Should I risk switching to Lantus before a 2month trip?

Hi all,
I was a bit nervous about posting here, but Julia & Bandit urged me to do so, so here I am.

I am hoping that someone who has experience with switching from Caninsulin to Lantus can give me some advise. I just came back from the vet's today, they did a blood sugar curve on my cat Neo (he was diagnosed roughly 3 months ago) and he's still pretty high. The vet told me ideally he should be between 5 and 8:
0815 - 18.2 (mmol/L)
0850 - 19.4
0915 - 20.2
0945 - 20.2
1030 - 16.8
1100 - 14.9
1200 - 20.0
1300 - 19.7

His levels were actually higher this time than a month ago, and the vet raised his dosage to 2x/day 5 IE of Caninsulin.

Thanks to the kind people on the board I was alerted to Lantus and have subsequently read some promising sounding articles. I took the article with me today (Intensive blood glucose control is safe and effective....) to the vet but she wasn't totally convinced. She told me that they have a protocol that they have to follow - the cat stays in Caninsulin until it's proven that he's not responding to it anymore. And according to her, he's doing really well on it. She was also skeptical of the article - that the people who wrote it had probably been sponsored by Lantus - and urged me to find and read articles on Caninsulin - according to her, it's just as effective and likely to result in remission. She did tell me that if I came back completely convinced that Lantus was the way to go, she would put a note in Neo's records that Caninsulin didn't work and would prescribe Lantus for me.

Now here's the real kicker. I have a home testing kit. I haven't actually done any testing yet, but I'm okay with getting scratched and bitten, if that's what it takes to make Neo feel better. But the problem is, in 1.5 weeks, I'm going to be away for 2 months on a business trip - to Japan. So it's going to be nearly impossible for me to get back in a hurry and I'll be in a totally different time zone. I am having to put my 2 cats into a "cat pension" as I couldn't find anyone trustworthy locally. The lady is a bit older but has reassured me that she's had diabetic cats there before and she's okay to give the shots 2x/day. I don't mind asking her if she would be willing to do the home testing twice a day, but my vet today really emphasized that I had to be very strict with the pension and tell them that they were not to up the dosage of the insulin on their own for any reason. I am really lucky in that my vet is reachable 24hours a day so in an emergency, someone is only a phone call away. BUT the only pension I could find that could take care of my diabetic cat properly is a 2 hour drive away, so if something happens, it's not like the lady can rush Neo to my vet. :?

So my question is, I have 1.5 weeks. Should I take the plunge and get Neo off dry food completely and switch to low-carb wet food only? There's also the problem with that, that all of the local pet stores that I've contacted have told me that they'd have to order the food that I am interested in. And it takes nearly a week to get in. So that really only leaves me with half a week to switch the diet and do testing. That makes me super nervous. Also because I have no idea how comfortable the lady who's going to be looking after him really is with the whole procedure - she certainly won't be as invested in it as I, for instance, am/would be.

My gut is telling me to wait until after I'm back from holiday and hope for the best. What do you guys think? Am I being a sissy? Over cautious? Is it actually scarier (please say not because I'm already working myself into a lather) to leave things the way they are? Since I've had him, Neo has never had an "episode" (knock on wood) and the only outward sign that he has diabetes is the enormous amount of water he's drinking and subsequently eliminating. Otherwise he's pretty bright-eyed, alert, and active. I'm really scared that will change and I won't be around to do anything about it, which would of course be absolutely horrific.

Opinions, experiences, please? In the end I know I'll have to make and live with the decision, but I would really appreciate your input. Thank you so much!

 

Hi and Welcome to LantusLand! Really we are not sary at all here! :lol:

We need a little more information to get started. First off I assume the first column is time, but how long after the insulin shot were they taken. That gives us the best idea of how the insulin is working. When we post our tests it is usually in terms of how many hours after the injection: e.g. one hour after the shot is +1 , two hours after is +2……… Since most of us are in the US I have taken the liberty of doing the conversion to mg/dl which is what most of us are used to looking at.

• 0815 - 18.2 (mmol/L) = 328mg/dl (ed: got the first 2 mixed up corrected now)
  0850 - 19.4 = 350mg/dl
  0915 - 20.2 = 364mg/dl
  0945 - 20.2 = 364mg/dl
  1030 - 16.8 = 303mg/dl
  1100 - 14.9 = 268mg/dl
  1200 - 20.0 = 360mg/dl
  1300 - 19.7 = 355mg/dl

You seem to have a lot going on all at once. :YMHUG: Don't worry things will work out. Usually we try to change things slowly and one at a time. I hope others chime in w/ more advice.

I'll be right back, just want to get you bumped up to the top of the list.

 

Here's what I said about it over in Health:

However, that was just my opinion because I don't have experience with a change in insulin, and I was torn giving that advice because it is definitely better to make changes slowly when you can monitor. I'm really not sure which route would be safer.

One factor that could also make a difference is whether or not the lady caring for your cat will be able to control his access to the dry food. If she free-feeds and doesn't want to do controlled feedings, a diet change might not be possible while you're away.

 

Ok others can see the conversion now and not have to do it over.

First off, Neo is adoreable!!

On the insulin: In the US Caninsulin goes by the name of Vetsulin and the manufacturer haw withdrawn it because of production problems, so no one here uses it. Lantus (or Levemir) are long lasting insulins designed to avoid rapid swings in insulin levels, but it takes a while for it to get balanced out in the system. In the long run I would say definitely switch, but with someone else taking care of Neo for 2 months I don't know. Lantus likes regularity, more than 15 minutes variance of shot time can influence the reaction to the drug. As you said a care taker who is not as invested in Neo's wellbeing may not be as careful of giving the shots consistently.

Testing: It is always a good idea to test! We test before every shot to be sure that the BG is not too so we will not put our cats in danger of hypo. Lots of things can suddenly change and cause BG levels to spike or drop. We do not determine the dose by that test though, we only use it to go ahead and shoot, delay the shot until it is safe or skip the shot all together. Lantus doses are determined by the lowest point in the cycle, not the preshot as are other insulins. Without tests during the cycle it is impossible to know how low the BG levels dropped. Very low BG is dangerous. We have a saying here "Better too high for a few days than too low for an hour!"

You can get lots of help learning to test here. I think one of the biggest problems is our own nervousness, the cats can sense it. When we calm down and become confident so do the cats and testing becomes easy. Many even purr during the test, because they know they get a treat after! :lol:

Changing food: Most cats have their BG numbers drop significantly once they are eating a low carb wet food. It is usually a very rapid response. That means that their insulin dose would need to be dropped. What food are you trying to get? If it is one of the "prescription diets" I would just look for a low carbohydrate wet food that is readily available. The special diabetes diets here really aren't very good quality and not low carb enough, besides being expensive and only available through the vets. This is a link to a food list of cat foods available outside the USA. http://binkyspage.tripod.com/nonusfd.html I know there are other European members who may have other suggestions. Just about any canned food is better for your cat than any dry food.

That said many cats are so addicted to the "kitty crack" dry food that they don't recognize real food when they see it. Transitioning can take a long time and be very difficult with some cats. At the pension would Neo be with other cats and have access to their food? Another consideration. Has he ever been given canned food? If so and if he liked it the change over will be easier.

I know I may have raised more questions than ever, but I hope it will help to work things out. There are a lot of folks here to help you work it out.

Where will you be in Japan? I'm supposed to go in late November!

ETA: Here's the link to your last condo in health

 

Thanks all! I personally think all cats are adorable, but Neo & I thank you. That pictures of Tess is at the top of the adorable scale, for sure! I love when cats stretch out like that. :mrgreen:

And thank you for the coversions - sorry about that. Yes, the first column is time. Aha - so that's what all the plus numbers are - that makes sense! He was fed at 0631 that morning, and got his shot at 0636 or so. I hope that's not bad for him. He won't hold still for me unless he's eating. ;-)

Julia actually showed me the post/article (I can't recall) that said that Caninsulin isn't available in the US anymore. I am sure I can get my vet to switch over eventually, but she's pretty adamant about me giving it a chance. EU and US are different, she has a protocol she has to follow, blah blah. But at least if I insist she said she will switch me to Lantus.

Hm - the testing and shooting or not sounds rather complicated. :shock: I have less and less confidence that I will be able to get Jasmien (the lady who will watch after my cats) to do this. Also I'm worried that she's not going to be able to keep an eye on the food. And my cats are actually still in the "what the heck are you doing in my territory?!" phase - Neo is the new addition and Groovy still isn't having it after 6 months, although at least I can keep them from fighting if I keep my eye on them. Jasmien is a cat behaviorist in addition to running a pension, so she's going to work on them getting along better during the 2 months that I'll be away. I'm not sure that I'm comfortable asking her to take glucose readings on top of the other work she'll be doing. :? But I do think that if I give her very clear instructions on what and when to feed him, she would do that for me. I just don't think she'll be happy/comfortable taking blood readings and/or adjusting insuline dosages and deciding whether or not to give the injection. And although it's probably silly of me to feel this way since it's not like I know what I'm doing either, I'm not sure I'm comfortable with her doing that either. I'd rather give her a strict schedule and ask her to stick to it 100% - I think she would do that.

Is it a good idea for me to go ahead and change his food at least? I have 1.5 weeks to test and see if I can get him to stabilize at a bit lower level. Or am I reading correctly in your posts that it might not be so smart?

It took me about 30 minutes today to take the first test. I could *not* get the back of his ear to bleed no matter how many times I tried. I ended up trying on my own thumb just to make sure the lancet pen was working - it sure was! :lol: I finally tried pricking the inside of his ear and boy oh boy his blood just spewed out onto the floor - I felt like I was in a horror movie, not to mention guilty! Luckily, it didn't seem to hurt, but apparently it itched a lot as I was then trying to hang on to him, turn on my meter (which had been on so long it turned itself back off) and then hold the little stick up to his ear. Blood everywhere (his and mine) and I was sweating my butt off, but at least I got my very first home reading! Hurrah!

It was 19.6 mmol/L, which I believe is then 352.8mg/dl? So still pretty high, I believe, since the vet told me it should be between 5 and 8 mmol/L. I am going to try to prick him again in a little bit (I've been out all afternoon) and hopefully it will go a bit smoother this time. He's a real sweetie, though. He was purring when I first put him on a towel, and he was squirming every which way to get away from me, but didn't try to bite me. He only does that when I try to give him his insuline. Well, so far, anyway!

Oh - and I found a list of Dutch wet food that supposedly has no carbs in it. So I went to the local pet store today and checked the labels and came back with a slew of Animonda vom Feinsten Classic wet food. No rice or grains or sugar in the ingredients list. Just protein (and some animal byproducts :S) and minerals, is all I see on the label. So I got him beef, turkey, chicken, mixed meats, etc. He gobbled it down without any problem. Luckily he doesn't seem to be a picky eater - he was a stray so I think he'll eat pretty much anything. The flies that make their way into our 20th floor apartment would attest to that if they weren't being digested in his belly. :lol:

And lastly, I'll be traveling around in Japan, but from mid-October onward I will be in Tokyo. Too bad I will miss you (I'm due to fly back on November 12) - it might have been fun to meet somewhere.

Thank you everybody! I really appreciate your opinions. Sorry for the wordy reply.

 

i don't have a definite opinion, but a couple of thoughts.

neo's ears will begin to bleed more easily a couple of weeks after you've started poking the heck out of them. they grow more capillaries and before long you'll get blood every time. one ear often bleeds better than the other.

if you can find neosporin ointment with pain relief - the stuff is miraculous for taking away the pain. i slather it on at bedtime and let the ears heal overnight. wipe off most before you test because it'll goo up your strip if there's too much. try it on your own finger poke!

are your kitties going to jasmiene's or is she coming to your place to care for them?

i don't think i feel qualified to give an opinion about whether or not it's safe to switch. our general guidelines say to hold the dose for 5-7 days after starting, with testing pretty much every few hours to see what they are doing. we've seen many cats go off of insulin in the first month, and if neo were one of those who responded really well and needed downward adjustments in his dose, we wouldn't want to send the little guy into hypoglycemia. if you can get jasmiene to test, that would be a different story. she could connect here and we can give her daily advice on what to be doing with the dose to do the best with neo.

we have one member in hong kong who's cat's well on his way off of insulin within his first month, including a switch to canned food. you can look up ahmin & christine and look at his spreadsheet, and perhaps that would give you an idea of what can happen in the first month of tight regulation on lantus. of course that doesn't happen to all cats, but she's been lucky with ahmin, and we do see it regularly.

 

Thanks for the thoughts. The guys are going to stay as Jasmien, and unfortunately her English isn't very good so I don't think she'll be coming on the boards. But I will keep plugging away with my home testing and bugging you guys for help. If I should start posting back in the "general" boards rather than here, please do let me know!

And there is absolutely nothing like Neosporin over here, but I'm going to be in the US for a week right at the end of my Japan trip, so I'll definitely pick up several tubes and bring them home! I have one half-empty tube here so I'll go chase Neo down and smear some on his ear. Thank you for the tip!

I managed to get another test result. I got bitten an uncounted number of times, so I'm really looking forward to when his ears bleed more easily! I guess it'll go back to the beginning since I'll be gone for 2 months, though. :? Oh well.

But let me see, this reading would be:
+12 - 18.8 mmol/L (338.4mg/dl)

I don't even know if that's really high or actually not so bad. It sure seems bad when he's supposed to be down to 8 mmol/L. I will try again tonight before I go to bed!

Oh - and I just had to share this as I find it really sweet. Even though this was only the 3rd try (2nd attempt I gave up before I lost my finger), Neo came over straight away and flopped down onto the towel as soon as I laid it out on the floor. My "local" Asian market (a 20 minute drive away) didn't have Bonito flakes :sad: so I am giving him some dried protein snacks, so I guess that part is working. He's a crazy little guy though. Purring and clawing and biting at me all at the same time. :lol:

 

i want to bump you up again so someone sees this . . .

the treats work wonders on getting them to tolerate the testing. people told me their cats would come and purr through it, and i'm thinking "right. no way mr punkin will do that." as i'm on the floor, pulling on him to get him out from under the sofa to test him.

but truly, he comes when i call him, he purrs through it, although he does flick his ear a lot - and i'm sure it's all for the little boiled chicken breast bit that i give him when we're done.

 

Hi and welcome to Lantus Land!

Your situation is really complicated and I think that if it were I, I would not make the switch to Lantus and the change to only wet food until after I got home from my trip. There are just too many variables, and too many pitfalls. This is just my opinion and you may decide otherwise. But leaving such a momentous change in the hands of a petsitter who will not be able to test and who has no experience with Lantus is, I think, a bad idea. The food issue also complicates everything. You won't know which cat is eating what. Since Jasmien is an animal behaviorist, perhaps you should stick to having her acclimate your cats to each other and not ask her to undertake what could well be a daunting task for her. (Most of us here, when we came on the board, had no idea what we were doing and found the protocol a very steep learning curve. I think this is something you really have to do yourself!)

Perhaps you could spend the next 2 months reading about Feline Diabetes, Lantus, the protocol we use, etc. etc., so that you will be ready and eager to begin Neo's switch to Lantus when you get home. Print out all of the "Stickies" (informational posts) at the top of the Lantus Forum and learn as much as you can.

Best of luck to you and Neo. I hope that everything will work out.

Ella & Rusty

 

Hi all,
Thank you so much for the comments! And thank you for saying my situation is complicated. I sometimes get a bit panicky about everything and it's so nice to hear someone tell me that it *is* complicated and I'm not just being a silly goose.

I have taken Neo off the dry food - he had some yesterday morning but I did my best to keep him out of it the rest of the day, although he did manage a couple of times to get to my other cat's food and start gobbling down. When I checked the litter box this morning, his poo seemed better - less runny, more firm (I was posting in the general forums about his diarrhea). But could the change in food have made such a difference already? The vet did charge me for a diarrhea profile so I'm sure I'll hear back from them next week to see if it's anything else, but it was a nice change to scoop some less runny stuff out of the box for a change!

I do feel that it's too much to ask Jasmien to learn and follow the protocol on top of everything else. And I'm hoping that Neo's levels might drop the tiniest bit if the stress between those two would, if not go away completely, reduce substantially. Not to mention my stress - I always have to keep an eye open for who's doing what. Boy I wish I was like my 1st grade teacher and had eyes in the back of my head!

I'm not sure what to do about the food, though. Maybe just reduce the dry way down? I haven't seen Neo this active in the morning ever. Usually after his shot he's flopped down on the floor and resting, and today he's still up and roaming around. Maybe hunting for food? He seems hungry, but I wanted to wait to give him more until a bit closer to lunch. So yes, I see what you mean about the food also being complicated. :sad:

I got a lot of good stuff to read from Julia & Bandit, but I'll have a look at the top of the Lantus board and see if I'm missing anything. Thank you!

 

regarding the Blood Glucose numbers - just fyi, a non diabetic cat's BG runs from about 50-120ish. organ damage starts with sustained BG's of over 200-225ish. following the lantus protocol our aim is to keep our cats between 50-120 so that their pancreas can heal and begin producing insulin again.

hypoglycemia starts becoming a concern if a cat drops below 40. we use high carb food or karo syrup (or some other sugar) if our cats drop below 50. because lantus is a gentler insulin most cats don't seem to show visible signs of hypoglycemia until they are really low - like under 30. in other words, a cat can be hypoglycemic without showing obvious signs.

most vets want cats on insulin to stay in the 100-200 range - high enough that they likely won't become hypoglycemic, low enough to hopefully prevent organ damage. their assumption is that people don't hometest.

so . . . we're all pro-home-testing here. i gave my cat insulin for 2 months without home testing and now i'm so very aware of how things could've gone terribly wrong. we were lucky. i'm not trying to scare you, it's just that you've presented a situation that yes, is complicated. personally, i don't really know how to guide you because i would say to never shoot insulin into a cat without testing them.

just to keep Neo safe, i would think the minimum Jasmien would need to do is to test before shooting the insulin - and you should give her a no-shoot number, so if she gets a BG reading below that number she doesn't give insulin. there are videos on youtube on how to test and if you test Neo from now until you go, he should get used to it and behave ok for her.