switching from PZI to Lantus, need advice please

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Carl & Polly & Bob (GA)

PZI user, Amy, switching to lantus per vet recommendation. She plans to start Saturday and needs to know how to get from "there" to "here".
Ruby was on pretty low doses of PZI (.5u most recently), with erratic preshots (blues and reds, and everything in between). Vet is starting at 1u BID, Lantus.

Can somebody help her out?
http://felinediabetes.com/FDMB/viewtopic.php?f=28&t=63132
Thanks,
Carl

ETA - updated subject line for Amy and Ruby
 
Re: Can someone advise in Health on insulin switch?

Hey there! I'm Amy and my girl is Ruby. She's been on PZI since right before Christmas. I keep her spreadsheet up to date and I'm on the boards a good chunk of the day.
I'm as nervous about making the switch on Saturday as I was when we first got her diagnosis. Quick background on her...she's about 11 and a chunky 14-ish lbs. Right before Christmas she was drinking a lot of water and I could tell she was just wrong. We took to the vet on December 21st and found out that day she had a nasty bladder infection and diabetes. She stayed at her regular vet on the 21st - 23rd because she was so dehydrated and her glucose was pushing 500. We transferred her to the 24 hour clinic the night of the 23rd and then got to bring her home on Christmas eve. Our vet completely supports home testing especially because Ruby gets so stressed when she's in their office. I use an AlphaTrak meter on her. It tends to test any where from 80 points higher (when she tests in the 300s and higher) to about 30 points higher (when she's in the 100s) than a human meter.

I picked up the Lantus and U-100 syringes tonight. I'm confused by the markings on the syringes so I'm going to try to swing by the vet tomorrow after work and have them show me exactly what 1 unit means.
 
Re: Can someone advise in Health on insulin switch?

A few more details...she eats 1 can of Fancy Feast twice a day. We made the full switch from dry to canned mid January.

When she was diagnosed she was testing in the high 400s. I started home testing on Jan 28th. The first two weeks I used a Relion Micro then switched to an AlphaTrak on recommendation of the vet. Its what they use in the office (a cat only vet) and she uses on her 2 diabetic cats at home.
 
Re: Can someone advise in Health on insulin switch?

ok, found you! :-D

welcome to Lantus Land! i think you'll find it's an easy transition. we started on prozinc and transitioned punkin to lantus without a problem. of course i didn't know a thing when we were doing it, but from my pov it was nothing! :lol:

i think you'll be happy with the changes you see in ruby's BG after the switch.

the first difference is that lantus is a cumulative insulin - often the first 3 days you don't see a lot of changes but as it builds, then we'll be able to help you interpret what's going on. after being on lantus for a while, most people see the numbers flatten out. you've kinda had some craziness going on so far. hopefully this will be a good move.

i'll ask some folks that are experienced in making the transition to stop by and check in with you. generally i think you just give the pzi at one shot time and give the lantus at the next time.

have you had a chance to read the New to the Group sticky at the top of this page? that's got some excellent basic info on everything - including how to read your syringe.

also, yay on checking in before you're using your lantus. it's handled differently than pzi - no rolling or mixing. make sure you read the sticky Info, Proper Handling & storage and take care of it properly so it will last you as long as possible.
 
Welcome Amy & Ruby! I know nothing about switching from PZI, just wanted to say hello. Julie has attached the relevant stickies for you so you are good to go. We hope you will post often and look forward to hearing from you!
 
Thanks Julie

I'm starting Saturday morning so I'll have all of Saturday and all of Sunday to watch her, but Monday I have to go back to work. Hopefully that's ok. Everything I'm reading says I need to watch her for the first 3 days.
 
Hi and Welcome Amy and Ruby.
You could start the Lantus on Friday night, that would give you 2 1/2 days to be home to monitor her. Just a thought.
 
At what intervals over that time period should I plan on checking her? She's really good about it, but she's got her limits.
 
As was mentioned, Lantus needs time to build up it's shed, and it could take up to 5 to 7 days.
The onset of Lantus is usually about 2 hours after you give the shot. For example: if you test her at 6:00pm on Friday, and give her her insulin and her dinner, then you could try testing her at +2 (8:00pm), and then depending upon that number, we go from there.
 
The newbie info mentions the feeding schedule. Normally I put 1 can of fancy feast in her bowl in the morning and again in the evening. Sometimes she finishes it all right off the bat but most of the time she leaves a bit and then goes back a few hours later for "lunch". Is that ok?
 
Welcome, Amy!

I want to check in with some experienced Lantus users about the transition. When cats have switched from Lantus to Levemir (another long-acting, depot-type insulin), it's suggested that the dose be reduced by 30%. I don't know if this would hold for a switch from PZI. What I've seen on several occasions is that numbers seem to drop for a couple of days with an insulin switch then come back up to roughly where they were. What I think would be helpful to us and you, is if you could keep testing they way you have been and open a new thread (we call them condos) for your kitty on Friday. If you put something like "Dose - switch from PZI" in your subject line, we can take a look and help you with the initial dose based on what your most recent numbers look like.

I suspect you will be more comfortable getting several spot checks over the first few days. It will give you a feel for Lantus even though it can take 5 - 7 days for the initial dose to stabilize and a "shed" to form.

As far as feeding, we typically recommend frequent, small meals. This is true regardless of the insulin. You don't want to overwhelm a healing pancreas. Many people here will use a timed feeder or make "catsickles" (frozen, watered down cat food) that they leave out when they're gone.

I suspect you are going to need to think differently about Lantus than PZI. We do not adjust dose based on the pre-shot number. Dose changes are based on the nadir. We also shoot lower numbers they you're used to. Over the next few days, I'd suggest reading some of the posts here and taking a look at our spreadsheets. If you've got questions, please ask. People are very generous with their information.
 
I used to have Blackie on ProZinc prior to Lantus, and had to change my way of thinking with regards to the onset of the insulin. If I remember correctly, with ProZinc you think about the PS #s, and not the nadir. Whereas with Lantus, you think about the nadir and not so much of the PS #s. Lantus is a different way of thinking. I began giving her 1u BID, and gradually increased it every 6 cycles by 0.25u until she reached a point, and then she started getting dose reductions.

I think you're going to like Lantus just fine, and I think you kitty will do well on it. Congratulations, and welcome to Lantus Land! You're going to get a lot of information from the people on here. :-D
 
I've had trouble figuring out her nadir. It seems to range anywhere from +4 to +7. Ruby likes to throw lots of curve balls at me.

I'm going to print out a bunch of stuff and start trying to digest it. Lantus seems so much more complicated than PZI and I admit its got me worried. And I've been a nervous wreck with PZI!
 
If you had started on Lantus and then switched to PZI, you'd probably think PZI was more complicated! It's just what you get used to and then having to change your mindset. There are also a lot of people here who can lend a hand and help you get up to speed.
 
Hi all
I just wanted to clear up a misperception I've seen a couple times in this condo and often elsewhere.
Dosing with a "P" insulin is not just based on the preshot. It is a combination of the PS and the nadir. The drop from PS to nadir is looked at to determine if a dose is too high or too low. In PZI we encourage testing before shots of course, but also around nadir during one cycle or the other depending on the bean's day to day schedule.

Carl
 
Hi guys and welcome to Lantus Land from us! We never used Prozinc insulin, but we did make a switch from vetsulin (no longer made) to lantus. For us, it was a pretty easy transition because she had only been on vetsulin a few months so we were new to EVERYTHING! Lots of people in lantus land that are always willing to help answer your questions and guide you along. Don't be nervous, you're going to do great!

The difference between the tight and relaxed group depends on you and your schedule. To be in the tight group, you really want to stick to the 12/12 shot schedule with plenty of spot checks. The relaxed group has members in it that sometimes, due to work, kids, etc, can't consistently stick with the 12/12 schedule. Lantus really likes a consistency and that is what the tight protocol offers. I personally think tight protocol gives your kitty the best chance at regulation, and possibly OTJ (off the juice) Others I am sure will weigh in with more advice/opinions on these two groups.
 
The majority of the time I can stick to the 12/12. Every so often, like last night, I was about 2 hours later than normal.
But I can't be home during the day to check her on weekdays. I'm gone from about 7:15 AM until 5:30 or 6:00 PM.
I usually do her AMPS around 5:00 AM.
 
We all do what we can, but we are not really as rigid as the TR name implies. Occasionally time adjustments have to be made, usually we try to pan ahead and adjust in 15 minute increments. But sometime, stuff happens, the we just need to be patient and let the shed readjust. W/ Lantus, shooting more than 15 minutes early acts like a dose increase and late like a dose decrease.
 
This is one of the things that makes me nervous with Lantus. With the PZI my vet said there was no need for concern if it was an hour later or an hour earlier, unless her number was super low. 15 minutes is really tight.
 
hello and welcome to the group amy and ruby!

you've already been given quite a bit of advice. i wanted to pop in to say hi as well as comment on some of your concerns:

starting dose --- after reviewing ruby's ss, i honestly think starting at 1u bid would be a mistake. with the response she's been getting since the switch to an all wet diet, i'd start out with a lower dose. the dose can always be increased if necessary. it's much easier on the caregiver to go up the dosing ladder than to come careening down. if i were in your shoes i would continue to collect data as you have been and then ask about a starting dose on friday. since lantus is a "depot insulin" meaning the effect is cumulative (one dose builds upon the next), i like dyana's idea to start with lantus on friday night. that'll give you the weekend to keep tabs on her.

feeding schedule --- most of us have found feeding small frequent meals before nadir helps us to regulate our kitties. this can be especially helpful if ruby is super carb sensitive. however, free-feeding is definitely an option many have employed successfully. some cats are grazers... and that's fine. the important thing is to have food available for ruby.

TR or SLGS (relaxed group) --- the difference between practicing TR and SLGS is not about the ability to shoot 12/12. obviously, shooting 12/12 is better, but life doesn't always afford us the luxury of shooting 12/12 on the dot... every day. we deal with it and make adjustments accordingly. no biggie. we can help you with schedule adjustments.

once kitty is tightly regulated, i've found (with alex) shooting up to an hour late or early hasn't made that much difference in her numbers. however, i have accumulated an awful lot of data on her over the years.

the major difference between SLGS and TR can be found in how often dose increases are made, when to reduce the dose, as well as setting a low shoot number.

TR is fast paced with the possibility/probability of dose adjustments made after 3 days. when following the SLGS method, one would generally hold doses for at least a week (unless kitty were to drop too low on that dose). TR comes with requisites (found in the TR Protocol sticky). after becoming data ready, we generally shoot on preshot numbers over 50.

SLGS makes concessions for kitties who have not been transitioned to low carb wet food. the dosing guidelines in the SLGS method also tend to run kitty in a little higher range than we do with tight regulation. the SLGS method sets the no shoot number at 150 along with suggestions for when kitty is in that 150 - 200 preshot number range (FAQ 4.4).

which method is best? we've had kitties go OTJ using both methods. and some kitties will go OTJ no matter what the caregiver does or doesn't do. lol!

i'm one of the few active posters left on the fdmb who has used both TR and SLGS. i can tell you what i've seen. we have had kitties go OTJ using SLGS, but we've had many more go OTJ using TR. the idea behind TR is to bring kitty's numbers down into the normal range as soon as possible after diagnosis. my observation is backed by the research done by Roomp and Rand cited in the TR Protocol sticky, but i would be remiss if i didn't mention not every cat will go OTJ. alex has been on and off insulin over the last six years. her longest honeymoon period was almost 3 years, but she's been back on insulin now for almost 2 years. i've personally chosen to continue practicing TR because alex feels better in normal numbers and i'm trying to prevent possible damage to her other organs with running her in higher numbers. that's what insulin therapy is all about... keeping the cat healthy and happy!

good luck with the switch! if you decide to follow the TR protocol, there are many here to help.
 
Its not that I don't want to go the TR route. Having to be out of the house at work for a good chunk of the day worries the begeebus out of me.
 
Hi, and welcome!

I understand completely on the being at work thing! I'm single, live alone, and have been doing the "sugar dance" with my cat Willie for over a year now. I will say that I am very lucky in that he isn't a "diver," a cat that will go careening down very quickly, but I have worked out my schedule to where I get up very early, shoot, then either head back to bed or read for a bit. I work a full-time schedule with a 20 minute commute each day and I go to the gym 3-4 nights a week. You just play with your schedule and find what works best for you. Most days, I'm able to get at least a +2, and could hang out until +3 or +3.5 if I really had to. For mid-cycle checks, I count on my one day working at home, and evenings/weekends to fill those in. Willie's spreadsheet is in serious need of an update, but suffice to say, he's doing great.

I hope that helps!! :-D :-D :-D
 
Our schedule right now is that we get up at 5:00, I test her, feed her and shoot her. I leave around 7:15 or 7:30 so I try to test her before I leave if I get the sense something's weird.

I get home about 5:30 or 6:00, test her, feed her & shoot her. Then I test her again around 11:00 pm, before I go to bed. I'm barely getting enough sleep right now, so its about the best I can do unless there's something crazy happening.
 
Hi Amy and Ruby and welcome to LL,

Your schedule sounds like lots of people's schedules. On weekends you can try to fill in some of the other hours; you are already getting a good mid-cycle test every evening (the bedtime test is one of the best tests to get). If you can fit in an "out-the-door" test in the morning (around +2), that will tell you a lot about how Ruby's day will go, and you will be able to determine (after you get a little more experience) what kind of food you should leave out for her while you are at work. You will settle into a routine very quickly after you get over the initial trepidation. As it is, it looks like you are doing great.

My first diabetic cat (Stu) was on PZI Vet for 4 years before it was discontinued and he was switched to Lantus. I shot PZI Vet blind (didn't know any better; didn't know I could home test and the vet never suggested it). I often shot an hour early, or 2 hours late and never thought anything about it. When Stu was overdosed on Lantus by a new vet, I found this board and began to learn about FD, about how Lantus works, etc. etc. Stu was never regulated on PZI Vet. Starting Lantus as a long-term diabetic, he gradually became pretty well regulated. I think that you will find it to be an excellent insulin. Since Ruby was very recently diagnosed, she has an excellent chance of becoming diet controlled using Lantus. When you make the switch, try to put out of your mind everything you learned about working with PZI. Lantus is a very different insulin, so just start fresh and look forward. I know that you will do well. And you have the folks here in Lantus Land to help you out whenever you have questions.

Best of luck,

Ella & Rusty
 
i just want to reassure you that you don't have to give up your life to do this. everybody here has normal lives and we work around all the normal things.

also, you don't need to try to know everything about lantus and the protocol now. we watch out for new people and we'll tell you when you need to know something and point you to where to find it. for myself, i found it hard to absorb information that wasn't relevant to my particular situation yet. when i was in the particular situation, then i got it.

ask lots of questions! we'll help you learn. don't worry about that part. for now, all you need to be considering is the next few days. you've gotten suggestions for a plan from now til Friday, and then if you start Friday night someone will suggest a dose for you based upon what they see in the next few days on PZI.

glad to meet you!
 
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