Making the switch to Lantus - Need help with initial dose

[Becky & Morlei]

Hello everyone!

We have been using ProZinc since Morlei's dx on 1/2/12. She has never dropped to what would be considered a "normal" number, I think her lowest has been 152. She likes to hang out between mid to high 200s, even with dose increases/decreases. We had some success at the beginning and got some blue numbers but now it just seems like whatever dose we give her the numbers stay the same. So after showing the vet that the original prescribed 3u wasn't doing as much as we would like we got the script for Lantus. I bought the Solostar pens and U100 3/10cc syringes with half unit markings. They only had 29 gauge, I would have preferred 30 but we used 29 with the ProZinc so it's no big deal. I'm going to watch the video on how to draw the insulin out of the pen tomorrow night.
Morlei is on a wet food diet, was Sophisticat but we are transitioning to Fancy Feast because apparently all four cats decided they hate Sophisticat at the same time...that's what I get for stocking up when they went on clearance!
I test for ketones whenever I catch her in the box, she has always been negative or between negative-trace, I have a hard time with matching the color sometimes.
The vet prescribed 2u of Lantus bid but I need everyone's help in determining the proper starting dose because of her previous use of ProZinc.

Now about adhering to the protocol...I want the best chance of remission for Morlei so I would like to follow it as closely as possible. However, the only days of the week either myself or my fiance can get a proper curve is Sat, Sun, and Mon. On the other days of the week I can only test from +7/+8 to PMPS then PMPS to about +3/+4. For people who work during the week, how do you follow the protocol (while still maintaining a job and at least part of your sanity)? Thanks!

Morlei on her testing blanket giving me the "hurry up and test me so I can eat!!!" glare.

 

[Sandy and Black Kitty]

Re: Making the switch to Lantus - Need help with initial dos

Hi there and Welcome to Lantus Land

Sounds like you already know the basics of feeding and testing. I believe the TR protocol gives you your kitty the best shot at possible remission. Check it out - ask questions...

Folks who work have strategies to manage work and TR - I'm sure they will chime in with tips around testing times.

I don't have personal experience switching from Prozinc to Lantus, however there are others who do. going by the TR guidelines, 1.5u would be a starting dose for a 13 lb. kitty.
Regarding testing for ketones, I found if I read the strip next to a window in daylight it was easier to see the result.

 

[Blue]

Re: Making the switch to Lantus - Need help with initial dos

Hello everyone!

We have been using ProZinc since Morlei's dx on 1/2/12. She has never dropped to what would be considered a "normal" number, I think her lowest has been 152. She likes to hang out between mid to high 200s, even with dose increases/decreases. We had some success at the beginning and got some blue numbers but now it just seems like whatever dose we give her the numbers stay the same. So after showing the vet that the original prescribed 3u wasn't doing as much as we would like we got the script for Lantus. I bought the Solostar pens and U100 3/10cc syringes with half unit markings. They only had 29 gauge, I would have preferred 30 but we used 29 with the ProZinc so it's no big deal. I'm going to watch the video on how to draw the insulin out of the pen tomorrow night.
Morlei is on a wet food diet, was Sophisticat but we are transitioning to Fancy Feast because apparently all four cats decided they hate Sophisticat at the same time...that's what I get for stocking up when they went on clearance!
I test for ketones whenever I catch her in the box, she has always been negative or between negative-trace, I have a hard time with matching the color sometimes.
The vet prescribed 2u of Lantus bid but I need everyone's help in determining the proper starting dose because of her previous use of ProZinc.

Now about adhering to the protocol...I want the best chance of remission for Morlei so I would like to follow it as closely as possible. However, the only days of the week either myself or my fiance can get a proper curve is Sat, Sun, and Mon. On the other days of the week I can only test from +7/+8 to PMPS then PMPS to about +3/+4. For people who work during the week, how do you follow the protocol (while still maintaining a job and at least part of your sanity)? Thanks!

Morlei on her testing blanket giving me the "hurry up and test me so I can eat!!!" glare.

What a sweet looking girl, your Morlei! I love the picture!

It sounds like you are doing great in your preparations, and I just wanted to say a few things.

About the curves, please don't worry because tons of people are working Monday to Friday and they are not home to do much testing, so curves are usually done on the weekends or whenever a person has days off.
On a typical work day, I may test in the am before shot time and while getting ready for work. Then, I could get a test when I come home from work, then a test just before the pm shot. During the evening, I try to get a few tests, but for sure, a test just before bed is needed.
Then on the weekend, I try to get a curve with tests every 3 hours and sometimes every 2hrs.

I just wanted to ask what meter you are using for testing; the freestyle meters are not great, giving false readings, so if you are using that kind, you may want to switch to another type.

you can forget about the previous insulin as Lantus is quite different, and you would likely be safe to start Lantus at 1u dose, then build up the shed and increase as needed.

 

[arozeboom]

Re: Making the switch to Lantus - Need help with initial dos

Welcome!
I'm out of the house M-F from about 7:30 AM to 5:45 PM. I normally get in a +1.5 in the morning, maybe a +4 or +5, if I can sneak home at lunch and then as late as a +6 in the evening. This week in particular I haven't gotten a whole lot of sleep. She seems fine with the whole thing, I think. I'm having a rougher time that she is. If your finance helps with the testing, I would think that will make it easier on all three of you.

You can check out Ruby's SS if you want to see how her first week has gone.

 

[Anne & Zener GA]

Re: Making the switch to Lantus - Need help with initial dos

Hi Becky, welcome to Lantus Land! I hope lantus works well for Morlei. What a cutey! Initial dosing is based on weight so Morlei will have to 'fess up with the real number. I don't know the formula although someone will come along who does.
Liz, Zener's other mom

 

[kim and simon]

Re: Making the switch to Lantus - Need help with initial dos

Welcome, Becky and Morlei! I love the picture of you on your testing blanket, Morlei. Looks like you are good at following "the procedure" so you can get to the fuds!
My cat was diagnosed in January, so I'm kind of new here. I will just say welcome and best wishes! There are lots of helpful people here in Lantus Land.

 

[julie & punkin (ga)]

Re: Making the switch to Lantus - Need help with initial dos

my understanding is the weight based formula is for cats that are newly diagnosed. when a kitty has already been on lantus their previous dose and BG numbers are taken into account for the initial dose. sounds like we've got a day or so to figure that out.

we'll give you some ideas on working around your work life. it's do-able - most of us have plenty of commitments as well. your syringes sound fine - glad you're going to take a look at the sticky and the video. it's expensive enough that you want the lantus to last as long as possible!!! the food sounds good too. just fyi - apparently the fancy feast turkey & giblets and savory salmon are both 7% - they were reformulated since the Janet & Binky's list was last updated. we feed mostly chicken feast and beef feast (both 4%) to punkin, with fish not more than once a week. fish can be hard on boy kitty's plumbing!

most of us don't do "curves" per se - at the beginning the protocol calls for you to test preshots, +3, +6 +9 and pm preshot. might be a good idea to start on Friday night or Saturday morning so you have a couple of days to watch numbers as she settles in. once Morlei (is that pronounced Mor-lee? gotta get it right in my head! LOL) has a few tests we'll be able to see how she responds to the insulin and we'll be able to help you figure out which tests are the most important to get. we each get those particular tests for our cats based upon what we've learned about our own cat. some people adjust the shot time to accommodate their schedules. it also really helps to have a timed feeder so you have peace of mind when you leave the house for work. if you can leave food it's like insurance.

glad you're checking in and opening a condo - i've seen you pop up here and there with Amy & Ruby! nothing like knowing someone before you move to a new place! always makes it nicer and easier!

welcome to lantus land! glad you're here!

 

[Jill & Alex (GA)]

Re: Making the switch to Lantus - Need help with initial dos

hi becky! happy to hear you're getting ready to make the switch to lantus.

as far as an initial starting dose goes... julie's right. we like to give careful consideration to kitty's performance on the insulin used previously. i think you could start at 2u - 2.5 units bid. 3u of prozinc didn't seem to do much and when you dropped the dose to see if it made any difference... it didn't.

if i were in your shoes, i think i'd start at 2u bid. we can always fast track you up the dosing scale if it's obvious the starting dose was too low instead of holding the initial starting dose for the customary 5 - 7 days. you'll want to test at shot times and at +3, +6, and +9 for the first 3 days. you'll also want to continue to test for ketones. please post daily so we can track morlei's progress... in case dose adjustments need to be made sooner rather than later.

two questions:
--- does morlei have a history of DKA?
--- are you using a freestyle meter?



edited to add:
i forgot to mention...
the reason for testing so often in the first 3 days is because some kitties experience a significant drop sometime within the first few cycles. it doesn't necessarily mean the starting dose was too high. it's just better to watch for the drop in the off-chance it'll happen to morlei.

 

[Becky & Morlei]

Re: Making the switch to Lantus - Need help with initial dos

I just wanted to ask what meter you are using for testing; the freestyle meters are not great, giving false readings, so if you are using that kind, you may want to switch to another type.

We are using the Relion Micro, I'll put it in my signature because I'm sure I'll be asked that a lot!
I also have the control solution from them and use it before every new bottle of strips.

Welcome!
I'm out of the house M-F from about 7:30 AM to 5:45 PM. I normally get in a +1.5 in the morning, maybe a +4 or +5, if I can sneak home at lunch and then as late as a +6 in the evening. This week in particular I haven't gotten a whole lot of sleep. She seems fine with the whole thing, I think. I'm having a rougher time that she is. If your finance helps with the testing, I would think that will make it easier on all three of you.

You can check out Ruby's SS if you want to see how her first week has gone.

I will definitely check it out! Thanks!

my understanding is the weight based formula is for cats that are newly diagnosed. when a kitty has already been on lantus their previous dose and BG numbers are taken into account for the initial dose. sounds like we've got a day or so to figure that out.

we'll give you some ideas on working around your work life. it's do-able - most of us have plenty of commitments as well. your syringes sound fine - glad you're going to take a look at the sticky and the video. it's expensive enough that you want the lantus to last as long as possible!!! the food sounds good too. just fyi - apparently the fancy feast turkey & giblets and savory salmon are both 7% - they were reformulated since the Janet & Binky's list was last updated. we feed mostly chicken feast and beef feast (both 4%) to punkin, with fish not more than once a week. fish can be hard on boy kitty's plumbing!

most of us don't do "curves" per se - at the beginning the protocol calls for you to test preshots, +3, +6 +9 and pm preshot. might be a good idea to start on Friday night or Saturday morning so you have a couple of days to watch numbers as she settles in. once Morlei (is that pronounced Mor-lee? gotta get it right in my head! LOL) has a few tests we'll be able to see how she responds to the insulin and we'll be able to help you figure out which tests are the most important to get. we each get those particular tests for our cats based upon what we've learned about our own cat. some people adjust the shot time to accommodate their schedules. it also really helps to have a timed feeder so you have peace of mind when you leave the house for work. if you can leave food it's like insurance.

glad you're checking in and opening a condo - i've seen you pop up here and there with Amy & Ruby! nothing like knowing someone before you move to a new place! always makes it nicer and easier!

welcome to lantus land! glad you're here!

Thanks for letting me know about the Turkey & Giblets, I just fed that to her the other day, didn't really have any effect on her numbers but I like to keep her under 4-5%. Her name is actually pronounced Mor-lay. I modified it from Morleigh (Mor-lee)...got the name from U2 guitarist Edge's wife haha.

"hello and welcome becky!
we do not use the weight based formula nor do we recommend a standard starting dose of 1u bid for those switching from another insulin. instead we give a whole lot of consideration to kitty's performance on the insulin used prior to the switch.
when you're ready to switch, please start a thread asking for recommendations." - Jill & Alex
This is from Amy & Ruby's Lantus convo when we were talking about what to do for the initial dose. I'm hoping she'll stop by and give me her recommendation for a starting dose.

Thank you for the warm welcome! I can't say I'm looking forward to this new adventure but I'm happy to have all of you by my side!

 

[Jill & Alex (GA)]

Re: Making the switch to Lantus - Need help with initial dos

I'm hoping she'll stop by and give me her recommendation for a starting dose.

she did! look above your post. :lol:
i think i posted while you were typing.

 

[Marje and Gracie]

Re: Making the switch to Lantus - Need help with initial dos

Welcome Becky and Morlei!

We're so glad to have you here in Lantus Land. We look forward to seeing you post as often as you can and we'll be here to answer your questions.

 

[Becky & Morlei]

Re: Making the switch to Lantus - Need help with initial dos

I'm hoping she'll stop by and give me her recommendation for a starting dose.

she did! look above your post. :lol:
i think i posted while you were typing.

Haha thanks Jill, you're awesome! I didn't even see it! We'll start on 2u Saturday morning.
To answer your questions: No history of DKA and we're using the Relion Micro.

 

[Ella & Rusty & Stu(GA)]

Re: Making the switch to Lantus - Need help with initial dos

Hi Becky & Morlei,
Welcome to Lantus Land! We're very glad you're here. It sounds like you are all ready to begin the Lantus "adventure". Ask as many questions as you need. Someone will always be here for you.

Ella & Rusty

 

[Becky & Morlei]

Re: Making the switch to Lantus - Need help with initial dos

I have a question about feeding during the first few days on Lantus (and when doing curves). Morlei's numbers never shot up while feeding her four times a day on the ProZinc, but do I need to hold off on the two feedings that are between shots until I see her nadir on the Lantus? Or should I just continue with my normal schedule because that's what she's used to? I really can't go down to two meals a day permanently because she won't have it and it's not fair to my other cats that like to eat less but more frequently.
Thanks!

 

[arozeboom]

Re: Making the switch to Lantus - Need help with initial dos

Based on my experience (you know, because I've had a whole week of experience!), I just pull Ruby's food 2 hours before her shots. She grazes the rest of the time. She's pretty carb sensitive though and gets bit of a food spike.

 

[Sandy and Black Kitty]

Re: Making the switch to Lantus - Need help with initial dos

Feed as usual, just not after +10 (that could artificially inflate the PS number)

ECID however many kitties do best with several smaller meals per day - easier on the pancreas.

I use a timed feeder so BK is fed around the clock - AMBG, +4, +8, PMBG, +4, +8.

 

[Becky & Morlei]

Re: Making the switch to Lantus - Need help with initial dos

Based on my experience (you know, because I've had a whole week of experience!), I just pull Ruby's food 2 hours before her shots. She grazes the rest of the time. She's pretty carb sensitive though and gets bit of a food spike.

Still more experience than me!

This is our feeding/shot schedule:
10-10:30am: AMPS-1/2 5.5oz or 1 3oz can wet food-SHOT
5:30pm: 1/2 3oz can wet food
10-10:30pm: PMPS-1/2 5.5oz or 1 3oz can wet food-SHOT
1-2:00am: 1/2 3oz can wet food (she sometimes will not finish this one because it is so close to her evening meal but always has it finished by 4-5am)

So as long as there's no food 2 hours before the shots I am safe to keep her two snack times? I just want to make sure we are getting the correct numbers so we can accurately increase/decrease her dose. With the ProZinc I didn't have to worry as much because it was based off the pre-shot numbers, not the nadir.

 

[Becky & Morlei]

Re: Making the switch to Lantus - Need help with initial dos

Feed as usual, just not after +10 (that could artificially inflate the PS number)

ECID however many kitties do best with several smaller meals per day - easier on the pancreas.

I use a timed feeder so BK is fed around the clock - AMBG, +4, +8, PMBG, +4, +8.

Thanks Sandy! Just wanted to make sure before we start tomorrow. Everyone is so fast at posting here, I'm typing up a response and I already have an answer by the time I post! You're all awesome!

 

[julie & punkin (ga)]

Re: Making the switch to Lantus - Need help with initial dos

once you get started there might be some adjustments here and there, but however you start, stick with it for a few days so we can see how it goes. when you've got multiple factors (the dose, the timing of eating and carb content of food) it's best if we only adjust one factor at a time to see how things are affected.

punkin is not a grazer (he's a Hoover!) and i found that his numbers were better if i gave him all of his food with his shot and in the first 3-4 hours after the shot. at the beginning i put out a small meal at +6, but past the nadir can mean that the insulin strength is past and nothing's available to work on the carbs. i've probably said that badly, but you get the idea. for grazer kitties, as long as they don't eat in the 2 hours preshot, that's usually fine.