Insulin switch

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kellykramer

kellykramer

Member Since 2013
Oliver he is 14 has had Diabetic for several Months,
Been treated with PZI 2 to 3 units randomly since diagnosed 2 times daily. Levels are up and down like a roller coaster. Usually 400 to 500 before insulin and 200 to 300 after.
Has fell to 38 once and 100 a few times. ???? Weird Guy. :)
We are switching insulin's to Glargine starting at 2 units. ( which means I have to switch syringes also.) from 40U to 100U

My question is should I wait till Monday when Vet office is open? They are open Sat. 8 to 12, but is there a huge difference or side affects known with a switch?
Just thoughts would be helpful thanks

Kelly
 
If you start with an appropriate dose and are home testing, there isn't a need to wait.

The starting dose of Lantus is calculated from lean weight in kilograms multiplied by 0.25.

How much does he weigh?
How much should he weigh?
Take the lower weight and convert to kg
(Pounds divided ny 2.2)
Multiply by 0.25
Round down to nearest 0n25 units.
That is your starting dose.

What are you feeding him?
 
You should take a look at the sticky notes posted in the Lantus - tight regulation forum. Whether or not you choose to use that protocol, most of the information is still be relevant. One thing to note, some kitties have a strong reaction to their first days on Lantus. From the protocol sticky:
Kitty should be monitored closely the first three days when starting Lantus or Levemir.
Blood glucose levels should at least be checked at pre-shot, +3, +6, and +9.
More monitoring may be needed.
Click to expand...
It may be that the weekend is the best time to switch because then you can monitor more closely. It could be a non event but you never know. Lantus is a depot type insulin. It takes a while to build the depot, so we recommend holding the dose for 5-7 days initially to see the full effects (unless kitty earns a deduction).

Other things we consider when recommending initial dose is the dose on previous insulin's and whether Oliver has ever testing positive for ketones. Has Oliver ever tested positive for ketones? I'd recommend testing while you make the switch.
 
How do you check for Ketones?
Is Glargine the same as Lantas?
If I gave him PZI this AM is it Ok to do the New Insulin tonight? Then do I want to wait till AM so I am up and testing reg? Hate to give it to him at 7 PM then test at bedtime, go to bed till morning?

Oliver weighs 11 lbs probably should weigh 13 ish ?
He eats about 1/2 C of Fancy feast pate 2 times daily. Temptation treats during shots. ( Tried freeze dried shrimp and chicken) will eat seldomly but does eat a few temptaions during shots.
I am also figuring out how to do the spreadsheet, got it pulled up just not sure how to make it accessible on here?

Have a call into vet (Who is very helpful and informed) we are doing all we can to work together weekly at least.
I check BG a few times a day and do curves if necessary. Just a roller coaster.
Are there any known side affects that I should look for in Glargine beside going to low?
Thanks all so much
Kelly
 
kellykramer said:
How do you check for Ketones?
Click to expand...
See my signature link Secondary Monitoring Tools for tips.

kellykramer said:
Is Glargine the same as Lantus?
Click to expand...
Glargine = Lantus

kellykramer said:
...If I gave him PZI this AM is it Ok to do the New Insulin tonight? Then do I want to wait till AM so I am up and testing reg? Hate to give it to him at 7 PM then test at bedtime, go to bed till morning?
Click to expand...
I'd do it in the morning, so you're awake.

kellykramer said:
...Oliver weighs 11 lbs probably should weigh 13 ish ?
He eats about 1/2 C of Fancy feast pate 2 times daily. Temptation treats during shots. ( Tried freeze dried shrimp and chicken) will eat seldomly but does eat a few temptaions during shots.
Click to expand...
If he needs to weigh a bit more, you might increase his food another ounce or two - about 1/2 can of FF
 
He has just lost so much muscle tone. Due to being sick. But Ok I will add a bit more to his diet. He will eat about 1/2 of the 1/2 c then get shot and go eat again. He likes to nibble but that is all he gets till night before next shot.
Treats randomly and a few at shot times.
 
Temptations are unfortunately, rather high in carbs. If you need to get a bit more muscle on him, try boiling some chicken breast, then cut it into small cubes. See if he'll eat that for treats. The protein will help his diet and it'll be a no carb snack. Freeze any you don't need and thaw as required.

To add the SS to your signature, go to the User Control Panel (check top left of screen), then go to the Profile Tab and select Signature. If you head on over to the Tech Forum, there is lots of help over there. Or here is a post on editing signatures.

I haven't heard of any side effects from Lantus glargine, other than hypo.
 
Thanks I think I will get it tonight at the pharmacy and give it to him in the AM. See how it all goes. Thanks for all the info. I will also get chicken breast and do as you have suggested great idea. :)
Hugs
 
I still can't see your SS. You need to share it. There is a blue button the top right of the Google Spreadsheets that says Share. You need to select it and anyone with a link view it.

Next step is to add the Spreadsheet to your Signature. Go to the User Control Panel, Profile Tab, then Signatures. The link I gave you before tells you how to do it.
 
Hello Kelly and extra sweet Oliver!!

Just adding another 2 cents to the advice you've already gotten.

If you've never tested for ketones, then we have to kind of assume he's never had them, so at his weight, the starting dose for Lantus would be closer to 1 unit twice/day. (although since he's already been on Pro Zinc, others may have another dose in mind)

It works in a totally different way than Pro Zinc...it's a "depot" insulin and when you first start, it takes 5-7 days to "fill the depot", so you're probably not going to see a lot of progress right at first, but it's important to test at least 4 times/day...more if possible, so you can see how he reacts.

The 4 tests you really MUST do if at all possible are the Pre-shot tests (always test before giving insulin) and one mid-cycle during the AM cycle (at somewhere between +5 and +7) and then a "before bed" test on the PM cycle so if it looks like he might go low, you can set an alarm to check later.

If you can get more, that's all the better!! You'll learn more quickly how he's doing!

Depot insulins don't go to work all at once like Pro Zinc does...The insulin goes into the tissues (filling the "depot") and then slowly is being used...as the amount "in the depot" increases, the action of the insulin will too...so you always hold the same dose for several days to see how each dose dose controlling his BG numbers.

These are the general guidelines when you first start:
"General" Guidelines:
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).
Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Good luck to you! We'll be with you to help you any way we can!
 
Ok will look into how to post the SS. Gee ? Crazy hard

Started the new insulin Lantus today 2 units this AM. He is doing fine I guess so far. He was lower pre shot then he has been for a long time 285. Always keeping me on my toes.
Thanks everyone for thoughts I appreciate all the info I can get.
Will keep ya posted.
 
You want to get tests between 5 to 7 hours after the shot. This is around the time of the nadir, or lowest point in the shot cycle. Around days 3 to 5 is when the cumulative effect is most likely to become apparent, so be prepared to watch for any signs of hypo and to monitor the glucose levels.

You may not need it, but be prepared with a can of high carb gravied food, a backup box of test strips, ample lancets ... and coffee or other caffeinated beverage if it happens when you were planning to go to bed! A before bed test (at least +2) can be a good indicator if he might be heading lower than desirable.

You'll be fine and everyone here will help whenever they can.
 
We still can't see your spreadsheet, so you need to change it so we can see it.

Sign into your Google account and get on your spreadsheet.
Up in the top right corner is a blue box that says "SHARE"
Click SHARE and choose "Anyone with the link"
Click "Done"
That's all there is to that part!

Then, we'd like you to put the link into your signature box. To do that, go to the top left side of this page and find "User Control Panel"
Go to "Profile"
Find "Edit Signature"
In that block that shows up, put your name and Oliver's name, date of diagnosis, type of insulin you're using, brand of glucometer you have, any health problems (other than diabetes) that kitty has..and anything else you think might be useful for us to know. I have added where I live and that China is eating whatever I can get her to eat off the food chart....and don't forget to add the LINK to your spreadsheet! It doesn't need to be fancy...just copy and paste the link you get from the address bar when you're looking at your spreadsheet.

By getting all that information into the signature block, it will save us a lot of time asking you the same questions over and over again!
 
Oliver is doing well. Have updated SS and shared it for all to view and on my signature I think. LOL
Please let me know if you can see it. :) Thanks
His levels remained low and constant through the day yesterday, He was out and about and at feet all day which was awesome
normally he was in the tub or sinks begging for water. Sleeping and lazy like. Just different.
Low at PMPS so feed him a lot and waited till it was up a bit to give shot. Gave temptations at shot and he did well all night.
Got up to check on him but did not do BG. I will though the next few days as I see it deposits in body. need to be aware at night too.
I feel we should have started with this insulin has really made a difference it seems just in 1 day so far. Praying it will be the one that turns my boy around.
At 200 bucks I hope so.
:) Feeling positive and blessed
Thanks
Kelly and Oliver
 
Yeah Kelly!! The spreadsheet works fine now!!

A few things you need to know....We all pretty much test/feed/shoot within about 5-10 minutes. You shouldn't feed Oliver for at least 2 hours prior to Pre-shot tests because you want to know where his blood glucose is WITHOUT the influence of food.

IF you get a Pre-shot number under 200, you should stall, don't feed, and post for help. If you go to the first post, you can edit the Subject line and add something like "STALLING...need help" and people will get on as soon as possible to help advise you.

If for some reason, nobody has been on to help you, you should retest in 20 minutes to see if Oliver's numbers are rising. If they are (and he hasn't had any food), it means he's going up and it's probably perfectly safe to go ahead and shoot the normal dose for that cycle. Here's some info you should probably print out so you have it anytime you need it (the board sometimes has gone down for a little while and with winter coming, internet service can be cut off at times) Shooting and Handling Low numbers.

As you get more data on how Oliver reacts to Lantus and food, the "no shot" number comes down, but for safety, we use the 200 for new diabetics who don't have the data to know what's "normal" for their cat. Eventually, you'll shoot even with numbers as low as 50...but that's aways off yet so don't worry!

Again, good luck to you and Oliver and we'll be here to help in any way we can!

Edited to add: 2 units MAY be too much for Oliver. We usually start no higher than 1 unit twice/day until we see how our kitties react to it. The "low PMPS" number on only his 2nd cycle may mean it IS too much (although 173 isn't really a "low number"). When you got the 173, the best thing to do would have been to "stall" , don't feed, and ask for help like suggested above. You may need to go back and start at a lower dose and work up slowly so you can find a dose you can consistently give every 12 hours without having to stall but we'll just watch closely and see how he does for now.

Right now, you're still "filling the depot" so as it fills, you could start seeing some much lower numbers, so be sure to test as much as possible (within reason of course...don't need to test every hour). Getting a mid-cycle test will be important to make sure he's not going too low. If he does drop below 50, that needs to be taken very seriously and you should post the 911 and ask for help...at least for the first few times..until you understand how to handle lows better anyway.
 
I too only Test, feed and then shoot. within 10 min. :)

Last night it was lower then 200. and above a 150 so was thinking feeding would raise it up then rechecked waited 15 min then gave shot as it was higher then.
Why do you not want to feed to raise glucose then shoot?
Numbers are higher today but still lower then they have been. He's still up and around. Urine is a lot less and less frequently. As is water consumption and bugging me for something all the time.
Still holding out hope for a much better Oliver.
Thanks for info. I have printed out the lower numbers info. In case of outage. Ugh yes Winter is coming NOT READY.
Kelly
 
Why do you not want to feed to raise glucose then shoot?
Click to expand...

Because you need to know what his BG levels are without the influence of food. If you feed him to bring it up each time before shooting, you're artificially raising his fasting BG number when it's entirely possible that he needs a lower dose in the first place.

If you're HAVING to feed to get him to a safe shootable number, it makes more sense that he doesn't need as much insulin...does that make better sense?

We'd expect his numbers to be a little wonky for now...this is only his 3rd cycle out of at least 10 to "fill the depot", but it's nice to hear that he's starting to pee less. I remember the first sign of my China feeling better was she was preening again. Her coat had looked so awful and I'd just figured it was "Old cat disease", not diabetes. Now her coat is as thick and lush as it was when she was a young adult.

Keep up the great work Kelly!! The journey has just begun :-D
 
HA I hear ya on the "old Cat Disease Hair" OM he looks so rough. I am a dog groomer so it just pains me to see him not preening and keeping clean. I don't want to bug him any more then I already do... so haven't brushed etc. as much as needed but am going to wait till we get a bit more stable.
I do get the don't feed and wait thing now. I do not feed at all only at pre shot every 12 hours ish and a random treat or nibble of FF when he is starving (he thinks) but its never close to shot time.
I did last night thinking well its close to good #'s? IDK
I read through the link you gave me to print off and Its making a lot more sense now. :)
Again thanks so very much.
Its so comforting to know i have people to talk to that actually get it.
I have to cancel plans or make husband go alone. He get frustrated as does my daughter. But Hey Oliver is my "SON" love of my life. So
cant abandon him and wont.
Kelly
 
Re: Low AMPS

Oliver s AMPS was 185 which really is 205 as my monitor is 20 points lower then Vets and their more accurate test they performed to be sure.
SO Is this an indication its to much insulin? I am thinking so.... and would not want to shoot him with 2 units? He has not ate and is spunky and feeling very good.
I will stall till i hear from someone on what to do :)
My vet opens at 7:30
Kelly
 
Rechecked in 20 min its at 206 which is then really 226. I hate this adding pts to monitor. I do have a new one same brand? Wonder if that would be a better idea to switch to it?
I am going ahead and feeding and shooting AMPS of 2 units. i am home today and can keep a close eye on him.
I will then call vet this AM and discuss lowering maybe a bit ? Opinions on this would be grateful. What to say?
Thanks
Kelly
 
The relationship of your monitor to your vets monitor is imprecise. A single comparison doesn't do it. And the discrepancy is not going to be the same at all values.

The FDA allows ALL home glucometers to read within 20% of what a lab would get - higher OR lower. This means
100 mg/dL represents a range of 80-120 mg/dL
200 mg/dL represents a range of 160-240 mg/dL
And so on.
As the test values get higher, the +/- 20% range gets wider; that really doesn't matter as high is high. You figure out what you need to do to reduce it and take action.

Just report your actual numbers.
 
I would hold the dose for a week. Lantus is a depot insulin which means it takes time to build up in the cats system before you really see how the dose is working. Its a week to build up at first so you need to give it a week to settle - unless he drops under 50. A

fter the first week, dose changes can then be made every 3-5 days. This explains the protocol: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

So far it looks ok!
 
Hi again Kelly!

On the meter difference, almost all of us use human glucometers here because the AlphaTrak (that most vets use) cost WAY too much to refill the test strips (I think I've heard they're about $1 each!! Can you imagine the cost if you tested 8 times/day??)

The AlphaTrak runs "about" 30 points higher than the human ones, but since most of us use the human ones, we're comfortable with you giving us the actual number you get with your Contour.

When we see any number, we always think "plus or minus 20%, so we take the normal variance in meters into consideration.

Now that you've got your spreadsheet up and working, and are ready to really start this great adventure, let me be the first to invite you to the Lantus Tight Regulation Forum. Over there, you'll get lots of people who use Lantus helping you and advising you.

We post a little different over there. Each day, you start a new post (we call them "condos") In the Subject line you put the date, cat's name and your AMPS number.
(so yours for today would say: 11/25 Oliver, AMPS 206 (Your AMPS today isn't the 185 since you "Stalled" 20 minutes...You always put the number you actually shoot)

As you get tests during the cycle, you add those numbers to the Subject line...so yours now would be: 11/25 Oliver, AMPS 206,+3 301,+7 278

In the body of the post, you give the WCR (Whole Cat Report)..How Oliver is doing...is his appetite good? Is he acting like he's feeling better? Anything that tells us how he's doing "beyond" just the numbers. You'd also add any questions you have here. (If you do have a question, it's best to use the ? icon you see above the "Subject" line so as people scan quickly through the forum, they can see you have a question in your condo---To make it so people can easily see it, it MUST be done to the first post of the day, so if you've already posted your condo, and later in the day you have a question, you need to go back to that first post's subject line and add the ? there...the actual question you can ask as a "reply".

Also, we have what we call the 5 P's...is he Purring, Preening, Playing, Peeing and Pooping?

Hope to see you there, but if you are always free to continue to post here in Health!
 
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