ProZinc to Semglee Switch w/ketones- advice??

Good morning, I'm looking for some advice/experience from those of you who may have switched from ProZinc to Semglee (or Lantus) and/or have experience with ketones. Jack's numbers were not really coming down on the ProZinc and so I asked the vet to switch to Semglee or Lantus (was only able to get Semglee generic so that's what we are moving to) We started at 1unit of generic Semglee this morning, from 5 units of ProZinc. She was unable to tell me what to expect on his numbers, but said not to increase to 1.5u until at least 3 days (6 cycles had passed) even if I see 500+ on the BG. Does anyone have any advice or experience they can share? I'm working from home so I can monitor his BG every 3 hrs today but other than that I'm a nervous wreck he's going to go sky high...he was already 372 at his AMPS.

Also, Jack has been showing ketones (0.3-0.8 mmol/L until this morning when we got 1.0) in his blood (completely unable to get a urine sample from this boy) which despite an emergency trip to vet for fluids, and continuing to do 200mls fluids daily (just about a week now) they seem to be increasing instead of decreasing. The vet doesn't seem as concerned about them as I am, and claims other than bringing the BG down (obviously) and fluids there is nothing to do for him. I am not seeing any signs of ketoacidosis....he's eating, drinking, moving around, etc. I don't smell anything wrong with his breath. Any advice or anything else I can do for these? And what is a true, run to the ER and bankrupt myself ketone number on a Nova max Plus blood ketone meter??

Thanks in advance!

 

First, you do not need to start your dosing over when make a switch from Prozinc to glargine. They are entirely different types of insulin and if Jack wasn't seeing much movement at the old dose of Prozinc it makes no sense to drop the dose. Some cats do have a marked response to an insulin switch so you could drop the dose from 5.0u to 4.5u but I would NOT drop the dose back to 1.0u.

Part of the reason for not dropping the dose precipitously is that it will take 5 - 7 days for the insulin depot to stabilize. You won't see glargine having the effect you're looking for until the depot is formed, providing you're at what will be a good dose for your cat. Glargine is a very different insulin than Prozinc. I'd encourage you to take a look at the sticky notes at the top of the Lantus board in order to have a better understanding of the difference. You may also want to consider posting there. One quick question -- Are you using different syringes for glargine than you were using for Prozinc? Prozinc is a U40 insulin and you need U40 syringes. Glargine is a U100 insulin and you need U100 syringes.

This post on ketoacidosis has links to a couple of journal articles that discuss what numbers to look for on a ketone meter. Generally, around 2.4 and above is a concern.

 

Yes, I am using U100 syringes. I already gave him the 1u this morning; you recommend going up to 4.5 at PM shot time? I'll check out the sticky notes, thanks for your reply, and the ketone advice; I don't think the link to ketoacidosis is a hotlink, but I'll search the forum.

 

Sorry about that! Here's the link.

I would increase this evening. Just make sure to get some tests in to make sure Jack isn't one of those kitties that makes a transition "exciting."

 

Thanks again! I plan to test every 3 hours today- I'm working from home. And thanks for the link!

 

Jack's numbers so far today: AMPS 7am =372, 10am= 299, 1pm =274, 4pm= 381. I need to make a decision on what dose to give him at his PMPS, which is 7pm. Seeing how far down he came today, I don't know if 4.5 units would be too much. What do you think I should do...stay at 1unit? Semglee is like Lantus where it is a depot insulin that sort of 'builds up' in his system, right? Or maybe I didn't understand that correctly. I just don't want to give him too much....

 

Semglee is a generic form of Lantus -- they are both glargine. They are both depot insulins since they are the same thing. With a switch between Lantus and Levemir (both are depot-type insulin), you drop the dose by 30%. If that would make you more comfortable, a drop in dose by that amount would be 3.75u.

 

Since we started at 1unit yesterday, and Jack went down to 274 at the +6 hr mark, I was concerned about raising the dose to 4.5 as was suggested here. That seems a drastic increase, and to my understanding the glargine stays in his system longer, so any increase in dose is also acting off the previous dose. I'm doing fluids at home to manage the ketones, but don't want to get into a hypoglycemia situation. I'm working from home so I can watch and test frequently, but still don't want to get to that point. I'm trying to rearrange my thinking as suggested by other members to not focus on the AM & PM PS numbers, but when I saw 459 and 0.8 blood ketones this morning, I must admit I was unhappy. I saw you suggested trying 3.75units but I had already given him 3units by the time I got back to see the post. What should I do about the PM shot? Stick to 3units? Go to 3.75? Go to 4.5? I was trying to do SLGS because that got my other cat into remission, but upping Jack's dose every time doesn't follow that. But then, I do want the best dose asap and we do have the ketone issue. I just want to do what is best for the cat and that doesn't give me a stroke from stress. I appreciate any and all advice. Thank you.

 

The piece that I think you're missing is that it takes about a week to stabilize the depot. As I mentioned previously, some cats have a marked response to a change in insulin but that response is short lived. The overlap between doses is not likely to happen until you've been using glargine for 5 - 7 days. If you've not already seen it, this is a link that provides more background on the insulin depot.

At this point, perhaps sticking to 3.0u would do what's best for your stress level. You can't take care of Jack if you're having a stroke!! If you're considering TR, we have the option of fast tracking the dose if it's clear that 3.0u isn't giving decent results.

Also, if Jack isn't fully transitioned to canned food yet, you're only option regarding dosing is SLGS. To use TR, your cat must be eating a low carb, canned food diet.

 

Thanks for the link...I have read it a few times, it doesn't stick or make total sense all the time...i think the anxiety is creating a mental block. He hates wet food, i have read the sticky by Dr Lisa...it doesn't seem to work in our multiple cat household, between my crazy and ever changing work schedule, and Jack's behavior when trying to get him to eat wet food. I think we are stuck with SLGS for now because he only picks at wet food, no matter how attractive I try to make it or what brands I offer. I'll stick with 3units for at least the next 6 cycles and post every day for dosing advice/support with his bg and ketone issues. Thanks again for everything!