?

 

11:30- 69

I think I'll feed another couple tsp? He should be at about the point where he drops his lowest... Think it's ok for me to go to bed?

 

Sounds good.... 54 and then 69 are fine numbers... you want them all the time!

Gayle

 

Just one other point on the study you quoted on Lente and Glargine. As a scientist, myself, I have to question any study with a sample size so small as 13 cats.....

 

So close! Great numbers tonite though. The more ofthose, the more he heals and feels better. Maybe dose decrease next time I wouldn't be surprised. Tomorrow he will probably bounce..