Todd's mom Heather
Member Since 2018
Todd is switching from Prozinc to Lantus. He said to go 48 no insulin before starting... what have any of you done?
Switching to Lantus. Protocol for transitioning?
- Thread starter Todd's mom Heather
- Start date
Steph & Quintus & L & O
Member Since 2017
Here we tend to simply switch insulins from one shot to the next. You might find the discussion on Kya's thread useful: http://www.felinediabetes.com/FDMB/...row-from-prozinc-starting-dose-advice.209149/
In your case it's a bit hard to say, because you've been changing the dose so much with Prozinc that it's hard to get an idea what an "insufficient but stable" dose of Prozinc would be. I guess I would maybe start with 1.5ui (but this is really a guess, wait for other opinions/advice before going ahead).
With Lantus it is super important to give a stable dose of insulin. If you change the doses like you've been doing until now you will not get the benefits of Lantus, and risk putting your kitty in a dangerous situation. I don't want to freak you out, but it's important to stick to one dose! If you increase, you increase by 0.25, and you hold the dose a certain number of cycles before increasing again. You'll want to take some time to read the stickies at the top of the forum to familiarize yourself with how Lantus works. Do come back with any questions you will certainly have.
In your case it's a bit hard to say, because you've been changing the dose so much with Prozinc that it's hard to get an idea what an "insufficient but stable" dose of Prozinc would be. I guess I would maybe start with 1.5ui (but this is really a guess, wait for other opinions/advice before going ahead).
With Lantus it is super important to give a stable dose of insulin. If you change the doses like you've been doing until now you will not get the benefits of Lantus, and risk putting your kitty in a dangerous situation. I don't want to freak you out, but it's important to stick to one dose! If you increase, you increase by 0.25, and you hold the dose a certain number of cycles before increasing again. You'll want to take some time to read the stickies at the top of the forum to familiarize yourself with how Lantus works. Do come back with any questions you will certainly have.
Todd's mom Heather
Member Since 2018
The vet I've been to see most recently said to start with 1u. The previous vet said 2.
No vets have said to stick to a stable dose. Whenever I've asked what to do, they have responded by shrugging or saying that "not many owners test at home". Which isnt an answer, either.
I'm doing my best of course, and I promise I won't jump all over the place with Lantus. I will go slow and only increase after enough data shows I should. But MAN. I am so frustrated that since July, no vet has given my consistent or helpful advice.
Thank you so much for responding. I've been reading up on Lantus stickies!
No vets have said to stick to a stable dose. Whenever I've asked what to do, they have responded by shrugging or saying that "not many owners test at home". Which isnt an answer, either.
I'm doing my best of course, and I promise I won't jump all over the place with Lantus. I will go slow and only increase after enough data shows I should. But MAN. I am so frustrated that since July, no vet has given my consistent or helpful advice.
Thank you so much for responding. I've been reading up on Lantus stickies!
Bellasmom
Member Since 2018
This might be helpful
http://www.felinediabetes.com/FDMB/threads/start-low-go-slow-method-slgs.129446/
http://www.felinediabetes.com/FDMB/threads/start-low-go-slow-method-slgs.129446/
Sue and Luci
Member Since 2017
That's the RIGHT thing to do...let your data guide you.
Unfortunately vets don't get a lot of training for Feline Diabetes - I believe I've read somewhere that it's about 6 hours during their entire Vet School training experience...so consider yourself lucky - get your advice/guidance and support from this forum - there are people on here who've had years of experience with Feline Diabetes - they will guide you. Please put a '?' on any thread when you're not sure what to do, when. The experts will come on and help you. Take heart...these folks are lifesavers! Not the vet...they just don't know - we try to forgive them for what they do not know...(most of the time)...
Todd's mom Heather
Member Since 2018
So should I go out and buy a human meter? Since this doc references those numbers?
Todd's mom Heather
Member Since 2018
That's the RIGHT thing to do...let your data guide you.
Unfortunately vets don't get a lot of training for Feline Diabetes - I believe I've read somewhere that it's about 6 hours..they just don't know - we try to forgive them for what they do not know...(most of the time)...
Thanks. That's what it seems like. Vets just dont have the experience. I'm grateful for this board and all the years of experience owners have!
Sue and Luci
Member Since 2017
Absolutely! I went to Walmart and bought one of their brands and the matching strips - they're very inexpensive to use and more economical than a meter exclusively for pets. You can keep the Alpha Trak or Pet Meter for when the numbers are really low and you want to watch carefully for hypo situations. In the meantime - getting a human meter will allow you test frequently so you'll get to know your cat's patterns, when he's high or low...and you'll see trends for when all of that happens. It's just a matter of affordability. The pet strips/meters are more accurate but at $1 per strip it can get to be so expensive you may be reluctant to test as often as needed and that can be very dangerous. So spend $20 or $30 for a human meter and coordinating strips (be sure to get the same exact brand of strips as the meter)...there are lots of them on the market - just make sure you go where you can go easily because you'll go thru a lot of strips.
I personally use the OneDrop subscription meter/system because we test a LOT - and at $49.99 a month unlimited strips delivered to my home work best for me. I also have purchased a Pet Meter from Advocate for when Luci is really low and I want to know her numbers more accurately - as in my case the OneDrop tends to read a bit lower than the Pet Meter. All of these meters and cats are different, so what works well for one, might not work as well for another. I like the OneDrop for convenience and the size of the blood drop required is very small - you may want to try a couple of systems before you settle on one - or you may get really lucky and get Todd into remission before going on like we have - starting year 2 on Lantus.
Wishing you the best in your journey!
Todd's mom Heather
Member Since 2018
Thank you!! This info is really helpful. $50 a month is better than over $100. That's for sure.
I am terrified of him ever going low because it would happen when I'm asleep or at work. Ugghhhh...
Sue and Luci
Member Since 2017
Heather, I've also noticed when looking at Todd's SS that you seem to change dosage frequently. Once you've adopted one of the protocols discussed in the stickies you may notice that the recommendation is to change the dosage by only .25 and to wait at least 6 cycles (please see protocol for those cycles) before switching the dosage again. Lantus takes time to work as it's a depot drug. I have no experience with Prozinc - but would like to point out that this is most likely a major difference for you in your switch from Prozinc - just another point that you'll want to be sure to be patient with Lantus and not change it as frequently as you've been modifying the dosage of Prozinc.
I hope you find my comments helpful More reading on your part will be enormously helpful. Hang in there
I hope you find my comments helpful
More reading on your part will be enormously helpful. Hang in there
Todd's mom Heather
Member Since 2018
Yes, SO helpful, thank you. I will be patient with the lantus. Its not like he hasn't been riding high for weeks already But yes. I know to go slow and change doses slowly and in small increments.
I hope he stops having days where he starts in the normal range, so I skip the shot, and he is super high later on.. just jumping all over. I'm so tired of putting him through this. I really hope Lantus helps.
Sometimes I wonder if his pancreas isnt totally shot, and there are days it functions just fine. I guess that's why I test so often!
Seriously, thank you so much for your time and suggestions I am really grateful.
Sue and Luci
Member Since 2017
I hear ya! That's why is really helpful if you can test as much as you can when you can! Weekends and holidays are great for testing a lot - as you'll be gathering data and you'll be able to tell when he hits his nadir (the lowest reading on the cycle)...typically (of course Luci is not being very typical right now, so I don't have much room to talk!) I think she's playing 'guess when my nadir is' with me lately!
But as a general rule, if you get lots of test you'll see a pattern developing and you'll know more about when those low numbers are going to hit. I always get a 2+ (two hours after giving insulin)....usually I get a clue about what's coming at that first 2 hour test - if she's dropping like a rock I have to do something - test more usually since I work from home - I set an alarm to check again in 30 minutes or an hour based on the amount she's dropped - and I get some medium or high carb food ready - just in case.
Another thing you'll want to do if you haven't already is prepare your arsenal - when you're at Walmart shopping for your human meter/strips; sashay on over to the cat food isle and get some of those Gravy Lovers Fancy Feast and check out the higher carb ones as well - one is Fancy Feast with Cheddar and gravy - it's like 21% carb. Dr. Pierson's food chart has all the medium and high carb foods listed - so be sure to get some of those to have on hand for when Todd decides he's going to go swimming in the lagoon or chasing sharks
(going into the green numbers or too low!)...Those foods can be used to 'steer' him back into a little higher numbers...the trick is when to feed it to him - if you have to leave for work - sometimes it's best just to give some medium or high carb foods and try to pop in mid-day to see if he's still in decent numbers...all that info in the stickies about what to do when you have to go to work (that work thing...what a pain sometimes, huh?)...Anyway...try to get those tests on days when you can - you can call it 'getting a curve' if you like because you'll see those numbers start high, then slope downward...then back up...the curve...
We're all here to help you
Sue and Luci
Member Since 2017
Yes, with Lantus we never (well almost never) skip a shot. Only with a low number (you'll see those numbers in the stickies) that you'd skip a shot. If Todd is already too low (like 40 or 45 you would not give a shot)...but just take your time and be ready to deal with shooting lower numbers (there's a whole stickie dedicated to that)...and the most important thing - if you're ever in doubt - post a HELP on the board - so some of the experts can guide you. The first time that happens is SCARY! Lantus loves consistency; same times of day every day - 12 hours apart; slowly increase or decrease dosage. You'll see results - eventually...it's a process
Take a look at Luci's SS - and you'll see some of her starts are downright awful! No explanation as to why she does that...maybe a bounce? Maybe just Luci being Luci...and then she's dramatically sliding into the lagoon...it's her way. I learned early on that she likes drama - that's why I call her the Queen - it used to be Drama Queen...but now just 'The Queen' or HRH (Her Royal Highness)...it's an ever evolving name thing as Luci shows me who's in charge here...and it's not me 
Todd's mom Heather
Member Since 2018
when you're at Walmart shopping for your human meter/strips; sashay on over to the cat food isle and get some of those Gravy Lovers Fancy Feast and check out the higher carb ones as well - one is Fancy Feast with Cheddar and gravy - it's like 21% carb.
We're all here to help you
He is so picky about food. Only eats certain cans of the FF pate. He was incredibly ill last spring (hepatic lipidosis, feeding tube for months, meds all day, etc) and certain foods set off pancreatitis out of nowhere.... so unfortunately, even if he *wants* to eat a certain food, it could make him sick. But yeah, he used to love gravy and bits wet food, but after he took an antibiotic that made him sick, he stopped eating it. I think he associates the upset with the food... Now it's just pate!! Not that that's the worst thing in the world... he will eat that at least, it if I put it in front of him.
Sue and Luci
Member Since 2017
Check out Dr. Pierson's list - there are a lot of options for other kinds of foods with high carbos...some people also use rice flour, etc. to bring on the carbs. There's always honey or karo syrup - or even ice cream - anything to get those carbs into him and get him up - just in case he goes too low...better to have something on hand than to have to run to the ER with a hypo situation.
I have a couple of observations.
First, Prozinc and Lantus are very different types of insulin. With Prozinc, the dose is largely based on the pre-shot number. Thus, there are frequent changes in dose. With Lantus, the dose is primarily based on the nadir. Functionally, this means you will need to get more spot checks around the middle of the cycle. You will not be able to test only at shot times. This also means you will need to get at least a "before bed" test during the PM cycle every night.
Because Lantus is a depot type of insulin, you need to give a dose at least 3 days to stabilize before you evaluate the effectiveness of the dose. (The amount of time you hold a dose varies depending on whether you're using the Tight Regulation Protocol or the Start Low Go Slow method for dosing.)
Using a human meter is fine. Many (most?) of us do use a human meter due to the expense of the strips for a pet meter. I would not, however, encourage you to use both meters. You'll drive yourself crazy. Pet meters are calibrated differently than a human meter. The numbers run a bit higher in the lower ranges and the gap widens the higher the numbers go. Pick a meter and stick with it. It is not necessarily a matter of accuracy. It's a matter of the calibration of the meters.
There are options with what a starting dose would be. You can start over. With the SLGS method, you start at 0.5u if your cat is already on a low carb, canned food diet. With TR, the starting dose is based on your cat's ideal weight (starting dose = 0.25 x ideal weight in kilograms). The latter is usually around 1.0u for an average cat. However, you can make a direct switch in dose from Prozinc to Lantus given that the two types of insulin are different pharmacologically. I'm not sure that it makes sense to drop your dose all the way back. Sometimes, a kitty can have a marked response to a switch in insulin. Perhaps splitting the difference from what your vets suggested and starting with 1.5u makes sense?
Also, please make sure you have U100 syringes. The syringes need to match the concentration of the insulin. Lantus is a U100 insulin so you need U100 syringes, preferably marked in half unit increments. Prozinc is a U40 insulin so you have different (U40) syringes.
You mentioned that gravy foods make Todd sick. It's possible that this is due to a gluten sensitivity/allergy. Many cats can't tolerate gluten. My Gabby couldn't. You can use corn syrup, maple syrup, honey, etc. as an alternative to a gravy based food to raise numbers.
First, Prozinc and Lantus are very different types of insulin. With Prozinc, the dose is largely based on the pre-shot number. Thus, there are frequent changes in dose. With Lantus, the dose is primarily based on the nadir. Functionally, this means you will need to get more spot checks around the middle of the cycle. You will not be able to test only at shot times. This also means you will need to get at least a "before bed" test during the PM cycle every night.
Because Lantus is a depot type of insulin, you need to give a dose at least 3 days to stabilize before you evaluate the effectiveness of the dose. (The amount of time you hold a dose varies depending on whether you're using the Tight Regulation Protocol or the Start Low Go Slow method for dosing.)
Using a human meter is fine. Many (most?) of us do use a human meter due to the expense of the strips for a pet meter. I would not, however, encourage you to use both meters. You'll drive yourself crazy. Pet meters are calibrated differently than a human meter. The numbers run a bit higher in the lower ranges and the gap widens the higher the numbers go. Pick a meter and stick with it. It is not necessarily a matter of accuracy. It's a matter of the calibration of the meters.
There are options with what a starting dose would be. You can start over. With the SLGS method, you start at 0.5u if your cat is already on a low carb, canned food diet. With TR, the starting dose is based on your cat's ideal weight (starting dose = 0.25 x ideal weight in kilograms). The latter is usually around 1.0u for an average cat. However, you can make a direct switch in dose from Prozinc to Lantus given that the two types of insulin are different pharmacologically. I'm not sure that it makes sense to drop your dose all the way back. Sometimes, a kitty can have a marked response to a switch in insulin. Perhaps splitting the difference from what your vets suggested and starting with 1.5u makes sense?
Also, please make sure you have U100 syringes. The syringes need to match the concentration of the insulin. Lantus is a U100 insulin so you need U100 syringes, preferably marked in half unit increments. Prozinc is a U40 insulin so you have different (U40) syringes.
You mentioned that gravy foods make Todd sick. It's possible that this is due to a gluten sensitivity/allergy. Many cats can't tolerate gluten. My Gabby couldn't. You can use corn syrup, maple syrup, honey, etc. as an alternative to a gravy based food to raise numbers.
Todd's mom Heather
Member Since 2018
Until Saturday it is impossible for me to get any glucose levels during the day. So do you think Todd will be ok on 1 unit till I can check throughout his cycle this weekend? I feel so wretched that I can't until then. But that at least gives him 4 days before I can do a curve and see how things are going.
He always wakes me up for a snack between 2 and 4am. I can check his glucose then!
I definitely have u-100 syringes.
Steph & Quintus & L & O
Member Since 2017
This is more than likely due to the fact you were varying the dose so wildly. Adding insulin to a cat’s number’s is not a simple addition « if I add this much insulin, lenunvers will drop by x ». So whatever the insulin, Caninsulin and Prozinc included, the dose is based on how low it will take the cat, and unless you are giving a stable (or reasonably stable) dose there is no way you can really predict the nadir based on the preshot. This is why giving a stable dose at regular hours works best — and remember, insulin is a hormone, not a « medicine », and there are all sorts of delicate metabolical equilibriums going on behind the scenes with it. It is not a headache pill that you take when you have a headache but don’t take whenever you don’t.
With Caninsulin and Prozinc, a sliding scale is possible if a stable dose has really been tried and fails, but most often it will take the shape of minor variations in the dose, not wild swings.
I would really expect the wild swings you’ve been seeing in BG to be due to the wild swings in insulin dose. This will get much better as you give a stable dose, so don’t worry too much about it.
As long as you can tests preshots and a « before bed » test, I’d way you’re good to start. All the more if you get a « 2-4am one »!
How much time after the morning shot do you leave the house, and how much time before the evening shot do you come back? There might be time for tests there, unless you’re away nearly 12 hours. Any chance of coming home on lunch break, if it were necessary on some days?
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Todd's mom Heather
Member Since 2018
Well like this morning, I will give him his shot now, and I'm leaving in an hour. I'll be back in 10.5 hours. I cant come home as I work 30
mins from home. I couldn't sleep last night for worrying about what will happen today. And I'm crying as I type this. I am so. So. Scared.
His AMPS is 361.
I guess I could start super low, and just start with .5 units. I am moving in 2 weeks and will be much closer to my work, then. Thank god.
Todd's mom Heather
Member Since 2018
I'll just do prozinc agaib. I am way too scared.
Maybe I can bring him to my parents for a couple weeks where someone will be home with him. Especially during the move/transition. And then I will know someone is there just in case.
Thank you everyone for your help. I know this will work out.
Maybe I can bring him to my parents for a couple weeks where someone will be home with him. Especially during the move/transition. And then I will know someone is there just in case.
Thank you everyone for your help. I know this will work out.
Steph & Quintus & L & O
Member Since 2017
You'll be fine! There is less risk of hypo with an insulin like Lantus. I think you're scaring yourself up just over the fact it's not the same insulin. Just pick a dose you're comfortable with (but honestly, not under 1ui) and stick to it until you can do a curve, doing AMPS/PMPS and a "before bed" test. What you were doing with the dose-hopping was much more risky than what you're about to do with Lantus, even if you take 2ui as your starting dose.
Do find a way to calm yourself down -- you're actually afraid of the safer option here.
Do find a way to calm yourself down -- you're actually afraid of the safer option here.
Todd's mom Heather
Member Since 2018
Thank you. I did not know there was less of a risk of going low with lantus. Back in March, another (different, since his normal one was booked out) vet said Todd was diabetic, and put him on lantus. Within 3 weeks all of his numbers were below 100, and weekly checks showed he wasn't "diabetic" again till July. So that has left me with the feeling that he will drop quickly again. I will give him lantus tonight.
Steph & Quintus & L & O
Member Since 2017
What Lantus will do is bring his numbers down more consistently over the day. It's not like Caninsulin or Prozinc where there is a drop and then BG comes back up and then drops again and then comes back up. With Lantus it's more stable, so if you're monitoring (even with just those three tests a day I told you) and keeping the dose stable, increasing it by small steps when you can monitor enough/do a curve, then the risk of a "bad surprise" is really low. Whereas with Prozinc, if I look at your spreadsheet, aside from the days when you did manage to sneak in a test during the day, we have really no idea how low he's been going, specially with the dose variations.
So with Lantus, your AMPS/PMPS will probably be higher than the lower point of the curve, but you have to imagine this curve is way flatter than what you'd have with Prozinc.
Another difference is that Lantus is a bit like an ocean liner, meaning it has inertia, if that means anything to you. The "power" of the dose slowly builds up as you go from one injection to the next. Usually it takes 5-6 injections to reach an equilibrium and see how low the dose is taking the BG. But it's gradual, so if the numbers start becoming lower, you'll see it coming, and you can decide to lower the dose proactively if you know you won't be able to monitor, or make arrangements (when that is possible) for extra monitoring. But I wouldn't worry about getting caught off-guard.
Start with a low enough dose that you're comfortable. Get your three tests in (I see you never have done any tests after the evening injection, this is an important thing to start doing, and you can always manage to get at least one in before going to bed, even if it's just one hour after the injection). If there is a day where you can get an extra test in, go for it, that's more data to lean on. And try and do a curve or partial curve when you are at home on the week-ends.
The "speed" at which you go to try and find the right dose can be adjusted to take into account how much you can or cannot monitor your cat. If you're at home all the time, then you can can be more agressive. If you're away a lot, then you are less aggressive.
Keep posting on the board and you will be helped.
So with Lantus, your AMPS/PMPS will probably be higher than the lower point of the curve, but you have to imagine this curve is way flatter than what you'd have with Prozinc.
Another difference is that Lantus is a bit like an ocean liner, meaning it has inertia, if that means anything to you. The "power" of the dose slowly builds up as you go from one injection to the next. Usually it takes 5-6 injections to reach an equilibrium and see how low the dose is taking the BG. But it's gradual, so if the numbers start becoming lower, you'll see it coming, and you can decide to lower the dose proactively if you know you won't be able to monitor, or make arrangements (when that is possible) for extra monitoring. But I wouldn't worry about getting caught off-guard.
Start with a low enough dose that you're comfortable. Get your three tests in (I see you never have done any tests after the evening injection, this is an important thing to start doing, and you can always manage to get at least one in before going to bed, even if it's just one hour after the injection). If there is a day where you can get an extra test in, go for it, that's more data to lean on. And try and do a curve or partial curve when you are at home on the week-ends.
The "speed" at which you go to try and find the right dose can be adjusted to take into account how much you can or cannot monitor your cat. If you're at home all the time, then you can can be more agressive. If you're away a lot, then you are less aggressive.
Keep posting on the board and you will be helped.
Kris & Teasel
Member Since 2016
Excellent response from Stephanie!
Kris & Teasel
Member Since 2016
Also excellent!! Believe me, I agonized a long time before switching Teasel from ProZinc to Lantus. He lived on his trampoline with ProZinc but I was familiar with it. The prospect of trying Lantus was daunting ... but it turned out to be a non-issue. Teasel was (and is) still bouncy but less so and I found the dosing guidelines for Lantus to be very useful at the beginning.