Farine's case : switching from Caninsulin to Lantus

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kimouette

kimouette

Member Since 2012
Hi everyone!

I recently posted a new thread in the main forum to introduce my friend Alain and his sugar kitty named Farine.

Here's the post :http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=97821
One week ago a man named Alain called me because he had questions about his sugar kitty called Farine (which means “flour” in French). She is 15 years old and weights a little less than 12 pounds.
Over a year ago she was diagnosed with diabetes and after couple of weeks on Caninsulin she went off the juice. Unfortunately couple of days after, she was diabetic again… That was 10 months ago.

So for 10 months now, Alain has been giving her 3u of Caninsulin twice daily (unfortunately without testing) and feeding her a mix of Friskies canned food and dry kibbles.

He saw a video I posted on Youtube explaining how to test a cat with a glucometer, so he got himself a glucometer and started to test Farine as often as he could.

Here is Farine’s spreadsheet : https://docs.google.com/spreadsheet/ccc ... hZ1E#gid=0

As soon as he contacted me I told him that low carb canned food was the first change he had to make. I also helped him to choose an “ok” brand. So tomorrow (Tuesday) he will start to feed Farine ONLY “Fancy Feast Ocean white fish and Tuna Classic”, no more kibbles. He might change to Evo 95% chicken and turkey in two weeks, but he will first start with the FF flavor I just mentioned. During this diet transition he is prepared to change the insulin dosage.
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He is currenly buying some Lantus and new u-100 0.3ml syringes at Costco.
If you look at Farines spreadsheet, you will notice that the she went from 3u to less than 1.5u during the last couple of days. She is not well regulated with Caninsulin (which is why he is switching to Lantus), but it seems like there's something kinda regular in terms of AMPS values and PMPS values (always elevated in the morning, relatively low in the evening).

The last scale he has been using is right here :
8.3-9.0...........0.25u
9.1-9-4...........0.50u
9.5-10.2..........0.65u
10.3-11.1.........0.75u
11.2-12.2.........1.00u
12.3-13.8.........1.15u
13.9-15.8.........1.25u
15.9-17.9.........1.35u
18.0-19.9.........1.50u
20.0 and more....1.65u

With this scale he gets almost perfect nadir, but still quite high values at +12 in the morning

Any advice about the starting dosage for Lantus (probably tonight or tomorrow), would be greatly appreciated!

Thanks a lot!
Kim
:)
 
Hi, Kim! Will Alain be posting here once he starts using Lantus? Is he in Switzerland, as well?

Frankly, I would lean toward starting Farine a bit under dose. Based on Farine's weight, current dose of Caninsulin, and factoring in that some cats have a marked response to insulin, I would start at no more than 1.0u.

Please make sure he understands that Lantus is very different than Caninsulin. You do not use a sliding dose scale. It will be helpful if he reads the starred, sticky notes at the top of the Board -- especially the note regarding the Tight Regulation Protocol.
 
Hi there,
I am Alain the Farine "father" :)
I start lantus tomorrow and with the help of Kim we decided to start with .5u.
She is 11 pounds and her best wheith would be 10 pounds. So I should begin with 1.0u but as we absolutly want no to have Hypo we are very careful. After 3 days we will see what to change if needed.
I have read most of documents here but as I speak just a little english many things are a little confused. SO this is why I count a lot on Kim and all of you to help.
Lets cross our fingers...
BTW a big difficulty is to shoot exactly 0,5u... this is so thight... (1u is about 1.5mm)
 
Welcome, Alain -- and Farine!

Starting at 0.5u is fine. It is a very safe dose. Unless Farine has a history of ketones, I think it's fine to start at a lower dose.

I don't know what kind of syringes are available in all parts of Europe. I know BD syringes are available in Germany and that you can get syringes that are in 0.5u increments. Having syringes that have 0.5u marks will help you with consistent dosing.

Do you read German? If so, there is a counterpart to this site located in Germany and there is documentation there.
 
Bonsoir Alain! If you are in Quebec, you should be able to get the BD Ultra-Fine 11 syringes (courte), purple and yellow box. They are marked 3/10 mL/cc pour 30 unites or moins, 8mm longueur de l'aiguille, 31G calibre de l'aiguille.

I use digital calipers for the BD syringes and find 1.0unit is about 1.6mm, but it depends where the zero line is. 1.5 is close enough.

My Neko also started on Caninsulin and switched to Lantus. Your English is much better than my French.
 
Hi Sienne,
No I do not speack german... thank you for your post. Yous cats are real beauties...

Wendy,
What I found and bought is BD Ultra-Fine u-100 3/10cc for 30 units or less 12,7mm lenght needle 29 gauge.
I did not use caliper to measure it... (just my draftman eyes... :) but it is very close to your measurement.
Anyway .5u is very difficult to be always identical. But i'll do my best!
 
Could someone look at Farine's results today (first day on Lantus), and tell us how she could go from AMPS 270 to 275 at +4, and then 301 at +6?

https://docs.google.com/spreadsheet/ccc ... hZ1E#gid=0

She ate her normal food (Evo chicken/turkey) and doesn't seem to show any weird symptom... But still her BG levels seem to be going up and down...

Thanks for your help!

Kim (and Alain and Farine)
 
It takes time to fill the insulin depot. The first shot you gave today, only part of it went to use right away. The other part of the insulin went into the depot for later use, and will be slowly released into the bloodstream.

After you inject it into your subcutaneous tissue, the acidic solution is neutralized by your body to a neutral pH. Because glargine is not soluble at a neutral pH, it precipitates out into a form that's not soluble in subcutaneous fat, and there forms a relatively insoluble depot. From that pool, or depot, of precipitated glargine in the tissues, small amounts slowly move back into solution over time and then to the bloodstream.
Click to expand...

The numbers you got today are all within about the same range. They are tightly clustered, within 30 points of each other.

You need to give the depot time to fill.

•Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
Click to expand...
 
It's going to take at least several days for Farine to show much movement in BG numbers. Lantus is a depot-type insulin. A small amount of each shot goes to establish the depot. In addition, unlike Caninsulin, Lantus is not as potent. In other words, it doesn't pull numbers down the way a shorter acting insulin like Caninsulin does. However, what you lose in potency, you gain in duration and in a much gentler action. I think the hardest thing for people who are switching from another insulin to appreciate is that using Lantus requires patience.
 
Thank you Deb & wink,
I do not catch everything but I know Kim will. So she will explaine to me (in french :)
Just for you to know the +6 is 301, the +8 is 310 and the +10 is 302... (it finally began to go down) I hope it will stay down direction... if you understand!
Thank you
 
I understood everything sienne & Gabby...
Thank you,
Lets be patien
PS: what a beautifull Wink's spreadsheet Web & wink. I want it for Farine!
 
Actually during first cycle none of the Lantus kicked in. I guess it all went into the depot.
During second cycle, we finally see the BG levels decrease at +3.
Maybe we should have waited for the second cycle to do a curve, cuz that first one is completely useless.
I have to admit that I was afraid of a "high-flat" rebound!!
I'm just glad it's finally working!

Nice job Alain!
:)
 
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