5/13 Chuck 412 AMPS

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Chuck and Susan

Chuck and Susan

Member Since 2010
Chuck has been Symogi-ing (if that's a word) like crazy ever since we started back on Lantus. The only time his numbers were stable was the week we took him off Lantus completely. Back on Lantus, back to Symogi...

Talked to his vet today (took the civies in for nail trims), showed him graphs and test results for the last 3 weeks -- all show Symogi effect. He said he would have a conference tomorrow specifically to discuss Chuck's case, and that they would likely recomment a switch in insulin, since Lantus doesn't seem to be doing the job this time around. I'm guessing they'll recommend ProZinc, but don't know that for sure.

So, if looks like we'll be leaving Lantus-land again...
 
Hi guys .. sorry to hear that chuck is having such a rough time .. I only have experience with lantus really so can't offer advice on other insulins but hope you find one that works well for him .. have a great day!
 
The really sad thing is the vet says Lantus is their "Holy Grail" for feline diabetes... But it just doesn't seem to be working for Chuck this time around...
 
Have you tried Levemir? It works a lot like Lantus, except the onset is usually around +4 and the nadir is around +8.
 
Dyana, I'm waiting for a recommendation from the vet. I may research Levemir a bit and "push back" on it if I need to. I really want as gentle an insulin as possible due to Chuck's age (18)...
 
just a thought, but it looks like there have been times recently when you have given a smaller dose but given it more often (like +8). Is that something that would be sustainable for you? Because he has held his own pretty well on those days. I'm thinking that 1u is dropping him too fast and too low, but also not lasting a whole 12 hours. Just an idea, though I like the idea of trying Levemir even better.

I like Levemir too. It works similarly to Lantus (same protocol), but in many cats it lasts a bit longer and for most cats the onset is later (so they might not drop as fast and as early). It might be a very good choice for Chuck. I used Levemir for Jazzy, and just started my new cat on it too and he is doing well already. I'm not as familiar with Prozinc.
 
So, do you think doing 1/2U every 8 hours or so might work for Mr Chuck? My shot threshhold is 250; below that, no shot. But, maybe a 1/2 unit between 200 and 250 would do some good.

I've tried everything I can think of to get his numbers stabilized -- even to the point I was going to increase the dosage to bring the numbers down -- then he threw that 47-75-131-137-184 run in about 12 hours and then went to the moon 2 hours later.

He tested at 455 preshot tonight, so he got a full shot. I'd like to keep him on Lantus because that's what I'm familiar with (and the vial of Lantus was about $150 while a vial of Levemir is going to be about $175, plus I'd have to learn Levemir), but if that's the way we need to go, that's the way we'll go.
 
Question:

on days like 5/8, did you shoot 0.5u at the 262 and then another 0.5u at the 268 seven hours later?

Then 5/9, shot 1u at the 380 and another 0.5u eight hours later?

Just making sure I understand your spreadsheet.
 
Yes to both questions. I guess I figured, on 5/8, he didn't need one at pre-shot time, but since he was climbing an hour later, he needed at least 1/2U. Then, 7 hours later, not much change, so another 1/2U.

What I'm aiming at is trying to find when he's climbing and giving at least 1/2U at that time (if he didn't get a full unit earlier).

Or, in the case of 5/10, he got the full unit at PMPS, but basically climbed the entire night, so another full unit at +8, followed by another full unit at +4, another full unit at +12 even though he was dropping a bit (488 to 337).

Then, he started dropping, and was at 47 at +8, 75 at +12, 131 at +15, 137 at +17, and 184 at +19. I kicked myself for not testing between +19 and +21, because he shot to the moon in that period of time. He's had 3 units since 5/12 PMPS, and is currently at 349 (+3). On 5/12, I could tell he was feeling really good even without testing because he was very social and wanted all kinds of attention. Then, at +21 when he shot up, and further at +23 (503), he withdrew to the closet floor. He's still pretty much hanging out there, although he has been out and about today (I had today off from work).

So, up until now, my thoughts were one of two things: Take him completely off insulin (again) for a week, and then start him back at 1/2 unit every 6-8 hours OR try to get him on a 1/2U 6-8 hour schedule without letting the depot drain.

However, I think the vet is going to recommend changing insulins. If I understand correctly, Levemir is much like Lantus as far as schedule goes, correct? Every 10-12 hours?

Gotta tell you, he's driving me nuts and it's a pretty short drive!!
 
Yes, Lev and Lantus are, for all practical purposes, very similar. The biggest difference is that the nadir for Lev is later. The dosing principles are the same and the protocol is identical.
 
Chuck and Susan said:
...OR try to get him on a 1/2U 6-8 hour schedule without letting the depot drain.
Click to expand...
hi susan! libby and sienne asked me to look at chuck's spreadsheet. i think you're on the right track. he doesn't seem to always get enough duration off a dose. i think if he were mine i would attempt dosing a small amount TID... every 8 hours. we usually don't suggest it because it's a pretty rough schedule. another alternative that's been mentioned is to switch to levemir. imho, you'd have similar duration problems with a switch to prozinc.

see what libby thinks...



ETA: check out the "lantus & levemir: what's the difference?" link in my signature.
 
Jill & Alex said:
Chuck and Susan said:
...OR try to get him on a 1/2U 6-8 hour schedule without letting the depot drain.
Click to expand...
hi susan! libby and sienne asked me to look at chuck's spreadsheet. i think you're on the right track. he doesn't seem to always get enough duration off a dose. i think if he were mine i would attempt dosing a small amount TID... every 8 hours. we usually don't suggest it because it's a pretty rough schedule. another alternative that's been mentioned is to switch to levemir. imho, you'd have similar duration problems with a switch to prozinc.

see what libby thinks...
Click to expand...
yes, that's what I was thinking too, if you can manage the schedule. It's tough, though. I would reduce the dose and shoot every 8 hours, as long as he is rising at +8 (I think +6 is probably too early, I would give +8's a try first and see what that does). Or switch to Levemir and see if you can get more duration and maybe that would let you stick to a +12 schedule.

I think either of those ideas is worth trying.
 
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