2010 Aaha Diabetes Management Guidelines For Dogs And Cats
Renee Rucinsky, DVM, ABVP (Feline) (Chair) | Audrey Cook, BVM&:S, MRCVS, Diplomate ACVIM-SAIM, Diplomate ECVIM-CA | Steve Haley, DVM | Richard Nelson, DVM, Diplomate ACVIM | Debra L. Zoran, DVM, PhD, Diplomate ACVIM | Melanie Poundstone, DVM, ABVP - Download PDF - Introduction Diabetes mellitus (DM) is a treatable condition that requires a committed effort by veterinarian and client. This document provides current recommendations for the treatment of diabetes in dogs and cats. Treatment of DM is a combination of art and science, due in part to the many factors that affect the diabetic state and the animal's response. Each animal needs individualized, frequent reassessment, and treatment may be modified based on response. In both dogs and cats, DM is caused by loss or dysfunction of pancreatic beta cells. In the dog, beta cell loss tends to be rapid and progressive, and it is usually due to immune-mediated destruction, vacuolar degeneration, or pancreatitis.1 Intact females may be transiently diabetic due to the insulin-resistant effects of the diestrus phase. In the cat, loss or dysfunction of beta cells is the result of insulin resistance, islet amyloidosis, or chronic lymphoplasmacytic pancreatitis.2 Risk factors for both dogs and cats include insulin resistance caused by obesity, other diseases (e.g., acromegaly in cats, hyperadrenocorticism in dogs), or medications (e.g., steroids, progestins). Genetics is a suspected risk factor, and certain breeds of dogs (Australian terriers, beagles, Samoyeds, keeshonden3) and cats (Burmese4) are more susceptible. Regardless of the underlying etiology, diabetic dogs and cats are hyperglycemic and glycosuric, which leads to the classic clinical signs of polyuria, polydipsia (PU/PD), polyphagia, and weight loss. Increased fat mobi Continue reading >>
Lantus Insulin & Weight Gain
Lantus, or insulin glargine, is a brand of injectable insulin prescribed to treat both type 1 and type 2 diabetes. Injectable insulin is used to replace the insulin you no longer make or to overcome your body’s resistance to your own insulin. In addition to reducing your blood glucose level, insulin exerts a variety of metabolic effects and changes the way you process energy. One of insulin’s common side effects is weight gain. Video of the Day In healthy individuals, the pancreas produces insulin in response to rising blood glucose levels. Your pancreas secretes insulin whenever you consume a meal containing carbohydrates or proteins. Insulin stimulates the cells in your muscles, liver and fat tissue to absorb glucose, which is then converted to glycogen or fat and stored for future use. Diabetics no longer make their own insulin or, in the case of type 2 diabetics, their cells are “insulin resistant” and don’t readily respond to insulin’s signals. Injectable insulin, such as Lantus, reduces blood glucose levels in diabetic patients. Insulin is a “storage” hormone. It triggers the conversion of glucose and fatty acids to glycogen and fat, which are deposited in your tissues for future use. In addition, insulin inhibits the oxidation of glucose and fatty acids and the metabolism of proteins and amino acids for energy. Thus, insulin’s net effect is to decrease your daily energy expenditure. According to Drugs.com, insulin therapy – including Lantus – often leads to an increase in total body fat as the result of “more efficient use of calories.” The intensity of insulin therapy – the frequency of administration and total dosage – influences how much weight you might gain while using Lantus or any other form of insulin. In general, higher dose Continue reading >>
Is 22 Units Dosage Of Lantus Once Daily Sufficient For A Type 1 Diabetic?
If you are a Type-1 Diabetic and just take Lantus, you will likely die, or at least be very, very ill. T-1 is an autoimmune disease where the body turns on the beta cells, mistaking them for an infection, and wipes them out. T-1s have no native insulin in our bodies and to survive we must import all the insulin we need from outside. Like folks living on rocky islands, we depend on the supply ships. There are a number of different kinds of insulin in the world, and a number of different delivery devices too. Lantus, the one you asked about, is what we call a basal insulin. Think of it like a time-release medication. It is designed to provide for over-night and between meal coverage for our bodies; but it’s not up to the task of helping us with the huge rush of sugar that comes with any meal. For this we need fast-acting insulin. T-1s use a therapy called MDI, for Multiple Daily Injection (or insulin pumps, which are a high tech way of accomplishing the same thing). You might get away with just one Lantus shot. Some folks need two. But you will still need fast acting insulin before every meal. As to how much insulin you need, just like cars, your mileage may vary. No two people are the same. In general, smaller frame lighter people need less, while heavy people need more. There is no maximum amount of insulin. You take what you need to take to get the job done. For what it’s worth, the starting point for calculating total insulin needs for T-1s is 0.55 units per kilo of body weight. About half that dose would be basal and half fast-acting. So reverse engineering your 22 units and converting kilos back to pounds I get that 22 units of Lantus would be the typical amount of basal insulin that a 180 pound Type-1 would need. But that same person would still need another 22 Continue reading >>
Lantus 3 Ml Cartridge
Consumer medicine information (CMI) leaflet Please read this leaflet carefully before you start using Lantus 3 mL Cartridge. Download CMI (PDF) Download large text CMI (PDF) What is in this leaflet This leaflet answers some common questions about Lantus. It does not contain all the available information. It does not take the place of talking to your doctor, pharmacist or diabetes educator. All medicines have risks and benefits. Your doctor has weighed the risks of you using Lantus against the benefits they expect it will have for you. If you have any concerns about using this medicine, ask your doctor or pharmacist. Keep this leaflet with the medicine. You may need to read it again. What Lantus is used for Lantus is used to reduce high blood sugar (glucose) levels in people with diabetes mellitus. Lantus is a modified insulin that is very similar to human insulin. It is a substitute for the insulin produced by the pancreas. Lantus is a long-acting insulin. Your doctor may tell you to use a rapid-acting human insulin or oral diabetes medication in combination with Lantus. Lantus is not addictive. Ask your doctor if you have any questions about why Lantus has been prescribed for you. Before you use Lantus When you must not use Lantus Do not use Lantus: - If you have an allergy to: any medicine containing insulin any of the ingredients contained in Lantus listed at the end of this leaflet Some of the symptoms of an allergic reaction may include: redness, swelling, rash and itching at the injection site rash, itching or hives on the skin shortness of breath wheezing or difficulty breathing swelling of the face, lips, tongue or other parts of the body - If you are experiencing low blood sugar levels (hypoglycaemia - a "hypo"). If you have a lot of hypos discuss appropriate t Continue reading >>
Should Insulin Glargine Be Dosed Once Or Twice Daily?
Should Insulin Glargine Be Dosed Once or Twice Daily? Insulin glargine (Lantus, sanofi-aventis) claims to have a 24-hour duration of action. Is there any advantage to using it twice daily? If so, what patient population might benefit from twice-daily dosing? Response from Jenny A. Van Amburgh, PharmD, CDE Associate Clinical Professor, School of Pharmacy, Northeastern University, Boston, Massachusetts; Director of the Clinical Pharmacy Team and Residency Director, Harbor Health Services, Inc., Boston, Massachusetts Since its approval in April of 2000, insulin glargine has been used successfully in the treatment of sustained hyperglycemia in patients with type 1 or type 2 diabetes mellitus.[ 1 ] Long-acting insulin formulations such as glargine offer patients a steady, "peakless" 24-hour release of insulin for blood glucose control, in a convenient once-daily dosing schedule. Insulin glargine exerts its therapeutic effects by mimicking the basal secretion of pancreatic insulin to provide around-the-clock coverage for patients with elevated fasting plasma glucose levels. As with other diabetes treatments, the goal of insulin therapy is to prevent both microvascular (eg, retinopathy, neuropathy, nephropathy) and macrovascular (eg, stroke, myocardial infarction) outcomes. Although insulin glargine is US Food and Drug Administration-approved for once-daily dosing, the actual duration of action ranges from 10.8 to more than 24 hours in some patients.[ 1 , 2 ] This fairly wide range suggests that a second dose may be necessary to achieve optimal glycemic control, although this is considered off-label use.[ 3 , 4 ] To further investigate the variability in duration of action, an 8-week, 2-way crossover study was conducted in 20 patients with type 1 diabetes who used insulin asp Continue reading >>
How Do I Get Lantus Insulin Less Expensively?
November 2, 2013-- How do I get Lantus Insulin Less Expensively? DCIN receives this question a few times a week from US caregivers of diabetic cats. I am often amazed by the question because of the “good” insulins for diabetic cats, Lantus can be the least expensive per unit. The problem often lies in knowing how to find the insulin inexpensively. (The hints I give also apply to Levemir, another human insulin often used by diabetic cats.) Your vet gave you a prescription that probably read “U100 Glargine/Lantus 10ml vial.” Lantus is the brand name for the generic insulin Glargine. Lantus is an insulin for humans and is only available from a human pharmacy (although some vets do hold some in stock). The company Sanofi makes Lantus, and no other companies currently make a generic Glargine because Sanofi still has an international patent on the insulin. That may change in 2014, and by then Sanofi may have developed a “second-generation” Lantus that is patent protected. Lantus is a U100 insulin, which describes the concentration of the insulin in the liquid suspension. A 10ml vial is the insulin’s containment device. It is a small glass bottle with a rubber stopper at the end that you pierce with a syringe. At a US retail pharmacy, a 10ml vial of Lantus can cost about $180 to $200. WOWZA! That does seem cause for sticker shock. A 10ml vial of U100 insulin holds 1000 units of insulin. At $200/vial, that is a price of $.20/unit. If your cat gets 2 units of insulin twice a day, that is $.80/day for its insulin (if you could completely use a vial of Lantus insulin). It would cost less each day to give your cat its life-saving medicine that to buy a soda from a vending machine. However, the problem with buying Lantus in a 10ml vial is that, properly handled, Lantus Continue reading >>
Tilly's Diabetes Homepage
Home Story 6 important factors Blood glucose values The future? Links Guestbook About this site Disclaimer • see your vet and get his or her approval of this protocol before you start!!! • talk to your vet regularly about your cat's progress • see your vet immediately if your cat develops additional problems (e.g. ketones, hypoglycemia, vomiting, fever, bladder infections, etc) Read this first • this protocol was developed by lay people, including myself, who are members of the German Diabetes-Katzen Forum. It has since been published in the Journal of Feline Medicine and Surgery. • the majority of cats do very well on this protocol, some cats do not (generally these are hard-to-regulate cats) • it is more time-consuming than most other protocols, but still definitely doable if you work a regular full-time work week • it is more expensive than most other protocols, but costs can be reduced by e.g. buying glucose test strips from online pharmacies or reputable sellers at eBay • members of the German Diabetes-Katzen Forum buy 3 ml Lantus/Levemir cartridges, refrigerate them after opening and routinely use them for 6 months or more - when refrigerated, opened cartridges of these insulins are extraordinarily stable • you will need to test the blood glucose levels of your cat multiple times per day • you will need to know about hypoglycemia and be prepared to deal with it • you will need to test for ketones regularly to start with and know about ketoacidosis, but be aware that ketones don't occur once a cat is (and remains) properly regulated • you will need a brand-name glucometer made for human diabetics that measures whole blood (not plasma-equivalent) and which uses 0.6 µL of blood per test or less • you will need to use syringes which allow yo Continue reading >>
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Lantus Side Effects Center
Lantus (insulin glargine [rdna origin]) Injection is a man-made form of a hormone that is produced in the body used to treat type 1 (insulin-dependent) or type 2 (non insulin-dependent) diabetes. The most common side effects of Lantus is hypoglycemia, or low blood sugar. Symptoms include: hunger, sweating, irritability, trouble concentrating, rapid breathing, fast heartbeat, seizure (severe hypoglycemia can be fatal). Other common side effects of Lantus include pain, redness, swelling, itching, or thickening of the skin at the injection site. These side effects usually go away after a few days or weeks. Lantus should be administered subcutaneously (under the skin) once a day at the same time every day. Dose is determined by the individual and the desired blood glucose levels. Lantus may interact with albuterol, clonidine, reserpine, or beta-blockers. Many other medicines can increase or decrease the effects of insulin glargine on lowering your blood sugar. Tell your doctor all prescription and over-the-counter medications and supplements you use. Tell your doctor if you are pregnant before using Lantus. Discuss a plan to manage blood sugar with your doctor before becoming pregnant. Your doctor may switch the type of insulin you use during pregnancy. It is unknown if this drug passes into breast milk. Insulin needs may change while breastfeeding. Consult your doctor before breast-feeding. Our Lantus (insulin glargine [rdna origin]) Injection Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. Continue reading >>
Calculating Insulin Dose
You'll need to calculate some of your insulin doses. You'll also need to know some basic things about insulin. For example, 40-50% of the total daily insulin dose is to replace insulin overnight. Your provider will prescribe an insulin dose regimen for you; however, you still need to calculate some of your insulin doses. Your insulin dose regimen provides formulas that allow you to calculate how much bolus insulin to take at meals and snacks, or to correct high blood sugars. In this section, you will find: First, some basic things to know about insulin: Approximately 40-50% of the total daily insulin dose is to replace insulin overnight, when you are fasting and between meals. This is called background or basal insulin replacement. The basal or background insulin dose usually is constant from day to day. The other 50-60% of the total daily insulin dose is for carbohydrate coverage (food) and high blood sugar correction. This is called the bolus insulin replacement. Bolus – Carbohydrate coverage The bolus dose for food coverage is prescribed as an insulin to carbohydrate ratio. The insulin to carbohydrate ratio represents how many grams of carbohydrate are covered or disposed of by 1 unit of insulin. Generally, one unit of rapid-acting insulin will dispose of 12-15 grams of carbohydrate. This range can vary from 6-30 grams or more of carbohydrate depending on an individual’s sensitivity to insulin. Insulin sensitivity can vary according to the time of day, from person to person, and is affected by physical activity and stress. Bolus – High blood sugar correction (also known as insulin sensitivity factor) The bolus dose for high blood sugar correction is defined as how much one unit of rapid-acting insulin will drop the blood sugar. Generally, to correct a high bloo Continue reading >>
Is There A Maximum Insulin Glargine (lantus) Dose?
Is there a maximum insulin glargine (Lantus) single-injection dose? Anecdotally, I have heard that patients receiving more than 50 units should split the dose from daily dosing to twice-daily. What’s the evidence? The question of a maximum insulin glargine dose is not straightforward because it encompasses several issues: How long does insulin glargine last? Does it ever need to be given twice-daily? Is there a difference in efficacy between daily and twice-daily insulin glargine dosing? Can you administer more than 50 units of insulin glargine as one single injection? Pharmacodynamics and Duration of Insulin Glargine In theory, insulin glargine should last a full 24 hours without a significant peak effect. Glargine forms a depot effect because it is only soluble at an acidic pH.1 In the vial (pH 4), the drug is completely soluble. Once injected, the solution is neutralized to biologic pH (7.4), which causes the insulin molecules to precipitate. These microprecipitates slowly dissolve over a 24-hour period. This slow dissolution results in a slower onset and a lack of a peak effect compared to other insulins, as shown below: Efficacy of Daily versus Twice-Daily Lantus Administration Although insulin glargine should last a full 24 hours, there is some evidence that its duration of action may be reduced to 20-23 hours, particularly following injection due to its delayed onset of activity of about 3-5 hours.2 Currently, the best estimate is that 15-30% of type-I diabetics will have pre-injection hyperglycemia and may benefit from twice-daily dosing. The idea of twice-daily dosing was explored in an 8-week, open-label crossover trial of 20 patients with type-I diabetes.2 Patients received either 100% of a pre-determined dose daily (dinner) or 50% twice-daily (breakfast an Continue reading >>
(insulin Glargine Injection) 300 Units/ml
Toujeo® is a long-acting human insulin analog indicated to improve glycemic control in adults with diabetes mellitus. Limitations of Use: Toujeo® is not recommended for treating diabetic ketoacidosis. Contraindications Toujeo® is contraindicated during episodes of hypoglycemia and in patients hypersensitive to insulin glargine or any of its excipients. Warnings and Precautions Toujeo® contains the same active ingredient, insulin glargine, as Lantus®. The concentration of insulin glargine in Toujeo® is 300 Units per mL. Insulin pens and needles must never be shared between patients. Do NOT reuse needles. Monitor blood glucose in all patients treated with insulin. Modify insulin regimens cautiously and only under medical supervision. Changes in insulin strength, manufacturer, type, or method of administration may result in the need for a change in insulin dose or an adjustment in concomitant oral antidiabetic treatment. Changes in insulin regimen may result in hyperglycemia or hypoglycemia. Unit for unit, patients started on, or changed to, Toujeo® required a higher dose than patients controlled with Lantus®. When changing from another basal insulin to Toujeo®, patients experienced higher average fasting plasma glucose levels in the first few weeks of therapy until titrated to their individualized fasting plasma glucose targets. Higher doses were required in titrate-to-target studies to achieve glucose control similar to Lantus®. Hypoglycemia is the most common adverse reaction of insulin therapy, including Toujeo®, and may be life-threatening. Medication errors such as accidental mix-ups between basal insulin products and other insulins, particularly rapid-acting insulins, have been reported. Patients should be instructed to always verify the insulin label bef Continue reading >>
How Do We Decide How Much Lantus To Use?
I am tired of trying to find a comfortable level of Lantus. At this point, I am taking 62 units at bedtime. Endo/doctor will not allow me to take more than one injection per day, and prefers bedtime. So, what's the problem? Most of the time, my three hour peak (following a meal) is between 130-160. However, there are times like today, where my BG spiked to 240 at the three hour point. This shouldn't be, because I eat the same thing for breakfast, every day. The amount is no more, or no less. It is a healthy mix of ground flax seed, wheat bran, oat bran, Quaker Oats oatmeal, and seven canned peach slices, diced and mixed in the cereal. This is not the first time, since I went to 62 units, that I have spiked at over 200, and it must mean that I am either counting the carbs wrong (today I added an extra 4 unit of insulin to compensate for any errors), or I need more Lantus. My Endo and his nurse/nutritionist will not give me a scale. They simply started me at 54 units last year, and told me to adjust accordingly. Well, the accordingly is driving me crazy, because I can't seem to find a happy medium (and I'm not referring to a joyful Palm Reader - LOL). Does anyone have a suggestion that I can use to find a level of Lantus that will wipe out the sporadic spikes? Alternatively, are the sporadic spikes something to be expected? I'm sorry if I left that out. Yes, I take novolg, the units are based on my carb count. OK. I am not sure that a doctor will give you a sliding scale for your basal insulin Lantus. I have wrestled with the same situation often and I just change my units used, my doctor lets me adjust up or down as long as I do my adjustments in small increments. I am usually low on my fasting reading but am good for the rest of the day and I can't seem to tweak the ri Continue reading >>
Multiple Dose Insulin In Type 2 Diabetes
Introduction Levemir (Detemir) & Lantus (Glargine) & quick-acting insulin before meals This page is aimed at people with type 2 diabetes needing multiple dose insulin (basal bolus). If you have a fair amount of insulin from your pancreas still, you will not need this intensive insulin regime, and may just need tablets or once daily insulin as opposite. If your type 2 diabetes is quite severe, and you have very little remaining insulin, then your diabetic control is similar to type 1 diabetes. This page discusses intensive insulin control, and this is taken further in the insulin dose adjustment pages above. You naturally need to speak to your diabetes nurse and doctor for individual advice. If you have no or very little remaining insulin from you pancreas, and are prone to hypos, then your diabetes is nearly equivalent to the type 1 diabetes patient, and you may benefit from the same intensive insulin 'regime'. This is discussed on this page below and the adjusting insulin dose pages taken from the DAFNE Program. Complex insulin regimes do lead to better glucose control, fewer hypos, and better weight control than twice daily insulin (NEJM 2009). Controversies First The two long acting insulins are Levemir (detemir) or Lantus (glargine). Levemir is shorter acting, with a peak 9-12 hours. Lantus generally has no peak in the first 24 hours, and its action may take 3 days to complete. Therefore anyone with a slightly irregular lifestyle in theory will be better off using twice daily Levemir rather than once daily Lantus. At present, this decision is usually made by diabetes doctors and nurses. If you do use once daily Lantus, and your glucose levels fluctuate, then you should consider twice daily Levemir instead. Second Another controversy is the use of analogue insulins s Continue reading >>
- Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE)
- NIHR Signal Insulin pumps not much better than multiple injections for intensive control of type 1 diabetes
- Caffeinated and Decaffeinated Coffee Consumption and Risk of Type 2 Diabetes: A Systematic Review and a Dose-Response Meta-analysis
Insulin Glargine (lantus)
What is INSULIN GLARGINE-INJECTABLE, and how does it work (mechanism of action)? Insulin glargine is a bioengineered (man-made) injectable form of long-acting insulin that is used to regulate sugar (glucose) levels in type 1 and type 2 diabetes. Individuals with type 1 diabetes do not produce insulin on their own; and individuals with type 2 diabetes do not produce enough insulin, or insulin is not as effective due to insulin resistance. Insulin glargine works the same way as natural human insulin, but it's action lasts longer. It helps diabetic patients regulate glucose or sugar in the body. Insulin glargine works by promoting movement of sugar from blood into body tissues and also stops sugar production in liver. Insulin glargine is man-made insulin that mimics the actions of human insulin. The FDA approved insulin glargine in April 2000. What are the side effects of INSULIN GLARGINE-INJECTABLE? Common side effects of insulin glargine are: Local allergic reactions that may occur at the injection sites are: Long term use of insulin glargine can lead to thickening of fat tissues at the injection site. Severe allergic reactions are: Swelling under the skin Bronchospasm (tightening of chest that leads to difficulty breathing) Individuals should contact a healthcare professional if they experience any of the above reactions. What Is Type 2 Diabetes? Type 2 diabetes can affect all people, regardless of age. Early symptoms of type 2 diabetes may be missed, so those affected may not even know they have the condition. An estimated one out of every three people within the early stages of type 2 diabetes are not aware they have it. Diabetes interferes with the body's ability to metabolize carbohydrates for energy, leading to high levels of blood sugar. These chronically high blo Continue reading >>
Insulin Glargine
Why has my veterinarian prescribed this medicine? Insulin glargine is a long-acting insulin used in cats with diabetes mellitus to help regulate blood sugar. How do I give this medication? "An overdose could seriously harm your cat." This medication is injected under the skin (subcutaneously) usually twice a day. Read the label carefully. Allow the medication to come to room temperature before injecting. This medication does not need shaking or swirling. Ensure your veterinarian has demonstrated the proper technique for withdrawing the insulin and proper injection technique. Do not dilute or mix glargine insulin with diluents or other medications. Measure the dose with reasonable care. Double-check the dose in the syringe. An overdose could seriously harm your cat. The dose is generally only a few units of insulin and the gradations on a syringe are tiny. Try to give this medication at about the same time each day. Do not give the pet more insulin than directed and do not give more often than directed. Try not to miss giving any doses. It is a good idea to keep two vials of insulin on hand, just in case one is broken or you run out over a weekend or holiday. Be aware of your pet's normal behavior. This will help determine when something is wrong. If your pet is not acting normal, suspect low blood sugar (hypoglycemia). You may wish to carry packets of honey, packets of sugar or a small bottle of corn syrup for emergency administration when leaving home with your pet. What do I do if I miss giving a dose? Give the dose as soon as possible. If it is almost time for the next dose, skip the missed dose, and continue with the regular schedule. NEVER give the cat two doses at once. How do I store this medicine? Keep this medicine out of reach of children. Store the insulin in Continue reading >>
