6/22 Yoda switching to Lantus from ProZinc

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Kelly & Oscar

Kelly & Oscar

Member Since 2010
This is my first post in LL. I just got word from Venita that my foster kitty, Yoda, will be receiving 3 cartridges of Lantus in the mail on Thursday. He came to me about 10 days ago in the beginning stages of DKA, very dehydrated, and malnourished. He is anemic right now (not sure of the cause as of yet), possible beginnings of CRF, on Clindomyacin for his mouth (possible stomatitis - last dental was 9/09), and on 50ml of fluids every other day. His latest update thread in PZI land is here: viewtopic.php?f=24&t=17862

With a history of very high ketones (a trace amount still remain) and currently getting 2u of ProZinc BID - should we start the lantus dose back at 1u BID? I have read through all the stickies several times. I think I remember reading somewhere that you keep the dose you were at if you are switching, but I can't find it again for the life of me. We are currently using u100 syringes with 1/2 unit markings for micro dosing with Oscar, so we already have a stock pile for Yoda's Lantus. His preshot #s are usually from the mid 300's to low 400's.
 
Kelly:

Welcome to LL!!
Ordinarily, we would drop the dose back or do a weight-based calculation for starting dose. With a ketone prone kitty, especially one with an infection/inflammation present, we would be more aggressive. Even the dosing protocol would take the dose of ProZinc into consideration for any cat switching to Lantus. If you look in the link, the quote you're looking for is in the section about the initial dose.

I'll see if I can get some of the experienced members here to take a look and lend a hand with Yoda's initial dose although I suspect they will suggest you stick with the 2.0u unless the numbers suggest otherwise. It looks like you have a meter that tests for blood ketones at home and will be continuing to test for ketones. If you're not already doing so, please add water to Yoda's food in addition to the sub-q fluids you're giving.

I gotta say this is a very lucky kitty to be in your care. It sounds like he did not have a good bunch of beans taking care of him from what you described! Please let us know how we can help.
 
Yes, that is the protocol I read that in - thanks for finding it!

I always add a bit of water each time I put down food. In addition to getting more water in him, I also find it keeps the wet food from drying out. I will still test for ketones - since the levels have dropped considerably from where they were, I have moved to testing every other day until they get to a negligible amount.

I think the previous owners were just oblivious to what was going on with poor Yoda and didn't want to deal with the hassle of a sick cat in the end. Thank you for all your help so far! cat_pet_icon
 
I'm not sure if you've dealt with DKA. It's serious -- it almost killed Gabby and there are several of us here who would never, ever wish the experience of a cat with DKA on anyone. It is expensive both emotionally and financially. So please understand that I'm saying this from experience: Until the ketones are gone, test daily. Ketone levels can skyrocket in the blink of an eye. You could test in the AM and have a track and test in the PM and be running your cat to the ER in the PM. And don't add just a little water. Think about food being soupy -- provided that Yoda will eat it that way. Getting the dehydration resolved will help to get rid of the ketones. Squids and water -- whatever way you can get it in -- will help get rid of the ketones. You may want to pick up a box of Ketostix. You dip the stick in Yoda's urine and after 15 sec. you will get a color coded reading. The Ketostix are between $10 - $15 for a box of 50 -- much cheaper than the blood ketone strips. (Of course, you've got to stalk your kitty to the litter box.)
 
I understand your concern - believe me! His ketones are 1/3 what they were 2 weeks ago. I know he wasn't in full blown DKA at that time, but he was close. Another day or two and he probably would have died I think (I don't think his previous owners would have taken him to an ER vet). He is properly hydrated now due to adding about a 1/4 cup of water per 3oz of FF and giving fluids daily until I felt he was no longer dehydrated. He has been to the vet already and I have already experienced his ketone level spiking on us (day 2 to day 3 the levels doubled). The blood test gives a more real time reading and I purchase the strips on ebay for a fraction of the cost. We have been on a steady decline in ketones for the past 2 weeks and his overall behavior improves dramatically each day. The thing about testing blood ketones is that it tests the most acidic type of ketone (there are 3 types) and the ketostixs test for the other two types. It is normal to have 0.3mmol or less in the blood if the BGs are not regulated, but more than that should be watched closely. I know this because my Oscar has had this level of ketones for a few months now as we battle with his insulin dosage and I have done a lot of research on this.

I am not diminishing your concerns at all - just giving you some background into our situation.
 
Thanks, Kelly. It's hard to know what someone's knowledge base is and you are clearly on top of things. Yoda's safety is all of our concern. Like I said before, I think Yoda is very lucky to have found you.
 
Hi Kelly, with the presence of ketones then I definitely think you should stay with 2 units when you switch. We might want to fast track up the dosing scale (we accelerate things when ketones are hanging around), if the numbers don't come down quickly. It looks like he is under dose on Prozinc. We usually find that Lantus is a little less potent than other insulins (we don't have as much experience with cats switching from Prozinc yet). That means that Yoda will probably need some dose increases to get where he needs to be.
 
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