? Changing insulin?

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Brashworks

Brashworks

Member Since 2015
My girl Genghis was Dx nearly a month ago. She was put on Caninsulin and has had one dose adjustment (from 2.0u to 1.0u after a low number).

She has had a few curves done at home and she always tests nicely. Not too steep a drop and not too high a rise over 12 hours. But other days, her nadir has been <5.6 (68 - 98 at +3 and sometimes +4 or even +6) and her AM and PMPS numbers suggest that the duration is well under 12 hours.

She had been on a mix of dry and wet food pre-Dx and she is now exclusively on FF low carb varieties. She eats pre-shot by about a half hour, then again at her shot. Pet sitter feeds her again about +3 or 4.

Based on her nadir number not supporting a dose increase and the fact that I can't dose every 8 hours or be here to feed her mini meals through the day, or increase dose in conjunction with increased meals at around nadir (if only I could see consistency in the peak time!), I am pondering changing to a longer acting insulin.

Suggestions? Is it too soon after only a month? Is there anything special I need to do before switching her to something longer acting like Lantus?

Thanks for any thoughts.
 
If you're not getting the duration you need, a different insulin may do better.
BCP PZI, ProZinc, and Levemir are 2 other alternatives, in addition to Lantus.
 
Thanks @BJM. I've read the Lantus/Levemir SLGS protocol again and considered the dosage guidance there. I have two Lantus pens in my fridge as we speak - any special consideration for changing insulin type beyond figuring the starting dose and changing syringes to 100u?
 
For a starting dose, compare to the result of the following steps with your current dose:
How much does your cat weigh?
How much should your cat weigh?
Take the lower number.
Convert it to kilos if in pounds (pounds / 2.2)
Multiply by 0.25
Round down to the nearest multiple of 0.25.

What are the 2 numbers - current dose vs Lantus starting dose calculation?
Something about 3/4 of the higher number may work to start.
 
@BJM thank you!

I've been poring over feeding strategies and trying to figure out her ideal weight, how often to feed, thoughts on managing lowish nadirs with food. Trying to digest all the info (no pun).

I'm going to discuss Caninsulin's duration issues with my vet next week when I am on holidays and am home to monitor her if/when I make the switch to Lantus. I don't think he is opposed to Lantus - the Caninsulin is certainly more affordable (not the whole issue but he also knows I am spending nearly the equivalent of my mortgage payment to treat my one dog who has heart disease).

Thanks again for your reply.
 
Another way to gauge weight - can you feel the spine bumps and hip bones very clearly with little muscle? Likely underweight. The Lantus dose is based on lean weight, so if underweight, that is the one to use.
 
You might consider a sliding scale with the Caninsulin/Vetsulin, too.
This is where you group the starting glucose levels by 50s or hundreds over the last week or two, then look at how much drop you got with the insulin dose(s) in each range based on nadir period tests. Based on that info, you then add a slight increase for the higher pre-shots that haven't dropped enough by nadir, and reduce slightly for lower pre-shots that dropped enough to make you nervous.
Ex 1 unit in the 250-350 mg/dL range looks pretty good. you might go up to 1.25 when over 350 mg/dL.
 
Thanks for that weight assessment - I don't have a baby scale but from what you have said she is clearly underweight.

I had never considered a sliding scale with Caninsulin - very interesting. It's making me look at her SS in a very different light - less focus on colours and more on what her numbers are like on 1.0u taking the PS reading into consideration. If I had a lightbulb over my head, it would be shining brightly about now!!

I'm doing a curve today and if she is, say, above 350 at her PS over the weekend, I'll give it a try for a few cycles, especially since I will be here to monitor her. Going back to work with those 12 hour gaps in information during the day do indeed make me nervous!

Thank you so much for this.
 
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