2/10-Lantus duration question

Status
Not open for further replies.
S

SarahFL

Member
My cat has been experiencing prolonged hypoglycemia (viewtopic.php?f=3&t=5771&start=0). Her bg is back up to the normal range for now, but I'm concerned about it dropping again. My vet, who hasn't used Lantus before, thinks that we're well beyond the active period of the most recent injection (28 hours ago), and is starting to wonder whether we have something else (like an insulinoma) going on. How long is it possible for Lantus to keep acting after I've stopped giving it? Is it possible for it to still be acting 24-48 hours after injection? Sarah's been on Lantus for 2 months now, but has only been well-regulated for the past week or so.

Also, after this hypo episode, how long should I wait before I start giving Sarah insulin again? I'm going to start over with a much lower dose, but I definitely don't want to do it too soon and end up making her hypoglycemic again.
 
Lantus does have a slower absorption rate than other insulins, but I don't know if it can last for over 24 hours. I would wait to hear from more experienced folks, especially in regards to dosing. I would have no clue how to advise you to dose. I can guess that you will need more data, more spot checks, the info on your ss is a bit sparse.

Maybe you want to find a new vet? It would be really helpful if your vet could answer your questions. I've also had luck talking about Lantus with my local pharmacist. I often find the pharmacists know more than the dr's anyway. :shock:

Good luck.
 
Hi Sarah,
You might want to repost this tomorrow, so more people see it, but I would recommend you not start insulin for at least another 24-48 hours.. if it's even necessary then. Sometimes they just don't need insulin after a hypo... it's a wait and see kind of thing. Keep on posting here or health with your numbers .. or both places and we'll help you out with when you should restart. It's all gonna depend on what you feed as well as what number she is at so please let us know how she's eating and what she's eating. :smile:

As far as duration, I've never seen a hypo go on as long as yours on 3u of Lantus, but I am not quick to say it isn't still going to happen. It's possible that she's ok right now, but I'd be leaving high carb and dry out for overnight. Do you sleep lightly? Many cats will get the attention of their owner pretty persistently if they are having a problem, so she may try to wake you up.

Insulinoma is extremely rare in cats, and it doesn't seem likely it would be present in a diabetic cat, as they are tumors that produce their own insulin. I also wondered if something else was going on but I could not think of anything I had ever read or seen that was similar.
 
Carolyn and Spot said:
Hi Sarah,
You might want to repost this tomorrow, so more people see it, but I would recommend you not start insulin for at least another 24-48 hours.. if it's even necessary then. Sometimes they just don't need insulin after a hypo... it's a wait and see kind of thing. Keep on posting here or health with your numbers .. or both places and we'll help you out with when you should restart. It's all gonna depend on what you feed as well as what number she is at so please let us know how she's eating and what she's eating. :smile:

As far as duration, I've never seen a hypo go on as long as yours on 3u of Lantus, but I am not quick to say it isn't still going to happen. It's possible that she's ok right now, but I'd be leaving high carb and dry out for overnight. Do you sleep lightly? Many cats will get the attention of their owner pretty persistently if they are having a problem, so she may try to wake you up.

Insulinoma is extremely rare in cats, and it doesn't seem likely it would be present in a diabetic cat, as they are tumors that produce their own insulin. I also wondered if something else was going on but I could not think of anything I had ever read or seen that was similar.
Click to expand...

She usually eats EVO (out all the time), although for the last 2 days she's been getting anything that she'll eat.

I don't think she'll wake me up if things go south--she usually hides in the back of the closet if she doesn't feel good. But, since she often sleeps there anyway, it can be difficult to tell the difference.

My vet and I (he's great, just hasn't had a client use Lantus before) are wondering if her pancreas is starting to kick back in, since her diabetes was steroid-induced.
 
ok, well sleep as lightly as you can. Try to set your alarm and get up just long enough to test her in a few hours, just to be sure she's maintaining. Like I said hold off the insulin for a good while, don't restart based on a number or two. We're gonna need to see a pattern of at least 12 hours of sustained over 200 numbers to feel like it's time to intervene and that's going to depend on carb content of eaten food. EVO is low for dry food, if that's the EVO you're talking about, but it still makes a significant difference.

I gotta head to bed but I'll be keeping my fingers crossed for you two :)
 
Sarah:

It's possible that you have a unique situation and we can certainly help you to brainstorm. However, if there is an insulinoma, unless one of the vet techs who frequent the board is around, your question may be beyond the expertise of the average person here. What I would suggest is that your vet make use of some of the technical resources that he has access to. There is a message board (Veterinary Information Network or www.vin.com) specifically for veterinary professionals where he can post a question, much like you're doing here. Your vet can also call the closest vet school and speak with either a veterinary pharmacologist/pharmacist if he feels the question is about the drug or someone there who specializes in endocrinology if he thinks the problem is diabetes-related.

Given the duration of steroid treatment and an infection shortly after steroids were discontinued, it is possible that your cat's pancreas is beginning to kick back in, even if it's doing so in an inconsistent way. It's also possible that 3.0u is too much insulin. It's hard for me to come to any firm basis to draw an inference from since there are cycles where you don't have spot checks -- especially in the evenings when many cats run lower BG levels.
 
I had to sign in this morning to check on you! Lantus duration CAN last a long time in an overdose situation, which looks like what this is even though that dose has been ok in the past. For some reason her insulin needs suddenly changed, but most likely that is because her pancreas started working (let's hope so, anyway!). I would not worry yet about insulinoma, the pancreas restarting is much more common than that so is more likely in my opinion.

It can take more than 24 hours for an overdose to work its way through, so we just need to wait. I agree with Carolyn, let's wait and just keep testing for another day or two and see what happens. Keep posting here and we'll help keep an eye on her patterns. Sometimes a prolonged hypo can lead right into remission without ever needing another shot again! Or she might need to resume shots in a couple of days, but not at a 3 unit dose.
 
Hi! I was checking Sarah's SS. Have you had any chances to get spot checks today 2/10? I see that she did get to 140 last night.
 
I think it's great that your vet had you start with Lantus despite his not being familiar with it. It's a great insulin, and there have been many, many cats that have had good results from it. Several have been able to go OTJ (off the juice) all together, but most would agree that the expertise you'll find with this group is irreplacable.

I would hope that your vet will work with you and continue to learn, but you will get valuable assistance here that most vets can not provide. This is not meant as a criticism, just an observation. People that post here have daily (actually hourly) experience with using Lantus, capturing data, spotting trends, etc. Since you get more accurate results home testing than you would at a vet clinic, I'm not sure the average vet sees a true curve at their practice. :)

Good luck with Sarah. You got her through a rough patch.
 
hi sarah...how are you doing today? i looked around for an update from ya and checked spread sheet looking for a number today, can't find anything. if you see this please let me know how you guys are doing, k?
~jojo

ps. about the question at the beginning that you asked, it is very common for a cat to go off insulin altogether after a hypo, or to go off insulin shortly afterward. in fact going off insulin is a pretty common occurrence for cats on lantus (no hypo needed) as we see here all the time and as the veterinary studies prove. there is more info in the stickies at the top of this page.

hope to hear from you soon....
 
Status
Not open for further replies.
Back
Top