How to change from Humulin to Lantus?

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Msbrigitta

Msbrigitta

Member Since 2012
I need some advise on the safest way to change from Humulin to Lantus. Merlin is on 3 x 1.5U and still all over the map after 2 weeks and I've read enough about Humulin that we want to change asap.
He's doing very well otherwise, eats like a pig, has actually gained 1/2 lb. this week, and is in good spirits.
We'll start with Lantus on Thursday (since we're in the middle of nowhere that is the day we can finally pick it up). I've read about .25 or .50 per kg ideal body weight and somewhere else per kg lean bodyweight?
He used to be around 11 pounds which seemed to be just right for him but now he's a pretty lean 9 pound so what do I do?
Start with 2 x 2U? 2 x 1U? What do you think? Would it be safe to than test him at 3+, 6+ and 9+ or more often?
We also want to switch him around that time to wet food (again, we cannot get to it before that). Would you do that first? Simultaneously? After he's stable?

Also, I've created some BG SS's but I'm such a dork I can not figure out how to attach that to my signature, even with the guidelines. Is there an easier way?
Any help is very, very much appreciated. This forum has been a godsend!
 
The dose per kg formulas refer more to newly diagnosed kitties than to one who is switching from one insulin to another. I believe with a switch to lantus, you would base the starting dose on a percentage of your current dosage of Humulin. Could you please post this question in the Lantus TR forum so that people who need to see it are sure to? That will give them a couple of days to help you in figuring it out...

Carl
 
My now GA diabetic cat switched from Humulin N to Lantus as well several years ago. We went from 4 units BID of N to starting at just 1 unit BID of Lantus and then changed from dry food to canned food. You can do a few random bg tests once you are on Lantus. +3, +6 and +9 are good in addition to the AMPS and PMPS. Try to vary the times you do a random test so you get a general idea of how your cat's bgs are.

Were you able to at least publish your SS? If you got that far, there is a box that appears with the link for your published SS. That is the link you want. You can go back to the Publish As A Web Page box at any time in your SS to get the link again. Come here to FDMB and access your Control Panel ( http://felinediabetes.com/FDMB/ucp.php ) On the left side of the screen, click on Profile. Then click on Edit Signature. Paste the link to your SS in there. Click on Submit to save it.

To automatically have the signature show you in your posts, click on Board Preferences while you are still in the Control Panel. Click on Edit posting preferences. Click on the Yes option next to Attach my signature by default. Click on Submit.
 
Welcome to FDMB.

Generally, you can switch unit-for-unit less 30% when a cat is switching from another insulin to Lantus. The catch here is that Merlin is on a TID dose. Generally, you'd add up the total amount of insulin per day (4.5u) and take 70%. In other words, you'd be shooting 1.5u twice a day.

However, if Merlin has been on insulin for only 2 weeks, you could use the formula for initial dose. The formula is: initial dose = 0.25 x ideal weight in kilograms. If Merlin was at a good weight at 11 lbs, with this formula, your starting dose would be 1.25u. (The info you read with the 0.5 multiplier is dated and Roomp & Rand changed this in their more recent publication.)

Since the doses are so close, it's your choice. I also want to be sure you understand that Lantus is given twice a day at as close to 12 hour intervals as you can manage. You do NOT want to be giving the above noted doses three times a day. The duration of Lantus is substantially longer than that of N and Lantus is administered twice a day.

There are a couple of caveats, though. Are you home testing? Are you feeding a low carb, canned food diet?

There is a wealth of information about Lantus in the starred, sticky notes at the top of the Tight Regulation board. That information is outlined below.
  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal versions -- the Tilly Protocol developed by the counterpart of this group in Germany and the Queensland/Rand protocol developed by Jacqui Rand, DVM and published in one of the top vet journals.
  • New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
  • Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
  • Lantus depot/shed: This is an important concept for understanding how Lantus works.
  • Lantus & Levemir: Shooting & Handling Low Numbers: What data you need in order to be able to work toward remission or tight regulation as well as information if you have a low pre-shot number or a drop into low numbers during the cycle.
 
I just did the same thing about 6 weeks ago.

1.5U Humulin N TID to Lantus. Chip was on the NPH for about 2 months before the switch. Looking back I wished I'd held the 1.0U starting dose of for the full 7 (even 10) days to see where we were at. Starting at 1U bid would likely be safe.

However I'd like to see your Humulin N spreadsheet before recommending an ideal starting dose for Lantus.
 
We also want to switch him around that time to wet food (again, we cannot get to it before that). Would you do that first? Simultaneously? After he's stable?
Click to expand...
Doing both the insulin and the food switch at the same time might be challenging. It can be done though. You should be aware that the change from dry to low-carb canned should have a positive impact on Merlin's BG. Some cats show a big improvement just from the diet change. And it is safe to assume that you will also see improvement in the numbers from the switch to insulin, which is much better suited to work on cats than Humulin is.
It would probably be best, if you are doing both things starting later this week, that you make the switch to canned food gradually rather than cold turkey. Like maybe half and half for the first few days?

Sienne gave you two good options on dose. 1.5 or 1.25 to start, every twelve hours. I think I'd probably go with the lower dose due to the fact that you'll be feeding less carbs. Testing like you mention, every three hours on the first cycle at least would be a good idea too. You'll see a different "curve" with Lantus. It will probably begin to act later in the cycle than you've seen with Humulin. "Normal", (if there is such a thing with cats) nadir with Lantus would be expected to happen about 6 hours after the shot, where with Humulin it's likely you've seen the "low point" within 3 or 4 hours of shooting? Ideally what you are looking for eventually (once he gets used to the new insulin) is a flatter curve than you'd see with a faster acting, shorter duration insulin. It will take a few days until Merlin "settles" into the way that Lantus works but that is how it works. If you read the links Sienne gave you, you can get a good understanding about how Lantus works differently than Humulin. One or more of those links will also explain when the best time for testing is, and what you can expect to see as far as a curve goes. It is recommended that for the first few days you test fairly often, to see what kind of patterns you see with the BG numbers. In the big picture, the patterns are more important than the specific numbers are. Patterns repeat. Numbers don't, not exactly anyway.
Between now and Thursday, do lots of reading! And ask any questions that come to mind too.

Carl
 
Thank you all so much!
I read some of the links and got already most questions answered. Awesome! I think I go for the lower dose, either 1 or 1.25U, BID and will change the food over gradually.
I'll try again to get my SS up. Thank you 'squeem3'!
I'm re-posting on the Lantus TR board also, as suggested by Carl, but thank you all so far! You're the greatest!
Brigitta and Merlin
 
Newkitty was on 5 units BID of Humulin U when we traded to Lantus (had to, they discontinued U). We started over at 1 unit BID and gradually worked our way up to 3 units BID. Then we had to start working our way down again gradually until she went off the juice almost a year and a half ago (despite still being on high steroids and high carb dry). I think you will be happy with Lantus. I did not want to switch from U because I knew it so well but Lantus is a good drug. Good luck.
 
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