Changing to Lantus Dosing Advice

[Bear & Lora]

My Kitty Bear has been on Prozinc since he was diagnosed in August 2018. Bear is a great bouncer who has had DKA once at the end of September. I had only been home testing for 6 or 7 days when that happened.

As I have been increasing his doses in small increments his BG has been all over the place. Our Vet recommended a few options as she is concerned that we could have another bought of DKA.

I have tried one of the options for a short time, which was using a secondary insulin (Novolin R). The thought was if the R insulin was used as Bear's BG was going up at the end of his bounce, to lower the BG and prevent reds and blacks and possibly get his body used to lower BG so that he might experience less of the panicky liver affect. My conclusion was that, yes it did help but the extensive hourly testing and monitoring can't be done in the near future.

Another option was to switch to Lantus, a longer lasting insulin and see if Bear's overswings/bounces are less extreme.

I have gotten a Lantus pen but I need dosing advise. With Bear's current dosage of 4.4 units which is 11 units of Prozinc on the U-100 I need some experienced members to get a reasonable dosage. Bear was overdue an increase of Prozinc but with his bounces into Red and Blacks I was holding to see if he would stabilize a bit.

I can test him as needed for the next few days.

 

[Sue and Luci]

Nice job on the testing! I'm not familiar with Prozinc or R but know those are both fast acting insulins - we've been on Lantus since the beginning and it's a slow acting insulin - builds a depot so it takes time - and testing to determine when your cat hits his nadir (the lowest point in the cycle)...hopefully some of the experts will come on to help you with your question regarding making the switch from one to the other. Have you reviewed the Stickies at the top of this forum to see if there's any info in there about switching from one to the other?

Best of luck to you - hopefully the Lantus will help get rid of those scary high numbers!

 

[Jill & Scooter]

I’m not qualified to give you dosing advice, but I think you will like the Lantus. It often gives much flatter cycles, but as a Sue said, it does take time, so be prepared to wear your patience pants! Good luck! I hope it works really well for Bear!

 

[Sienne and Gabby (GA)]

I see a couple of things on your spreadsheet from Prozinc. First, you're not getting duration and there's the bouncing that you noted. In part, it can be hard to tease out what's a bounce vs if you're not getting sufficient duration. The high numbers at pre-shot can be a clue regarding duration. While Prozinc gives much greater duration than R, it has less duration than Lantus. One other issue is that I suspect you've been holding the dose too long. (See below.)

You can use the same dose of Lantus as Prozinc when you switch. You need U100 syringes (it sounds like you already have these) and you could start either at 4.0u or 4.5u. Some cats do have a marked response to an insulin switch so this is a vote for slightly reducing the dose. However, if ketones are a concern and you can monitor closely, I'd lean toward starting at 4.5u.

A couple of questions. How much R are you shooting? We typically start on very small doses. There are a couple of reasons for starting at a small dose. First and foremost, R is very powerful. It's misuse could easily cause a fatal hypoglycemic crisis. Barring anything terrifying, if you shoot a higher dose, it may trigger bouncing all by itself. When that's the case, it's hard to tease out what's the result of a "normal" bounce in response to lower numbers vs a response to the R. The other issue is that with R, you need to do a curve which, in this case, means testing every hour for 4 hours in order to tell how your kitty is responding to the insulin. And (if this isn't already enough), you do not want the nadir on R to overlap the nadir with Lantus. The overlapping nadirs could make getting numbers back into a safe level challenging.

Since it sounds like Bear has had issues with ketones, are you testing for them? You can either get urine test strips (Ketostix) at any pharmacy in order to test urine or you can buy a meter that will allow you to test for blood ketones. The latter is more up to the minute whereas testing urine means that you're getting results that are not at the moment. Either is fine -- the test strips for blood ketones are pricey, if that's a concern. There are a couple of ketone meters on the market -- Precision Xtra and NovaMax are the ones most people here seem to use. For now, if you're not already testing for ketones, please get some strips and test regularly. It's one of the best forms of prevention and being able to test at home will save you $$ from having the vet do a blood ketone test.

There are differences in how you use Lantus vs Prozinc. Overall, Lantus dosing is based on the nadir -- the lowest point in the cycle -- and not on the pre-shot number. Further, you don't "slide" the dose. Doses are adjusted usually in 0.25u increments.

Please take a look at the sticky notes at the top of the board. In particular, you will want to review the dosing methods. We use 2 approaches to dosing here -- the Tight Regulation Protocol (TR) and Start Low Go Slow (SLGS). With either approach, the dose is held a much shorter time than what you've been doing with Prozinc. As the name suggests, the dose is held longer with SLGS -- a week. Doses with TR are held for 3 days unless nadirs are under 200. The exception with either approach is if numbers fall into dose reduction territory which differs for each approach, the dose is reduced at the next cycle.

All of this said, when a kitty is prone to ketones, all bets are off. Using R may be a good strategy providing it's used carefully so it doesn't create more problems than it's meant to help. The formula for ketones developing is based on not enough insulin, not enough calories, and the presence of an inflammation or infection. If Bear has been off his food and you're seeing small ketones developing, it really may not matter what you feed him, as long as he eats. You may need to be more aggressive with his dosing in order to keep ketones at bay. The basal/bolus approach (i.e., Lantus is your basal insulin and you use R as a supplement or "bolus") is fine but ultimately, you want to wean off of using R once the Lantus depot is established (this takes about a week) and you're seeing lower numbers. I'd also talk to your vet. When Bear was diagnosed with DKA, did the labs show any source of inflammation? Does your kitty need dental work? Was pancreatitis present?

 

[Bobbie And Bubba]

Hi Lora and welcome to the L, B & L forum. I also think you will like Lantus . Bubba was on ProZinc for 6 months before we switched and I am glad that we did. The dosing is different and the biggest difference is that with Lantus you dose according to the nadir you get with consideration to the pre shot number which is the opposite on dosing ProZinc.

Question: Do the vets know what caused the DKA back in Sept?

With Lantus, there is a protocol which makes it easier to know what to do whereas ProZinc I felt like I was guessing. The 4.4 dose you were shooting with ProZinc would still be same with Lantus. You don't need to convert U40 syringes to the U100, the conversion is all ready done.

On 12/13 the 4.4 dose did get him into the greens and he bounced as he likes to do and after giving the bounce 6 cycles to clear, he hasn't gotten back into the greens again.

There were some yellows in the cycle early on Dec 22 and Dec 24 and no more test afterwards and then PM pre shots were a lot higher, so some lower numbers could have been missed. With that said, I think I would start him at 4 units of Lantus to see where that takes him. Let's see what some others think.

Look over the stickies to decide whether you will do Tight Regulation or Start Low Go Slow. You test enough for TR and with a recent DKA, I would want to get him into better numbers as fast as the TR protocol allows.

 

[Wendy&Neko]

Hello and welcome to you and sweet Bear. His name and face made me smile, as we get black bears in our neighbourhood.

I agree with Sienne on the dosing. 4.5 might be better, given you had recent DKA and can monitor closely. Be aware that some kitties have a strong reaction to the insulin switch, so make sure you have high carb food on hand. I read on you SS that you were feeding kibbles? Does he not like high carb wet? I would also post here regularly, at least to start, so we can help you over the initial learning curve.

We have a few of us here who have used R with Lantus and Levemir. Were you using the U100 syringes to dose it? Just asking cause I see doses of 0.1 and 0.2, whereas we would typically start at 0.1 and go to 0.25 units. At Neko’s peak, she got as much as 0.5 units of R. We typically build an R scale, so amount of R given is based on BG value at the time and time of cycle. I agree that the amount of testing with R can be tiring at first, until you know it’s effect. Depending on the ketone situation, it may or may not be something you add to Lantus. Hopefully the longer duration of Lantus will be enough for Bear.

Full of questions, sorry. How is Bear feeling? Any other health issues besides the DKA either now or on diagnosis?

 

[Bear & Lora]

A couple of questions. How much R are you shooting?

The last time I used R was 12-14. I had started very low 0.1 and then went up. I documented the R use in the remarks. I also added the amount in the boxes like at his prozinc +6 I entered 0.1 R under his BG and at his +7, I also entered +1 R.
I had actually used information from a thread Humilin R vs Novolin R in which Jill and Alex had advised a fellow prozinc user on Novolin R. Our Vet had recommended a much larger dose, but I am extremely cautious where life and death of my cat are concerned. The R duration was about 4 hours, nadir at 1.75 or 2. I was administering R late in his cycle at +7 or +8 so the Nadirs didn't coincide. I only used R, 5 times.

When Bear was diagnosed with DKA, did the labs show any source of inflammation? Does your kitty need dental work? Was pancreatitis present?

No they didn't show inflammation, no signs of pancreatitis, and his mouth was checked for dental issues. It is mystery to as what infection completed the recipe for DKA. MrWorfsMom helped by entering all his labs and she didn't see any bad #s, as to his health which was also what the vet had said at the E.R.

We use 2 approaches to dosing here -- the Tight Regulation Protocol (TR) and Start Low Go Slow (SLGS)

I will be straight forward with you, I am torn between choosing the right method. Tight Regulation fits the best but is dependent on Bear's reactions. If he is experiencing overswings/ bouncing in his best interest I think we might need to hold his dose until he clears it. Also at this time I am free to test multiple times through out the day but within the next week or two that will change and I will be limited. I am my mother's caregiver and she is soon to be released from skilled nursing. I will always be able to test before preshot and close to Nadir. TR seems best to get Bear regulated sooner and decreases his chances for DKA.

SLGS will have to be used once my mother is home and we have weekly Dr's visits, daily home health wound care nurse, home shower aide and a home physical therapist all to fit in. My house will become a bee hive of activity.

Since it sounds like Bear has had issues with ketones, are you testing for them?

I test Bear frequently and put them in a box on his SS, so I can keep track of how often and especially when he has gone red or black. I color the boxes light blue so I can locate them easily.

 

[Bear & Lora]

Question: Do the vets know what caused the DKA back in Sept?

Thank you for the welcome.
No they couldn't find the infection. As far as ketones, I am 99% sure Bear had a massive amount of them because he was on high carb food (Vet recommended, We don't use him anymore), and more than likely sky high BG with not enough insulin. I didn't find Dr Pierson's Article for a month and a half after Bear was diagnosed, then her office referred me to FDMB.

 

[Bear & Lora]

I agree with Sienne on the dosing. 4.5 might be better, given you had recent DKA and can monitor closely. Be aware that some kitties have a strong reaction to the insulin switch, so make sure you have high carb food on hand. I read on you SS that you were feeding kibbles? Does he not like high carb wet? I would also post here regularly, at least to start, so we can help you over the initial learning curve.

Hi Wendy. I must say I am glad you responded. You have responded to me in the past and Linda MrWorfsMom had told me you were highly knowledgable. My anxiety went down a notch or two when I saw you.
I am a bit concerned about the possibility of a stinging side affect with Bear being a higher dose cat.

As far as the kibble that was a bad buy from Petco. I picked up some additional Tiki and assumed the kibble would also be a low carb food without researching it. Anxiety was the cause of me giving the kibble. I was new to using Novolin R and when I saw his BG dropping rapidly I grabbed the highest carb I knew he would eat with relish. I have a few Friskies with Gravy to use for Hypo. I have actually been mixing the Tiki Kibble into my German Shepherd's food sporadically to get rid of it. I hope to not have to use the R also.

I am absolutely on board with posting and advise with the use of Lantus. It doesn't seem as clear cut as an in and out insulin.

Were you using the U100 syringes to dose it? Just asking cause I see doses of 0.1 and 0.2, whereas we would typically start at 0.1 and go to 0.25 units.

I was using the U-100 and what I labeled a 0.2 was probably closer to 0.25. Ouch, it was really hard to measure the tiny drops of R insulin.

How is Bear feeling? Any other health issues besides the DKA either now or on diagnosis?

He has some neuropathy in his back and front legs. He walks on his hocks and places his front legs down so much that they catch on the rugs. It is a bit shocking to see. I have had him on Zobaline since 11-17, twice daily mixed with food at preshot. I am sure it helps some but until he is better regulated I'm not expecting a fast miracle. I know it can take a good amount of time to see results from Zobaline.

Since I know you took a detailed look at Bear's SS, I suspicion that the last of the prozinc bottle that we are using is somewhat ineffective. I think our mixing technique has been flawed, we have been overly gentle turning it two to three times. The end of his last bottle of Prozinc gave us similar results. I think his Pancreas kicked in a little to bring his preshot down to 293 this morning.

 

[Bear & Lora]

Nice job on the testing!

Thank you.

Have you reviewed the Stickies at the top of this forum to see if there's any info in there about switching from one to the other?

I have reviewed them and no I didn't find anything that referred to dosing when switching insulin.
I really hope Bear does better on Lantus, from everything I've seen it has good reviews.

 

[Bear & Lora]

Question: Do the vets know what caused the DKA back in Sept?

No his labs didn't show any signs of infection. It's a mystery, but poor regulation definitely played a part.

 

[Bear & Lora]

One other issue is that I suspect you've been holding the dose too long.

You are absolutely right the 4.4 units was held too long. I was waiting to see if Bear would stabilize. He was getting some nice blues but either he was bouncing or the insulin wasn't lasting? Then once the Holidays were here I knew I couldn't test him as needed for an insulin switch or to increase his dose. Life sure can put a kink in your timeline.

 

[Kris & Teasel]

You're in a great place for excellent L insulin advice, Lora.

 

[Bear & Lora]

You're in a great place for excellent L insulin advice, Lora.

I believe you. I hope you check in on Bear and i at least once in a while. Or a lot. Lol.

 

[Bear & Lora]

You're in a great place for excellent L insulin advice, Lora.

It feels like I've been switched to a different classroom after spending most of the year in the other.

 

[Bear & Lora]

You're in a great place for excellent L insulin advice, Lora.

Go figure, we have a Bear surprise. I kind of thought we were going to go red or black for PMPS, now I'm pretty certain.

 

[Sue and Luci]

It feels like I've been switched to a different classroom after spending most of the year in the other.

This is a very active group - plenty of advice and support...just ask! As I told another newbie - there's lots of cat-mama's here - we all love and care about our sugar babies - and there's a wealth of advice to be shared. What we hope to do is not to overwhelm you with so much information your head will spin - I think that happens anyway - so much to learn - so many things to do right as you begin your journey with FD - or not the beginning perhaps - just a switch on the tracks? At any rate we're all here to help - support - and hopefully guide you to helping your Bear get to a better place with those numbers - tell him the other kitties frequently go to the lagoon (green numbers) and they're learning to surf there (slide along with those green numbers)...my Luci is still learning - after a year - she still hasn't gotten the hang of it...but she tries...and she gets into trouble chasing the sharks (going below 50)...there's an entire dictionary of slang here: http://www.felinediabetes.com/dictionary/cat-health-dictionary.htm
for all this jibber-jabber to help keep us from getting depressed I suppose ... we're all in this together and it goes one day at a time... Every now and then there's an OTJ party - for that happy day when a kitty actually gets 'there'!! And all too often an announcement of a kitty cat passing - so sadly one of our group has to give us the sad news that one of our sugar babies has Gone Ahead...heartbreaking to read about those - and lately it seems there have been too many...

Please feel free to read as many condos as you can - it's really enlightening to read about other journeys, the ups and downs - and you can join in on the conversations - and let us know how things are going in your part of the world.

It does sound like you have a lot of responsibility with your mom living with you. My mom is 88 and I just couldn't do that as I work from home (wording in my contract doesn't allow me to provide home care for children or seniors)...so she lives in an adult foster care facility near my home - but she's still quite a responsibility - so I understand all too well what you're going through...

At any rate...we're all happy to have you here

 

[Bear & Lora]

This is a very active group - plenty of advice and support...just ask! As I told another newbie - there's lots of cat-mama's here - we all love and care about our sugar babies - and there's a wealth of advice to be shared. What we hope to do is not to overwhelm you with so much information your head will spin - I think that happens anyway - so much to learn - so many things to do right as you begin your journey with FD - or not the beginning perhaps - just a switch on the tracks? At any rate we're all here to help - support - and hopefully guide you to helping your Bear get to a better place with those numbers - tell him the other kitties frequently go to the lagoon (green numbers) and they're learning to surf there (slide along with those green numbers)...my Luci is still learning - after a year - she still hasn't gotten the hang of it...but she tries...and she gets into trouble chasing the sharks (going below 50)...there's an entire dictionary of slang here: http://www.felinediabetes.com/dictionary/cat-health-dictionary.htm
for all this jibber-jabber to help keep us from getting depressed I suppose ... we're all in this together and it goes one day at a time... Every now and then there's an OTJ party - for that happy day when a kitty actually gets 'there'!! And all too often an announcement of a kitty cat passing - so sadly one of our group has to give us the sad news that one of our sugar babies has Gone Ahead...heartbreaking to read about those - and lately it seems there have been too many...

Please feel free to read as many condos as you can - it's really enlightening to read about other journeys, the ups and downs - and you can join in on the conversations - and let us know how things are going in your part of the world.

It does sound like you have a lot of responsibility with your mom living with you. My mom is 88 and I just couldn't do that as I work from home (wording in my contract doesn't allow me to provide home care for children or seniors)...so she lives in an adult foster care facility near my home - but she's still quite a responsibility - so I understand all too well what you're going through...

At any rate...we're all happy to have you here

Bear is giving me a surprise on his last day of Prozinc and is riding some lower green, so I am doing OCD testing. This is a rare event for him, lol.

 

[Bobbie And Bubba]

It feels like I've been switched to a different classroom after spending most of the year in the other.

I get it! I was weepy the day before our switch, but I’ll tell you , it was the best move !

Keep posting and keep asking questions as that is how we all learn.

 

[Sienne and Gabby (GA)]

I suspicion that the last of the prozinc bottle that we are using is somewhat ineffective.

Ha, ha, ha, ha!! Bear heard you and decided to prove otherwise!! Cats seem to do that.Threaten a dose increase and their numbers turn blue or green.

Starting on TR and switching to SLGS if you need to is fine. I suspect that since you know the basics of managing FD, TR may end up being easier than you think. I worked full time and was still a testaholic.

You have indeed switched to a different classroom. The pharmacology of Lantus is very different than Prozinc and it will take some getting used to a depot-based insulin. (And BTW, you couldn't have gotten better help with R and from Jill & Alex. She's probably the longest term member of this board.)

Please don't hesitate to ask questions. The members of this forum are very generous with their time and knowledge. We're here to help.

 

[Bobbie And Bubba]

Bear is giving me a surprise on his last day of Prozinc and is riding some lower green, so I am doing OCD testing. This is a rare event for him, lol.

Yep! I suspected that those yellows on the Am of the 22 and the 24th had preceded some lower numbers not caught as the PMPS showed big bounces. That is why I suggested 4 units as a starting place. Others think 4.5.

ETA: Do what makes you comfortable.

 

[Bear & Lora]

So I think I will err on the side of caution since many cats react strongly to an insulin switch and Bear's green surprise surfing. Bear also has shown an extreme skin allergy to flea saliva plus some sinus allergies and that concerns me a bit with the side effect of Lantus possibly stinging at higher doses. I will start with 4u,

Now does anyone know how to add a Ttitle Line on his SS to add Lantus so I can see his history on one page?

 

[Wendy&Neko]

Starting lower is fine, though it likely won’t impact any potential stinging. We’ve had some cats on much smaller doses feel a sting, and some fine on much larger doses. Some cats are also completely boring on an insulin switch, especially since Lantus is a depot insulin, so the first few cycles partly fill the depot, and partly go to the blood stream for immediate use. ECID.

For the SS, just enter a blank row the day before you start Lantus and put someth8ng like “start Lantus” on 6e row. That”looks make it easy to spot.

Good luck!

 

[Bear & Lora]

Starting lower is fine, though it likely won’t impact any potential stinging. We’ve had some cats on much smaller doses feel a sting, and some fine on much larger doses. Some cats are also completely boring on an insulin switch, especially since Lantus is a depot insulin, so the first few cycles partly fill the depot, and partly go to the blood stream for immediate use. ECID.

For the SS, just enter a blank row the day before you start Lantus and put someth8ng like “start Lantus” on 6e row. That”looks make it easy to spot.

Good luck!

I'm a bit spreadsheet challenged. I have a vast knowledge on how to restore pics and file but haven't hardly worked with office programs. Can you give me a few more details on how to do that please.

 

[Bobbie And Bubba]

When you start Lantus, before that entry, just type" Lantus Starting Today" across the row. Each cell could have a word. Go to Bubba's SS and click on 2015. Scroll down to Dec 1 and you will get an idea of how I did it. Then I filled in color to each cell.

 

[Bear & Lora]

When you start Lantus, before that entry, just type" Lantus Starting Today" across the row. Each cell could have a word. Go to Bubba's SS and click on 2015. Scroll down to Dec 1 and you will get an idea of how I did it. Then I filled in color to each cell.

Thank you. My husband was on my laptop and labeled the SS. The only down side is I didn't see how he did it. Lol.

 

[Wendy&Neko]

The way you've done it looks perfect.

 

[Bear & Lora]

The way you've done it looks perfect.

Thanks I wish I could take credit, lol. My husband is the savvy one. How would you suggest I post for the next few days? Tests preshot +3 +6 and +9 and put the results on a thread?

 

[Wendy&Neko]

How would you suggest I post for the next few days? Tests preshot +3 +6 and +9 and put the results on a thread?

That's as good a way to start as any. Of course we might have to change the plan based on how Bear responds.

 

[Bobbie And Bubba]

Thank you. My husband was on my laptop and labeled the SS. The only down side is I didn't see how he did it. Lol.

Perfect! I don’t know how to get rid of the cells line your hubby did. However it’s done so you and other know where Lantus starts.