? Transitioning to Basaglar from Vetsulin with active UTI

Vlad has been through the ringer, but he's doing decent all things considering. He has been on vetsulin for weeks now, after being in remission for months. Currently on antibiotics to try to calm down a tooth infection and now a UTI. Urine sent off for culture, waiting on the results to see if we need a different antibiotic. He has blood in his urine, which is disconcerting.

That being said, over the past 5 days he's been doing a lot better. He's gone from 5.5 lb to 6.2, he's eating much more, and drinking, not constipated anymore.

I have Basaglar, and want to transition him. Vet recommended waiting to transition from vetsulin until we get his BG more stable. It seems to me that having a more stable BG would help everything, so I'm considering transitioning him now. He's on 4.4U in the morning, 4.2 U in the evening (only because he has gone low a few times at night). His AMPS/PMPS is always high, hoping if I get him on a glargine insulin it might flatten a bit.

He's only 6.2 lbs, doc recommended 0.75U basaglar once we do transition. Am I crazy for wanting to transition him now instead of waiting to clear UTI? How long should I hold 0.75U before increasing if he's staying in the 500's or something? I'd start him at 1U, not sure if that is wise at his weight.

 

bumping this for some experienced eyes...

Did your vet give you a reason for starting the basaglar dose so much lower than the current vetsulin dose? Usually we do a pretty close transition, perhaps a little lower for caution, but not 4U->0.75U lower. Glargine is much better for producing flat numbers, but if he needs ~4U insulin to get to blue with vetsulin, I worry that it might take you a while to work up to the proper basaglar dose if you start at 0.75U.

Looks like you are already using U-100 syringes with the vetsulin, so that's good! It will just be a direct measurement with the basaglar, no conversions.

 

The only reason she gave me was how little he weighs atm, at 6.2 lb. I'm definitely ready to transition, I'm just not sure where to start dosage wise. And I'd hate to make any mistakes while trying to get him through this UTI. Seems to me though, that a more stable BG might possibly help.

 

I agree with Nan. Normally when we transition from one insulin to the next we take the dose of the previous insulin into consideration when determining the dose of the new insulin.
Your vet probably did the calculation of 0.25units/kg but that is for newly diagnosed cats, and it looks as if Vlad has been a diabetic since 2018. Is that correct?
Has he always been on Vetsulin? What is his normal weight? Has he just lost weight recently or is he normally a small cat?

 

Vlad was only on Vetsulin for maybe 6 months in 2018 before going into remission. He has been off of insulin since then until the past month. When he was dxd he was 13 lbs. After getting him into remission he stabilized at about 9 lbs. A bit over a month ago he lost his appetite and started losing weight. Turned out he had a tooth infection and a UTI that kicked him out of remission. So he hasn't been on vetsulin again this year.

Before we figured out the tooth infection he was hardly eating, and he lost a lot of weight. He got down to 5.5 lbs. ATM he's on an antibiotic for the infections, and feeding him soupy fancy feast, he's up to 6.2 lb. He is still very very skinny, but thankfully heading in the right direction weight wise. He is normally not this small, at all. I would love to get him up to 9-10 lb.

 

Poor fellow has had a rough trot..hopefully with the tooth infection and UTI treated he will improve and put on more weight.
I think he will do much better on the Lantus insulin. I think the only way you will get more stable BGs is to swap to Lantus. If you wait like the vet says you could be waiting a long time.
How are you measuring the insulin...your doses are 4.4 and 4.2 which are unusual?

The only thing that concerns me is his weight as far as the dose goes but if he is having 4.4 of vetsulin I think that 4 units of Lantus should be OK. It’s a depot insulin so the dose needs to be the same for both doses. You can’t chop and change the doses. His insulin needs could reduce once the infections are treated.
I am going to tag @Wendy&Neko to get her input.

 

I agree, as long as you can monitor closely the first few days, I'd try 4 units. If you can't monitor as closely, maybe down to 3.5 units. Are you testing regularly for ketones?

As for the infection, it'll help us help you if you list when you start and stop meds on the spreadsheet, specifically the Remarks section.

 

The unit changes are 0.2 increments because I was using a U100 syringe to measure a U40 insulin, the increments are due to the conversion.

 

I started Vlad on 4.0 U of Basaglar this morning. With the lock down and everything, I am able to keep a very close eye on him. I intend to test him every 2 hours from 7am to 10pm. If I need to change his testing times I can do that. Thank you for the direction everyone. I've been a little nervous about switching him.

 

Did his shot, seemed like a good shot to me. He was Hi PS, and 2+ he's still Hi. I'm so used to vetsulin acting so quickly, now I'm not sure if its just coming down slower because its a slower acting insulin, or if I got a fur shot. Poor little dude.

 

If you think you did a good shot, you probably did. You're right that lantus acts very differently than vetsulin. We'll see where he is later today, but even then it won't be the full picture of what lantus can do before the depot is built.

 

=\ 3+, still so high my glucometer can't read. I smelled the injection site, smells like Basaglar. I'm not so confident anymore. His next shot is in 9 hours. Anticipating a string of bad numbers.

 

+4, no change, still "Hi" reading on his BG. I guess there is nothing I can do about this until his next shot. Ugh. This is the longest he's been this high since he's been getting insulin. I feel terrible.

 

We don't have any diabetics in the house anymore and I can't find a magnifying glass to see the carb count.
Marco had UTI's every other month until we switched all five cats to Royal Canin SO. Some people have tried fountains and/or super clean water for UTI with great success, Marco would be in all the toilets when we adopted him. Good luck.

 

You don't need to test every hour today. The Basaglar onset is around +2 to +3, and if you haven't seen any action by then, it'll be a slow cycle.

He's probably bouncing from the really fast drop last night as well.

 

I haven't seen any indication of insulin activity, bg still "Hi" at 6+, I can only imagine it was a bad shot, I should have seen something by now otherwise. He's had such a hard time I just hate him not feeling good because of a bad shot. Can't wait til his PM shot.