Making the change to Lantus from PZI

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millerb

Member Since 2012
Hi everyone. I'm relatively new to these forums and have already gotten a ton (overwhelming!) of information.

Brief background: Skipper (male, 15.5 yrs old) diagnosed with diabetes Dec. 3, 2011. He has been on Prozinc ever since, but we were never able to get his BG under control (lowest ever reading at the vet was 450, and that was fasted for 10 hours). He also has CKD, hyperthyroidism and anemia (the numbers vary, but he's not making reticulocytes). Our vet sent us to see an internal medicine specialist, whom we saw March 5 and again March 12. She switched us to Lantus, and I gave the first dose Tuesday at 5 p.m. I tested his BG at 9 p.m., and it was 405. At 4:30 Wednesday morning, it was 393, and at 5 p.m. yesterday, it was 533. This morning at 5:15 a.m. it was 453. You can see his spreadsheet via the link below which has the results of a curve I did last Saturday on ProZinc.

My question is, how long does it take to determine if the Lantus is working? Will it happen right away, or is there any ProZinc remaining? Is there a buffer period where things have to get reset? Since the vet started us at 3 units 2x a day, and I've seen many posts say that is too high (I asked the vet about it and she didn't want to go any lower yet), I want to know if I should be wary of low BG. I'm not home during the day so I can't check it midday except on weekends.

Thanks for the continued help!
 
Hi Beth!

Ruby and I just made the change a 3 weeks ago. Lantus is really different than PZI. It does take awhile to build up in their system. You'll see it referred to as the "shed" here or filling the shed.

Ruby has responded pretty well but she also doesn't have the other issues that Skipper does. It seems to me that her numbers improved pretty quickly, but there have been some stretches of not so good days. I basically wanted to just say hi and welcome you to Lantus Land, as they call it. Everyone here has been incredibly helpful and very patient with all my little freakouts.

Amy
 
Hi and welcome to LantusLand. :-D Initially we give Lantus 5 to 7 days to build up the shed, so you don't see immediate results when starting. Part of each dose gets store and then slowly released, This is what gives lantus it's longer duration. That's the downside of the insulin. You don't see immediate results. There is a LOT of waiting to see what will happen.

Could you give us a little more information? What other meds is he on? What is he eating? When is he eating in relation to the tests? What dose was he on w/ Prozinc?

Lantus works best in cats if you can shoot on a strict 12 hour schedule. Changing the shpt time can act as a decrease if you shoot late it can act as a decrease in dose and an increase if you shoot early. Every time you change a dose it can be another 6 cycles for the shed to balance out again.

Since we all live in different time zones we refer to the hours past shot time instead of actual time, So +4 is 4 hours after the shot, etc. Always get a preshot test and since you work during the day try to get a mid cycle test at night. Eventually you will see approximately when skipper goes lowest. That is the nadir and it is this reading that we use to determine the dose for Lantus, NOT the preshot reading. We just take that to be sure the BG isn't too low to shoot safely.

One other thing is to try to take food away 2 hours before the preshot test. We want to see a number that isn't influenced by food. Other times try to get the test in before feeding rather than after.

We have some memmbers here who are very good at reading SS and under standing how and when to adjust a dose. I'm sure you will hear from them soon.
 
Hi Beth,

My Racci is also 15+ and started on PZi but switched to Lantus. She does much better on Lantus. I hope you will be as pleased as I am with the change.

I was wondering what you are feeding? Racci was a dry food addict and as soon as I switched her to wet food, which I'm still in the process of finding what she likes, her bg dropped tremendously. She's now in normal or at least the range where damage isn't done a lot of the time. A wet, low carb diet is very important for a diabetic. I don't know how that goes with her other conditions, so you would have to check on that but we have experts on the board who can help you with that also. We have a list of wet foods and what the carb, phosporous, etc content is here:
https://docs.google.com/file/d/0B8Uu8g1u8Su9YTgxNGE1MDItM2MyMC00Y2Y3LWI4ODMtMzhkYTkxOGM4NThk/edit if no one has given it to you yet.

Welcome!

Melanie & Racci
 
Thanks. I'll try to answer your questions here:
The only other med Skipper is on is methimazole, 2.5 mg twice daily, for hyperthyroid. The meds keep it under 2.0, or under good control.
I also give him subQ fluids (Lactated Ringer's, 250 ccs) every other day.

The food is the tricky part, for a variety of reasons. Skipper is allergic to beef, and my other cat is allergic to chicken, and they often eat out of each other's bowls. Skipper has always been a dry food eater and grazer, and it's just been in the last year that I've introduced wet food, which he hates. I've only found 2 kinds he will eat, and I have to do a lot of coaxing: Wellness CORE salmon, whitefish and herring, and Blue Wilderness Salmon. I've tried duck, venison, rabbit and turkey, and one or both cats vomits them up. He is also eating dry DM food. I know that you all are anti-dry food, and I talked to the vet about it, and she said since his weight is so low still (he was down 3 lbs. from normal in early January, and has only been able to put 1.5 lbs. back on since), that it was more important to get him to eat than to worry about what he's eating. She also said some diabetic cats do better with dry food to graze on because it keeps their BG more steady. And, he can't be on a low carb/high protein diet because of the CKD. Right now his kidney levels are good, but I want to keep them that way. He won't eat any treats or people food, like baked chicken meat or salmon.

Skipper was on 5.5 units of Prozinc, twice a day. We started with 1 unit 2x a day in December, and increased 1/2 unit each week. He continued to lose 1/2 lb a week until Jan. 10, when he went into ketoacidosis and had to be in the ICU for 3 days. He was barely 8 lbs. His normal weight is 11-11.5 lbs.

I try to stay as close to 12 hours between doses as I can, but usually make it within 12.5-13. That's the best I can do with my schedule. I get up at 4:30 am to test and feed him, work from 8-4:30, then test him when I get home around 5-5:15 pm.

I appreciate all of the advice and knowledge on this forum and the test kit you all sent. I have spent a fortune since his diagnosis (his blood calcium was sky-high for a while, and cancer was suspected but never found), and have needed all the help I can get. Thankfully our new specialist is cognizant of that and hasn't asked to do any more expensive testing.
 
Hello and welcome to lantus land :cool:

You may have already seen this article on transitioning from dry to wet.
Many folks here have gone through the process and will surely pop by with recommendations.

Information on the TR protocol can be found here I recommend you read it,, along with information on the SLGS protocol

Being that Skipper has a history of DKA, I recommend TR - provided you can successfully transition to wet prior.

Are you urine testing daily for ketones? I went through DKA twice with my cat. You must be super vigilant to keep them at bay.
Has he regained any of the weight he lost?

Plenty of folks here who work outside the home and can assist with tips to work around scheduling challenges.

Regardless of which protocol you choose to follow, you are welcome to take up residence here in Lantus TR.
Lot's of tribal knowledge :-D

I think you'll like Lantus, it's a great insulin for kitties.
 
Welcome to Lantus Land!!

Some of the people who have already posted have mentioned a few things about Lantus. I think you will find its use is quite different than what you're used to with PZI. Like others have noted, Lantus is a long-acting type of insulin. It is pharmacologically considered a depot medication -- it's what we refer to as a "shed." This allows for doses to be cumulative and for overlap between shots. It is also comparatively gentle -- it doesn't yank numbers down.

Lantus dosing is based on the nadir, not on your pre-shot values. This is why we encourage people to get spot checks as often as they are able.

Hopefully, some of the members who have made the switch from PZI to Lantus will be stopping by and offer some of their experience.

Please let us know how we can help. People are very generous with their time and information.
 
hi beth! i just want to add my welcome! i hope skipper does great on the lantus - most cats do.

if he can't eat the canned food you can accommodate the dry food carbs with a higher dose of insulin, following the more conservative SLGS protocol. we can help you figure that out.

i'd encourage you to post here every day so we can get to know skipper's situation and give you a hand with getting his numbers down.

glad to meet you!
 
Thank you all for the warm welcome! We've been on Lantus for 3 days and I'm already seeing improvement in the BG numbers. I checked it last night +4 after pm shot, and his BG was 250. It's NEVER been that low. Today it's been in the 300s, which makes me happy. I'm going to try weaning him off the dry food, but will have to figure out a midday meal that my husband can give at lunchtime, because Skipper still has 1.5 lbs to put back on.

Monday I call the specialist for a weekly BG report and weight report. She is allowing me to call in because otherwise I have to take off work to go see her, and I can't do that every week. I'm going to give her the spreadsheet URL so she can check it periodically herself. Whoever made that gets a big hug from me!
 
If you are trying for weight gain the calories/oz. is much more important than just the amount of food fed. The last column of the food list Melanie gave you is the calories per can. It varies by the flavor, but roughly FF is around 30 to 32kcal/oz , Wellness around 40, EVO about 38. One of the highest is Blue Wilderness at 44.

Most cats need between 20 kcal/lb. (inactive) to 30 kcal/lb. (active). Tess was pretty skinny at dx too and it took several months for her to start gaining weight back w/ about 15% more calories than she would normally need. The highest calorie food i found is Nature's Variety Raw Organic Chicken, 65 kcal/oz. On the plus side it is fairly low in phosphorus too.

Tess is also on the edge of renal insufficiency. I still feed a low carb/ high protein diet, but keep the phos. low. Over the last 6 month's her renal values have significantly improved, just by sticking to food lower than 200 mg. phosphorus per 100/kcal. Have you checked out Tanya's site? There is as much info on CKD as there is about FD here.

BTW: you can modify the SS to your own needs, like adding a column for weight or put it in the notes section.
 
HI Beth,

Your Skipper could be my Racci in his food likes. It's amazing how alike they are in their tastes! :lol: Racci was a dry food addict also and I just finally got her switched. She still gets her Purina DM Dry as treats for her tests and meds and was also a free feeder. She's a big cat, almost 20 lbs, and was all the way up to 5 units of lantus to acomodate her dry food. Now she also will only eat the canned fish. Core Salmon mix, and Wellness Salmon & Trout are the two that she lives on. I sometimes hide the wellness turkey in the salmon and get away with that but other than that, still looking. Occasionally I can get her to eat home cooked chicken. It depends on her mood. It took me a long time to switch her. I also believe that the number 1 thing is to put the weight back on first but I would encourage you to keep feeding the wet also because it really makes a difference. She's down to 3.75u now and is in normal or near normal glucose numbers much of the time.

I just know you will love lantus. I had the same results when I switched. I had very little success on PZI for the longest time. As soon as I switched and we found the correct dose for Racci she started to go down. The hardest thing to get used to is not reacting too much to the pre-shot numbers and remembering that the nadir (lowest point) is what you should be setting your dose on. If there is anything I can help you with please don't hesitate to ask. We have people who are very good at deciding doses and use subq's and will be better able to assist you with that but testing, or switching her over to the wet food when you're ready, or any general question I'd be happy to help.

Melanie & Racci
 
Has anyone suggested a timed feeder? It's a great way to make sure there's food available throughout the day. I use a 2 compartment feeder. There are also 5 compartment ones.
 
Someone did suggest a timed feeder. I'm not sure how much to feed him, though. Here's my usual feeding schedule:

4:40 am 1/2 can Wellness CORE salmon, whitefish and herring and a 1/2 cup dry dm
5 p.m. same

However, he's a grazer, so if he doesn't finish his wet food, my other cat will finish it for him. She's put on a little weight during this period, and I can't let her gain any more. So I'm hesitant to give another 1/2 can of food because if he doesn't eat it, she will. And, she won't touch dry, so I don't have to worry about her eating that.

Thanks for tips!
 
Welcome to Lantus. You will find lots of wonderful advice here to help you. Lantus is a wonderful insulin - it worked very well for Jake(ga). Good luck to you both :-D
 
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