Switching from Vetsulin to Lantus

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I'll be starting the Lantus tomorrow or the following day. Whenever I pick up the U100 syringes.

Vetsulin was really difficult to find the appropriate dose. 1.5 was consistently getting him too low to shoot, 1 was way too little, and 1.25 was not keeping him in the 200s reliably.

Anyone willing to look at the chart and give me a recommendation on starting dose? Is 0.5 units lantus a good place to start based on his numbers with vetsulin?

Bonus:
I just got back from a trip out of town (Tuesday morning through Thursday night) and the autofeeder was working fine when I left. A neighbor was giving him 1.25 units AM/PM while I was gone and refilling the feeder/icepacks. However, Artemis has been protesting the feeder and acting very strange since I came back. Lethargic and uninterested in me or his food. Can't tell if he's not feeling well, if he's angry about the feeder being used instead of a bowl, or upset that I was gone and hasn't recovered? I came back the night before last. Hate to start on a new insulin when he's acting strange but it makes no sense to me to stick with vetsulin any longer than necessary. Hoping he might feel better on Lantus. Anyway, any advice on this is appreciated.
 
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Welcome to LLB. Are you planning on following SLGS? Since you are feeding wet you could follow TR or SLGS. You test enough. I’d start with 1.25 either way but let’s get more opinions.
 
This is from the dosing methods sticky.
  • If the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration
  • Generally, shots are to be given 12 hours apart.
 
It’s generally based on the dose your cat is currently on and how low the nadirs. Since you are seeing higher than we want nadirs there’s no reason to decrease the starting dose. If 1.25 was taking your cat into green or low blue I would have suggested 1.0 to start. Lantus works differently from Vetsulin. You will hold the starting dose for 5-7 days unless the nadir falls under 90. It can take 5-7 days for the depot to build.
 
Can you add some comments to your SS that you were away which explains no tests from pm Aug 15th through Aug 17th? As Elise mentioned, when switching between insulins, we take into consideration how the previous insulin and dose was working. You don’t have any data at night on this dose, which makes it somewhat difficult to gauge how the 1.25u of Vetsulin was working. Even a +2 or a before bed test is really helpful to get an indication of what is happening at night. With Lantus, that would be a good habit to get into.

When making decisions about dose, you take into consideration how low the previous insulin was taking the cat. Without the pm data, you are missing half the picture. From the data you have, nadirs are in the mid- high 200s, so 1.25u would be a safe place to start, and given from what we can see, the nadirs are in that range, I wouldn’t go with a lower starting dose. I would encourage you to test all preshots and get midcycle tests in for both cycles am & pm) when you switch to Lantus. The more data you have, the better you can determine how Lantus is working for your kitty. It’s a different acting insulin, so you’ll likely find onsets, nadirs and duration will be different.
  • Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
  • Peak/Nadir - the lowest point in the cycle
  • Duration - the length of time insulin continues to lower blood glucose
 
Christie & Maverick said:
Even a +2 or a before bed test is really helpful to get an indication of what is happening at night. With Lantus, that would be a good habit to get into.
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I'll do my best. A +2 is probably all I'll be able to reliably/routinely get on PM.

Christie & Maverick said:
midcycle tests in for both cycles am & pm)
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PM midcycle tests will not happen. Unfortunately.

Christie & Maverick said:
you’ll likely find onsets, nadirs and duration will be different.
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Hope that the duration will be extended on glargine. This seemed to be the most deficient part on vetsulin aside from a huge gap in reaction between 1.5U and 1.25U vetsulin.

Fingers crossed this treats him well. I'll stay up a while longer and get a +2 and +3 or +4 tonight.
 
A before bed test works just fine, when you can :)You may find that with Lantus the +2 is a good indication of how the cycle might go. Usually when you get a lower +2 than preshot, that can often suggest an active cycle where additional monitoring will be needed. Mid cycle is a bit relative, the goal is to get a sense of how low the dose is taking the cat, and when.

I hope you’ll find Lantus works well, good luck!
 
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Christie & Maverick said:
A before bed test works just fine, when you can :)You may find that with Lantus the +2 is a good indication of how the cycle might go. Usually when you get a lower +2 than preshot, that can often suggest an active cycle where additional monitoring will be needed. Mid cycle is a bit relative, the goal is to get a sense of how low the dose is taking the cat, and when.
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Got it. I'll do my best to make sure he gets at least a +2 reading every night.
 
tiffmaxee said:
It’s generally based on the dose your cat is currently on and how low the nadirs. Since you are seeing higher than we want nadirs there’s no reason to decrease the starting dose. If 1.25 was taking your cat into green or low blue I would have suggested 1.0 to start. Lantus works differently from Vetsulin. You will hold the starting dose for 5-7 days unless the nadir falls under 90. It can take 5-7 days for the depot to build.
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Sounds good. Found my 1/2 unit marked u100 syringes early so I've started at 1.25 units glargine tonight.
 
Cats often drop lower at night which is another reason to occasionally get a test later in the cycle. It’s not required. If your before bed test is on the low side that’s the time it would be good to set an alarm to get a later test. You could also get a +11 if up early in the morning. Again not a must do.

What is really needed is a test before every shot to make sure it’s safe to shoot though . I am pretty sure you will be much happier with the results you get from lantus. It’s not going to happen overnight though.
 
Twinkleboots said:
I generally try to test whenever I can. A +11 is possible for sure.

How low would you say warrants this?
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If a bug drop before bed or under 200 and definitely green would help catch night nadirs. Definitely not necessary every time but once in awhile until we see the response to lantus. When will you start? Leave some space on your spreadsheet when you do and at first try and post daily. If nothing to say simply supply the link to the previous day. That way if we see a later test might be a good idea we can make the suggestion. It gets busy here so sometimes out of sight out of mind.
 
tiffmaxee said:
If a bug drop before bed or under 200 and definitely green would help catch night nadirs. Definitely not necessary every time but once in awhile until we see the response to lantus.
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Ok so if he goes under 200 for his PM+2 or if he drops a large amount between shot and +2?

How large a drop is concerning?

tiffmaxee said:
When will you start? Leave some space on your spreadsheet when you do and at first try and post daily.
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I started already. Last night at 1.25 units. Seems to be working well so far. Spreadsheet is up to date.
 
Would you mind leaving a few blanks rows before you started lantus, rather than just in comments? And write across that you switched to lantus. It will take at least 5-7 days for the depot to build and to see full effects of lantus.

Large drops aren’t necessarily concerning. They just mean you might have an active cycle. Have you read any of the stickies at the top of this forum?

Here we start a new thread every day. I’m going to link how to post to this and you can start today with a new thread. The title in the subject needs to be in a particular format:
?8/20 Twinkleboots AMPS 341 when to test
 
Would you mind leaving a few blanks rows before you started lantus, rather than just in comments? And write across that you switched to lantus. It will take at least 5-7 days for the depot to build and to see full effects of lantus.

Large drops aren’t necessarily concerning. They just mean you might have an active cycle. Have you read any of the stickies at the top of this forum?

Here we start a new thread every day. I’m going to link how to post to this and you can start today with a new thread. The title in the subject needs to be in a particular format:
?8/20 Twinkleboots AMPS 341

https://felinediabetes.com/FDMB/threads/posting-guidelines-please-read.231511/
 
From the Basics sticky an example of an active cycle.

Example of an ACTIVE, but NOT necessarily typical Lantus and glargine biosimilars cycle:
NOTE: Until kitty is pretty well regulated, the description below is NOT not what you'd consider a "typical" Lantus/Basaglar/Semglee cycle. It takes time and patience for kitty to achieve a "typical" cycle! The example below is what you're working towards (a nice shallow curve). A relatively flat cycle is the ultimate goal.

+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number. Onset begins around +2 for most cats. You'll probably see an active cycle if the +2 is the same/similar OR lower than the preshot number. Continue testing!
+3 - Often lower than the PreShot number.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle. NOTE: ECID. Not every cat has a mid-cycle nadir. Adjust the hours on this example to fit your cat.)
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (one of the quirks of Lantus/Levemir/Biosimilars: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.

Keep asking questions and I suggest gradually read the stickies. There’s so much to learn so dint get overwhelmed.
 
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