Switching insulin

Mphair84

Member Since 2018
Alright, I'm getting nowhere with Prozinc. He's been on it for over a year. I've tried and hung on probably more than I've should. The whole ordeal gives me anxiety, but I'm not getting anywhere with Prozinc.

Here is my thing, usually have 3 days off in a row and I can get midday numbers on those days but M-Th I have no way to get readings until at night after AMPS. I shoot at 6.

Can I start Lantus on a Friday, then be set for Monday?

I have read a lot stickys in Lantus, but I need help.

What's the best way to change over?
How should I start?
How do I get Lantus? Or should I try Levmere? (My vet has neither)

Please, how do I start this?
What Stickys should I make sure I read?
 
First, welcome to the group!

It looks like Prozinc wasn't awful but more that you weren't getting sufficient duration.

Chances are that if you start dosing with Lantus over a weekend, you won't be "set." Because Lantus is a depot-type of insulin, it takes approximately 5 - 7 days for the depot to form and stabilize. You may not see a great deal of response until the depot settles down.

Changing over: Generally, you can make a direct change in dose. You don't need to wait for Prozinc to clear out of your cat's system and you can start at your current dose. If you're feeling apprehensive about starting at 1.25u, then start at 1.0u. One thought, given your schedule, is to start at a dose of 1.0u and start earlier in the week -- Tues. or Wed. -- so once the depot has built up, you will be home over the weekend to monitor.

I'm not entirely sure I know what you mean by, "How do I start?" I'm going to interpret that in terms of which dosing approach to use. You have 2 choices -- the Tight Regulation Protocol (TR) or Start Low Go Slow (SLGS). Each has it's pros and cons. TR requires more testing and is a more aggressive approach. You are testing enough to use TR. With TR your cat must be on a low carb, canned food diet only. TR also has the advantage of having its basis in published research and has a strong track record for getting cats into remission. SLGS pre-dated TR and is the approach that has been used here not just for Lantus but for other insulin as well. Dose increased are made weekly (vs every 3 days with TR) and the threshold for when you reduce is different.

Purchasing insulin: Both Lantus and Levemir are human insulins so if you want to spend big bucks, you can purchase them at any pharmacy. Because they are human medications, vets don't stock them. Many people here purchase their insulin from Mark's Marine Pharmacy in Vancouver. The savings on the cost of Lantus is substantial. I'm tagging one of our members who knows more about using Mark's than I (@Chris & China (GA)). I used Lantus throughout Gabby's life. There are pharmacological differences between Lantus and Lev and I'm happy to go into the differences if you'd like. However, the important way that they differ is when their onset and nadir occur. With Lantus, onset is at around +2 and nadir at around +6 versus with Lev, everything is about 2 hrs later. (These times are approximate because some cats' onset and nadirs are typically early or late.) I stuck with Lantus because of my work schedule -- I could get several tests in before I left for work because Gabby had an early nadir and those tests let me know if her numbers were dropping. If I'd been using Lev, I would not have had benefit of that information.

Sticky notes: Read them all!! Start with the New to the Group and read up on the two different dosing methods and the sticky regarding the insulin depot.

Syringes: Please make sure your vet gave you an Rx for syringes. You will need U100 syringes for Lantus or Lev. It's helpful to have syringes that are marked in half unit increments.

And please ask questions. People here are very generous with their time and knowledge.
 
Until I make the official switch I increased to 1.5 to get him in better numbers. I appreciate all the help and advice.

I have read most of the stickies a few times, but I'm in the process of reading them again. I'm really hoping this helps my Stuff Tuff but I expect it's going to be just like starting over again and I'm not expecting a lot of results for a least a month or so.

start at a dose of 1.0u and start earlier in the week -- Tues. or Wed. -- so once the depot has built up, you will be home over the weekend to monitor.
So starting on a weekday of a low does of 1u won't be bad even though I won't be able to get midday numbers until Friday? I highly doubt it would be too much to make him go too low. I can start him whenever, whatever is best. I can get nightly numbers if that will help too until I can do a full curve that weekend.

I was going to start with SLGS method first and once I feel more confident possibly switch to TR. Right now my cat gets little dry, which I'm not opposed to stopping, but I wanted to wait till the bag was out. Plus, my cat is addicted to dry and when he doesn't get any he scavages for dog kibbles. :/ He's horrible, but less bad if I give him a little YA.
With Lantus, onset is at around +2 and nadir at around +6 versus with Lev, everything is about 2 hrs later.
So Lantus seems it's pretty much on schedule as Prozinc. So that shouldn't be that much different. Tuffy gets low at +6 and +8. I don't understand what you mean by everything being 2 hrs later. Do you mean an increase/decrease in numbers every 2 hrs or instead of his nadir being at +6 it really would be at +8?

The biggest thing is I won't be able to test to get him started unless it's at night or if I start him on the weekend. I'm not against starting him during the week, but didn't know how being gone till PMPS would work.
 
I don't understand what you mean by everything being 2 hrs later. Do you mean an increase/decrease in numbers every 2 hrs or instead of his nadir being at +6 it really would be at +8?

I think she was talking about the difference between the nadir on Lantus versus Levemir.....the nadir on Lantus is usually around +6......on Levemir, it's usually at least +8 (sometimes even later)
 
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