Maybe Switching to Lantus and Need Pros' Advice

I'm attaching a PDF of Teasel's BG data for the 2 months he spent on Lantus after his diagnosis a year ago. I followed my vet's protocol of select dose, give for a week or so, do an every 4 hour curve, confer with her on new dose, repeat. I knew nothing about bouncing, insulin resistance and all the myriad nuances of treating FD in an unpredictable cat. I wasn't testing AM/PM before shot but was feeding low carb wet food and doing curves as per her instructions. She was stumped by his lack of typical response and after the last curve on this table, suggested stopping insulin for 48 hours and doing a restart. After 24 hours, Teasel was in DKA. We began ProZinc after that scary and expensive episode.

You can see from my SS that he's up and down like a yoyo - mostly up though. One day a dose will give me a blue and another day it'll have no effect at all. It's difficult to sort out whether he's bouncing and will come down or has gotten stuck in high numbers because that's his tendency. He seems to build resistance easily and I think that got us into trouble with the Lantus. He spent far too long on an ineffective dose of 1 u, a dose that caused extreme bouncing initially.

I have read that the bioavailability of PZI insulin isn't optimal (in some cats?). It's great in terms of flexibility, both in dose timing and sliding scale dosing. It's very easy to fraction doses. However, I've been using ProZinc for 10 months now and haven't been able to get him settled. He's doing OK- appetite is great, peeing reduced, no extra water drinking, no ketones, etc. He's lethargic in the first half of his cycle most days and perks up as the dose is wearing off.

Re Lantus:

1. I need to know what a safe starting dose is based on where he is right now with ProZinc.
2. I'm reluctant to leave him at a (possibly) too low starting dose as per the TR and SLGS protocols because of the insulin resistance issue.
3. TR is probably a better choice for us given his dose stickiness. He gets no dry food ever, except for freeze dried meat treats as rewards.
4. I'm in Canada so Lantus can be bought OTC for a very reasonable price.

Looking for feedback from all the usual suspects. If you need more info, I'll be checking here often.

 

@Wendy&Neko
@Sienne and Gabby (GA)
@Chris & China
@Bobbie And Bubba
@Marje and Gracie
@Jill & Alex (GA)
@Doodles & Karen

Your feedback is requested. Apologies if I've forgotten others. These are the names that came to mind.

 

Morning, Kris! I'm interested to hear what the experts have to say-- I learn so much by discussions of the non-standard cases like Teasel. I don't really know enough to be able to comment extensively on this case, but it certainly does look to me that the Lantus was never given a chance to work properly. I hope that, with the help of the pros, you can devise a new approach that will work for your sweet Teasel!

 

Thanks, Nan. I agree that the first kick at the Lantus can wasn't handled properly. I also know that Teasel isn't likely to become an easy cat just by doing the switch.

 

In looking at your SS I would likely start with a lantus dose of 2.5 or 2.75u. There is no need to drop the dose to the recommended starting dose in the stickies when you have data and Teasel has been on insulin. Usually the switch is done in a 1 :1 ratio.

Also agree that Lanus was not likely given a good chance in the beginning. @Bobbie And Bubba made the switch and a few others. You would need to start testing a bit more and certainly getting a before bed test every night. I'll leave it at that for now and sure others will chime in later today.

 

Thanks for this Karen. Much appreciated!

 

You'd be surprised what can happen when following the protocol and testing as much as needed to get there.

 

Just to add another variable , is Levemir also on the table, or are you just considering Lantus?

 

Bump

 

I'd try Lantus first. It's more commonly used, my vet knows it but not Levemir, etc. Having said that, I'd be undertaking the switch without my vet's involvement. Staying with what's more familiar for now.

 

bump

 

bump

 

Others come on the board later in the day. We're all also mourning the loss of another sweet kitty named Gussie today.

 

Thanks, Karen. I know about Gussie completing his bucket list. What a wonderful kitty he was.

 

I'm glad you are making the switch, Kris I think you gave Prozinc a good chance - Murphy was on it for the 1st 10 months as well. I hope you will be lucky and get him regulated on Lantus. It will be nice to have you on this board

 

Thanks, Carol. I've been inching (centimetering?) in this direction for quite a while. I'm brave when it's stuff for me but an absolute worry wart when it comes to the fur kids. I just need advice on a starting dose of Lantus.

 

Kris, u r the bestest kitty Momma. Ain't that the truth , that when it comes to them we are all detail and info....it's just the immense sense of responsibility , that they are innocent and at our mercy. I KNOW u will make the right choice for Teasel, the cutie pie

 

Morning Kris. It's snowing here (Vancouver), so a little slow getting going this morning.

I agree with Karen that I'd start at least on 2.75 units. He'll likely need to go higher in dose cause I don't see green on 2.75 units of Prozinc, but we take the dose of the existing insulin into consideration when we switch. I would switch when you can monitor closely, that means for 24 hours if necessary. The recommendation are to test at least every 3 hours the first day. Some cats have a strong reaction to a new insulin, some don't. Of those that react strongly, some do it the first cycle, some the second. So keep that in mind for your first shot of Lantus. Also keep in mind that since Lantus is a depot insulin, you may not see the full effect of the dose until at least 6 cycles after you start.

What Teasel did on Lantus one year ago is old news and likely is no indication of what he'll do now. I also agree with your comment that some cats build up resistance or glucose toxicity quite easily. I had to "keep the pedal to the metal" so to speak with Neko. If she didn't keep seeing green at least every few days, her bounces got worse and I'd have to increase.

A question for you - what is your goal for Teasel? Where would you like his blood sugar to be? Are you comfortable seeing him in green? Note that you will need a different mind set on the L insulins, we dose based on how LOW the dose takes kitties, which is why we nag about those before bed tests. Neko was another that loved to go low and night and bounce during the day. And another difference is that eventually you will have to learn to shoot full dose on lower numbers. Lantus is great at keeping low numbers low and flat. Shoot low to stay low is our motto.

FWIW - my vet hadn't heard of Levemir for kitties but I liked it better for Neko than when she was on Lantus. And I was glad I switched when we had to go up to higher doses a second time.

 

Thanks, Wendy, for the detailed reply. I like that you get my concerns about resistance because I'm pretty sure it's an issue for Teasel. As for where would I like to see his numbers - safe greens would be nice. I don't have much experience down there because he's been SO variable in his responses. I've been overly cautious dosing because I can never be sure of what I'll get.

I've said that I don't think he'll be easy to manage on Lantus either. I stand by that until I see evidence to the contrary. I follow many folks on the L&L forum so I see the craziness some kitties still show. It would be great if his energy level was better on Lantus. He's usually lethargic in the first half of his cycle on ProZinc.

Levemir might be an option down the line. For now it would be Lantus.

 

Sorry, just seeing this now. I didn't receive an alert for the tag.

There's not much to add to Karen's and Wendy's comments. Data more than a few weeks old doesn't mean much to me, so after looking at current data, if I were in your shoes I would resume Lantus at 2.75u bid. Monitor frequently the first few days. As Wendy mentioned, I suspect you'll be increasing the dose before too long, but let's see how things go. One never knows!

Your comment made me smile. I hope Teasel is cooperative!

Try to forget what you know about Teasel and Prozinc and post often.
Good luck with the switch!

 

Thanks, Jill. I must admit that Teasel's old data as well as the DKA episode still haunt me.

 

That's totally understandable. Perhaps knowing that you'll be going about this differently this time may help. You're also an experienced caregiver who is familiar with BG and ketone testing. I'll be candid, switching insulins is a tricky time when we're dealing with a cat who has experienced DKA or is ketone prone. However, one of the pluses is there are several of us who will jump on as much as a hint of ketones by immediately suggesting a stepped up plan of action. Count on it. We don't mess around with these kitties.

Test for ketones often and keep us informed, ok?

 

I have a fairly new bottle of Lantus that was bought just before I decided to switch my friend's cat to Lev when I was babysitting at Christmas. I'd be happy to send it to you if you pay shipping.

 

OH NO!!!!!! Just got home got the tag and went here first, sorry Kris, I am sad to get this news

 

Kris, I am going to respond tomorrow I had a long day and just got home and I am wiped out. I do have a few things to add that might make you feel more comfortable should you switch.

 

Take your time, Bobbie. I can wait. I appreciate all the feedback received so far.

So sad about Gussie. I'd been following his bucket list story and looking at his videos. What fierce determination he had!

 

What a kind offer! I worry about shipping insulin in cold weather. I'm in Ottawa and who knows what the temperature will be on any given day. It's fairly reasonable in price here as you know so I'll go buy the cartridges.

 

Just like Jill, I didn't get an alert about the tag. Sorry to be late to the party.

You've gotten some great suggestions. The one thing I want to point out is that I would not use FS strips in an AT meter. At one time, Abbott manufactured both the AT meter and the FS meter and strips. Abbott no longer makes the AT meter. There is no reason to think that the FS strips will work in an AT meter. As I'm sure you realized, the AT strips cost an arm and a leg. Most of us tend to use a human meter. In fact, the protocols we use are based on the calibration from a human meter. It's entirely up to you whether you opt for the AT or a different meter. However, I would not put my faith in results with FS strips and an AT meter.

The other suggestion I'd make is to review the sticky notes at the top of the board, especially those that discuss the two approches to dosing that we use. These are the sticky notes on the Tight Regulation Protocol and Start Low Go Slow.

Jill's right. I'm among those who had a kitty start this journey with DKA. As a group, many of us are very sensitive to the signs and symptoms. Ketostix are your best friend!

 

Thank you, Sienne! I have a Freestyle Lite meter as well as the AT meter so no problem changing. I've already printed out all the stickies and reviewed them in detail, underlined, etc. It seems that I won't be the only one who's been spooked by a DKA experience. I've just begun logging ketone test results on my SS. I'd been keeping them in a separate pencil and paper record book.

 

I keep bumping this up because it appears that tagging hasn't worked well today, as per peoples' comments.

 

Kris, you are certainly not alone in dealing with DKAs ability to haunt .

 

Yes, I know you had a bad scare with Elmo. Such dangerously ill kitties ...

 

Do you have any additional questions? Or are they all answered?

 

I think I have a pretty good handle on things, Wendy. Bobby will be giving me her take tomorrow. I haven't heard from some others I tagged but that's fine. As I said above, I've read over all the info stickies, have my Freestyle Lite meter ready to go and need to decide what day(s) I can be available to do all the monitoring that's recommended at the start.

 

Once you've got all your questions answered, it helps to remove the ? from the subject title. Some of us scan for them and it's good to know you got the information you need.

 

Done.

 

Good luck, Kris, and welcome!!

 

Thanks, Carol. I have to figure out when to start because I have AM commitments tomorrow, Monday and Tuesday.

Question for you: when you switched Murphy from ProZinc to Levemir, did you do 1:1 dosing? A couple of the experienced folks here recommended that but I worry given Teasel's unpredictable responses to insulin. Also, Sue (Frankie and Rom's mom) said she lowered the dose to less than half when she switched Frankie. With Rom, the vet advised a 1:1 but it ended up being too much. I realize that "know thy cat" is a governing principle here. That's why I'm asking. Murphy shares some of Teasel's "excitability".

 

I checked your 2016 SS and I see that your last PM dose of ProZinc was 1.6 u and your first dose of Lev the next AM was 1.25 u. Was that a "just in case" reduction?

The change in meter will mess up my thinking but I'm willing to do it so folks here will understand the numbers. I have a Freestyle Lite meter. I'll have to set up a new SS even though I see that the cutoff points for BG colour coding only affects the low greens.

 

Kris, with history of DKA and the numbers Teasel is currently seeing I would not start much lower on the Lantus dose. Lantus is good at providing flat cycles but not great at pulling numbers down because it's a depot insulin. See what dose he's on the day you're going to switch. If you're nerved on doing the 1:1 taking it down .25u or so is fine, you can fast track him. Like Wendy mentioned some kitties do have a marked response to an insulin change the first 24 hours so you'll need to monitor as suggested above. When you do switch, make it clear on the SS and we can ask @Marje and Gracie to convert your current SS to reflect switching to a human meter too. No need to create a new one.

 

I don't know where everyone got the idea that ABBOTT no longer manufactures the AT2 meter or the strips for it. Granted the packaging on the meter and strips both now have Zoetis on the label however this does not mean the product itself has changed or is being manufactured by someone other than Abbott.

Zoetis is not in the business of manufacturing either meters or test strips. They are marketing the product, not making it. Zoetis in fact has always been owned a piece of the AT2 meter in partnership with Abbott. In the past they let Abbott market the product but they have now bought out ABBOTT's animal division and market the meter themselves.

The strips for both the FS and AT2 meters have patents on them and those patents have not changed since Zoetis took over the marketing. They are identical on the AT2 and FS strips which means the strips are still the same strips manufactured by Abbott. The AT2 strips have always had one extra US patent and that has not changed either further proving the strips are indeed still an Abbott product. The other proof is that the butterfly logo on the FS strips still appears on the AT2 strips. Since the logo is a trademark belonging to Abbott, Zoetis could not use it if they were now manufacturing their own strips. So while I am not advocating use of the FS strips in the AT2 meter, they will still work but will add another variable to the readings one gets simply because there are 5 different cat codes on the AT2 meter and one doesn't know which is most accurate for their specific vial of FS strips.

 

Kris - it was recommended that I start Murphy on 1.5 units of Lev, but I started lower at 1.25 instead. I was very glad I did, because he had an immediate reaction to Levemir, and I had two reductions within a week (down to 0.75 unit) I remember having such high hopes at that point - only to have them dashed as time went by, and little unregulatable Murphy re-emerged. But you have the DKA issue that Murphy did not have. Yes, Murphy and Teasel are very much alike in this regard (erratic responses to insulin). I also use Freestyle lite meter. Thanks for info above, Linda.. Kris, we have discussed this before, I continue to really dislike the human meter readings, but two things 1) there is a real psychological boost because you will get much lower numbers and 2) it really is easier for the board to give advice. I sincerely hope you have great luck with Lantus

 

Hi Kris I just wanted to add that since you have been systematically raising Teasel's dose with the Pro Zinc already which in not different that how it is done on Lantus , that should help you feel comfortable with the switch and the starting dose on Lantus.

Here couple of advantage I saw for switching to Lantus :

1. There is someone always on board since this is such a large group and peeps are from all over the word in different time zones. Any questions are answered very quickly.

2. With Lantus being dosed on the nadir and not the pre shot, you will be able to shot lower numbers since the Lantus give a flatter curve. That will allow you to get more insulin in him when the numbers start coming down .

3. I personally loved that there was a protocol with TR that took a lot of the guess work out of dosing. With Pro Zinc I was always guessing as to what dose to give when the pre shot number was lower than I was used to seeing.

You have been over here studying and reading posts and I think you will be just fine.

One question, I noticed on you SS that you marked scruff a few times Is it an occasional time that you shot the scruff? As it is believed that the absorption of insulin is poor in the scruff.

 

I shot mostly scruff/shoulders area for 5 years. I experimented with the flanks and found no difference. ECID maybe?

Back to dosing, Carol had been seeing green on Murphy on the Prozinc 1.6 unit dose when she switched to Levemir. In that case, dialling back a bit made sense.

Your morning committments next week, how long are they and at what part of the cycle?

 

I have shot the scruff when I wanted to slow down the cycle otherwise, I always shoot the shoulders. When Bubba was first DX the vet told me the scruff was not an idea spot because of absorption . And you are probably right about it being an ECID thing .

 

Typically, the only time you lower a dose when switching insulin is when you switch between Lantus and Lev. When switching between a different type of insulin to Lantus/Lev, you are able to keep the dose of the non-depot insulin when you switch. There are some exceptions as Wendy noted above.

As for where you shoot, I shot Gabby in the scruff for 6.5 years. Every time I got the bright idea to shoot elsewhere, especially the flank, I'd give a fur shot. She also let me know she was not amused by a shot anywhere else. (Gabby was a tortie and was expressive with respect to her displeasure.)

One housekeeping note: When you start up with using Lantus, you will want to open a new thread (we refer to threads as "condos" every day. You'll notice that people use a format for the subject line -- date, kitty's name, AMPS-#, +#). We also link the previous day's condo to the current condo so it's easy to go back to track what's been going on.

 

Thanks, Karen.

Hi Bobby,

I rarely use the scruff anymore, mostly his sides and flank. I had to work out ways to hold his skin properly because my hands are extremely weak and my opposable thumb is a dud. At first I used his scruff because I could manage it. Eventually I devised ways of using the other areas. Where there's a will there's a way.

Thank you for your feedback.

 

I'll be gone from +2 to +5 or +6 based on when I'd be dosing.

 

With Lantus, getting a +2 test is quite helpful. If it's around the same as the preshot, you'll have a normal Lantus cycle. A +2 that is lower means a more active cycle that needs testing. Of for people who will be going out during the cycle, it could mean leaving out higher carb food to eat.

 

Hi @Kris & Teasel . Glad to see you are taking the plunge again. I hope it works out for you this time. Just to clarify, it was the RVC vet who halved Frankie's dose. He was on 8 units twice a day on Caninsulin and he started Lantus on 3 units twice a day. He wasn't a good vet (for the RVC I hate saying that) but even he realised 8 units starting on Lantus would have been daft.

 

Thanks for the clarification, Sue.

 

When's the day, Kris?

 

Hi Carol,

I had an AM to mid day commitment today, likely another tomorrow and again Tuesday. I was/will be out from +2 to around +5 or +6. I wouldn't be able to do close monitoring in the first half of the cycle. Might have to wait until Wednesday.