switching from vetsulin to lantus

Aslan (dc) is being changed from vetsulin to Lantus tonight or tomorrow. He has been on 14 (U100 syringe) units of vetsulin twice a day and the vet said to start 7 units of lantus twice a day. Does this sound right? Aslan's last injection was noon. Should I wait until tomorrow morning to start the lantus so all the vetsulin gets out of his system?

I have been feeding a mixture of Purina DM dry and evo (for carbs with the vetsulin). Should I change the food to all DM? Aslan refuses canned food or human foods.

I am starting to get panicky over this - but Aslan is laid back and calm (a mostly Maine Coon with some norwegian - long VERY dense fur that easily gets matted).

He has never done really well on the vetsulin...and we have been through several vets & just found this one who at least wants to deal with a diabetic cat and cares- even though he is an hours drive away and we probably pass 40 other vets on the way!!!

I will submit this and hope it gets posted - I have not figured out how to work this site yet!

Janet & Aslan...... JLSindy AT aol.com

 

BUMP

Moved in from the hallway.

 

I don't have any advice for you.. as I'm not familiar with vetsulin or high doses of lantus.. but I just wanted to let you know that the doses your talking about are pretty high and so it may take a little bit for someone with experience in that area to get back to you (esp since it's night time for many of the people here).. hang in there though.. advice is coming!

 

hello and welcome to the group!

generally speaking, you would shoot lantus 12 hours after the last shot of vetsulin. however, aslan is on a very high dose of insulin. without any history or data, i don't know if you should wait or not. seeing as i'm coming to this late... it may be a moot point.

as far as a starting dose of 7 units twice a day... while 7u of lantus is a lot less than the 14u of vetsulin he was on, 7u twice a day is a VERY high starting dose. none of us know if it's appropriate for aslan without knowing a lot more information.

most newly diagnosed kitties here start with around 1u bid (twice a day). if the vet is using weight to determine a starting dose the formula is 0.25u per kg of the cat's ideal weight and is dosed bid. when switching from another insulin to lantus, the dose should be raised or lowered by taking this information into account.

most of us use a slightly modified version of this dosing protocol: http://www.tillydiabetes.net/en_6_protocol2.htm

dr. lisa has some very good diet information on her web site: http://catinfo.org/. she also has some tips on transitioning dry food addicts to canned food: http://catinfo.org/TipsforTransitioningPDF12-18-09.pdf. you might want to take a look if you haven't already.

try not to panic. aslan will get used to the routine if he isn't already.

finding a vet who will work with you is very important. i'm glad you found one!


if you could give us more information, it would be helpful...
--- when was aslan diagnosed with diabetes?
--- how long has he been on vetsulin?
--- how did you arrive at 14 units twice a day? it's a very high dose unless kitty has a health condition requiring high doses of insulin such as acromegaly or insulin auto antibodies (IAA).
--- are you testing aslan's blood sugar at home? if not, here's a link to hometesting links and tips: http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=287
--- if you are testing aslan's blood sugar at home, could you please share the last 2 -3 weeks of numbers with us? you can find instructions for setting up a spreadsheet here: http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=16

we also encourage all those who are new to the site to introduce themselves and give information about their cat on the Health Forum where you'll receive a propoer welcome from the members of the board: http://felinediabetes.com/FDMB/viewforum.php?f=3.

hope to see you posting often...

 

Aslan was diagnosed 7/2008 when I requested the vet to test him. He was drinking and peeing a lot.

The first vet we talked to really did not even want to discuss diabetic cats - so we wrote him off right away. The second vet did diagnose him and the next day we had to go out of town for a few days. We left the cat with him and asked that a curve be done while we were gone. When we returned, I asked what the curve results were and was told the Dr. did not know what I meant by 'curve' he gave 'smack' tests. We left that vet pronto - even though we still stopped by each month to get the Vetsulin (we were going to try it on our own) and they never noticed from July of 2008 till last December that we never brought Aslan back!!!!!!

We had a diabetic cat in the 90's and the WONDERFUL vet we had then has since retired.

We then did find another vet that we did like - we knew Aslan needed help because he was not doing as well as we expected he should - and she was better and was the one to increase to 13 units twice a day. She did all kinds of expensive tests and thought we should switch from the U100 needles to the U40 as she said it would be easier to adjust small changes (my take was that she saw $ in selling the U40 - and we told her NO).

Aslan was doing OK but never as well as our cat in the 90's so when we had to board him last November, we found a wonderful, very knowledgeable woman who had a experience with diabetic cats. She also does rescue work (cat's kept in different facilities) and recommended this vet highly as she agreed Aslan could be doing better.

We could not afford to go to the vet until earlier this month. He did a glucose test and fructosimine test and wanted to increase the Vetsulin to the 14 (U100) units and said we would notice dramatic improvements almost immediately - which we did. He wanted to do that prior to switching to the Lantus.

Aslan is actualy an outdoor 'neighborhood' cat. He is about 10-12 years old. He is a Maine Coon (the boarding lady thinks he has some Norwegian as his coat is so dense).

After he was diagnosed, we started keeping him in our breezeway (he would be a house cat but he sprays----I can tolerate anything but the spraying). He does not spray in the breezeway - so we have put a gate between our kitchen and dining area and he stays in the kitchen. That is important since these northern Ohio winters can get cold. Also, we have started getting cyotes back in our area so we feel better with him inside. Aslan is very loveable and soed get along with our cat and all the other neighborhood cats and dogs.

Aslan is GREAT about the shots - very laid back.

I tried the home testing with the first cat and was never successful (the vet was close and so reasonable we just took him there). My husband was working then also. Since then, my husband has retired and had heart surgery, a stroke, and lung surgery all in 2007 - so we do not have the funds we used to. I just do not have the time and patience to get into something new at this time such as the testing.

We did give Aslan the 7 units of Lantus this morning and are watching him closely. We chose not to give him the Vetsulin last night. He did start drinking lots more water by this AM and from what I understand the Lantus will take several days to kick in.

The vet said to keep an eye on him & bring him back in 10 days for testings and to call immediately if anything came up that caused us concern. The vet knows we do have some experience with this - I am just really concerned because of the switch in insulins.

We ae hesitant to switch to a canned food as Aslan is a diehard grazer (he cries when no food is down - and he always saves a few morsels) and has maintained his weight well. He is about 11 pounds. However, we will consider the switch should it seem better for him in the future.

At one time we had 13 cats (all rescues, strays, or throw aways) and are down to one house cat and 3 neighborhood cats that we share care with a neighbor. We would still have 13 cats and maybe some dogs - if vet care had not gotten so expensive. The vet that took over our old vet's practice almost tripled the prices! We have a room that is the 'quarentine room' whenever one of the neighborhood cats needs seclusion & medicine - so even our neighbor has a key to the house and she helps take care of them. Our dogs are all gone, but we have a another neighbor that 'shares' his black labs with us - we even get to babysit sometimes!

Sorry to ramble on like this. Hope it makes sense and answers some question.

Thanks for your interest. (I just checked on Aslan - he sends his "Meows").

JJ & Aslan

 

hi there,,

welcome to the Lantus forum, you've received really good advise already.

One of the main questions asked by Jill was -

--- how did you arrive at 14 units twice a day? it's a very high dose unless kitty has a health condition requiring high doses of insulin such as acromegaly or insulin auto antibodies (IAA).

Do you have any test results (paperwork, invoices) of what tests Aslan has been thru at the vets?

I just to clear up, you are not home testing right?

will you be able to keep us posted on Aslan today?

 

Just wanted to drop in and say welcome to the group.
KiKi and I are also making the switch from Vetsulin to Lantus (day 4 here) -- it is very nerve-racking not knowing what to expect with new insulin. But everyone here is sooo helpful whenEVER you need them. Truly a GODSEND!
Anyhow, I just wanted to say you're not alone ;-) we are traveling the same road

 

I'm going to give you a couple of links on hypoglycemia, if you don't already have info like this from your vet, please print these out.

From GENERAL RULE OF THUMB FOR TREATING HYPOGLYCEMIA
link...

Knowing how to respond to a hypoglycemic event whether or not symptoms are present can save the life of your diabetic cat.
The following general guidelines are intended for those who home test the blood glucose levels in their cats. These guidelines are not intended to replace the advice given by your Veterinarian. It is very important that you discuss any and all treatment options with your cat’s physician BEFORE an event has occurred.

-----> viewtopic.php?f=14&t=1122

Since you are not hometesting, you may just have to keep an eye out for any of the symptoms listed in this link, and contact your vet immediately should you come across anything like this.

Hypo toolbox list that every DC owner should have:

----> viewtopic.php?f=14&t=2354

 

I may be misinterpreting here, but it sounds like Aslan was on 14 units of Vetsulin in a U100 syringe, which, if my blondeness is not affecting my math abilities, is ~ 5.6 units. Still pretty high though.

 

Yes - it is my understanding that 14 units in a U100 syringe is the equivalent of 5.6 units in a U40 (suggested Vetsulin) syringe. The first vet we went to just converted the Vetsulin to be used in the U100 syringe and we stayed with that as we were used to them and here in Ohio syringes can be bought over the counter (no Rx needed) and are less expensive OTC than through the vet.

 

MJ - thanks for that clarification. I'm not familiar with the conversion from the U40 to U100 syringes. So that means that Asian is actually getting more Lantus than Vetsulin?

Janet - we do rely heavily on testing here. One of the members here used an alternate form of testing rather than BG testing. I believe she did urine glucose testing. Regardless of what form of testing you do, it will be difficult to understand Asian's progress without having any data to base dose changes on. Lantus dosing is based on the lowest point of the cycle (the nadir). With the amount of insulin Asian is prescribed, we would have no way of knowing if numbers are dropping low and then bouncing up high. A fructosamine test might then show a high average BG resulting in the dose being raised since the lows and highs are canceling each other out. To be honest, if you are having to take Asian to the vet every couple of weeks for a fructosamine test, this is going to be at least as expensive as doing some form of testing -- although I'm not familiar with the cost for the urine testing. The brand of meter and strips at Walmart are very reasonably priced, if this is an issue.

Also, could you describe how you and your vet arrived at this dose of Lantus?

 

Aslan was on 14 units vetsulin and switdhed to 7 units lantus....both using the U100 syringe twice a day - so the lantus is half the amount of vetsulin.

Aslan has had two fructosimine tests. One about a year ago with another vet ($98) and one earlier this month with the new vet ($22). The results of the recent test are what led to increasing the vetsulin from 13 to 14 units prior to the switch.

The new vet wants to redo the tests (glucose and fructosimine) about 10 days after Aslan started the lantus.

We were given a Ascencia Contour testing kit by someone from Freecycle. I have not tried it as I remember spending MUCH time on mayn occasions trying to test our cat back in the 90's (warmed ear with cloth, rice bag, all kinds of tricks) and the only blood we got was mine! Aslan is very good about his shots and he has been declawed in the front (not our doing); however, he is very skillful at using his hind claws when he desires and I do not think Walgreens had enough bandages!

I am continuing to keep a close eye on Aslan and watch for any signs that something is amiss. So far his is doing very well - but this is just the beginning of day 1! He is loving all the additional attention and brushing!

 

Hi JJ,

I have a high dose cat. He has acromegaly. I am going to try not to be blunt, but there are only 3 tests that will tell you if your cat is a high dose cat and Aslan hasn't had any of them. They are IAA, Acromegaly (both blood work) and Cushings (urine, and then bloodwork). Many vets do not understand feline diabetes, and in my most humble opinion, any vet that thinks 14u of Vetsulin (which has been recalled due to varying degrees of efficacy leading to DKA and overdose) is a reasonable dose, hasn't been doing his/her research. This is not a normal dose of insulin for a diabetic cat. To start a cat, that was on a recalled insulin, at 7u of Lantus is incredibly dangerous.

Please reconsider your decisions, both on the dosing and on the hometesting -- we can help you and we want to help you, but we don't want to offend you either. I have tested several cats, including a diabetic I just cat-sat for 2 weeks, who didn't want to be tested. There are ways and tricks to doing it that can help you, and that can turn your testy cat into one who comes looking for tests and treats. Believe me, it's a lot safer and a lot less expensive than going to the vet. Lots of pictures, videos and walk throughs here: http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=287

Consider the reasons:
1. Vetsulin has a short duration in a cat, 8-10 hours max. Lantus can last 14-18 hours or more. You can imagine the overlap that could suddenly happen and snowball into a hypoglycemic experience, as one dose stacks on top of the next.

2. Fructosamines show regulation. A cat that is being overdosed will show an unregulated result on fructosamine, same as a cat who is underdosed. You can have no way of knowing what is happening with that test.. just that something is not working.

3. A heavily overdosed cat can enter a state of rebound that leads to glucose toxicity as the liver will work very hard to fight hypo, which will cause you to have to continually and drastically increase your dose in order to correct it. Your insulin costs will become gigantic, and that's only if you are giving enough insulin to break it. When it does break, a prolonged hypoglycemic event can occur.

4. Finally, your cat may actually have one of the high dose conditions I listed before. These conditions will require specific treatment, which you can only give if you know what you need to treat. Hometesting will allow you to understand whether you even need to have the tests run, or if Aslan is like every other "normal" diabetic cat and can be regulated on a "normal" Lantus dose, which is somewhere around less than half of what you are currently giving.

I hope you will take my concerns as they are meant, of concern and caring. I am not trying to tell you off or make you feel badly, quite the opposite: I am trying to empower you.
(((hugs))) to you and chin scritches to Aslan..
..C

 

please check your vial of vetsulin. vetsulin is a U40 insulin. does it say U40 on your vial?
if your vial of vetsulin says U40, when you draw up to the 14u mark on a U100 syringe you are administering 5.6 units of vetsulin... not 14 units.
conversion chart: http://www.felinediabetes.com/insulin-conversions.htm. please read the explanation at the top of the page.
is this what you've been doing?

if your vetsulin is U40 and you're using U100 syringes and drawing up the vetsulin to the 14u mark on the U100 syringe, you have been shooting 5.6u of vetsulin twice a day.

lantus is a U100 insulin. when you draw lantus up to the 7u mark on a U100 syringe, you will be shooting 7u of lantus. this is not half the amount of the vetsulin you were shooting before. please speak to your vet about the dose.

you seem reluctant to test aslan. this forum is a numbers driven forum and for the most part practicing tight regulation based on collected data. i'm not sure what kind of information or help you're looking for, but maybe i'm missing something. how can we help?

again, i'd like to encourage you to post on the Feline Diabetes Health Forum to introduce yourself and aslan to the board and for general information:
http://felinediabetes.com/FDMB/viewforum.php?f=3.

 

Hi! Welcome to lantus land--
I have a cat that would not let us blood test her for almost a year--We used Purina Glucotest Urine detection system, which on amazon is $6.00 a pkg, and lasts about 5-7 days--You put it into scoopable litter, it comes in little squares, and when Aslan
pees on the squares, the color changes and gives you a urine glucose reading--It is afterall, some indication where this cat's glucose level is, but the only thing is that urine is stored in the bladder for 3-5 hours, so when it is excreted, it is the past reading, not the current--That's why I checked the litter box 2-3 times a day, just to see where she was..One of our longest members managed her outdoor cat this way for 14 yrs.
BUT blood testing is the ONLY up to the minute way to monitor-It is what we use here--There ar isolated cases & should be an interim measure.

If I were you I would try a packet of Glucotest, for a week & I will be glad to help you interpret it as I have a packet here with the color chart indicating the urine levels--OK??
Just today, keep your eye on Aslan, as that is a pretty high dose of lantus, but I hope it will be fine...

 

Jill,

Vetsulin is a U-40 insulin and lantus is a U-100 insulin. I do not dispute that. 14 units of Vetsulin in a U100 syringe is = to 5.6 units of vetsulin in a U40 syringe...I do not dispute that either. I was trying to note the syringe after each dosage so apples could be compared to apples...but K guess it does not work that way.

I did go to the link you provided twice and did not see anywhere to post anything. I saw a bunch of questions regarding mostly food and/or contents but did not see any introductory place to someone new to post and indicate what to post. Maybe I missed that.


Carolyn,

I really do appreciate all the information, comments, and concerns. I am printing them out to reread and try to digest later. I can get them to the vet also, I guess I am too ignorant to be offended or put off by them. I can only do the best with what I know and understand.

I guess the numbers did not seem too big to me as the cat I had in the 90's was on 18 units twice a day (on an insulin that is no longer made) prior to honeymooning for the duration of his life.

I was looking for some feedback on what others thought about the amount of the conversion and the general thought that I am getting is that it is too much lantus. I have no qualms about reducing the dose.

Maybe my husband can read throught the information while I meet with tax clients this evening. He tends to understand medical stuff better than I. I have much work that needs to be done for tax and acocunting clients. That is the difficult part of being self employed - there is no one else to put the work onto.

We do not have much choice on vets. We are on the 4th and he is the first that seems to even really understand or care about Aslan. Maybe I should have just gone with the first vet and just had Aslan put down. I just hope Aslan does not suffer because of my stupidity and incompetance.


Roni,

Thanks for the information about the glycotest. I have not hear about that before. Perhaps my husband can find some around here tomorrow and we can at least try that to start. Maybe the vet knows where to get it. If not, I can order from Amazon - might have some time tomorrow to get to that.

So far Aslan seems fine. I hope he continues. Well some tax clients have arrived - time to go put on my other hat.

JJ

 

I think the prevailing concern is that Asian is getting a whopping big dose of insulin. The cats here who are on similar doses have been carefully worked up from a lower dose all the time being monitored to insure that their optimal dose of insulin isn't missed. Dose changes, based on the protocol we use, are made in 0.25 to 0.50 increments based on the lowest BG level in the cycle. Even the cats with the conditions that Carolyn mentioned have their doses raised in small increments. The way we approach achieving tight regulation or remission is by knowing what our kitties' BG levels are via testing.

No one is suggesting that you are operating out of stupidity or incompetence. No doubt what was known about feline diabetes in the 90's has changed. That's the nature of research. In addition, finding a good vet is often a challenge. The longer you are here and if you read other members' condos, you will hear stories about the full range of veterinary care. There are any number of people here who like their vets for everything except their ability to manage diabetes. Hopefully, by the time you and/or your husband have the chance to read and digest the information you've printed out, you will be well on your way to developing a surprising amount of expertise in managing Asian's diabetes.

The link Jill provided will take you to the Health board. You may want to copy your first post here as a means of introducing yourself. It's really the same process as here except the purpose of the two Boards is different. The Health Board is used for a myriad of purposes. It serves as the gateway to the specific insulin support groups, such as this one. It also is a forum for questions related to illness, medications, food, testing, and pretty much anything else.

 

Please do not think that, we can help you help him. I will tell you a little story about someone locally to me I just met. She needed a sitter for her diabetic cat, and she was worried he was suffering. He was quite sick and had severe neuropathy. He was dx in September, put on PZI and went up to 9u. Then he was put on Vetsulin and went up to 9u. When I met her, he was at 5u Lantus about a month ago, and now he's at 8.5u. He really is a high dose kitty, but she figured it out, and she's able to give him the insulin he needs. Now he is feeling better, peeing less, and very active. We can help you to figure this out with Aslan, whether he's high dose or not and help you get the treatment he needs either way. (((((hugs))))) Cats can thrive with feline diabetes, so please don't feel you've done the wrong thing.
..C

 

Hi you guys! I'm so glad that you found your way to FDMB as I think the folks here can really help you.

I know you've had tons of advice, so I'll try to keep mine simple...

1. 7 units lantus is too much to start at. period. it doesn't matter what he was on for vetsulin, it makes no sense to start at an even higher dose of lantus.

2. hometesting is daunting. So. Consider a few options, including dropping that dose in a huge way (I think perhaps you wrote on the health board that you did drop the dose???), and perhaps on the weekend try testing again if you have the equipment. Also consider letting us know your approx location in case one of us lives nearby.

You don't have to get the hang of hometesting right away if you choose to go that route, but it will make things easier and safer for all of you.

Jen