Transition from Vetsulin to Lantus

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Bedina

Bedina

Member Since 2023
First, thank you again to all who weighed in yesterday and last night. I'm so grateful.

After a higher pretest last evening, I did a scant 1u. I don't know how low it got last night (+2 at 272 and +5 at 144), its as in the mid-200s this am. Bringing it down more slowly seems better. I think I will do a similar scant 1u again. I'll have to be careful with strips, though, as Chewy doesn't deliver until tomorrow and I just have 7 left.

But the apparent better bg night aside, it was rough. She woke up around midnight and at 2am and while she wanted a snack, she could barely walk - she just kept collapsing. I don't think it was bg. The way she looked at me made me believe shew as telling me she was done. I picked her up, put her back to bed with me, and sobbed while she slept, making mental plans for today if I needed to make the call.

The she woke me up at 6:30, meowing, for breakfast. I almost cried again.

In addition to the other issues, she's very arthritic. It's why she gets acupuncture, I use an Assisi loop, and before the numerous issues of the last two months, I had planned to start her on Solensia. I want to pay attention to her now and let her tell me when she's done, and I thought it was last night.

I'm exhausted. I just need to type this. I have to get ready for work.

Thank you.

Continued from here due to thread length: https://felinediabetes.com/FDMB/thr...pping-fast-edit-resolved.276004/#post-3061021
 
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@Bron and Sheba (GA), thank you. I had read it's best practice to start a new thread if the existing crosses a certain threshold. Is it better to stay in one?

I did check. It was actually the 2 am wake up when she seemed so boneless. Her BG was 144.

EDIT: And she still seems herself. I aimed, as best I could, for .5-.75 units, as per PSBG was a bit lower today. I aim to check at +4 or +5 as I'm low on strips and I don't see that they're available locally (more arriving tomorrow).

If I get one of the monitors at Walmart, can I "duel-track" on a separate spreadsheet tab and transition over to using that?
 
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Bedina said:
First, thank you again to all who weighed in yesterday and last night. I'm so grateful.

After a higher pretest last evening, I did a scant 1u. I don't know how low it got last night (+2 at 272 and +5 at 144), its as in the mid-200s this am. Bringing it down more slowly seems better. I think I will do a similar scant 1u again. I'll have to be careful with strips, though, as Chewy doesn't deliver until tomorrow and I just have 7 left.

But the apparent better bg night aside, it was rough. She woke up around midnight and at 2am and while she wanted a snack, she could barely walk - she just kept collapsing. I don't think it was bg. The way she looked at me made me believe shew as telling me she was done. I picked her up, put her back to bed with me, and sobbed while she slept, making mental plans for today if I needed to make the call.

The she woke me up at 6:30, meowing, for breakfast. I almost cried again.

In addition to the other issues, she's very arthritic. It's why she gets acupuncture, I use an Assisi loop, and before the numerous issues of the last two months, I had planned to start her on Serenia. I want to pay attention to her now and let her tell me when she's done, and I thought it was last night.

I'm exhausted. I just need to type this. I have to get ready for work.

Thank you.
Click to expand...

I’m so sorry it’s so heart breaking to watch our babies not feeling well and not know what to do. Minnie did let me know when she was done and I believe Babs will too. But you need to focus on what’s right ahead of you, one moment at a time and right now it’s the diabetes.
 
Yes, I was going to bring up test strips because we go through them fast on days like yesterday. If you only have 7 left, try to use 3 today and 4 tomorrow since you don’t know what time Chewy will deliver. Sometimes I get my stuff at night.

We do try to keep the threads at less than or up to 50 comments so thanks for starting a new thread. It’s a good idea to post a link to the old one at the top so folks can refer to it and read the backstory.

So glad the new dose is working and you’re getting less scary numbers :cat:
 
Sorry for all the separate comments but if you get the ReliOn supplies today, you can certainly use that to test. Are you planning on switching completely? It’s ideal to pick one or the other because you’ll be getting different numbers and it will be confusing to try to go back and forth using both. I’m not sure about dual tracking but you can add what meter you used to the notes section.

why Cerenia? Is she nauseated or vomiting? If you mean for the arthritis, I’m not aware of Cerenia helping with that… A lot of people use gabapentin. I used it for a while when Minnie had neuropathy from the diabetes
 
I'm sorry, not Cerenia - Solensia (she has vomited some, but less since being on the prednisolone). She is getting a low dose morning and evening of gabapentin for arthritis (as she's gotten older, even 50mg can leave her very unstable now).

Actually, I gave her a mininimally higher dose of gab last night as she seemed a bit more sore from the arthritis than usual.
 
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I second what people are saying about switching to a human meter if cost and availability of strips are factors. Strips for the Alpha Trak are crazy expensive.
A fair number of steroid induced diabetic cats stop being diabetic when the steroid is removed. However, this is a slow process involving lots of testing as a cat races down the dosing scale. You may go through a lot - repeat, a lot – of strips. It is recommended that people always keep a bottle of strips in the hypo kit and always have at least 100 strips on hand (possibly more if you stick with the Alpha Trak because you cannot get them locally).
If the vet insists on using a pet meter (vets used human meters before pet meters were marketed), then with the strips arriving tomorrow you can have a separate spreadsheet for the Alpha Trak to show the vet and using the strips for it sparingly.
 
Thank you.

To remove her from the pred, we have to have a plan in place to address the inflammation (the pred has made a great difference). I'm going to speak to my vet friend about it. In the meantime, she does seem to be responding well to the Vetsulin. My primary vet is out today, but I"m calling tomorrow to ask for Glargine.

There is a Walmart across town. I'm considering Walgreens, as their prices are also reasonable and it's very convenient. I'll continue with the Alpha Trak and go out today in pursuit of a human meter.
 
ReliOn Premier and strips obtained. I'll set that up tonight.

+5 reading at 148, which I'll take. If it dropped substantially from the morning 244 prior to now, she didn't indicate it. She's purring and asking for a snack (which she just had earlier, so we'll probably not do that).
 
Walgreens won’t have the testing supplies for the ReliOn. Maybe the lancets but not everything else. If you already got the meter from Walmart no need for Walgreens right? Moving forward, you can re order supplies at Walmart online. They only thing you have to go into the store for are the syringes which are not sold online.
 
@Ale & Minnie (GA) , correct - I have the ReliOn now. It may take me a day or two to transition.

My vet is off today, but I just sent an email to ask for a transition to a Lantus generic, which the front desk staff promised to bring to her attention first thing. :)
 
I've set the ReliOn up but as I have an unexpected night meeting tomorrow and a kind friend is going to check and dose her tomorrow, I'm taking the opportunity to test with both.

Pet monitor Alpha Trak 2 = 320; human monitor ReliOn 229
 
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Bedina said:
My vet is off today, but I just sent an email to ask for a transition to a Lantus generic.
Click to expand...
Important: if you switch to Lantus, you will need to get different syringes. You will need U-100 insulin syringes, preferably 3/10cc with half-unit markings. But they must be U-100 syringes.

Why?
Because Lantus and Vetsulin are different “strengths” (concentrations) and so require different syringes. If you use the old U-40 syringes with Lantus, you will significantly overdose your cat.

All of the numbers can be very confusing at first, I know. Ask any questions you might have. We’ll help you figure it out.

(If you switch to Lantus, I strongly encourage you to mark the old u-40 syringes as for Vetsulin only and put them high up in a cupboard where you can’t accidentally grab one).
 
Thank you, @JL and Chip. :)

AM reading 320 AT/217 human monitor. I pushed the dose up slightly closer to 1 scant unit.

I also set up a second spreadsheet to duel track with a human monitor until I can transition over.

EDIT: Vet just responded that she's pleased kitty is tolerating all of this and she's calling in a syringe and Glargine subscription (pens)!

I have a lot to read on transitioning and a full day at work.
 
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The syringes you need for the Lantus are the U100, 3/10, 30 or 31 gauge, 6 or 8 mm insulin syringes with 1/2 unit markings.
Make sure those are the ones the vet is ordering. It’s possible they won’t know about syringes with 1/2 unit markings on them.
 
Hi be sure the U-100 syringes for lantus/generic have the half unit markings because it's easier when you have to increase or decrease by 0.25 units
you can get them at Walmart the other box may look like this either one is fine
upload_2021-9-5_23-18-9-jpeg.62508
 
Or you can get these also
https://www.adwdiabetes.com/product/1316/surecomfort-u100-syringes-half-unit-31g-3-10cc-5-16in-100ct
Check this out
https://www.goodrx.com/insulin-glargine?dosage=five-3ml-prefilled-pens-of-100-units-ml&form=carton&label_override=insulin glargine&quantity=1
One pen would last me about 4 to 6 months . we use the pens just like a vial, you would just insert the syringe it the gray rubber stopper on the pen and draw out your insulin
Its generic lantus



Or this one also

I see some members will call CVS, Rite Aid, Costco, Walgreen's, to get the price for 5 pens
Posted by another member
One members posted this
. I paid $175 for a box of 5 pens at Walmart pharmacy, but GoodRX coupon says you can get it for around $90 if you have a Rite Aid pharmacy near you.

We don't use the pen because you can only adjust the dose by full units, we adjust the dose by 0.25 units at a time. Are the U-100 syringes you already have do they have half unit markings


Just take the cap off the pen and use a U100 syringes and pull the insulin out of the pen!
syringe-in-pen-pic-jpg.45006
 
When you do switch over to lantus and start using the relion human meter I would note that in your signature and put lantus and the date and relion meter and the date so members are aware of it. On your SS for the human meter I would put Relion up top where it asks you
 
Thanks so much I'll do that.

I'm also wondering if what was diagnosed as pancreatitis isn't something like IBD. She's eating too much (based on the vet's guidance of calories intake, but it's clearly too much for her), but after she does eat, she looks bloated and uncomfortable for a bit.

I have an appointment today to with our home vet for a B12 shot and accupuncture. Will discuss.
 
Great news about your vet prescribing Lantus!! Did you get the Lantus syringes on your Walmart run yesterday?

you know you can give the b12 injections yourself right? I did it for Minnie and I’m doing it for Bobo now too. Just wanted to make sure you know. Of course you then need yet another type of syringes :arghh:
 
That's scheduled for today to discuss as well (me giving B12 shots).

Also to discuss:

- continued steroid use - prednisolone or transition
-diet

I didn't pick up syringes but a friend dropped by her supplies that include U100 .3ml volume 1/2 unit markings. If that's correct, I have 20 of those to get me started.
 
There are also b12 chewables you can give daily instead of the injections, but not all cats absorb b12 orally as well. Bobo actually likes eating them but I find that I still need to supplement with the injection once a month

Nutramax Cobalequin Chewable Tablets B12 Supplement for Cats & Small Dogs, 45 count:
https://app.chewy.com/cVnkVQq9Iyb
 
Thank you!

My vet left me shots but I'll look into these. She's normally good with treats. The prescription was for 6 weeks, but I think I need to continue with them.

I realized I've been feeding her more than I need to (based on another vet's caloric intake guidance). I'm not sure if this is what's making her stomach a bit upset but it can't be helping.
 
I would say 9.5 and she's a lb over that. The vet had advised 270 when I was desperate to get food in her, and she's probably been eating 220 and gaining on it.

I picked up some 3 ounce cans of Koha limited ingredient pate turkey and duck, as well as some Wervua Truluxe pretty in pink and steak frites (the last of what she's primarily been eating for the last two years until she got sick in February and we're off it).

I've more recently been feeding Weruva Slide n' Serve Pate chicken breast as it was one of the few foods she'd eat prior to the steroid, which the Weruva "additional nutritional info" indicates is under 7% carb dry matter. She just vomited a bit of liquid and did the same yesterday. I don't know if this is diet related, the GI mass, pancreatitis, nausea, the lowered steroid (the vet advised going lower than 5mg on the prednisiolone if possible; she's at 3.725 right now) or something else.

It's just constant worry, isn't it?

EDIT: she ate the Koha turkey pate.
 
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I'm reading about the "start low go slow" process to transition to with Lantus (glargine). I'm picking up the pens tomorrow and I'll probably look to start on Saturday so I'll have two days at home to monitor her.

With obviously limited data, we're currently at around .75 U of Vetsulin. Today has been a good day so far that has looked like this:

7:30am -Test then feed (Wervua although experimenting with other lower carb foods) approximately 1/4 of planned calories
-Wait half an hour; dose with Cerenia and then give shot
-Small snack at +1 before departing to work
-Snack at +4 (my lunch break)
7:30 pm -Test again, then dinner, wait half an hour, shot at +12 hour mark
-Repeat snacks before bedtime

As a reminder, I'm fairly sure this was prednisolone triggered. She had fasting senior bloodwork on Feb 1, prior to the pred, and her BG was fine.

Here are just a few of questions I'm considering - I'd appreciate any thoughts.

1. It seems like .5 U is a reasonably low starting point to begin, considering the most recent dose, numbers, and diet. Would anyone (with the understanding this is not vet advice) suggest higher or lower?
2. I've witnessed the fast Vetsulin drop and early nadir and I've been avoiding snacks this week after +5 to be safe. Do I correctly understand that with Lantus it's less of a concern to space out snacks?

EDIT: Started new thread due to low evening reading.
 
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Bedina said:
I'm reading about the "start low go slow" process to transition to with Lantus (glargine). I'm picking up the pens tomorrow and I'll probably look to start on Saturday so I'll have two days at home to monitor her.

With obviously limited data, we're currently at around .75 U of Vetsulin. Today has been a good day so far that has looked like this:

7:30am -Test then feed (Wervua although experimenting with other lower carb foods) approximately 1/4 of planned calories
-Wait half an hour; dose with Cerenia and then give shot
-Small snack at +1 before departing to work
-Snack at +4 (my lunch break)
7:30 pm -Test again, then dinner, wait half an hour, shot at +12 hour mark
-Repeat snacks before bedtime

As a reminder, I'm fairly sure this was prednisolone triggered. She had fasting senior bloodwork on Feb 1, prior to the pred, and her BG was fine.

Here are just a few of questions I'm considering - I'd appreciate any thoughts.

1. It seems like .5 U is a reasonably low starting point to begin, considering the most recent dose, numbers, and diet. Would anyone (with the understanding this is not vet advice) suggest higher or lower?
2. I've witnessed the fast Vetsulin drop and early nadir and I've been avoiding snacks this week after +5 to be safe. Do I correctly understand that with Lantus it's less of a concern to space out snacks?

EDIT: Started new thread due to low evening reading.
Click to expand...
@Bedina
I can tag a few members for you
@Bron and Sheba (GA)
@Wendy&Neko
 
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Bedina said:
I'm reading about the "start low go slow" process to transition to with Lantus (glargine). I'm picking up the pens tomorrow and I'll probably look to start on Saturday so I'll have two days at home to monitor her.

With obviously limited data, we're currently at around .75 U of Vetsulin. Today has been a good day so far that has looked like this:

7:30am -Test then feed (Wervua although experimenting with other lower carb foods) approximately 1/4 of planned calories
-Wait half an hour; dose with Cerenia and then give shot
-Small snack at +1 before departing to work
-Snack at +4 (my lunch break)
7:30 pm -Test again, then dinner, wait half an hour, shot at +12 hour mark
-Repeat snacks before bedtime

As a reminder, I'm fairly sure this was prednisolone triggered. She had fasting senior bloodwork on Feb 1, prior to the pred, and her BG was fine.

Here are just a few of questions I'm considering - I'd appreciate any thoughts.

1. It seems like .5 U is a reasonably low starting point to begin, considering the most recent dose, numbers, and diet. Would anyone (with the understanding this is not vet advice) suggest higher or lower?
2. I've witnessed the fast Vetsulin drop and early nadir and I've been avoiding snacks this week after +5 to be safe. Do I correctly understand that with Lantus it's less of a concern to space out snacks?

EDIT: Started new thread due to low evening reading.
Click to expand...
I think 0.5 U would be a good starting dose for the Lantus as the 0.75 U of vetsulin dropped the next preshot to 169 and there were no tests inbetween, but we can assume the BG dropped lower than that during the cycle.
I would also choose either the pet or the human meter and don’t try and compare the two. It just doesn’t work and will drive you crazy. Lantus is a more gentle insulin with an onset of around +2 and nadir anywhere between +3 and +8 but usually around +4-+7.
I would try giving snacks at +2 and +4 to start with (both cycles) and see how that goes. You may have to move them around a bit, depending on the BGs. How does that sound?
 
Bron and Sheba (GA) said:
I think 0.5 U would be a good starting dose for the Lantus as the 0.75 U of vetsulin dropped the next preshot to 169 and there were no tests inbetween, but we can assume the BG dropped lower than that during the cycle.
I would also choose either the pet or the human meter and don’t try and compare the two. It just doesn’t work and will drive you crazy. Lantus is a more gentle insulin with an onset of around +2 and nadir anywhere between +3 and +8 but usually around +4-+7.
I would try giving snacks at +2 and +4 to start with (both cycles) and see how that goes. You may have to move them around a bit, depending on the BGs. How does that sound?
Click to expand...

Very doable, and thank you. :)

I ordered an auto feeder (the CatMate 5 meal) and will get that set up for use this weekend so we can both get used to it.

I believe I've read it's not necessary to delay the shot after a meal as it's suggested we do with Vetsulin, right @Bron and Sheba (GA)?

Pondering the timing of a test now. Do I perpetually push my work schedule to later and shoot 8:30 am/8:30 PM or do I bump I forward for morning convenience 6:30 am/6:30 pm and never see friends in the evening again? LOL
 
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With Lantus you test/feed and shoot one after the other. No need to wait after feeding before giving the shot.
As far as the schedule time ……you need to find a time that suits you.
Think about if you do the 6.30:6.30 schedule …you might have time to get a +2 before you leave for work. And will you get home in time to do the pm dose?
If you do the 8.30:8.30…will you have to leave straight away for work. Will you be able to have time to stall if needed?
It’s a personal thing really. What is going to suit your life and is best for Babs.
You can always go out after the 6.30 pm dose. Or were to you thinking of staying out after work?
 
Bron and Sheba (GA) said:
With Lantus you test/feed and shoot one after the other. No need to wait after feeding before giving the shot.
As far as the schedule time ……you need to find a time that suits you.
Think about if you do the 6.30:6.30 schedule …you might have time to get a +2 before you leave for work. And will you get home in time to do the pm dose?
If you do the 8.30:8.30…will you have to leave straight away for work. Will you be able to have time to stall if needed?
It’s a personal thing really. What is going to suit your life and is best for Babs.
You can always go out after the 6.30 pm dose. Or were to you thinking of staying out after work?
Click to expand...

Thanks, Bron - your questions are good ones.

I'm actually really lucky to live very close to work and to have schedule flexibility at work when I need it. Because we skipped the shot last night, I tested at 6:30am this morning, fed, then dosed at 7. It made it much and more relaxing to coordinate my morning, and I was able to leave her a snack at +2. If I have a complication one evening, a friend and neighbor in walking distance may be about to test and shoot for me. Some of this is borrowing trouble, which I'm prone to do. :)

EDIT: I tested at +5 and got 130, down from 334 on .5U. I'm wondering if dropped any lower before I got home. The value of testing!
 
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Lantus pens obtained! But Safeway couldn't source the syringes with the 1/2 unit markings - only the whole units. I probably should have taken them for backup but I left them, although they said they'd set them aside in case I need them.

A friend who used Lantus on her cat dropped by her supplies this weekend. That include Walgreens U-100 .3mL volume 1/2" needle length with the half unit markings, but they're 29 gauge rather than 30 or 31.

I'm assuming that's a thicker and therefore less comfortable needle? I actually wasn't planning to transition her until Saturday so that I can closely monitor her, so I do still have a bit of time to sort out the syringes.
 
Yes the 29 is a thicker needle.
I’m glad the earlier time is working out
With Lantus, which is a depot insulin, it takes up to 7 days initially for the depot to fill and for you to get the full effect of the dose. So keep the dose the same u less the BG drops under 90 in which case you reduce the dose.
INSULIN DEPOT
 
Bron and Sheba (GA) said:
Yes the 29 is a thicker needle.
I’m glad the earlier time is working out
With Lantus, which is a depot insulin, it takes up to 7 days initially for the depot to fill and for you to get the full effect of the dose. So keep the dose the same u less the BG drops under 90 in which case you reduce the dose.
INSULIN DEPOT
Click to expand...

That's very helpful, Bron - thank you!

I'm still trying to get my head around Vetsulin, and why she's had a couple of days of "normal' end of day BG reading when everything I've read everywhere says it shouldn't last that long. I stayed backed off tonight and it's dropping more slowly. She seems to be feeling pretty good.

Outside of the stress of having a newly diagnosed cat and trying to navigate all of this (which is made so much easier by this group), this is actually pretty fascinating.
 
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ARGH.

Three days on the Cerenia which has made a huge difference in how she seems feel, but now she's starting to not want to eat. It's taken 25 minutes to get 40-50 calories in her with her meds mixed in.

I have some Mirataz from prior to the ultrasound (so a month old) that I'm going to dose her with. Will also try to get a snack in her in an hour.
 
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