Chloe

Hi folks, Chloe has been on Prozinc for a year and unable to regulate. She had two DKA's. The recent one (she's still in the hospital) was the other day. So the vets and advice I got from FDMB was to switch to Lantus. Should I start a new spreadsheet for Lantus?

 

You're in the best place to get excellent advice about using Lantus, Roberta! Good luck!

 

It’s fine to use the one you have, I would just block a whole row in a different color and write “switched to Lantus” on it.

I’m sorry Chloe is in the hospital with DKA. Hope she’s feeling better soon and really hope Lantus makes a big difference for you.

 

Hi Roberta!! I'm sorry to see that Chloe is in the hospital. I hope she makes a speedy recovery.
I hope Lantus does the trick for her and gets her numbers down. It took me awhile to understand how Lantus/Lev works as its very different from ProZinc. You'll have plenty of help over here in L/L. Sending lots of get well vines to Chloe

 

I hope Chloe gets better soon and gets to come home soon. Sending prayers.

 

Welcome, Roberta!

A quick question -- what's the carb amount in the 9 Lives that you're feeding Chloe? There are several varieties that are fine and others that are very high in carbs.

Shifting to Lantus will take some re-thinking on your part. With Prozinc you can adjust the dose based on preshot numbers. With Lantus, the dosing is based on the nadir. Looking at Chloe's SS, that means you're going to need to do your best to get some spot checks during both the AM and PM cycles. It will also mean you will need to get a few curves so you can identify when Lantus onset begins and where her nadir falls.

Am I correct in assuming you've already started Lantus? If so, it looks like you're getting the hang of holding the dose for at least 6 cycles/3 days. I'd encourage you to look at the sticky notes at the top of the board. There's an overwhelming amount of information in those posts but it will help you to get a handle on how Lantus works. In particular, you may want to review the two dosing methods we use -- Tight Regulation and Start Low Go Slow.

 

As far as I know, she's still at the vet. But she was on prozinc up to the day she went into the hospital with DKA.
The vet may have switched already during her time there, I'm not sure.

 

I just spoke to the vet at the hospital who said that Chloe did not respond to the garganine (Lantus) and should return to Prozinc. Apparently, she's a difficult case. Is Levemir another option? I'll take her back to my regular vet later this week and see what she thinks.

 

ummmm....

Lantus isn't the best insulin for controlling DKA when the symptoms are acute. A shorter acting insulin is typically used. Once the crisis is over, Lantus can be started. It takes about a week for the Lantus depot to be established. You wouldn't expect to see much change in Chloe's numbers during that initial time. Levemir is an option. However, if your vet is expecting an overnight change, it won't happen with Lev, either. While the mechanism of action is different, functionally, Lantus and Levemir act in much the same way.

Can you find out what your vet meant by Chloe "not responding" to Lantus. There are a huge number of vets who really don't understand how Lantus differs from shorter acting insulins.

 

What hospital is she in here in Tucson?

 

I agree with Sienne. Switching to Lantus or Levemir when a cat is in or just coming off of DKA is not the time to switch insulins because the action is lacking while building the depot. Once things are back to normal is a much better time to consider a switch to either Lantus or Levemir.

If the switch is made before kitty is on the way to recovery, ketones can easily re-enter the picture. At that point, if hospitalization is not necessary, the caregiver usually has to resort to using Lantus/Levemir as a basal dose and R as a bolus. It's do-able and has a successful track record, but the treatment usually ends up being intense due to the learning curve and very time consuming for the caregiver.

 

That's what I assumed a vet would do once ketones are at a very low number, so toward the end of Hospital stay. But the stay might not be long enough for any depot to build up. So, I agree.
That makes a lot of sense that most vets don't fully understand the way lantus and levemir work in felines.
Hope her regular vet can get her started once Chloe is safely away from DKA, if she still wants to switch.

 

I called the hospital to try to get Chloe's BG readings and type of insulin used, times, and units, but they put me on hold for a really long time. I just ordered a new vial of Prozinc so I'll be going back to the Prozinc board, but before I leave, I wanted to share this with you: http://www.cbc.ca/news/canada/briti...per-from-pharmacies-and-wholesalers-1.1304362

 

Veterinary Specialty Hospital on La Canada and River. I don't have time to mess around changing insulins. I'm at the bottom of the Prozinc vial. I just ordered a new vial and I hope it gets here in time before my other bottle runs out. Tomorrow, Monday, I'll call my regular vet. They're supposed to fax her the records of her hospital stay.