Using Lantus, aka Glargine, and Detemir in Your Cat

We were given a prescription for Lantus, and no useful instructions to go along with this as the locum who was subbing for our vet wasn't familiar with it's use.  When our boy had previously dropped insulin use we had, thank goodness, discussed with our vet that Lantus could be an insulin worth trying if he did need some again.  This means that our chart, "Hamlet's Lantus Experience", starts off a little slow and bumpy until the vet came back of holiday.  It also took a few days for me to track down the article written by K Roomp and Jacquie Rand. 

The first article, "Dosing protocol for cats on glargine or detemir using daily home monitoring of blood glucose concentrations to adjust insulin dose", is meant only to be used with readings you collect using a human glucometer in the first section, which is what most of us find effective enough for our cats.  If you are using a meter developed for feline readings, use Table III only in the same paper.   This article is meant for use when you test daily, and gives you recommendations of when to increase or decrease dosages depending upon nadir, (low point in the curve), readings.  This isn't an easy reading to find as cats seem to 'surf' as it is put in one article I read, on a level of insulin once the dose has been established.  The wonderful part about this is that your cat can stay 'within range', (not too high or low), throughout the 24 hour period, if you give two shots per day, 12 hours apart.

There is a second paper, written by by Rhett Marshall and Jacquie Rand, designed for owners testing on a weekly basis once your cat is stable.  That paper is called, "Dosing protocol for cats on glargine or detemir and glucose monitoring every 1-2 weeks".  We have been testing on about a weekly basis, and doing so through the lower part of Hamlet's very stable 'surfing' period at the 3rd hour, 6th hour, and 9th hours, as recommended by our own veterinarian.

We found it very effective to maintain a chart online for our veterinarian and others to be able to see easily at short notice.  I have a template available for mmol/L readings used over most of the world, and mg/dl readings for US use.  Click on the hypertext in this posting to reach the items you wish to access.

If you are using either of the charts provided above, save the one you access under a name of your own choosing.  You may then post freely on it.  Make sure you have a record of the link to your own copy.    Under "Google Docs" at the top of the chart you will find a tab marked "Tools".  If you want to provide access for others to your chart, (read only), then you go to this tab and open the link labelled "Protect Sheet".  You would then click on the button to choose the second option, "Only Me".  You might want to then create a tinyurl link that will allow you to easily remember the URL when sharing with others.

In regard to ongoing testing when your cat is using this type of insulin, there is also another paper put out by The University of Queensland that gives you guidelines for patterns of testing to use to obtain the information you need without doing full curves as with other types of insulin.  "General information" gives the pattern to be used, although we don't bother with the "O", or "12" hour tests suggested as they don't fall on either the nadir or apex, (low or high readings), in the curve. 

You may also note that point four in the General Information article suggests that if insulin is kept refrigerated it will last longer than the one month suggested by the manufacturer.  If you take the insulin out a short time before the shot is needed, you can fill the syringe and leave the syringe on the counter to warm, while returning the insulin vial to the refrigerator.  We have found this is working fine for us, with the insulin remaining wonderfully stable, and we are nearing the end of our third month of use with the first vial.  In fact, our boy is already dropping his need for insulin so we have had to back off and start again at a lower dosage once making contact with our veterinarian.  As he is nearing 19 years of age, and has permanent scarring on his pancreas, this bodes very well for the use of Lantus, Glargine, or whatever term is used in your area for this type of insulin.

I should also point out here that we have run across people who have been told to shake these types of insulin, but as there is no precipitate to mix with the carrier, this will only create annoying bubbles that are of no use to you.  DO NOT SHAKE!

I must add, here, that we are very grateful for the work Jacquie Rand has been doing in this area of her research as it has proved to be of such a benefit to us and others at this time in our cats lives.