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Case Study: Bruiser's 3-week remission on Lantus

We followed the Rand/Marshall protocol[1], which had given excellent results with Lantus[2]. Bruiser was diagnosed June 28 after which I studied hard to learn as much as I could quickly. I switched vets and less than two weeks later got him on glargine and a somewhat less aggressive approximation of the protocol. After being on glargine for about a week, his dose started reducing so quickly that it was very hard to stay on top of it.

I had envisioned achieving a fairly smooth regulation before his dose dropped to nearly nothing, but that was not the case because we were chasing the dose downwards. Deciding what the dose should be to smooth him out was a real challenge, because what wasn't quite enough 1 or 2 days ago might be too much today. During one week, I was taking the dose down about 1/2 unit every day. Typically, he'd end the day too low for the dose I'd given him that morning, so I'd have to think hard about just what token dose should be given if any in the evening. This typically resulted in somewhat high numbers the next morning. The dose was then reduced to avoid the low evening preshot value, but it would usually happen again.



If you look closely at the abstract which reported the result achieved with the original 6 cats, you may notice some interesting things. They all started at 0.5 unit per Kg, but 5 out of 6 averaged 0.2 unit/kg by day ten. At day 17, 4 out of the six were no longer on insulin. Thus, one should expect to be chasing the dose rapidly downwards as I did. It can be a bit confusing and is not for the feint of heart. I started somewhat below .5 U/Kg, but would recommend starting even lower than I did. Perhaps half that should be the standard for someone without a great deal of experience with this sort of thing. However, I think it would still require very close monitoring and much cautious thought.



I actually had some advantage over a typical caregiver. I am a math professor who had already finished classes for the summer and put my usual summer research on hold to do this. It was most of my life for a few weeks and I didn't spend much time away from home. I had to get by on less sleep than I would like. I do have a very cooperative cat.



I think glargine is very nice and should be tried by most everyone. Just be ready to adjust that dose. I would recommend daily curves until things settle down. Once every 4 hours is probably enough, but I would recommend a reading at 2-3 hours on some days to detect possible rebound events.

ReferencesEdit

  1. Rand/Marshall Protocol
  2. Rand/Marshall Protocol & Lantus



Further ReadingEdit

View Bruiser's insulin log (PDF format) during his 3-week treatment and remission.

Ed Smith
Jacksonville, AL
USA
esmith@jsu.edu

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