NOT Urgent - Questions about transitioning from Vetsulin to Lantus

@Marje and Gracie, and other Lantus experts:
Please see my list of questions regarding switching Susie to Lanatus on March 2nd.

QUESTIONS FOR TRANSITIONING SUSIE FROM VETSULIN TO LANTUS
Effective March 2, 2021

What dose will Susie start on based on ideal weight and current spreadsheet? She weighs 13.92 lbs. but the vet wants her down to 10 lbs. which I think is too low. I would be happy if she were at 12 lbs. I tried to convert the lbs. to kg on the sticky but I was denied access. She has been on Vetsulin since 12/18/20.

Can I start her at SLGS? I’m still a little confused about the difference between that and TR although SLGS allows me to be in higher numbers With SLGS I should be concerned if numbers drop below 90. TR you become concerned if numbers drop below 50? What is the main difference/differences between SLGS and TR?

I am currently feeding Susie 1 can of Fancy Feast, or Publix, pate preshot in the morning and at night. She gets ½ can around +6 or +7 in the am cycle and around +3 in the nighttime cycle. Is this okay?

No mixing at all with the Lantus pen – correct?

Don’t inject the insulin overflow, or air, back into the pen – correct?

What is the average length of time a pen will stay good if refrigerated properly (between 36 -46 degrees)? Look for cloudiness, particles or loss of efficiency in the glucose values. Rubber stopper cracked or insulin frozen are reasons to toss.

Fine Dose Graduations: I hope I never have to try to do these. My eyesight is not the best even with magnifying glasses.

What are the Phases? I see the comment that many long-term diabetics get stuck in Phase 3 or 4.

Regarding the Solostar Pen:
· Instructions say to take the pen out of the refrigerator 1 to 2 hours before you use it to allow it to warm up. I won’t be doing this will I?

· Instructions say “Do not use a syringe to remove Lantus from the pen”. Why would it say that if that is what I am going to be doing?

Is Susie more likely to gain weight on Lantus like in humans?

If I don’t like the effects of the Lantus on Susie is it bad to switch back to the Vetsulin? Is it bad to keep switching insulins?

 

I believe Levemir is less likely to gain weight on? Or was it in humans I read that?

You can always switch.
Mine was on Caninsulin, then Levemir and then prozinc and now back to levemir.

Yours is relatively new diabetic. With Lantus or Levemir you'd have a good chance of remission, specially on TR.
So it's worth considering!

 

Thanks, SashaV. Trying to get Susie into remission scares me. I worry about the low numbers and the hypo. I'm going to take this nice and slow. Good to know if I don't like the Lantus I can try something else. I don't think I would go back to the Vetsulin/Caninsulin.

 

If hypos scare you, you should definitely get of the caninsulin. The lower numbers is safer on the L insulins. They surf long and gently.

You would also need the right syringes to inject her with. We don't use the pen itself. So the pen is only out if the fridge when we draw insulin up.

 

Her starting dose will be based on the dose of her previous insulin.
Looking at her SS today, I would say you could safely start at 1.25u.

The main differences between TR and SLGS

• Reduction point 50 on TR /90 on SLGS
• Length of time you hold on to doses TR you assess the dose every 6 cycles, and make a decision whether to hold or increase, that decision is governed by how low the dose is taking the cat. On SLGS you have to hold for 1 week, even if numbers are high, do a curve and decide on whether you have to change the dose based on the nadirs.
• When you take a reduction it may hold or it may fail, if it fails on TR you can take them up to the previous dose, as soon as that becomes apparent (we can help you work that out) on SLGS you have to hold on to the reduction for a whole week regardless.
• you do need to get midcycle tests with TR, you don't have to in principle with SLGS, though in practice many folk do, makes it easier to make the dosing decisions if you have the data available to you. You have ample daytime tests for TR, but you would need to make sure you at least always get a before bed test.
  

No we don't use the pen we use U100 syringes (you cannot use the vetsulin/canninsulin syringes they are U40 unless you run the conversion to be able to draw up the correct dose)

I don't know, it's for humans so they don't need to fine dose like we need to do for our kitty, I did it and everyonw who has a pen does it, it is fine.

Folk do swap insulins, if they don't get good results, you need to give it a fair go to assess. Generally folk don't move back to vetsulin, they may try Lev, if they have problems with Lantus, Lantus is longer acting and more likely to give you smooth shallow curves, with time once they settle into a good dose.

 

Good luck with the switch. My girl was much happier on Lantus than Caninsulin. Later I switched to Levemir, but she was a higher dose cat.

If you switch back to Vetsulin, you would be the first person I've ever seen do that on my time here. As Gill said, you do need to give it several months to see how any insulin goes. It'a a hormone, their body has to do some adjusting.

More smaller meals are ideal. Lantus is a gentler insulin so you don't need to get a lot of food in them right away. Ideally you would also feed most of her food before nadir. After that the insulin effect is wearing off and carbs can make it wear off faster. You might want to move that AM +6/7 feed up, depending on where you find her nadir ends up.

With both methods, you get concerned or give higher carb food if below 50 (on a human meter). Reductions are below 90 or 50 depending on dosing method. Make sure you read our Dosing Methods Sticky Note. We don't refer to Phases here. Also the Sticky Note on Insulin Care and Syringe Info will answer a lot of your questions.

 

I have the U100 syringes with the 1/2 unit markings and will only keep the pen out of the refrigerator when I am getting the insulin. Good to know the Lantus is better for lower numbers.

 

Thanks for all the good information, Gill and George. I'm concerned with starting Susie higher than 1 unit. I would want to see how she handles the switch but if all agree then I will try the 1.25. I'm also worried about getting that tiny .25 right on the syringe.

Good explanation of the differences between TR and SLGS. I like the SLGS right now because I can be more careful with the numbers going under 90. With the numbers under 50 I would be freaking out. I think it is just too soon for me to be playing that game. When I am more comfortable I will.

I do have the syringes (U100) for the pens. I feel good about switching to the Lantus now that I found a place that I can afford to buy it. Also, am hoping for more consistency and a more gentle insulin for Susie. Thanks again for all the info!

 

Thanks for the advice, Wendy & Neko. I would not go back to the Vetsulin. I will give the Lantus plenty of time.

I have never really been able to figure out when her nadir is so generally feed lunch around +6 or +7. Is a half of a 3oz can too much at one time for mid cycle (am and pm)? I definitely will be giving her a full can at AMPS and PMPS. She is always really her hungriest at those times.

I did see the reference to "Phases" on page 4 of the Tight Regulation Protocol (TR) Sticky but I guess it doesn't matter.

Thanks for your support.

 

The Tilley's Diabetes Homepage (where TR started), refers to phases but the way we've worded it, we don't refer to those phases.

The nadir on Lantus will likely be different than it was on Vetsulin, so you get to be a newbie for a little while again.

 

I will be a newbie for a long time. Trying to understand all of this is mind boggling. Never been able to figure out the nadir and even more confused when my PMPS is lower than my +9 at times. Critter Mom says that Susie might still be producing insulin - just not enough. I'm really looking forward to more clarity with the Lantus. The "deep bucket dives" with Vetsulin I hope will disappear. Between AMPS and PMPS has been a roller coaster. I have been at 1.25 units, with the Vetsulin, for a while now. When I tried to bump her up to 1.5 she stopped eating. I'm just looking for a little consistency. Hope the Lantus can give that to me.

 

By the way, when you say I need a "before bed test" I am in bed around 7:00 pm.

 

That's very common when the bounce is breaking. Neko's actual nadir varied a lot, but on Lantus, was most often in the +7 to +9 range.

 

Is that shot time?
Are you up a few hours before shot time?

 

How strange that the nadir was so late for Neko.

 

I am up at 4:30 am to begin my day. I have two dogs that need immediate attention at that time. I give them 20 to 30 minutes and then I get Susie's food and rice sock ready around 4:55 am. I get her blood test, feed her and then shoot her within 30 minutes. Usually right around 5:30 am. The same for the evening cycle. Susie gets her test, her food and her shot by 5:30. Because I get up so early - I go to bed very early. I do wait 20 to 30 minutes after she eats to administer the shot. This is my schedule. Kind of like having a job that requires you to get up early but I do it because I know that at some point, if her numbers drop, I do not want to be up at midnight to test at +6. Would rather catch the test earlier at night.

 

Sorry about the questions they seem so personal, it's just trying to figure out your schedule. I also have two dogs, I know how it is first thing in the mornings with them.

Sure get a test before bed, that would be around +1 to +2 depending on when you actually end up shooting Lantus. Some members will get up in the night to use the bathroom, and they will often grab a test then, I'm not one of those so if I needed to I set an alarm and would test and go back to bed if all ok.

With Lantus, unlike vetsulin, you don't feed Susie 30min before her shot time, you would feed and shoot all within 10min. A lot of us shoot while kitty has her head in the bowl. So perhaps that might mean that you are shooting at more like 5am? Lantus has a slower onset than vetsulin, that is why it's recommended not to wait to 30min between testing, feeding and shooting.

 

Yes, I am aware that there is no lag time between the test, food and shot with the Lantus. It will be nice to get it all over with at once. I probably will have it all done around 5:00 am and again around 5:00 pm. I'll be honest with you, Gill. I am not one of those looking to try to get Susie into remission. I'm already a very nervous person and the idea of getting lots of low green numbers terrifies me. I would be happy with readings around 90 to 120. I might get braver as I learn more and get more comfortable. I am so frustrated with the Vetsulin. I have been locked into pretty much the same pattern for a while now and when I did increase the dose to 1.5 Susie stopped eating a few days later so I went back to the 1.25 units where I have sat for a while with some pretty good numbers and some not. She is reading too high but I can't increase the dose. Anyway, I don't mind the questions. It is good to have someone who "has my back". Thanks!

 

Hi Summer,

That's fine and you can aim for that at least initially, with lantus when you get into those lower ranges, and get the regulated the curve is gentle/ almost flat and more predictable than when you have large fluctuations in BG from PS to nadir.
But it takes us all a while to get used to those lower numbers, we all feel that anxiety.

George got into remission, but all I wanted for George when we started on Lantus was to get him regulated, remission came as an added bonus.
He is still with me, still in remission, 21years young, and BG of 80 yesterday.

I hope that with Lantus you will get better duration, and with the Depot insulins, it can be easier to bring the overall range down.

You're welcome. I sometimes feel that folk must feel like we pry with all the questions we ask, it's just to better understand the CG situation, and to be able to take that into account when advising them or helping decide on a strategy. I just posted quickly, I was busy with the dogs and cats here, and when I looked back I thought the post seemed quite short.

I am in Europe, where are you in the US? just thinking of what time of day it is for me here when you shoot.

At

 

I am amazed that George is still with you after additional scares of a heart murmur and kidney disease! That is a testament of your love and care for him. It is truly rare for a cat to get that old - especially one that has had health concerns.

I am in Florida. Eastern Standard Time and it is 12:30 pm right now. I do not expect you to follow all of my concerns. I know that if I have an urgent problem, and properly post it on the Feline Health Forum with a 911, then someone will be around to help me. Thanks, again.

 

For cats that have already been on another insulin, as Gill said, we don’t use ideal weight. We look at the dose she is currently on and the BGs it’s getting her to. I also agree with Gill that 1.25u is a reasonable dose to start her on Lantus but you will need to be sure and test those first couple of cycles as, sometimes, they can have a good response to Lantus. I’d suggest you start the Lantus on a daytime cycle when you can be home to test and that you make sure you have the hypo toolkit and a variety of low, medium, and high carb foods as well as syrup and plenty of testing supplies.

If starting at 1.25u really scares you, you can start at 1u Lantus but it might leave her at higher numbers for a bit longer. Be sure that when you start, you put it in the subject line so members in the LBL can keep an eye out to help you.

Good luck and glad to have you with us. Please be sure and read our Posting Guidelines. It’s very different than what you are used to on Health.

 

Hi Gill. Just wanted to let you know that my vet wants me to start at 1 unit - not 1.25. He just wants to make sure that she adjust to it well before we up the dosage. Will be starting tomorrow morning unless something unforeseen happens to delay the transition.

 

No problem.
I'll look out for your first Lantus Thread tomorrow.
Paws crossed all goes smoothly for the switch.