5/26 Loudogg AMPS 348 +5 307 +8 287 - PMPS 327 +3 261

Yesterday

Morning all,
So I gave Lou his first dose of 3u, and he did nothing but climb. He didn't go out of the mid 300s the entire cycle from what I can see. Is this a normal first reaction? I feel like I should up his dose to 3.5 going forward since he clearly didn't have an extreme reaction to the glargine (which I worried about). What do you think?

I can't help but be hugely disappointed (and tired) this morning....

 

Patience. It can take a few cycles to see the results with a depot insulin.

 

Thanks Wendy. I didn't expect him to go hurtling down into the greens or anything, but I guess I at least expected it to look like I had given him a little insulin. For what it's worth, I did end up giving him 3.5u today. Maybe only in part as a kneejerk reaction, but really I think he'll need it based on his previous dose.

 

It's only his 2nd dose of this insulin. Think of his 1st dose as if it was a fur shot. There is no depot yet so it was like getting nothing, which would result in higher reading.

Hold tight, it can take a day or two to start seeing results.

 

One of the hardest concepts that we all struggle with initially is how the depot works. Lantus isn't like most other types or insulins. If you think in terms of an antibiotic, you take a dose or two and your fever starts to come down and/or you start to feel a bit better. The same is true for the faster acting insulin -- you give a shot and numbers can and usually do drop, even after the first dose. There's some indication of this with your Vetsulin numbers. The depot will be among the major differences you'll need to get used to with Lantus.

Lantus/Basaglar and Levemir are depot types of insulin. This means that it takes a while for the depot to form -- usually up to a 5 - 7 days. With every dose, a small amount of insulin is deposited into the fat tissue and stored as microcrystals. These crystals dissolve over time giving Lantus it's long duration. Every time you change a dose, it disrupts the depot and it usually takes up to 3 days to re-stabilize the depot, although the length of time it takes varies from cat to cat and can shorten appreciably as a cat is nearing regulation and/or remission.

 

Thank you for the explanation Sienne! I know I read up on the depot, but I honestly still had no clue it would be so slow going to start. It's basically like I'm starting all over again as a brand new member, and I don't like the feeling, haha. It's hard going from a faster acting insulin to a depot insulin, but I hope it'll be good for Lou once the depot gets filled. There's been a bit of activity today at least, so that helps reassure me that my insulin works at least.

 

You're exactly right. Switching to a depot-type of insulin is an entirely different ballgame. Everything your thought you knew will be different with glargine. A couple of big differences:

• There's a depot to take into consideration. Thus, nothing happens instantaneously. Think of it like steering an ocean liner vs a rowboat -- it takes a lot longer to turn an ocean liner.
• You don't adjust the dose based on the pre-shot number. Dosing is based on the nadir.
• Doses are held for a prescribed length of time depending on which protocol you're using (a week with SLGS, 3 - 5 days depending on where Lou's numbers are with TR).
• I'm not sure how you decide to reduce a dose with Vetsulin. Again, the point at which you reduce varies based on whether you're using TR or SLGS.

And just to make sure, you are using U100 syringes? (Vetsulin using U40 syringes.) It's something vets sometimes forget to tell their clients.

 

That's such a wonderful analogy! There really aren't any hard and fast rules for Vetsulin. Dosing was based on nadir, the preshot number, and the cat's own reaction to the insulin. Sometimes it felt like I always had to be on my toes, and other times it felt more like the SLGS process. It's going to be really hard reprogramming my brain to not change things on a whim. I'll try to think of the Titanic... the slow turning, not the sinking, haha.

I do have the U100 syringes, and I think Lou appreciates the smaller gauge. I'm thankful I have this forum, because technically my vet told me nothing more than the name of the insulin and an online coupon she found. Nothing about syringes.