Exploring Lantus w/ Vets Help

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snorton

snorton

Member Since 2012
Hello All -

I'm new to this Board, but not new to FDMB. Was in PZI land for a while. My kitty Jean Luc is having a horrible time getting regulated on PZI. Vet and are planning to convert to Lantus.

What suggestions do you all have? This will be my vet's first Lantus kitty. She is a new grad and has been reviewing all the new info Lantus and feels it is the best way to go for my little guy. I will be doing the curve at home.

First question - pens or vials? I know we have to use U100s with either. Little guy is 11.5 - 12lb. Does anyone have any dosing suggestions? Vet suggested starting with 1U.

As a new comer to Lantus, what should I know and what should I not do? Any and all feedback is welcome.

Thank you.
 
Welcome to Lantus Land, Shannan & Jean Luc!

You'll get plenty of answers and help here. There are a bagillion stickies you can read. Don't let it overwhelm you, it can be a bit daunting at first.
 
Welcome. :) I'm pretty new here myself( less than a month here in Lantus Land), but it was cheaper in the long-run to buy the pens for me. Other than that, the stickies helped me a lot. I'm sure some others who know more than I do will come along and help as well.
 
The pens are the most economical way to go.

One big "DON'T" if you are switching from Prozinc.... Lantus should not be shaken or rolled like you would do with Prozinc or PZI. It doesn't need to be mixed. It comes clear, and it should always look that way. Most people store it in the fridge someplace other than on the door. Make sure and read the Sticky thread on "proper handling" on the index page.

Carl
 
Welcome! We just entered Lantus land 3 weeks ago and Jasper is already doing much better, really glad we switched from Humulin.
We got the Lantus pens based on the input here. Our pharmacy would not give us a single pen we had to buy the box of 5 pens which was $$$. The single vial is less expensive up front than 5 pens, but with cat size doses probably end up discarding a lot of the vial. The pens seem more economical in the long run. We keep all the pens in the fridge to help the Lantus last as long as possible. You may want to put the date and cats name in your original subject like other posts in this forum, I think some of the experienced folks may use the date to sort the list.
 
Oh, and the folks here will need to know what your current dose of Prozinc is, so they can help you determine what a good starting dose will be on Lantus.

Carl
 
Shannon

A warm Lantus Land welcome to you and Jean Luc. When a kitty has been on another insulin and is switching to lantus, we generally recommend your lantus starting dose be 70% of current insulin dose. Jean Lucs current dose on PZI is 1.75u and so a conservative lantus starting dose would be 1.25u (1.75 x .7 = 1.225). One thing I noticed is that he really responded to a higher dose of PZI ( 2.25u) and so, while you may start at 1.25u, you may have to systematically move up the dosing scale in the small increments we increase by on the Tight Regulation and Start Low Go Slow protocols to see some progress. There is no problem starting wt 1u if that is your and your vet's preference and if he doesn't respond quickly, we can fast track him up the scale a little. Sometimes the first few cycles can see numbers dropping but we will help you if that occurs. Typically, the dose stabilizes after that.

It's important to note that one of the big differences between PZI and lantus is consistency in dose and shooting times. So it's best to have a dose that you can safely shoot twice a day because we adjust doses based on the nadir with only small consideration given to the Preshot. That means if you get a preshot of 400, you aren't going to change his dose based on that number. Lantus does best when you can shoot every 12 hours (when your PS number is safe to do so) so you need to give some thought to what shooting schedule works best for you.

If you work, it's good to set a shot time that allows you to get a +2 before you leave as that number can tell you a lot about what kind of cycle Jean Luc will have that day. We also suggest an in the door test if you work and also a before bed test...and of course, always the PS tests.

Another big difference between PZI and lantus is that lantus is a depot insulin. When you give PZI, it goes in, does its thing, and then is gone from the system. But lantus has a cumulative nature where one shot builds upon the one before and so what you shoot in one cycle affects the subsequent cycle....and often several subsequent cycles. We can teach you more about the depot as we go.

I'd like to suggest you start by reading all of the stickys at the top of this forum. They have a lot of great info regarding the protocols, how to handle lantus, info regarding the insulin depot, etc. Ask questions...we are here to help :-D
 
Thanks all for the thoughts. He is currently on 1.75u ProZinc 2x per day.
He isn't regulated on this dose. Any idea on starting dose for lantus!
 
Welcome to Lantus Land!!

There are two considerations with respect to your starting dose. The first is your current dose of PZI. Marje explained that in some detail. The other is your cat's weight. If approx. 12 lbs is an ideal weight for Jean Luc, then the initial dose would be 1.35u (initial dose = 0.25 x ideal weight in kilograms). Since we like to factor if a safe margin given that some cats have a marked response to a new insulin, the 1.25u dose that Marje calculated is a fine place to start.

If your vet hasn't come across the article I'm attaching, it's a good resource that describes the dosing protocol we use here. It is the research study that supports the Tight Regulation Protocol.


Just to summarize the points that people have made and that are important for this protocol:
  • Do not shake, roll or let Jean Luc use your Lantus as a hockey puck.
  • The pens are more economical than a vial. You may be able to find places that sell a single pen but most often, you need to buy a box of 5 pens.
  • You do not change the dose of Lantus based on the pre-shot value. Doses are changed based on the nadir.
  • Lantus likes consistency both in terms of shooting as close to every 12 hours as possible and in terms of dose. Doses are allowed to settle, usually for 3 days. The initial dose is allowed to settle for 5 days in order for the insulin depot to form.
  • Lantus onset is usually around 2 hours after your shot. Thus, you don't need to feed prior to shooting. Most of us test, feed, and shoot within a 5 - 10 min. time span.
  • Do not feed 2 hours prior to shot time. You don't want your pre-shot number influenced by food.
  • The assumption is you're feeding a low carb, canned diet.
  • You'll want to get tests at +3, +6, and +9 on several occasions during the first several days.
Please let us know if you have questions or how we can help. The people here are incredibly generous with their time and information.
 

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Jean Luc Exploring Lantus w/ Vets Help

If all works with my proposed plan, I hope to pick up the Lantus tonight or tomorrow at latest and start on Thursday evening. I will be asking for the pens. I will be around Friday to watch and test him. Nervous, but hopeful this will bring the BG down into acceptable levels.
 
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