Switching from PZI to Lantus - Advice?

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runscottie

Member Since 2013
Hello all,

Its been about 4 months now since my Rice Krispies has been diagnosed. After a terrible experience with the vet that first diagnosed him, I have switch vets and found a vet clinic that I love. Today I took my kitty in for a second visit so they could do some bloodwork. While there I shared my spreadsheet with my vet and she recommended that we switch from PZI to Lantus. I didn't see any problem with that and also it would be nice to be able to buy insulin + u-100 needles just at a local human pharmacy instead of having to go via Pet med websites, etc.

Basically I am wondering if anyone can give me some tips as I will be a brand new Lantus user? Is is different enough from PZI that I need to adjust in some way?

She has me starting low and slow, were going to start with 1 unit for the first week and then go from there. Kitty has been off of PZI for the past 24 hours and I am going to be picking up the new insulin tonight/tomorrow morning and putting him on Lantus. Any advice would be appreciated!
 
There is no reason to stop the PZI for 24 hours. You can just start the Lantus 12 hours after the lat PZI shot. One unit seems like a good starting does.
 
Hi Diana and Krispies!

Sounds like you guys have found a much better vet! I like the fact that she has you guys at a very good starting dose and wants to hold it for at least a week. Some vets like to do a "detox" before starting a new insulin, but as Larry said, you don't actually need to do that going from PZI to Lantus. Don't worry; it won't make much difference if you wait, but it won't hurt anything if you start earlier, either. ;-)

runscottie said:
Basically I am wondering if anyone can give me some tips as I will be a brand new Lantus user? Is is different enough from PZI that I need to adjust in some way?
Click to expand...

Yes, it is quite different from PZI and there is a whole new way of looking at BGs and patterns when it comes to Lantus. In the Tight Regulation Lantus Forum there are "Stickies" at the top to help guide you through the process, which I've summarized for you below:
  • New to the Group?: General Info on Lantus, glucometers, syringes, dosing, what a typical Lantus curve might look like, food lists, etc....
  • Tight Regulation Protocol: dosing information.
  • Info, Proper handling, & Storage: syringes, pens vs. vials, etc....
  • Insulin Depot: explaining how the depot works and how Lantus and Levemir differ significantly in dosing from all the other insulins available (i.e. PZI/ProZinc).
  • Shooting and Handling Low Numbers: What to do when you see numbers under 200 when first starting out or 150 after you've been doing it for a while. Specifically for introducing the "shoot low to stay low" method of the Tight Regulation protocol. This also significantly differs from PZI/ProZinc as you may often be shooting pre-shots under 100.

As for testing with Lantus, dosing is based moreso on the nadir/low point than on the pre-shots (unlike PZI) so I always try to get at least 4 tests minimum each day:
  • AM Pre-shot test to know if it's safe to give a shot
  • AM mid-cycle test, if possible (this one I sometimes skip because of work). It lets me know how the dose is working and how low Mikey might go
  • PM Pre-shot test to know if it's safe to give a shot
  • Before-bed test to see how low he might go overnight while I'm sleeping
All other tests, I consider them as more data points on how Michelangelo reacts to the insulin in that particular cycle, how food and/or activity affects his numbers, if he needs an increase or decrease in dose, how he might be handling a new dose, etc.... I basically play fill-in-the blank across the week and try to grab tests at different times across different days with a few repeats thrown in.

Please let us know how else we can help you!
 
The most important thing is you must stick to the same dose for 5 days on the first dose before any increase, then 3 days on any later doses before any increase due to the carryover effect that Lantus has. It is rather like steering an ocean liner - you can turn the wheel, and hours later, you're finally going in a new direction.
 
Thanks for the replies!

What exactly is the difference between 'tight' and 'relaxed' regulation? My current situation, and what i had been doing with PZI, was testing twice a day before meals and giving insulin immediately after feeding. On the weekends I would try to get nadir readings, but as you can see from my sheets I'm not very reliable with getting the mid cycle readings.

Will I need to step up my mid cycle readings with Lantus? This kind of worries me because I work during the day and at night I'm just not very consistent with doing testing before bed. I suppose I can step up my game, but just being realistic i'm not sure I will be very consistent.
 
You get the readings between +5 and +7 whenever your can.
Some folks will do it on a day off; some will set an alarm to get up in the middle of the night to get it. You need it to evaluate how well the dose is working and to make dose adjustments, since you can't adjust upward based on the pre-shots.

You can still reduce 0.25 units based on going below 50 mg/dL
 
Hi!

I've used both ProZinc which is like PZI and Levemir (a depot insulin similar to Lantus). Yes, you will need to do more testing with Lantus or Levemir. If your schedule is variable, I'd stick with PZI, it's more forgiving as far as one's schedule or life style is concerned. You can use U 100 syringes with PZI, check on PZI/ProZinc forum for the conversion formula, but you'll need to buy PZI from a compounding pharmacy just as, I imagine, you have been doing... We switched from ProZinc due to a shortage of it at the time. I have 2 cats who went into remission(s) using one or the other insulin or, even, both.
Best wishes,
Sophie
 
Tight Regulation is more intense and can require much more testing and monitoring and lots of daily posting for help and advice on the TR Forum. Relaxed is just that; you post as often as you can and you go at a pace that works for you and your cat. Relaxed follows the TR Protocol for the most part but not as "tightly" regimented and/or with modifications (since Every Cat/Caretaker is different).

I used to post in TR but my work schedule wouldn't allow me to test as intensively or increase doses as rapidly. Michelangelo is also a bit of an odd case where reductions simply don't work too well on him and increases had to be done s l o w l y so I switched over to Relaxed. There are people in Relaxed who have been doing this for years with multiple cats, people who are on their second run after a kitty fell out of remission, people who have switched insulin (sometimes multiple times) because their cat doesn't respond the same way to insulin, people who can only get three tests a day in but do curves on days off, people with long-term diabetics. All sorts of variety but the end goal is the same: getting the cat as regulated as possible and hopefully into remission.

Check out the posts in both forums and see which one suits you best. You can post in TR and follow Relaxed (just note it in your signature) or you can post in Relaxed and follow TR. It's up to wherever you feel most comfortable posting. :-D
 
Hi!
KPassa has made some good points. What you may want to take under consideration is the depot storage, which can cause hypo episodes to be quite lengthy, since it takes 3 - 5 days to drain the depot. PZI does not respond similarly.
Best wishes, Sophie
 
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