Considering switch to Lantus

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Djamila

Djamila

Member Since 2015
Hi there! My cat Sam has been on Prozinc for five months as of today. This is his second round of FD and he was OTJ for a little over a year in between the first and second diagnosis.

He's really doing quite well, but he's been stuck in low numbers with between 0.2 and 0.4u. It's time to get a new vial of insulin, and since it's looking like he's planning on staying on the juice for the longer-term, I'm thinking about making the switch to just even out his numbers a bit more.

I'm wondering if some of you could look at his spreadsheet and share your thoughts on if we should make the switch, or should stick with Prozinc. And if you agree that a switch makes sense, I'd love to hear your thoughts on the dose.

Thanks in advance!
 
Hi Djamila! Since he is on such a low dose of ProZinc, I would imagine that the dose exchange would be about the same. But, that said, I am not sure and would like some of the veterans eyes on your thread. He is so close.........
 
He is close, but it feels like he's been close for-ev-er!!! I figure the second I put down the money for a new bottle of insulin he'll get un-stuck and go OTJ. But if that's what it takes, I'm willing to pay! ;)
 
Hello and Welcome to the LL forum.
:bighug::bighug::bighug:


A move to Lantus, may have the effect of flattening out the cycle, in theory, you should see nadirs at about the same range, but he will stay there for longer, the longer duration/overlap and depot from Lantus would be responsible for this. If he can stay in green for longer it's conceivable that it might give his pancreas a better chance to heal, so it may be worth trying. As he's on a small dose and well regulated, if you are going to make the swap, see if you are able to get a single pen from somewhere, it should work out more cost effective that way, should you find it doesn't fit in with you, or even better if he were to only need it for a short time (paws crossed and antijinx)

Usually when changing to lantus from prozinc a 1:1 conversion is used, so you would keep the dose the same.

If you haven't already, have a read of the stickies on TR and SLGS, Lantus works quite differently to Prozinc, the biggest difference being that we make dosing decisions based on how low the dose is taking kitty, so figuring out what his nadir is becomes important, and from what other folk who have made the change have said, it takes some getting used to.

Looking at Sam's ss one thing strikes me, and that is that there is practically no data for Sam after +5/+6, with Lantus you want to, if it's possible to grab some spot tests in the latter part of the cycle, wherever possible to build a better picture of his patterns. If that's not possible on a day to day basis, due to work etc, perhaps on days off or when you have some time grabbing those extra tests would be informative. Take a look at the TR on a fulltime job sticky, that has lots of hints.

How do you currently feed Sam? How much and when? Depending on what you are doing you may need to reconsider.

If you decide to make the swap, I would schedule if for the weekend so you are available to test/monitor closely just in case he were to have a strong reaction.

If there are any other questions keep on asking them.
 
Thanks so much for your thoughts and questions! Sam is free-fed low-carb wet food - both canned and raw. I generally keep him at or under 5% carbs. He isn't overly sensitive, but seems to feel best around that level. He doesn't eat dry food, although he wishes he still did! :p

The absence of later cycle tests is because on Prozinc he has an early nadir - usually around +3. Because he tends to be quite consistent, and doesn't tolerate testing well, I usually grab the nadir and then occasional spot checks to make sure it hasn't moved too far from the +3. If his nadir is going to be later, he usually makes it quite obvious by staying high through the +3 test. He's been thankfully easy to manage on Prozinc so far.

He'll have to be tested more to make the switch since we don't know how he'll respond to Lantus, or where he'll nadir at that point, but on Prozinc it's worked to capture the key points in the cycle and then leave him alone.

I'm thinking to make the swap in a couple of weeks once school is out. I work on a schedule similar to a teacher and will be off for a few weeks when schools get out here. That way I'll be able to monitor him more closely for a couple of weeks to see how he does and make adjustments/steer as needed. And right now I'm planning to use the TR protocol since SLGS doesn't seem like it would really work with the numbers he's getting these days.
 
Djamila, the following is taken from the Stickie New to Group and this explains the importance of test other than the nadir test. It helped me a lot.


BECOMING DATA READY:Are you data ready to handle a lower preshot number?

Everyone focuses on the +6 spot check to find the cat’s nadir, but there is a reason to collect data in the very early and very late part of the cycle. The +10s and +11s and +1s and +2s are often the “neglected spot checks,” but they can be almost as important as the nadir.

Why the +1s and +2s? Let’s say you have a lower than usual preshot. If you have collected the data to know what usually happens after you shoot and how long it usually takes for the insulin to start having an effect (onset), you may see that shooting low is actually very safe for your cat. If your cat typically rises through +1 and +2 before the insulin starts to work between +2 and +3, then you can feel comfortable knowing that your cat will actually be much higher before the insulin starts to work. If your cat typically has little to no food spike or an early onset, then you may need to be more conservative with low preshots. You are not shooting the number your cat is at now – you are shooting the number your cat will be at when the insulin kicks in. You need to know what that number will be. You are then using the lag time (aka overlap and carryover) to your advantage. It is important to note that while Levemir may typically have a later onset than Lantus, that is not true for every cat. Know thy cat.

Why the +10s and +11s? These spot checks will help keep you out of trouble. Again, let’s say that you have a lower than usual preshot. If your preshot is higher than +10 or +11, you know the insulin from that cycle is waning, the cat is on his way up, and the number is probably shootable. If you have a preshot that is much lower than your +10 or +11, knowing why will help you decide whether or not to shoot. Some Lantus and Levemir users notice a dip at the end of the cycle, meaning that the preshot is always a bit lower than +10 or +11 (but usually still higher than the nadir – the cat dips to a nadir at mid-cycle, then rises, then dips again). If this is your cat’s pattern, then this type of dip is not a reason to delay a shot. On the other hand, if your cat has a bounce clearing and is still careening downhill at shot time (usually characterized by numbers that drop for the whole cycle, without a clear nadir), then you will want to take that into consideration as you make a decision about shooting. Know thy cat.

Knowing whether your cat is one that dips at the end of the cycle can also help you with dose increases. If your nadirs are not that great and you are considering an increase, but then he dips again at the end of the cycle, you might be tempted to delay the increase. If you know that this is a usual pattern for your cat, you will know that you can ignore that dip and go ahead with the increase.

Do not forget the “neglected spot checks.” They are more useful than most realize.

Know thy cat. Be data ready to handle the situation.


ETA: here is the link and it was under "Where do I find"
http://www.felinediabetes.com/FDMB/...regulation-shooting-handling-low-numbers.147/
 
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