New Member, May 2, 2023: help switching from Caninsulin 3.8 units to Lantus 1 unit

Hi,

I've been waiting to switch Jessi from Caninsulin to Lantus because I wanted to have a way to monitor her closely at home. We had the Freestyle put on Thursday 11 and I have been using it to monitor her BGs pretty closely, with a few gaps here in there.

I still have a lot to learn and study. I am a bit overwhelmed and don't have the time and energy to learn as quickly as I would like, but I am truly doing my utmost. I haven't gotten the information I gathered with the sensor yet onto spreadsheets and quite honestly I find it daunting right now.

I would rather not wait until I can set all that up before switching to Lantus because Jessi is having too many swings (bounces?) and it's wearing us both out. The last couple of days her nadirs were pretty low, especially at night, around 47. This morning I gave her about 3.6 instead of 3.8 and tonight I decreased the dose to about 3.2 to be safe (the vet suggested a half unit less, I calculated 3.2, when I asked if I should decrease given her low BGs the last few days).

Update: BGs are staying in the 200s for several hours now, first time since I have been watching with the Libre. I assume that is because I lowered the dose. Maybe it was too much of a reduction.

The vet (the head vet at the clinic I originally took Jessi a few weeks ago), who isn't following us closely and was kind of dismissive on the phone, told me to start on 1 unit of Lantus in the morning, with the 0.3ml, u-100 microfine syringes. This is down from the original 3.8 Caninsulin which was starting to seem to be too much. I don't trust him much, his knowledge is very limited, and haven't yet found one I can rely on consistently in this situation. I actually speak to a different vet almost every time I call because its a 24 hour clinic so depending on when I call I get different answers to my questions and concerns. I hope to find someone more reliable and experienced with FD soon.

Can I get advice on whether 1 unit is too much to start her out on?

Would it be better to start off at a lower dose to be safe? Can you explain the depot a little more to me and what that means in terms of what I can expect to see in the first days?

If the general consensus is that I shouldn't change without first providing spreadsheets, I will follow that but I'm concerned about how long it will take before I can actually get that done. And in the mean time I would have to keep deciding day to day how much Caninsulin to give.

I find spreadsheets a bit dizzying, honestly and I'm so sleep deprived right now that even focusing enough to write messages here is hard.

Can someone help me transfer information from the Libre to the spreadsheets?

I have to decide now if I am going to switch to Lantus in the morning or not, so if you could give me your opinions I would appreciate it.

I can provide more information in a list form from the Libre just for this thread if you tell me exactly what you need to see in order to help me decide.

Thanks so much!

 

Yes @Bandit's Mom can help you set up the spreadsheet!

47 is too low and regardless of the dosing protocol you decide to follow for Lantus, he earned a 1/4 unit reduction already. With SLGS he earns a reduction every time he goes under 90 and with TR under 50. What food are you feeding right now?

I’ll defer to others about the starting dose question.

 

For me you can post the Freestyle Libre graphs here. You have to specify when you inject. and feed.

 

I don't entirely understand what you are saying. What do you mean by "regardless of the dosing protocol you decide to follow for Lantus?" I am feeding Terra Felis wet: Rabbit, Rabbit-Turkey, Rabbit-Beef. Please realize I am new to this Forum and I don't yet understand all the protocols, terms, acronyms, etc. I did reduce the dose once and then again. Are you saying I should or shouldn't switch to Lantus?

 

How do you post the graphs here?

 

You want to head over to the Lantus forum and read all yellow sticky notes at the top. That’s the best place to start. There are 2 dosing protocols and dosage advice is based on which you’re following. Read this:
https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

 

You should switch to Lantus, yes, but since you don’t have a spreadsheet we can’t see when you’ve done any dose adjustments. Once you do, we’ll be able to see all of that. Thanks!

 

Ok, I finally figured out what you wrote. I am so tired I misread the sentence. So whatever reduction is earned on Caninsulin stands for Lantus too? Since her BGs never went below 200 on 3.2 units of Caninsulin this evening, probably the dose is too low now. So what does that mean for the Lantus dose? Should I start it at .75 or .5?

I will probably go with the SLGS method at least for right now. I am using Freestyle, not blood glucometer testing.

I can't thoroughly study the Lantus forum sticky notes and the dosing protocols page before morning. Should I still switch to Lantus? If so, should I reduce from what the vet prescribed, 1 unit?

 

I don’t want to give you starting dose advice going from caninsulin to lantus, but you will need to stick with the initial Lantus dose for 7 days. Lantus needs consistency so ideally you’re not tweaking the dose everyday, only if he goes below the threshold number, as it takes a few days for the lantus depot to build. Tagging a few others to answer the initial dose question @tiffmaxee @Bron and Sheba (GA)

 

I was going to say exactly the same as above. I cannot give you advice, as we are still on Caninsulin and "only" in the research part of the change-to-Lantus mission, but it is important to hold the starting dose for 7 days, because as opposed to the in-and-out nature of Caninsulin, Lantus takes time to build up.
What I have seen by others' posts here shows a very general conversion of 4iu Caninsulin = 2iu Lantus, as in the final dosing. You still need to start lower, which you already would with the 1iu.
Again, this is not an advice, this is simply what I have come across on this forum, many times.

 

It’s better to start lower than higher so if you don’t get any other replies here, my advice is to start at 1 unit. Patience is part of the game. Feline diabetes is a marathon not a sprint. You hold the initial dose for 7 days then you’d do a curve but with the libre you’ll just have to record the bg every 2 hours for an 8-10 hour period. From there, you’ll get advice on dose adjustments. The important thing will be to get your spreadsheet done so members can give you dose advice. We can’t really do that if we can’t see the data.

 

Hi. Let me take a look at the spreadsheet. Be right back.
I see you dint have a spreadsheet. What is the current dose?

 

Usually the starting dose is slightly lower than the dose you were giving. Were you giving 3 units? You would not want to go down all the way to .5 or .75.

 

She doesn’t have a spreadsheet. She’s using the libre. I tagged @Bandit's Mom to help her set one up. She’s been giving around 3.8-3.2 not sure how she’s measuring that. Given the 47 she mentioned I told her to reduce by 1/4 unit so if she’s giving 3 units, should she start Lantus at 1 or 1.5?

“I would rather not wait until I can set all that up before switching to Lantus because Jessi is having too manyswings (bounces?) and it's wearing us both out. The last couple of days her nadirs were pretty low, especially at night, around 47. This morning I gave her about 3.6 instead of 3.8 and tonight I decreased thedose to about 3.2 to be safe (the vet suggested a half unit less, I calculated 3.2, when I asked if I shoulddecrease given her low BGs the last few days).

Update: BGs are staying in the 200s for several hours now, first time since I have been watching with the Libre. I assume that is because I lowered the dose. Maybe it was too much of a reduction.”

 

If she’s been shooting 3.0 why do you think she should start lantus so low? Usually it’s slightly less than the last dose and if the last dose was too high I would think 2.5 or 2.0 since there isn’t a ss but I think we need to see what a few others think. @Wendy&Neko @Bron and Sheba (GA)

 

@evedroid, your comment “a very general conversion of 4iu Caninsulin = 2iu Lantus,” is not correct.
When swapping from one insulin to another insulin, apart from taking into account how the cat has reacted to the current dose of the insulin they have been using, we normally stay around the same dose when swapping to the new insulin… often reducing it slightly about 0.25 units or 0.5 units.

 

I would like to see the Spreadsheet set up and some data put in before giving an opinion on the dose.
I do think that 1 unit would be too low a dose to start off with though, if the current dose is around 3 units.

 

Can you list the preshots and lows from the Libre for the past 5 days?

 

I don’t know that we’re going to get an answer before tomorrow. She wanted to start him on Lantus in the am and I don’t know that timeline they’re in.

 

I don’t know what dose I was asking you guys. But she said he had been doing low for the past few nights so not sure how many times that happened and how many dose reductions he earned total

 

I've been on FDMB somewhat longer than you have. I have NEVER seen the conversion you speak of. The conversion is 1 to 1 but we do look at how kitty is going on Caninsulin when suggesting a starting Lantus dose. We need to look at the spreadsheet before making a starting dose suggestion. As someone who's vet had us switch from Caninsulin to a lower dose of Lantus, I also have experience in the errors of going to reduced doses when you switch.

 

Thank you all for your replies.

Can I please ask that anyone commenting on my post please read it carefully and completely first. In some cases, it seems like you are looking at other people's comments instead of my post.

I live in Italy, this means there is a 6-9 hour difference to those living in most parts of the US. I stayed up pretty late waiting to get answers, but I had to go to sleep. I ask for your patience and understanding.

I didn't do the switch yet. Too much uncertainty and confusion. I also learned that Lantus could sting more and since I already have a sensitive, jumpy cat, who can jerk away suddenly while I'm giving the shot, I hesitated to make things even more difficult.

I am going to give it a few more days with Caninsulin so I can figure out what dose is actually the best on Caninsulin before switching and what caused the sudden low numbers those 2 times. Today I gave 3.5 and she never went below 99, and stayed in the low to mid 100s for about 2 hours until going up into the 200s. Preshot was 309 before food, 387 after she ate most of an 80g can of Terra Felis Rabbit.

I don't feel comfortable doing a one to one conversion from Caninsulin to Lantus to start out. As far as I knew Lantus is much more concentrated than Caninsulin, isn't that so? In any case, I think I will play it very safe and at start with 1 unit. IF anything I was asking if I should start lower, like .75 or even .5.

I also wanted to understand how long does it take to fill the depot and in the meantime does that mean she is living without insulin all that time?

I wonder if the 2 unusually low numbers this weekend may have been caused by something I was doing differently. Because I had missed 2 shots, 2 nights in a row this weekend, I was super nervous about not repeating that so I was over compensating. One thing I did without thinking was lift up repeatedly the area where I had shot to check to see if it was wet and even pushed down on the area a few times, not hard, but more than I ever did before. I wonder if I inadvertently massaged the insulin in faster than it would normally go in. I had read something about how you should avoid pressing on that area for that reason. Could that be have caused the sudden extreme low points)

Please go easy with the acronyms, it can make it hard for me to understand what you are writing. It takes time to learn all these things.

If you prefer shorter messages, I can divide my questions and comments into multiple replies. Just tell me what is best.

We got the sensor on Thursday, May 11 in the afternoon, I began scanning that same evening. (On 5-12 I didn't have access to the App to scan the sensor for a lot of hours so I have no idea what the preshot and low points were in the evening)

Below are the preshots and low points from the last 7 days since 2 days included missed doses. Is that all you want from the Libre? Any other information you need that I can provide without a spreadsheet for now?

date/ time, preshot (after food)/ time, nadir, [gave as close to 3.8 units Caninsulin as can be judged by the eye each time unless otherwise noted]
5-11 / 20:34, 322/ 22:42, 128
5-12 /08:51, 376/ 12:02, 75 [no info for evening shot]
5-13 /08:42, 389/ 12:54, 75 (3.9units) || 20:48, 438 FUR SHOT, no low point, highest BG was 438
5-14 /08:04, 376/ 12:26, 86 || 19:53, 370 shot gone wrong, no low point again, highest BG 422 (gave 3,9 units AM and PM)
5-15 /07:37, 385/ 10:13 145 || 19:06, 356 (3.9 units) / 22:17, 47
5-16 /07:46, 377 (3.6 units)/ 11:23, 69 || 19:32, 358 (3.2 units), 197
5-17 /08:07, 387 (3.5 units)/11:02, 99 ||

just to explain, originally the vet wrote on paper 3.8 but told me it could be 4. I gave her a conservative 3.8 since April 11, so more than a full month, until I got the sensor and then after a couple of days increased it by .1

 

The numbers help a lot. The time is 7:32 a.m. where I am. Is it 4:30 p.m. fir you? How many hours until shot time?

Lantus rarely stings unless a cat is in a high dose, probably over 7 units so I would not worry about that. Max was very skittish and e er minded the shots. Your insulin does not last the full 12 hours in cats and why it’s used with some success but better for dogs. Cats drop hard and fast and the go way up. Lantus is much more gentle and lasts 12 hours and there’s even carry over once the depot builds.

It would be a huge mistake to go back to .5 or even. 1.0. It will lose precious time in getting regulated. The quicker a cat gets regulated the better chance of becoming diet controlled. However you can not rush the process either.

If this was my cat I would start no lower than 2 units. See what others think.

Our spreadsheet is easy to use. All you do is plug in the number and it does the work for you. I never used a spreadsheet before.

 

Everything you asked is totally fair and the only thing we ask in return is that you bg plug the numbers into our spreadsheet format. It makes it a lot easier for us and it takes a lot less time than scrolling up to find the post and weed through the writing to find the numbers. It’s just not efficient and a lot of members here will refrain from giving you dose advice if they can’t see a spreadsheet because they don’t want to make a mistake and give you incorrect advice which is completely understandable. Also, just like you, our members are all over the world so a time stamp doesn’t mean anything, what’s important is how long after the shot you got that number and that’s why the spreadsheet uses +2,+3 and so forth as opposed to a time. And once it’s setup, you’ll also be a lot easier for you! Tagging @Bandit's Mom again to help you set it up

Lantus starts working within 2 hours of the shot and keeps working for 12 hours unlike caninsulin which wears off way before that. The depot simply means that a hit of each Lantus shot gets saved in your cat’s body or reserved in case it’s needed later. It’s important to have patience as I said before and nor adjust the doses all the time just because you’re seeing higher numbers. Sometimes it’s a bounce and your cat needs to clear it so you want to hold the initial dose for 7 days. And then again, depending on the dose protocol you pick either 3 or 5 days for each adjustment. If you’re going to wait a few days, I really recommend that you read up about the 2 protocols and select one to follow. I think SLGS (starts low, go slow) is probably the best one for you to start with.

the more information you have, the less tentative or unsure you’re going to feel and that’s the reason for all the detailed info in the sticky notes. I still refer to them all the time.

 

The other thing we ask so we know you read our comments is that you use the “like” feature. That way we know and don’t have to keep repeating ourselves.

question for you, what type of syringes are you using and how are you gauging the 3.8 or 3.2 doses? @tiffmaxee are the syringes for Lantus and caninsulin the same?

 

You need U100 syringes. This sticky will help. Keep in mind the dose used with the previous insulin is taken into account. That is why .50 it 1 unit is too low. Also we increase and d dresses in .25 increments.
https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

 

The conversion I spoke of was given by a friend (amongst others I have seen, which some golden oldies may have missed ), who's cat was transitioned from Caninsulin to Glargine in the UK. Although I'm unaware whether or not the concentration of your Lantus and our Glargine would be any different, I was told on many occasions that "The human insulin is 2.5 times stronger than the pet version, which is one of the reasons why it needs different syringes" thus the 2-1 conversion. And presumably that's the reason why Stef's vet advised her to start on 1IU Lantus, if she's injecting 3(ish)IU Caninsulin. To me it seems, that with 1IU her vet recommended already calculated the slight drop for the transition.
She is in the EU, thus if there were any differences in concentration, I would definitely go by what others on my end of the world experienced with the drug.
But as ya'll frequently like to point out I am just a newbie, so what do I know... a newbie clearly cannot do their own research and educate themselves, unless it's via you guys, right?
I rest my case, and pass it back to the almighties that obviously know better.
Bless up.

 

@evedroid Golden oldies? That’s kind of rude. You dint need to listen to our advice but let other newbies to decide if they want to.

 

I wasn't addressing you in particular, I'm sorry if you feel that I did. Could you please point out where did I say, they shouldn't listen to your advice? I'm happy to discussion if you feel it necessary, but let's do it in private, so we don't take up precious space on Stef's thread. Thank you

 

Update: Finally got in touch with the a vet from the office of the Endocrinologist who put the sensor on last Thursday and their instructions are to start 2 units of Lantus twice a day. I will begin tomorrow morning (Thursday 18) Honestly, I am a little nervous about it, but I have honey on hand and I am home all day and night so....

I am in CET time zone. If you are on the East Coast (US) I am 6 hours ahead of you. West Coast, I am 9 hours ahead of you, etc...

I use the U-100 BD Microfine .3ml syringes but I am happy to change to something with more lines, and if there is a special instrument for dosing much more finely, I would be very pleased to know what it's called and how to get it.

My measurements are approximate. Just how the original vet told me to give 3.8 and then verbally rounded it up to 4. But I am cautious, so I was always aiming for that 3.8 the best of my ability with the naked eye and the microfine syringes. I am noticing what a big difference just one or two drops more or less make, so I need to find a way to dose more precisely. Suggestions please....

 

I definitely will not raise the dose until the Vet tells me to and I run it by you all too. His people are monitoring the Libre results directly through LibreView. I don't have to send them, they just log on and find them.

I hear what you are saying about reading all the information, but for me, it actually can have the opposite effect of making me much more hesitant, overwhelmed and unsure. I have to take things in at a pace that I can handle, otherwise I am running on panic and exhaustion mode all the time and that will not be very good for Jessi.

But be assured that, as I said in my reply below, I am very cautious, if anything I tend to play it safe.

Yes, I agree that SLGS is probably best for now.

 

That’s all sounds good. Lantus is quite different from what you are used to and much more gentle. When you have time I suggest reading all the stickies on the lantus forum. There’s way too much information to absorb so take it in a little at a time. We were all scared at first and lean on each other for support. We don’t always agree which for some can be frustrating. Feline diabetes is just not simple. every cat is different (ECID) is so true. Also just when you think you understand your cat, they change the rules. They lead this crazy dance. At first when I joined I was shocked when people started to give me advice. What, listen to strangers instead of my vet who is wonderful? I soon learned that sometimes people here just know more and my vet was not available 24/7. Ask lots of questions and before long you will be answering others. This is the best place you never want to be. Good luck and I hope lantus works much better.

 

I can only agree with Elise given what I learned with Minnie’s diabetes, I diagnosed Bobo last month, treated him with her guidance and the guidance of other wonderful folks here and he’s now on remission trial. All of it without once consulting my vet. I guess that makes me a testimonial ha!

You’ll learn so much here, you’ll be able to guide others soon enough. Nothing like practice to make it perfect!

 

I have 1-2 unit marked syringes. Since we dose here by 1/4 units I’ve never had to do anything other than 1,1.25,1.5,1.75,2 so forth and I eye ball the 1/4 measurements. Some folks use calipers to measure precisely and they swear by it.

 

Lantus is more concentrated than Caninsulin, it is a U-100 insulin instead of a U-40 insulin. But you also use U-100 syringes for Lantus instead of U-40 and the two syringes are different sizes. So two units of Lantus is less volume that two units of Caninsulin. We've seen members accidentally use U-40 syringes for Lantus, and end up giving 2.5 times as much insulin as they meant to.

I did the switch from Caninsulin to Lantus. Neko was on 5 units Caninsulin. The vet told me to go back to 1 units. I wasted 3 months getting back to 5 units of Lantus, and she needed even more. I'm glad the vet said you could do two units as someone here also suggested. I think you could actually go to 3 units, but being extra safe for a short while is OK. And better to do if you don't have a spreadsheet set up for us to help you.

The BD Microfine are good syringes, that's what's used by most people in Europe. They have 1/2 unit markings on them, that's the smallest you can buy.

There are two methods for dosing smaller amounts of insulin. There is a paper ruler specifically for the BD Microfine syringes. Insulin ruler template for use with BD syringes: https://www.diabetes-katzen.net/insulinruler.pdf
The second method is to use digital calipers to measure the dose. You won't need that right away, but keep it in mind. To start, most people just eyeball the in between doses. Over on the Lantus forum we have a Sticky Note with pictures of the in between doses to help you out with that.

Generally it's larger dose cats that are sensitive to the Lantus acid base, but I've also seen it on smaller dose cats, though not common. Levemir does not have that acid base and is one of the reason most higher dosed cats switch to Levemir, as you can see I did, though Neko was only on a couple units at the time - she was happier with Levemir. The issue with Levemir is that it has a later onset and nadir (low point), which doesn't always fit into people's schedule.

 

@evedroid
I think I might be one of the golden oldies you refer to, as I pointed out to you in the other thread where you said 4 U caninsulin =2 U Lantus, that this statement was incorrect. @Wendy&Neko also commented on your statement. So is she another golden oldie? Is this the way to treat moderators who spend hours every day of their time helping other people's cats?
Telling people they are golden oldies is obviously meant to be derogatory and discrediting and is not the way we speak to each other on this forum. Please use respect.
I want to correct some more of your misinformation:
You said... Although I'm unaware whether or not the concentration of your Lantus and our Glargine would be any different, I was told on many occasions that "The human insulin is 2.5 times stronger than the pet version, which is one of the reasons why it needs different syringes" thus the 2-1 conversion.
The insulins sold as Glargine and Lantus and biosimilars are all the same strength all over the world. There is no pet version of Lantus/Glargine/Biosimiar insulins. Cats which are prescribed Lantus use the human Lantus insulin (or biosimilar). Not a cat version...there is no such thing with cat Lantus
I think you might be getting mixed up with Prozinc which is a cat insulin and uses U40 syringes. There is a conversion chart when using Prozinc, if you want to use the U100 syringes that are used for Lantus instead of the U 40 syringes. But most people use the U40 syringes when using Prozinc.
Prozinc is a completely separate insulin to Lantus. Prozinc is an in and out insulin and Lantus is a depot insulin.

Again another depreciative comment. I would suggest before you make further comments you make sure your sources are correct.
We encourage everyone to educate themselves about FD...education is power. But if we see information that is incorrect, we correct it, as we don't want our CGs to be given misinformation. This is a peer reviewed forum.

 

@Stefania S
I'm apologise for hijacking your thread above, but I needed to correct incorrect information
Bron

 

I never said there is a feline/pet Glargine?! I said Glargine being a human insulin is stronger, than the pet insulin, Caninsulin.
Edit: Yes, I see the confusion. I have only copied part of the conversation, which did not make it clear that it was about insulin vs insulin as in pet insulin (Caninsulin) vs human insulin (Glargine). My bad. Although using common sense, and/or thoroughly reading previous material, it was pretty clear, due to the context.

Golden Oldie:
• something, especially a song or film, that is old but is still well known and popular.
• a person [member] who is no longer young [new] but is still successful in their field.

Should I have referred to you as a senior instead? Senior member... Old member... Golden oldie member...
It is not an insult, the opposite if anything, but this just shows how attack-oriented a lot of replies that is directed toward anything a "newbie" says. Even the fact that it is required to title our threads as "newbie" is derogatory on it's own, in my opinion. If I am to be explicitly called new, why can you not be called old? Oh yeah, double standard, that is why, of course...
But each to their own, and obviously, who cares about a newbie's opinion, right?

Being a scientist myself (I know, crazy concept! We do exist outside of this platform!), I am educating myself, but I understand it is hard to believe, given my "only joined a week ago" stamp. There are resources and DOIs outside of this page as well, you know. I am happy to direct you to a conversation where I was in fact provided incorrect information by a senior member, with peer reviewed evidence supporting my point, as opposed to theirs. Did I receive a reply or even any acknowledgement? No. You guys are mainly loud when it's time to attack, then slither away if proven wrong. I at least have the decency to acknowledge if and when I am in the wrong, but it unfortunately cannot be said about a lot of the "here for longer than you are" members. (God only knows what I should address you people as, without you getting offended.)
And with that said, I made it clear above, that everything stated is my experience, and is not an advice.

Perhaps try and be less judgemental toward others, and be the humble, wise educators this community portrays itself to be, as opposed to condescending, short-tempered biased teachers, resembling those working in community schools, who get hung up on and triggered by trivial, unrelated matters or terminology, such as 'golden oldie'. Or perhaps, you know, take your own advice, and do your research on terminologies you're not familiar with.

We are supposed to be here to help each other, not picking on, and bullying those that are new, and stating experiences that may not aling with your narrative.

Again, I rest my case. The way some of you old members speak to those new ones who come here for, and to help, is disgraceful. You guys are the passive-aggressive, disrespectful ones here.
Yes, I said old member. Yes, I said senior member. Go ahead and feel free to pick out whatever you please of this post to be angry about on this occasion, if you really have so much time, and nothing better to do/no one to help.

I will not read, nor will I engage further with any of this toxicity and gaslighting here.

 

Let's please focus on @Stefania S and her kitty Jessi here. This thread has gotten seriously derailed. A reminder post that is good for all to read:
FDMB Guide to Posting and Etiquette

Stefania, I hope your questions on Caninsulin to Lantus conversion have been answered. Good luck with the switch!

 

Argh! I’m afraid I may have messed up the shot again. No wetness on the fur, but I poked several times and felt like the needle wasn’t going in, kitty was squirming making it hard....

I could smell the insulin a little in the area, Lantus has a much stronger smell. But does that mean it didn’t go in? Where does it go if not on the fur? There is no way it shot out because the needle was sunk into skin and fur with no way out.

Darn! I guess time and numbers will tell....

Update: it obviously made it in because the BG went down some. Preshot was 394, at +2 it was 201

 

Don’t ever give another shot. Its possible some or most of it got in. It happens to us all, so don’t worry.

 

I know, of course

 

Questions: around when would the nadir be with Lantus?
What is the relationship between feeding and injecting with Lantus vs Caninsulin? How concerned do I have to be to have her eat a full meal before the shot?
If Lantus lasts longer can I expect to see low-mid numbers that last longer than with Caninsulin, assuming this dose is adequate?

After a little research I am getting that Nadir can be anywhere between 6-14 hours, is that right?

If so, we could be giving insulin right at the lowest point? That’s a bit scary.

2 units twice a day, right? Not once a day. So the next shot could happen when BG is at its lowest.

 

Jessi is definitely behaving differently after the shot. Even with Caninsulin after the shot she would sleep a bit, and she does sleep quite a lot in general. But I notice she has less appetite. Usually by now she would have eaten another half can instead she sniffs at it and walks away.

She does also have an infected anal gland again (second time in just one month.) I started Clavoseptin yesterday so she could be feeling yucky from all of that too.

But just checking in case it could be a concern. Maybe a lessened appetite is a good thing as long as she eats a good meal by +6

I will update if/when she does.

Update: she is eating fine just not as ravenously. Three cans so far today total. She’s just eating more gradually over the course of hours rather than scarfing down one or more cans at a time. She did eat the first AM meal fast, but her BG was up at 313 so it makes sense.

Lowest recorded BG today +6.5 101
Numbers rising now, +8 196

(recap: it’s our first day of Lantus 2 units, from Caninsulin 3.8)

Preshot was 394 after eating

I really think it’s the infection making her feel extra yucky, I’ve seen it before.

 

Onset of Lantus is around +2 and nadir can be anytime from +3 to about +8 but mostly around +6

Offer a meal before the dose of insulin. If she doesn’t eat it all at once, that is OK as the onset is not until around +2.
You don’t have to feed 30 minutes before the shot like you do with caninsulin.
If she doesn’t eat all the food before the shot, offer it to her about an hour later, or leave it down for her to snack on.

It will take up to 7 days for the depot to fill and the full effect of the dose to be felt. But the Lantus will last longer than the caninsulin. You may or may not see much movement in the BG numbers straight away.

Occasionally the nadir can be when the next shot is due or a bit later but mostly it is around the +6 give or take a couple of hours. Every cat is different.

If you find the preshot is lower than you are used to, stall, don’t shoot and test again in 20 minute

yes, 2 units twice a day.

Are you testing daily for ketones in the urine.?
If you think she is unwell, she may need a vet visit. With DKA in the recent past, we want her eating well.

What is happening about your spreadsheet? Would you like @Bandit's Mom to help you set it up. It will make helping you much easier.

 

Ok, thanks for all the info. Haven’t tested for ketones at home yet. Getting the strips today. Have to get a different litter box to use. Will do so today. Takes time to organize all these things and I am working on it all day and into the evening

 

I wish I had pushed for Levemir. At the time I just wanted to get her off Caninsulin to something better and the vet seemed more familiar with Lantus so I just went with that.

 

I will get there. Give me a little more time. Working overtime to do it all.

 

Nadirs can and do vary by cat. My girl's Lantus nadir was usually around +8 ish, but as early as +3.5 and as late as +13. Yes, one hour after the next shot. Typical nadir is around +6. Your job is to find out when Jessi nadirs. Note, cycles that are bounce breaking can make for later nadirs. Neko also had a late onset, more like +3 or a bit later.

You can use the same litter box. Some people use a long handled spoon or a make a little cup out of tin foil. Tips here: Tips to catch and test a urine sample

Antibiotics can also make them feel yucky as it destroys the good bacteria in the tummy too. You can give probiotics (human kind OK if multiple strains of probiotic), a couple hours away from the antibiotic.

 

As for the smell after the shot this morning, sometimes you'll get a little drop on the outside of the needle when you are trying to get rid of bubbles in the syringe. So that could have gotten on kitty's fur. And yes, it is strong smelling!

 

Yes, I’m sure the antibiotic also makes her feel icky.

I have been giving her Vivomixx for a couple of weeks. It seems to be the same formula as VSL#3. Not sure about quantities, I just sprinkle some on.

Ooh, I am so looking forward to trying to catch the pee of a highly vigilant, jumpy cat! ‍♀️

 

So, how am I supposed to get any sleep if I’m not sure when the nadir will be and if it can change at any time???

 

You will learn your cat's patterns over time. Some cats (like mine) were less likely to have a consistent nadir, but others do. Running curves every once in a while will give you an idea of your cat's blood sugar patterns. Note, these patterns tend to be over several cycles. But with the spreadsheet are more easily spotted.

 

Just found this posted by a member about Levemir
The biggest difference between Lantus and Lev is that its onset and nadir are later than with Lantus. If a cat's nadir is at +6 with Lantus, nadir with Lev could be a couple of hours later. This may be a consideration for your schedule. I stuck with Lantus because of the timing of the cycle and my cat's time of onset and nadir. Other than the timing, Lantus and Lev act in a very similar way

Part of that process is getting a feel for basic concepts:

• Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
• Peak/Nadir - the lowest point in the cycle
• Duration - the length of time insulin continues to lower blood glucose

 

So, it’s almost 8am, past time for insulin and I can’t get a read on the sensor. I’m pretty sure the vet would tell me to go ahead with insulin anyway. Trying to do a blood test will freak Jessi out so much that it will jeopardize the shot, which is why I use the sensor.

I haven’t had enough time monitoring yet to know for sure but so far her BG hasn’t gone lower than 100 on Lantus.

Shoot or don’t shoot? We just started, skipping now will really mess with progress

Update: it came back online. I had already given her the shot, though behind schedule. I called the emergency line at the clinic where the Endocronologist who put the sensor on works and they said to do it since the dose is fairly low and her BGs have been moderate, not going below 100 since being on Lantus. So I gave her the shot and about 40 minutes later the sensor decided to speak again. This does happen fairly often, at least once a day that for anywhere from a few minutes to an hour it kind of goes offline. Then it comes back again. Who knows what’s going on in those interstitial pathways...

Anyhow, all good, except for my moment of stress and being late doing the shot, alls well that ends well!

 

I’m just seeing this. What did you decide to do?
With DKA in recent past it’s not a good idea to skip doses.
Can you tell me what have been the numbers up until the libre stopped

 

Did you see my update? I did give the insulin and
the sensor did come back online.

The numbers haven’t gone below 100 that I am aware so far, although on the sensor graph it looks as if they may have momentarily gone a little below in between scans (an hour apart). Keep in mind I am scanning very often especially after +3 for several hours. Her onset seems to be between +1 and +2 and her nadir so far seems to be between +5 and +7

So far results look good with Lantus, much more green, much less dark orange.

I will give more numbers soon. Going on 3 hours sleep after a week of no more than 4 every night, and a month of 5-6. I need to find a way to rest more or I won’t make it.

 

No I didn't see your update. It was later than when I posted.
I'm glad it is working again and you shot.
Have you thought again about the spreadsheet. It is really hard to help you if we cant see the data on a spreadsheet. I can ask @Bandit's Mom to help you

 

@Stefania S
Hi if you are using lantus now you need to change that on your signature, you still have Caninsulin ,we don't want members to think that's what insulin you are using
Just tap in your name up top then tap in signature and you can put lantus as of what ever the date was

 

The libre is convenient, but there are glitches and that’s why we recommend home testing.

 

Today BGs went quite LOW: lowest was 59 at +6.25

I was assured by several different vets previously that this is ok as long as she at. She had an entire can about an hour and a half before, so I don't know why it stayed low for so long (about an hour). I offered honey on the food but she wouldn't eat it. I offered it again on a teaspoon with some of the gravy from her food and she licked it a little. She is looking very tired. She also has an infection and just started antibiotics. I know she is in pain from the infection.

I kept a close eye on BGs with the sensor. I was told that the Libre reads about 10 lower than the glucometer so that 61 might have actually be a 71.

There are so many different things affecting this little kitty, it's hard to know what is doing what and why she is looking the way she is. The infected anal gland is about to rupture so that is hurting a lot.

I wonder why the numbers were so much lower today? Possibilities: she didn't nibble between meals like yesterday. In fact she had eaten 3 cans by 2pm whereas today she only had 2. Yesterday she at lots of little meals rather than a couple of big ones like today. Also she forgot to ask me for food and I got distracted with some things I was doing and the time went by without her eating for more than 6 hours. And also, when I was dosing the syringe the plunger was ever so slightly under the line, while yesterday it was every so slightly over it. A few drops extra and a few nibbles less...

could there be other factors making it go so low today?

Btw, she doesn't like honey. I had a feeling. So that isn't going to work. I have to get my hands on some corn syrup and see if she likes that better. I am still in the process of finding and ordering high carb food. I already have some medium carb food in the house but who says she'll eat it.

Onto dosing. I am finding it very hard to be precise with dosing. Lantus is harder for me because I can't inject back into the cartridge. That means I have to take a lot extra because there is always one bubble that won't go away easily. Today it took more than 2 units extra and having to put the syringe back in the cartridge to take out some more before I got the bubble out. And I am still unsure about the amount that is in the syringe. Even though the plunger is ever so slightly above the 2 mark, which I intentionally did, because the upper most mark is quite a bit below the upper part of the syringe, not quite a half unit but close.

This is where it gets very stressful for me. It seems like just a few drops more or less can make such a big difference especially with Lantus. So now I am much more unsure about getting it right when I am filling the syringe.

Since she went so much lower today, should I take off .25? How the heck do I manage to do that precisely? And without having to repeatedly stick the needle back into the cartridge because I overshot the mark.

Help please!

I have to do the shot soon so if you can advise quickly that would be great, thanks!

 

In a low numbers event (lower than today's numbers) if your cat will not eat high carb food, you would dip your finger in honey then open the cat's mouth and swab the inside of the cheek.

Did you try mixing honey in a bit of food?

Ask your pharmacist for "liquid glucose" for diabetics. It usually comes in small tubes. I believe this product is common in the EU.

 

Yes, she earned a .25 reduction since we talked about you following SLGS. I’m sorry I don’t remember your dose and I know you don’t have a spreadsheet setup yet so I can’t check.

are you using 1-2 unit marked syringes. Can you please take a pic and post it?

 

Another thing. The honey or Karo they don’t have to like it. If it’s an emergency, you rub it on their gums. Neither one of my cats liked either so I’d just put some on my finger and rub it on the side of their mouths.

I’ll let others talk about the best way to measure Lantus. I always just eye ball the 1/4 units

 

Any thoughts about starting a spreadsheet? Is the lack of one because you need help? @Chris & China (GA)

 

I took a photo of the filled syringe but then I couldn't find a way to share it here.

I reduced it yes, but I'm not sure if I reduced it enough. What's happening is that she feels awful from the sacculitis which just burst a little while ago, so hopefully she'll feel better soon but this is coinciding with the sensor quitting, her eating less and nadir probably happening in the next hour at +6. She did eat about two thirds of a can about an hour and a half ago but I had to hand feed it to her while she was lying down.

I did manage to get a pre preshot number which was around 302 and rising, but nothing after that. Makes me nervous considering her low numbers earlier today and

Bad timing with all of this.

I may break out the glucometer at this point, but it could get pretty crazy at almost 2 am with me feeling dizzy from exhaustion trying to test a very uncompliant cat who is gushing bloody stuff all over and in a lot of pain to begin with. I might end up doing more harm than good....

or I may have to take her to the clinic which I was trying so hard to avoid...

I'm so tired I'm falling asleep as I'm writing this even though I'm stressed about the situation.

Update: just when I had decided if it didn't work I would give it a go with the glucometer, the sensor came back with 224 at +5. That's quite a bit higher than it was the last few times at +5 so I feel a little better. It could and should still go down some and probably this time I gave her too small of a dose, but better to be safe given the unpredictable situation, right? at least I don't have to worry as much about her eating. I think her appetite will return soon.

The sacculitis is quite painful but once it opens it heals quickly and she feels better fast, at least that was how it went last time.

Poor little one, so many physical challenges all at once...

 

I’ve tagged @Bandit's Mom a few times too but she may be away

 

The libre only lasts for about 2 weeks. How long have you had it for? 302 is high enough but it would be great if you could get another reading now. I don’t know that trying to hand test at 2am for the very first time is a good idea honestly

 

Hi @Stefania S , I can help set up a spreadsheet. Will send you a PM with the details I need. Look for it in the Inbox at the top right corner of this page.

 

No more readings. It lasted about 7 days. It could also be internet since we are in flood zone here. Or it could be the App, don’t know...I noticed it needs a consistent strong internet connection, which normally we have but right now could be wobbly.

She’s doing much better now that the sac opened. I will watch her very closely. Later if I can’t get a read close to nadir I will attempt an ear prick. Not my first time, but every time has been VERY unsuccessful. She goes into underground (deep hiding) mode and then everything gets super hard including getting her to eat, doing injections, etc...she remembers these things for a long time. Not like other cats who shake it off. That’s why I opted for the sensor. Otherwise I never would have. I don’t like making her have this thing on her body.

 

Are you giving her a treat immediately after testing? Whether it’s a success or a fail, give her a treat to build positive association. I also do a lot of petting and verbal praise telling them how good a boy or girl they are and what a good job they did

 

Stephania --

This is a housekeeping note. We try to keep threads to around 50 posts. How about starting a new thread?

 

HELP again!

We are in LOW numbers and going down as far as I can tell.

The Sensor is giving me some readings and strangely it keeps charting a broken up graph even when it doesn't give me a number reading and right now it shows me she is in the red zone, above 50 still, but going down.

I just fed her and poured some juice from canned corn in her food, hoping that will do it. She ate almost an entire can but I notice it takes quite a bit for numbers to rise after feeding regular food. I went to take a long needed shower and wash my hair and this is what I find when I get out.

Jessi loves corn, so I may just offer her some of that and see if she'll eat it. That would be high carb enough, right?

I'm supposed to give insulin in the next half hour. I can't give her insulin when she is that low right? Even if it is Lantus with a slow release...

I notice a lot of up and down with Lantus throughout the day, not as dramatic maybe but definitely more frequent than with Caninsulin. It makes it really hard to pinpoint the nadir.

I thought I had a sense of that and now this!

I'm going to wait for the numbers to go back up, hoping the sensor will show me what I need to see, before insulin, right?

How far up do they need to go?

 

You def don’t shoot if she’s in the 50 range. Can you you free hand test to make sure the libre is accurate? I wouldn’t shoot anything under 150 maybe even 200. You still don’t have a spreadsheet so I can’t tell what the progression was or how she got to the 50 and I can’t see how she does with the food. This is why it’s so important. I’m not positive about corn. It should be but I’d rub some honey or Karo on her gums like I mentioned before. If she’s going low, you want to feed and retest in 20-30 minutes to see if what you gave her is sending her bg up or not.

also for the future if you want a fast response you need to start a new thread with help on the tile and or a 911 before it depending on how life threatening it is.

 

Skipping the dose entirely.

I tried to test in a location and at a moment where I thought it might work, she seemed so lethargic and passive but as soon as she felt me holding her down even just a little and holding her ear between my fingers she used all her strength to do what cats do to escape.

How can the vets tell me to just give her the usual dose even when I can't see the numbers??? Clearly 2 is too much for her. This was even a lower dose, this morning I gave her about 1.75 units. But I think her numbers were in the mid 200 which is lower than usual preshot. I say I think because the Libre is giving me occasional numbers but broken up charts that show much more than the scanned BG numbers. So often I can see what came before the scan.

She goes bonkers for corn, I haven't seen her that excited for food in a while. I only gave her about a spoonful but she would have eaten a lot more. I don't want to make her BG spike but I also want to get her out of danger.

I can try another test, but there is no way to coax Jessi into being restrained. She goes ballistic, not aggressive, but in complete flight (as in run and hide) mode. I have to use a lot of force to restrain her and that makes it nearly impossible to put a needle into her ear and then put a test strip to the drop of blood at the same time.

When it comes to being restrained in any way, Jessi is a wild animal. She has always been that way. Same goes for having any part of her body held for more than a split second.

Tried a second time, the calm, gentle soothing way. Nothing doing. As soon as she felt the needle against her ear she jumped away. Only thing left is the forceful, confining way, but that will have permanent damaging effects on her. Will try again tomorrow.

If we skip two shots, I have no idea what will happen. Vets not very helpful at all in this situation.

Guess I'll post a new thread next time. Don't quite understand the 'etiquette' on that, but as you wish.

 

With DKA in the recent past it is not a good idea to skip doses. Don’t skip two shots please. If Jesse is lethargic, that is another reason why not to skip a dose. I would test again in an hour to see if the BG has risen enough to give the dose. You may need to give a reduced dose.
Are you testing for ketones in the urine?
Stafania, we really want to help you but unless you set up a spreadsheet, it is almost impossible for us to give you dosing advice.
@Bandit's Mom is happy to do that for you but you need to respond to her PM. For us to help you, we need to see the recent BGs and the dose of insulin Jesse is on. We can’t keep scrolling back through 70 posts to find out information all the time.
We want to help you, but we need that Spreadsheet set up please.

 

I am putting on my moderator's hat.

It is virtually impossible to offer informed guidance without benefit of a spreadsheet. Our cardinal rule involves the safety of your cat. Not being able to see your cat's blood glucose values in a consolidated format that is more than what's going on this minute is a problem. You are asking for advice and saying the situation is emergent. We cannot in good conscience help if we don't have the full picture. Experienced members have been pleading with you to get your spreadsheet set up.

Personally, I will not put myself in a position of offering input that could potentially harm someone's cat. Not having a spreadsheet to look at puts me in that position.

 

Can you try maybe testing her in a bathroom, so she has no where to go, that might help get her more used to testing. It doesn't hurt her, she's just not used to getting poked & poking her is not traumatic for her. I never thought I would be able to test my boy whom is known as the terror at the vet, but I just kept trying & giving him boiled chicken as a treat. Now he comes running when I say test time & sometimes he's already laying in his chewy box that I test him in. Check out his spreadsheet when you get a chance, I guess I'm a test aholic

 

I've actually have a much stronger bond with Panzer since testing, alot of us on here develope a bond, he is definitely my heart kitty ❤

 

Just a suggestion…. try wrapping kitty in a towel. I use it with rescued ferals who do NOT like restraint. Put the cat on a open towel and pull the corner or edge up and over. Some cats actually like the security for a short time.

 

After the stickies about not letting threads be longer than a certain amount, I felt like I shouldn't post here anymore. But then I was dropping the conversation and starting a new one which is a little awkward.

I just wanted to say that I skipped the dose last night and this morning after a good meal gave her a little more than 1 unit. I was writing a new thread earlier, but it's really like a continuation of this one, so...not sure what to do.

Sensor stopped working completely probably because she was kicking it so much. It lasted about 7 days so I did collect a lot of data, but most of it was while we were on Caninsulin. Still, I learned a lot. I will get a replacement very soon. Until then 1 unit Lantus, half the original dose seemed like a good choice.

I'll go ahead and post the message I wrote in a new thread in response to some of the replies here. You can let me know if it doesn't read well.

 

All you have to do is type something like "Previous thread:" then copy the link for this page and paste it on your new thread. That way, people don't have to search for your initial thread and neither do you.

 

Well, as a Moderator, I'm strongly encouraging you as to what to do and what the conventions of this board are. There is a sticky note at the top of the board with this information. Scrolling though 80 posts will likely ensure that people will not read the entire thread. As was suggested, copy the URL into your new thread and anyone can go back to find information.