New member. Switching from Vetsulin to Lantus need help with new starting dose

[Nicole- Spicy Sushi]

I sent a lengthy email yesterday asking our vet to switch Sushi from Vetsulin to Lantus. She’s been on the Vetsulin since 9/4/22 and her vet thinks she’s regulated on it but I do not. She says we will need to start from scratch on Lantus. Is that true? She’s currently on 2.75units every 12hrs. Would starting her over at 1unit Lantus put her at risk for DKA? She has been dealing with a recurring UTI which is officially cleared now and just got over a pancreatitis flare 3 weeks ago and I’m worried switching will set her off in some way while she readjusts… but I know in the long term this is the best insulin for her. Based on her SS do you think she’s currently regulated? If we switch, what new dose would you recommend? Sushi is currently 9.4lbs if that comes in to play at all. Thank you!!!

 

[Bron and Sheba (GA)]

Hi Nicole and Sushi and welcome to the forum
Your spreadsheet is only showing that you are giving insulin once a day. There are no units in the PMPS column and no testing in the pm cycle at all, and very few preshot BGs.
Also you don’t appear to be testing every day.
Have you filled out the SS correctly? Do you need to add any more data.?

Based on her SS do you think she’s currently regulated? If

No she is not regulated.

If we switch, what new dose would you recommend?

I think we need to see a lot more data and tests done in the pm cycle before we can say what dose to start on. At the moment we only have less than 1/2 the picture and there are not a lot of preshot tests done, to see if it is safe to give the dose.

She says we will need to start from scratch on Lantus. Is that true

When swapping from one insulin to another, the current dose is taken into account. We do not advocate “starting over again”
I think swapping from vetsulin to Lantus is an excellent idea. But I would strongly recommend you get all those extra tests in I have mentioned above, and test daily, so we can safely recommend a starting dose for Lantus
Bron

 

[Nicole- Spicy Sushi]

Hi Nicole and Sushi and welcome to the forum
Your spreadsheet is only showing that you are giving insulin once a day. There are no units in the PMPS column and no testing in the pm cycle at all, and very few preshot BGs.
Also you don’t appear to be testing every day.
Have you filled out the SS correctly? Do you need to add any more data.?

No she is not regulated.

I think we need to see a lot more data and tests done in the pm cycle before we can say what dose to start on. At the moment we only have 1/2 the picture and there are not a lot of preshot tests done, and test daily, to see if it is safe to give the dose.

When swapping from one insulin to another, the current dose is taken into account. We do not advocate “starting over again”
I think swapping from vetsulin to Lantus is an excellent idea. But I would strongly recommend you get all those extra tests in I have mentioned above so we can safely recommend a starting dose for Lantus
Bron

She is getting the Vetsulin 2x a day I just have not been filling in the PMPS units because we’ve not managed any PM blood checks yet. I understand the data is lacking but I do need to express that Sushi needs to be restrained for literally anything. Her vet brought euthanasia up after dx because she is basically they have to use full anesthesia just for simple blood draws on her. I’m not exaggerating they have to put her in a chamber tank and gas her because she’s that ridiculous lol!! The fact that her dad and I have pulled off these many checks and have been able to inject her twice a day is a major feat in itself so please understand we are doing much better than we ever thought we could. Her vet asked us to only check her once every two weeks with no mention of PS checks initially which is why there is so much time between readings. It was not until I found the FB group that we realized we weren’t checking enough and we really have been trying, even though it looks like we have not based on her SS. She tries to hold back the teeth for mom and dad but everything is a challenge with Sushi and I’m depending on her dad to be home to hold her for me and having us both home at the same time for checks isn’t easy. The other issue is I have no choice but to test on the weight bearing back paw pads to avoid getting bit and to keep the sample site steady so infection is a constant concern. After her curve on Saturday her feet seemed noticeably sore. Aw man, I had been feeling quite proud of ourselves for pulling off as much as we have but now I’m feeling pretty damn defeated all over again like I’m failing her. If she were a cat that could handle the simple act of being touched I would be testing her as much as you all are… but I am realizing realistically I’m never going to achieve what’s best for her and now I’m holding back tears again because I worry she’s never going to get regulated. We are going to continue to do our best but daily testing just isn’t feasible with Sushi. I’m going to add the PM units in my SS just to make that less confusing and I’m talking her dad into waking up with me overnight to check her at the +6 because I think that seems to be her nadir point. Sorry for the confusing SS and lack of data…. I’m guessing it will be safest to start her on 1U unless we can get a bunch more readings before getting the new insulin? Her vet still needs to even agree with the switch and then we’ll be using Marks Marine in Canada so it’ll be at least a week or two until we get the new insulin I’m thinking

 

[Bron and Sheba (GA)]

Don’t apologise. I understand having a difficult kitty to test can be challenging. Well done getting as many tests in as you have.
We do have some people here who have difficult kitties to test but a lot of them have come around to be much easier following our hints on how to do hometesting. I’m going to send you a link on HOMETESTING HINTS AND LINKS . Have a look at all the links and see if any help.
Using one spot and taking her there, rubbing her ears and giving her a low carb treat several times a day will help.
Do that for a few days so she associates treats with her ears being touched. Don’t attempt tests while you are doing that.
I found with my kitty Sheba the best way to test when I was learning was to kneel on the floor and then sit back on my heels.I got everything ready including the treat and testing equipment. Then I put Sheba between my knees facing the same way I was so her tail end was butted up against me and if she backed away there was no way to go. I didn’t restrain her but just held the front on her body around the chest and I had easy access to her ears. I then out the food in front of her and while she was eating it, I did the test.
Try humming or singing as you do the testing. Cats pick up quickly on how we are feeling and can get stressed by it as well.
See if that helps or anything else in the link.
Keep getting as many tests as you can and I will ask a couple of others what they think the dose should be….I know they will want to see some tests from the pm cycle first so see if you can get those. And as many preshot tests as you can manage.
Keep posting and asking questions. We want to be able to help you.
Bron

 

[Nicole- Spicy Sushi]

Thank you so much for your tips! Our one saving grace with Sushi is even tho she hates to be pet she’s ok with being held because I’ve subjected her to it daily since rescuing her. She still hates it but for whatever reason she really doesn’t struggle to get away she just protests audibly. I thought I’d do ok with ear pricks on her because her ears are really the only thing she actually enjoys being touched but she’s just so dramatic she goes crocodile on me and my biggest worry is she gets a lancet to the eye! Getting the toe pads done is soooo quick and easy because dad can hold her like she’s accustomed to and I can just grab a back foot and go. And it bleeds instantly with a lil squeeze each time! I’ve seen some photos and posts where people have gotten their samples on the inside part of the ear which is hairless and I may give that a go because her black furry ears made it hard to see even if she were to cooperate long enough. I really would like to try getting tests done using her accessory pads on her front paws but we haven’t worked out yet how dad can hold her in a way that I can keep her from biting at the lancet. She has mastered “biting” me in a way that makes it hurt but not break the skin (most of the time) but I get nervous when there are sharp objects she could hurt herself on. You should see this cat when the comb comes out, we have to stop each time because she bites the comb and gags herself. She’s ridiculous but we love her and she’s worth it. I’d prefer to not use her back pads but I am doing my best to keep her litter box and floors extra clean until I can master getting blood pricks elsewhere! Thank you so much for your response again! Very relieved to have going the FB group and this forum

Don’t apologise. I understand having a difficult kitty to test can be challenging. Well done getting as many tests in as you have.
We do have some people here who have difficult kitties to test but a lot of them have come around to be much easier following our hints on how to do hometesting. I’m going to send you a link on HOMETESTING HINTS AND LINKS . Have a look at all the links and see if any help.
Using one spot and taking her there, rubbing her ears and giving her a low carb treat several times a day will help.
Do that for a few days so she associates treats with her ears being touched. Don’t attempt tests while you are doing that.
I found with my kitty Sheba the best way to test when I was learning was to kneel on the floor and then sit back on my heels.I got everything ready including the treat and testing equipment. Then I put Sheba between my knees facing the same way I was so her tail end was butted up against me and if she backed away there was no way to go. I didn’t restrain her but just held the front on her body around the chest and I had easy access to her ears. I then out the food in front of her and while she was eating it, I did the test.
Try humming or singing as you do the testing. Cats pick up quickly on how we are feeling and can get stressed by it as well.
See if that helps or anything else in the link.
Keep getting as many tests as you can and I will ask a couple of others what they think the dose should be….I know they will want to see some tests from the pm cycle first so see if you can get those. And as many preshot tests as you can manage.
Keep posting and asking questions. We want to be able to help you.
Bron

 

[Melinda and Kitkat]

A warm hello Nicole and cutie pie little Sushi,
I read your post and see you do indeed all have a big challenge ahead. I just want to offer you some hope that you, hubby, and kitty CAN get through this.
My kitty was friendly enough about being handled (a bonus for us that you may not have as a starting point), maybe not so much his ears, and he isn't a cuddler lap cat, but he was VERY difficult to test! in the beginning when we started testing he instantly turned from a happy cat to all claws, howling, trying to bite, fighting and struggling to get away from us, obvious wild eyes and panic. For his sake, we were determined to battle through it. My hubby would test, I would hold him. It was heartwrenching at first.....BUT!!!!!, over the days, with patience, and trying different recommendations here, Kitkat did slowly settle down, this helped us settle too.
May I point out a few things in your post please ???

I’m not exaggerating they have to put her in a chamber tank and gas her because she’s that ridiculous lol!! The fact that her dad and I have pulled off these many checks and have been able to inject her twice a day is a major feat in itself so please understand we are doing much better than we ever thought we could.

Yes!!!!! You have achieved in a short time something amazing. You and hubby know Sushi best, and you are doing a medical procedure successfully that gives your vet pause. You need to give yourself and Sushi credit. Not all cat's accept all this in the beginning so pat on the back to you two, and a butt scratch for Sushi. EVERYONE here can understand you are doing all you can and are doing the best .

The other issue is I have no choice but to test on the weight bearing back paw pads to avoid getting bit and to keep the sample site steady so infection is a constant concern.

If this is easier right now, then so be it, I think quite a few here test the back paw, tagging @Diane Tyler's Mom.

Aw man, I had been feeling quite proud of ourselves for pulling off as much as we have but now I’m feeling pretty damn defeated all over again like I’m failing her. If she were a cat that could handle the simple act of being touched I would be testing her as much as you all are… but I am realizing realistically I’m never going to achieve what’s best for her and now I’m holding back tears again because I worry she’s never going to get regulated. We are going to continue to do our best but daily testing just isn’t feasible with Sushi.

Again, you do need to be very proud of what you've accomplished, the feeling of defeat is VERY real, but don't let it defeat you. Ok? As it says in the links above, and the many members here, Sushi will change her cat brain thinking and overcome her fear... she too is still learning that you are helping her with every step.
I have high hopes that Sushi, over the next little while, just may surprise you as she comes around.
And you WILL achieve what is best for her. I have no doubt.

 

[Diane Tyler's Mom GA]

If this is easier right now, then so be it, I think quite a few here test the back paw, tagging @Diane Tyler's Mom.

@Nicole- Spicy Sushi
Hi Nicole I only test on the ears , just keep at it Bron has given you some excellent tips .

 

[Wendy&Neko]

My girl was switched from Caninsulin (Vetsulin is how it is branded in the US) to Lantus. My vet made the mistake of having us start over at 1 unit dose. It took me literally months to get back up to the dose she should have been on.

In post #4, Bron included a link to a page with lots of testing tips and videos. Under the videos is a link to how to test a fractious cat. A tip from one of my local TNR groups for ferals is to wrap completely in an old towel and cut small ear sized hole in the towel. That way even the head isn't poking out.

 

[Nicole- Spicy Sushi]

Oh my gosh thank you all so much for your wonderful words of encouragement! We managed to get a middle of the night reading of 108 at +6 which was great! But then her AMPS those morning was 691!!! I decided to go ahead and place an order through Chewy for a Lantus pen and called the office first thing this morning saying I need her to approve it when they contact her and to call me to discuss starting doses. I really hope Chewy contacts her before she leaves for the weekend and she approves it. I’m so discouraged by how high she is swinging. I know it’s more important to look at the lows and kinda ignore the highs when determining dosing adjustments but I’ve read a regulated cat should be 120-300 throughout a 24 hr period and Sushi is not even close to that. I’m worried about what these swings and her being so high over the renal threshold for so many potential hours of the day will do to her long term!

 

[Wendy&Neko]

@Diane Tyler's Mom can give you suggestions as to the best place to buy Lantus in the US.

 

[Diane Tyler's Mom GA]

Hi Nicole I am frim N.J. also
You can have the vet write the script for generic lantus ,many members use it, The brand is much more expensive, just call around and see who might have the generic
Here is some info
Check this out also
https://www.goodrx.com/insulin-glargine?dosage=five-3ml-prefilled-pens-of-100-units-ml&form=carton&label_override=insulin glargine&quantity=1
The 5 pens will last about a year, we use the pens just like a vial, you would just insert the syringe it the gray rubber stopper on the pen and draw out your insulin
Its generic lantus



Or this one also

I see some members will call CVS, Rite Aid, Costco, Walgreen's, to get the price for 5 pens
Posted by another member
One members posted this
. I paid $175 for a box of 5 pens at Walmart pharmacy, but GoodRX coupon says you can get it for around $90 if you have a Rite Aid pharmacy near you.

@Nicole- Spicy Sushi

 

[Nicole- Spicy Sushi]

You can have the vet write the script for generic lantus ,many members use it
Here is some info
Check this out also
https://www.goodrx.com/insulin-glargine?dosage=five-3ml-prefilled-pens-of-100-units-ml&form=carton&label_override=insulin glargine&quantity=1
The 5 pens will last about a year, we use the pens just like a vial, you would just insert the syringe it the gray rubber stopper on the pen and draw out your insulin
Its generic lantus



Or this one also

I see some members will call CVS, Rite Aid, Costco, Walgreen's, to get the price for 5 pens
Posted by another member
One members posted this
. I paid $175 for a box of 5 pens at Walmart pharmacy, but GoodRX coupon says you can get it for around $90 if you have a Rite Aid pharmacy near you.

Excellent thank you so much!!! I think we actually may end up going through Marks Marine in Canada after we get her started on this first pan from Chewy! A box of 5 pens of Lantus pens is $165, plus shipping. They also have basaglar and semglee on their site for a little less. What I really like about marks marine is after we send them her first rx they will refill it for us without us ever needing to contact her vet again. I went the chewy route this first time because I figured it would be the fastest and easiest for her vet. I am fairly certain this is her first time she’s ever prescribed Lantus because she told me I can’t draw from the pen and need to use the needle attachments per Chewy. So i said f it I put the order in for the needle attachments that I’ll never use just to get her to approve the rx and I ordered u100 3/10cc needles myself from Amazon lol. I just need to get her started on it ASAP. But now she’s off until Tuesday and won’t approve it until then. She contacted me by email late last night. I called the office today to see if one of the other two vets could approve it with the “proper” needles for the pen so I don’t have to wait until Tuesday. **fingers crossed **

 

[Diane Tyler's Mom GA]

Yes Marks Marine is great
Did you get the syringes with the half unit markibgs from Amazon ?
With Lantus you want to get the U-100 syringes with the half unit markings because we adjust the doze by 0.25 units at a time. Even though the half unit markings are 0.5 adjustments it's easier to use these when having to adjust by 0.25 units
units

• .Any of these syringes are fine to use
• BD Ultra-Fine, CarePoint Vet, Monoject, GNP, UltiCare Vet Rx, Sure Comfort, and ReliOn are just some of the brands available with half unit markings.
• Syringes come in ½ inch or 5/16 inch needle lengths. Needle gauges are 29, 30 or 31 (31 being the thinnest)
• Full and half-unit syringe scales:

DIA10

10% off your next order!

You will need a script , if you call ADW Diabetes they will take some information from you and contact your vet to fax over a script. Ask for refills
We use the syringes because if you just use the pen you can only adjust by full units

 

[Diane Tyler's Mom GA]

When you do switch to Lantus or the genetic ( much cheaper) you will need to put in your signature now Lantus and the date
On your spreadsheet also up top and put a blank line above the date you start Lantus and put Switched to Lantus

Have you ever thought of using a human meter , that's what our numbers are based on. If you feel comfortable using the Alpha Trak that's fine
I used that in the beginning bit the strips got to expensive for me to afford
If you would like a suggestion on a human meter just tag me

 

[Nicole- Spicy Sushi]

When you do switch to Lantus or the genetic ( much cheaper) you will need to put in your signature now Lantus and the date
On your spreadsheet also up top and put a blank line above the date you start Lantus and put Switched to Lantus

Have you ever thought of using a human meter , that's what our numbers are based on. If you feel comfortable using the Alpha Trak that's fine
I used that in the beginning bit the strips got to expensive for me to afford
If you would like a suggestion on a human meter just tag me

The u100s with the half unit markings on Amazon are exactly what I ordered! And I will definitely update my sig when we get her started on the good stuff! I think when we get closer to running out of strips we may look into a human meter, I know the strips are much cheaper! Thank you for your help!