Admin Advise Switching to Lantus from Prozinc, 1.7mmol blood ketones.

Hadaza

Hadaza

Member Since 2023
Hi all,
I’ve been messaging for help in a few places, but have been instructed to post here for the most precise help.
Firstly, my kitty Calcifur is at risk of death if he goes into DKA because he has cardiomyopathy, I have been told by multiple vets it would be the end for him.
This is, I believe, the biggest concern at this point because his BG #’s are quite consistently above 500. I think being conservative with his insulin doses may be more dangerous than a hypo episode.
I have a complete hypo toolkit ready, I am feeding very pure raw food that I have consulted with a traditional Chinese medicine vet to find the best for Calcifur, and I have myself, my partner, or a trained friend with him at all times to watch his #’s.
We have been instructed by our vets and some very knowledgeable folks on here that switching to Lantus may help his BG numbers goes down and be more consistent.
The last blood ketone test was at least 2 weeks ago and was at 1.7mmol, and I consistently test for ketones in his urine which there haven’t been any yet.
I feed him twice a day (he’s 18 pounds with an ideal weight around 16 pounds) around 125 calories and give him small snacks when he takes his medicines for a total around 250 calories or slightly above. He drinks lots of water throughout the day, and only goes outside at night (we are in Texas and it is deadly outside during the day right now). He hasn’t been showing the clinical signs of DKA yet but it’s hard to tell sometimes as he is lethargic except when his BG goes below 250.
This should sum up most of the relevant information, please ask me for anything else, I am currently buying blood ketone strips to test that at home as well.

So my questions to all of you are, should I switch to Lantus ASAP? What dose should I start him on? Should I switch to more than 2 meals a day? Should I stop listening to his general vet (she recommends 1u Lantus and 2 meals per day)? Should I try to get his ketones low before switching to lantus (as recommended on here in another post) by increasing Prozinc aggressively for a short time?

Thanks, you all are the best.
 
Since he’s on a low carb diet and tested a lot I would give lantus a try and switch to TR at least until his numbers come down.

We take the current dose into account and with numbers this high I would start with his current of dose of 2.75. I found feeding small meals until nadir worked well. I would not limit him to two meals. Just make sure he’s not getting more calories than needed. With DKA in the history less insulin could be a big problem. I haven’t used Prozinc but I see Wendy has seen your post on the main forum which I will link here for continuity and see who has given you input so far. Prozinc is a good insulin too but I’m just not familiar with it.
https://www.felinediabetes.com/FDMB/threads/help-all-around-please.279489/#post-3087726

Edited. I see Bron suggested 2.5 so start there. That is why linking posts is a good idea. And welcome to LLB.
 
Just so that there is no confusion I’d like to state that he doesn’t have a history of DKA.
His blood work 2 weeks ago showed he is at 1.7mml/l. This puts him at risk for developing DKA, and he also has cardiomyopathy, meaning DKA would almost surely be deadly.
 
Does he have any ketones in the urine at the moment.?
My point on the other thread was, if he is still showing ketones, it is not a good idea to swap to a depot insulin until the ketones have gone. You said he still had a trace of ketones.
You also mention only feeding twice a day. With a history of ketones, you need to be feeding more than twice a day.
Ketones can form when there is not enough insulin and not enough food for the cat. The cat needs energy, so if carbs are not available , the cat uses the fat and protein in its body instead of the carbohydrates and the by product of this process is ketones. So you need to make sure that those two things are addressed by feeding enough food so he doesn’t need to use the fat and protein stores and give enough insulin.
 
Hadaza said:
The last blood ketone test was at least 2 weeks ago and was at 1.7mmol, and I consistently test for ketones in his urine which there haven’t been any yet.
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You said yesterday He is showing trace ketons in urine, according to Ketodiastix. I test him frequently.
However you say to day there have been none as yet.
Can you clarify please?
 
Im regards to ketones. At the vets office they found no ketones in his urine only in his blood. The ketodiastix show in between negative and trace when home testing. It’s hard to establish which is the actual true color. The Vet said urine color could affect the test strip results.
Before he had been checked at the vet for ketones in the urine (June 30th)I was already home testing with ketosticks and the color on the keto strip has been consistent since I first began testing him at home (May 30th).

All this being said, the vet analysis says no ketones in urine and home testing reads in between negative and trace.

I hope this makes sense.
 
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Hadaza said:
The Vet said urine color could affect the test strip results
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I have never heard of this before. I doubt it is true. The manufacturers couldn’t put out a reliable test that was affected by the colour of the urine as there is such a variation in the colours of urine, especially human urine, which the tests are made for.
Are you able to show us a urine ketones test result against the colours on the bottle please. you will need to read it exactly 15 seconds after dipping it into the urine and take the photo straight away as the colour will keep changing. Thanks!:)
We just need to establish that Hadaza has no ketones in the urine before swapping to Lantus for his safety.
 
Bron and Sheba (GA) said:
I have never heard of this before. I doubt it is true. The manufacturers couldn’t put out a reliable test that was affected by the colour of the urine as there is such a variation in the colours of urine, especially human urine, which the tests are made for.
Are you able to show us a urine ketones test result against the colours on the bottle please. you will need to read it exactly 15 seconds after dipping it into the urine and take the photo straight away as the colour will keep changing. Thanks!:)
We just need to establish that Hadaza has no ketones in the urine before swapping to Lantus for his safety.
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I will upload photo as soon as he goes potty
 
I’d like to note that with the increase this morning from 2.5units of Prozinc to 2.75 units, Calcifur’s stayed above 500 on the FSL and a measurement of 493 @+7 on the Relion meter.
 
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Hadaza said:
I’d like to note that with the increase this morning from 2.5units of Prozinc to 2.75 units, Calcifur’s stayed above 500 on the FSL and a measurement of 493 @+1 on the Relion meter.
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This is the ketone strip at exactly 15 seconds
view
view
Ketone strip image
 
Bron and Sheba (GA) said:
I have never heard of this before. I doubt it is true. The manufacturers couldn’t put out a reliable test that was affected by the colour of the urine as there is such a variation in the colours of urine, especially human urine, which the tests are made for.
Are you able to show us a urine ketones test result against the colours on the bottle please. you will need to read it exactly 15 seconds after dipping it into the urine and take the photo straight away as the colour will keep changing. Thanks!:)
We just need to establish that Hadaza has no ketones in the urine before swapping to Lantus for his safety.
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Is it safe to say that there are no ketones in urine? If so, thoughts on making to switch to Lantus? I should have his blood ketone meter in by tomorrow to have verification of where those levels stand. Also, he didn't respond to the .25 increase this morning, putting him at 2.75, so we increased his pm shot to 3 units. He stayed HI all day.
 
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I think you can swap to Lantus in the morning as long as you test daily for ketones and feed the extra snacks during the cycles and not just give the 2 meals a day.
What do you think about starting at 2.75U lantus @Wendy&Neko?
 
Im not too familiar with Lantus, would I expect his numbers to be high for a few days while the depot is accumulating? And was this the concern for not making the switch if ketones were present in the urine? Or could his BG’s drop rather low? Are Lantus and Prozinc equivalent in strength? Friday and Saturday are the two days of the week I have a sitter stay with him. Knowing the above info would give me a better indication of when I should switch him to Lantus. Either tomorrow if Lantus take a few days to start its job or Sunday morning, when I can be there to monitor around the clock.
 
Unfortunately, cats tend to be ECID in how they respond to an insulin change. Some do go higher as we wait for the depot to build, some have an immediate reaction. We do take the numbers on the current insulin dose into consideration when switching and usually suggest 1 for 1. We do suggest being able to monitor fairly closely for the first couple cycles after an insulin switch. So maybe Sunday would be better for you, unless the sitter tests?

Are you monitoring Calcifur's respiration rate? Always a good thing with heart kitties. Any chance he's getting into contraband somewhere when he goes outside? Wouldn't be the first cat to do so.

Do you have the U-100 syringes needed for Lantus?
 
Calcifur has a FSL sensor so she can test this way. She isn’t trained to blood test though. Would this be reason for concern? I typically have a sitter scan every hour until I get home at 3:30am.
I do take him out in the evening but never let him out of my sights. I do monitor respiration and have the U-100 syringes.
 
I will try and get some shut eye. Not getting much of that these days. I’ll check for any updates to this thread before Calcifur’s 9am (central) insulin shot. Thanks to all who have been helping us. I am so grateful to each one of you!
 
The syringes you need for the Lantus insulin are U100, 3/10, 30 or 31 gauge, 6 or 8 mm insulin syringes with 1/2 unit markings..
They are different syringes to the ones you use for Prozinc
When you start Lantus, you stay at the same dose for 5 to 7 days to let the depot fill.
Have a look at the 2 dosing methods HERE
As long s you are not feeding any dry food, you would be better following the tight regulation (TR) dosing method.
 
Bron and Sheba (GA) said:
How are things going @Hadaza ?
Did you do the swap to lantus?. I can't see any data in the SS after the am shot on 13th
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We started him yesterday on Lantus, 2 units. We went a little less than y'all suggested on dosage because he would be with a sitter and wanted to be more conservative until I could be with him 24/7, which is on Sunday. I have determined we will go the TR route considering he is at risk for DKA. Monday morning (after 6 cycles) if his levels remain as they are (nadir above 300) I will increase the dose by .5 units.
 
When you first start Lantus you need to stay at the starting dose for 5 to 7 DAYS for the depot to fill. This is important. Then after the initial wait for that long you can increase after 6 cycles if the BGs indicate you can.
Can you draw a coloured line between the finish of Prozinc and the start of Lantus please so it can be easily seen?
 
Bron and Sheba (GA) said:
When you first start Lantus you need to stay at the starting dose for 5 to 7 DAYS for the depot to fill. This is important. Then after the initial wait for that long you can increase after 6 cycles if the BGs indicate you can.
Can you draw a coloured line between the finish of Prozinc and the start of Lantus please so it can be easily seen?
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Do Lantus shots need to be injected in the same area of the body? Or can I alternate areas? How do I determine to wait 5 or 7 days?
 
Hadaza said:
Do Lantus shots need to be injected in the same area of the body? Or can I alternate areas? How do I determine to wait 5 or 7 days?
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With the high BGs Calcifur has been having, I would wait the 5 days before increasing the dose.
Here is a photo of where you can inject the insulin. It is a good idea to alternate the sites. Otherwise the area could toughen over time.


upload_2023-7-16_17-20-11.jpeg
 

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Calcifur is very close to DKA. His legs are getting wobbly. Below is from the TR method link you sent me. We are going to increase tonight by half a unit.
  • Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
  • Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
  • Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.
 
With his high numbers, you can increase by 0.5 units tonight. If you were following TR, it does allow faster increases and allows a 1/2 unit increase after 6 cycles. You might want to consider following TR, if you can, at least until you start seeing better numbers and out of ketones danger. And modify your signature to show you are following TR. Speaking of which, do you have any recent ketones tests? You should be testing daily and adding the test result to the spreadsheet.

A couple admin things for this board. First, please start a new thread with each day, with a link to the previous day's conversation. This forum has enough kitties that people don't want to read through a lot to get caught up for more urgent situations.
POSTING GUIDELINES PLEASE READ

Please modify the spreadsheet to have a blank line after the last day of Prozinc and before the first day of Lantus. It's a significant event we need to see.
 
Yes, testing for ketones. Couldn't get one yesterday. His blood ketone meter arrives this evening. Trying to get one today before pet sitter arrives. I've updated spreadsheet and will follow the guidelines. Thank you!
 
Yes, we are dividing 125 calories between 4 meals 2 times a day. Largest amount of calories at shot time and never feed after nadir. Does that sound good?
 
250 total. He also gets chicken broth 2 times a day with probiotics. That’s not included in the 250 and also small amounts of canned food (ff classic) to administer his medications. By small I mean just enough to cover the capsules.
 
Hadaza said:
250 total. He also gets chicken broth 2 times a day with probiotics. That’s not included in the 250 and also small amounts of canned food (ff classic) to administer his medications. By small I mean just enough to cover the capsules.
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With ketones in the picture or recent past, we recommend feeding more calories than you normally would because food is one of the things that can keep ketones away. If 250 calories is what he would normally eat, I would increase the amount a bit more.
 
Bron and Sheba (GA) said:
With ketones in the picture or recent past, we recommend feeding more calories than you normally would because food is one of the things that can keep ketones away. If 250 calories is what he would normally eat, I would increase the amount a bit more.
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Okay, I will increase his caloric intake.
 
Is he a good weight at the moment.?
A good rule of thumb is 20-33 calories per lb depending in the energy level.
So if we go with 20 cals per lb... that is 20x17=340 calories.
So what you are suggesting is 250 cals +150 cals = 400 cals which is I think is the minimum you should feed with ketones in the recent past.
 
I’ll take a better look those calculations after a good nights sleep. I’m wiped! Thank you for the info!
Also, Would you kindly send me a link where i can learn about this information? Specifically, ketones and food.
 
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