Switching from Isophane (Novolin N) to Lantus and confused

Myrtlesmum

Myrtlesmum

Member Since 2017
I've been reading up on all the info on this forum and succeeded in getting very confused! Myrtle has been on Isophane, may have a slight case of DKA (vet today gave her sub-cut fluids and told me to feed her as much as I can) and I'm about to go out and buy a ketone monitor. The vet said that if Myrtle's numbers tonight are between 15-20 (270-360) or over to start on 1 unit of Lantus, if less wait until the morning to make sure all of the Isophane is out of her system - does that sound right? Reading the stickies on this forum has scared me a bit though? Is nadir sooner with Lantus? I thought it was supposed to be less harsh than Isophane? or have I got it all wrong? Do I need to be testing more often with Lantus? I'm about to start a new job and I'll be getting up at about 5am and be out of the house for about 12 hours a day so if Lantus is less predictable than Isophane I don't know if I want to go down that road.... Or have I got it all wrong? Am I suffering from information overload?
 
Welcome. I was lucky that I wasn’t worked no but many have full time jobs. I would probably have followed SLGS if I was but this might be helpful to read.

http://www.felinediabetes.com/FDMB/...ion-possible-with-a-full-time-job-yes.129378/

Lantus doesn’t onset until +2 or +3 so it is more gentle. It’s dosed according to the nadir rather than preshot but preshot are important to make sure it’s safe to shoot.
 
If the vet thinks there is a ‘slight case of DKA’ I would not skip the dose of insulin tonight. If there are ketones in the picture you need to be giving insulin. I think it would be fine to start the Lantus at PMPS if it is 12 hours since the last shot.
If you are unsure about how much to give , post and ask for assistance
ETA did the vet give you the U100 0.3 ml syringes that go with the Lantus insulin?
Don’t use the U40 syringes with the Lantus
 
Bron and Sheba said:
If the vet thinks there is a ‘slight case of DKA’ I would not skip the dose of insulin tonight. If there are ketones in the picture you need to be giving insulin. I think it would be fine to start the Lantus at PMPS if it is 12 hours since the last shot.
If you are unsure about how much to give , post and ask for assistance
ETA did the vet give you the U100 0.3 ml syringes that go with the Lantus insulin?
Don’t use the U40 syringes with the Lantus
Click to expand...
I went out and bought a new glucose monitor today which also does ketones. The ketone reading just now (4pm) is 0.1 which after much googling I found out that under 0.6 is normal for humans so I figure (hope) that 0.1 is normal for cat. The dehydration may just have been because of the vomiting and eating less. She has Cerenia on board now as well as some fluids and seems perky (especially now that the sun has finally come out - I swear all that cat needs to be happy is a spot of sunshine to lie in). I used U100 0.3 syringes for isophane too so I'm good to go.
 
I did not skip a cycle to start Lantus, when switching from NPH. My switch was within a week or so post-DKA though so skipping insulin at any point would have been bad!
 
Novolin (also called NPH, N, Humulin N, Normal insulin) is much harsher than Lantus. It's onset is almost immediate thus, you need to have fed your kitty prior to giving a shot. Lantus onset takes roughly 2 hours for most cats and so you can test, feed, and shoot within a very few minutes. Again, for most cats, the nadir is at around +6 (6 hours after your shot). Lantus also lasts approximately 12 hours. Novolin's nadir is roughly at around +4 and it does not last 12 hours. It is not a long lasting insulin.

Because Novolin is a short to medium acting insulin, it should be out of your cat's system by the next shot time. There is no need to skip. Generally, you can give the same amount of Lantus as you've been giving of Novolin.

There are a few other differences between the two types of insulin.
  • Lantus dosing is based on the nadir, not on the pre-shot numbers. Since it sounds like you're out of the house during the day, you will want to do what you can to get tests during the PM cycle, weekends, holidays, if you wake up in the middle of the night, etc. so you have an idea of how Myrtle is doing on Lantus.
  • Lantus is a depot-type of insulin. This is not the case with Novolin. As a result, Lantus is more gentle but is less potent and you get longer duration with Lantus than Novolin.
  • Dose changes are held for at least 3 days on the TR Protocol or for a week if you use SLGS as your dosing method. Every time you change a dose, it has an effect on the depot. You need to give the depot time too stabilize. If you make back-to-back changes in dose, you get weird numbers.
  • As a result of the depot, Lantus does best with consistency. You have a relatively narrow window for when you shoot. As close as you can get to 12 hours is best. An early shot (more than 30 min) can act like a dose increase whereas a late shot can act like a dose reduction.
It all does get more than overwhelming at the beginning. It truly does become routine. Please don't hesitate to ask questions. The members here are very generous with their time and knowledge.
 
Last edited:
You must log in or register to reply here.
Back
Top