? 03/26 Mowgli AMPS 355 Not seeing much of a change

AmandaE

AmandaE

Member Since 2019
Hi All,

I know that it takes a while for Lantus to build up a "depot" but Mowgli's BG last night didn't seem to change at all after his Evening shot. I am worried that I am administering his insulin incorrectly with the pen. I know it's early to get discouraged but I was hoping he would have some relief from his high BG during the day / night.

I am planning to start Mowgli on the transition to wet food this week, I had thought I saw an article on the board with advice on how to slowly transition a cat that is just starting insulin... Not the tricks and tips from cat info but actual % break downs for the slow transition so that I don't have to worry about Hypo. I can't seem to find it now... any advice?

Do you think I am administering Lantus wrong or is this a normal result for the beginning? Is Mowgli just building his depot?

I know you guys don't use the pens to administer, but since I'm doing SLGS he will be on 1u for a bit... does anyone here use the pen and have advice for administration? I don't find any of the online videos I've found very helpful

Thanks for your advice.
 
Not sure why you started on such a low dose of Lantus. Normally we take the dose of the previous insulin into consideration when you switch. Anyway, he’s on too low a dose of Lantus, that’s why you aren’t seeing much action. I would have started on at least 3 units. It probably has nothing to do with the pens or administration.

Dry food will also make a difference. I don’t think there is any hard and fast formula for transition, just do it slowly. Maybe swap out 25% for several days, then go to 50% the rest of the week, etc. So you do it over a couple weeks, Part of it will depend how well you can monitor. It can take a couple days to see the full impact of a food change on the numbers. The pace may also depend on how well their tummies handle the change. He may need longer for the transition. For your reading pleasure https://catinfo.org/docs/TipsForTransitioning1-14-11.pdf

Here is the link to your previous post here for continuity http://www.felinediabetes.com/FDMB/...nd-a-switch-from-caninsulin-to-lantus.212377/
 
Wendy&Neko said:
Not sure why you started on such a low dose of Lantus. Normally we take the dose of the previous insulin into consideration when you switch. Anyway, he’s on too low a dose of Lantus, that’s why you aren’t seeing much action. I would have started on at least 3 units. It probably has nothing to do with the pens or administration.

Dry food will also make a difference. I don’t think there is any hard and fast formula for transition, just do it slowly. Maybe swap out 25% for several days, then go to 50% the rest of the week, etc. So you do it over a couple weeks, Part of it will depend how well you can monitor. It can take a couple days to see the full impact of a food change on the numbers. The pace may also depend on how well their tummies handle the change. He may need longer for the transition. For your reading pleasure https://catinfo.org/docs/TipsForTransitioning1-14-11.pdf

Here is the link to your previous post here for continuity http://www.felinediabetes.com/FDMB/...nd-a-switch-from-caninsulin-to-lantus.212377/
Click to expand...

I had started on a low dose of Lantus at my vet's direction, it could have been that he didn't agree with Mowgli's previous vet in Nova Scotia who had prescribed 5u of Caninsulin BID. He assured me there was some formula that determined how much Lantus that Mowgli should get, and since it's an insulin for humans I thought the combination of the type of insulin, dosage direction of my vet, the SLGS technique, and the insulin depot I've read about here was enough to justify the 1u BID dosage... admittedly I have no experience and I'm not discounting your advice... more explaining why I didn't question the 1u.

Most of the posts I've read about starting dosages said that anything more than 2u is too high to start with, when I first started on the board last week and mentioned that Mowgli was on 5u of Caninsulin BID, multiple users recommended backing off to 1u BID. I felt like this was also echoed in comments on my Lantus intro that stated it can take 3-5 days for the Lantus to build up, because of this information, your recommendation of 3u BID is creating some confusion for me... Is there a dosage formula you used to come up with that starting point or is it more based off of his Caninsulin dosage? I am relieved though, to hear that you don't think that it has to do with my administration technique, and I agree that because of his BG a higher dosage could make sense, I'm just not confident on where to start. For a path forward do you think I should:

a) Wait a few more days to see if the 1u BID builds up and Mowgli starts reacting more favorably (with gradual transition to wet food)?
b) Switch to 2u BID with the gradual transition to wet food?
c) Switch to 3u BID and begin the transition to wet food?

I should mention I can't be home from 6:50a - 5:00p to monitor him during the week because of work, in case that affects any recommendations.

Thanks for your recommendation on feeding, I have already had a peek at the transitioning doc and food list... I just wanted to make sure I wasn't transitioning too fast. I will try the 25% - 50% - 75% to full transition over the coming weeks and hope his poor tummy can handle it... I have a feeling the switch to wet food will be the best thing that can happen for him... and even though it will be painful (for my patience) I think that I will even switch my healthy cat Nyx to wet as well so we can mitigate any potential future health problems for her as well.

I hope I can get Mowgli straightened out soon!
 
Just for reference, my Neko started on Caninsulin, got up to five units seeing mid blues around nadir. I switched to Lantus at 1 unit on recommendation of my vet. I wasted three months getting back up to five units, and she actually needed more. She had a couple high dose conditions, so got to 8.75 units. And she was on low carb raw. Anyway, that tells you where I am coming from. I am not saying you will need that much and the dry food will be a factor, Suggestions you get here will vary based on experience of the people giving suggestions.

Starting dose more than 2 units might be high, but Mowgli has already been on insulin a while, so he’s not “starting”. Are you testing regularly for urinary ketones? That’s always a good thing to do if you go back in dose. Any sign of ketones and we would definitely fast track increases.

With SLGS, the suggestion is to hold the dose 7 days. You do need the depot to build too. As for what to do next, when is the next day you can monitor more closely? In the mean time, I would start the food transition.
 
@Wendy&Neko Definitely I can see where you're coming from, it's a very good point that I should keep the experience of each member that offers advice in mind before taking action. A lot of the advice I had received said that if I start too high I might miss my ideal dose, that's what I'm worried about. I haven't been testing for ketones but Mowgli tested negative for Ketones at the beginning of the month in his labs. His only health problem is his Blood Glucose levels. I agree that he isn't starting on insulin but just with the switch to a different type I thought of it as starting over which is a misunderstanding on my part.

The next day I can monitor closely is Saturday. I work Mon- Fri 8hr days but I have a 40 min commute on either end (~10hrs away from home)... I was thinking of doing a curve either Saturday or Sunday to see how Mowgli is responding to the Lantus, and hopefully he will have built his depot by then as well. I don't want my ignorance to get in the way though... if I should increase the dosage I am willing to... I don't want Mowgli to suffer - I also don't want my eagerness for him to get better to cloud my judgement and jump to a higher dosage too quickly if I should actually wait, that's why I'm questioning so much, I don't have any experience with this and I just want to do what is best for Mowgli.

I need so many advice :confused::confused::confused:

What do you think I should do?
 
Start the food change ASAP, while you keep the dose. Then we can consider an increase closer to the weekend so you can be around to monitor and curve. And we’ll start to see if the food change is helping before any dose change.

By the way, people do worry about starting too high a dose, because we do see that far too often. I remember one vet starting a cat on 10 units of Lantus. :eek: Fortunately the cat lived. However, there is a difference between starting fresh on insulin and switching from an existing insulin. I have also seen a lot of cats go back to low doses, which seldom is successful, and get sick with ketones because of it.

You got this. :bighug:
 
@Wendy&Neko Ok perfect! a path ahead, thanks for your time and patience as I work through this all. I will hit the ol' supermarket and find Mowgli something new for his diet... hopefully he can digest it well!

10 units!? insulin for a small child... it's a frustrating feeling to not be able to trust your vet.
 
@Wendy&Neko ... based on Mowgli's SS do you think it could be a good time this weekend to try upping his dosage? if so, do you have a recommendation for the increased dosage? I plan to be home all day Sat and Sun to monitor.

Thanks for your advice and expertise :)
 
Sorry to be late replying, I had to pop out of town today for a bit.

Anyway, if you don't see anything below 150 by end of tomorrow, I think you could increase on Saturday to 1.25 units. As per the SLGS guidelines, you hold the dose a week, do a curve or equivalent (you have lots of PM data), and nadirs are above 150, you increase by 0.25 units.

In future, it's better to start a new post each day. People here tend to respond more to current posts. Also, if you have a dose question, it's a good idea to add the "?" icon to the subject line and put something like "dose question" or "dose increase?" on the subject line. Once your question has been answered, you can take away the ? icon and change the subject. That way if you have a new question, people will notice it. Especially if the person you tag is out of town.;)
 
Sweet thanks. I was thinking of doing a curve with the one unit. I still don’t think I know what Mowglis Nadir is because I haven’t been able to get those samples.

I’m using Pens so I think that I’ll have to grab some syringes. I have so many U40 from caninsulin. But I’m a little nervous to use them for a 0.25u increase
 
Take the u-40 syringes back to the vet. Mine refunded me all the unopened ones. You will need to use the U-100 syringes, most likely the BD Ultrafine II you can get at a people pharmacy. They are much nicer to use than the U-40 syringes.
 
Thanks for the advice, unfortunately, the vet that provided the syringes is in Nova Scotia and Mowgli has moved out with me to Alberta... I will probably end up donating them to a vet in town. Along with a vial of unopened caninsulin that they sent from NS.

I wonder would Canadian pharmacy’s have the same brand?

Also don’t worry about the late reply! I’m not offended that you have a life outside of this forum. ;)I appreciate the response and will take your advice for any future posts to be started in new threads!:smuggrin:
 
Most Canadian pharmacies only have the BD syringes. I found a rescue organization with a diabetic dog, and donated the Caninsulin to them. Some one will find a use for it.
 
Oh good idea! I should definitely check the SPCA. I Don’t know how I didn’t think of it, thanks for the inspiration.
 
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