4/21 Jake Vet wants to switch him from Lantus to Humulin N

Jake's vet keeps suggesting that I switch him to Humulin N. Jake has been on Lantus since November, 2009. He is 19 and has been diabetic since 2002. He has been on several insulins already including Humulin N.
He does not vomit as much on the Lantus as he did on other insulins, but he has suffered a significant weight loss. In Sept 2009, he was about 10 lbs. He is now at 8 pounds (down from 8.6 about 2 weeks ago). Because I have not hometested regularly, I don't know if this weight loss is from the insulin or some other condition. He has had blood tests and xrays done. Other than high blood pressure, there is no indication of other disease besides diabetes. He was on amlodipine for high blood pressure but on that he seemed to have no appetite. I've taken him off of that and his appetite has improved.
Unfortunately, I was not able to home test him very well until recently. I finally found 2 meters that work really well for me. Before finding these meters, I took him to the vet to be tested pretty regularly.
Now with the two meters I have (the Freedom Freestyle Lite and a ReliON), I am able to home test on a regular basis.
I am trying hard to get him regulated slowly but his numbers indicate this doesn't seem to be working. You will see that I started hometesting with the Free style, but then switched to a ReliON. The ReliOn results seem way more accurate based on the testing I did on myself (59 on the Freestyle versus 90 on the ReliOn). His weight loss is very troubling to me. I syringe feed him 1 can per day of either Newman's own organic turkey or A/D. In addition to that, he is offered some Purina wet food to eat. I try to get him to eat whatever I can.
Any advice is appreciated.

Hi Lydia :mrgreen:

Looking at your spreadsheet it appears that you are not being consistant with the doses you are giving. With Lantus it is important to give the same dose every day until it is time to either increase or decrease. Lantus does not work on a sliding scale......you must start at a given dose and gradually increase. I think this may be why Jake is having a hard time getting regulated. Lantus dosing is based on the nadir and not the preshot numbers.

Have you read the stickies at the top of the Lantus Board? There is one that exlpains how Lantus works (explains the "shed") and there is also a copy of the modified Tilly protocol that we follow here.

STICKY: LANTUS & LEVEMIR - INSULIN DEPOT -AKA- STORAGE SHED
STICKY: LANTUS & LEVEMIR - TIGHT REGULATION PROTOCOLS

It is fantastic that you have started to test at home. Some others will come along I am sure and give you some more advice. But my advice is DON'T SWITCH FROM LANTUS!!!! Lantus is great.

Welcome to LL :YMHUG:

Lantus is one of the BEST insulins to give a cat. Switching back to N in my opinion is a HUGE step backward!

I agree with Paige. Looking at your ss, you've changed doses several times and not by a small amount either. Can you tell us the reason for these dose changes and how the amount was decided.

Please take the time to read the "starred" posts at the top of this section, so that you can better understand how Lantus works, including dosing, when to change the dose, how much to give etc.

Don't let the vet push you into going backwards and doing something that you won't be happy with.

I supect your vet is simply more familiar with Humulin N. I have no experience with other insulins, but people that have switched TO Lantus and Lev are generally much happerier with the result. I wouldn't do it.

What caught my eye first was that you said he does not vomit with Lantus, right there, I would tell the vet you are sticking with Lantus.

I bet now that you are home testing regularly and begin to follow the protocol outlined in the links the others have provided, you will start to see an improvement in Jake's response to Lantus.

I think the big problem is that for other insulins, you change the dose based on a preshot number and when that changes, you also change the dose. You can't do that with Lantus. With Lantus and Levemir, there is a shed involved and it's important to consider the shed whenever you change the dose.
Think of a spare gas tank.
That tank has to stay full, so your first few shots are mostly getting dumped into that tank, and very little is getting used by Jake. Each shot, the body says 'how's the tank? Got room?' and if it's not filled, most of the shot goes into that tank. After a few shots, the body says, 'how's that tank? Got room?' and the reply is Nope we are all full. At that point, Jake gets the whole shot and you will see his numbers start to react much better.

That tank also figures into reduced doses. Once Jake is reacting and his numbers get low enough, you will want to reduce his dose. Well, just because you give him less in the next shot, don't expect him to react to that lesser amount. How come? That's right; he has to get rid of, or use up the excess in his spare tank, that shed.

So if you are giving 2units and want to go up to 2.25units, some of the first few shots will have to go to topping up your tank, that shed, which is short by .25units.
Of course the reducing will work the same; if you go from 2units down to 1.75 units, the body's got to dump the extra .25units.

The stickies/starred posts at the top of the main screen will explain it all to you in much better words, and you will find the protocol which helps you to know when to increase, hold, and decrease.

I would say to stick with the Lantus if for no other reason than Jake is not upset by this insulin.

I know. I feel Lantus is a better insulin. I don't feel I should switch even though my vet keeps mentioning it.
I did read the stickies but it took awhile for it to sink in that he needed to stay on the same dose even when his numbers were too high or too low. In either direction I get really worried and my first reaction is to cut back or increase. I have stopped that now that I fully comprehend the significance of how Lantus works as opposed to the other insulins that he was on for so many years. I'm really lucky and so thankful that Jake survived all those years of me being a failure at hometesting.
I had been giving him about 1.25 and then yesterday PMPS increased to 1.5 because of his high numbers and weight loss. Should I just stay at 1.5 for a few days and see how he does? How many days do I allow the insulin to work before I increase or decrease?

Welcome Lydia.

From your description, my first thought is that maybe Jake isn't getting enough calories to gain weight. For a 10 lb cat (if that's Jake's ideal weight), he should be eating 208 calories to maintain his weight. (calories = 13.8 x lean weight + 70). I'm not sure what the calorie count is on the food you're giving. If Jake isn't interested in eating, I'd encourage you to discuss an appetite stimulant (mirtazepine or cyproheptidine are the ones most frequently prescribed) with your vet if all of the other tricks to entice Jake to eat haven't worked.

My diabetic cat, Gabby, was put on Humulin N at the time she was diagnosed. It wasn't my regular vet who started her on N. Rather, it was the vet at the ICU where she was hospitalized. Once we'd gotten her DKA and other problems under control and the first fructosamine looked awful, my vet, who's a feline specialist, switched Gabby to Lantus. For what it's worth, her comment about the other vet's choice of insulin was, "Humulin is good for dogs. It's not a good insulin for cats."

I'd also look at the carb content of what you're feeding. The A/D is what we could consider medium carb (i.e., it's 13%) vs. low carb (under 10%). The Newman's own looks like it's lower in carbs.

Hi Lydia..My cat Moonie & I have been here 2 yrs- Moonie was dx'd 1/08--She was started on Humilin N and for several months she got sicker & sicker, I couldnt control her to bg test, shoot or even feed--She hid all the time, and was not well at all. This was right after her dx, and I came on this website. Moonie wasnt doing well so vet told me to go to 4 units of N--I said NO--he got mad & sent me to a specialized vet center.
They told me to put her on lantus & that was how our lives with FD turned around--Also by coming on here!!
I hope you stay on lantus, it is the best of all the insulins...

Yes I plan to keep him on Lantus because I agree after everything that I've read it is best for cats. I've always thought so. It was my idea, not my vet's, to switch him to Lantus in the first place.

As for getting enough calories, I'm going to feed him 2 cans of A/D per day for maybe 1-2 weeks. I'm syringe feeding him to make sure he gets enough. A/D is easiest to syringe feed, but he loves Newman's Own. I now syringe feed to make sure he gets enough. He often wanders away from his food dish and then one of the 4 other cats will eat his food. Does anyone have any suggestions about other high calorie wet foods? We've honestly tried almost everything out there at one time or another, but I'm always willing to try again.

Lydia & Jake said:

As for getting enough calories, I'm going to feed him 2 cans of A/D per day for maybe 1-2 weeks.

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It's 180 calories per can of A/D. 2 cans per day seem .... a lot. Maybe it's just me, but I think 360 calories sound more appropriate for a convalescing kitty like Jill's Alex.

Also wondering if a 19-year-old has lower calorie requirements. I don't know. Meowzi is almost 17, and maintains her weight on roughly 110 calories plus a whole bunch of treats daily, but I think she's unusual.

Has your vet ruled out any other possible causes for the weight loss? How are his teeth? You mention hypertension - has he had a T4 done to rule out hyperthyroidism?

Does anyone have any suggestions about other high calorie wet foods? We've honestly tried almost everything out there at one time or another, but I'm always willing to try again.

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Eukanuba's Maximum Calorie is 340 calories per can, but I don't hear of many kitties liking it.

We syringe-feed too, and we use Wellness Chicken, which is 220 calories per can. It has a really nice consistency for syringe-feeding; I don't even have to blend it - just add 1-2 tsp water per oz, push through a strainer (99.9% of it goes through) and add more water as desired.

2 cans of A/D seems like a lot to me too so I'm rethinking my original plan and then this morning AMPS was 529, which is super high. I don't know if this is from the A/D or something else. I just really want him to if not gain weight, at least stop dropping weight so fast.
Jake has lots of blood work done in December, 2009 and he has no other conditions that require treatment. He had a T4 and several other tests including full urinalysis and xrays. (One of my other cats is hyperthyroid with pancreatitis so I'm familiar with that too.)
Most of his teeth were removed in September, 2009 due to advanced periodontitis.
Since it's been about 4 months since all the blood work and with his age, maybe it's time for more tests. We are visiting the vet this Saturday.

I had to say hi from one Lydia to another. My Rosie is a cat who seems to require fewer calories than the average to maintain her weight. I guess there is a range, just as with people. If it were me, I would try feeding him enough to get him to the weight you'd like and not worry if it is too many calories. Then you can back off until he maintains.

Hi Lydia - it's always nice to meet another Lydia.
I really just want him to maintain his weight and maybe gain a little so you are probably right and I shouldn't worry too much about the calories. I just worry about syringe feeding him too much food. I just worry a lot about him.

Hi Lydia and Jake! Had a little time to read (quickly) through your condo and it seems like you have a fairly good handle on things now. I saw your post title and needed to stop in and give my two cents...so no to Humulin N!...but looks like you have already made up your mind on that...good. Spot was on it for 7 months...I tried every thing possible to make that stuff work, but it didn't. Went to Lev (not lantus for personal reasons) and Spot went otj a little over a year later...however right now he is back to LL for a short visit.
I don't have time right now to check out your ss, so I'll try to do that later..@ work and can only drop in occasionally for short periods of time.
So, I'll check you guys out later....have a great day..oh, and Welcome!