Anything I should know when going from Prozinc to Lantus?

vstarjewel

vstarjewel

Member Since 2019
At the high risk of sounding like a TOTAL flake . . . Max had an exam appointment today with a new vet. Despite the fact that I felt that his last vet was acting in his best interest, I still had a gut feeling about the clinic as a whole, along with being unhappy with the way things are handled there. The vet I saw today has special interest in feline care (she mentioned she has a diabetic cat at home, her second diabetic kitty passed away recently as the age of 19). I gave her my spreadsheets, my notes, bloodwork results, everything. First thing she said: "This is an IMPRESSIVE chart" ;). I explained to her that I wanted to switch to Lantus as Max's BG readings never stabilized, no matter what was done. I wanted to try a slow/delay release version. She said she prefers to start with Lantus, and said that she would give me an rx for it. I've placed an order with Mark's pharmacy (as recommended here), and hope to receive it in 10 to 14 days.

Not sure if anyone can chime in, but did anyone notice changes when switching? Anything I should maybe watch out for? I know the Lantus has to "build up" for a bit for it to give reliable numbers . . . any idea how long I should wait before considering dosage changes, or any changes for that matter? I know ECID . . . but it would be nice to get an idea ahead of time.
 
Can't chime in about the switch, but welcome :)

Make sure to read the TR guidelines here http://www.felinediabetes.com/FDMB/...-low-go-slow-slgs-tight-regulation-tr.210110/

Here's the core, you're gonna want to give it 5-7 days for the depot to build up and then increase every 3-5 days based on what numbers you're seeing. Decrease when you get numbers below 40-50ish.

General Guidelines:
  • 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.
Increasing the dose:
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
  • Increase by 0.25 unit after 3 days (6 consecutive cycles) if nadirs are greater than 200, but less than 300.
  • Increase by 0.5 unit after 3 days (6 consecutive cycles) if nadirs are greater than 300.
 
Julie, I can't give you any personal experience about changing from Prozinc to Lantus. But, I can and do suggest you read the stickies at the top of the Lantus forum so that you know how Lantus works, what syringes to have on hand (they are different) and when you start the Lantus, put those U40 syringes out of reach, and the protocols used here for Lantus.

There is a lot of information on the glargine insulin there, it will take more than one reading through for you to get full benefit. Start reading the posts there in the Lantus forum, see how the members report the BG in the title every day, note comments, questions and responses. Be sure to ask questions so that you are getting feedback.

When you change insulin please create a blank line on your spreadsheet after the last dose of Prozinc and then type in STARTED LANTUS, so everyone knows it's a different insulin. Your BG test results may look different, as Lantus takes a bit to build up the depot. Be as educated as you can be before the changeover.

Good luck with the change, I hope it works for Max.
 
I just switched too after Yoshi was in remission for two years. Lantus was the only insulin I could get and I’m freaking out with this whole depot thing.

It really works differently.
 
I made a switch from a different short acting insulin to Lantus. In addition, I've been hanging around here long enough that I can provide some information.

First, how your think about dosing with Lantus is totally different than other insulin. The biggest difference is in the pharmacology -- Lantus is a depot type of insulin. There's a sticky note on the depot.
  • When switching, you can use the same dose of Lantus as Prozinc. You do not need to start over.
  • When starting Lantus, it takes roughly 5 - 7 days for the depot to become established. You may not see much of a change in Max's numbers during this initial time. Once you're past the first week, you don't want to give the depot at least 3 days before increasing a dose -- the depot needs to stabilize. However, if Max's numbers drop, you can reduce the dose sooner than 3 days.
  • Lantus dosing is based on the nadir, not on the pre-shot number. Ultimately, you can work your way down to shooting low numbers but it's not recommended until you have sufficient data to know how your cat responds to Lantus.
  • Because dosing is based on the nadir, it's essential to test during the PM cycle. It looks that was not part of your routine. At the very minimum, please get a "before bed" test every single night. Without that information, you are missing half of your data and you will have no way to know if Max's numbers warranted a dose reduction during the PM cycle. Many cats visit lower numbers at night.
  • Likewise, because dosing is based on the lowest number in the cycle, you do not slide the dose based on the pre-shot number. If you test at pre-shot and have a number than what you're comfortable with, please post and ask for help. We'll walk you through the options.
  • It's important to do your best to stick as close to a 12-hour shot schedule as possible. Because of how the depot works, an early shot acts like a dose increase whereas a late shot acts like a dose reduction.
  • There are two methods of dosing that we use -- Tight Regulation (TR) and Start Low Go Slow (SLGS). They are both described in the sticky note on dosing methods. Pick the one that you're most comfortable with. As long as there is not dry food in Max's diet, you are free to pick whichever method you want. If he's eating any dry food, you're limited to SLGS. You can always change the dosing method providing you meet the assumptions for the method.
I've probably forgotten something about making the switch from Prozinc to Lantus. Either I'll remember or someone else will chime in.
 
Looks like Sienne filled you in on the particulars. I’ll just add that your biggest challenge is likely to be forgetting the ways of Prozinc.
 
yes it's a new environment, in some ways a good way to practice patience -- rather than responding Right Away, you are taking into consideration what has been happening the last couple or three days, what direction are things taking ...

lots of times it's "let's see what happens next" rather than making a change immediately

little bit of new language too, some of the posters on Lantus (and I'm one of them) tend to be chatty and talk about cats as if they were living on a tropical island

there's a sticky note on the Lantus forum that explains some of the terminology -- you'll find you go back and read the stickies often, so much information to absorb
 
Sandy and Black Kitty said:
Looks like Sienne filled you in on the particulars. I’ll just add that your biggest challenge is likely to be forgetting the ways o
f Prozinc.
Click to expand...


I TOTALLY get the difference between Prozinc and Lantus . . . primarily because I take daily meds that are "extended release" . . . not the exact same thing as depot, but it has the general premise. That was the main reason I was so adamant to switch.

Just out of curiousity . . . what do you mean by "forgetting the ways of Prozinc"? Just to be clear, I was advised to give Max 2 units Lantus every 12 hours . . . same pretty much as the schedule was for Prozinc . . .??
 
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Sienne and Gabby (GA) said:
I made a switch from a different short acting insulin to Lantus. In addition, I've been hanging around here long enough that I can provide some information.

First, how your think about dosing with Lantus is totally different than other insulin. The biggest difference is in the pharmacology -- Lantus is a depot type of insulin. There's a sticky note on the depot.
  • When switching, you can use the same dose of Lantus as Prozinc. You do not need to start over.
  • When starting Lantus, it takes roughly 5 - 7 days for the depot to become established. You may not see much of a change in Max's numbers during this initial time. Once you're past the first week, you don't want to give the depot at least 3 days before increasing a dose -- the depot needs to stabilize. However, if Max's numbers drop, you can reduce the dose sooner than 3 days.
  • Lantus dosing is based on the nadir, not on the pre-shot number. Ultimately, you can work your way down to shooting low numbers but it's not recommended until you have sufficient data to know how your cat responds to Lantus.
  • Because dosing is based on the nadir, it's essential to test during the PM cycle. It looks that was not part of your routine. At the very minimum, please get a "before bed" test every single night. Without that information, you are missing half of your data and you will have no way to know if Max's numbers warranted a dose reduction during the PM cycle. Many cats visit lower numbers at night.
  • Likewise, because dosing is based on the lowest number in the cycle, you do not slide the dose based on the pre-shot number. If you test at pre-shot and have a number than what you're comfortable with, please post and ask for help. We'll walk you through the options.
  • It's important to do your best to stick as close to a 12-hour shot schedule as possible. Because of how the depot works, an early shot acts like a dose increase whereas a late shot acts like a dose reduction.
  • There are two methods of dosing that we use -- Tight Regulation (TR) and Start Low Go Slow (SLGS). They are both described in the sticky note on dosing methods. Pick the one that you're most comfortable with. As long as there is not dry food in Max's diet, you are free to pick whichever method you want. If he's eating any dry food, you're limited to SLGS. You can always change the dosing method providing you meet the assumptions for the method.
I've probably forgotten something about making the switch from Prozinc to Lantus. Either I'll remember or someone else will chime in.
Click to expand...

Little confused about the line in red . . . does that mean I should NOT give at least 3 days before increasing? Or should it be You do want to give the depot at least 3 days . . . ?

Definitely doing the SLGS. I think it would be a more accurate way to assess Max's numbers. I do want to toss in there that the vet gave me a free bag of Purina RX for diabetic cats . . . she said she it was donated and if I wanted to give it a try I could. Since it is normally $42 per bag, Max loves it o_O. Don't know that I would purchase it in the future, but the free bag was VERY kind of her to give us!

Would testing in the morning, 6 hours later, 6 hours later (dinner time), and 3 hours later work? That would be the only way I could get 4 readings in a day with my work schedule (10 am to 7 pm). I take a sleeping medication at night, so taking a reading 6 hours after PM reading isn't safe for either of us.
 
Hello and welcome from me too. I’ll start with answering last questions first. Lantus nadirs are typivally at +6, but not all cats like to be typical, and there can be variation from cycle to cycle. My girl on Lantus mostly nadired between +7 and +9, but as early as +4.5 and as late as +13. I would suggest, rather than always doing +6, get some tests in the +4 to +7 range during the day. When you get a chance, do a curve to try to pinpoint when Max likes to nadir and then you can tailor testing more to him. Lantus dosing decisions are based on how low the dose takes the cat, so catching nadirs is important.

As for night, if +3 is your before bed time, that is a good test time. Use that +3 test, and how much of a drop from PMPS that is, to determine if you need to leave higher carb food out to keep Max safe. Do you have an auto feeder? We have had several members with sleep issues. You might want to add a brief note to your signature so people don’t keep asking about later night tests.

By the way, Tight Regulation requires the four test per day, SLGS does not, though more data is not always better. And more data is the way to better assess how Max is doing on a dose, not the dosing method type. SLGS has more safety build in for those who cannot or will not test as frequently.

I think there might have been a typo in Sienne’s note, with TR you do hold the dose at least three days (six cycles). For SLGS you hold each dose 7 days. For both dosing methods, the exception to holding the dose is if they earn a reduction.

I would return the “diabetic” dry food. Thanks but no thanks to the vet. Those “prescription” dry foods are all way too high in carbs. If you want to feed dry, you are limited to using SLGS for dosing. Plus he will be much harder to regulate.

I see your vet suggested 2 units for starting Lantus. We usually take the dose of the previous insulin into consideration so that is good not to start back at the beginning. Since Max has seen green on 2 units of Prozinc, I would do the switch when you can monitor a little more closely.
 
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