How to safely change from Humulin to Lantus

[Msbrigitta]

I posted this on the main health board but somebody suggested to move over here so here I am!
I got some good advice already and have been reading some links to how to handle BG's in general and the way Lantus works different than Humulin but still would like your take on a few things too if possible.
I need some advise on the safest way to change from Humulin N 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 N 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 Friday (since we're in the middle of nowhere that is the day we can finally pick it up). I've read about .25 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 1, 2 x 1.25U? What do you think?
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!
Brigitta and Merlin

 

[Dale 'n' Chip]

Start with 2 x 1, 2 x 1.25U? What do you think?
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?

I think that will depend on what the Humulin dose is doing now. Is he bouncing, or not getting enough? And when changing the food that reduces the dose.

If you look at Chip's Lantus Record the very top line is the typical 8 hours of 1.5U Humulin N for Chip, after his food was already changed. That was obviously too much Humulin for low carb wet food in Chip's case.

 

[Roni and Moonie]

Lantus is an every 12 hour insulin..Moonie was on Humilin when we came here & it made her not so well, so she was changed ...The shots are BID and we test the BG's several times a day & Night...Lantus is much gentler than Humilin & you will find your cat will feel even better on it..The mid point nadir for lantus is between +5-+6, and the onset happens at about +3--Please feed your cat after you shoot him am & pm--It goes test, feed, shoot--All this can be found in the Stickys at the top of the Lantus page.
Personally, the lantus was much more effective than Humilin N, and my cat got much better with it, as it is a longer acting insulin..My cat weighed 10 lbs and the starting dose was 1.0U twice a day..It would help if you introduced the wet food gradually, so the cat's numbers dont drop suddenly from the new food.

Go to the top of the page here to Board Links and click on Tech Support & that should guide you to where you want to go to post those things--Good Luck and Welcome to Lantus Land!

 

[Marje and Gracie]

When changing from another insulin, we don't use the .25u/kg of ideal weight.

We'd like to see a spreadsheet so we can see what he's doing. We'd like to see how he's doing on the current dose he is on before we recommend w starting dose for lantus. So the sooner you are able to get a SS up, the sooner we'd be able to look t it and recommend a safe starting dose.

 

[julie & punkin (ga)]

brigitta, if you have the ss created, that's the hard part.

to attach it, go to your user control panel at the top of this page (for my computer it's on the top left, some have it top right)
click the blue tab across the top that says "profile"
on the left column, click "edit signature"

now you're in the right spot.

on the top of the blank text box is a row of buttons - click the one that says "URL"
it will look like this:
you want to put the address of the spreadsheet in between the center brackets [color=#FF4000]HERE[/color]

then go to the bottom of the text box and click "submit." that should attach it.

make sure on the ss itself that you have it set to share to anyone that has the link. that will let people look at it to advise you.

the reason the spreadsheet is so vital is because we can look at any data you've got from previous doses and blood glucose tests and be able to suggest a dose that will be safe for you to start at. what was his BG at diagnosis?

also - that dry food is key. some cats can become diet-controlled diabetics simply from switching from dry to canned low carb food. the transition has to be done safely when you are already giving insulin. some dry food can be as much as 40% carbs or even more - and you're going to want to switch to canned low carb that is definitely less than 10%, many people average around 5%. a cat's natural diet is a mouse, which only would contain a few carbs from the grains in its stomach. the Tight Regulation Protocol we follow, which is the only study/protocol that has been published in veterinary scientific journals for diabetic cats, is based upon the success achieved with a low carb canned food diet. they go in tandem, so making that switch is key. it isn't uncommon for a newly diagnosed diabetic cat to go off of insulin fairly rapidly if they are on lantus, a low-carb canned diet, and follow the protocol. we have cats in that situation go off of insulin regularly.

we can help you every step of the way to do this safely and encourage you to post daily until you've learned how to manage Merlin.

 

[Sienne and Gabby (GA)]

I posted this in Brigitta's thread on Health yesterday:

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.

 

[Ann & Tess GA]

Are you trying to upload an Excel file for your SS? If so, I just tried to upload an Excel file as an attachment and it doesn't work for viewing online. It gets downloaded to the computer of whoever wants to look at it and you would need to re upload it every time you wanted to update it. Very cumbersome.

The SS needs to be on a cloud based server and Google Docs is the easiest and the one we use here. It's a free service. First you need a Google account. It has been a long time since I created a new SS, I would go to the Tech Support Forum and ask for a walk through.

Once you have the SS up and running you can copy the data cells from your Excel SS , select the appropriate cells on the Google SS and paste your data in. You must have at least as many cells selected on the Google SS as you wish to paste or it will not work. I'm not sure if the color coding will transfer either, you may need to go in and manually color the cells.

 

[Dale 'n' Chip]

Thanks for letting us see the spreadsheets. I agree you'll want to use google documents for an online spreadsheet going forward.

Looks like the Humulin N had the best curve at 1.0U

So I would start with 1.0U bid Lantus.

Go slow changing the food, get plenty of numbers in the process.

 

[Sienne and Gabby (GA)]

Brigitta:

I made a small error. If Merlin is underweight, you want to use his actual weight when calculating initial dose. That would work out to 1.0u of Lantus.

 

[Msbrigitta]

Yes, I guess that's what I tried to do Ann, I'll try again through Google Docs later.
As far as the ones that are showing now; you'll see 2 files, one's from when we had him on BID and the next one we're using at the moment while he's on TID. (Humulin N that is)
Pffff.... that was worse than pulling teeth :smile:

I changed the colors and numbers a little from the original so look carefully!

Anywho, as you can see he's still all over the map. When he was diagnosed his BG was 374, now we're hitting the 400's sometimes! Beats me!
I'm looking forward to the Lantus to arrive tomorrow and hope things will improve!
We're also waiting to pick up some canned (low carb) foods tomorrow since he didn't even want to go near the can of Evo we bought 2 weeks ago. We tried everything, mixing it, warming it, taking his dry food away.....he didn't budge.
What do you think happened today? The little bugger started to scarf everything down when it was mixed with a little ground beef!
Now I wonder, how much should he eat? He's used to be 'free' fed but we're now making sure he eats after each shot. Since he gets three shots a day, that means 3 meals. Does he need something in between? What do you do for the night. He likes to eat than too. The dry food he was getting was Evo turkey, can I still give him some to nibble on?
I'll start as suggested by Sienne and Dale with 2 x 1U. Wish us luck!

Thanks , Brigitta and Merlin

 

[Sienne and Gabby (GA)]

With the shorter acting types of insulin, like Humulin N, it's important that your cat eats before you give a shot. The reason is that insulin onset with N is very quick. If food isn't on board to offset the effect of insulin, you risk numbers dropping low very quickly.

Because Lantus is a long-acting insulin, most of us test, feed, and shoot all within a few minutes. (I probably takes me about 5 minutes to do all of that.) Typically, onset is in about 2 hours. So, if Merlin is a grazer, it's OK. There are any number of people here who's cats are free fed. The only limitation is that you want to pick up the bowl 2 hours before your shot time. You don't want to feed past +10 in order to make sure your pre-shot test isn't influenced by the effect of food. As far as feeding at night, many of us used a timed feeder. I linked the one I use.

Frankly, I would ban dry food from the house. It's amazing how dry food can spike numbers up. If you are going to need to transition off of dry and on to canned, that's another issue. But, once Merlin is transitioned, you want to stop the dry food. There's a reason we refer to dry as "kitty crack."

Dr. Lisa's site has a formula to estimate the number of calories per day your cat needs. It's a generous estimate.

Required calories per day = [13.6 X optimal lean body weight in pounds] + 70​