Joining L&L Land this week! Still trying to nail down the starting dose...

Hello hello!!
After getting a new script from my vet at the beginning of May, the time to switch is finally here! I was hoping to start seeing some light at the end of the tunnel (a last hurrah), but Lou has been all over the place with the Vetsulin. I'm at the point now where I am so excited to try something different, it's overriding (for now) my intense fear of trying a new insulin. So... back to my original point of posting (Ha, hijacking my own post I guess)..

We will be starting him on Glargine, specifically Basaglar. Lou is currently on 3.5-3.75u Vetsulin. I've heard the starting dose of L&L would be comparable to the dose the kitty is currently on. My vet suggested starting him at 2.5u when I make the switch. I don't think I would like to go any lower than 2.0u, but obviously, I am no expert. So questions/concerns below:

1. What dose would you say I should start him on? I think the 2.5u is a decent starting point, but I'm curious to know if you think I should go higher.
2. We will be starting with the SLGS method. Honestly, I would like to do TR, but we still give him YAZ. I plan on weeding him off once this bag is finished. I've read the sticky about following TR while working full time. I work 10-hour days, and there would be no such thing as testing anything except maybe a +11. Would it be possible to follow TR with this tight of a schedule? I work 4 days a week, so I can test other times, just not religiously everyday.
   
3. I thought I heard someone here say something about feeding at a strict schedule. We feed multiple meals a day, but I'm curious what times other people feed. I'd like to help the cycle, and I've wondered if I haven't circumvented it at times.
4. My last double is on Thursday. My original plan was to switch him over Saturday am or Friday pm. I have all of Memorial Day weekend off, so I can watch him closely the first three days. Does that sound okay? Does it sound crazy to start Friday pm? I'd like to be able to test after the depot fills, so I'm thinking of starting as soon as I can.

Thanks in advance for any help you can provide me!

 

I wouldn't start any lower than that, that's for sure....I might even suggest starting at 3U

Yes you can do TR....just get as many tests in as you can...and if you can't get them during the AM cycle, the PM cycle becomes even more important!

Most of us feed multiple times a day, but what you'll need to do is see what works best for Lou. Some cats do better getting most of their food before nadir, but some cats can eat all the way up to +10 without any problems. It will just take some experimenting and good record-keeping to see what works best for Lou. (a lot of people will put an * in the cells when they feed too)

Friday PM is fine...and if Friday is a short enough day, you could even consider starting Friday AM. It usually takes 5-7 days for the depot to fill so it's unusual for them to have a big drop on the 1st dose (although it can happen!)

 

With ketones on board I would err towards the slightly larger dose if you're hesitating between two! I'd say go ahead with TR, and don't fret too much about feeding times: one of the things Lantus is good about is that it's more compatible with grazing

Just do monitor closely on the first couple of cycles: we've recently had some "surprises" when switching to Lantus/Levemir from vetsulin (ask @Lilli Plume and Plume) on what seemed to be a conservative dose choice. Green values are a great "problem" to have, though!

 

Welcome to the group!

Does Lou have a history of ketones/diabetic ketoacidosis or are you using the NovaMax as a preventative measure? This may make a difference with respect to your starting dose. (We also like to know if a kitty is prone to developing ketones.)

What I would suggest is that you get a feel for how much you can test as well as where Lou's onset and nadir fall after about a week on Lantus. It takes about 5 - 7 days for the insulin depot to form. It takes about that long for the dose to settle in and you'll have a better sense of how Lou is responding to the switch in insulin. Some cats have a marked response the first few cycles (i.e., lower numbers) and then things settle down. Given your schedule, having more information will help especially since you'll still be feeding your cat YA.

The only thing "strict" about feeding is to not feed 2 hours prior to shot time. You don't want the numbers influenced by food. Many people do not feed their cat after nadir. There's less insulin available to offset the waning amount of insulin available so a snack later in the cycle may cause the numbers to rise. When you feed may depend on what the cycle looks like. For example, my cat had an early nadir and had a tendency to have dramatic drops early in the cycle, as well. I spread out her food over the first 3- 4 hours of the cycle to help offset those drops.

 

Thank you for your responses! Lou thankfully has no history of ketones or DKA, so I definitely use the NovaMax as a preventative measure. I struggle to catch him in the litterbox to use the urine ketostix (and never when I really want to test him), so I figured testing blood ketones would be much easier for both of us to get the info we needed. He's never run higher than 0.6 on the NovaMax (in the obviously short time I've been using it ).

 

Welcome!! Your work schedule is similar to mine. I work M-Th. I would test Rex before I went to work for his t/f/s then as soon as I got home, I'd test again. That was +10. Then I just filled in the gaps on my days off.

 

Friday is the big day, and I keep waffling about the starting dose. I work a full day Friday, so I'll make the switch on the PM cycle. I think 2.5u is a comfortable starting point. However, there are a couple of problems. 1. Lou has been metabolizing his insulin at a much slower rate, peaking at around +6-8 on average. Since Vetsulin usually peaks at +4-6, it seems like once he's peaking, the majority of the insulin has been used up, which means I've had to up his dose to compensate. 2. It also seems that he might have a bit of glucose toxicity going on, which I haven't been able to keep up with. It seems as soon as he settles with a new dose, he needs an increase. These factors make me think I should start at 3u instead.

My fear with starting at 3u is if the first problem is the primary one, I'm afraid the slower action of the basaglar will even him out enough to where he won't need the higher dose. I don't want compounding hypo problems with the depot. Honestly I still haven't the foggiest idea how the depot truly works in hypo/too-high-dose situations, so I might be talking out of my behind. Of course, if it is glucose toxicity, he needs the higher dose. Thankfully, he has never had ketones (knocking on wood), so that's one less thing to worry about.

Ugh, I am tired of running around in my own mind about this, so I need your assistance. Can you explain how the depot works (so I can stop worrying about that aspect)?

Thanks in advance!

 

Bumping, please.

 

I think 3 units is a good starting point. As far as I know, it’s an even trade going from Vetsulin to glargine, so you’re only dropping the dose a tad just in case he has a dramatic response. He is on 3.75 now so I feel like anything lower than 3 would just be frustrating and take a lot longer to get him where he needs to be. As long as you are able to monitor closely for the first few days, it should be okay. You can evaluate the 3 units after 6 cycles when the depot fills and go from there.

 

Thank you so much for bumping this up for me!!

Thanks for your reply Stacy! I think you're right. I have been going back and forth and back and forth, and it's good to have another opinion to help cement things. I had talked to my husband last night, after Lou had another uneventful day. I had decided that if I was thinking of upping him to 4u, it would be silly to start at anything less than 3u. The only thing holding me back was I'm sure the bottle of Vetsulin we have is done, so that's not helping matters. My husband had the same thought process, and had even suggested starting at 2.75u if I was uncomfortable so it would take less time to get up to a workable dose.

Thank you again everyone for your feedback and suggestions! I'm nervous and really excited to get Lou started!!

 

Another thing to think about, we usually look at what has been a good dose on the old insulin, ie. one that has gotten them into green, when thinking about the dose on the new insulin. The lowest you've seen lately is mid blues, so 3.5 already has a bit of room. I wouldn't go lower than 3 units.

I presume you have the u-100 syringes? One of the things I liked about the switch was the much smaller needle gauge on the u-100 vs the u-40 syringes. I hope you'll be pleased with the switch, I was, and so was Neko.

 

That's a good point. It's good to know the doses are comparable between the two. It makes me wonder if I shouldn't start at 3.25u or 3.5 instead. I think I've just been hoping he wouldn't need as much on the new insulin, which is naive I know and not rooted in any logic.

I'm really excited about the smaller gauge as well. We had very briefly used U-100 syringes with the conversion chart when dosing really small amounts (a lifetime ago!), and Lou seemed to barely notice they were there. I've got the new syringes and I just have to hide the old U-40s once the switch is made to avoid any issues.

 

Cats need as much insulin as they need. ECID, don't sweat the dose. It's the blood sugar numbers that count. I can say this cause Neko was just seeing blues on 5 units if Caninsulin (ie Vetsulin), and vetty switched us at 1 unit. Boy was that a waste of time. It's OK to be a little cautious, just not too much.