Lantus units to give

Hi everyone, this is going to be my first day using Lantus. I was on Caninsulin before. I have been giving Poopers 3 - 3.50U daily because his numbers have been pretty high. I asked yesterday how much insulin to give and this was the response
https://www.felinediabetes.com/FDMB/threads/switched-to-lantus-how-many-units.248176/#post-2799455

I 100% trust what everyone is saying... but I just got off the phone with the vet and he kind of scared me saying if I give too much insulin that it can be very bad for him to just give him 1U daily and to only go up by .50 if needed. I don’t know what to do now. I have to give his insulin soon and I’m not sure how many units to give

 

I’ll actually start tomorrow because my sister forgot we were starting the new insulin and gave him Caninsulin (she gives it to him in the morning I do it at night). But please do still leave your opinion. My sister was thinking of doing 2U so then it’s not too low but not too high either..

 

I trust the advice of the ladies last night, they've helped me many times. Tagging them again @Christie & Maverick @Wendy&Neko @tiffmaxee

If Pooper was in lower (green/blue) numbers then yes I'd be more cautious when switching. But his numbers are very high, there's plenty of wiggle room. I really don't think you run the risk of going too low.

It can be equally bad to let him stay too high for too long. You run the risk of DKA, neuropathy, and kidney damage.

Cats metabolism is too high for once daily shots, it really needs to be two shots 12 hrs apart, same dose each time. The increases depend on the numbers you're seeing (in the dosing methods they linked you to last night).

Another thing to keep in mind, many vets are perfectly happy to let cats run in the 200s and 300s. I really have no idea why, it's above renal threshold for sure. Many times I've been told "oh 350 isn't too bad"...yet normal range for a non diabetic cat is under 120 (even 100).

 

At this point I’m not even sure what to think of the vet I didn’t really like the conversation we had this morning. I will start tomorrow morning and based on the numbers i’ll either do 2U or 3U. Unfortunately the vet got me very nervous he kept saying that Lantus is too strong and it’s a human insulin and that it will be too strong for cats

 

Oy. Definitely find a new vet! He sounds very uninformed/misinformed. Some people here try to educate their vet if they like them otherwise.

If you'd like to see some comparisons, look at my spreadsheet. Last year Mr kitty was on Vetsulin to start with, you can see it would drop him from 260 to 94 in just a few hours. That's harsh, and why Vetsulin isn't recommended for cats really. Imagine how you'd feel with your blood sugar dropping and spiking like that! He's been on Lantus since January, you can see we don't get nearly the huge drops. One of the main points Lantus IS it's supposed to be a much smoother curve.

 

yeah I should call another vet... I have no idea why Poopers numbers are so high I will for sure look at your spreadsheet. I’m gonna keep an eye on him and check him during the day I’m going to talk to my sister as well and see what we should do but I definitely trust you guys more at this point...

 

His numbers are high because he's diabetic, that just is what it is lol but also the food, if you can get him off the dry and onto low carb wet that will help a lot (but if you do this let us know! It changes the insulin strategy/dose)

It takes a little while to find the right dose

 

Ok I will let you know if I do that! Thank you!

 

In total, I have taken Butters to four different vets following her dx, each time hoping that one of them would have some great knowledge about feline DM. None of them have. After I first joined FDMB, I didn't realize I could post daily on the LLB board and get help there. So for almost two months I tried to follow vet number two's advice on insulin dosing and testing and we got nowhere. High numbers with some scary lows. The vet actually ended up ghosting us, so confused was she by her numbers. I posted back on FDMB Feline Health for help, and was told to post daily on LLB. So I did. Butters became tightly controlled less than two months after that. During that time, I was exclusively managing her diabetes with help from people on the board. My biggest regret remains that I did not do this sooner. Vet number three didn't work out because she wouldn't allow me to have an opinion on anything or ask questions.

Even Butters's current vet (number four) who we think is wonderful, does not have great knowledge of feline DM either. When we switched to him in November 2020, I sent him this Roomp & Rand article "Management of Diabetic Cats on Long-Acting Insulin" and provided a link to Butters's spreadsheet so he could see her progress. He fully supported my goal of wanting her to be tightly regulated, and we haven't discussed her diabetes since other than he occasionally tells me what a great job I'm doing. The difference with him versus the previous vets she saw was that he knows he doesn't have all of the answers, and he listens to my opinions. if I want to do some of my own research, he supports that. It feels like a partnership.

This to say, imo your best bet is finding a vet who will work with you as a partner in the care of Poopers. Ask to set up an interview with any potential new vet. Read through this thread on Vet Interview/Screening Topics and come up with a list of questions. They should be willing to answer any questions you have. If they aren't, or if you don't like the answers, then at least you know they probably aren't the right vet for Poopers.

 

Lyla said it all beautifully. My vet dies know about FD but is very conservative. My regret is that I didn’t test at home from day one. I went to my vet’s office a couple times a week for nadirs. That resulted in stopping insulin for about 3-4 weeks when Max wasn’t ready. Big mistake.

Since you will follow SLGS and will hold the dose for a week unless a reduction is earned by falling under 90, I would not start with too low a dose. I used Lantus only so never switched. I’d go with 3.0 as Wendy suggested. It will take a week for the depot to build.

 

We've had many hundreds of cat go into remission on Lantus. It wasn't too strong for any of them. I get the feeling your vet is more comfy with dogs and dog insulin (Caninsulin). So was my vet. She was in fact thrilled when I said I wanted to treat Neko, most of her cat clientele didn't want to "bother". I was the first client to home test, first that she knew of with acromegaly and IAA and treated for acromegaly (I taught her about that too), first on Lantus, then Levemir. While she didn't know a lot about feline diabetes (I got that here), she was willing to learn and really knowledgeable about a bunch of other topics, like kidney disease. Which came in handy. We had a good working relationship. After a month of dropping off weekly spreadsheets to the office, our relationship evolved to her asking what Neko's dose was when we visited, but no other involvement.

 

What Lyla and Wendy described is also similar to my experience.

I left my first vet, he put Sammy on Vetsulin, told me to just come in once a month for a curve, and don't bother changing food. Whenever I'd ask about anything I always just kind of got a "well you can do that if you want, I guess" but not much actual support.

My current vet was recommended by my local Facebook mom's group actually, a few of them happen to have diabetic cats. He's very methodical (I'd call him the ultimate nerd...and I'm a chemical engineer lol), and is always sending me papers and articles and things he comes across. He has access to the spreadsheet any time he wants, but he kind of just lets me do my thing and makes suggestions when I have questions/concerns.

 

I will definitely go through the vet interview process because my vet kinda sounded like he was only as interested when I was purchasing everything there.
He got upset because I read him the syringe box that I purchased and said “ you know what I don’t understand what your saying so just give him 1U” and I of course got very upset. He even said “if you give your cat too much insulin he might end up on the other side...” why would I want to hear that. I will for sure follow what you guys say

 

Yeah, I was thinking of starting tomorrow but I won’t be home to watch him and I very nervous so I might start on Sunday and just monitor him very closely and keep updating the sheet

 

As Wendy said, the first shot doesn't often cause a big drop but I have seen it a few times in cats not on Lev. Start when you feel comfortable. The depot will take a week to build.

 

Thank you so much for your help! It means a lot

 

Like Wendy mentioned, we see lots of kitties here who start out on a suboptimal insulin for cats (i.e., Vetsuin or Novolin) and even more vets who are not terribly good at treating diabetes. All we focus on here is diabetes (mostly) versus the range of problems that cats, dogs, ferrets, and snakes have which is what many vets are dealing with. To be honest, Pooper's vet wasn't raising his dose in a crazy way. Chances are that you'll see a better response to Lantus. You may also want to start posting on the Lantus (LLB) board.

By any chance have you changed your cat's diet from what you noted in your signature. The Glucosupport dry food is very high in carbs. This may be why you're not seeing a great response to insulin. Even the RC canned is 14% carb -- this is at the high end of a medium carb food. We consider low carb to be less than 10% and most people here are generally feeding their cats a food that's in the 5% range. If you've not already seen it, this is a chart listing canned foods and their nutritional information.

 

Hi, just a small housekeeping note - please change your Signature & Spreadsheet - it still says Caninsulin. Thanks.

 

we have not changed his food its maintained the same.

 

will do, just wondering, you also think i should do 3U of Lantus or 2U?

 

I'd start with 3U. We usually start at close to the same dose but tell you to monitor carefully just in case.

With Lantus, it usually takes 5-7 days before you see the full effect of the starting dose but some cats like to surprise us (and they all staunchly refuse to read the rulebook about how this is supposed to work!!!....LOL)

 

LOL! Ok thank you so much for your advice!

 

You might want to look at a food change. It would really improve his numbers. If he doesn't like wet, you could first transition to a low carb dry food like Young Again, Dr. Elsey's Cleanprotein or Wysong Epigen 90. That would give you some time, to attempt the transition to wet food. Feeding high carb food and shooting a large dose of insulin is counterintuitive!

The food change can make a big difference to his numbers. We have had cats go off insulin after a switch from a high carb prescription diet to a low carb canned diet. So please make any change gradually and with careful monitoring of his BG so you can reduce the dose as needed.

Like Sienne suggested, if you post on the Lantus forum, you will get responses to your post faster.

 

Poopers dry food is a diabetic food, the vet gives it to us and it is low carbs. He does like wet food and we try to give him more wet food rather than dry

 

Replying on your latest post in the Lantus forum.