new to lantus

Sybil and Zoe

Sybil and Zoe

Member Since 2018
Zoe has been on Vetsulin since diagnosis 10/2018. It never really touched her. I have been fervent in checking her BS at least pre shot twice daily and sometimes doing curves on weekend. Finally I took her to vet in March to get follow up curve--they did a fructosamine and it came back 516. She had stayed in mid to high 300's on my meter (alphatrak2 w/freestyle strips) no matter what I dosed her. I got her up to 5.5 units of vetsulin and the vet put her back on 3 when she was kenneled in January for a quick trip out of town. Didnt matter because she still ran about the same. Finally with the 516 the vet kept her for 2 days and tried to stabilize her but ended up bumping her to 6 units and she still ran in mid to high 300s. I said I know vetsulin is not working and she has to be changed to the $$ Lantus. I received a couple of pens yesterday from a fellow member and have ordered a vial from Canada.

I started the Lantus and have stayed home from work today because I am scared of her reaction with all the references to bottoming out on a new insulin. I know it is early and just had two shots, but I am not seeing much happen. Its weird that she drops a little about the 3 hour mark and then starts climbing again. I only started her on 1 unit tho the vet had ordered 2 u due to her BS levels. I was just afraid to dive right in. I will kennel her tomorrow and maybe they can adjust it since I have to be outof town for the day and cant watch her.

I need for a seasoned Lantus person to look at her numbers and see what they think.
 
also, I see people talking about feeding more often. I'm a little afraid I will confuse the BG numbers if I give her food inbetween.
 
I am by no means nearly as experienced as other users here, but Lantus typically takes a few cycles to get going. Have you read the stickies at the top of the forum page? Lots of good information there about how Lantus works, and some dosing methods. Most important thing to know is that Vetsulin is not a long-acting depot insulin, meaning it doesn't store in the body and build up a reserve of sorts. Lantus is a long-acting insulin, and it does build a depot or reserve, which is why it works better for cats--they can pull a little more if/when they need it. Building the depot/reserve is why it takes a few (maybe several) cycles to see an effect.

Given the high dose of vetsulin, 2U seems a pretty safe starting point for Lantus, but it is completely understandable to want to start low and increase slowly. The first time Max was diagnosed he started on 2U, never went higher, and went on this crazy slip-slide down in doses when he went into remission (that was at least a month into it though). This time he's only on 1U, and seems to be responding well, but it's taken some time. I was also very nervous about how he'd do this time around with dosing, and started with the Start Low and Go Slow method. He's doing better with the Tight Regulation Protocol now, but this week has been a bit stressful with him not just dipping into the greens, but diving right in. His cycles are starting to show some patterns, which will make things easier going forward.

So...take a deep breath, read some stickies, come back and ask questions. And if you're running into an issue, be sure to put it in the post title, or update your title line until you get the help you need. There are lots of awesome long-time Lantus users around here that can help out.
 
Thanks so much for your reply! Yes I have read the stickies. I think I am just on volume overload because there is so much to read! I would love to do the tight regulation because I feel so bad that Zoe has been running so high for so long. I know it has only been 6 months since actual diagnosis but I think she was in trouble a month or two before that. I dont want her to get nerve damage because I drug my feet about the better choice of insulin. Sigh cat mom guilt:(. I will talk to vet tonight. Thanks!
 
I hear ya...it’s a lot to take in. I still reread some stickies regularly. You’ll get there, don’t worry.

I made it sound like we’ve been on Lantus forever...definitely not the case. We’ve been on it for all of 3 weeks. Feels like longer since we wasted time on novolin first.

And yes, we all get the mom guilt at some point. We were completely flabbergasted by Max’s loss of remission. His kidney symptoms are the same as diabetes, so it never crossed my mind. He could have been in trouble for quite some time before we caught it, and we only did because he had a really bad infection and we needed to see what his kidneys were doing before deciding treatment. The vet didn’t see the diabetes coming until it hit him with the full blood panel.
 
Information overload is perfectly normal especially since much of what you learned using Vetsulin does not apply to Lantus.

First, regarding dose. It is very rare to see numbers bottom out with an insulin switch. The only time we recommend that the dose be reduced, and then only by 30%, is a switch from Lantus to Levemir. If, in fact, Zoe needs more insulin, it's going to take a while to get the dose up to a range where your cat's numbers may start moving. (And having typed that, Zoe being a cat will probably prove me wrong.)

Lantus is a long-acting, depot-type of insulin (vs Vetsulin which is short acting an doesn't have a depot). Because it is a depot-type of insulin, it can take 5 - 7 days for the depot to form and to stabilize. Do not expect to see much movement until the depot is in place providing the dose is adequate.

A few observations based on Zoe's spreadsheet. With Lantus, we would not hold a dose that isn't working. Thus, shooting 3.5u for roughly 2 months would only happen if you stopped posting to the Board and were not getting input regarding dose. Depending on which dosing method you opt for, either Tight Regulation of Start Low Go Slow, the dose is increased every 3 - 7 days if numbers are not in a good range.

Dose increases and decreases are typically done in 0.25u increments. Increasing Zoe's dose from 3.5u to 6.0u would probably have old timers like me screaming, "What was her vet thinking?" at my computer screen. We increase doses slowly and systematically so you don't whiz past what may be an effective dose for your kitty.

Regarding switching insulin, I'm hoping that you have U100 syringes. Vetsulin uses U40 syringes. Lantus is a U100 insulin and you need syringes that match the concentration of the insulin otherwise you're not dosing correctly.

With Lantus, dosing is based on the nadir -- the lowest number in the cycle. Vetsulin dosing is based on the pre-shot number. Thus, it's very helpful/necessary to get spot checks with Lantus. Getting only pre-shot numbers is not adequate since you have no clue whether you're missing numbers that would signal a dose reduction.

Vetsulin acts rather quickly -- it's important to have food on board roughly 30 min before you give a shot. This is not the case with Lantus. Lantus onset is at about +2 and nadir is at around +6. These times are approximate since there is considerable variability with respect to onset and nadir among cats. (My cat's nadir could be as early as +3.) Because you have time before the insulin kicks in, most of us test, feed, and shoot within a very few minutes. I used to give Gabby her shot when her head was in her food bowl.

Please let us know if you have questions!

 
Hello and welcome. My girl started on Caninsulin, same thing as Vetsulin which was rebranded to sound less like a dog insulin. Neko got up to 5 units of Caniinsulin before we started back at 1 unit of Lantus. Big mistake. We normally take the dose of the current insulin in mind when switching, but my vet had me start back at one unit. Turns out some cats just need more insulin. Neko got up to 8.75 units of Lantus and I wasted a lot of time getting back up there. You don’t have much mid cycle testing on Vetsulin, but I think you will find 1 unit is too low a starting dose.

It’s fine to spread out the feeding on Lantus, it's A much gentler insulin so you don’t need to feed all at once. Smaller meals is also easier on the pancreas.
 
Sienne and Gabby (GA) said:
Information overload is perfectly normal especially since much of what you learned using Vetsulin does not apply to Lantus.

Regarding switching insulin, I'm hoping that you have U100 syringes. Vetsulin uses U40 syringes. Lantus is a U100 insulin and you need syringes that match the concentration of the insulin otherwise you're not dosing correctly.


Click to expand...

OMG I stopped reading mid post Sienne! That is a great help and I just realized I was using u40 syringes. It didnt even occur to me to switch syringe. I purchased about a 6-12 month supply of u 40s from ADW when she started on the vetsulin and I was needing more supplies. What dose have I been giving her? If you hadn't posted I would not have recognized until who knows when. I am in a pickle now without u 100 and to buy from vet are way more than online. Now that I have quit hyperventillating iver the syringe, I can go back and finish your post. Bless you for thinking of this for me!OMG I stopped reading mid post Sienne! That is a great help and I just realized I was using u40 syringes. It didnt even occur to me to switch syringe. I purchased about a 6-12 month supply of u 40s from ADW when she started on the vetsulin and I was needing more supplies. What dose have I been giving her? If you hadn't posted I would not have recognized until who knows when. I am in a pickle now without u 100 and to buy from vet are way more than online. Now that I have quit hyperventillating iver the syringe, I can go back and finish your post. Bless you for thinking of this for me!
 
See if this chart helps. It's backwards for what you need to do and I wouldn't recommend trying to do the backwards calculation. If you're in the US, you will need a prescription from your vet for syringes. I'd actually get 2 prescriptions. One, you can take to a local pharmacy and pick up some syringes. The second Rx you can mail to ADW and get syringes at a better price.

And BTW, shame on your vet for not telling you this! Maybe the vet can GIVE you u100 syringes given the lack of information.
 
Sienne and Gabby (GA) said:
See if this chart helps. It's backwards for what you need to do and I wouldn't recommend trying to do the backwards calculation. If you're in the US, you will need a prescription from your vet for syringes. I'd actually get 2 prescriptions. One, you can take to a local pharmacy and pick up some syringes. The second Rx you can mail to ADW and get syringes at a better price.

And BTW, shame on your vet for not telling you this! Maybe the vet can GIVE you u100 syringes given the lack of information.
Click to expand...

Actually, you don't need a prescription for syringes in the US. I've been able to buy them at Walmart and RiteAid without one. Walmart is FAR cheaper, about $13 for a box of 100 syringes.
 
sybil said:
OMG I stopped reading mid post Sienne! That is a great help and I just realized I was using u40 syringes.
Click to expand...

Great catch @Sienne and Gabby (GA)! You must have had a real gut feeling about the u40 syringes- Spidey sense!!

@sybil if you used a u40 syringe to measure 1u of Lantus you would have actually administered 2.5u of Lantus. That is because the concentration of Lantus (or any u100 insulin) is 100units /mL whereas Vetsulin (or any other u40 insulin) is 40units / mL. When you drew Lantus into a u40 syringe, you drew an insulin that is 2.5times as strong as a u40 insulin (100/40=2.5)

What a relief that you didn’t administer 2 units using those syringes like your vet had suggested - if you had Zoe would have actually gotten 5units of Lantus :nailbiting: Shame on your vet indeed!

It looks like Zoe was ok in the end, I’m so glad :)Good luck with the switch to Lantus!:cat:
 
Gosh thank you so much and I am so thankful it wasn't more! I was trying to figure out how much I had given. At first I thought I had given only .25 units. I also am thankful nothing bad happened. In fact nothing happened at all. I am going to continue to check her hourly through the +6 mark tonight. Poor baby's ears have been pokes do much lately. I have got to sleep tonight because I have to drive to SC (I live in NC) which will be about 3.5 hr drive and back tomorrow evening. I wanted to kennel her but my vet is not there this weekend. I agree there have been some stumbles with this vet clinic. It actually is an emergency vet /practice which I needed because she used to be so skittish I could never take her during regular hours. I could walk in anytime. But she is much more accustomed to being handled now and I can take her without grabbing and avoiding claws. I would love to take her to a cat clinic only--there is one in town, but was a lot pricier when I took some previous cats there which is why I changed. At this rate all the money I have spent on Zoe I am not looking to spend more. I am so thankful for the expertise of this board!!!!:)
 
I know what you mean! If it wasn’t for this forum I’d be BROKE!

I’m not a dosing expert period, I am fairly new here myself - but I think Zoe will be ok since her body is used to high insulin doses already. I think that’s why Sienne and Wendy might have mentioned that you could probably afford a higher Lantus dose.

It might be worth it to call and interview the cat clinic. Especially if they don’t put your cat in a life threatening situation;) You will definitely be saving money following the advice on this board. I know I certainly have!

I’m looking forward to following Zoe’s progress! Have a great weekend :cat:
 
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