11/18 Neo - AMPS 212, +3 234

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Maya & Neo

Maya & Neo

Member Since 2011
Hi all,
So I'm back from holiday and we're going to switch to Lantus since the Caninsulin still isn't doing its job. I've gone through and read all the help links (I think) and I've printed out the tight regulation protocol so I will have it handy.

I'm just a bit nervous because the vet office obviously doesn't know a lot about this and at least the assistant is treating this with what I consider a cavalier attitude as she didn't know what Lantus was and was telling me that I only needed to make an appointment with the vet to discuss if I wanted. :o

So just in case they leave me more or less on my own (I am going to make an appointment anyway), is there anything else I need to read/do? I already have a supply of u100 fine dose syringes ready to go, plus a new glucose meter that also measures ketones and my hypo kit ready (may I never need it).

I just weighed Neo yesterday (he was up to 4.7kg) and I'll weigh him again before I do the switch.

But I'm wondering - do I have to wait at all between switching from Caninsulin to Lantus? I guess I should start a new day with Lantus rather than doing Caninsulin in the AM and Lantus in the PM?

Thanks very much!
 
Re: Switching to Lantus - anything else I need to know?

I'm sure someone with more experience will come along and answer your specific questions, but I wanted to stop in and welcome you to LantusLand! This truly is the best place for you and your diabetic kitty to be. It sounds like you are well on your way to being very well prepared!

To be honest, a lot of us are working through this somewhat on our own. The folks here know diabetes and Lantus inside and out, and while I do love my vet, I come HERE for all my diabetes help. Just keep asking lots of questions, and you will find all the answers and support you could ask for, and then some!

Again, welcome aboard!

Amy (& Trixie)
 
Re: Switching to Lantus - anything else I need to know?

Reading the Tight Regulation Protocol is a good start. I'd also suggest reading the other starred, sticky notes, as well.

Lantus requires a very different way of thinking about insulin. Unlike Caninsulin, it is a long-acting insulin and is a "depot" type of drug. These factors influence the duration and overlap of shots. Most importantly, Lantus dosing is based on the nadir -- the lowest point in the cycle. This means you will not only need to test before you shoot, but get spot checks during the AM and PM cycles. We encourage people to get at the very minimum, one test per cycle in addition to your AM/PMPS. You do not slide your dose based on the pre-shot numbers. Instead, you will be holding doses typically for 3 days (unless a reduction is warranted).

The initial dose of Lantus can be based on your cat's ideal weight. It also takes your dose on your current insulin into consideration. You don't need to wait -- you can switch directly.
 
Re: Switching to Lantus - anything else I need to know?

Hi and Welcome to Lantus Land, it's great that you are all prepared with having read all the stickies. There is so much there that most of us re-read them many times. We will have a lot of questions for you before anything else. What will your starting dose be? 1 unit is a very common starting point, better to start lower and not miss the right dose. You can always increase. Do not get frustrated if you aren't seeing results for the first several days. Lantus builds up a reserve in the body and you will not see the full effect for up to a week. Every time we adjust the dose we usually wait 3 days for the "shed" to get balanced out.

Caininsulin does not build up a shed so there should be no problem just switching. Be sure to do it at a time when you will be around to check on Neo, though. It's been a while since our switch so I hope for corrections if I have mis-remembered.

How things work around here; We each start a new thread (topic, or we call them condos, 'cause we live here!) The format in the subject line is, date, cat's name, AMPS # (AM pre-shot BG #). You can put a brief note on any concerns . Just look through the topic list for examples. Since Lantus is dosed based upon the nadir lowest point in the cycle we tend to test a lot. People are reluctant to give advice without a lot of data to show what is happening. So , TEST! A lot! We always test just before the shot, and at least once during the cycle. It is important to find out just how long after the shot Lantus onsets and when th nadir is. You will need to test at a lot of different times to see the pattern. Then to complicate matters things can and do shift around.

Keep the subject line updated w/ the test results, since we are all over the world we use a "+" and the number of hours past the shot: one hour later is +1, 2 hours is +2 ……… To change the subject got to your first post of the day and click "edit", but don't change the text body. Put any new comments in a new reply.

Have you read the info on how to set up a spread sheet on Google Docs? That is how we keep track of everything, and it lets others see how Neo is progressing.

Good luck and Welcome again.
 
Re: Switching to Lantus - anything else I need to know?

Thanks for the speedy reply, all, and the encouragement! :)

I've read all the other stickies too, so I guess I'm good to go. :)

Yes, I have the spreadsheet already in my signature, and I'm fully prepared to do more testing again. I'll update my subject line once I've spoken to the vet and switched him over to Lantus. I'll try not to get frustrated or impatient, but really hoping Lantus will make a difference! :)
 
Re: Switching to Lantus - anything else I need to know?

Maya, welcome and best wishes with the switch to Lantus. I see you are from the Netherlands. Just curious, what meter will you be using? Elaine
 
Re: Switching to Lantus - anything else I need to know?

Thanks very much!

I use the FreeStyle Freedom Lite for normal measurements, but I have the ADC Precision Xceed to let me measure blood ketones as well (I also have urine strips for measurement).
 
Re: Switching to Lantus - how to start?

Okay, so that's pretty disappointing. The vet's assistant basically refused to make an appointment for me so I'm going to have to call tomorrow morning to try to talk to the vet directly. /sigh

And I had a look at the prescription:
Glucose < 20mmol/L (360 mg/dl) then .25 u/kg (2x/day)
Glucose > 20mmol/L then .5 u/kg (2x/day)

So would anyone be willing to have a look at Neo's sheet and let me know where I should start? I have no idea what Neo's ideal weight should be, so I guess I should just use .25 u/kg of his actual weight?

Advice is definitely appreciated as my vet's office is obviously not going to be overly helpful! (Nor do I overly trust them at this point)
 
Re: Switching to Lantus - how to start?

Hi Maya,

Welcome to LantusLand! I'm a relative newbie myself and have no advice or answers for you, I just wanted to say "Hi". I look forward to making this trip through the world of feline diabetes with you.
 
Re: Switching to Lantus - how to start?

I switched Donovan from Vetsulin (Caninsulin) to Levemir (very similar to Lantus), and it was a very good decision. My vet, however, suggested a starting dosage of 6U :o which I luckily did not follow. I did accidentally give him more than intended on the first dose because of the change in insulin type (U40 to U100), so please pay special attention to that. I had been using U100 syringes with Vetsulin to better control the dosage, so each line/unit on the syringe was equal to 0.4U insulin; but when I measured the Levemir, out of habit I drew it up to 2.5 lines, which *is* 1U Vetsulin, but it's 2.5U Levemir :shock:. I had intended to start at 1U. Donovan's BG numbers were high at the time so there was no real harm done on that one shot, but I had a small heart attack when I realized what I had done.

As others have mentioned, Vetsulin/Caninsulin doesn't stick around in the system long, so there was no waiting or adjustment period when I changed to Levemir. I switched him on Oct 6, and by Oct 17 he gave me a lovely curve of green. No more ugly pink, red, or black numbers :cool:. Not everyone has such immediate success, but I do hope you find it more effective for Neo.

MJ&Donovan
 
Re: Switching to Lantus - how to start?

**** I just saw on your SS a note that you're "slowly putting him back on low-carb wet food diet".
What exactly does this mean? Has he been eating higher-carb food until now?
 
Re: Switching to Lantus - how to start?

Maya & Neo said:
And I had a look at the prescription:
Glucose < 20mmol/L (360 mg/dl) then .25 u/kg (2x/day)
Glucose > 20mmol/L then .5 u/kg (2x/day)
Click to expand...

A lot of vets here haven't learned the difference in the insulins either. That dosage scale he gave you is appropriate for short acting insulins, but not shed building ones. Consistency is the key here, we only change the dose after about 6 cycles. The shed has to have a chance to stabilize. With every shot a little is stored, then some of the stored insulin is released.

Here is a chart to judge body weight for you cat. Generally if you see a waist behind the ribs and if you can barely feel the ribs w/ the flat of your hand he is considered to be at his ideal weight. Every cat is different (ECID) Tess is only 8.5 pounds, many other cat can be at ideal weight at 14 or 16 pounds.

So, 4.7kg times .25u/kg is 1.17u. I'd start at one unit if you think Neo is looking good, or close to ideal weight. Generally, we hold the first dose for 5 to 7 days to allow the shed to build, then 3 days after an increase or decrease. Again ECID, Tess usually makes me wait an extra cycle or two. :roll: ETA: I just saw your SS. If the previous insulin had been dosed higher , it may call for more insulin to start, but if no one else chime in w/ a better dose I'd start at 1u. It is better to start low and work your way up.

You really need to get those mid cycle checks in for Lantus. That is where the dosing is determined. Remember, the preshot test is to be sure that the BG is not too low to safely give insulin. The dose is determined by the nadir.
 
Re: Switching to Lantus - how to start?

If there is indeed a diet change occurring now, I'd lean toward 1U to start as well.
 
Re: Switching to Lantus - how to start?

A couple of questions:

What dose of Caninsulin was Neo started on?
What is the typical dose you're giving now?

Also, MJ's question about food is important -- are you feeding any dry food? If so, how much is Neo eating of dry vs. low carb canned food?

Are you able to get spot checks during the AM and the PM cycles?

Oh -- and the vet tech doesn't know what she's talking about. Lantus dosing is NOT based on a sliding scale. The article I've attached is from a top veterinary journal. It's the dosing protocol we use here. You might politely suggest that the vet tech do her homework.
 

Attachments

Re: Switching to Lantus - how to start?

I'm seeing lots of low pinks/high yellows on 4U currently (4 cycles so far). Looks like Neo was on 5U at the beginning of September, decreased and changed doses relatively often, then went back up the dosing ladder :-|. Not a lot of mid-cycle data recently though - perhaps because Maya was away? Here's hoping Lantus makes a difference.

MJ&Donovan
 
Re: Switching to Lantus - how to start?

Hi all,
Thanks very much for the advise. I'll go and look for something that'll help me make sure that I'm giving 1u of Lantus on those other needles, as I didn't even think that they would read differently - so thank you for the heads up! My vet office is useless, apparently, as they gave no warning about that at all. Actually, they didn't even discuss the dosage with me. I had to decipher it from the paper they handed me. So needless to say I'm also going to look into finding another vet.

Just to make sure, as I'm a bit confused when I reread the post, if each line on a u100 syringe is .4u, then wouldn't 2.5 lines be 1U? The needles that I have are these: https://www.mediqdirect.nl/producten/32 ... m-30e.aspx . So is the picture shown here correct? Is this 1U? https://picasaweb.google.com/1061861157 ... 1493964002

I was away for 6 weeks and during that time the person who was looking after him stopped doing the mid-day cycle. I will definitely do extra spot checks as I'm able, although since I work I will likely only be able to do 3 checks a day. We started out at 1u twice daily on Caninsulin and I'm currently giving him 4u, but I think I'll go with 1U of Lantus to start with as I'd prefer to be cautious and I think Neo's pretty close to his ideal weight (unfortunately he also developed a fat belly while I was away but as he was too thin I guess it's not too horrible).

I had him entirely on low-carb wet food before I left, but again, the lady put him back on dry food while I was away. She said he wasn't eating, so I can't blame her, but I'm having to wean him off of dry food again. Still, as rough estimate, he's having 9 parts low-carb wet and 1 part dry (or maybe even less over a day) so I will hopefully have him completely off the dry food again soon.

Thank you all. I'm going to do my best!
 
Re: Switching to Lantus - how to start?

They dry food could definitely account for higher numbers and as you get him back to canned it is a good idea to start on a lower dose. Numbers can drop suddenly when the carbs from the dry clear the system.

Those needles look correct. And you are right on the picture of 1u too. The needles have half unit markings, for when you are on in between doses, that helps a lot. Don't worry about those conversions, you have u100 needles for u100 insulin. So you just go off the markings on the needle, jjust remember th smaller lines on the left side are the half unit divisions. MJ had been using u40 insulin in u100 needles to see the dose better and was saying she forgot to stop doing the conversion when she switched to the stronger insulin. U40 insulin has 40 units of insulin per ML, while u100 insulin has 100 units. It is 2.5 times more concentrated and the barrels of the syringes are narrower to let you read the markings more easily. (Most of us still need magnifiers though!)
 
Re: Switching to Lantus - how to start?

Sorry for the confusion - and I need to run to an appointment -- but here's the quick version.

IF you use U40 insulin (like Vetsulin/Caninsulin) in a U100 syringe, each line = 0.4U
I was using U100 syringes with Vetsulin so that measuring partial doses was easier.

If you use U100 insulin (like Lantus), each line = 1U. I believe you already have U100 syringes, so you are all set. There are no conversions to make. My mistake was that when I switched, I still had "each line = 0.4U" stuck in my head, so my brain automatically thought 2.5 lines = 1U. If it was Vetsulin, that would be correct. It was Levemir, a U100 insulin, so it is more concentrated, and 2.5 lines does NOT equal 1U. It equals 2.5U.

To repeat, if you are switching to Lantus and have U100 syringes, there are NO conversions.

I'll check back with you later - gotta run!

MJ&Donovan
 
Re: Switching to Lantus - how to start?

Okay, that makes sense. Thanks very much! I'm going to go to the drug store today to hopefully pick up some Lantus. :)
 
Re: Switching to Lantus - how to start?

Hi all,
I picked up Lantus today and due to test and give the dosage in just about 30 minutes so it's a bit late to ask but...

I was reading the Lantus guide and it says not to shake or roll my vial. Do I still agitate it though, to mix everything up? And by agitate, I mean tipping it back and forth like the vet showed me how to do with Caninsulin.

Thanks in advance for the advice!
 
Re: Switching to Lantus - how to start?

NO mixing, NO rolling, NO nothing. Treat it very gently, including perhaps storing it inside the fridge instead of on the door so it doesn't get jostled around every time someone opens it.

MJ&Donovan
 
Re: Switching to Lantus - how to start?

Thanks so much for the super speedy reply! We were very cautious with the vial and the first dosage of Lantus seems to have gone in! I'm already happy about the new needles because although I can hardly feel anything going in (which means a lot of checking after), Neo doesn't seem to feel these either (he kept squeaking with the other ones) so that makes me feel a lot better.

And we'll make some space in the main part of the fridge so it doesn't get jostled by opening doors. :)

Thank you again!
 
Re: 11/16 Neo - PMPS 15.0 (270)

Hi Maya, welcome to LL!

I see you have already gotten a lot of info and advice, I just want to add one thing...please be sure to test for ketones regularly. It is suggested to test for ketones regularly when you start Lantus anyway, but I see a note near the top of your SS about trace ketones...if Neo is ketone prone, it's very important to keep a close eye on that.
 
Re: 11/16 Neo - PMPS 15.0 (270)

Thanks, Laurie. Could you please quantify regularly for me? Daily? Weekly? I have no idea what is reasonable and what is over-the-top. :-D
 
Re: 11/17 Neo - AMPS 256

Okay will do. Thank you. :)

I have been trying to find on the forum what to do in case I do find keytones - can someone please point me in the right direction?
 
Re: 11/17 Neo - AMPS 256, +3 263, +6 272 - ketones .15 g/L

So I've tested twice now with Ketostix to be sure, but he's definitely creating ketones. :(

According to the chart, he's showing at 0.15 g/L (1.5 mmol/L, 15 mg/dL).

He was ravenous this morning and gobbled up 2 tins of food (200g wet food in total) but hasn't really wanted anything since. And he seems to have less energy today.

Suggestions on what I should do would be greatly appreciated!
 
Re: 11/17 Neo - AMPS 256, +3 263, +6 272 - ketones .15 g/L

Hi Maya, you might want to put HELP in your subject line to get attention to your question about ketones. I don't know the answer but someone will.
Liz
 
Re: HELP 11/17 Neo - AMPS 256, +3 263, +6 272 - ketones .15

Maya:

I'm assuming you are testing urinary ketones. What's the description regarding the test result? If the reading is "Trace" or less, don't panic. Just add as much water as Neo will tolerate to his food. If the reading is more than "trace," you need to get Neo to the vet. Ketones can develop into diabetic ketoacidosis (DKA) quickly and it is an emergency situation.

When you're using Ketostix, the numerical measurement isn't helpful since it's not precise. If you have a meter that tests blood ketones, then the number is important.

Ketones most often result from infection, not enough insulin, and not eating. It sounds like Neo is eating! There may be an infection present which may mean that you need to see you vet for lab work.

I just want to double check -- are you using U100 syringes?
 
Re: HELP 11/17 Neo - AMPS 256, +3 263, +6 272 - ketones .15

Hi Sienne,
Thanks for the reply. Yes, I'm testing urinary ketones. And it's not trace, it's one step above, what on the bottle is called "Faible", but means nothing to me (nor to Merriam-Webster). I just got a meter that tests blood ketones, but it didn't come with strips so I ordered them today and they will be here tomorrow.

I'll add water to his food and call the vet to see what they say. Thank you!

And yes, I'm using u100 syringes.
 
Re: HELP 11/17 Neo - AMPS 256, +3 263, +6 272 - ketones .15

Take a look at the color coding in this link. I think you're getting "small" ketones.

I'm checking in with a few of the others. I'm thinking that your insulin dose may be too low. You were giving approximately 4.0u of Caninsulin and using U40 syringes before switching to Lantus?
 
Re: HELP 11/17 Neo - AMPS 256, +3 263, +6 272 - ketones .15

Hi Sienne - yes, the colour is equivalent to "small" - very handy link - thank you!

And Liz, you're brilliant, I just tossed the word into Google Translate and it's indeed French for "low".

Yes, we were giving 4u of Caninsulin with u40 syringes before switching to Lantus, but I think, looking back at the XLS that it might be safe to say that on average he was getting more like 3u for a longer period of time (the 4u was only for 3 days).

Thank you for all the help! I am a bit freaked out by the ketones, but I guess it's not that bad yet. And the vet is supposed to call me back as they were too busy to take my call.
 
Re: 11/17 Neo - AMPS 256, +3 263, +6 272 - ketones .15 g/L

Well so much for the vet. "There's nothing you can do." Is his answer. He told me that I just had to get the BG under control with insulin and told me to "hang in there" for a few days and then I could bring him in for blood testing and they'd take a look at his liver. Not that I think they would actually do anything to help at this point.

Thank goodness for you guys!
 
Re: 11/17 Neo - AMPS 256, +3 263, +6 272 - ketones .15 g/L

Hi there!

I'm not too keen on the vets response. . .

I want to stress what Sienne recommended - at this time it's very important to add as much water as Neo will tolerate to his food.
Continue to monitor ketones periodically as the picture can change rapidly.

Any gingivitis? Has Neo ever had dental cleaning?
 
Re: 11/17 Neo - AMPS 256, +3 263, +6 272 - ketones .15 g/L

I'm not keen on the vet's response either.:( I'm hunting to for a new vet this weekend for sure.

I will be sure to mix in extra water with the wet food this evening and will check his ketones as much as I'm able, also with the monitor once the ketone strips arrive tomorrow.

He had his teeth checked this summer and the vet said he was fine. No, he's never had any dental cleaning. I bought some cat toothpaste and toothbrushes, but I was hesitating to use them as I wasn't sure it was a good idea. Guess I'll have a good look at the ingredients and see. Unless there's any reason why I shouldn't try brushing his teeth?
 
Re: 11/17 Neo - AMPS 256, +3 263, +6 272 - ketones .15 g/L

Brushing Neo's teeth is fine -- if he'll let you. My kitten demands that I brush his teeth but I started doing it early and he associates getting his teeth brushed with treats! You also want to find a toothbrush that is appropriate for a cat and not a small dog. This is the toothbrush and toothpaste I use. I think the company is based in Europe so you may be able to track it down.

Is there a vet school in Amsterdam? Maybe calling there and finding out if there is someone they'd recommend?
 
Re: 11/17 Neo - AMPS 256, +3 263, +6 272 - ketones .15 g/L

Maya,

Small ketones is not something to be unconcerned about. I don't understand the vet's response, there absolutely is something that can be done about it! Ketones can turn into an expensive, life threatening emergency quickly. I would not try to manage anything above trace ketones at home...you need to find a vet and get him there today. Yes, you need to add water to the food now, but you need to get vet care for him ASAP....you can't wait for the weekend.
 
Re: 11/17 Neo - AMPS 256, +3 263, +6 272 - ketones .15 g/L

I want to underscore what Laurie said. DKA is life threatening and expensive. Most of our cats that survived spent days on an ICU at a very great expense. It is something that requires prompt treatment. Please keep checking ketones. If the level is still above "trace," please get Maya to a vet or to an emergency clinic.
 
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