New diagnosis and question about timing of Lantus dose

Hello! My 6-1/2 yr. old male, Max, was recently diagnosed with diabetes. A potential complication is that he also has stomatitis, so he has been on prednisilone for a little over a year. Over the past several weeks, the vet has had me reduce the pred. dosage from 3ml down to 1.5 ml., and his gums seem to be doing okay.

I started him on 1.5 un. of Lantus today. I was told that he needs to receive this every 12 hours. Is there any wiggle room in the timing? I'm sure this question has been asked many times on this forum, but I don't have time to weed through it. I'm a divorced mom with 2 kids. 8am and 8pm will work most of the time, but I get home at 8:45 one evening a week. Is that a problem? My girls are involved with dance and the competition season is just about to begin. In a couple of weeks I have to take my daughter to a dance event from 7:15pm until 9pm. Am I supposed to drive home after I drop her off so I can give Max his insulin? And at the end of the month, we will be across town in the evening for a dance competition that typically goes fairly late. I do not have the money to board him for the day in these situations. What do people do? I am overwhelmed by this.

Leah

 

Re: New diagnosis and question about timing of dose

Personally, I do not think that 45 minutes later one night a week is going to totally destroy his dosing schedule, but there are those that dose lantus daily that might advise otherwise. You might want to change your topic heading to include the word "lantus" in it to get more eyes here quicker.

Did your vet discuss with you the need to change his diet to all canned foods that are low in carb count? Because that will help lower his bgl, too. You are going to be home testing his bgl, yes? And lastly, the recommended starting dose of Lantus is 1 unit every 12 hours - not 1.5 units, so you might want to start with 1 unit. Some vets try to base the dose on weight, and for felines, that is not so accurate. And the prednisone is probably what has caused the higher bgl, because it is one of the possible side effects, unfortunately

~M

 

Thanks for your reply. The vet says that oral pred. doesn't usually have any affect on bgl. They might have me test at home, but not at first. I'm supposed to go back in 3 weeks. Should I call them and ask about lowering the dose to 1?

 

Re: New diagnosis and question about timing of dose

Welcome!
Unfortunately, I don't use Lantus but many others do so you should have a lot of answers tomorrow.

I've used a variety of other insulins over 2 1/2 + years always on a 12 hr schedule, and I have always just tried to time it as close as possible to the target. Sometimes I have gradually moved it one way or the other over a few days to prepare for a day where I know I have to give it early or late. For example, the day you come home late at 8:45,could you give the morning shot at 8:20? I also have one of the vet techs from hospital who lives not too far away that I trust if I just can't be home. I give her $15 cash/visit.

Since you are new to this, I hope you are learning to do some home testing. It's not hard once you learn and it really helps avoid an emergency with your sweet Max. Is he eating canned low carb food, because this can really help. Just be careful changing things unless you are home testing.

I'm sure you will get lots of advice from some of the experienced folks here, so please check back! cat_pet_icon

 

Once you start testing, be sure to check out Hocks.com ( see the link above) to compare the price of your test strips. I bought some last week that were 1/2 the price I paid at sams, and it helps this message board. I was SOOO excited. Good luck

 

Many vets do not even suggest home testing. Why? Well, a lot of them want you to have to come into the office for costly vet done curves. Others just don't think about it because not all pet parents are going to be vigilant enough, or care enough to to it. But think of it like this - would you give one of your children a shot of insulin w/o knowing what their blood sugar level was? If the answer is no, then it should be no issue at all for you to learn to, and be vigilant enough to test at minimum before each and every injection. Human glucometers - available at every pharmacy, Wal-Mart, etc. - do a fine job for testing.

I would not hesitate to call your vet and speak to them about lowering that dose to start out. I lowered my Stormy's on my own and TOLD my vet that I had done it afterward. I got a simple, "uh, okay" out of him when I told him. As far as oral pred not affecting bgl, well, I had several tell me it does. My cat was not diabetic until he got a shot of pred - followed by a week long oral course of it. The pred caused Stormy Blue to become a diabetic.

~M

 

Hi Leah welocme to FDMB :mrgreen:
Fabulous your using Lantus :mrgreen:

Recent research has shown that if used within 6 months of diagnosis it has a really good chance of putting kitty into remission.

Before I explain about times, some q's.

What food are you feeding? Best to give wet under 10% carbs (my preference is 5% as that is the natural amount of carbs kitties get from their natural foodsource-mice)
A lot of beans feed Wellness. Have a look at Janet and Binkys foodcharts:
http://www.felinediabetes.com/diabetic-cat-diets.htm (It's the % carbs your concerned with for now)
If your feeding a higher carb at present, I wouldn't change as you don't know what effect that 1.5u is having on his numbers.Could be stopping them dropping too low.

Feeding Low carb food reduces how much insulin kitties need and doesn't overwhelm pancreas (which isn't working properly in a diabetic cat)

Mary was right saying you should usually start at 1u twice daily.
Hometesting is a biggy as well.Gives you much better control of kitty's diabetes and allows you to adjust insulin requirements whilst keeping kitty safe (minimises chance of hypo significantly).

I see your a busy mum and this is ok too. Alot of people are out all day so can't get many spotcheks. You can work round this and generally beans (us humans)adjust dose on a week end when they can get spot checks.

Hometesting is easy once you get the hang of it. You can either go to a pharmacy and get one or see Cindy's post at the top regarding hometesting kits.


There are lots of people here who will help you.

Lantus is a long avting insulin and 12 hour dosing is important. Giving a shot 15-20 mins earlier/later is o.k but more than this can cause something called overlap.
I don't know how much time you have to read but suggest you click on the Lantus isg and read the stickies at the top which tell you all about Lantus,how to handle and use etc.
For difficult timesit may mean you have to give a reduced shot if your shooting early, or if your giving late, the next shot may need to be reduced. Not ideal, but we all have lives to live.
This is another reason hometesting will be even more important for you.
As a bare minimum, you need to test kitty's blood sugar just beforee you feed and shoot in the morning, preferably get a check at +4 or 6 (hours after the shot) and the same again in the evening, before yhe eats and you shoot.
If you can't get spot checks in during the day, generally people try and get them in during the evening.I know in your case this may mean a late night (are you a night owl? :smile: )

So, yes this is completely doable, yes you need a level of organisation and sometimes you may have to plan ahead to fit dance class etc in, but certainly not the end of the world and as I said plenty of people here to help you.

Please ask as many questions as you like and if you could tell us what you feed, how much and when.

 

Testing before each and every shot is the only way to know if the blood glucose level is safe to give insulin - especially in the beginning! And 1.5U of Lantus is higher than members of this board recommend.

If you call to ask about the dose, ask what they based the dose on. The only reasonable answer is the cat's "ideal" weight - that means given the size of the breed and sex, what your cat should weigh, NOT what it actually weighs. The formula is this: .25U/kg of IDEAL weight. So unless your cat should weigh at least 14 pounds, 1.5U is too much.

Even with that formula, we have seen cats become regulated on less than or near to 1U of insulin. My cat Gandalf is a Maine Coon body type and weighs 15 pounds, yet his best dose is a little more than 1U of an insulin very similar to Lantus.

In addition, the proper way to determine optimum dose for Lantus is to work up to the dose which levels their blood glucose the best. If you begin above 1U, you may surpass that optimum dose. And it is best if you get the readings at home to eliminate vet stress which will raise the blood glucose and create inaccurate curves (the graph generated from blood glucose levels taken every couple hours). If they want you to take kitty back in 3 weeks to do the blood glucose curve, please decline - you can do the same thing at home, with more accurate results. Then take the results to your vet.

As for not being able to give shots every 12 hours - if your schedule is stable (no surprises - you know which days you have to be home late) you can begin adjusting the shot times 15 or 20 minutes at a time the day before. Thursday you need to give shot at 8:45/9:00PM. On Wednesday AM give shot at 8:15, Wednesday PM give shot again at 8:30, Thursday AM give shot at 8:30 again, Thursday PM you can give later shot at 8:45 or so.

Hope this helps. Glad you found us. It's helpful to have a support system when dealing with feline diabetes and we are here for you.

 

Giving a shot one hour early or late should be no problem. I not infrequently give shots (with Lantus) more than one hour early or late. For example, today I gave the AM shots at about 4:30 AM but the evening shots will be at about 8 PM. The next morning shots will again be at about 4:30 AM.

Although a one unit BID is sort of standard, I would have no problem starting at 1 1/2 units bid if I have tested BGs before shots. Since your Max is a pred, he will likely need a higher dose of insulin.

 

That may work for your cat, but Every Cat Is Different. It does not work for mine, as example.

Please explain your reasoning here on not having a problem with 1.5U. 1.5U is 50% more insulin than 1U. That's a wide variance at such a low dose. You may be correct about the pred, but she should ask her vet if that's why they recommend 1.5U.

Just trying to lessen confusion for the newbie.

 

I know each cat is different. I have four cats on Lantus and it works for all four. A key is what do you mean when you say it does not work for yours? It may not be optimum but it "works" for mine. I have been doing it for years.

Regading the 1 1/2 units bid. I did say it was not desired (no standard) but was probably OK based on testing BGs and because Max is on Pred.

 

I use levemir which is similar to lantus, but in my opinion a little less "fussy" with timing, storage and shelf life than lantus...that is how it is for us, but every cat is different.

With the Levemir I try to move the timing no more than 15 minutes to half an hour...the worst that happens is some wonky BG numbers in the next 2 or 3 cycles, but then it straightens out.

If you know what your schedule is later in the week, you can start adjusting the timing by 15 mins each cycle until you are on the timing you need to be for one of the dance functions.

Others here have had luck with different types of dosing ( split, etc) that you may want to explore once you are more familiar.

If it were me and my cat and we were new to dosing and not hometesting yet, I would caution AGAINST shooting more than 1 hour early or late....these insulins- Lantus and levemir- tend to build up an overlap effect, that is what makes them so good for cats, but shooting too early amounts to giving a higher dose of insulin for that cycle than what is usual...that can cause BG to go lower than what is safe... (like filling the bathtub to the top and then adding more water before releasing some down the drain first...water starts to spill over the edges and makes a big mess on the floor!)

Hometesting from the very start is most important! Otherwise you'll not know the progress of the cat in that time and when you do finally start testing it will be like starting over.

Testing at home is cheaper and more accurate than the vet- meaning the BG is often skewed at vet with stress and such.

No doctor for humans would tell a mother not to test their child right away...that would be dangerous. I think alot of vets tells furmoms that b/c they don't expect the person will put that much effort into "just an animal". By being here looking for answers you clearly feel your sweet kitty is worth the effort :thumbup

let us know how we can help further (((hugs)))

 

Hi, Leah, welcome.

My opinion in that you should err on the side of caution until you are testing regularly. You should know what his basic preshot number is and how low he goes from the given dose. Until you have some data, you are "shooting blind". Becasue of that, for now I would suggest dropping to 1u bid, and try your best to stay on the 12/12 schedule. It isn't the end of the world if you can't, but be aware that shooting early equals a dose increase and shooting late equals a dose decrease. Do you have any BG numbers yet? For instance, what was Max's blood glucose (BG) at the vet? Did they do a fructosimine test to confirm the diagnosis? Also what symptoms did he have that caused you to take him in?

Are there any plans for addressing the stomatis with extractions in the future? My sister's diabetic cat had really bad stomatis, was on pred, and his BG was hard to regulate until he had a full extraction done. Now he is very well regulated on a low dose of PZI (under 1u bid, last time I asked).

Because Max has the infection/inflammation, it is especially important that you learn to hometest because if he does have higher BGs he may be prone to ketones which can turn very serious, very fast. You can also test for ketones at home with ketosticks you hold in his urine stream or dip immediately after he finishes and before it soak into the litter. You can buy them at any pharmacy.

We can help you learn to home test and there might be someone that lives nearby that can come over and show you. When you buy your meter, what will end up being the major cost is the strips. Many people here use the Walmart Relion meter, which has a good rating from Consumer Reports and the strips are one of the cheapest. Once you are hometesting, you can safely start changing his diet to a low carb wet/canned one. This will go a long way toward regulating him.

While there is good evidence that remission (no need for insulin) is acheivable with a diet change and a short course of insulin, preferably lantus or levemir, I think it is about 70% that go into remission. So it is not a guarantee and I don't want you getting the wrong idea. Regulation and a happy, healthy cat is the first goal. My guess is that as long as Max has active stomatis and is getting pred, remission may not be realistic. With multiple health issues, often the diabetes has to be worked around the other issue(s) - meaning, you give as much insulin as is needed to keep him in good numbers as long as you can each day.

 

Not all newbies understand that what works for your cat(s) may not work for theirs, so some clarification is needed.

Does not work for Gandalf = he cannot hold the BGs within range after late shots of an hour. Just yesterday AM I was only 1/2 hour late, so PM shot he was 70 pts. higher than AMPS. PMPS given at new +12 time was in good range. Other factors involved? Sure, always could be.

Is there wiggle room on shot times? Sure there is, but an hour late can lose shed built up and an hour early can result in too much shed. Shed = storage of previous dose.

 

I just need to make it very clear that what works for Larry may be all well and fine... but Larry has been treating his cats for many years and is home testing.

It is not advisable for a new person who is not yet home testing or does not have a good amount of data to shoot at more than 13 hours or less than 11 hours... It's the less than 11 hours that could be quite dangerous for the kitty.

We all have to keep in mind what the norm is when dealing with kitties... and here the norm is a starting dose of 1 unit twice a day with the insulin given at as close to 12 hours apart as possible. Life is important too though so we can work with flexible schedules. There are ways to change the time over a couple of days so that one is shooting at more of a 12.5 and 11.5 schedule and then back again.

 

I am stressed out already. I guess the first two times I "gave" Max his shot, I didn't actually puncture his skin because last night I moved his fur out of the way, I KNOW I got it in correctly, and he flinched. I was supposed to give him his morning shot an hour ago, and he's hiding under my queen-sized bed, right in the middle of course. Why do some people say cats are dumb? :roll:

Ok, I finally retrieved him and dosed him.

Sheila, I brought him in for his yearly wellness check. I had no idea he was sick. He's already been drinking a lot of water and urinating large volumes because of the pred. But looking back, the volume HAD gone up, but I can't think of when that was. He had high bgl (350), and he was spilling into his urine. They did a fructosamine, and it came back somewhere in the mid-300's. This was mid-Dec. They wanted me to start him on insulin right away, but I was freaked out about him having diabetes, and money is a HUGE issue, or lack thereof. I asked if we could try diet and reducing pred first. He's half-way switched to M/D, and I bought some Nature's Variety raw medallions. Neither of my two cats will touch the stuff! They get canned food every now and then, moreso lately. So I brought him back in for a glucose test one week later, and it was 300. Reduced pred. a little more, brought him back in, and it was 250. I thought we were onto something. Brought him back in 3 weeks later for a fructosamine, and it came back last weekend at 483. :shock: So here I am.

Another question is that he hardly seems to eat, especially the dry food, since getting insulin. I know that both diabetes and pred cause increased appetite. Thankfully I had a few cans of food left so I could put a little out right at dosing time to make sure he ate. This morning I mixed some of the can with a medallion of the raw. I'll see later on if he or Katie, it the raw. I really wish they would, it's such a good food!

I think that's it for now.

Max trying to keep cool during a heat wave last summer :lol:

 

Please visit the Lantus Forum and read the 5 top posts. It will tell you everything you need to learn about handling, dosing and use of Lantus.

Lantus Forum


Lantus is a 12 hour insulin, meaning you need to stick as close as possible to the 12 hour rule. Yes, there is some wiggle room, like 15 minutes here and there, but when going 30 minutes, 45 minutes or even an hour early or late with the shot, it is like giving a dose increase or decrease.

Also, how was the 1.5 units determined? For most cats, the recommended starting dose is 1.0 or 0.50 units.

It's very important that you start to understand how Lantus works in the cat and how it is different from other insulins.

So, again, please read the first 5 posts on Lantus ISG and please feel free to post there as well.

The folks on that board have vast experience with Lantus and can certainly help guide you as far as dose and shooting schedules, especially if you need to be creative with the schedule and go off a 12/12 one.

 

Leah, I am sorry you are stressing about this. It probably doesn't help much to know that we all went through this. I cried when Beau was diagnosed, because I had just lost his best buddy to lymphoma after caring for her for nine months, and he had other health issues so it felt like a death sentence. And it didn't help when my mom told me that night to "put him down". sigh....

Anyway... about the food. The MD is not a great food and a lot of cats don't like it. Yes, it is canned, yes it is lower carb than most dry, but it is expensive and there are better, cheaper foods. I feed Friskies pate and Special Diet versions and Fancy Feast - all under about 8% carbs (most 3-5% carbs) from Janet and Binky's food list. I add a little water to it to help with hydration.

He needs to eat, so I would suggest buying a sampling of those foods and see if he will eat them.

I have also gotten the medalions and my cats love them, but I warm them in the micro on low power, turning them, until they are about "body" temp. It brings out the smell - and kitties love stinky food! You can also crush a few dry kibbles and sprinkle them over canned food. I keep Innova Evo Cat and Kitten on hand for ocassional treats. It is, hmmm, 7% carbs? Beau will get 4 kibbles, max, as a testing treat every so often.