Help interpret BG values and dose, Caninsulin

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Helena and Gandalf

Helena and Gandalf

Member Since 2016
Hi! (Long post with a lot of questions!:rolleyes:)
I'm new to FDMB, found it the day before yesterday and have been reading threads almost non-stop since then. :coffee::bookworm:
My wonderful, beutiful grey fluffball Gandalf :cat: got his diagnosis in Jan this year (we recently passed the 6 month mark!). We started out on Lantus Solostar prefilled pens and after about 5 months we realised that 2 units 2x daily was too much, he bounced a lot, so we went down to 1 unit 2x daily. We assesed the situation after about 1,5 weeks when we figured he would have settled on the new dose. We tested a lot the following week (maybe I should have mentioned, we hometest!:)) and it turned out he were at about 16-17 PS and had nadirs around 10-11. So, very stable values but too high. We went to our vet 2 weeks later and we decided to switch to Caninsulin instead. After all I have read here about Caninsulin this now feels like a bad move... After looking it up, I see that Lantus is also available in vials, so maybe that would have been a better switch?

Anyways, now he is on Caninsulin and we are gonna give it a go! I would love to get some help with iterpreting Gandalf's BG values. We have only been on Caninsulin for a few weeks so there is not a lot of data yet. We are also just finishing our first real curve on Caninsulin, and I will be updating the SS as we go.
The first two weeks on Caninsulin were crazy, as you will see in the SS, and all is explained under Remarks, so we are only confident in the values from the last 4-5 days. When, would you say, is he hitting his lowest values? What do you say about the dose? Is 1,5 U BID still too much? Should we even go down to 1 unit and then increase again if necessary? After the relatively flat curve today I am starting to feel that maybe he could work on Caninsulin? But because of his low number (9,1) PMPS yesterday and the 1U shot, this might just be a coinicidence. Could the high number this morning have been a bounce due to the 1U he got even though his reading was low? (I just learned fom here this morning that the recommended no-shoot value for newbies on Caninsulin is around 11. Oops! :nailbiting: But all went well!)

Also, so far we have been testing first and then giving him his shot as he eats. After doing some reading, and better understood how Caninsulin works, we plan to start feeding him 30 min before shooting tonight. Should we still give him 1/3 of his meal at +1,5 when trying this?

Best regards, Helena

Edit: Made changes in the SS, realised that the conversion did not work if I used commas. :oops:
 
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For the future, yo can use the Lantus pens as a vial and just stick the syringe needle in in where the pen needle goes and draw out the insulin. Most users can use a 110 ml Lantus vial before it goes bad but can use a 3 ml pen before it goes bad. Also, only trying the reduced 1 uit lantus does before changing to Caninsulin is too short of a period. At least a month or longer is really required before changing insulins.

What is Grandalf eating?
Anything unusual to explain the relatively low 6/10 BG reading?
I would keep the the 1 1/2 units for at least three days and see what happens and only reduce if y get a low reading like you received on 6/10.
With Caninsulin and similar insulin you remain on the same dose for about 5 days before changing dose unless you get a low BG like you got on 6/10.
 
Maybe it was not clear but he was on 1 U Lantus 2x daily for over a month before we were at the vet.
Wow, I hade no idea you could use the pen like that! Good to know!

He is on raw food, and he has been eating the same thing and same amount since january so I cannot see that it should have been food-related. Then we Will keep him on 1,5 U and hope for better result on lower dose the next time he is low PS.
 
Now we are even more confused! Yesterday he was
18.4 @ PMPS
13.9 @ +1
15.4 @ +6
And this morning
13.5 @ AMPS
How can that be?!? I mean he should not peak later than +6? He has shown no signs of that earlier.
We only gave him 0.5U AM, but have no idea what is going on!

Here I can add that he did eat something out of the ordinary. He snuck up on the countertop and took a big chunk of curry chicken (more chicken than sauce)... We did not notice any signs of a dissorted tummy so he is probably just fine, but I guess that could have something to do with the weird AMPS.
 
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Hi Helena. Wow, Gandalf is gorgeous!!! Glad you're home testing, that's the most important thing you can do. I don't know much about caninsulin, so I'm not sure about your dosing strategy. What are the question marks on your spreadsheet prior to June 5 in the units column?
 
Hi Helena ~ And welcome and glad you found us because there is so much information here. It is interesting that you switched from Lantus to caninsulin as usually it is the other way around. Lantus is a depot insulin and is long lasting and caninsulin is an in/out insulin with shorter duration and fast steep drops.

I think if Gandolf were started on Lantus at 2 units twice a day, that could have been too much for him and only reducing the amount for 1 1/2 weeks to 1 units might have shown that maybe he needed 1.75 units.

What are the ?? marks on the SS in the unit column and does this SS represent how long he has been on Caninsulin?

I will tell you this, there are very few people using this insulin. If you go to the that forum, you will see that it is quite dead for reasons I mentioned above, too short of duration and to fast the drops.

IMHO, I would go back to the Lantus and let the peeps here help you with dosing to find the right dose.

Gandolf is a beautiful cat!
 
Thank you!
We were told by our vet to give 3 U, we decided not to start out that high but began at 1 U for a couple of injections. It was a hectic week in school so we have no notes on when we gave 1 and when we started to give 3 U, hence the questionmarks. We have no clue what doses we gave those days. That seems absolutely crazy in retrospect but we new absolutely nothing about Caninsulin when we started it. We basically learnt all we now the last few days, and feel we have been verk lucky nothing horrible has happened.
 
Was the 3 U to start for the Lantus or the Caninsulin? Most cats are started on Lantus at 1 unit twice a day. Starting to high can cause a lot of bouncing and make the numbers higher looking like the kitty needs more insulin when in fact they need less. We recommend increasing and decreasing in .25 unit increments for just that reason, too not go over the right dose.
 
Thank you so much!
I asked for some advise in our swedish Facebook-group as well and there are not many cats in sweden on Caninsulin either. So I plan to contact vet the coming week and discuss what to do, I definitely want to switch from Caninsulin. I feel Gandalf has been a bit depressed the last few dags and also his fur is looking worse. What do you guys think about Prozinc? He was doing well on Lantus so maybe it is best to just go back.

The Ss is all days he has been on Caninsulin.
 
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The 3 U start was for Caninsulin but we decided at home to start at 1. But later we followed vets recommendation and gave 3. There are some short explanations under remarks in The Ss.
 
We realised earlier this week as we starten to learn more about Caninsulin that he probably were given way to much and lowered to 1.5 U.
 
Caninsulin was designed for use in dogs which have a different metabolism than cats, that's why it doesn't work as well for our kitties. ProZinc is a great insulin as is Lantus. If you go with the Lantus, use a syringe to draw the insulin from the pen. That way you'll be able to fine tune your dosing. That will help you find his optimum dose.
 
I had Bubba on ProZinc for 6 months then I switched to Lantus and he started to turn around. We have a saying here that the best insulin for kitty is the one that works. Prozinc is a fine insulin as well. It is hard to say should you switch to Prozinc when we can't see a SS with data for when he was on Lantus. If it were me, I would go back to the Lantus and let the L & L forum help you with where to start and how to increase. Lantus has one of the highest remission rates for diabetic cats.
 
Sharon14 said:
Caninsulin was designed for use in dogs which have a different metabolism than cats, that's why it doesn't work as well for our kitties. ProZinc is a great insulin as is Lantus. If you go with the Lantus, use a syringe to draw the insulin from the pen. That way you'll be able to fine tune your dosing. That will help you find his optimum dose.
Click to expand...
Good point Sharon on both accounts.
 
I am using caninsulin and the shape of the curve done yesterday is a normal shape for this particular insulin so my feeling is the 1.5 units dose is about right, I would try to hold this dose for now if you can, but do reduce if you are not confident about his pre-shot numbers being safe for the full 1.5 units, his low point is 5-7 hours from yesterdays curve which is fine, and he dropped about 10 points from the pre-shot number. You are looking for a u shape curve which doesn't drop too quickly. If you look at my spreadsheet you can see where I have had issues with bouncing when the dose is a bit high and it does take a few days to settle. If I was in your position I would look at going back to the Lantus if that suited him better or have a discussion about Prozinc. I am hoping to change insulins soon but I am awaiting some further advice from the specialist, in the UK we don't really have much choice about what insulin we start with so I am getting used to caninsulin issues!
 
We felt like the curve yesterday was good, nice to get some confirmation about that. Thanks!
But what about this morning?!? How could he have 18.4 PMPS, 15.4 at +6 and then only 13.5 AMPS this morning?? That really confused us!
That is really nice about Sweden, no regulations or stuff like that. The downside is that the research and public awareness of feline diabetes has just recently started here, while US and UK has been doing it for several years.
 
Sometime strange things happen! I had a 9.1 PMPS the other day which came from nowhere, the only thing I can think of is that she was running around a lot of the day asking for food and must have been using up all that sugar in exercise. It may be that Gandalf dropped a bit early last night and you missed the low point, for some cats there is a small second drop after the 7-8 hour mark and this may have happened as well and he was on his way back up when you checked him this morning.
 
Amen to that!

Now I need some new advice.
I really don't want to use Caninsulin aymore and I'm just back from a trip to the pharmacy. I still had the prescription to Lantus so I picked up a box. Both me and my partner feel that we want to go back to Lantus as quickly as possible, like tonight.
The vet here is not open on sundays so I can not call and ask for advice. Also our vet is as inexperienced as we are, she has only had a few diabetespatients before and I believe most, if not all, of them were dogs. She is really good in the sense that she really listens to us, so my feeling is that she will just say that we should go ahead and switch back if we feel like that's the right thing to do. So it is better I ask here, what should we look out for when switching? We thought that we should start again at 1 U (which was also the startingdose we got for Lantus when he was first diagnosed in January). Unfortunately they had no syringes available but it doesen't matter since we are not starting off higher than 1U, maybe though it would have been good to start even lower? What do you say?
 
The best thing for you to do would be to go to the Lantus Forum today, and ask for dosing advice for tonight. You can explain that you started on Lantus and switched to Caninsulin and now want to go back to Lantus and what should you start at. The really experienced dosing people will help you start. Link this thread to the new thread on Lantus. Below is the link to the Lantus Forum.

http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/
 
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