Switch to lantus: Do ss #'s look ok?

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Kim & Twice

Kim & Twice

Member Since 2013
Hello All,

I did it. I made the switch to Lantus! Well....I picked up the Lantus. Would you recommend .5 units as a starting dose and are the U40 syringes the right ones for this insulin? I'm going to start this after work today so I can get some decent data. Also, do I feed before the dose as I did with Caninsulin?

Thank you
 
Re: Switch from Caninsulin to Lantus

Hiya Kim,

Yay! Well done!

I'm pretty sure that Lantus is a U100 insulin (check to see if it says 'U100' on the vial), so the U40 Caninsulin syringes will be the wrong sort. It should be possible to get U100 syringes with half-unit markings too. You'll find them pretty tiddly after the Caninsulin syringes!

I think too that you can't put Lantus back into the vial as you might with Caninsulin. So any excess drawn up into the syringe needs to be discarded. (Lantus folks please correct me if I'm wrong!)

As to when to feed, I've no idea and so will leave that to the Lantus folks here (of which there are many!) :-D . Just wanted to let you know about the syringes to give you time to get some for later...

Edited to add:
Kim, here are links to 2 stickies from the Lantus forum. The first here is about handling and storing Lantus, and the second gives info on the 'insulin depot' which is very useful for understanding how Lantus will differ from Caninsulin.
viewtopic.php?f=9&t=151#p873
viewtopic.php?f=9&t=150#p857

Good luck, Kim! Here's hoping this is the beginning of great things for Twice!

Eliz
 
Re: Switch from Caninsulin to Lantus

Hi Kim,
You need U100 syringes for Lantus. They should have orange caps over the needle. They are available with half-unit markings on them which makes dosing easier. You DON'T want to use the U40 syringes with Lantus, because you would be giving two and a half times as much insulin than you think you are giving.
 
Re: Switch from Caninsulin to Lantus

The sequence with Lantus is the same - test, then feed, then give the shot. You don't need to delay after feeding like you might with Caninsulin. Some people give the shot while kitty is eating and distracted.

What dose of caninsulin have you been giving?
 
Re: Switch from Caninsulin to Lantus

Yes, you need to get U100 syringes and try to get them with 1/2 unit marks. Just to let you know, some pharmacies don't even know they have syringes with 1/2 unit marks and will tell you they don't but they do. If you live near a WalMart a lot of us use the Reli On brand.
Lantus takes up to 2 hours to take affect (reach onset), so you have some time to get food in before the insulin starts to lower the BGs. We do test, shoot, feed, but some do test, feed, shoot, but it's all done within 5 minutes.
Good luck with the Lantus. It's a good insulin for cats.
 
Re: Switch from Caninsulin to Lantus

Good luck with the Lantus :-D Chyna was on Caninsulin to start with and I switched to Lantus after a month and a half (and it helped her to remission). Make sure not to roll/mix the Lantus. I kept mine in the original box, then in a mug with a handle on the middle top shelf of my fridge to prevent jostling (don't keep it in the door).

The reading stickies Elizabeth posted should help:) There are Lantus forums if you're interested found here http://www.felinediabetes.com/FDMB/viewforum.php?f=5. Tight regulation is the busiest and has a stickie for new people to read near the top of the page that will explain how that forum works. I started not knowing which protocol I was going to follow but still posted in tight regulation.

I always fed right after Chyna got her Lantus, since she always gulped it up (she loved the change to wet food so that was a treat) and then had several small meals left out as "catsickles" (frozen portion of cat food mixed with water) or in an autofeeder. On the days she didn't feel like eating then I worried especially when I had to leave for work, so it doesn't hurt to feed before the shot just to make sure they have food on board. I know quite a few people do mini meals for the first few hours (with autofeeders when working) when the nadir is early onset if their cat drops BG quickly and some do mini meals up to nadir but every cat is different and some have very late nadir. I know and remember there is a lot of reading and it's different from the Caninsulin so post with questions if it's overwhelming :shock: Hope you have a great day!
 
Re: Switch from Caninsulin to Lantus

Welcome to FDMB!

The starting dose of Lantus can be based on your cat's ideal weight. However, you also want to take your current dose and other factors, such as any medical issues, into consideration. How much does Twice weigh? Unless your cat is very thin or very "fluffy," this usually calculates out to somewhere in the neighborhood of 1.0u.

I looked at your SS. There is a version of the World SS that has a tab that automatically converts the numbers into the US format, which is what we use here. This is the link to the instructions. You'll see the link to the World template with the automatic conversion under the "Getting & Using the Template" instructions and you want the 2nd template in the instructions. It will make it much easier for you when you're posting unless you want to manually convert the numbers. Likewise, most people will not be familiar with making the conversions so it will be easier to offer assistance if you have a SS that does the conversions automatically.

I'd encourage you to read the starred sticky notes at the top of the Lantus board. There is a wealth of information in those notes that will help to get your started.
  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal version -- the “Tilly” Protocol developed by the counterpart of this group in Germany, which was also published by Kirsten Roomp & Jacqui Rand, DVM in one of the top vet journals.
  • New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
  • Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
  • Lantus depot: This is an important concept for understanding how Lantus works.
  • Lantus & Levemir: Shooting & Handling Low Numbers: What data you need in order to be able to work toward remission or tight regulation as well as information if you have a low pre-shot number or a drop into low numbers during the cycle.

A couple of points that differentiate Lantus from Caninsulin.
  • Lantus dosing is based on the nadir (lowest point in the cycle) and not on the pre-shot value. Thus, you do not change the dose based on the pre-shot (unless you test and the number is too low to shoot).
  • Generally, dose adjustments are made in 0.25u amounts. This is why people were encouraging you to get syringes with half unit markings.
  • Lantus is a depot-type of insulin. This allows it to have a long duration and allows for a cumulative effect. It also makes Lantus gentle compared to Caninsulin. Because it is a depot insulin, doses need time to "settle." Unless a dose reduction is indicated, a dose needs consecutive days to see if it is effective. It can take between 5 to 7 days when starting Lantus for the depot to stabilize.

Please let us know if you have questions. The people here are very generous with their time and their information and everyone is here to help.
 
Re: Switch from Caninsulin to Lantus

Thank you everyone. OK, so Twice weighs 12lbs now...lost alot of weight and muscle tone after the predisone. He has been getting 1unit caninsulin in a.m. and 1.5 in p.m.
I got the syringes with the half marks as suggested. Still not sure what dose to start him on tonight? Is it the 1unit?
 
Re: Switch from Caninsulin to Lantus

I see the conversions (although I'm Canadian so I look at mmol/L and despite being on the boards awhile I still write all mine down as that and understand it best ;-) ) I'm not a dosing expert although going by weight only it looks like it would be a good start as 1u, so hopefully someone can chime in on that. If you want to add something like "switch from caninsulin to lantus: what dose?" into your original subject line it may get more eyes on here for you :-D Just hit edit on your original post and it will let you change the subject line:)
 
Re: Switch from caninsulin to lantus: what dose?

Thanks for the tip on editing Rachel. I'm supposed to give Twice his meds in 10 minutes, so I think I will go with the 1unit. I have been reading all the sticky's I can get my eyes on, but I'm still unsure about this dosing thing with the Lantus. You dose by the nadir, but what if you can only get one nadir reading in 24 hours? Also, I see that I am to stick with a dose for 5-7 days to give everything time to set up. When do I start this dose by the nadir routine... I have seen the notes on what to dose for different nadir ranges, just not sure when to use this info...
 
Re: Switch from caninsulin to lantus: what dose?

Yes Kim....I'd say 1 unit is a good dose to start with...it's where most of us start unless the kitty is really small.

Just remember to get a pre-shot before giving anything (without feeding for at least 2 hours) and we recommend you don't shoot if the pre-shot is under 200 (at least at first)

You can "stall", don't feed, and retest in 30 minutes if you get a number under 200...and use that time to post so someone can help you through it.

As you get more data on how Twice responds to the Lantus, you'll gradually learn to shoot lower numbers, but for now, keep it at 200 or above unless you have help from someone here.

Getting a +2 or +3 is a good indicator of how active the cycle might be too. A similar number to the pre-shot number and it'll probably be a quiet cycle. A big decrease from the pre-shot number, and it's probably going to be an active cycle requiring more testing.

Get a "before bed" test in too if possible. The sooner you get the data, the sooner you'll be able to really see how Twice is doing.

Good luck to you!! Happy to see you using a better insulin for Twice too! :-D
 
Re: Switch from caninsulin to lantus: what dose?

For now, get as many tests in as you can Kim....We will help you learn how to read the patterns as the week goes by. You want to keep giving the same dose for the 5-7 days UNLESS Twice drops below 50, which earns a reduction of .25

What's your current shooting schedule and work schedule? We may be able to help you adjust it so you can get more tests in
 
Re: Switch from caninsulin to lantus: what dose?

One more "tip" for your Spreadsheet....You need to make it VERY clear that you've changed insulins...You might want to either put CHANGED TO LANTUS in caps in the Remarks and then click on the little paint bucket and choose a color to make it stand out, or you can even add another line and in the PM cycle for tonight, you can put L A N T U S (use one letter in each space) and then start a new line with your PM cycle readings for tonight

So you could have 2 lines for 10/19

One with the AM dose/readings and then in that same line, in the PM cycle put L A N T U S
and then one line under that for 10/19 and just the PM dose..and maybe even L A N T U S in the AM cycle info....it's just important that you somehow make it stand out on your spreadsheet until more people know you've changed over :-D
 
Re: Switch from caninsulin to lantus: what dose?

Thank you Chris. I made the ss changes. Starting to feel like a pro at that part..lol.
As for my schedule;
4am-wake up, feed dogs, make lunch, get ready for work
5am-get preshot, feed Twice and all the other kitties, give the insulin, leave for work
4pm-Return from work
5pm-get preshot, feed and insulin
I try to get a couple more readings in here +2, +4, ..
9pm-sleep

I work 6-7 days/week. I no longer work the 12hr shift though as I would be gone from the house for 14hrs at a time. Too long for Twice to wait or have any sense of a normal life.
 
Re: Switch from caninsulin to lantus: what dose?

OK...if you just changed your schedule a little, and when you first got up, got your Pre-shot, fed and shot Twice, you could make your lunches, feed the dogs and get ready for work, and get a +1 before heading out the door...that would help tell you if you might want to leave some higher carb food down for Twice in case he's dropping too fast.

(Or you could get up at 3, test/shoot/feed and get a +2 which would be even better, but who wants to get up at 3am?..but you will eventually get to the point where you can "sleep test" too....there are lots of times I have gotten up at un-Godly hours to get a test, put the result on the spreadsheet and gone back to bed and if it weren't for the proof of the spreadsheet, I wouldn't have remembered doing the test...LOL)

Then when you get home at 4, you could repeat the AM routine...test/feed/shoot as you come in the door, and that would give you the opportunity to get some +2's and +5's routinely on the PM cycle...where they tend to go lower anyway

I know we have lots of people who work full time jobs and figure out a way to do it...some may even have to give the shots a little "off" the 12 hour schedule, but hopefully Twice will settle into some good, safe numbers for you soon
 
Re: Switch from caninsulin to lantus: what dose?

Thats great you have moved to Lantus! Make sure you read the links above that Sienne gave and ask questions!

This initial dose should be held for a week to allow the Lantus depot to build up (unless as Chris says, she drops under 50).

Then changes made in 0.25 increments - waiting 3-5 days each time. We can help advise on when and how much if you have questions.

Also make sure you keep the lantus in the fridge, not the door (read siennes link on storing and handling) and it should keep for up to 6 months.

Wendy
 
Re: Switch from caninsulin to lantus: what dose?

Thanks Wendy. I have been reading like mad here. Photocopying as needed for quick reference. Just want to do this right. I stayed home from work today as i wanted to get some more readings on Twice for this change (didn't notice I was down to 10 strips and no pharm open in our area). But should be able to get some decent readings to see how he reacts to this change. I will be keeping his ss up to the minute. I also set up another post about him getting a regrowth on his tongue (reason for pred long term in first place).
 
I got a bunch of numbers today to get an idea of how this insulin will work. Hoping for a couple more tonight.
 
Yeah it's still too early to know how the 1 unit dose is going to work, but with the drop from 261 to 122 in 2 hours means Twice is most likely going to have an active cycle, so it'll be important for you to test tonight...at the very least, I'd get a +5 or +6 (but I'd probably try to get a +4 and +6 and see how he's doing)

If he does happen to drop below 50, you'll want to catch it as soon as possible and bring him up some. If you DO get a number below 50, don't panic! Depending on how low he goes, you want to give a teaspoon or two of the "gravy" off of a Gravy Lovers type of food and retest in 20-30 minutes. (if he goes below 40, you'd want to give a little more gravy...or you can add a couple of drops of Karo or maple syrup into a teaspoon of his regular Low carb food) We would want to get him coming up into safer numbers, but not send him through the roof

After you give the gravy (or low carb food + Karo) use that 20-30 minutes and post and ask for help. You can use the 911 icon in the FIRST post so you'll get eyes on it quicker, but you should have the How to handle low numbers sticky printed out in case it takes a little while for someone to get online to help you.

I do not want to worry you...it's just better to be prepared than it is to panic....there's no way to know what he'll do later in the cycle, but a fast drop like that usually means an active cycle...and an active cycle doesn't necessarily mean a low one.
 
I just remembered you don't have a lot of strips...another way you can kind of tell his numbers might be going too low is he'll be really hungry. Most of our kitties will go looking for food when their numbers go lower (I know China is an absolute PEST, so it's a good sign for me to grab a quick test)

If Twice does go below 50, you'll need strips to keep testing until he comes up into the 60's and stays there without having any food for a couple of hours...which brings up the next topic...if at all possible, always try to have a spare box of strips tucked away...the one time you really NEED them is no time to not have them.
 
Ok. At the +2 he had dropped quick so I gave him about a tbls of fancy feast pate as a mini snack. He is now +4- 2.1mmol. I don't have that higher carb gravy food. Should I give some of the m/d kibbles I have left over?
 
You can crumble a few of the kibbles on the top of the food. Do you have any karo syrup or honey? Maple syrup?

You only have 3 strips? We will need to use them sparingly then.
 
OK. You will want to get another test 30 minutes after this last feeding. And post the number, I'll be watching for it.

It takes 30 minutes for the number to show up in his BG on the meter.

And you'll probably need to feed another tsp or two then, but depending on the number you see, you might need to add a half dozen drops of honey to it.

If he's ravenous, that is good. It's a sign he realizes his blood sugar is low, like a human will grab for a candy bar or coke when they go low. You just don't want him to eat too much too soon and not keep it down. "Scarf and barf" is what we call that. ;-)

You can go ahead and give him another tsp of FF now with 3 or 4 drops of honey on it.
 
Oh, and one thing you can practice in between tests and feeding? You'll need to see if you can eyeball .75u in the syringe. You can practice with water with a used syringe.

Dropping below 50 means he will be needing less insulin going forward.

You did a great job catching that quick drop at +2 and testing again at +4, by the way. :-D
 
Carl, it's 9:30 now and he's eating the wet food with a few drops of syrup. Do I test at 10pm, or now since I first fed him a bit at 9pm? Also, he's still hungry...I;m holding more food back though. Otherwise he seems coordinated.
 
Wait until 10, I would say. The two feedings should have brought him up by then.

If you see any weird behavior, test prior to that. We're trying to balance safe and "only 4 strips". I know you haven't done "this" before, but I have, lots of times. If you see anything weird, post as soon as you can. You're doing great!
 
Are you alone? Is there anyone who could make a quick run to get strips and/or HC gravy food?
 
Not alone, but an hour and forty five minutes to the nearest city center. We are in the middle of a very small farming area.
 
OK, then we'll work with what we have.

Definitely will want strips first thing in the morning though. If needed, we'll use all 4 tonight, and hold off on morning insulin until you can get some strips to test before that shot.
 
I promise to NEVER be this low on strips again. I can't believe I blew through 100 already. I feel just horrible.
 
Nah, don't feel horrible. You aren't the first person this has happened to. ;-) Kitties seem to plot these things!
 
This is just a recap (in US numbers) in case anyone else drops by...

PMPS ~ 261 1u
+2 ~ 122
+4 ~ 38 Fed 2 tsps LC
+4.5 fed 10 dry kibbles, and 1 tsp LC with few drops of karo
 
Thanks for checking in Carl!! I had a feeling this might happen!

Slow down and breathe Kim...38 is low, but I'm glad you caught it early!

We don't generally like using dry to bring up the numbers because it does take longer to break down and bring the numbers up..and then it takes longer to clear the bloodstream, which is why we say to keep that Hypo kit stocked up at all times.....stick to the low carb food and a couple of drops of honey or syrup but don't give him too much...we might want him to keep eating for awhile

Will watch for the test coming up at 10
 
OK...up to 43 so you want to go ahead and give him another teaspoon or 2 of low carb food, plus another several drops of Karo/syrup

Retest in an hour unless something tells you to retest sooner..we have to save those strips
 
OK, to me, that is a 43.

You will want to feed him 2-3 more tsps of LC with 5 or 6 drops of karo/honey mixed in, and let him munch. And test again in 30 60 minutes. Usually it's 30 minutes, but we're conserving strips and feeding a little more than "normal".

This is what we call "later, rinse, repeat". You want him up to 100 or higher in the next hour or two. So you're looking for a 5.6 or so.


You doing okay?
 
I thank you both so much Carl and Chris. I am so scared. Twice seems to be content enough right now. I'm trying to not be a wreck, because he is so sensitive to my feelings. He's sticking close by and gobbling up that food and syrup
 
Is it karo syrup you are using? If so, that's perfect. It's better than honey to bring up the numbers.


You're very welcome Kim. Great job putting the 911 Icon up. It caught my eye as I was checking the board. Try not to be a wreck. You're fine, and so is he.
 
Yeah Kim...You're doing great!

I haven't been on the board near as long as Carl has, but I've read a lot of posts and helped quite a few people through their low numbers. Carl's one of the best here so I'm glad he checked in and that you'd put the 911 up.

You can probably go ahead and take it down now. You have our attention and at least one of us will stay with you until we know Twice is OK for the night

If you get concerned again, put the 911 back up though. We want you to feel safe going through this...and believe it or not, the next time it'll be easier...and the time after that even easier
 
Yes I am giving karo syrup (corn syrup). You both have such supportive and kind words. I can't tell you how much it means to me.
 
Just checking in on you to say you're in awesome hands with Carl and Chris, and you're doing great! I know it's scary, I've been there, I think we all have! I wish you were closer so I could give you some strips, I grew up on a farm so totally get the isolated from stores thing. Our kitties like to keep us on our toes :shock: They also like night time pajama parties and fuds with syrup ;-) Keep up the great work :-D
 
Kim & Twice said:
Yes I am giving karo syrup (corn syrup). You both have such supportive and kind words. I can't tell you how much it means to me.
Click to expand...

Don't make me blush! Seriously, you're welcome. I will point out though that this isn't the very first time you've had to deal with an unexpected low number. It looks like you had to feed low numbers twice while using Caninsulin. And both times, Twice seemed to respond well to the food.

Lantus is just a different beast, and the nadir is usually later. But Twice should be getting close to that point now.

The goal here is to bump up the numbers using LC and karo, test an hour later, and hopefully see him rise the next couple of tests. 80, 100, or even higher.

He's "made his point". He says "1u is too much", the 38 means his dose gets reduced. He's likely the "bounce" due to the low number, so don't be surprised if you see a high number later tonight or tomorrow morning. It's expected, and no big deal. Bounces happen, and then they go away.
 
Keep on smiling :-D :-D :-D Reducie already :mrgreen: . I've noticed a lot of cats on here seem to prefer to have their beans stay up all night with them to pay attention and feed them good fuds :lol: What meter are you using? I noticed you're a fellow Canadian and was just curious, I ended up with Accu chek and got strips much cheaper off ebay to have a supply in the cuboard:) They were mucho expensive at the pharmacy but I did have to buy from there a few times when supply was too low for my liking :? And I just saw the avatar, what a pretty kitty Twice is :smile:
 
Carl-thank you for the heads up on his numbers. As I wont get the strips until about 9am and his dose is usually at 5am, I'm guessing I should skip the morning one entirely?
On the Caninsulin he shot up and down so fast I didn't have time to get too panicky. I also had a lot more supplies on hand :oops:

Rachel- I'm using the Bayer Contour meter and they give you a free meter every time you buy 100 strips. The strips apparently vary in price depending on where you live, which I think is bogus. But I'm in an area where they are more affordable I am told. $90/100.
 
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