Maybe switching insulin, ketone questions

[Howiesmom]

I find out tomorrow the results of Howie’s Tests for IAA and Acromegaly as his dosages just aren’t doing anything and it’s almost time to bump him up to 5units. Depending on those results, my vet has seriously talked about switching him from Prozinc to Glargine (I’m guessing Lantus). What should I know about switching insulin? Based on his SS, are there recommendations out there of what his starting dose should be? I want to make sure we don’t start him too high. I’ve read the sticky notes on Lantus and it sounds more intense than Prozinc.

Also, he has had small amount of ketones for a couple weeks (originally caught them at Labor Day), they went away for a few days and now are back. I give him 50mL sub q fluids twice a day when he is eating, but he’s really starting to hate me as he won’t stand still and I’m sure I hit muscle. We just can’t shake these ketones though. He’s eating fine and is perky. Any advice on other things to try/do besides fluids? Is it uncommon to have ketones for a longer period of time? Believe me...I know they’re not good.

 

[Chris & China (GA)]

Based on his SS, are there recommendations out there of what his starting dose should be?

When switching insulin's, we take into consideration the dose you're already on, so you'd actually start Lantus at no less than 4U

Just be sure to test frequently, especially for the first several days. Some cats react differently so you want to keep a close eye on him.

 

[Bron and Sheba (GA)]

How often are you testing for ketones? and how many ketones each time you test?
Are you recording them anywhere? Recording them on that SS is a good idea, then we can see the results quickly.

The only issue I can see with changing to Lantus (glargine) from Prozinc, is that the depot Of the Lantus needs to fill over a few days and until then the full effect of the dose is not felt and with ketones in the picture, you will need to be testing for ketones twice a day to ensure the ketones don’t increase during this period.

I don’t think Lantus is more intense than Prozinc, it’s a depot insulin and not an in and out insulin like Prozinc.

You could try feeding more food to try and get rid of the ketones. The other thing to do is increase the insulin dose. But if you are going to swap insulins you need to do one thing at a time.

Lets see what the test results are and in the meantime increase the food intake..
When you are ready to swap insulins post and ask for help.

ETA: if there are still ketones showing, you might be better to stay with prozinc temporarily and increase the dose of prozinc and get rid of the ketones first, before swapping to lantus.
Lantus is a great insulin but when there are ketones in the picture its not the best time to swap, because the depot takes a few days to fill.
Another thing to consider is, if the results do come back and Howie is acro, Levemir would be a better insulin to swap to as it doesn't sting in larger doses. It is much the same as lantus as far as action and depot is concerned.

 

[Howiesmom]

When switching insulin's, we take into consideration the dose you're already on, so you'd actually start Lantus at no less than 4U

Just be sure to test frequently, especially for the first several days. Some cats react differently so you want to keep a close eye on him.

Thank you so much! This is very helpful!

 

[Howiesmom]

How often are you testing for ketones? and how many ketones each time you test?
Are you recording them anywhere? Recording them on that SS is a good idea, then we can see the results quickly.

The only issue I can see with changing to Lantus (glargine) from Prozinc, is that the depot Of the Lantus needs to fill over a few days and until then the full effect of the dose is not felt and with ketones in the picture, you will need to be testing for ketones twice a day to ensure the ketones don’t increase during this period.

I don’t think Lantus is more intense than Prozinc, it’s a depot insulin and not an in and out insulin like Prozinc.

You could try feeding more food to try and get rid of the ketones. The other thing to do is increase the insulin dose. But if you are going to swap insulins you need to do one thing at a time.

Lets see what the test results are and in the meantime increase the food intake..
When you are ready to swap insulins post and ask for help.

ETA: if there are still ketones showing, you might be better to stay with prozinc temporarily and increase the dose of prozinc and get rid of the ketones first, before swapping to lantus.
Lantus is a great insulin but when there are ketones in the picture its not the best time to swap, because the depot takes a few days to fill.
Another thing to consider is, if the results do come back and Howie is acro, Levemir would be a better insulin to swap to as it doesn't sting in larger doses. It is much the same as lantus as far as action and depot is concerned.

So much good info! Thank you! He just shows small amount (15) on the ketone sticks I have. He had a urine test done last week and that’s what it showed as well. He’s been begging for more food even though he already gets 400 cal (8.8lb cat) already. I didn’t realize food intake can impact ketones so much! Hopefully the vet calls today with his results...his first day back from vacation and it’s his normal surgery day. I will for-sure reach out with more questions!