switching to Lantus... maybe

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bjg

bjg

Member Since 2012
I'm very new to feline diabetes, as well as this forum. I first posted last week. For background, here's the link: viewtopic.php?f=28&t=81218
The vet put my cat, Taliesen, on 3 units of Caninsulin once a day to start. When I started looking around here, as well as other websites, Caninsulin didn't seem to be the best option. Lantus and Levemir were suggested. I took Taliesen to the vet on Friday so we could see how he was faring. His blood sugar only moved from 22 to 20. The vet raised his dose to 5 units. I brought up Lantus. He knew nothing about it or any insulin other than Caninsulin. He was upfront about that and said if I wanted to use Lantus, he couldn't help me, but he would prescribe it for a fee anyway (prescriptions for insulin aren't needed where I live, so I was annoyed by that). He told me to find out more about it online. So here I am. I have about 3 or 4 days left of Caninsulin and I need to make a decision by then. I know that Caninsulin and Lantus are fairly different and that's about all I know. I'm not scientifically or medically-minded, unfortunately, so a lot of the things I should know are going over my head. I don't have a clue how 5 units/day for Caninsulin converts to Lantus. Is there one type of Lantus or do I need to request something more specific at the pharmacy? Any other important information or resources would be greatly appreciated!
 
bjg said:
I'm very new to feline diabetes, as well as this forum. I first posted last week. For background, here's the link: viewtopic.php?f=28&t=81218
The vet put my cat, Taliesen, on 3 units of Caninsulin once a day to start. When I started looking around here, as well as other websites, Caninsulin didn't seem to be the best option. Lantus and Levemir were suggested. I took Taliesen to the vet on Friday so we could see how he was faring. His blood sugar only moved from 22 to 20. The vet raised his dose to 5 units. I brought up Lantus. He knew nothing about it or any insulin other than Caninsulin. He was upfront about that and said if I wanted to use Lantus, he couldn't help me, but he would prescribe it for a fee anyway (prescriptions for insulin aren't needed where I live, so I was annoyed by that). He told me to find out more about it online. So here I am. I have about 3 or 4 days left of Caninsulin and I need to make a decision by then. I know that Caninsulin and Lantus are fairly different and that's about all I know. I'm not scientifically or medically-minded, unfortunately, so a lot of the things I should know are going over my head. I don't have a clue how 5 units/day for Caninsulin converts to Lantus. Is there one type of Lantus or do I need to request something more specific at the pharmacy? Any other important information or resources would be greatly appreciated!
Click to expand...

Caninsulin is a horrid insulin and with your being in Canada, like me, you are VERY lucky. You do not need to have a prescription to get insulin. That's pretty funny about your vet saying he would give you a prescription for it, but then again.... Levemir and Lantus are human insulins so maybe this vet does not know if it was needed or not. If you are in Toronto, I have a good suggestion for an excellent vet.

I know that Lantus is a very good insulin, but I think you would do well to switch to Levemir as some cats are a bit jumpy on Lantus, but do better on Levemir. I know this fact first hand from my cat Shadoe who did visibly better on Levemir.

Don't worry about the starting dose for Lev or Lantus; it would be wise for you to start at the beginning, with a dose of 1unit.

You can go to any Shoppers Drug Mart or many other places with pharmacies, and get a package of 5 cartridges of Levemir, or Lantus if you choose to go with Lantus. You will also need to pick up different syringes; get a box of the U100 syringes that have 1/2 unit markings on the side of the barrels. Ask the pharmacist to help you if you can't see the boxes.

Where are you located in Canada? There are several people here who are in Canada and may be near you and able to help you if needed.

When you go to pick up your insulin, pick up a box/container of KETOSTIX so that you can test his urine for ketones. As well, pick up a blood glucose meter, the test strips, and lancets for the meter. Since you are not in the US, you can't get the Relion meters. Good meters are Bayer contour (my favorite), and also any of the OneTouch meters. The Accu-Chek are not bad and the Precision are so so. I would not recommend the FreeStyle or any of the TRUResults meters as some people have received unreliable numbers for their cats. You do not need to buy the expensive vet pet meter if it's suggested either.

For the BG numbers that most people use here, you can convert your numbers...
http://www.felinediabetes.com/bg-convert.htm

your numbers of 22 and 20 convert to fairly high numbers of about 400 and 360.

you will not be converting your current dose of Caninsulin to something equivalent in other insulins because it's not similar at all. It's hard to tell how well or poorly that your insulin is doing because the numbers of 22 and 20 may have been taken at the vet office when the insulin had already worn off, or had not yet started working. The best thing to do would be to start home testing and switch over to a good insulin and at a typical starting dose of 1unit, then follow the protocol.
 
Blue/Gayle said:
I know that Lantus is a very good insulin, but I think you would do well to switch to Levemir as some cats are a bit jumpy on Lantus, but do better on Levemir. I know this fact first hand from my cat Shadoe who did visibly better on Levemir.
Click to expand...
Gayle's perspective is dictated by her experience. Both Lantus and Lev are good insulin. Each has its pros and cons and the information about one vs. the other can be found in this link. Given the large number of people here who use Lantus, there have been surprisingly few complaints. The only time anyone has seen a cat become "jumpy" with Lantus is on very large doses and it's a subjective opinion. There are cats who have been started on Lantus and switched to Lev and done well; other cats fare the same as they did on Lantus. Every cat is different and responds differently.

There are differences between Canninsulin and Lantus. One of the big differences is that Lantus dosing is based on the lowest number you get in the cycle. Dose reductions occur if your cat's numbers drop below 50 so home testing is very important. With Canninsulin, dosing is based on your pre-shot number. Canninsulin is also shorter-acting and it is a much harsher insulin than Lantus.

The AAHA (American Animal Hospital Assn) has published guidelines for managing diabetes in cats and dogs. They specify the insulin that should be considered. PZI and Lantus are the two types of insulin recommended for cats.

I'm attaching an article published in one of the leading veterinary journals that describes the dosing protocol we use. You may want to share the article and the AAHA guidelines with your vet.


Please let us know what questions you have and how we can help.
 

Attachments

Thank you for the replies!

I could use a good vet... don't know that I can afford a good one, though! I've already learned at least 100x more on here than I did from him.

I considered pen cartridges, but I don't think they're the best idea for me, at least while I'm starting out. I'm not very good at getting the little bubble out. It takes me a little while and almost every time I've had to put the insulin back into the vial. I would've wasted a LOT if it was a cartridge. Will I still need the needles with the 1/2 unit marks?

I'm in Ontario, though I'm not a fan of saying anything more specific online :S

I got a OneTouch meter yesterday. It's the same one my Mom uses, so she'll be able to help me figure it out. My vet didn't suggest I should get one at all! He told me to come back weekly for an unspecified amount of time to test Taliesen, $29 each week. Well, Friday was over $50. So that's not happening again. Fortunately, I'd already been to this forum and saw that he should be tested more frequently and that I'd be fine doing it myself. (Except for the first time, I think... which I'm dreading.)

It'll be really disappointing to go down to 1 unit. He's 22lb right now (was 27 before becoming diabetic), but I know I need to be careful even if he is significantly larger than most cats. At least I'm be making the switch early on...

Looks like I have a lot more reading to do. Thank you both, again!!!
 
Hi bjg. I just want to welcome you to LL. You'll be so happy you found this forum. I was very nervous about home testing but after the first couple of times you get use to it. Your cat will as well. All I have to do with PurrFace now is place him in the testing spot and he lays down for the test. Sometimes he even purrs. You might want to get some freezed dried treats for him to have after his test.
When he was diagnosed our Vet put him on 3U Humulin N BID and told us it was a lifetime condition. He said he never heard Lantus and that home testing wasn't necessary. We asked him to research Lantus, he did and switched us to it.
Don't get overwhelmed with all the info. Take it bit by bit as you need it and you'll find each day you understand a little bit more.
Everybody on the FDMB are great and more than willing to help and are always there for support.

Have a great day.
 
Frosty, I love your cat's name!
I thought switching to Lantus would be a fairly easy choice, but it turns out it's quite a bit more expensive than I was expecting. I was thinking it would be about $50 for 10ml, but it's $75 (Walmart). They didn't have a price for Levemir. I got prices for other options, though I don't know if any of them are any good or if they can even be used with cats. The reason I'm entertaining them at all is because they're all about $27 for 10ml. Humulin N, Humulin R, Humulin U, Humulin 30/70, Novolin NPH, Novolin Toronto, Novolin 30/70. Can any be crossed off the list right away? I'm about to start looking around this forum for more info on these, but I thought I'd post here to start.
 
I should say that while I'm concerned about costs, Taliesen is my primary concern. If the options I listed turn out to be not so good, I'll be going with Lantus.
 
Your kitty should do much, much better on lantus or levemir. Either of these insulins will give him the best chance of going into remission especially if you are able to follow the Tight Regulation protocol that Sienne linked for you.

Both are excellent insulins. I agree with Sienne....I know of no one else other than Gayle who says their kitty was jumpy on lantus. I don't think you can go wrong with either insulin.

You can't inject back into the vial with either of these insulins...or the cartridges or pens either. You can inject AIR into the vial but not the cartridge/pen. Unless one of us has a high dose kitty, the pens/cartridges are more cost effective. Most of us use them.

You will need to buy U100, .3cc syringes; you can get them in 1/2 unit markings. If you buy the pens/cartridges, the pharmacist might also try and sell you the pen/cartridge needles. Don't buy them....we use regular insulin syringes.

Since your kitty has only been on insulin less than a week and if you plan on following the Tight Regulation protocol, his starting dose would be .25u/kg of IDEAL weight. It is not our standard procedure in this forum to start every cat at 1u. If he had been on caninsulin longer, we'd have you start him on roughly 70% of his current dose.

Please be sure you read the New to the Group and TIght Regulation Protocol sticks before you switch so you can have a little more info. There is also a Start Low Go Slow Protocol which we can help you with although most members in this forum follow the TR protocol. We are happy to have you here either way.

Finally, if you are just starting hometesting, here is a great video....it's what we used to learn how to do it:

[youtube]_zE12-4fVn8[/youtube]
 
Hi there-
Just wanted to say "Welcome" to the best place you never wanted to be. I can't offer a lot of advice, but we have had a wonderful experience with Lantus and have just celebrated our Fur Ball going OTJ (that stands for off the juice, and he is in remission). We read A LOT of information on this board and joined LL once we discovered it. I think the diet change as well as following the tight protocol suggested here has made all the difference.

Keep reading and then re-reading as this information is so overwhelming in the beginning. I am by no means an expert but have found this resource to be invaluable. Post as many questions as you have and someone will get back to you. Marje has given you a lot of good info and she is dynamite in her wealth of knowledge, compassion and assistance!

Karen
 
From what I've seen online in the past hour or so, I do see that Lantus and Levemir really are superior and now I have a vague understanding why that is. I can also see how the increased cost is justifiable, based on how different they are from other types of insulin.
The insulin can't go back in, even if I haven't taken the needle out of the vial? I try flicking bubbles out, but they don't budge. I really, really don't want to have to waste insulin if I can avoid it. Any tips (for when I switch)?
I read that you can't shake the cartridges. Do you have to be extra gentle with them? Will I be paranoid that it's gone bad if I move it too quickly or if it turns over at some point?
I'm hoping that even though Taliesen is larger, by controlling his diet he won't end up needing very high doses.
I'm not exactly sure what Taliesen's ideal weight is. My family and I have tried guessing, but I wouldn't call them educated guesses. What would his ideal weight be based on? His original weight, current weight, height, length...?
I'm reading the Tight Regulation Protocol and Start Low Go Slow. Of course, I should've read them earlier, but I didn't realize how important it would be until now. That, and I'm beyond overwhelmed by the information available and little snippets of info appeal to my eyes more than the long stuff. It's possible I've got this completely wrong (like I said earlier, a lot goes over my head), but is the main difference that tight requires constant testing and alteration of the dose and slow doesn't? With all of the extra work and attention to the details that tight entails, can I assume that it leads to a healthier cat and higher likelihood of remission? Honestly, testing 4 times a day is putting me off, partly because of the work and scheduling required (which is completely possible in my case, but a challenge), but also because I don't see myself ever getting used to pricking Taliesen (even though it doesn't actually hurt him). Am I not committed enough if I don't manage his diabetes this way? And... now I've watched that video and I'm an uncomfortable combination of faint and nauseous. I know I need to watch it, but I keep looking away. I'm feeling really horrible about all of this suddenly. I'm going to go freak out away from the eyes of this forum...
 
Ok...Deep Breaths!! Nice and slow. Remember....every single one of us was in your shoes at one time. My Gracie is a tiny cat and she was just 4 when diagnosed. The last thing I wanted to do was to stab her in the ear with a lancet! But guess what? She doesn't care. She sleeps through it. You just want to be sure you get the edge and not the vein, ok?

Here's a picture showing the vein and the sweet spot:
sweetspot.jpg


The ears get toughened over time although you can't feel it. I usually poke right on the edge and get good blood drops. Here are some other tips:
1. warm the ear first using a rice sock warmed for a few seconds in the microwave or warm a wash cloth and wrap it in a baggie and use it to warm the ear
2. use a large gauge lancet (29g) to start and then as you both get used to it, go to a smaller one like 31g
3. put a little dab of Neosporin with Pain Relief OINTMENT (not cream) where you poked each time
4. alternate ears; you will find that one ear generally bleeds easier than the other

It does get easier!!!!!

To answer some of your other questions:
No...you cannot put insulin back in the vial or pen at all. It can cause it to go bad. Under the New to the Group link I gave you, there is a video on how to draw doses using pens/vials. So you draw the dose, take the syringe out, then flick your bubbles to the top and expel them. Never put insulin back into the vial or pen. Most of us are careful with our vials and pens. Some members have accidentally dropped them with no problem. They are probably more resilient than we think. Even still, I keep mine in the crisper drawer with a refrigerator thermometer on the box to be sure it doesn't roll around, get jostled, or get subject to temp changes like it would in the door. No...you should not be paranoid if you move it too quickly or it turns over. Just don't roll it, shake it, or inject back into it.

One extremely important thing to remember about lantus and levemir is they are long duration, depot insulins. That means that the first several shots you give goes towards the "depot". When this depot is full, then the kitty starts to use the shot you give each day. That's an oversimplification but the point is...don't expect to see quick changes in numbers right away like you would with a harsh, short acting insulin like Caninsulin. With the "L" insulins, each shot builds upon the preceding one...that is why we hold doses.

Yes, the TR protocol will give him the best chance of going into remission. It is more aggressive in that we only hold the dose 3-5 days (after the initial dose which we hold longer to fill the depot) if the kitty is not making progress. So there are parameters where you increase and decrease the dose. The SLGS has you holding each dose a week and then reassessing. Do kitties go in remission on it? Yes...but the TR protocol has the best results.

Most of us here are testaholics. You don't have to be to follow the TR protocol. We want you to always...every single cycle....get a preshot test. We do not shoot blindly. If you work, we suggest you get a +2 and/or out the door and in the door test; at night, a +2 or a before bed test. When he starts getting into normal numbers, you will probably need to test more.

This Cat Body Condition Chart should help you determine a ballpark for his ideal weight. If he is really thin, we use a different formula so let us know if that is the case.
 
I'm nearly at the end of this vial, but for the next one (or cartridge), I'll make sure I don't put insulin back in. I hadn't even thought about the temperature changes on the fridge door. The crisper would be a lot better!

If I choose to do the slow route for now, can I switch to tight later?

Taliesen's body is hard to describe. He used to be overweight in every way. The most noticeable (to me) difference in him now is that he's lost all of the fat on his back. His face is thin, his paws are thin, his neck is thinner. His sides are thinner, but his stomach hangs as low as when he wasn't diabetic. I hate describing this, because I know it's my fault. I denied what was happening for too long. Anyway, he fits partly into the underweight category (I can easily feel his vertebrae) and partly in the obese category ("Abdomen rounded; waist barely visible to absent"). To me, he's far too thin, but it's my poor judgement that made this happen, so I can't go by that. I've been reassured by my Mom and sister that once his diet and doses are sorted out, he'll still lose weight, but he'll look healthier and his back won't be boney anymore. So, probably not actually too thin. Also, he's a tabby, but I suspect his frame is larger than the average Maine Coon. I should get a tape measure out and see how he compares. 18 lb is where my Mom and sister thought he should end up, but like I said, that was just a guess.
 
You can absolutely do the relaxed forum to start with and change over to TR (tight regulation) as you are able.

I was totally freaked out by testing Fur Ball and my husband did most of the poking. That first week, however, really was tough. It would take like 5-7 pokes each time before we could get blood. Oh I felt just terrible. BUT. After our evening of low numbers (check out Fur Balls SS on 9/27-10/1) you will see how many times I had to test him. Wanted to make sure he was safe but it was also an amazing opportunity to see how his body responded to the insulin and food. Soooo long story short, the testing really has gotten easier and Fur Ball now purrs through it. And like Marje said sometimes the kitties will even sleep. As we have gone OTJ he almost isn't sure about eating without testing as we would test on the couch, get lots of love and snuggles and then he would eat. :lol: :lol: :lol: We have to do some of that now so he'll eat!!!

I really do think he has associated the testing with love and feeling better. I know if can feel mean and cruel, but if you can get over that initial hurdle you will be pleasantly rewarded for your efforts.

You can also ask your vet for an estimate of what they believe Taliesen's ideal body weight will be. Fur Ball was probably about 24 pounds before he got sick (overweight) and when we took him to the vet on 9/5/12 he weighed 17ish pounds. We do not have a scale and have not weighed him since, but I think he is aobut 16 or so. He is so much healthier.

Keep reading. :smile: I know how overwhelming it is.

Karen
 
Hopefully Taliesen will sleep through the testing, eventually. For the moment, I'm the Bringer of Wet Food, so if he sees me, he's up on his feet. He'll only relax if I'm out of the room or if I feed him.
Your spreadsheet and results are amazing, certainly something to aspire to!!!
I have a LOT more to learn and figure out, so I'll definitely keep reading!
 
No matter whether you use TR or SLGS, you need to get pre-shot tests and at least one test in both the AM and PM cycle. The reason for the minimum numbers of tests is that the pre-shot test tells you if it's safe to shoot. However, Lantus dosing is based on the nadir or lowest point in the cycle so you need to get at least one spot check during each cycle. If you don't get those tests, you can easily miss a dose reduction or put your cat's safety at risk.

The difference between TR and SLGS isn't in the number of tests. The approaches differ with respect to how soon doses are changed. With TR, we evaluate the dose every 3 days/6 cycles. With SLGS, doses are altered every 7 days/14 cycles. In addition, the criteria for a dose reduction differs between the approaches.

The other big difference is that the TR Protocol has research to back it up. The protocol has been tested and published in one of the leading vet journals. It has an enviable track record for getting cats into remission.

I wouldn't worry about dose. Low or high dose is unimportant. Taliesen's body needs what it needs. Your job is to figure out what that is. The goal is to get your cat's BG numbers into a healthy range that prevents organ damage. It that means he needs 0.5u or if he needs 7.0u that's what his body requires.

FWIW, no one taught me how to give an injection let alone how to test. I brought my cat home after three days on the ICU and realized that neither the vet tech or vet showed me how to give Gabby a shot. Thank goodness for YouTube! It's also how I learned to test. I'm fortunate that I'm not squeamish about blood or needles but it did take a deep breath and a lot of calm thoughts. And a lot of treats for Gabby. What helped me was a bit of perspective. There was a conversation on the Health board with someone who didn't see the point of testing. One of the members here asked the caregiver a question: "If this were your child, would you not test before giving an injection of a drug that could be dangerous?" That was the point that I closed the computer and went out and bought a meter. Testing is ultimately the best possible way you can keep Taliesen safe. You have control over his diabetes only if you test. You clearly love your cat. The way that you can get his diabetes under control is to have the data that will allow you to do so and to protect him. Testing will empower you to do just that.
 
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