Dose advice switching from Caninsulin to Lantus

Hello all,

we are here to ask for your kind dose advice on Lantus considering that we are on Caninsulin since 1 months and now maybe switching to Lantus as suggested from my vet.

Our cat Wally has been hospitalized for 10 days from 11/14 to 11/24 cause of DKA, but after that he was sent back home with regular glucose levels and no ketones...

- Since then we switched to wet food (he is eating both Purina DM and GranataPet Chicken for Kitten).
- We started with 1UI of Caninsulin as soon as we noticed some values about 200
- He has been on 5U + 5U of Caninsulin until yesterday morning
- We lowered yesterday to 4U+4U based on suggestions received on Caninsulin forum... seems like we rushed too much on dose increment (...we trusted vet instructions)
- I showed my vet the situation on the spreadsheet and talked about the possibility of a bounce effect
- he suggested to switch to Lantus and start over with 2U AM and 2U PM

A few more info on the background of Wally on this post http://www.felinediabetes.com/FDMB/threads/dose-check.208457/

I would like to know your opinion about this switch and the dose considering we are switching from 4U AM + 4U PM Caninsulin

Thank you for sharing your experiences

 

I'm very glad you came here to the Lantus forum. There are many very experienced people who will help. Give it a little time.

 

Thank you for the warm welcome... Anyway so far our 4U of Caninsulin is giving us some better results than 5U from what I can see on the spreadsheet

 

While you're waiting for a response, take a look at the yellow information "stickies" on this forum. Start with the one about how a depot insulin works.

 

Hello and welcome. My girl was on 5 units of Caninsulin before we switched to Lantus. Unfortunatel6 my vet had me switch to 1 unit (it was before I was active here). Anyway, long story short, it took me three months to get back on track and she ended up maxing out at 8.75 units of Lantus. Luckily I did not have ketones to worry about. Are you testing daily for ketones? We will keep asking that until you do and put the ketone test results in the spreadsheet. It impacts our dosing strategy. We are more aggressive with ketones in the picture as we want to avoid another DKA.

Typically we take the dose of the current insulin into consideration, which would mean at least 4 units of Caninsulin. Especially with recent DKA to worry about, You might want to look at Bear’s post and spreadsheet. He just started Lantus today after switching from Caninsulin. Read his yesterday’s post too. Are you able to monitor closely for a few cycles when you make the switch?

 

Hello Wendy,
Thank you for your feedback.
I will receive my ketone device (Freestyle Optium) in a few days (it will arrive hopefully before the end of the year).
Vet doesnt have either... They used the same device when he was hospitalized...
I confirm i can test the full cycle, until 7 jan because we are home for season holidays....
I will follow Bear’s post, thank you for the advice

 

Welcome to the group!!

If you need to test for ketones, you can also get Ketostix at any pharmacy. These are strips that you dip in your cat's urine. A ketone meter is definitely worth it but if money is a concern, the strips for a ketone meter are expensive. The urine test strips are a fraction of the cost.

If I may make a suggestion.... It wasn't immediately obvious that the information in your signature was a link to Wally's spreadsheet. Can you either add "spreadsheet" to the link or change it around so the information about Wally (Wally Russian Blue - AccuCheck Aviva) isn't the clickable link and instead, make something like "spreadsheet" the clickable link. It would also be helpful if you included some additional information in your signature:

Some of the above information you've already included. We also recommend that if you're located outside of the US, you indicate where you live. Knowing what country you're in helps us if we are making recommendations about food, where to buy products, etc.

Please let us know if you have questions. There are quite a few differences in using Lantus versus Caninsulin. It's particularly important that you have U100 syringes. Caninsulin uses U40 syringes. We make dose adjustments in 0.25u amounts so it's helpful to get syringes that are in half unit increments. Dosing iwith Lantus is based on the nadir -- the lowest point in the cycle.

For now, I'd encourage you to review the sticky notes at the top of the board. There is an overwhelming amount of information in the sticky notes. It will become routine after a few weeks. In the meantime, we're here to help.

 

Hello group,

I did my homework and studied the yellow stickers posts.

We are here ready with Lantus pens and U100 syringes with 0.5U marks...

Unfortunately not ready yet with ketone tester, should arrive hopefully on monday.

In the mainwhile we completed another cycle with 4U caninsulin as you can see on the speadsheet.

I'm uncertain if we should switch already tomorrow to 2U AM + 2U PM Lantus as suggested by our vet... or wait for the results of the ketones before taking any decision....

What is your opinion?

 

You don’t need the ketone tester to switch. It is a safety mechanism to have in place, just because of the history of DKA. Can you not get Ketostix from your local pharmacy? Human diabetics test for ketones too, so it should be available easily. Actually if you go to a lower dose as suggested by the vet, the ketone testing is even more important as not enough insulin is one of the factors in DKA.

I suggest switching to the higher dose of Lantus as suggested, when you can monitor closely, getting several tests the first couple of cycles. You may or may not see anything at first because the depot has to build. It some cats have a strong initial reaction to an insulin change.

 

Thank you for your feedback.

We tried to test on urines but it has been quite difficult considering that our cat uses a Litter Robot like the one in these pictures
https://www.robotshop.com/media/cat...-air-automatic-self-cleaning-litter-box_1.jpg

This is why we prefer the blood testing.

I'm worried of the reaction to the new insuline this is why i'm waiting ... ...and also I tell you the truth I worried about suggested dose to start with... We talk often to our vet, but he's not an expert on diabets (he had only 10 pets with diabet so far). When in needs he refers to the endocrinologist that cured Wally when he was on hospital.

 

The people here with a lot of experience like @Wendy&Neko will give you good advice. You can trust them.

 

@Sienne and Gabby (GA) was one of the knowledgeable people I leaned on when I started. There are a number of us who have probably looked at hundreds of spreadsheets and still hanging around, even though our own diabetic kitties have passed on. Just helping others, as others helped us.

I really liked my vet too. But I was the first client with a diabetic cat to home test, the first of her diabetics to use Lantus, then Levemir, the first cat she knew about with a positive diagnosis for acromegaly and IAA (insulin auto antibodies), the first to go for stereotactic radiation treatment. You get the picture. We learned a lot from each other about feline diabetes and she was willing to learn. I still worked closely with her on the other things she knew well, such as kidney disease. Most of what I learned about diabetes I learned from the experienced people here.

With Wally, I would worry about all the time he is spending in high numbers, especially with DKA in recent history. Some cats need higher doses than others. The important numbers are the blood sugar readings, not the size of dose.

 

Hello,

I wanted to update that we started Lantus 2U twice a day this morning. Starting numbers are again high.

I will follow SLGS... We will test every 2 hours. If you have any advice please let me know!

 

Hi Stefano,
You lowered Wally's dose quite a it and the Lantus "depot" has not filled yet so the higher numbers aren't surprising. Have you read about the depot in the yellow info threads on this forum? It can take a couple of days to see the full effect of a Lantus dose because of that depot, especially at the start. If Wally stays high you might want to try TR for a while because of the DKA episode. You can go back to SLGS later if you wish. It's important that other members who read your posts have the basic information about Wally in your light grey signature text. Please include what meter you use, that he had DKA (and when), other health conditions he might have, what he eats (just say low carb wet or similar). The signature text has to be kept very short so keep it very concise.

 

Hello, thank you for the infos. I confirm I've read all the yellow sticker posts and I will update my signature in a few moments.

We just received our device for blood testing ketones.... this is the device

https://www.aconlabs.com/intl/glucose/on-call/gk-dual-bgms/

Result is not a good number for what I understand 4.4 mmol/L

He seems a lot hungry.... he's 4.5Kg and I'm feeding him 270kcal/day (half morning, half evening)

Please advice

 

Yes, under 2.4 - 2.5 mmol/L on a ketone meter is negative to trace ketones. At 4 or higher the risk of DKA is high. Unregulated diabetic cats are always hungry and if he needs to gain weight feed as much as he wants in several small meals each day.

 

Just noticed the spreadsheet noting a ketone test of 4.4. I assume that was with the meter and I believe any reading over 2.55 indicates ketones are present and I would strongly recommend you contact your vet. Is Wally eating and drinking well? It's likely the vet will want to increase the insulin dose. You need to be sure he is eating and drinking enough as well.

Just noticed you and Kris have now posted regarding this. Kris has experience with DKA and is a great source of info on that subject.

 

Wally is eating and drinking alot....He always wants food. I just gave him 50gr extra of his daily food.
Can I give him more when he asks?? I'm measuring his weight daily to keep him at his current weight of 4.5kg....

The device I used for ketones says the reading are reliable only if taken from the fingers.... now I'm wondering if it's a good device for my cat.

I will contact my vet for the ketone numbers

 

An unregulated cat cannot process and use the food they consume normally which is why many if not most cats lose weight. It's Ok to feed them more than they would normally need and in this case, the ketones are indicative that he does need more food. Feed him whatever he will eat at this point because keeping the ketones away takes precedence over maintaining his weight. It's highly unlikely he will gain until he gets better regulated.

 

Hello I had the opportunity to speak with our endocrinologist. He said values are high but don't modify the doses yet because it's too soon to evaluate.

In the meanwhile I'm feeding Wally some more until satisfied and monitor glucose every 2 or 3 hours and ketones daily

Thank you so much for your support

 

I misunderstood you earlier. I didn't realize that 4.4 mmol/L was the reading you got on a blood ketone test this AM. Those meters are for humans and any chart that's included with it will be risk levels for humans. The guidelines we use here (eg. over 4 mmol/L is a risk for DKA) are an adaptation to be used for cats. I have one but usually use urine strips instead.

I would caution you against leaving Wally's Lantus dose at 2 u for very long. He's already had DKA and I know from experience (twice!) that ketones can build quickly. Vets often want a dose held for 7 to 10 days before a change. That can be too long if ketones are showing. My cat's first DKA episode happened after my vet suggested a 48 hour no insulin trial because he didn't seem to be responding well to Lantus (in the early days when I was clueless) and 24 hours later Teasel was in full DKA.

Ask for advice here from the experienced Lantus people. I'm quite sure they'll suggest increasing sooner.

 

Do you think there's the necessity to open a new thread to ask for advice?

I just gave Wally his PM dose of 2U.... glucose level is moving quite linearly today.

If any experts wants to give his advice it will be very welcome

 

Wendy (in post #5 above) was suggesting that the Lantus 2u dose might be too low as generally they would suggest staying with the same dose when switching from Caninsulin to Lantus. Given Wally's BG numbers, I'd raise him to at least 3units tomorrow unless he gets some dramatic reduction in his BG overnight. I think you could safely go up to 4units but it's up to you what you feel comfortable with. Lantus will not cause the same sharp drops in BG as the Caninsulin so as long as you can monitor, either option is fine. As Kris said though, with ketones in the picture, you don't want to hold a dose too long if his numbers are not showing improvement.

 

I agree.

 

Do you confirm that the Lantus effect will not be visibile until the next 2-3 days?

This means that whatever BG number I see tomorrow before shot, I should move at least to 3UI. Correct? I think I will do the increase as suggested tomorrow morning and monitor Wally the whole day.

Also I wanted to ask if ketones can be measured in any moment of the day or if there's a specific timing for it.

Thank you for your advice.

 

You can measure ketones at any time.
Some cats will show a reaction to a change of insulin in the first couple of days and others don't. With Lantus it takes a few days to fill the depot so while you may see some effect, it won't be the full effect. You are safe to shoot if BG is at least 150 pre-shot and Wally is eating well. If you get a AMPS lower than 150, and/or Wally isn't eating well, I'd suggest you post for advice.

 

With Lantus, the first couple of days some of the insulin will go to the blood stream and some will go to the depot. You should see some impact on the blood sugar numbers, but maybe not as much as if the depot were full.

I agree with the others, 2.0 units was small a starting dose.

 

Hello, thank you for your advice.

Today AM dose was 3.0U ... BG at AM was 506... i'll keep monitored for BG and Ketones every 2 hours

 

Hello all my friends and happy new year.

Wally's Today ketons are down to 2.1 (was 4.4 yesterday).... seems a good improvement to me.

BG nadir today was 405..... Wally seems okay, a bit less hungry (we are feeding him much more than usual)!

Any advice is welcome, otherwise we'll remain on 3U

Please advice if you see anything to suggest

 

Wonderful news about the ketones. Just keep monitoring at least daily. You can stay with the 3u for the moment but if the ketones do start rising again, it would be a good idea to increase up to 4u. Happy New Year!

 

Stefano:

We suggest that that you open a new thread (we also refer to threads as "condos") every day. You can link the previous day's condo to your current thread as a means of keeping all of Wally's information together. Frankly, there's a point where the condo's become too long and only someone who is very intrepid will opt to read the entire amount of information contained therein. So, how about starting the New Year with a new condo. (There's information about the idiosyncrasies of this Board in the New to the Group sticky.)

As others have noted, when switching from a shorter acting insulin like Canninsulin to a depot type of insulin like Lantus, you can make a direct switch with dose. In other words, you could have started at the same dose of Lantus as you were previously giving with Caninsulin.

There are a number of differences between Lantus and Caninsulin. It's important that you shift the way you think about dosing.

• Lantus dosing is based on the nadir and NOT on the pre-shot numbers. You're doing a great job of getting spot checks so this shouldn't be an issue.
• You do not slide the dose. With Lantus, unless a dose reduction is indicated, the dose is held for a specific period of time. That length of time varies depending upon which approach to dosing you opt to use. Beyond the initial 5 days, you adjust the dose after 3 days with Tight Regulation (TR) or after 7 days with Start Low Go Slow (SLGS). Making back-to-back changes in dose will give you wonky numbers.
• It takes 5 - 7 days for the Lantus depot to become established. Thus, you don't want to make frequent changes in dose during this time. The depot is what makes Lantus a gentle insulin with a long duration.
• Please be sure you are using U100 syringes. Lantus is a U100 insulin and the concentration of the insulin (U100) needs to meet the calibration of the syringes. (Caninsulin is a U40 insulin.) Do not use the syringe tip for Lantus pens. It's best to use a syringe.

Your options with respect to dosing are either the Tight Regulation Protocol or the Start Low Go Slow approach. Ordinarily, it's entirely up to you which you choose. With a cat that is prone to ketones, though, I would strongly encourage you to consider using Tight Regulation. This is a more aggressive approach to dosing but also has the benefit of research to support its use. Ketones develop if there is an infection or inflammation present, not enough insulin is being given, and the kitty isn't getting enough calories. You had asked about feeding Wally. Until you are reassured that ketones are under control, I would not be overly concerned about how much you are feeding. Fundamentally, with a ketone prone cat, all bets are off. Ketones can be very dangerous -- or even life threatening. We do not mess around if levels are beyond trace. In addition to testing for ketones, making sure you are giving enough insulin, and insuring that Wally is eating, I would recommend you add water to Wally's canned food. Water, or any liquid, helps to dilute ketones.

Please let us know if you have questions. There's a lot to absorb in the beginning.

 

Thank you GA for your detailed post. Very much appreciated.

I will begin tomorrow morning updates on a new daily post.
I am going to switch to TR at least until monday, Its feasible until monday bacause then i’ll be back at the office for my daily job.

Wally is eating well so far and he loves additional water in his food, overall he seems satisfied with the new quantities.

I want to ask you some advice before my tomorrow morning shot.

1) Unless BG values are below 150. Should I keep 3U? I understand I will ask for advice if BG is below that value
2) Should i adjust the dose if tomorrow BG value is above 500? Or should I wait 3 day on 3UI before any increase?
3) Should i increase the dose if ketones are again above 4? I will blood test ketones before AM shot to be safe.
4) Today I gave Wally some more food between AM and PM shot. Should I be regular on timing additional food? I dont want to mess my measurements

Thanks!

 

Hello all, as suggested i posted updates in a new thread. Thank you for your feedback

http://www.felinediabetes.com/FDMB/...nes-2-1-need-advice-for-tomorrow-shot.208826/