putus_human
Member Since 2020
We want to start Lantus tomorrow and are torn on a starting dose. We've been on 1.75 units of Vetsulin.
I've done a bit of sleuthing of past posts and found the most common advice is to give the same starting dose or just slightly below the current dose when switching. There is a less common opinion that starting low again is a safe bet because some cats can react strongly (e.g. drop lower) with an insulin change.
I pulled together 6 case studies of old spreadsheets. 2 seem to support the "hold steady or take a bit off the dose", 3 seem to support that starting low would have been better, and 1 is inconclusive.
Curious what you all think about this, if you have other case studies to share, or if you care to weigh in on my own dosing strategy?
I was leaning toward a 1.5 starting dose (original post for continuity: https://www.felinediabetes.com/FDMB...with-a-complicated-kitty.238695/#post-2681495) based on how frequently I see people recommend the "hold steady or a bit below" dose, but after reviewing the evidence I'm leaning toward a 75% dose, so 1.25 units. I guess the strongest counter-argument here is that Putu is still pretty high and may due for an increase to 2 units anyway, which would put her "switching dose" right back at 1.5 units.
Also, huge thanks to everyone who made their spreadsheets available. It was like consulting a few experienced "friends." Of course, I'm just looking at numbers out of context, so if I misinterpreted anything please chime in to correct me.
Case Study 1: Lou
I've done a bit of sleuthing of past posts and found the most common advice is to give the same starting dose or just slightly below the current dose when switching. There is a less common opinion that starting low again is a safe bet because some cats can react strongly (e.g. drop lower) with an insulin change.
I pulled together 6 case studies of old spreadsheets. 2 seem to support the "hold steady or take a bit off the dose", 3 seem to support that starting low would have been better, and 1 is inconclusive.
Curious what you all think about this, if you have other case studies to share, or if you care to weigh in on my own dosing strategy?
I was leaning toward a 1.5 starting dose (original post for continuity: https://www.felinediabetes.com/FDMB...with-a-complicated-kitty.238695/#post-2681495) based on how frequently I see people recommend the "hold steady or a bit below" dose, but after reviewing the evidence I'm leaning toward a 75% dose, so 1.25 units. I guess the strongest counter-argument here is that Putu is still pretty high and may due for an increase to 2 units anyway, which would put her "switching dose" right back at 1.5 units.
Also, huge thanks to everyone who made their spreadsheets available. It was like consulting a few experienced "friends." Of course, I'm just looking at numbers out of context, so if I misinterpreted anything please chime in to correct me.
Case Study 1: Lou
- Spreadsheet
- Switch date: 5/28/2018
- Vetsulin dose: 3.75
- Lantus dose: 3.5
- Result: Held 3.5 dose for a while and numbers stayed the same. A couple of weeks later went back up to 3.75 and got greens.
- Conclusion: The "hold steady or a bit below" strategy probably gave the correct dose (gave ~90% of previous dose).
- Spreadsheet
- Switch date: 5/03/2020
- Vetsulin dose: 4.4
- Basaglar dose: 4
- Result: Hypo the next day. Hospitalization, seizure, and passed on a few days later.
- Conclusion: The "hold steady or a bit below" strategy did not work in this case, but this cat was very ill (gave ~90% of previous dose).
- Spreadsheet
- Switch date: 9/19/2020
- Vetsulin dose: 1.5
- Lantus dose: 1.5
- Result: Increased to 1.75 after 4 days, then 2 after 3 days. Stayed at 2 for a while hitting greens.
- Conclusions: This cat actually seemed due for a dose increase anyway, so the "hold steady" strategy seemed to work for the transition (gave ~100% of previous dose).
- Spreadsheet
- Switch date: 1/16/2016
- Vetsulin dose: 2-4
- Lantus dose: 1
- Result: Blue mid-cycle numbers immediately
- Conclusion: Not enough dosing and glucose measurements on Vetsulin to draw a conclusion here, but it's possible this cat was due for a dose decrease anyway.
- Spreadsheet
- Switch date: 7/27/2019
- Vetsulin dose: 3
- Lantus dose: 2.5
- Result: Got a blue pre-shoot the next day and had to skip a dose. Got a blue pre-shot the 2nd day and delayed then gave 2 units. Gave 2.5 units the 3rd and went hypo. Finally reduced to 2.25 and remained at that dose with green mid-cycle. Continued to get lower numbers and lower doses until remission 2.5 months later.
- Conclusion: 2.25 was probably a better starting dose (so ~75% of the Vetsulin dose)
- Spreadsheet
- Switch date: 9/9/13
- Vetsulin dose: 1.25F
- Levemir dose: 1S
- Result: Was getting blue numbers before switch and immediately saw blue numbers after switch (including a pre-shot).
- Conclusion: Shaving a bit off the dose seemed like a good strategy. I'm estimating this was ~75% of the previous dose (not sure how big F/S modifier was).
What you quoted was the Lantus to Levemir switch. When she went from Caninsulin (seeing blues) to Lantus, she went from 5 units to 1 unit. She ended up needing 8.75 units of Lantus. I wasted a lot of months. She had a couple secondary endocrine conditions making her more complicated. A straight comparison of numbers/doses may not work without details of the cat. ECID.