Lantus arrived and I’m terrified

Lisa and little

Lisa and little

Member Since 2018
hi all my Lantus arrived today and I am having an anxiety attack as I do not know what to expect with the switch from Prozinc. I have a few questions.
1- my insulin arrived from Marks Marine with the moderate temperature dot red! Is it still ok? I am on hold with them for the last half hour to ask but I’m sure many of you may know the answer to that.
2- what dose should I start on ? She’s been all over the map with dosing and numbers on PZI but most recently on 2.5 as we had some lows on higher doses and she even had a 53 early in one cycle a few weeks ago on 2.5. My vet recommended 1u ONCE a day to start which I know isn’t correct so again I look for my lifesavers on this forum for guidance.
3- what is the typical post shot hour I will start to see the effect of Lantus? 2hrs? 3hrs after shot?
4- What are the parameters of the NADIR hours on Lantus ?
5- I also don’t fully understand the “depot” thing. Is that depot stored for only 1 cycle or does it build up over time? That’s what truly terrifies me. If it builds over time how does a good dose not become too much? Not sure if I’m explaining my question correctly ....
6- can someone please post the video again of how to draw from an insulin pen? That’s freaking me out too. I have U 100 syringes and the doses of 1U and increments under 2U are confusing as they seem ever so small
All of your help is truly valued I couldn’t so this without you but I’m sure I’m going to have a panic attack nonetheless
 
Hi Lisa,
Try not to stress (too much!). A number of people here have switched from Prozinc to Lantus or Lev. Back in 2010 I had to switch my kitty "Stu" from PZI (this was in the days before Prozinc) to Lantus, because PZI was discontinued. I didn't know what I was doing and either did my vet. Gradually Stu got straightened out with the help of the wonderful people on this board (his vet overdosed him on Lantus because he didn't know that the Lantus dose is determined by the lowest number in the cycle--the nadir--not on the preshot number).
I want first to answer your question #5: the depot. Lantus is a depot insulin. This means that it leaves some of the dose in the cat's body (the purpose is to even out the cycle and make sure that the insulin isn't depleted before the next dose). At the beginning of Lantus use, the depot has to be "built". Therefore the full dose won't be available to work on the blood glucose until the depot has been built. It will take about a week for the depot to build. The depot will NOT continue to grow after it has reached it's established point. The size of the depot is determined by the size of the dose. Every time you change the dose, the depot has to "re-calibrate". So when you are increasing or decreasing a dose it will always take a few days for the depot to "catch up" to the new dose. If you follow one of our protocols (TR or SLGS) the period of adjustment is built into the protocol. Weird or wonky numbers are to be expected for several days after changing the dose. Just be patient and follow the protocol.

I know someone will soon be along to post that video again. Do you have U-100 syringes with 1/2-unit markings? That will make it easier to draw a dose that is less than full units. To draw from the pen, just use it as if it were a vial. Don't use the needles that may have come with the pen: they only dispense the insulin in full units.

Good luck. It's not as difficult as it seems at first!
 
6. Take cap off pen. You will see the stopper. DO NOT INJECT AIR INTO PEN. Or any insulin back into pen.

Otherwise, you draw insulin like you would from bottle. Pull up just a bit extra, flick bubbles out, adjust dose.
 
Ella & Rusty & Stu(GA) said:
Hi Lisa,
Try not to stress (too much!). A number of people here have switched from Prozinc to Lantus or Lev. Back in 2010 I had to switch my kitty "Stu" from PZI (this was in the days before Prozinc) to Lantus, because PZI was discontinued. I didn't know what I was doing and either did my vet. Gradually Stu got straightened out with the help of the wonderful people on this board (his vet overdosed him on Lantus because he didn't know that the Lantus dose is determined by the lowest number in the cycle--the nadir--not on the preshot number).
I want first to answer your question #5: the depot. Lantus is a depot insulin. This means that it leaves some of the dose in the cat's body (the purpose is to even out the cycle and make sure that the insulin isn't depleted before the next dose). At the beginning of Lantus use, the depot has to be "built". Therefore the full dose won't be available to work on the blood glucose until the depot has been built. It will take about a week for the depot to build. The depot will NOT continue to grow after it has reached it's established point. The size of the depot is determined by the size of the dose. Every time you change the dose, the depot has to "re-calibrate". So when you are increasing or decreasing a dose it will always take a few days for the depot to "catch up" to the new dose. If you follow one of our protocols (TR or SLGS) the period of adjustment is built into the protocol. Weird or wonky numbers are to be expected for several days after changing the dose. Just be patient and follow the protocol.

I know someone will soon be along to post that video again. Do you have U-100 syringes with 1/2-unit markings? That will make it easier to draw a dose that is less than full units. To draw from the pen, just use it as if it were a vial. Don't use the needles that may have come with the pen: they only dispense the insulin in full units.

Good luck. It's not as difficult as it seems at first!
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Thank you so much. I guess I’m still not understanding .. so let’s say she’s regulated ... that depot stays the same? I do have U 100s with half units. Do you recommend 1u? How many cycles do I hold the dose if it isn’t effective. Little took longer than most to adjust to dose changes on PZI.. usually 5 or 6 cycles. Would it be longer for her on Lantus maybe?
 
SLGS = Start Low Go Slow. Meaning low dose of insulin and holding each dose 7 days. Adjust by 0.25 units.

TR = Right Regulation. Raise dose every 6 cycles. No dry food. In addition to preshot tests, 1 extra mid cycle test each cycle.

They are 2 methods used here. Info on both in the lantus/ lev thread.
 
Olive & Paula said:
SLGS = Start Low Go Slow. Meaning low dose of insulin and holding each dose 7 days. Adjust by 0.25 units.

TR = Right Regulation. Raise dose every 6 cycles. No dry food. In addition to preshot tests, 1 extra mid cycle test each cycle.

They are 2 methods used here. Info on both in the lantus/ lev thread.
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Thank you. I didn’t get the acronyms but have read both protocols. I’m inclined to do a combination .. meaning start low and monitor like heck as she has been quite unpredictable so far on PZI Still not sure what the starting dose should be she is 11 lbs so if I convert that to kilos and multiply by .25 does that make sense ?
 
Since Little has been on ProZinc and current Pro-Zinc dose is a skinny 2.5u, you don't want to use the new diabetic calculation for dose....you'll just lose ground backing the dose up that much. I would give Little the same dose....2.5u. If that makes you uncomfortable, then drop it back to 2u but I wouldn't go any lower. And remember, it will take a few days to get the depot built up so you won't see the full effect of the dose for a few cycles so pick a dose and stick with it no matter what the pre-shots are. The only time you would reduce is if Little drops below 90 if using SLGS or below 50 using TR protocol.
Take a deep breathe Lisa. Little is going to be just fine and in a few days you are going to be wondering why you were so anxious. :)
 
Thanks so much Linda. I’m just a scaredy-cat lol. Am I missing something... it seems to me that the TR protocol is much like what I have been doing with PZI... mid day testing frequently and adjusting dose after 6 cycles usually in my case. The only difference I see w SLGS is a dose is held for 14 cycles. Am I interpreting correctly?? Also if Lantus is a U 100 meaning 100 units per ml and PZI has only 40 u per ml... the same dose would technically be 2.5 times the amount of insulin based on concentration correct? 2.5 seems way too high although I don’t know how much would end up in the depot ...
 
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I think you will probably want to go with TR pretty soon but for now if you want to start with SLGS that is fine. Get your feet wet and then switch. Starting off with SLGS yes you'd hold the dose for 7 days (14 cycles) unless Little drops below 90. If Little drops below 90, you reduce the dose by 0.25u. With TR you'd hold the initial dose for 5 to 7 days and make reductions if Little drops below 50. After the initial loading period with TR, you'd hold doses for 3 days or 6 cycles...with SLGS you'd hold the dose for a week after each dose change unless Little drops below 90.
Remember these dose adjustment readings are based on human meter readings so I assume you are using the Diathrive meter exclusively now?
 
Yes human meter. Any idea how much of a dose ends up in the depot? Just doing some math to try and figure out what dose to start with. You’re saying whether I choose SLGS or TR that for this initial switch I should hold for a week regardless - unless she goes too low? I’m curious as to why 90 and not 50 in both cases if I am mid day testing which I plan to do all week
 
Lisa, Mia was on 2.5u of ProZinc before we switched to Levemir. I was given advice ranging anywhere from starting over at 1u to starting with the same dose we were on with ProZinc. I chose to start her on 1.5u of Levemir, and that worked out for us (any more than that would have been too much). I know you are super nervous about the switch, so for your peace of mind, you may also want to start out at a lower dose than you've been giving on ProZinc.

I'm glad you are making the switch, and I hope it works out for you.
 
Thank you for that. Mia’s ss looks much like Littles Was thinking 1.8 but maybe I’ll take it down to 1.5 or 1.6 since the measurement will be more accurate.
 
Just a word of warning......I switched from Lantus to Levemir and followed vet advise to back down the dose at lot more than was recommended here only to have to play major catch up. Lantus and Levemir are different just as every cat is different. Ultimately Lisa the choice is up to you, but Little is not going that low on 2.5u right now and Lantus will take a few days to really work at full capacity so backing up the dose too much is only going to put you back further. You do enough testing (when not out of town) to easily be able to catch any need for a reduction should that be the case.
 
Lisa and little said:
I’m curious as to why 90 and not 50 in both cases if I am mid day testing which I plan to do all week
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My understanding on the difference between the 90 and 50 reduction points is this:

Tight Regulation is a more aggressive dosing protocol (with a lot of science backing it up). In order to be able to follow TR you need to do more testing to ensure your kitty stays in a safe zone. Because of the increased testing you will notice if your cat seems like they might start to dive and so it’s more safe to use a lower reduction point because you’re around more to notice any signs of hypoglycaemia

SLGS is a more cautious protocol that people (like myself) choose when they’re unable to test regularly due to work or other life situations. Essentially the higher reduction point is to reduce the chance of hypo happening while you aren’t there to monitor.
 
MrWorfMen's Mom said:
Just a word of warning......I switched from Lantus to Levemir and followed vet advise to back down the dose at lot more than was recommended here only to have to play major catch up. Lantus and Levemir are different just as every cat is different. Ultimately Lisa the choice is up to you, but Little is not going that low on 2.5u right now and Lantus will take a few days to really work at full capacity so backing up the dose too much is only going to put you back further. You do enough testing (when not out of town) to easily be able to catch any need for a reduction should that be the case.
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Yes that is my fear... undoing any progress I’ve made however so small. We’re it not for that random 53 I wouldn’t be so worried. I am doing the math and 2U is 200 units of insulin on Lantus while 2.5 PZI is only 100 units. So that would effectively be doubling with some going into a reserve ... vacillating till the am I suppose :banghead: and thank you all for helping and guiding me. It is truly a gift
 
Ok whoa! YOU ARE COMPARING APPLES TO ORANGES. ProZinc is a faster acting in and out insulin while Lantus is a depot insulin. You can't just do mathematical calculations comparing the two. The action of Lantus is much slower than ProZinc. Nadir usually occurs later with Lantus giving you a lot more time to determine where Little is going on a dose and lots of time to take some action to avert a low reading. Honestly Lisa, Lantus is not hard to work with. It's a bit different but it has it's advantages too.
I may be wrong but are you trying to calculate what you were giving based on using U40 insulin with U100 syringes. STOP! You are making this far more complicated than it needs to be. Little has been on insulin. I assume the 2.5u is the dose you were giving her in terms of u40 insulin rather than what you might have been drawing up in a U100 syringe?
 
Ok. Thank you. That’s why I am concerned and confused. Doing dumb math in my head. Always trying to figure stuff out. Yes she’s been getting 2.5 for quite some time whether it be with a U 40 or the co version on U 100
 
Lisa, while you could measure 1.8u or 1.6 u of U40 insulin using a U100 syringe, you are now dealing with a u100 insulin. You can easily draw up full units, quarter or half units of the U100 using the U100 syringes but drawing up 1.6 or 1.8 would require use of calipers and is far more work than you need to do at this time. If you are uncomfortable giving Little the 2.5u, drop it down to 2u. Little will be fine. The slower more gentle action of Lantus gives you more time to intervene should Little decide to do one of her dives. I get your angst knowing the drops Little has done occasionally on ProZinc but I also know you don't want to slow down or hold up progress and if you back the dose up too far, that's exactly where you'll be. ;)
 
Lisa and little said:
I guess I’m still not understanding .. so let’s say she’s regulated ... that depot stays the same?
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The current depot is the same as the current dose. It has nothing to do with whether or not Little is regulated. If your current dose is 2.5 Units, then the depot, once it is built, reflects the 2.5 Units dose. Let's say, for example, that Little needs an increase--to 2.75 Units. So you raise the dose to 2.75 U. The depot "follows along", taking a few days to get re-calibrated. Will Little be "regulated" on 2.75 U? Who knows? The important thing to keep in mind is that you are doing your best to keep your kitty's blood glucose in a healing range. That involves monitoring her blood glucose and making decisions based on the protocols about raising or lowering the dose. The "Sticky" on "Dosing Methods" is must reading. It will answer many of your questions.

You can do this! Don't worry! :)

p.s.: a Unit is a Unit regardless of whether it is U-40 or U-100. U-40 syringes are intended for U-40 insulin; U-100 syringes are intended for U-100 insulin. Just don't try to measure U-100 insulin in a U-40 syringe!! (You'll wind up with lots more insulin than you intended!)
 
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MrWorfMen's Mom said:
Lisa, while you could measure 1.8u or 1.6 u of U40 insulin using a U100 syringe, you are now dealing with a u100 insulin. You can easily draw up full units, quarter or half units of the U100 using the U100 syringes but drawing up 1.6 or 1.8 would require use of calipers and is far more work than you need to do at this time. If you are uncomfortable giving Little the 2.5u, drop it down to 2u. Little will be fine. The slower more gentle action of Lantus gives you more time to intervene should Little decide to do one of her dives. I get your angst knowing the drops Little has done occasionally on ProZinc but I also know you don't want to slow down or hold up progress and if you back the dose up too far, that's exactly where you'll be. ;)
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Woah thank you for this. I was still using the conversion chart in my head So 1u of u 100 is the first line to the right and 1.5 is the half unit mark below that.to the left. I just took my conversion chart off the fridge and hid it. Now it makes sense. Thank you so much. You guys are our lifesavers
 
Hi Lisa! I remember you from the PZI forum. Ming was on PZI and we switched to Lantus in October 2018 (and now he's on Levemir).

Lots of great, amazing advice here. You'll get it eventually. Right now, my advice is for you to put one foot in front of the other and just worry about the next step and not the next 10 steps. But definitely, do ask questions and ask as many as you'd like. Someone will happily answer them.

When are you planning to start Lantus? When you do, please make a new thread with the date, Little's name, and Little's BGs (AMPS. +2, etc.). You can also put things like "starting lantus! need help!" in the title. It's a little different here at the L&L forum and it helps us help you if the housekeeping stuff is done :D

Like a few have said, the first few cycles might not come up with much action. The depot needs to build and that takes around 6 cycles to build. So there won't be too much to fear in terms of whacky numbers but ECID.
 
Lisa, just stopping by to say hi! You are in good hands here, and you’re getting good advice.

I think Linda has given you good advice on the starting dose. You've known her for a long time now over in Prozinc land and you can trust her. Hugs to you as you start this next step in your journey. :bighug:
 
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