Help with preparing switch *long*

Status
Not open for further replies.
Spacey & Ella

Spacey & Ella

Active Member
Aloha everyone,

A couple of day's I wrote here with questions on what to read when switching to Lantus and when to switch and so on.
Well, I have read and now I have more questions...

Background info cat:
Spacey, diagnosed on Nov, 11th 2009, is on Vetsulin/Caninsulin at the moment. Since she has huge up-and-down's I want to change to Lantus.
She has probably an infection in her mouth, due to plaque and will have a dental next Wednesday. I started her on B12 this week due to some weak hind legs. I stopped her Metacam today, I believe she doesn't need it anymore and I honestly got a bit scared when I figured out that I gave her 4 times the preferred dose (Vet told me to give 5ml every day, preferred is 2.5 every two day's). She had antibiotics in Dec for her infection. But that has worn off I think.
She has no ketones, but her bg colors are just like a patchwork blanket.
She was also tested for pancreatitis with negative result.
Oh... and of course she is on wet/canned food only.

Background info owner:
I test ps and every day I have the chance I also do spot checks. Not only her nadir hours (which can be +3, +4, +5 or +6) but also every other hour so now and then.
I have bought U100 syringes with 1/2 unit markings and am heavily armed with arguments to switch to give to the vet (1 is that even the manufacturer of Caninsulin advices to switch since there seems to be a slide problem at the moment). I do check regularly her blood ketones and also have once managed to stop her from going into hypo.
I've read the info/links you guy's given me (unfortunately a lot of links in the faq seem to end up nowhere, i.e. they're broken).

I still have questions:
1. What else do I need to prepare the switch except 3ml cartridges of Lantus?
2. I've read on Tilly's website that she didn't start with 1 unit bid since her cat was on a different insulin already. Does that mean that the starting dose of Spacey also should be lower? And if so, how low? 0.25? 0.5?
3. As I understood first there has a shed to be filled. And that take's a couple of day's. Does that mean that I still give Caninsulin for the first, say, 2 day's of Lantus? To prevent her bg numbers to go up again. F.i: monday start Lantus AND give 0.5 unit of Caninsulin to keep some level of insulin in the body whilst the shed get's filled.

That's for now...
 
1. What else do I need to prepare the switch except 3ml cartridges of Lantus?

Just keep reading the information here, and try and forget everything you learned about Caninsulin :-D
2. I've read on Tilly's website that she didn't start with 1 unit bid since her cat was on a different insulin already. Does that mean that the starting dose of Spacey also should be lower? And if so, how low? 0.25? 0.5?
Yes If a cat has been on another type of insulin then the starting dose should decided upon taking that into consideration, however even though Lantus is a longer lasting insulin, it is somewhat less potent than for example Caninsulin. I think you have been giving Spacey .75U Caninsulin, so that may be a good starting dose with Lantus depending on how her BG is after the dental.
3. As I understood first there has a shed to be filled. And that take's a couple of day's. Does that mean that I still give Caninsulin for the first, say, 2 day's of Lantus? To prevent her bg numbers to go up again. F.i: monday start Lantus AND give 0.5 unit of Caninsulin to keep some level of insulin in the body whilst the shed get's filled.
Absolutly not! Although Lantus CAN take a few days to show an overall improvement in the BG curve, it does have an effect even while the "shed" is being built. It will lower her BG even on the first dose, it just takes several days for a more stabil overall lower flatter curve. We never mix insulins except in extreme cases (Ketoacidosis etc.) which would probably be done under intensive observation in a vet clinic.

One other thing you should familarize yourself with is the pictures showing the dose in the syringe. Samll doses of U100 insulin can be quie a challenge to measure, so maybe use one syringe and practice filling it with something colored (Cola, orange juice...) so you get a feel for .5U or .75U
That's for now...
 
With respect to starting dose, the Tilly protocol indicates that you can approximate a starting dose based on ideal weight. If you know what Spacey's ideal weight is, or can get a rough idea, this will be useful. We can help you calculate what the starting dose should be. You can't really make a lateral dose switch from Caninsulin since you are using sliding doses. Most cats start with a dose somewhere in the neighborhood of 1.0 unit, give or take.

With respect to building the shed, because you need to hold the dose of Lantus constant, giving two insulins would be dangerous. It's not like with certain medications where you can cross taper (i.e., decrease one while increasing the other) -- or at least I've never heard of this being done with insulin. Some cats do have a quicker response to Lantus; with some, it takes a few days.

Keep those questions coming!
 
With respect to starting dose, the Tilly protocol indicates that you can approximate a starting dose based on ideal weight. If you know what Spacey's ideal weight is, or can get a rough idea, this will be useful. We can help you calculate what the starting dose should be. You can't really make a lateral dose switch from Caninsulin since you are using sliding doses.
Click to expand...

Yes and No.....That is true for newly diagnosed cats where there is little other information to go on. However Tilly also says....
Begin with 0.25 IU/kg of ideal weight BID
OR
If the cat received another insulin previously, increase or reduce
the starting dose taking this information into account. Glargine
has a lower potency than lente insulin and PZI in most cats.

Other factors such as diet, rather or not a diet change is going to be taking place, ability of the caregiver to monitor the first few days, and BG trends)

I checked the SS and you have again increased to 1U, so if you were starting Lantus tonight I would say use the 1U, but there could be some major changes after Spacy has her dental, so deciding on a starting dose can't be made until you actually have the Lantus in your hand are ready to make the switch.

Good luck in convinceing your vet!
 
Monique & Spooky said:
With respect to starting dose, the Tilly protocol indicates that you can approximate a starting dose based on ideal weight. If you know what Spacey's ideal weight is, or can get a rough idea, this will be useful. We can help you calculate what the starting dose should be. You can't really make a lateral dose switch from Caninsulin since you are using sliding doses.
Click to expand...

Yes and No.....That is true for newly diagnosed cats where there is little other information to go on. However Tilly also says....
Begin with 0.25 IU/kg of ideal weight BID
OR
If the cat received another insulin previously, increase or reduce
the starting dose taking this information into account. Glargine
has a lower potency than lente insulin and PZI in most cats.

Other factors such as diet, rather or not a diet change is going to be taking place, ability of the caregiver to monitor the first few days, and BG trends)

I checked the SS and you have again increased to 1U, so if you were starting Lantus tonight I would say use the 1U, but there could be some major changes after Spacy has her dental, so deciding on a starting dose can't be made until you actually have the Lantus in your hand are ready to make the switch.

Good luck in convinceing your vet!
Click to expand...

I ordered the Lantus today!
With a bit of luck I can pick up the prescription tomorrow after work. Then Wednesday her dental and Thursday starting on Lantus... Thursday is my last day at work. After that I'm a week off. I'll be able to test her as often as possible.
 
Sounds good! Make sure you read about storing and using the Lantus pens. I hope Spacy's dentist appt. goes well. Stay warm!
 
Status
Not open for further replies.
Back
Top