? Switching insulins

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Ramon's mom

Ramon's mom

Member Since 2018
My cat Ramon is now under the care of a new vet who has, among other things, switched him from Prozinc to Lantus. Is there anything I need to know about switching? Ramon is pretty much just on raw rabbit (sometimes canned). He has also been taken off of 2 meds for some inflammatory conditions which now clearly had been raising his blood sugars. Now we're on the lookout for the return of symptoms of those but are hoping the diet change will manage that. Ramon had been on @ 3 units of Prozinc and now the vet prescribed 0.5 units of Lantus. First dose was last night and his AMPS went up from where it had been on the Prozinc. I know I can increase the Lantus dose but am not sure when to try that. Any words of wisdom for me? (I have been reading the documents in the Lantus forum but there aren't specific instructions for switching. For instance, I'm wondering how long to wait before increasing.)
 
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Hello!

I switched from caninsulin to lantus mid-March. The Lantus / Levemir board can be overwhelming because there are so many users and SO much information to sift through. Trust me though, you can post in there and someone with a lot of experience will be able to help you out!

One thing that you should consider before increasing dosage for Lantus is that it is a depot style insulin. This means that basically when you inject the insulin, it precipitates into a solid in Ramon’s body, and then his body starts to break it down and incorporate it into his body from there. Because of this, it often takes a few cycles for you to notice if the dosage is working or not. You might want to wait a week before changing the dosage to give the depot a chance to build up and take effect.

For specific instructions on the right time to increase you would need to pick a dosing method. For Lantus there are two: Tight Regulation, and Start Low, Go Slow. You should read the documents on these two practices to determine what your dosage strategy will be moving forward. (They’re in stickies on the top of the Lantus/Levemir ISH board.

For me I chose Start Low Go Slow (SLGS) because I’m unable to test during the day. As such I have to hold the dose for a week then perform a curve to determine if I need to increase or decrease kitties dose. Increases and decreases are done 0.25u at a time. If my cats BG goes below 90mg/dL at any point during the week he gets a decrease in dosage. He gets an increase in dosage if - at the end of the week during his curve that his nadir is above 150mg/L

Tight Regulation is more aggressive and involves multiple tests through the day and night. With this method you are able to switch doses (if necessary) every 3-5 days.

Have a look on the board and see what dosage method is best for you and then someone can help you on the Lantus board with any questions you have. For now, until you decide on a dosing method, I would consider keeping your dose for a week to allow Ramon to build up his depot.

I’m really happy with the progress that Mowgli is made since we switched to Lantus. I hope that Ramon sees some great results too!

Good luck!!:cat:
 
PS: Ramon is beyond handsome - I kind of want to maul him :eek:

PPS: Someone else is in the process of switching from Prozinc to Lantus, they have a recent post on the Lantus board Here
 
Ramon's mom said:
Ramon had been on @ 3 units of Prozinc and now the vet prescribed 0.5 units of Lantus.
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That's probably not going to be enough. We usually take into consideration the dose they're on when switching insulin.

I would have suggested starting at 2U. If you start too low, you can end up wasting a lot of time working your way back up.
 
Chris & China (GA) said:
That's probably not going to be enough. We usually take into consideration the dose they're on when switching insulin.

I would have suggested starting at 2U. If you start too low, you can end up wasting a lot of time working your way back up.
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Well, you're probably right. After 3 cycles on the 0.5 units giving him preshot readings in the high 200's, I bumped him up to 0.75 and have already had a drop - today's AMPS was 185. At this point I think I will have to slowly bump it up, unless others think I should up his dose in bigger leaps? He also went off his food so I am having to push him on eating as well as adjust the pain med he was put on (Ramon had been declawed on all 4 paws by the owner he was rescued from, so the new vet thinks he has pain from that and feels that his BG will go down also when he has enough pain killer in him).
 
I am in the same boat and posted on the Lantus board. I was scared to go directly to 2 units vet prescribed so I started at 1 unit and was hoping to see some action in lowering her houtof mid to high 300's but nothing so far.
 
As Amanda said, suggestions on when to do dose increases depend on whether you are following Tight Regulation or Start Low Go Slow. In any case, you should ensure that you have a good idea of how your cat is responding to the insulin (from sticky in this sub-group forum http://www.felinediabetes.com/FDMB/threads/the-basics-new-to-the-group-start-here.18139/:)

  • 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
Unfortunately, I am at work (shhh, don't tell anyone ;)) and I can't see your SS, but from your signature it seems that you have some history/experience with Lantus. You commented that you are seeing better preshots, most recently AMPS today of 185. This cycle if you can get a few additional tests in, you may see some lower numbers, which would suggest holding the dose. Just thought I'd mention this as we don't dose based on the preshot numbers, we really need to see how low the dose is taking the kitty.
 
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I did not discover this message board when he was on Lantus before, so I only tested at preshots and gave whatever dose the vet told me to. So I am just now actually learning the proper Lantus procedures. Once I discovered th FDMB I have been doing a combo of Go Slow and Tight Regulation with the Prozinc but am trying now the Go-Slow approach with Lantus just because I was personally having high anxiety with tight regulation. I still am testing during the day now to check for nadir with Lantus and these new doses, but am not planning to mess with the doses much unless he goes too low to shoot.
 
I'm finally home so I peeked at your SS, nice blue am cycle today :cool:! I believe the dosing methods of TR and SLGS were developed specifically with Lantus and Levemir insulins in mind, given the nature of how they are absorbed by cats, but that said, I started off with SLGS then transitioned to TR when I felt more comfortable with my understanding of how the insulin was working for my cat, as well as how he reacts to carbs. He still surprises me now and again though :). No need to rush, you may grow more comfortable as you gather more data and see how Ramon is progressing. Just a suggestion, when you feel comfortable, and want specific dose advice or Lantus help, feel free to post over on that sub-forum as well. My understanding is that kitties who were previously in remission, then have relapsed for various reasons may need to have a bit more of an aggressive approach to try and regain remission. Folks over there on L&L can help if that is your goal. Maybe I missed it, apologies if you mentioned it previously, but do you know what caused him to come out of remission? Keep posting in any case, people here on the forum really do try and help where and when we can :cat:
 
Christie & Maverick said:
.... Maybe I missed it, apologies if you mentioned it previously, but do you know what caused him to come out of remission? Keep posting in any case, people here on the forum really do try and help where and when we can :cat:
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Right after he went into remission last year I was sent to consult with an animal "nutritionist". She insisted he go on a diet kibble (Royal Canin I think) because she felt he was fat. So I followed her advice and of course that food is high carb. I didn't realize that I should have kept him on a low carb diet. (he had previously been on DM kibble which made him gain weight). Anyway I regret having followed her advice. I am pretty sure that is why he became diabetic again. Plus he was on drugs for some chronic conditions (cyclosporine and budesonide) which clearly were keeping his BG up. I stopped them in the last month and his numbers came down considerably. Now I have him on a raw diet and will keep him on it for life even if I am able to get him into remission again (I really hope I can!) I am amazed at all the poor advice I have been given by vets for this cat. I just found a vet here who actually promotes what is taught here and is helping me conquer his conditions and the diabetes in a much safer way. But its hard to ask him all the questions I need to ask, so I am grateful for this message board.
 
Now I have him on a raw diet and will keep him on it for life even if I am able to get him into remission again
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How is did the raw diet go getting started. Did Ramon take right to it? I have considered it and have actually purchased a bag of the suppliment from FoodFurLife. I have tried the freeze dried Stella's and Zoe likes it pretty good. Bella is hard nosed and will not do much more than sniff. Because of that she gets her own regular kibble in a microchip feeder. I put her on the low carb kibble by Young Again Mature and she liked it and I felt good about at least cutting carbs. But someone's poo was so bad just one go in the box stunk up the whole two story house. I thought it was that low carb kibble so I cut it out and went back to purina cat chow for her, but I think a lot of it is Zoe's wet food. The cat box is upstairs in a room and I keep it scooped and use a litter genie, but dang I hate for someone to come over because I never know when it is going to reek! Thats terrible to say but its true. I now think it is the wet food in general.

The reason I got off on poo is I think it was Dr Becker who said the raw diet produces smaller more compact and less stinky poo. I am adverse to grinding up meat and putting it in a dish but Im about to over that if the poo is less of an issue. I dont remember it being like this before the diabetes on regular kibble.
 
sybil said:
How is did the raw diet go getting started. Did Ramon take right to it? I have considered it and have actually purchased a bag of the suppliment from FoodFurLife. I have tried the freeze dried Stella's and Zoe likes it pretty good. Bella is hard nosed and will not do much more than sniff. Because of that she gets her own regular kibble in a microchip feeder. I put her on the low carb kibble by Young Again Mature and she liked it and I felt good about at least cutting carbs. But someone's poo was so bad just one go in the box stunk up the whole two story house. I thought it was that low carb kibble so I cut it out and went back to purina cat chow for her, but I think a lot of it is Zoe's wet food. The cat box is upstairs in a room and I keep it scooped and use a litter genie, but dang I hate for someone to come over because I never know when it is going to reek! Thats terrible to say but its true. I now think it is the wet food in general.

The reason I got off on poo is I think it was Dr Becker who said the raw diet produces smaller more compact and less stinky poo. I am adverse to grinding up meat and putting it in a dish but Im about to over that if the poo is less of an issue. I dont remember it being like this before the diabetes on regular kibble.
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I have been serving raw to my cats for a while. What's new for Ramon is that I used to also offer low carb canned and lo-carb kibble (Dr. Elsey's and Young Again - which by the way does not cause stinky poo in cats). Ramon is resistant to being limited to the rabbit only so its a little challenging. In my experience, cats on raw meat have very little poo at all. I think their bodies use all the nutrition and don't need to excrete anything. I live in the Minneapolis area (Minnesota, US) and we have stores that make their own fresh raw pet food. I have not had luck with the frozen brands. They will eat Stella and Chewy's but only unhydrated.
 
Wow how lucky are you to have a place that makes the raw food! I just guessed it was the Young Again but you are right it did not seem to change things after I stopped it. I would feel better going back to the Young Again over the Purina Cat Chow. That leaves the wet food. As a side chuckle, I just knew the dehydratred rabbit Stella's and canned food w/rabbit would be a good choice as Bella has been known to bring bunnies in to the house (some seemingly uninjured, some mortally wounded). So I figured she would like a rabbit diet. Nope not having it!
 
Wow how lucky are you to have a place that makes the raw food! I just guessed it was the Young Again but you are right it did not seem to change things after I stopped it. I would feel better going back to the Young Again over the Purina Cat Chow. That leaves the wet food. As a side chuckle, I just knew the dehydratred rabbit Stella's and canned food w/rabbit would be a good choice as Bella has been known to bring bunnies in to the house (some seemingly uninjured, some mortally wounded). So I figured she would like a rabbit diet. Nope not having it!
 
Wow how lucky are you to have a place that makes the raw food! I just guessed it was the Young Again but you are right it did not seem to change things after I stopped it. I would feel better going back to the Young Again over the Purina Cat Chow. That leaves the wet food. As a side chuckle, I just knew the dehydratred rabbit Stella's and canned food w/rabbit would be a good choice as Bella has been known to bring bunnies in to the house (some seemingly uninjured, some mortally wounded). So I figured she would like a rabbit diet. Nope not having it!
 
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