Preparing to switch to Lantus, starting dose advice?

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Laurie and Mr Tinkles

Laurie and Mr Tinkles

Member Since 2010
First a little history: Mr Tinkles is about 12 yo, dx with FD 4/27/10, 600 BG, started on ProZinc. He is a bouncy guy, likes to give me some wild swings in BG levels at times, other times he stays with flat curves or nice gentle curves. He has no history of ketones. He does have chronic URI/eye problems (suspected herpes related), has been on 2 previous courses of Amoxicillin and AB eye ointment, along with l-lysine (500mg BID, vet approved). It never completely clears up, and It always flares back up after he finishes the AB. He is currently about 2 weeks into a long course of Azithromycin, 5 days to start, then every 2-3 days for 6 weeks, along with AB eye ointment. I stopped the l-lysine yesterday, giving him a break after reading that it isn't good to give it continuously. I'm not impressed so far with how well the Azith is working symptomatically, but his BG is showing some sporatic improvement. Today he surprised me with a 37 at +6.5. Never a dull moment with this boy!

I made up my mind about 2 weeks ago to switch to Lantus, got the insulin, read all the stickies, etc. and when I was all set to post here in LL, Tinkles decided to throw me a curve ball and started giving me some better numbers. I held off to see if it would continue, but I am back to preparing to switch again now. According to the protocol, he should be starting on a dose of between 1.25-1.5u of Lantus, based on his weight (12 lb). I wasn't sure how to take the ProZinc dose (1.5u) into account, so I am looking for some guidance on a starting dose.

FWIW, I am pretty happy with ProZinc overall, my boy just loves those wild swings and I'm hoping to keep him in good numbers more consistently with Lantus, with the goal of getting his URI issues and FD under control.
 
Welcome Laurie! For some kitties Lantus can work a little more potently than PZI/prozinc so a starting dose of 1u or 1.25u may be a better option than the 1.5u in light of that lovely 37 he threw you today! Also, when you do give the first dose, keep a close watch on those numbers because sometimes that first cycle or two of a switch can throw some curve balls in and of itself. For some kitties you will see a steady pattern with a predictable lower nadir with each dose increase (see Yoda's spreadsheet), and some kitties give you flat unmoving curves until it all of a sudden kicks in (see Oscar's latest numbers). As long as ketones don't crop up and numbers don't get too high - it is best to hold that first dose for 5-7 days. Oscar and Yoda are rooting for Mr. Tinkles!!!
 
welcome to Lantus Land, Laurie!

Was there anything different today that might have made Mr. Tinnkles go lower than usual? Or do you think it is because of the dose increase to 1.5? Just curious, wondering if it is the dose that caused the numbers or something else.
 
Thanks Kelly! I have seen where some kitties have gone pretty low on the first dose or two, so I certainly will be watching like a hawk the first few cycles. I'm a data fanatic anyway, and Tinkles loves to throw those curve balls to keep me guessing!

No problem with holding the dose, I used prozinc much like lantus anyway. I just didn't realize it until I read the protocol! :mrgreen:

Thanks Libby, I didn't do anything different than usual today, fed the usual amounts and times, except after the 37. Prozinc has big effects with tiny dose adjustments with Tinkles, but if you look at the SS, there is no real consistency in his response to any particular dose...meaning he may respond after one cycle, or it may take 2 or 3 cycles to show response. I have been going back and forth between 1.45u and 1.5u because neither one seems to be working well. I think some of the inconsistency is due to the URI, but I can't tie it directly to symptoms either. He does seem to be feeling a little better today, eyes at least, but nothing dramatic. I did give him the Azithromycin this morning, but other days I did that he didn't respond like this, so???
 
if you like to test, then I would probably start at 1.25. That's a smidge lower than his last ProZinc dose, which worked for him. He might (probably will) get high numbers for a few days. You have to not react to them, just keep giving the same dose until it's time for an increase. That is sometimes hard for PZI people (I know, I was one!). We'll look at his numbers in a few days and see if he needs an increase. We usually hold the first dose for 5 days, but if his numbers stay high and flat we might increase sooner. Of course, if he goes too low, then he gets a decrease regardless of how many days it has been.
 
....and now he's bounced up to 476.

I'll start him at the 1.25u tonight, and keep an eye on him overnight. It might be a good time to switch, with the bounce anyway. I'll hold the dose, don't worry. I'm good at holding doses! :mrgreen:

Thank you!
 
honestly, ProZinc is probably better at bringing down bounces, so it might be to your advantage to shoot ProZinc tonight and wait til tomorrow to start Lantus. Did I just say that? :lol: I guess I'm thinking you might as well give him a nicer number to start at, so he doesn't sit that high for too long. Up to you!
 
Oh well, too late, I already shot the lantus. Maybe he will be one of those that gets a good reaction on the first cycle. It's ok either way, he will have to go through the adjustment anyway. He usually clears the bounce pretty quickly.

So I need to test at +3, +6, +9 minimum, right? I'll test at +2 anyway, I usually do.
 
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