Starting Lantus Tonight- What Do I Need To Know Immediately??

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Ozzy Pawzbourne

Ozzy Pawzbourne

Member Since 2016
I'm going through the stickies in the forum now.

Can anyone give me a smart pill in the next hour? Ha!

Just curious what I might need to know immediately before starting?

A little background and initial questions:
  • Ozzy has been on vestulin for last the month after barely surviving a DKA episode (this is how we found out about his diabetes dx). It doesn't last long in his system and I could never give him increased doses to bring his numbers down to healing ranges because he would nose dive around +3 and I'd have to steer him with food to try to avoid a hypo situation. Hence the reason for the insulin switch.

  • Ozzy has been between .75 and 1U of vestulin for recent doses. Our vet (who is not knowledgeable in lantus and took a leap of faith to let us try it - bless his heart!) prescribed 1U BID. Should I feel comfortable with this dose? Is 1U lantus comparable to 1U vestulin? I know they have different particles of insulin per unit (100 particles for lantus /U vs 40 particles/U for vestulin) so it seems lantus is more concentrated than vestulin so I am not sure if it 'stronger'?

  • I understand that lantus tends to produce longer slower drops in cats. I will probably be able to stay up to monitor Ozzy for his first PM cycle on Lantus tonight up to +5 (I might fall asleep after that) so probably want to be conservative this evening due to new insulin and the fact I can't monitor his whole cycle.

  • When are nadirs seen in lantus? I think I read somewhere around +6. Does that sound right? We are coming off vestulin which nadir'd in Ozzy between +3 - +4.

  • Can I give Ozzy his first dose of Lantus tonight a little early (like at +10) from his AM vestulin dose? I will be able to monitor his first cycle better that way.

  • I think vestulin is an 'in and out' type insulin as others have described vs a depot, but I don't really know the difference between the two. Can someone please explain? I think it means one goes out of the system completely at the end of the cycle vs a cumulative effect, but I am not sure.

  • How often should I be testing? With vestulin, I could go up to +4 and call it quits for the cycle because Ozzy's BG numbers always rose after that.

Any advice you can give a Lantus newbie who is giving lantus to her kitty for the first time in about 90 minutes???

Thanks in advance for any help!!:bighug:
 
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bumping you for help.

I don't have any experience with switching. My cat's nadir can be anywhere from +4 to +6 unless she is clearing a bounce.

The +2 test should give you an idea of the cycle. If it is similar or lower that the PS number it may be an indication of an active cycle.

Hope this helps.
 
The depot means that the insulin builds up in the system....you won't see the full effects of what a dose will do until you are consistent with it for about 6 cycles.
 
Welcome to Lantus/Levemir Land! We are running a little short of those smart pills but no worries...you'll learn fast. It sounds like you are on the right track by reading the stickys.

Ozzy Pawzbourne said:
  • Ozzy has been between .75 and 1U of vestulin for recent doses. Our vet (who is not knowledgeable in lantus and took a leap of faith to let us try it - bless his heart!) prescribed 1U BID. Should I feel comfortable with this dose? Is 1U lantus comparable to 1U vestulin? I know they have different particles of insulin per unit (100 particles for lantus /U vs 40 particles/U for vestulin) so it seems lantus is more concentrated than vestulin so I am not sure if it 'stronger'?
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Ozzy saw a little green action at 1u but he's been yellow with some blue at 0.75u. Yes 1u of insulin is 1u of insulin but the two insulins have a very different action and, as you noted, Lantus is less concentrated. With Vetsulin, onset is almost immediate and so you must have food in Ozzy even before you shoot. Vetsulin duration is 6-8 hours although some cats get a little more, some less. Vetsulin does not have a depot and so you can shoot based on the preshot.

Lantus doesn't generally onset until +2 so it's ok to test/feed/shoot all within about 15 minutes. Most of us feed while shooting just so the kitty is concentrating on eating and not the shot. Lantus duration is about twelve hours. When you shoot lantus it forms a precipitate and slow releases. When you start shooting lantus, part of the shot goes towards controlling the BG and the rest goes into the depot. We generally shoot on the nadir we expect and not on the preshot.

You might see a quick response to a Vetsulin shot but generally, when starting lantus, the depot has to fill before you see numbers come down. However, there are exceptions and we have occasionally seen cats respond to lantus with the first dose.

If you want to be cautious, you could start with his current Vetsulin dose of 0.75u since he's had some blue numbers there.

Ozzy Pawzbourne said:
  • I understand that lantus tends to produce longer slower drops in cats. I will probably be able to stay up to monitor Ozzy for his first PM cycle on Lantus tonight up to +5 (I might fall asleep after that) so probably want to be conservative this evening due to new insulin and the fact I can't monitor his whole cycle.
  • When are nadirs seen in lantus? I think I read somewhere around +6. Does that sound right? We are coming off vestulin which nadir'd in Ozzy between +3 - +4.
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Nadirs can vary but, yes, generally around +6 is what you might start to look for. We've had some cats here nadir at +3 on lantus and some nadir a bit later. Because you don't want to stay up late tonight, starting at 0.75u might be best. We can always have you increase the dose after 4-6 cycles if he's high and flat. With DKA in the past, you don't want him at too low of a dose of insulin for long.

Ozzy Pawzbourne said:
  • Can I give Ozzy his first dose of Lantus tonight a little early (like at +10) from his AM vestulin dose? I will be able to monitor his first cycle better that way.
Click to expand...
As long as it is clear he is past his nadir and his duration is waning, then yes, you can shoot at +10 with lantus. Remember from your reading that, due to depot and the approaches we use here, you want to try and shoot fairly consistently (around 30 mins max variation) with lantus. Sometimes we have to shoot early or late and we can help you get back on time when you need that assistance.

Ozzy Pawzbourne said:
  • I think vestulin is an 'in and out' type insulin as others have described vs a depot, but I don't really know the difference between the two. Can someone please explain? I think it means one goes out of the system completely at the end of the cycle vs a cumulative effect, but I am not sure.
Click to expand...
Yes, correct. Because lantus is a depot insulin, one shot builds upon the previous. When you increase a dose, it can take up to six cycles (but every cat is different) to fill the depot. When you reduce the dose with Vetsulin, the effects are immediate. When you reduce with lantus, the depot can affect up to six subsequent cycles so it's not always immediately clear if the reduction is holding.

Ozzy Pawzbourne said:
  • How often should I be testing? With vestulin, I could go up to +4 and call it quits for the cycle because Ozzy's BG numbers always rose after that.
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I would start tonight with a +2, +4 and either a +5 or +6 depending on whether he is flat or he's coming down. We like to do random tests at first when building data but it is often good to get a +2 test because if the +2 is similar to or less than the preshot, it's likely to be an active cycle.

Ozzy Pawzbourne said:
Any advice you can give a Lantus newbie who is giving lantus to her kitty for the first time in about 90 minutes???

Thanks in advance for any help!!:bighug:
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Ask questions...we love questions. We are a very supportive community and members will stay up all night with you if you are getting lower numbers. We also recommend that if you get a 150 or below, don't feed but post and ask for help and we will walk you through it.

Do you have plenty of strips, HC food, and a hypo kit?

And one other thought....it is ok to start tomorrow if you'd rather go with 1u and dose during the day.
 
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Marje and Gracie said:
If you want to be cautious, you could start with his current Vetsulin dose of 0.75u since he's had some blue numbers there
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This is the dose I was thinking of going with earlier and you're comment has confirmed that's what I'll do here shortly.
Marje and Gracie said:
With DKA in the past, you don't want him at too low of a dose of insulin for long.
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This is what I have been concerned about since I can't get him out of yellows on vestulin. And increasing his dose brings him down too quickly.
Marje and Gracie said:
As long as it is clear he is past his nadir and his duration is waning, then yes, you can shoot at +10 with lantus. Remember from your reading that, due to depot and the approaches we use here, you want to try and shoot fairly consistently (around 30 mins max variation) with lantus. Sometimes we have to shoot early or late and we can help you get back on time when you need that assistance.
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Ok, this I am a little concerned about but we will learn to adapt. I have somewhat of a predictable/unpredictable schedule but I can learn to adjust. But...I have been on vacation for last few weeks for the holidays and giving Ozzy insulin a little later in the ams/pms than I would if I had been at work. I go back to work on Tuesday. He is being dosed around 8:30. I need to bring him back to around 7 (am/pm). How do I get him back safely? Darn vacations!!
Marje and Gracie said:
Yes, correct. Because lantus is a depot insulin, one shot builds upon the previous. When you increase a dose, it can take up to six cycles (but every cat is different) to fill the depot. Likewise, when you reduce the dose with Vetsulin, the effects are immediate. When you reduce with lantus, the depot can affect up to six subsequent cycles so it's not always immediately clear if the reduction is holding.
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This is interesting and I appreciate you sharing this knowledge.
Marje and Gracie said:
We like to do random tests at first when building date but it is often good to get a +2 test because if the +2 is similar to or less than the preshot, it's likely to be an active cycle.
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I am not sure I understand this comment. What should his curve look like at +2? Higher than PS? On vestulin, he was already on his way to nadir at +2.
Marje and Gracie said:
Do you have plenty of strips, HC food, and a hypo kit?
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I'm stocked up for now. Thanks!
Marje and Gracie said:
And one other thought....it is ok to start tomorrow if you'd rather go with 1u and dose during the day.
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I really want to start tonight so I have more cycles to monitor before I return to work on Tuesday.

I am actually doing his PS test now and then going to shoot his first dose of lantus. I'll post back his PS number. I'm kind of curious what it is going to be since we gave him really low to no carb food today with some raw incorporated.

THANKS SO MUCH!!!
 
Ozzy Pawzbourne said:
I am not sure I understand this comment. What should his curve look like at +2? Higher than PS? On vestulin, he was already on his way to nadir at +2.
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On Lantus, the +2 can act a lot like a crystal ball....in some cats a +3 is better (you'll find out which works best for Ozzy)

If the +2 is about the same as the PS, it's usually a pretty normal cycle....gradually down to nadir (around +4 to +7) and then gradually back up again

If the +2 is higher than the PS, it can indicate there's a bounce starting.....those are the cycles where you can usually take a pokey break and get some sleep

If the +2 is lower than the PS, that's your early warning that Ozzy might be going a lot lower later in the cycle and you'll want to get more tests in
 
Chris & China said:
On Lantus, the +2 can act a lot like a crystal ball....in some cats a +3 is better (you'll find out which works best for Ozzy)

If the +2 is about the same as the PS, it's usually a pretty normal cycle....gradually down to nadir (around +4 to +7) and then gradually back up again

If the +2 is higher than the PS, it can indicate there's a bounce starting.....those are the cycles where you can usually take a pokey break and get some sleep

If the +2 is lower than the PS, that's your early warning that Ozzy might be going a lot lower later in the cycle and you'll want to get more tests in
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Thanks China. This is helpful!
 
Ozzy Pawzbourne said:
This is the dose I was thinking of going with earlier and you're comment has confirmed that's what I'll do here shortly.

This is what I have been concerned about since I can't get him out of yellows on vestulin. And increasing his dose brings him down too quickly.
Click to expand...

Lantus does not pull numbers down quickly so it requires patience. Normally, someone new to lantus would hold the initial dose 5-7 cycles but if he is high and flat, we will want to increase the dose sooner than that.

Ozzy Pawzbourne said:
Ok, this I am a little concerned about but we will learn to adapt. I have somewhat of a predictable/unpredictable schedule but I can learn to adjust. But...I have been on vacation for last few weeks for the holidays and giving Ozzy insulin a little later in the ams/pms than I would if I had been at work. I go back to work on Tuesday. He is being dosed around 8:30. I need to bring him back to around 7 (am/pm). How do I get him back safely? Darn vacations!!
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You can shoot early 15 mins twice a day or 30 mins once a day. Also, if he's really high once cycle, you can shoot an hour early. You can read more about changing schedules here.

Ozzy Pawzbourne said:
I am not sure I understand this comment. What should his curve look like at +2? Higher than PS? On vestulin, he was already on his way to nadir at +2.
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Chris explained this above so I won't go through it again unless you have further questions.

Ozzy Pawzbourne said:
I really want to start tonight so I have more cycles to monitor before I return to work on Tuesday.

I am actually doing his PS test now and then going to shoot his first dose of lantus. I'll post back his PS number. I'm kind of curious what it is going to be since we gave him really low to no carb food today with some raw incorporated.

THANKS SO MUCH!!!
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Sounds good. We will see what he is doing. You're welcome.
 
crap! i dont think they gave me the correct syringes. I don't see the half unit measurements. Here is a pix of box
 

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There is a big difference between a U40 and a U100 syringe but it's the 1/2cc vs 0.3cc that is more of a concern.

It will take me a bit, but if you want to shoot tonight, I can figure out what dose to shoot with those syringes. Or you can wait and start tomorrow night when you have a chance to get the correct syringes.
 
The problem with using a 1/2cc syringe as opposed to a 0.3cc syringe is that in some 1/2cc syringes, the lines are measured in 2u instead of 1u as you would see in a 0.3cc syringe. A 1/2cc syringe holds 50u of insulin and the 0.3cc holds 30u. So you would have to be super super careful to be sure and tell whether the 1/2cc syringes you have are marked with 1u lines or 2u lines. You could grossly overdose him.
 
Marje and Gracie said:
The problem with using a 1/2cc syringe as opposed to a 0.3cc syringe is that in some 1/2cc syringes, the lines are measured in 2u instead of 1u as you would see in a 0.3cc syringe. A 1/2cc syringe holds 50u of insulin and the 0.3cc holds 30u. So you would have to be super super careful to be sure and tell whether the 1/2cc syringes you have are marked with 1u lines or 2u lines. You could grossly overdose him.
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****!! Ok, checking. BRB..
 
ok, they have 1U lines. 50 lines total. From the 0 line to the 5 line, there are 5 dashes. So 1U for each line.

50 lines total.
 
Let me look at your pictures again.

I wouldn't use a U40 syringe. It would be difficult to draw that small of a dose.

BRB.
 
It's a TINY space between 1U and 0U!! Couldn't I just give Ozzy the 1 U? Isn't that the recommended starting dose for lantus? And he has no depot built up yet. Is 1U on the 1/2cc syringes still 1 u as compared to the 0.3cc syringe?
 
Ozzy Pawzbourne said:
It's a TINY space between 1U and 0U!! Couldn't I just give Ozzy the 1 U? Isn't that the recommended starting dose for lantus? And he has no depot built up yet. Is 1U on the 1/2cc syringes still 1 u as compared to the 0.3cc syringe?
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Yes it is the same but it's just easier to read on a 0.3cc syringe if you are shooting 0.75u.

The starting dose on lantus depends on whether another insulin has been used before or not. If another insulin has been used, the dose must be taken into consideration. For a newly dx cat that has never been on insulin, we have a couple different ways to calculate the dose.

I think you could draw 1u and squeeze off a tiny drop. While it hasn't happened often, we have seen a few cats respond quickly to lantus and I don't want you to be up all night if you shoot a unit.
 
ok, to make sure I'm crystal clear here- I am going to use the U-100 syringe that holds 50 units, and draw up the insulin to the 1U line and then squirt out a drop. Is this correct?
 
ok, wish me luck. Looks like it will be a later night than I thought. Happy New Year, righ!!!

Thanks Marje!

1u IS 1u, right??
 
I'm sorry you are way off your shot time.

Yes 1u is 1u but I just wanted to be sure your 1/2cc syringes were marked in 1u lines instead of 2u. It's easier to dose a small dose on 0.3cc syringes.
 
You can get the right syringes from WalMart tomorrow....you want Relion 3/10ml, 30 or 31 gauge, 8mm insulin syringes....they're $12.58 plus tax for a box of 100 and all their 3/10ml syringes come with half unit markings (even if they don't realize it)
 
Ok - the deed is DONE. Good luck Ozzy Pawzie!

Agreed, even 1U markings are a little hard to read. Especially since Lantus is so clear. Vestulin was a little cloudy looking so you could see it better in the syringes.

I squired out a drop. Could have even ended up with a .5 u dose.

Marje and Gracie said:
You're welcome. I'll be up a while to watch out for you.
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Thank you so much! Words cannot describe my gratitude!!
 
Chris & China said:
ou can get the right syringes from WalMart tomorrow....you want Relion 3/10ml, 30 or 31 gauge, 8mm insulin syringes....they're $12.58 plus tax for a box of 100 and all their 3/10ml syringes come with half unit markings (even if they don't realize it)
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Thank you for the suggestion. I will call and see if I can get them without a prescription. I got the box tonight from my vets office...for over $20! I will see if I can return, but not sure since the box is open.
 
Ozzy Pawzbourne said:
Thank you for the suggestion. I will call and see if I can get them without a prescription. I got the box tonight from my vets office...for over $20! I will see if I can return, but not sure since the box is open.
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Good job. They should take them back since they gave you the wrong ones. Hopefully, you can estimate the same amount of insulin in the morning until you can get the right syringes tomorrow.
 
Normally, we'd say he might come down because the PS is the same as the +1.5.

Let me look around and see if any of our overseas friends are up to check in on you. BRB.
 
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