? Switching from PZ to Lantus and starting TR

Lily's mom Ellen

Lily's mom Ellen

Member Since 2019
Hi,
Lily is almost 14 and was diagnosed in March of 2019 while we were out of state and started on ProZinc. By December 2019 she was up to 8 units and still staying high. Now home in CA, our "regular" vet switched her to Lantus but started her at 1 unit (May 16) based on the recommendation of another vet specializing in Internal Medicine. (Our vet is lovely but does not have much expertise with FD and insulin resistance.) Lily is suspected of having Acromegaly but has not been formally tested. She's often ravenous, eats 2 cans LC FF morning and evening and gets hangry through the day. I have to give her .5 can 2+ times daily to keep her from getting hysterical, eating paper and squabbling with my civvie. She has PD, PU and is ketone negative to date. We switched to AlphaTrak but are going back to ReliOn as I can't spare an arm and leg to pay for test strips.
Lily is currently on 2u bid and has not had BG <300.
I'm thinking of going with the TR protocol but am concerned about the initial dose being way too low and how much I should bring her up to start the TR. My understanding is that while the nadir (hard to tell when that is) is >300 I should increase .5u every 2-3 days. She's *never* been low, but I know ECID.
I've tried reading everything but get overwhelmed.
Any help would be appreciated!
 
The IM vet didn't do Lily any favors by suggesting you drop down to 1U if she was already getting 8 units twice a day of ProZinc.

We take into consideration the dose the cat was getting before when switching insulin types. It's not the same as if you had just starting insulin and had no data.

If she was up to 8U BID, then she'll probably need at least 8 units of Lantus but if you want to be a little more conservative, you could start at 7U

Some cats do have a marked difference in how they respond so you'll need to get some extra tests in to make sure she isn't one of them.

Make sure to always get at least 1-2 tests on the PM cycle too. The PM cycle is just as important (if not more so) than the AM cycle since most cats do go lower at night.

@Wendy&Neko has a lot of experience with high dose cats so hopefully she'll be able to add some words of wisdom.
 
Thank you! She's been on Lantus for a couple of weeks already. Is it safe to make a large jump in dose? Should I stagger it?
I just realized I should have put a question mark in my subject line. Oh dear!
 
Lily's mom Ellen said:
I just realized I should have put a question mark in my subject line. Oh dear!
Click to expand...

It's not 100% necessary...it's just handy if your post includes a question....once you get some answers, you can remove it.

The prefixes are handy for the people who offer advice because it's easiest to scan the forum real quick for 911's first, then ? and then work on commenting on the rest so the more urgent posts get answered fastest.

@Wendy&Neko is usually on a little later but she should be on soon.
 
On your post on Feline Health, I suggested you start Lantus at 7 units. That recommendation hasn't changed. If you are already on another insulin when you switch to Lantus, you don't start back at the beginning. Been there, done that, suffered the delay in getting to a good dose. Lily is lingering in damaging high numbers. If you want to wait, pick a day (and night) you can monitor closely, but it shouldn't be a problem.

Glad to hear you are going back to the Relion.

Are you thinking of having her tested for acromegaly? I would strongly suggest that.
 
Thank you, Wendy!
I'm sorry -- I didn't understand that was clear recommendation/ instruction. I will increase her from 2 to 7 units in the morning. Should I test at +3, +6, +9 or more? I can monitor her closely (except while walking dog) and PM testing also. I don't have control solution to recalibrate it, but I can go back to the ReliOn in the AM as well.
We didn't do the acromegaly tests for several reasons. Money is a factor (I have none and my daughter paid for the exam and the insulin). Definitely couldn't afford a scan for the acro or sonogram to look for GI issues (she wasn't eating much for a couple of days but is ravenous again). I hear there's a blood test for Acromegaly that's less costly? Even with a diagnostic test, the treatments looked completely unaffordable and didn't seem like they would help her in a significant or lasting way. How would it change the approach to diabetes? When I asked my very about that she said if there was no tx (radiation?), it wouldn't change things at all. I can ask my daughter if she's able to pay for it if simply knowing yes or know will make a meaningful difference to Lily's life. If the prognosis is the same whether we do the test or not, I don't know. I didn't even know how expensive Lantus was compared to PZ. :-(
There was also a possible vascular tumor on her ankle. So, thousands of $$.
 
You can start with a +3 test tomorrow and do the 6 and 9 unless you see her dropping a lot.

As for acromegaly test, I meant the IGF-1 blood test. It is sent to Michigan State University for the test. No one here does the CT or MRI scan, unless they are planning to do surgery or radiation. There is one other treatment that some of our acromegalic cats are on. It's a medicine called cabergoline (given daily) that seems to help reduce the growth hormone some. Here is a post about it. There haven't been large scale studies on it, probably tested with more cats here and a FB group and our experience is it does help with some of the symptoms and can reduce the dose needed. We've had three cats go off insulin because of it. It's must more affordable.
 
So far, so good. She was 291 at +6. Haven't seen yellow for a while! I'm feeding her smaller amounts through the day which is keeping me quite busy. ;)
I left a msg for our vet that we'd like to do the IGF-1. True to form, I waited too long so it probably means she'll need another stick. Thanks for the reassurance -- it means a lot!
 
I was watching along on the spreadsheet, glad to see that yellow. :)

Start with a quote for the IGF-1, the biggest unknown is shipping cost. Costs of the tests themselves aren't bad, but there is the blood draw too.
 
I think I missed the window on saving some $$, bit we'll see. I think it was around $125? No tech fee because we already had the blood. :-(
 
Lily's mom Ellen said:
We switched to AlphaTrak
Click to expand...
curious. why did you switch to the alphatrak when you switched insulins? were those related decisions?

Wendy&Neko said:
If you are already on another insulin when you switch to Lantus, you don't start back at the beginning. Been there, done that, suffered the delay in getting to a good dose.
Click to expand...

we have been talking to our vet about switching kit from prozinc to lantus. she also said that we would need to start back at low dose, e.g. 1U. why do you think the vets recommend this way rather than "matching" dose quantities of prev insulin?

tia ^jw
 
JOJI and Kit said:
why do you think the vets recommend this way rather than "matching" dose quantities of prev insulin?
Click to expand...
Because most vets get in the order of 5 hours of training in diabetes, for both dogs and cats. People here live and breathe it for years. Vets also don't have the access to hundreds of spreadsheets that we do, to do the analysis. Meaning, they just don't know.
 
JOJI and Kit said:
curious. why did you switch to the alphatrak when you switched insulins? were those related decisions?

we have been talking to our vet about switching kit from prozinc to lantus. she also said that we would need to start back at low dose, e.g. 1U. why do you think the vets recommend this way rather than "matching" dose quantities of prev insulin?

tia ^jw
Click to expand...

The meter switch was probably due to my own neurosis about Lily's BGs and pressure from clinicians. I though "more accurate = better in every respect" and thought the timing would be good. I did overlap the AlphaTrak with the ReliOn for a time so I could observe the differences. As it turns out, I don't like the AlphaTrak and test strips are very expensive. I'm doing another few days of double testing (both meters) since I increased Lily's dose, and will go back to ReliOn alone. I'm stubborn and need to see things with my own eyes -- if my mom were around she'd be rolling her eyes.

I should say our switch from PZ to Lantus wasn't based on any great insights on my part. I was concerned when Lily didn't seem to be responding to 8 units and went to my vet (who hadn't seen Lily since her dx). I don't why vets say to start a new insulin at the lowest dose when you've already been at a higher one. My vet consulted an internist who recommended it. After getting feedback here and high BGs from Lily, I asked why and was told that they were "not equivalent" and that we didn't want Lily to get hypo. I was given permission to go up to 2u. Maybe it's old school? An over-abundance of caution? I don't know the DVM who recommended it and they didn't have my data, so I can only guess.
 
I didn't see a new post for today, but I looked at the spreadsheet - awesome PMPS tonight! :) What a difference the Relion makes.
 
Wendy&Neko said:
I didn't see a new post for today, but I looked at the spreadsheet - awesome PMPS tonight! :) What a difference the Relion makes.
Click to expand...
Wendy&Neko


Wendy, I'm doing a full day curve today (q 2 hour tests). Lily's numbers have been lower but even with the ReliOn they are still higher than I'd like to see. She's been getting 7u of Lantus for over a week now and I've been spreading out her feedings (my notes aren't good). Time to increase? I'd be fine going up to 8u AM/PM.
Also, hoping to get the IGF-1 test next week. Is cabergoline still the best bet for Acromegaly?
Thanks so much!
 
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Did you give insulin last night? The units is blank. You also skipped a couple nights ago I see. Could you put "skip" or "NS" for no shot in the units column. That way we know there was no dose, instead of just forgetting to enter the value. Don't forget to try to get those before bed tests if you can - many cats go lower at night.

Since you are seeing some low yellow numbers during the day (not much data at night), I think we should be a little cautions and go to 7.5 units, which is what we'd normally suggest for cats over 5 units total dose. She has gotten really close to blue. :) How is Lily feeling in general?

As for cabergoline, it's not the best treatment, but pretty much the only one that's within the price range of most people. Gold standard is hypophysectomy or removal of the pituitary, but that costs over $10,000. :eek: And only done in New York City with experienced surgeons that I know of. It is brain surgery, you don't want to be someone's learning project.

Next day that you post, could you start a new thread. Our convention here is one post per day, with a link to the previous one. That keeps the posts shorter and more manageable given the number of cats here.
 
Yes, thank you!
I have corrected the spreadsheet and will go to 7.5 tonight, get later PM BGs, start a new post next time and figure out how to link to this thread.
Lily is quite crabby and mouthy, except after she's eaten. I'll save that for next post.
Thank you!
 
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