Transition from Vetsulin to Lantus

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Bedina

Bedina

Member Since 2023
Previous thread: https://www.felinediabetes.com/FDMB/threads/transition-from-vetsulin-to-lantus.276033/#post-3061738

New thread as the other got long.

I'm planning to start tomorrow am and monitoring closely (aiming for every 2 or 3 hours?). Based on my recent few days of numbers with Vetsulin (still using an Alpha Trak 2), I'm debating starting at .25 or .5 as she's been skewing lower and lower. I understand that with Lantus you it's ideal to "hold" for a week unless they drop too low. Definitely planning the Slow method.

(We added Cerenia and then Mirataz this week. She was hungry and purring and happy this morning, so I think it's working, but anyone who uses those consistently, I'd love to know your routine - is it daily? Staggered?)

Lastly, is it advised to switch to the Lantus forum from here, or is that primarily for tracking dailies?

Thank you all so much!
 
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Bedina said:
Previous thread: https://www.felinediabetes.com/FDMB/threads/transition-from-vetsulin-to-lantus.276033/#post-3061738

New thread as the other got long.

I'm planning to start tomorrow am and monitoring closely (aiming for every 2 or 3 hours?). Based on my recent few days of numbers with Vetsulin (still using an Alpha Trak 2), I'm debating starting at .25 or .5 as she's been skewing lower and lower. I understand that with Lantus you it's ideal to "hold" for a week unless they drop too low. Definitely planning the Slow method.

(We added Cerenia and then Mirataz this week. She was hungry and purring and happy this morning, so I think it's working, but anyone who uses those consistently, I'd love to know your routine - is it daily? Staggered?)

Lastly, is it advised to switch to the Lantus forum from here, or is that primarily for tracking dailies?

Thank you all so much![/
I think I would start off with 0.25 unit and see how that goes. You hold the dose for a week and then do a curve. If the BG drops under 90 you reduce the dose. It can take up to a week for the depot to fill and the full effect of the dose to be seen.
You can test, feed and shoot one after the other with Lantus. No need to wait for the food to be on board.
You can give cerenia once a day. I would continue that if it is working. And you give the appetite stimulant after the cerenia.
Draw a thick line across the SS and say started Lantus so we are aware when it changed over to Lantus.

Here is link to The Basics, new to the group, start here

POSTING GUIDELINES FOR THE LANTUS PAGE
Click to expand...
 
My answer to you somehow got caught up in your question above so I have copied and pasted it here.

I think I would start off with 0.25 unit and see how that goes. You hold the dose for a week and then do a curve. If the BG drops under 90 you reduce the dose. It can take up to a week for the depot to fill and the full effect of the dose to be seen.
You can test, feed and shoot one after the other with Lantus. No need to wait for the food to be on board.
You can give cerenia once a day. I would continue that if it is working. And you give the appetite stimulant after the cerenia.
Draw a thick line across the SS and say started Lantus so we are aware when it changed over to Lantus.

Here is link to The Basics, new to the group, start here

POSTING GUIDELINES FOR THE LANTUS PAGE[/QUOTE]
 
Bron and Sheba (GA) said:
My answer to you somehow got caught up in your question above so I have copied and pasted it here.

I think I would start off with 0.25 unit and see how that goes. You hold the dose for a week and then do a curve. If the BG drops under 90 you reduce the dose. It can take up to a week for the depot to fill and the full effect of the dose to be seen.
You can test, feed and shoot one after the other with Lantus. No need to wait for the food to be on board.
You can give cerenia once a day. I would continue that if it is working. And you give the appetite stimulant after the cerenia.
Draw a thick line across the SS and say started Lantus so we are aware when it changed over to Lantus.

Here is link to The Basics, new to the group, start here

POSTING GUIDELINES FOR THE LANTUS PAGE
Click to expand...
[/QUOTE]

Bron, thank you as always - your guidance has been a big part of why I survived the last week. I'm reading the The basics link now.
 

Bron, thank you as always - your guidance has been a big part of why I survived the last week. I'm reading the The basics link now.[/QUOTE]
I’m really glad I have been able to help you:)
 
Awesome that you’re doing the switch Bedina!

you don’t have to test that often, especially if you’re starting at .25 units, unless it makes you feel better. That would be like doing a curve and you’ll be doing that in a week. Lantus takes about 2 hours to crystallize and start working, which is why you don’t have to wait the 30 minutes after feeding.

did you sort out the syringes? I don’t know why I’m not getting any alerts for your other thread…
 
Ale & Bobo & Minnie (GA) said:
Awesome that you’re doing the switch Bedina!

you don’t have to test that often, especially if you’re starting at .25 units, unless it makes you feel better. That would be like doing a curve and you’ll be doing that in a week. Lantus takes about 2 hours to crystallize and start working, which is why you don’t have to wait the 30 minutes after feeding.

did you sort out the syringes? I don’t know why I’m not getting any alerts for your other thread…
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First, thank you about the not testing as much tomorrow assurances. that helps.

I also realized I'm currently using U-40 29G syringes with the Vetsulin and she's managing that fairly well, so it gives me a little time to get out and get replacements.
 
I switched back to this thread so that I can edit the title.

I gave her first dose of Lantus as a skinny .5. I checked at +3 and she's up to 329 after a AMBG of 200. In worrying that I'd give her too high a dose, I'm afraid I've overthought it and gone too far the opposite direction. She also clearly doesn't feel well today (back to being thirstier, etc), after days of acting like herself again.

Should I skip any snacks? She didn't eat much for breakfast, but if it's this high at +3 I'm worried about it climbing higher.

Is it normal for the first day of an insulin switch to not go the way you anticipated?

I'm worried I made the wrong decision. She's been doing well (200s preshot) numbers on Vetsuiln the last few days.

I'm sorry I've been so needy this week; thank you.
 
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Lantus is a very different insulin than Vetsulin. Vetsulin acts much more quickly (earlier onset), has an earlier nadir, doesn't last the entire 12-hour cycle, there's no overlap between cycles, and isn't a depot type of insulin. If you've not yet had a chance to read the sticky notes at the top of the Lantus board, I'd encourage you to do so.

Lantus takes roughly 5 - 7 days for the depot to form and for you to start seeing the effects of the dose. Once the depot stabilizes, it can take 3 days/6 cycles to see the results of dose changes. Because of the depot, you shouldn't make changes in dose, unless a dose reduction is indicated, for 3 days. So, when you're asking whether the first day isn't what you anticipated, the answer is "yes" because the depot hasn't yet been built.
 
Sienne and Gabby (GA) said:
Lantus is a very different insulin than Vetsulin. Vetsulin acts much more quickly (earlier onset), has an earlier nadir, doesn't last the entire 12-hour cycle, there's no overlap between cycles, and isn't a depot type of insulin. If you've not yet had a chance to read the sticky notes at the top of the Lantus board, I'd encourage you to do so.

Lantus takes roughly 5 - 7 days for the depot to form and for you to start seeing the effects of the dose. Once the depot stabilizes, it can take 3 days/6 cycles to see the results of dose changes. Because of the depot, you shouldn't make changes in dose, unless a dose reduction is indicated, for 3 days. So, when you're asking whether the first day isn't what you anticipated, the answer is "yes" because the depot hasn't yet been built.
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Thank you. I have read I just didn't expect such a jump when she'd been doing so well on Vetsulin.

I'm now wondering if I should return and stay to Vetsulin until I have a longer collect of data.
 
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Sienne and Gabby (GA) said:
I'm not a big fan of Vetsulin. It's also no longer recommended for the treatment of feline diabetes. You're much better off with Lantus.
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Thanks Sienne.

Wondering if I should stay in Vetsulin is not just the stress of transitioning, to clarify. I went from having what the vet told me was an exceptionally healthy 19 yo kitty on February 1 to finding out she has a GI mass, likely pancreatitis, a carcinoma (removed, thankfully), and now diabetes due to steroid treatment. As recently as a week ago, two vets were advising me that euthanasia might be the kindest choice. I've been a wreck for two months and we had three good days.

So much of questioning if I should stay on Vetsulin is my mental health. I need to try to calm down and breathe because I can't do anything about anything until tonight regardless.

Thank you again for the response.
 
As Sienne explained, the onset of Lantus is very different. I think the earlier you may see a drop in numbers at first is at +4. Remember at +2 it is just starting to release insulin into the body. I’d be curious to see where she’s at at +6. I wouldn’t limit the food, remember diabetic cats can’t process nutrients well so they need to eat. Give a regular .5 unit tonight. Remember also feline diabetes is a marathon, not a sprint. In the long run, Lantus will be better for both of you. I was always grateful that I had 2 hours from shot time to get Minnie to eat. I’d give her an anti nausea and wait 30 minutes for it to work and try to feed her again. She’d pretty much alway eat within those first 2 hours. She’ll have better numbers and less spikes on Lantus.
 
Ale & Bobo & Minnie (GA) said:
As Sienne explained, the onset of Lantus is very different. I think the earlier you may see a drop in numbers at first is at +4. Remember at +2 it is just starting to release insulin into the body. I’d be curious to see where she’s at at +6. I wouldn’t limit the food, remember diabetic cats can’t process nutrients well so they need to eat. Give a regular .5 unit tonight. Remember also feline diabetes is a marathon, not a sprint. In the long run, Lantus will be better for both of you. I was always grateful that I had 2 hours from shot time to get Minnie to eat. I’d give her an anti nausea and wait 30 minutes for it to work and try to feed her again. She’d pretty much alway eat within those first 2 hours. She’ll have better numbers and less spikes on Lantus.
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@Ale & Bobo & Minnie (GA) , thank you.

I've been fairly weepy today. I just lost it on a friend's shoulder. I just felt like I had my kitty back yesterday in terms of how she felt and I feel bad for her, but I've also been an emotional wreck for the last two months so it's much more than just the transition.

Her +6 number was 228 on the AT2. She did not have a snack prior to taking that but she asked for one so I gave it.
 
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Red & Rover (GA) said:
Lantus versus Vetsulin is similar to the fable of The Tortoise and the Hare. Vetsulin starts off with all its might and runs out of steam before the finish line. Lantus (once the depot has been established) is slow and gentle and wins the race.

IMHO, when decreasing steroids, a gentler insulin is the better option.
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Thank you, Red. And I have actually decreased the steroids slightly this week (my vet is of the opinion that if we can manage the diabetes, the steroid will be less of a concern).
 
It’s hard I know. Bobo is starting to show all the same symptoms Minnie had and I just went through 2 years of worrying and knowing I was slowly losing her. I’m emotionally exhausted too and there are days when a good cry on a friend’s shoulder or under the covers is the only thing that helps. But hugs to you!!!
 
Ale & Bobo & Minnie (GA) said:
It’s hard I know. Bobo is starting to show all the same symptoms Minnie had and I just went through 2 years of worrying and knowing I was slowly losing her. I’m emotionally exhausted too and there are days when a good cry on a friend’s shoulder or under the covers is the only thing that helps. But hugs to you!!!
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It's just been something, every 2-3 weeks for months, of "well, this is it. It would be cruel to continue". And then I was starting to feel like we had this together.

Bobo is so lucky to have you and all the knowledge you earned with Minnie. You've caught this so quickly. Please give him a kiss for me.
 
Ale & Bobo & Minnie (GA) said:
Give a regular .5 unit tonight. Remember also feline diabetes is a marathon, not a sprint. In the long run, Lantus will be better for both of you.
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I'm 20 minutes out from our evening test and I was starting to panic a bit, trying to recall what to go for. Thank you again, Ale! As she was 191 (AT2) at +10, I'm very curious now to see where she is at +12.
 
PMPS 204 on AT (154 human meter). That has come up from the +10 (191). Go for .5 as planned or stall a bit?

EDIt: OK, from what I've read all day, I think proceeding with .5 U should be safe as it's a low dose and she is trending up again. I can test her at +2 and +4. Alternatively, I can aim for a scant (.3-.4) again.
 
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I stalled and got a 185 (AT) at 12.20. I couldn't get a human meter reading, but I would presume base on others I've collected that it's below 150.

I went ahead and fed her - she's hasn't felt well and she's eaten poorly.

I'm reluctant to skip completely. But rather than .5, should I aim lower considering? (.25U?) Or as Lantus reacts differently, should I proceed as planned? I wasn't expecting this low (and clearly need to stop having expectations altogether regarding her response to insulin).
 
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She probably dropped because she needs food. That can happen when you stall sometimes.
I think you will be fine to give the 0.5 dose, as long as she is eating well and you can monitor the cycle, and you have supplies of high carb food if needed.
Remember the onset of lantus is not until around +2
 
Thank you Bron.

She's not particularly keen to eat - I'm trying to get more than a few tablespoons in her right now.
 
Bedina said:
Thank you Bron.

She's not particularly keen to eat - I'm trying to get more than a few tablespoons in her right now.
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If you don't think she will eat well this cycle, you could give the 0.25 unit dose, but I would go back to the 0.5 unit dose tomorrow. Just put in the remarks column (if you do reduce the dose) that she was not eating well today.
 
Thank you as always. She asked for food then she's declining so I did that. I'll try to get some more in her in an hour and I'll re-check BG.

The Cerenia really seems to decrease her appetite. I've been adding in Mirataz but not a full dose. I'l make sure to do that in the am.
 
I see you have given 0.3 Unit.
It is OK to do this if she is not eating and the BG is lower than normal as a one off.
Remember Lantus likes consistent dosing (its not like vetsulin where you can change the dose as needed) and if you chop and change the dose it will not let the depot fill properly. I know it is scary but you will need to learn to shoot lower preshots as well. That is the way you will get nice low and flat cycles that are typical when using lantus.
Are you waiting for the cerenia to take effect before adding in the Mirataz?
She might do better on ondansetron as an antinausea medication.
Let us know how you get on during this cycle. It is only 10am for me here in Australia so I am around for the next 12 hours off and on.
 
Brown is right. That’s one of the advantages of Lantus, you can shoot at lower preshot numbers. Anything above 200, I wouldn’t even stall and retest, I’d just shoot the regular dose. Do you have some baby food to try to give her? The Gerber ham works really well. Any other treats she really likes?
 
Thank you all ( @Ale & Bobo & Minnie (GA), so no worries about stalling and retesting at a 200 or above on the Alpha Trak or a human meter?). A friend just sent some tuna over so I'll try that.

@Bron and Sheba (GA), thank you for letting me know that you'll be around. :)

The Cerenia is working (no vomiting since I started it). I added in the Mirataz starting Friday am, but not the 100% dose. It'll up that tomorrow am.
 
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Bron and Sheba (GA) said:
Usually they say 220 or 230 on the pet meter in the beginning when you have no data. That BG number drops as you gather data.
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Thank you!

I slept hard and missed an earlier BG check. She's right now at 269 (pet meter) at +9. I need to try to get back on schedule after stalling so I'm going to shift her forward just slightly.
 
.5U down. Paranoid I got fur shot but I think the odor may have been from the needle and not an actual missed shot (I'm following the video technique of withdrawing slightly more from the pen then shooting out the excess to get to the right unit marker). My two days of feeling competent over all of this on Thursday and Friday were clearly not deserved.

Thanks, Bron. I hope you have a great evening.
 
If the fur spot wasn’t wet and it didn’t smell like insulin, it wasn’t a fur shot. Are you using light to see the area?

As Bron said, with Lantus the goal is to start shooting at the lower preshot numbers as ultimately, you want the preshot numbers to be as low as possible so she can be in the blues and greens most of the time. I’m glad you didn’t skip today :)
 
Ale & Bobo & Minnie (GA) said:
If the fur spot wasn’t wet and it didn’t smell like insulin, it wasn’t a fur shot. Are you using light to see the area?

As Bron said, with Lantus the goal is to start shooting at the lower preshot numbers as ultimately, you want the preshot numbers to be as low as possible so she can be in the blues and greens most of the time. I’m glad you didn’t skip today :)
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Thank you Ale! It did smell a bit of insulin, but there was some on the needle when I shot it, and so it's possible that's why. I did use a light but she has ridiculously thick fur. +4 at 241 (AT2), so definitely below 200 on the human meter (so I'm guessing NOT a fur shot). Yesterday she started trending lower as the cycle progressed so I'm curious to see what +7 or +8 looks like.

Getting her to eat today is a challenge but I just heated a bit of water in the kettle and poured it over her food, which she seems to like.
 
Makes sense. When it’s a fur shot the smell is super strong. A little bit of the scent can just be a drop left on the syringe. If you touched the spot after and it didn’t feel wet, it wasn’t a fur shot. And yea, if the numbers are going down then you know for sure.

the nadir onset is typically later with Lantus.

Have you ever tried Bonita flakes over the food? Does she like that? Hoping she’ll eat for you soon!
 
Ale & Bobo & Minnie (GA) said:
Makes sense. When it’s a fur shot the smell is super strong. A little bit of the scent can just be a drop left on the syringe. If you touched the spot after and it didn’t feel wet, it wasn’t a fur shot. And yea, if the numbers are going down then you know for sure.

the nadir onset is typically later with Lantus.
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Hmm. +8 286 (AT). Maybe it was a fur shot.
 
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