switching to Lantus from PZI but problems and questions

[stephanie and pheobe]

Hi - I hope you remember me - I used to have Pheobe, she had acromegaly. Since then (the past year and a half, Murphy her brother has also had diabetes.
We've been doing really well (PZI) ......... but now, it seems the PZI has had it (I think) as he has had higher numbers lately. I tried rebound test and infections etc but not reason for dodgy numbers (at least not infection - not doubly sure about rebound now ?)

Anyway - I have arranged to start Lantus on Saturday (Saturday because i am here) and was then trying to think of a starting dose when tonight he throws me a 30 (570)!!!! Only once before have we had a number like that, and that was definately rebound (in early days when he was on 2u...and then i shot 0.25 on a 10 (100)

So now, I'm thinking why the 30 (570)?!! Has the PZI really had it, or, have i just been giving too much? What staring dose for the Lantus if I have been giving too much?

Murphy has had his ups and downs (numbers wise) and, there have been times when he'll just not come down but we've always worked through it. I know he's been high for a couple of weeks now - I feel bad because I should have sorted new insulin before now ....I just thought he would hang on in there until Saturday.

Have copied below some of his numbers as a snap shot - and i'm sorry they are in UK denominations....I tried to find calculator but couldn't...sighs...

any thoughts? (and OK I deserve to be shot I know that) PLUS, what concerns me is the shed effect (I still haven't got my head around that) but how, if they do go low it can go on for hours. Beccause I'm not here much (I work shifts and most days i won't be able to get peak numbers..plus in the mornings I'm up at 5.30 but have to leave at 7.... would rather have slightly higher numbers at peak rather than push him too low. Is that possible?

The other thing as well - he has, on the PZI sometimes gone 30+ hours without insulin. How does that work with Lantus?

Any thoughts appreciated> Thank you....

___________________________________________________________
UK Numbers
Tuesday 21 June
6.15am (+12) 12.4 - 0.2 + little Bozita
12.20 (+6.05) 10.2
6.05pm (+11.50) 10.4 - 0.15 + little Bozita + little chicken
10pm (+4) 6.8

Wednesday 22 June
6.10am (+12.05) 10.9 - 0.15 + just ate little Bozita
9.14am (+3) 7.7 ate
11.20am (+5.10) 6.3 eating
1.20pm (+7.10) eating
6.10pm (+12) 7.9
8.32pm (+14.20) 9.7 - 0.1
10.25pm (+1.50) 8.9 eating

Thursday 23 June
6.54am (+10.30) 11.1 - 0.15
11am (+4) 8.4
6.25pm (+11.25) 7.8
9pm (+14) 9.4 - 0.1 didn't seem like anything and now he's eating

Friday 24th June
6.15am (+9.15) 10.6 - 0.15 + just ate Bozita
9.20am (+3) 9.7
12.30pm (+6.15) 6.0
6.15pm (+12) 11.8 - 0.15 + ate Bozita
9.50pm (+3.35) 8.3

Saturday 25th June
6.15am (+12) 11.7 - 0.15 weirdy shot (plus he moved not sure he got any) + little chicken
10am (+3.45) 12.0 - has eaten a lot this am
12.45pm (+6.30) 13.9 smidge (on 1st line) - eating
6.15pm (+12/5.15) 13.6 - 0.2 eating > could have been 0.25 or 3?
9.45pm (+3.30) 12.7

Sunday 26th June
5.55am (+11.40) 12.3 - 0.2
11.30am (+5.30) 8.1 - eating drinking
5.55pm (+12) 13.3 - 0.2
10.10pm (+4.15) 9.3

Monday 27th June
5.30am (+11.30) 11.5 - 0.15 had just eaten lots (hadn't eaten too much over night)
4.45pm (+11.15) 12.3 - 0.2 + little Bozita
10.15pm (+5.30) 9.7

Tuesday 28th June
5.15am (+12.30) 9.3 eating little
6.35am (+13.45) 10.6 - 0.15 + little chicken + ate
6.30pm (+11.55) 10.4 - 0.15 + little Bozita
9pm (+2.30) ate loads
9.37pm (+3.05) 11.6

Wednesday 29 June
6am (+11.30) 12.1 - 0.2 had eaten half hour before
6.05pm (+12.05) 12.7 - 0.2 (centered over line but didn't seem as much?) hadn't eaten much today
10pm (+4) 14.9 ugh!!


Thursday 30 June
5.30am (+11.30) 13.9 - 0.2 (more 0.3) eating
5.30pm (+12) 15.4 - 0.4 eating
9pm (+3.30) 13.7 eating

Friday 1 July
5.30am (+12) 13.0 - 0.2
4.30PM (+11) 12.6 - eating - 0.2
8.40pm (+4.10) 11.1


Saturday 2 July
5.05am (+12.35) 11.1- 0.15
11.30am (+6.25) 11.2 smidge 1st line - didn't seem like any in there again
5.20pm (+12.20/5.55) 10.1 little sardine
6.20pm (+13.20/6.55) 9.3 ate little
7.20pm (+14.20/7.55) 9.7 teeniest piece of chicken
8.30pm (+15.30/9) 10.7 - 0.15 + little Bozita

Sunday 3 July
7.30am (+11) 13.2 - 0.2
12.45 (+5.15) 9.7
6.16pm (+10.45) ate
6.45pm (+11.15) 13.9 - 0.2
9.35pm (+2.50) 8.0 - eating

Monday 4 July
6.30am (+11.45) 9.9
7.10am (+12.25) 10.6 - 0.15 ate little earlier
6pm (+11) 13.4 - 0.2
8.10pm (+2.10) 11.8

Tuesday 5 July
6am (+12) 9.3 little Bozita
7.10am (+13.10) 9.6 - 0.1 tiniest smidge
6.05pm (+11) 6.8 - little sardine - now eating Bozita
8pm (+13) 8.9
8.40pm (+13.40) 8.6 - eating
LOOK AT!!!!! **17/18th June

Wednesday 6 July
5.30am (+22.30) 12.7 - 0.2 + little Bozita
6pm (+12.30) 11.4 - 0.15

Thursday 7 July
6am (+12) 9.4 - little Bozita
7am (+13) 10.1 - 0.1 tiniest smidge - just ate
5pm (+10) 8.8 - has eaten quite a bit today as well
7pm (+12) 10.0 - 0.1 tiniest smidge + little Bozita
10pm (+3) 8.4

------------------------------------------------------------
Monday 1 August
6.08am (+12) 19.5 FAT 0.5
6.03pm (+12) 14.9 - 0.4 - trying the Pate again - is he eating too much? is it the Pate?
9pm (+3) 13.6

Tuesday 2 August
6am (+12) 13.8 - 0.4 < was this too much? (or, should i go back to FAT half over 13?
5.55pm (+11.55) 17.6 - 0.5 - hasn't eaten today either - am i rebounding him?
9.40pm (+3.50) 14.1

Wednesday 3 August
5.57am (+12) 14.0 - 0.4
5.58pm (+12) 14.7 - 0.4

Thursday 4 August
5.56am (+12) 11.5 - 0.3 eating
5.47pm (+11.50) 14.5 - 0.4 + little Bozita
9.15pm (+3.30) 10.7

Friday 5 August
5.54am (+12) 11.7 - 0.3 (more a fairly skinny half)+ little Bozita
5.46 (+11.50) 12.7 - 0.3 (more a skinny half) + little Bozita
9.38pm (+3.50) 9.0

Saturday 6 August
6am (+12.10) 12.7 - 0.3 (more a skinny half) + little Bozita - not happy this am - went to swipe me when tried to inject

_________________________________________________________________this is where he goes up and stays up-------------insulin nearly 4 months old and have seen specs...

Monday 3 October
6am (+12) 19.8 - 0.5
7am (+1) hiding under bed
5.51pm (+11.50) 11.6
7pm (+13) 13.0 - 0.3

Tuesday 4 October
6.10am (+11.10) 22.1 - 0.5
5.58pm (+11.50) 18.7 - 0.5
9.25pm (+3.25) 15.3

Wednesday 5 October
6am (+12) 19.9 - 0.5
6pm (+12) 19.9 - 0.5 think insulin has had it - can see specks

Thursday 6 October
5.57am (+12) 22.1 - FAT 0.5
6pm (+12) 22.6 - n FAT 0.5
9.39pm (+3.39) 18.2

Friday 7 October
6am (+12) 16.1 - n FAT 0.5
5.53pm (+11.55) 15.7 - n FAT 0.5

Saturday 8 October
6.09am (+12.10) 14.3 - n FAT 0.5
12.27pm (+6.20) 13.2
6pm (+11.50) 18.8 - n FAT 0.5

Sunday 9 October
6.15am (+12.15) 18.3 - n FAT 0.5
11.40am (+5.30) 13.4 eating - was hiding under bed earlier
5.51pm (+11.40) 14.7 - n FAT 0.5

Monday 10 October
6am (+12.10) 17.9 - n FAT 0.5
4pm (+10) ate
6.11pm (+12.10) 21.0 - n FAT 0.5

Tuesday 11 October
5.57am (+11.50) 19.2 - n FAT 0.5
5.59pm (+12) 20.1 - n FAT 0.5 little more FAT
9.34pm (+3.34) 18.2

Wednesday 12 October
5.58am (+12) 15.8 - n FAT 0.5
6pm (+12) 17.3 - n FAT 0.5

Thursday 13 October
5.53am (+12) 17.2 - n FAT 0.5
5.54pm (+12) 32.0!! WTF!! - FAT 0.5 - could he have eaten angus' food? Rebound?

 

[Marje and Gracie]

Stephanie:

I am just going to welcome you and Murphy to lantus land and let you know we are here to help and answer questions. However, I'm going to leave the dosing to those who are more familiar with switching from PZI to lantus and also can decipher your UK numbers. I know they will probably ask that you put together a google SS (see link below)....perhaps that converts World numbers to US numbers???

There are alot of folks who work and manage their cats on lantus. It's a much gentler, longer lasting insulin. If there is a way you can manage to shoot him early enough to then allow for you to get a +3 or so before you leave, that might be helpful. We say here "every cat is different" ECID...and that includes their response to the lantus and the effects of the shed. Some kitties do really nice, typical lantus curves; others don't. Keep in mind that if you start him on Saturday, it will take a few days for his shed to fill so you may not see much action regarding the numbers coming down. But as soon as they do, it would be best to do a curve so you can see if he has a discernible cycle (although nadirs can shift).

How to do a Spreadsheet

It would also be great if you could read through the Starred Stickys. There is lots of information there for starting out. Once you've gone through it, then let us know your questions.

I do recommend that you print out most of the stickys regarding (1) protocol (2) handling low preshots (3) dealing with low numbers. Many of us keep them together in a binder in case we need to refer to them quickly. I also recommend that if you do not have a hypo toolkit, that you get it put together before you start the lantus. It's not that we see that many hypos but we like you to be prepared.

[Hypo Toolkit

Welcome and we hope to see you and Murphy here daily!!

 

[Sienne and Gabby (GA)]

I hate to say this but we really do need the numbers in US measurements. If you use Windows, there's a calculator in the Accessories file. If you use a Mac, there's a calculator in your Applications folder. Also, you multiply the UK numbers by 18. So a 10 is a 180, not 100. It would also be helpful to know what dose you've been giving.

Lantus will work best if you can shoot every 12 hours. Going 30 hours between shots will deplete the shed and any progress you've made at a particular dose will involve starting the cycle count for that dose over again. (Doses, with the exception of the initial dose, are typically held for 3 days/6 cycles.) It's best if you can get at least 4 tests per day -- your pre-shot tests and one test per cycle. If you can't test during the day when you're at work, it's helpful if you can get additional tests at night and on weekends or days when you're not at work. Many of us work or are in school, or both. You do what you can to get the information and keep your cat safe.

The starting dose of Lantus can be based on a cat's ideal weight (initial dose = ideal weight in kilograms x 0.25). However, if a cat is switching from another insulin, the dose on that insulin along with any relevant medical history, such as ketones/DKA, are taken into consideration.

Whoever suggested that if a cat that's on a long acting insulin like Lantus goes low it goes on for hours, was misinterpreting information. All of our cats have gone into low numbers and we bring them up with high carb food. We monitor carefully because like with any insulin, as the food wears off, the numbers can drop again. IF a cat is experiencing a symptomatic hypoglycemic episode, this can go on for hours. It is rare that this happens. We are quite annoying about encouraging you to test in order to avoid symptomatic hypoglycemia. The people here will stay up all night with you to make sure your cat is safe and you have support and no one wants to lose a night's sleep!

Please take a look at the starred sticky notes at the top of the Board. They will be a good start for familiarizing you with Lantus. Please ask questions. We're here to help.

And, please set up a spreadsheet. If you use the World template, it will automatically convert your numbers so we can all take a look.

 

[Dyana]

You say your insulin is old and you see specs in it. Maybe your insulin is toast.

Anyway, I just wanted to say Welcome, and I hope you do do the switch to Lantus, and come here to post. We will help you all the way. We will need to see your numbers in the US conversions, though, please :razz: and what dose you're currently giving of the PZI.

Read the stickies at the top of the page and ask as many questions as you have.

Hope to see you post more often. And good luck on Saturday.

Oh, and I work a ton, too, so I just mainly get my testing done in the middle of the night (alarm clocks) and on my days off.

 

[stephanie and pheobe]

Hi

Thank you so much for you replies and apologies for not being back sooner. Just to let you know I've been given some fresh insulin so trying to sort out this 'higher numbers' period before i start the Lantus (so no, I haven't started yet) but I will keep in touch when i do. If that's OK..

And no probs re the numbers and converting to US measurements - I used to do that with Pheobe - just posted in a panic like you do and no calculator at hand.

Love to all your furries.

Steph (and Murphy too)

 

[Sienne and Gabby (GA)]

Good luck and let us know how things are working out or if you need us!

 

[Jill & Alex (GA)]

here's a link to the FDMB blood glucose concentration conversion calculator: http://felinediabetes.com/bg-convert.htm.
good luck!