Blackie is Coming to LL - Dosing Questions

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Ele & Blackie (GA)

Ele & Blackie (GA)

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We are ready to move Blackie from PZI to Lantus and I’m hoping that you can give us some help to begin this new journey.

Blackie is almost 17 years old and has been on Idexx PZI for almost 5 years. We changed his food to low carb canned in March of last year – the same time we began home testing. His insulin needs quickly decreased and we had him regulated at .4 to .6 units BID. Then he began having UTI’s. At first his numbers would go back down after the abs, but the last couple of times, his bg’s never returned to their lower numbers and he is now at 3.0 to 3.4 units BID. Other health issues are arthritis and early renal insufficiency. We have regular blood work done (results in the link below) and his teeth are good. He even had an ultrasound of kidneys and bladder and they found no abnormalities. His U/A’s usually show blood and bacteria, but the cultures have all come back with no growth.

I would like to get feedback on what dose we should start with. Also, would it be better to switch this weekend or wait until Monday? We currently test before every shot and generally at least one spot check every day and night. My DH, Robert, works from home and is usually, but not always, available to test whenever we need it.

I’ve read all of the sticky’s and will read them again before the change. I know that we’re going to have some new things to learn and old habits to kick. Thank you for all of your help.
 
Re: Blackie is Coming to LL

Welcome to Lantus Land, Ele and Blackie!! I am sure that you will be very happy with Lantus results.

The usual starting dose is 1u and then the dose is adjusted up or down after a few days according. If it was me, I would start Lantus as soon as possible...tonight, tomorrow...I see no need to wait!

There are lots of folks in LL that have the right amount of experience to help you, Blackie, and DH with this new adventure! Good luck and am looking forward to seeing your condo's in LL!
 
Re: Blackie is Coming to LL

Hi welcome to LL.

While the typical starting dose is 1 unit, given where you are with PZI, I would suggest waiting for someone who knows about more to determine if you should start at 1 unit or even .5.

Also, you are very right that you need to forget what you know about PZI. You need to learn how lantus works and how it does not work like PZI. The two do not correlate and instead pretend you are a newbie starting out. :-D

Read the starred information at the top to help familiarize yourself with how lantus works.

And it's all good, honest!
 
Re: Blackie is Coming to LL

Welcome to LL, Ele!

When you switch to Lantus from another insulin, we give consideration to the dose and response on the other insulin to choose a starting dose. Since Blackie is now on 3 units of PZI and getting some good numbers, I don't think we want to back all the way down to 1 unit. Let me ask you this, in general do you like to be fairly aggressive with dosing, or more laid back? It sounds like you can test when needed, I'm thinking that anywhere between 2 and 3 units would be appropriate, depending on your comfort level. Lantus is *usually* less potent than PZI, but of course ECID.
 
Re: Blackie is Coming to LL

Welcome to Lantus Land (LL).

We've had quite a few former PZI users switch to Lantus. I'm not among them but I have no doubt that others will stop by to welcome you and share experiences. Just a 'heads up.' You will need to forget everything you've learned and mastered about insulin once you make the switch to Lantus. The logic behind dosing is entirely different since Lantus is a long acting insulin. If you've been reading the stickys or any of our condos, you've probably seen that Lantus dosing is based on the nadir, not on pre-shot values. Your SS makes it very clear that you're used to getting mid-cycle spot checks in which will make the transition much easier. What you will also need to get used to though, is there is no dose sliding -- you shoot the same amount at AMPS and PMPS. Lantus likes consistency.

Whenever you decide to start is fine. It will take roughly 5 days to build a shed and for the full Lantus dose to be available to act on BG levels. This initial period is going to try your patience. Resist the temptation to tinker with the starting dose since it won't be surprising if numbers run high initially.

As far as dose, there are two considerations. First, do you know Blackie's ideal weight? Starting dose can be based on weight (dose = 0.25 x ideal weight in kg). Unless Blackie is huge, this usually works out somewhere in the neighborhood of 1.0u. However, the dosing protocol also stipulates that if a cat is being switched from another insulin, the existing dose can be taken into account. My guess is that we'd look to start on a number somewhere between your current 3.0u dose and a dose based on ideal weight. In fact, here's the information from the Tight Regulation Protocol:
In many cases, the starting dose of Lantus or Levemir has been 0.25 IU per kg of the cat's ideal weight and is always dosed BID (two times a day, 12 hours apart). If the cat received another kind of insulin previously, the starting dose should be raised or lowered by taking this information into account. When selecting a starting dose, it is important to know that while Lantus and Levemir have a longer duration than other insulins, they also have a lower potency in most cats.
Click to expand...

Please stop by and visit our condos and read our SS -- we're very social. But, more importantly, keep asking questions.
 
Re: Blackie is Coming to LL

Thank you for all the feedback so soon! To answer some of your questions.

Libby:
Let me ask you this, in general do you like to be fairly aggressive with dosing, or more laid back? It sounds like you can test when needed, I'm thinking that anywhere between 2 and 3 units would be appropriate, depending on your comfort level.
Click to expand...
We used to be very aggressive with dosing, but I got more fearful as the doses increased. I am very willing to be aggressive.

Sienne:
First, do you know Blackie's ideal weight? Starting dose can be based on weight (dose = 0.25 x ideal weight in kg).
Click to expand...
Blackie is about 13 lbs now and has ranged between 12 and 13 lbs for the last 4 years. I did the calculation and I came up with 1.5 units.

Nina:
How is Blackie's arthritis?
Click to expand...
Blackie still has an arched back and walks with his elbows out, but he still jumps on the furniture, goes for walks outside and doesn't seem to be in pain. We give him Dasuquin, Adequan injections and Gabapentin for the arthritis. I think the Gabapentin does the most good.

On the dosing, I would rather be aggressive and keep his numbers down. He has never had ketones, but when his numbers get high (over 400) he tends to get UTI's.
 
Re: Blackie is Coming to LL

I just talked to our vet and now I have more questions for all of you. I don't know how much experience my vet has with Lantus, but he was the only vet in our community I could find that would prescribe Lantus. He wants to start Blackie at 1 unit. I was really hoping to start him as something higher. Vet also said that with the Lantus pen (I have the solostar pens) I need to keep it at room temperature. Is that true?

Thanks for all your help.
Ele & Blackie
 

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Hi Ele! :) Welcome to LL! You've already gotten a good welcome and advice from people here and I can't offer dosing advice, so I will just comment on your last question regarding the storage. The insert (and customer service) will tell you to store the insulin at room temperature. I believe that many folks here keep theirs all in the fridge (as do I) because you can get longer shelf life out of it. I think there are some links to support this, possibly to Monique's posting on TT on the old board. I'm getting ready to run out the door to the vet (woohoo) but I will look later if no one else has chimed in.

You will probably experience some frustration during the switch, as we have talked about before, but I think you will be happy with the results. Don't be afraid to ask questions; everyone here is so knowledgeable and helpful. :)
 
Hi Ele and Blackie! Welcome to Lantus Land!
Stu is a former Idexx PZI vet user. He was diagnosed with FD in January 2006 and put on PZI Vet. We switched to Lantus last November, when it became impossible to get PZI Vet. When we were on PZI Vet we did not home test for blood glucose and the only tests we got were occasionally at the vet's. NOT A GOOD Thing, since we had no idea of anything! Stu was getting 5 units bid of PZI vet at the time he was switched to Lantus. The vet (we had moved in the meantime so this was a different vet) started him on 4 units of Lantus bid. On PZI vet I don't think Stu ever really responded to the insulin. He always drank lots of water and peed a lot. Fortunately he had no other health issues. Anyway, on the 4 units of Lantus I didn't see any change in Stu's water consumption, etc. Two weeks into Lantus he had another bg test at the vet's and his mid-day (nadir) number was so high that the vet bumped him up to 5 units. Two weeks after that, his bg levels were even higher, so he got bumped up to 7 units bid. Two weeks later, his number (same time of day) was 79!!!! I had noticed all during this period that he was drinking even more water and peeing even more. I got really alarmed at the very low number when the previous numbers had been so high, so I dropped Stu's dose back to 5 units, then to 4 units, started doing research on the Internet and found the FDMB. I began home testing Stu's bg. If it were not for the great advice and the compassionate help given by the wonderful people here, I fear that Stu may not have made it much further! I think he was caught just in time. His body was frantically trying to get rid of the high dose of insulin and the 79 bg number was a genuine crash.
To make a long story short. I was convinced by the people here not to try to regulate Stu by gradually reducing his dose, but by starting over at a low dose and following the Tilly Protocol with regard to raising the dose. We began the protocol on 28 January at 1.5 units of Lantus bid. Stu is doing fantastically well (see his spreadsheet) and getting better every day (with a few bounces back to higher numbers, but the trend is to lower numbers and a healthy body).
Here are some things to keep in mind in the switch from PZI vet: 1) Lantus needs to be given every 12 hours because of the "shed" (see the "sticky" on the shed). You don't have that 2-hour-in-either-direction leeway that you had with PZI vet; you have to plan ahead and when you need to break your schedule you should only change the dose time by 1/2 hour a day (all at once, or 15 minutes in the A.M. and 15 minutes in the P.M). If you shoot much earlier or later than that, you have to adjust the time of the next dose and then gradually get back to your normal schedule. 2) Lantus dosing is based on the nadir (usually around 6 hours after the shot), but we have to get before-shot bg readings to make sure that it is safe to shoot. All of this is explained in the protocol, but it is good to hear it repeated! The dose is changed very gradually when it is being raised: only by .25 or .5 of a unit and the new dose is held for a specified time (see the protocol). The reason for this is so that you do not miss your cat's ideal dose by jumping past it. 3) The manufacturer says that the vial or cartridge should be discarded after 28 days. Some people find that this is important for the way their cats react to Lantus, others feel they can easily use a cartridge or vial much longer (as long as you don't see snowflakes in it, or as long as it still is seeming to work "normally"). In any event, keep your pen/cartridge in the 'frige before you open it and after it is opened. The manufacturer's recommendation not to refrigerate is for humans, who typically shoot large amounts of insulin and don't like it to feel cold in their system.
I can't think of anything else at the moment. I didn't plan to write a treatise! I am basically a newbie here, so I can't answer your dosing questions. Experienced people will be along to help you with that. I have tried to follow everything that the experienced people here tell me to do. When I have questions or problems, I ask for help! When I finally went back to the vet who had prescribed 7 units and told him that I had started to home test, was following the Tilly Protocol, and that I had learned so much from the FDMB, he was very supportive and very interested in the protocol.

Welcome to Blackie and to you.

Ella & Stu
 
Thank you Ella for all of that information. We already try to stick to a 12/12 schedule. The only time we haven't is when Blackie has gone too low to shoot, but I understand that it will be different with Lantus. Also, thanks for the clarification on the refrigreration. I thought that was what I read, but wasn't sure.

I have to admit, I'm afraid of going all the way back to 1 unit, but if we can increase after 3 days if Blackie stays high, it makes me feel a little better. Now I think we'll just make the switch tonight. There would be no advantage to waiting until tomorrow.

Thank you for all the input.
 
I still don't think going down to 1 unit is necessary, but do whatever makes you feel better. Lantus is usually less potent than PZI and most cats end up needing a higher dose of Lantus.

I agree that there is no reason to wait, I would go ahead and start.
 
I was very careful to not roll the pen and I didn't put any air in the pen. But the small dose - I almost put the insulin back in the syringe that was over the 1 unit. But DH was watching me and said "Don't!" and I caught it.

I shot 1 unit from the U-100 syringes. Is that correct? I'm used to using the conversion chart for U-40 insulin and shooting 8 units in the U-100 syringes. The 1 unit felt like nothing. I'm nervous. Sorry.
 
Hi Ele and Blackie!
Welcome to Lantus land!

You've already been pointed to the stickies, briefed on food and dose.... I will offer the same as others.... a broom (or swiffer) to clean away all the PZI remnants from your brain. The cat will be fine... you on the other hand... will be tough one! I mean that in a friendly way of course.

Vets are not typically very knowledgeable on Lantus, but there is >50 SS for you to learn from ... everyday! :-D

Welcome and don't be afraid to ask lots of questions.

No pushing back in to the cartridge (gold star for DH) and only U-100 syringes.
 
Hi again Ele,
A tip I learned here on the FDMB recently. If you get an air bubble or draw more insulin into the syringe than you should, draw in some more (i.e., go up to 4 or 5 units). Then hold the syringe over a paper towel and gently TWIST the plunger until you get back to the correct dose. When you buy U-100 syringes, get the ones labeled "3/10 cc for 30 units or less". They have bigger spaces between the unit markings. Some U-100 syringes come with 1/2-unit markings. I have had good luck with the "Monoject Ultrafine Insulin Syringe, 30 gauge, 3/10cc with the 5/16 needle and 1/2 unit markings" You can buy them at Hocks.com (see the ad at the head of the FDMB page) for $17.49 for a box of 100. Good luck!
Ella
 
Helene, So glad to hear from you. I'm so glad Tizon went OTJ. And I do remember you from PZI Land. I've only seen a few former PZI'ers here, but you're right about the clean sweep of the brain. Thank you for the broom idea. I have to pretend I'm a newbie and I am a newbie to Lantus. You give me hope. Thank you for checking in.

Ella, Thanks again. That's what I ended up doing with the excess insulin. It just seemed like such a small amount I went to my old habits. I won't do that again.
 
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