Help Needed Re: Dosing With Lantus Versus Caninsulin.

I need assistance with dosing. I'm wondering how Lantus compares with Caninsulin, i.e. is 1U of Lantus equal to 1U of Caninsulin?

Here is some background information: Gryphon is an Acromegaly kitty diagnosed diabetic in June, 2018. His BG has been mostly high and unpredictable on Lantus, so my vet recommended trying Caninsulin instead. Gryphon is just coming around after a hellish week of illness and emergency vet treatments, including a bladder infection and UT blockage, and congestive heart failure. He was started on 4U of Caninsulin on November 25. He had been on 6U of Lantus for several weeks before that. My vet was very concerned about the high BG during the past week, and recommended several Caninsulin dose increases to 8U as of November 29. Today his BG dropped to 3.2 at +7. It is now back to 6 after a small meal. I'm wondering if I should reduce the dose to something equivalent to 6U Lantus?

Also, I wasn't sure whether to post this in the Lantus group or the Caninsulin group or here.

All suggestions very much appreciated!!!

 

@Kris & Teasel answered the same question for me - she said that if BG is under 5 on Caninsulin, it's time to reduce the dose. Also, from what I learned so far Caninsulin works faster than Lantus - my Bacardi's lowest BG is approximately at +5 (although yout kitty might be different. But it's possible that his BG was even lower than that earlier in the cycle). I am sure Kris will know the answer here and tell you more.

 

Thank you! Yes, I wondered if the BG had been lower. I wish I had tested earlier, but I'm so glad I caught the 3.2!

 

Yeah I know! It's crazy to see them going from blacks to almost hypo in a couple of hours and then back to black again. This forum is really helpful in getting some good advice, so I hope you'll get yours asap and Gryphon will feel better very soon!

 

Hi,
If you are using the Alphatrak meter, the 3.2 (58) is too low and you should take a reduction.
I'm not sure why you changed to caninsulin from Lantus, as Lantus is considered a much better insulin for Acro cats.
If the BSL are not coming down, you just need to increase the dose slowly. Have you talked to @Wendy&Neko about dosing acro cats?
Tagging @Rachel she may be able help you with the caninsulin....I am not familiar with it.
Post the +11 BSL and ask for help re the dose, but you do need to reduce it.

 

Yes, the 58 is definitely too low! I think jumping by 1 whole unit is way too much. Tonight I'm guessing you're going to see a bounce (a high number due to that low number you got) but you still want to reduce no matter what. I know 7 wasn't giving you what you needed, so I'd be tempted to drop to 7.25 and see what that does for you as long as he isn't too low which would be very surprising to me.

It's definitely possible he was lower earlier. Caninsulin can drop a kitty pretty fast early in the cycle. You want to get tests in earlier in the cycle. +3 is always great and maybe a +5 whenever you can get it. Then you can go from there to see how things are going.

I'm also surprised you were switched to Caninsulin. It's a fairly harsh insulin with a much shorter duration...Lantus or Levemir would probably be much better honestly.

 

Thank you all for your assistance! I truly appreciate your input. My vet made the decision to change to Caninsulin because he is very concerned that Gryphon's diabetes is not yet controlled after 5 months on Lantus. I think he feels that we need to get things under control quickly to avoid the complications of long-term, uncontrolled diabetes. I had asked him about possibly switching to Levemir, but he preferred to give Caninsulin a try. I am far from experienced or knowledgeable, but I am uncomfortable about the number of changes and dose increases that have been made, in the midst of many other factors that could be contributing to Gryphon's BG. The insulin change was made while Gryphon was very sick. He had congestive heart failure that hadn't been stabilized, a bladder infection that might not have cleared yet, and he was in pain. His kidney enzymes were also elevated so my vet suggested a kidney diet, (Hill's kd) for a few days. My vet also talked about changing to a high fibre diet, but Gryphon wasn't eating well so I just continued with his favourite foods, which are high protein, low carb. Gryphon's health and response to insulin has been perplexing, so I think we've been grasping at straws to try to make things work for him. I will talk to my vet again about choice of insulin, but for now, I want Gryphon to be safe. I know I need to reduce the Caninsulin dose, but by how much? As I said in my initial post, I'm wondering if it would make sense to lower the Canininsulin dose to whatever is equivalent to 6U Lantus, and adjust from there?

 

You mention that Lantus is considered to be better for Acro cats. Could you direct me to some literature on this subject so I could share it with my vet? He did say that he has never seen a case of Acromegaly, so this is a new experience for him. Thanks!!

 

Actually Levemir is probably even better than Lantus for acro cats as Lantus can sting in larger doses and Levemir doesn't.
You have had a lot going on, most of which could have elevated the BSLs. I'm glad you stuck with the lowcarb high protein diet!
Maybe your vet doesn't know much about Levemir....my vet didn't but researched it and was happy for me to use it.
Here is a link to the acro page which is not used much now, because they use the Lantus and Levemir forum but the info and stickies there is very good.
http://www.felinediabetes.com/FDMB/forums/acromegaly-iaa-cushings-cats.12/
Wendy will also be able to give you lots of valuable info

 

Another link
http://www.felinediabetes.com/FDMB/threads/acromegaly-the-basics-hope-you-will-read-n-like.45324/

 

My only concern about going back too much is ketones. Has Gryphon ever had them? Higher numbers can cause them which is why I ask.

My gut says the dose you need is between 7 and 8 given your rather high responses to 7 but sudden lows at 8. I could be totally wrong though. If you want to drop back to 6, by all means do it! I'd say you could go back to 6 units, stick with it for 3-4 cycles getting what numbers you can, then increase if needed. Make sure you're testing for ketones as often as possible, and that should help keep Gryphon safe. What do you think of this plan?

 

Thank you! I will do some reading!

 

Thanks Rachel! I gave him 6U and I'll test and monitor really closely for the next few days.

 

I second what Bron has said. Going to Caninsulin is going backwards. Both Lantus and Levemir are longer lasting, gentler insulins than Caninsulin. Neko was on Caninsulin first and it wore off fairly quickly, leaving her higher for longer. Unfortunately, too many Canadian vets are stuck on Caninsulin as their first choice. I don’t know if there are articles specific to insulin choice and acros, but they have been many acrocats on FDMB, and pretty much all of them did better on either Lantus or Levemir. And more do actually better on Levemir because of Lantus’s acid base and tendency to sting at higher doses.

Regulating an acro can be tricky, because tumour changes can change the amount of insulin needed. Plus pain, infection, inflammation plus heart conditions can all contribute to insulin resistance. Treat those issues and regulation will be easier. Picking one of our dosing methods and following it will also help,