4/18 - Sammy (7.5u) first dose lantus - amps 212; +1 182

Sammy's been diabetic since 2006 and tightly regulated on PZI Vet. Honeymooned and then fell off the wagon. He's on low-glutin FF and had six rotten teeth removed from his little head 12 days ago. He's got a heart condition (but came through the operation beautifully) and the latest tests show his kidneys aren't that great. We are now making the great leap off PZI, having for all intents and purposes licked the last bottle dry. He was at 171 +23 an hour ago after getting 4.4U - way, way more than usual because he was at 309 (at +11) but we've been getting these weird spikes lately. Anyway, I've been told to treat Lantus like PZI that would mean that he would get 2.2U. (I use U100 needles, btw, and use the conversion chart so the doses I've mentioned are U40 doses.) Since I'm terrified I'd appreciate any advise.

 

Re: Dosing Advice Sought, Moving from PZI Vet to Lantus

Hi Maureen. Welcome to Lantus. You will get lots of advise and support and help here.
Someone will be along very shortly to help you with dosing advice.

 

Re: Dosing Advice Sought, Moving from PZI Vet to Lantus

Welcome Maureen. Others will be along to get you started, so while you are waiting, you can start by reading the stickies at the top of the main Lantus screen, and put a profile and spreadsheet together which will help everyone to better guide you in the transition.

I am glad to hear that the teeth issue is in the past and you and Sammy both survived the ordeal.

 

Re: Dosing Advice Sought, Moving from PZI Vet to Lantus

good morning and welcome to lantus land! sorry to hear sammy fell off the wagon. if you haven't already, please take the time to read through the "stickies" at the top of the page. lantus is different from pzi from the way it's handled to it's use. dosing is based on nadirs with only some consideration given to preshot numbers.

as far as an initial starting dose is concerned, it's hard to comment without seeing the last couple of weeks of pzi numbers. there is a link in the "new to the group?" sticky to instructions for setting up a spreadsheet. a spreadsheet will help us answer your questions.

good luck with the switch!

 

Re: Dosing Advice Sought, Moving from PZI Vet to Lantus

Oh, god, I hope I haven't killed him. I figured I couldn't wait any longer so at +24 when he hit 212 I shot him with 7.5U (U100). I'll go struggle trying to a spreadsheet.

 

Re: Dosing Advice Sought, Moving from PZI Vet to Lantus

Hello

welcome to the Lantus forum.

Sorry can you clarify? You shot 4.4u of the last of your PZI this morning or 7.5u? Will you be home to monitor by spot checking Sammy?
Post if you need help ok?

Jill is one of our very experienced members here, and she likes to see data, so if she says - let's see some numbers, know what I mean?
When you have a chance, set yourself up with a spreadsheet and link it to your signature.
All the info is in the "stickies" up above (the threads with the "star" icon)

Hope to see you posting often, and I too am sorry you have to start back up again on insulin, but you're in good hands here!

 

Re: Dosing Advice Sought, Moving from PZI Vet to Lantus

want to make sure i'm understanding you...
you just shot 7.5u of lantus? was this the first dose of lantus?

do you have any high carb (18%) canned food and karo in the house if you need it to bring up numbers?
please get a +1 and +2 for starters. post the numbers when you get them...

 

Re: Dosing Advice Sought, Moving from PZI Vet to Lantus

Maureen,
Did you give Sammy a dose of 7.5u of Lantus using U100?

I just wanted to be clear on exactly what you did.

 

Re: Dosing Advice Sought, Moving from PZI Vet to Lantus

I shot the last of the PZI Vet yesterday at 8:17am. Sammy was at 309 so he got 4.4U (U40), which is 11 in U100 terms. At +8 he was at 111. At +11 he was at 107. At +14 he was at 85. At +18 he was at 93. At +23 he was at 171. At +24 he was at 212. That's when I gave him 3U (U40) or 7.5U in U100 terms.

 

Re: Dosing Advice Sought, Moving from PZI Vet to Lantus

Will you be around this morning to get spotchecks?
can you start with a +1 (thats one after this morning's shot and AMPS)

 

Re: Dosing Advice Sought, Moving from PZI Vet to Lantus

Hi Maureen & Sammy, and welcome! My post has crossed with all the replies you just received. The experts are concerned!! The following is what I wrote before I saw the above responses to your post:

You have come to the right place. The dosing experts will want to know how much Sammy weighs and will want to see his chart. So if you can get a spreadsheet and profile up and running, they will be happy. Instructions for setting up a spreadsheet in Google Docs can be found in the Tech Forum. The template we use has already been made and all you have to do is set up a free account in Google Docs and link your Google Docs spreadsheet to your signature. If you keep your spreadsheet up to date, the people here can see how Sammy is doing and make recommendations for dosing.

Stu was also diagnosed in 2006 and was on PZI Vet until last November, when we switched to Lantus. His initial dose was set too high and we had quite an adventure until I found this forum! Lantus works very differently from PZI Vet. It is given every 12 hours and there is very little wiggle room with regard to the timing of the shot (you don't have that hour or two of leeway that you have with PZI Vet). Also the dosing is based on the blood glucose number at nadir (when the number is lowest and the insulin is peaking), not at the pre-shot number. After the initial dose has been decided upon, we follow a modified version of the Tilly Protocol (see the informational "stickies" above). When making dosing changes, we go very slowly, raising or lowering the dose by .25 of a unit, or .5 of a unit (depending on the cat and a bunch of other factors). We then hold the new dose for a number of 12-hour cycles to let it "settle". Lantus like this go-slow approach. It sounds finicky, but it really does produce results.

There are many very knowledgeable people on this board who will give you sound advice with dosing. Someone will be along soon. In the meantime, read as many of the "stickies" at the top of the Lantus forum as you can. It's a lot of info. and Lantus has has steep learning curve, but it's worth it. And, again, welcome!

Ella & Stu

 

Re: Dosing Advice Sought, Moving from PZI Vet to Lantus

ok. thank you for the explanation. since this is his first dose of lantus and a high one at that, please get those early spot checks and we'll go from there. the +2 should be about the same as the preshot number.

the insulins are different strengths. for example, if he was doing well on 4u of a U40 insulin, we would probably recommend a starting dose of lantus somewhere right around 4 units (in a U100 syringe).

looks like you'll need to monitor carefully today. do you have high carb canned (18%) and karo on hand if needed?

 

Re: Dosing Advice Sought, Moving from PZI Vet to Lantus

Yes, I am going to be here all the time. I will do the +1 in 20 minutes.

 

Re: Dosing Advice Sought, Moving from PZI Vet to Lantus

do you have high carb canned (18%) and karo on hand if needed?
see you at +1...

 

Re: Dosing Advice Sought, Moving from PZI Vet to Lantus

Yes, I have Karo at hand. No, I do not have any high-carb food in the house. I specifically ask the vet if I should start like it was the beginning with 1U and he specifically said no treat as PZI. The vet btw is about as fancy as you can get. A slew of highly networked specialists.

 

Re: Dosing Advice Sought, Moving from PZI Vet to Lantus

If I do have to give him Karo how many cc's do I give him?

 

Re: Dosing Advice Sought, Moving from PZI Vet to Lantus

i agree with your vet. i wouldn't have recommended starting over at 1u bid either. however, using lantus and pzi are very different. you do not roll or shake the vial/pen/cartridge before using. dose adjustments are made according to nadir. sliding scales are not used with lantus. consistent dosing is the key to success with lantus.

 

Re: Dosing Advice Sought, Moving from PZI Vet to Lantus

is sammy carb sensitive? some cats are, some aren't. depending on the numbers... initially, i'd start out with a few drops (possibly mixed in a little bit of food) to see what kind of bump it gives. if it's not enough, you'd have to increase the amount. your meter will guide you.

since you have a head's up and can monitor carefully today, we should be able to manage the curve without any problems.

 

Re: Dosing Advice Sought, Moving from PZI Vet to Lantus

+1 is 182

 

Re: Dosing Advice Sought, Moving from PZI Vet to Lantus

a little dip. i'd feed a teaspoon of lc here... no more than that. we don't want him getting full in case we need him to eat later.
see you at +2.

 

Re: Dosing Advice Sought, Moving from PZI Vet to Lantus

I don't know if he's carb-sensitive. I've always managed with human food like beef if he was going a little low. He only had karo once in his life and that was on April 7 after the operation when the vet panicked. Should I go out and buy food or stay with him?

 

Re: Dosing Advice Sought, Moving from PZI Vet to Lantus

Sorry lc?

 

Re: Dosing Advice Sought, Moving from PZI Vet to Lantus

LC is low carb, MC medium carb and HC for high carb,,,you prob should get stocked up on HC and MC varieties when you can, this is something we like to encourage for you to keep in your hypo tool kit along with the Karo.

If you're close to a store and can get back quickly then yes, I would go, or send someone to go for you.

 

Re: Dosing Advice Sought, Moving from PZI Vet to Lantus

there's time to get some fancy feast grilled flavors in the house. they're usually around 18% carbs.
i have NO idea how this will all shake out today. he may drop or this may turn into a non-event. often times it does. i'm hoping for the latter considering this is the first dose of lantus, but monitoring is the only way we'll know for sure. better to be safe than sorry...


lc = low carb wet food

 

Re: Dosing Advice Sought, Moving from PZI Vet to Lantus

Ah, yes, I used to have that in a segregated part of the pantry as backup but not for a while

 

Re: Dosing Advice Sought, Moving from PZI Vet to Lantus

lc means "low carb" food. (mc= medium card; hc= high carb). Low carb (what we feed under normal circumstances) is anything below 9-10% carbs on Janet's and Binky's food charts (see the link to this in the sticky "New to the Group"). Medium carb is from about 10% to 14%; high carb is above 15% and any of the foods with "gravy" is high carb. MC can be "made" by adding high-carb gravy to low carb food, or a little Karo to low carb food.
Hope this helps a little!

Ella

 

Re: Dosing Advice Sought, Moving from PZI Vet to Lantus

this might be a good time to go to the store. :smile:

Welcome to Lantus Land!

 

maureen, i took the liberty of changing the subject line to reflect the dose and current numbers so others will be alerted to your situation.
hope you don't mind...

 

If it will take too much time to make a grocery store/Fancy Feast (FF) run, don't worry about it. A few drops of Karo or other syrupy stuff mixed into regular LC food will do the job.

And, welcome to Lantus Land. Sorry about the "exciting" introduction!

 

Three stores later. I found one flavor of griled. great, my complaining about the food worked.

 

sorry you had to go to 3 stores. at least you found one.
see you at +2...

 

+2 is 113

 

I know the feeling, I've been thinking there must be another FDMB person very near me. Last week I could not find the regular FF flavors that my cats like (chicken and turkey giblets) anywhere, and at my grocery store there was none of our backup, Friskies turkey, either. The first PetSmart I went to had 1 can of chicken feast and 4 cans of turkey. They checked in back and there were none. Went to another PetSmart later in the week, I got a case of chopped grill and a few cans of each of the others. Between two grocery stores I got I think 12 cans of each FF and a couple cans of Friskies. The two nearest grocery stores are often out of those flavors. What's up with that? Two of my cats like premium food and I have that, but one won't eat the good stuff at all so I have to have FF and Friskies.

 

ok. squeeze some of the gravy out of one of those cans of high carb food and let him have about a teaspoon. all we want to do is give him something to slow the drop without filling him up. i'd retest in 30 minutes to see if we've accomplished our immediate goal.
see you then...

 

OK, I make one teaspoon to be about 3ml so I shot that right down his gullet. Now he's looking for the can.

 

lol, the power of gravy, sooo addictive :lol:

you're doing great Maureen

 

lol! of course he wants the high carb food! hold off on it for now. we don't want to fill him up at this point.
how are you fixed for strips? have a lot on hand?

 

Looks like I've got about 62 strips in the house.

 

wonderful! more than enough.

 

Sammy weighs about 16 lbs. He has consistently weighed 16 lbs since the diabetes. His mother was a Maine Coon cat. His putative father was the homeliest cat I ever saw. His full sister is so pretty her name is Beauty. He is very smart and a wonderful patient. He's understood from the beginning that the insulin is good for him.

 

he IS a smart kitty to know insulin will make him feel better. good for him!

 

Hi Maureen I want to welcome you to LL along with Sammy you are in great hands today with Jill :YMHUG: :YMHUG: cat_pet_icon

 

Thanks. I wish it wasn't so dramatic.

 

83 at +2 hrs 40min & 30 minutes after +3ml high-carb gravy

 

i'd mix in a little karo with that. let's get him bumped up.
retest in 30 minutes, please...

 

I could shoot the Karo directly into him. He's not eating the lc FF. Should I give him the grilled?

 

he can have about teaspoon of high carb food. mix some karo into it...

 

Ok, figure about 1cc of Karo and maybe a bit more than a teaspoon of the hc FF

 

that's fine. the thing to remember while we're doing this today is we don't want to fill him up for two reasons...
we want him to eat when we need him to eat and we don't want him to get so full that he'll vomit.

right now we just want to stop the drop...

 

111 at +3.5 + hc food & 1 cc Karo a half hour ago

 

fantastic!
i think you could probably wait about 45 minutes to retest. he's probably going to bobble up and down for awhile. our goal is to control his numbers with food and karo (if necessary).

 

Right. See you in 45 minutes. And thanks a lot. A real lot. Whoops, I'm gonna cry.

 

awww, don't cry. you're doing great and so is sammy!!!
stuff like this happens... i couldn't tell you how often.
see you in 45 minutes...

 

oh, this is all my fault.

 

Welcome to Lantus Land, Maureen and Sammy! It is a very dramatic entrance, I mustsay :lol:

I see Jill is taking very good care of you, she is a life saver and is very very knowledgeable. Listen and you will learn! And since Jill is on board, I really don't have much to advise since she has got it all covered!

I have absolutely no experience or knowledge of PZI since Spot started on Humulin N (BIG UGH) and then he went on Lev, but I can tell you that you really do have to change your way of thinking when you switch insulins. Lantus and Lev are based on nadar, not pre-shots.

FWIW, I bought a black magic marker and marked the carb content on the lids and sides of all the cans of food that I bought so that I wouldn't make a mistake in feeding the wrong carb food at the wrong time. This system worked out very well, especially when I wasn't home and my mom needed to get some hc/mc food into him.

 

Yeah, the vet wanted to put Sammy on Humulin N. I even have a script for it here. But after Sammy got over the operation on his teeth I argued with him that Humulin N wasn't ideal. And I wasn't sure I could get the extra PZI Vet that someone else has here in time and importing the bovine stuff from England can take a long time so from what I'd read Lantus was Sammy's best bet. The doctor was under the impression that Levemir is better for cats with higher BGs than Sammy runs but Sammy's numbers have been really scattershot lately although getting those poisoned teeth out of his head could make a real difference (we postponed the operation for years because of his heart condition) so I thought that maybe even PZI (if we could get it) wouldn't be the best for him at this point

 

(((((maureen)))))
this was a simple misunderstanding. it could happen to anyone... and has happened before. you're doing a wonderful job managing sammy's curve. hang in there, k? we will get through this and soon it will become a distant memory...

 

And when you see someone post that has done the same or similar, you will have quite a bit of first hand experience! It's not exactly the most pleasant way to get it, but you have it now!

For the food, I also use a marker to label the %carb on each can and I also have 3 separate bins for LC MC and HC foods. The HC ones are in an entirely different drawer so that there is no chance of my reaching for LC and grabbing some HC by mistake.

And I agree; you did an awesome job working with Jill. Well done! :thumbup

 

(((Maureen & Sammy))) Welcome to Lantus Land, it sounds like you are doing a fabulous job with the support of many educated, experienced furbaby friends on FDMB. Don't feel too bad about this at all, when Baby began Lantus I was planning to give .5 units & ended up giving 5 UNITS!! Can you believe that? I about died! I had no clue how to read the syringe & thought the 5 marking was a .5 we (meaning FDMB & I) realized it when I got her +3 reading, look at my SS when you have time (1/7/09 -first entry) Needless to say, we got thru that day/night due to the help of a lot of great people, it was a real rough 24 hours for us - please listen to everyone (like you are)Jill completely saved my Baby's life that night & has been with us ever since. It is soooo scary :YMSIGH:
I just wanted to drop by & show my support & encouragment - you are handling this all so well. If you need anything - please let me or others know - we are here for you & I know it is a big job to do all this testing, monitoring/manipulating the #s, but we just have to & it is well worth it. Keeping an eye on Sammy with you & I just know everything is going to be OK :mrgreen:

Believe me, everything I have went through since that night has been a piece of cake in comparison - Baptism by Fire! ;-) That night helped me deal with many factors that I encounter now with expertise & ease!!

**This is not your fault - you did nothing intentional - if someone has the link to my 1st night - please feel free to share it .. you will see what a mess I was (& sometimes continue to be :lol: ) !!

 

155 at +4.5

 

nice! time to give those ears a break for awhile.
how about retesting in another hour? post the number...

 

No tears, Maureen. You are doing great!

This falls into the category of sh*t happens! I'm sorry your vet didn't have the box of cartridges or vial clearly marked with the amount you needed to be injecting. It is one of the huge advantages of this forum. There are a number of experienced people here who have walked members through situations like this and we are here pretty much 24/7. LL doesn't close like the vet's office (and we're much less expensive).

Nicole mentioned her first day in LL. Here's the link to Baby's condo.

 

Well.. seems you are having an edge of your seat kind of day!! Like others have said.. not the most stress-free introduction to Lantus..

What's done is done.. mistake or not you are doing the right thing right now which is all that matters (and we've all goobered something up at some point.. so welcome to the club ).. watching her close, testing lots and getting help.. you'll get through it.. and be a pro at the whole HC/karo deal right off the bat ..

Boy aren't you going to be disappointed when you find out how boring Lantus usually is .

 

Promise me it's boring. Promise me. Promise me. Oh, promise me.

 

It is.. it's (in the right dose ) a really gentle insulin.. you will probably spend most of your time getting frustrated that nothing exciting is happening.. once in a while there's a bit of excitement.. and then you wonder why you wanted it so bad.. and then back to booooring.. wishing something exciting was happening..

 

I just read your baptism of fire. Gee, I wish I could have been there for you, you poor lamb

 

Welcome to Lantus Land Maureen! Sammy likes to make an entrance doesn't he? {{{Maureen}}} What a morning for you! You're in the very best of hands though. This is a pretty amazing bunch of folks here =) Congratulations on making it through a pretty darn scary morning nailbite_smile

 

thanks

 

122 at ~5.5

 

ok, a little bit of a drop, but not much. how about giving him a couple teaspoons of his regular (low carb) food and retesting him in one hour?

 

Just wanted to stop by and say hi and welcome!!! you are in GREAT hands today! Glad you found us!!!!!!

 

You and me both.

 

OK, See you in an hour.

 

i'll look for you then.
before i forget, if sammy's numbers start going up, don't disappear on us. depending on the numbers, we'll need to look at a dose for tonight... if we decide to shoot tonight. i've been thinking about an appropriate starting dose. i'd like to see how the rest of the day plays out before suggesting anything, but i'm thinking it might be better to start sammy out with a lower dose than his last pzi dose. his insulin requirements may have decreased substantially since his dental 12 days ago. it may be why you've been seeing what you've described as weird spikes.
make sense?

 

OK, guys, while we have a semi-quiet moment I need to know what the protocol calls for. In PZI-ville we'd shoot at +6 or beyond if at 150 or over. What's Lantus' duration (like this isn't diabetes and I'm going to get a consistent answer)? How do I establish the nadir? Ah, I see you're reading my mind. Well, I think the infection could definitely have been playing havoc with his numbers. He was on an antibotic for 10 days too. Clindamyclin Hydrochloride (1.5ml every 12 hours). Last dose was last Monday (4/12). Since then he's done things like 309 at +11.5 and 171 at +23 or 236 at +24 and 79 at +17 after being at 74 at +7.5. His last PZI dose, however, was way over the norm at 11U. Sammy usually doesn't tolerate 10 and above well and has rarely needed it. He probably never had that much ever until this year.

 

lantus is a 12/12 insulin. it also has a cumulative effect... meaning one dose builds on the next. you won't see the "real" results of any single dose for a few days... which is why we generally hold a dose for 3 days (6 shot cycles) before increasing a dose. check out the protocols sticky towards the top of the forum. lantus dosing is different than what you've been used to.

testing is the only way to find out kitty's nadir... and as soon as you think you have it figured out... it'll move.
initially, i'd start looking for nadir by doing some random spot checks between +4 and +8.

to make sure we're all on the same page and to avoid confusion, when we talk pzi let's talk U40 units. when we talk lantus, let's use U100 units.
sammy's last good dose of pzi was 4.4 units, correct?

 

103 @ +6.75 That's after eating some lc FF an hour ago

 

Hope you are holding up Maureen :YMHUG: :YMHUG: :YMHUG: when you get time the sticky's at the top of this page have a wealth of information about using lantus maybe a in few days when you get a quiet moment you can take a look at them I still keep going back to them a reading them again since Do Lou and I are pretty new here

 

Yes, Sammy's last dose of PZI was 4.4U (U40)

 

i'd go ahead and give him some high carb gravy again. it's not that he's too low... it's just to prevent him from from taking a nose-dive on us.
i'd retest in about 30 minutes to see if the drop has stopped.

 

At what would be +7 he got 3ml (roughly a teaspoon) of hc gravy. Now he's eating the lc stuff his sister left behind

 

lol! the food from another kitty's bowl is always better! :lol:
next test will tell us if we've stopped the drop for now...

 

95 at +7.5, a half-hour after 3ml of hc gravy

 

oh, he just wants some more hc. let him have some. let's stop the drop.
see you in 30 minutes...

 

well the karo plus hc worked before. Should I do that again or just the food

 

go ahead and put a bit of karo in there if you'd like...

 

Half a cc of Karo and hc food eaten with gusto

 

hc is a real treat for him! :lol:
see you soon...

 

138 at +8.25 after 1/2 cc of karo and hc food a half-hour ago

 

Jill had to step away from the computer for a few minutes. good, maybe this time he'll stay up. I think you can wait another hour to test now.

Sammy's very last PZI shot was 4.4 units. You've said a couple of times that was much more than normal. What dose did you normally shoot? I assume you were doing a sliding scale.

 

looks good. i'd retest in an hour.

i have a few questions about his pzi dose, but need a couple minutes to get them together.
will be back shortly...


edited to add: never mind. libby asked the most important question...

 

Yes, I did the sliding thing. I was trying to figure out what a norm would be. :lol: His "normal" range was from 1.8U to 3U, maybe 3.5U.

 

hmmm. that sheds a different light on things when trying to figure out a good starting dose for lantus. let's see how the rest of the cycle goes...

 

Years ago - in August of 2007 actually - Sammy wasn't responding as well as he should have to 1.5U at 151-170 or 2U at 171-185. So he went 1.8U at 151-170 and 2.2U at 171-185 with anything higher remaining the usual ratio. He's been on that protocol ever since.

 

from May of 2006, five months after starting PZI Vet, he went on a honeymoon that lasted until May of 2007 then he was above 100 but rarely above 150. At the tail end of June 2007 he spilled sugar in his urine. The vet wouldn't give me insulin until he hit 300. That was in July 2007.

 

we'll have to see how the rest of the cycle goes. it may be wise to just skip tonight's shot to let his body calm down after this over dose. that will also give you a chance to get a good night's sleep and recoup from today's experience. you must be worn out.

libby and i have been discussing a good starting dose. after seeing the scale you've been using and considering the effects the dental may have had... it may be a whole lot safer to start with a reduced dose of 1.5u bid. if the dose is too low, we can always fast track him up the dosing scale if necessary. better to be safe than sorry.
what do you think?

 

Given my performance this far, I shall be happy to follow instructions. BTW, what's sleep?

 

lol! sleep is what you're probably going to enjoy tonight... so savor every minute of it! :lol:
i'm going to be off-line for the next several hours, but will check back here as soon as i get back. libby will be keeping an eye on what's going on here. she's one of the few people i would trust enough to care for my own kitty. you'll be in the best of hands...

 

When you find out, will you let me know? :lol:

 

113 at +9.25, roughly an hour and a half after karo & hc snack intervention.