Converting from Vetsulin to Lantus

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Klaree and Ollie

Klaree and Ollie

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Hi everyone!

Ollie (12 year old diabetic male, diagnosed 1 year 10 months ago) and I am new to FDMB. We were using Vetsulin and I free-fed him Hill's M/D. He got 11 units of U-40 Vetsulin BID (so about 22 units when using a U-100 syringe) with LOTS of variation in BG readings over the last year but fairly normal behavior (some lethargy here and there) and normal amounts of urination. Two weeks ago he had a dental and his pre-op blood work was: 95 Blood glucose and 322 Fructosamine (which the vet told me was 'excellent' for a diabetic). The dental (4 extractions) did not go well. In a nutshell I ended up having to admin sub-q fluids 3/day and force feed him with a syringe to keep him from losing too much weight (hepatic lipidosis fears...). After switching from Clyndimyicin (sp?) to Clavamox and using only a single dose of appetite stimulant, he started eating on his own and is now back to his normal self....except we switched him to Lantus and his BG is really high (started at >450, now reading around 250). We've been dosing with Lantus for 14 days. I was unaware that Lantus was radically different from Vetsulin and have been giving him too much....4 units BID. He is (obviously) overweight at 18 lbs and both my vets said he should weight about 14 lbs. I want to transition him to wet food (Wellness chicken, chicken/beef, turkey) as recommended by several people but really don't know how much Lantus to give him. Can I 'start over' with the calculated dose recommended from the protocol page: 1.6 units BID and start feeding wet food? If his body is now used to getting 4 units BID, will that cause trouble? Should I start over with the Lantus and THEN switch him to wet food?

Any help is greatly appreciated!

Klaree and Ollie
 
Hi there,

just wondering first, are you home testing?
Does your kitty have a history of ketones?

I'm going to cross post this to the Lantus forum to get you more Lantus eyes.

I'm assuming you have read the information stickies from that forum since you mentioned the protocol?

hang in there ok? Read as much as you can and check back for replies.
 
The switch to wet food... high protein & low carbohydrate will really help bring the BG levels down. So if you do switch it really is important to lower the dose for safety. Dry food keeps the BG's higher and the kitty needs that extra insulin.

So be careful to match food type to the amount of insulin. Most of us do start at a low dose and work up higher as needed. A lot of people use 1 unit as their initial dose, but your calculation is correct too.. ideal weight in Kg x .25 = initial starting dose. So that is a good place to begin. I'd call it 1.5 units since that's easier to measure. :-D

While Ollie is on dry food, the 4 units may have been ok... sort of.
But on wet food, that 4 units will probably be way too much.

Your fructosamine test was pretty good... 322 is about equivalent to an average BG of 178-180. Not bad at all!

Whether you start with the lower dose while switching food to wet at the same time or not depends on what you want to do. Just as long as you understand the relationship between the two. I wouldn't want you to give the 4 units after having changed to all wet food... you'd need to drop the dose first.

Dropping the dose and still giving DRY will probably result in some higher numbers.

I hope this makes a little sense. :-D
 
hi again,

glad to know you are home testing!
you've got some good info from CD & BigMac about the dose.
I'm adding the feline nutrition links for you as per Dr Lisa.

Dr Lisa's Feline Nutrition

Please read thru this one very carefully.
It is, as CD mentioned, very important to monitor numbers as you switch foods.
Transition From Dry to Wet Food


As for when to check BG levels, read through this link from the lantus forum. New To The Group If you scroll down, you'll see a chart that will help you know when to test.
Key times are pre-shots (AMPS and PMPS, and at least a couple during each cycle. Example +3 (know as "onset" when insulin starts to kick in. And "nadir" when insulin hits the lowest point)...nadir can fluctuate, so home testing is important in order for you to learn when your kitty hits their own peak.

Keep asking questions and post as much as you can. Lots of members here can guide you along.
 
Thank you all so so much for this advice, it really takes some of the stress out of this difficult process. I was thinking of this as a tentative plan:

1. Stop free-feeding now and drop the Lantus dose to 2 units BID. Schedule two 12-hour meals (roughly 90 calories per meal) of the dry food he has been getting (Hills M/D).
2. After 5 days (?) begin switching to Wellness canned - two 12-hour meals (90 calories per meal). Monitor blood-glucose.
3. After he is consistently eating the canned food (hopefully within a few days) - continue monitoring blood-glucose/adjusting insulin levels per the protocol instructions.

Can anyone see any obvious problem with this plan?

Thanks!

Klaree and Ollie
 
Generally, I like several small meals given more often instead of two larger meals. It is easier on the pancreas to have to deal with smaller amounts. Is 180 calories a day enough for Ollie?

I have a question about your Vetsulin dose... was Ollie on 11 units per shot or 11 units per day?
 
He was on 11 units BID. Was that really bad? I know that it was a lot but it was the dose that kept his numbers down. He also eats A LOT, and often, he has always loved to eat. I can do three small meals for the next several months but starting next spring I can only do every 12 hours. 180 calories was what my vet recommended but he may need more like 210 (15 calories * 14 lbs - ideal body weight). Is this what I should aim for?

Thanks!
Klaree
 
11 units is huge...but it may be he really did need it. I caution against going as low as 1 unit to start in case he really did need that much insulin. I also suggest testing him frequently and add in ketone testing using ketostix from a pharmacy.

Jen
 
Yes, with that big of a dose of Vetsulin to keep his numbers down, starting at 1 or 2 units is probably going to be too little Lantus. Especially since Ollie is still eating dry food, right?

Your calculations earlier in this thread (from the protocol page) were for figuring out an initial dose of Lantus, but it didn't take into account the previous insulin he was using. That 1.6u would have been as if this was his first dose of insulin... which not the case for Ollie. He has been using insulin for a while now and 'starting over' with THAT big of a dose difference probably isn't a good idea.

Perhaps staying with the 4 units of Lantus is better at this point... until you make the switch to wet low carbohydrate food. Then his insulin needs will probably change. We hope.

Keep testing!
 
Great news! I had pulled Ollie's dry Hills M/D earlier in the day and just before his PM shot I tried to give him some of the Wellness Chicken and he LOVED IT! I only gave him 2 units of Lantus for his PM dose, his PMPreShot BG was 300. I am not going to put the Hills back down but will be checking on him throughout the night and will likely give him a small meal +6 hours.

Feeling optimistic...thanks to everyone at FDMB!

Klaree and Ollie
 
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