Transition question

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Barnbuddy

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Whenever I transition my horses to a new feed I take away some of the old and add a little new until eventually all the old is gone and they are eating the new. is there any reason why this can't work with Insulin? Instead of giving 9U of Canninsulin I'd give 8 and 1 U of Lev. Then 7 and 2 and so on.... Seeing as how I'm being advised to give R as well as Lev....still 2 insulins. Also do I need a different size syringe for Lev?

Joanne
 
I have absolutely NO experience with lev or lantus or combining insulins, so my opinion should not count for anything. So PLEASE wait until you get some other opinions before acting on that.

The biggest problem I see with that is it confuses what the lev is actually doing. I don't think dropping 1-2 units like you did a few weeks ago is a true rebound test, so there is still a (very small) possibility that BB is getting way too much insulin in the first place.

If we KNEW he had acromegaly I am pretty sure that they would increase the speed at which they increase his lev. Again, I don't know this for sure and have NO experience with that. Did you give that new article (with the teeth pics) to your vet? It sure would be helpful to know.

BTW- the fructosamine will tell you and your vet if your meter is in the "big ball park" of being accurate. It's suppose to be the average of the last 2 weeks of his BG. If your meter displays it, you should make a note of the 14 day average (now) and compare it to the number that the vet tells you for the result. The fructosamine should be a significantly lower number because most of your testing occurs when the insulin has worn off (at preshots).
 
Hi Joanne,

I can't explain why, but I'm almost certain that you cannot mix two long-acting insulins. You will simply stop the Caninsulin and start the Lev (and use R as needed if the BGs are too high). When low-dose cats are switched, you shoot about the same amount. We are going to need help to figure out how much Lev you should shoot, although I'm certain it will be somewhat similar to the Caninsulin (maybe 7u?). You are intending to make the switch Friday, right? Hopefully we can get some experienced eyes in here today or tomorrow.

ETA: You will need u100 syringes (human insulin syringes) for both Lev & R. You want to buy the ones w/ 1/2 unit markings. I get mine from Walmart; many people order online from Hocks.
 
agree with Heather - I would make a cold turkey change - no mixing of insulins and no reusing needles (contaminating the vial).

Both Levemir and R are U100 insulins and require U100 syringes.

I like these from Hocks:
http://hocks.com/hocks-healthcare/hocks ... 40030.html
U100 insulin syringes, 3/10cc, 5/16" long 31gauge needle with half unit markings (I get Monoject brand)

To get my order up in value to get free shipping, I also buy my lancets, meter and test strips from hocks.
 
Whenever I transition my horses to a new feed I take away some of the old and add a little new until eventually all the old is gone and they are eating the new. is there any reason why this can't work with Insulin? Instead of giving 9U of Canninsulin I'd give 8 and 1 U of Lev. Then 7 and 2 and so on.... Seeing as how I'm being advised to give R as well as Lev....still 2 insulins. Also do I need a different size syringe for Lev?
Click to expand...

That's a great plan for feeding horses but it doesn't apply to insulin. The properties of the 2 insulins are not understood and predictable enough to know what would be acting when etc. Normally when switching insulin you use your current dose as a basis for the new insulin. As a safty manover we often give the first dose of the new insulin 1-2 shots at a reduced amount. The reason for this is to be certain the cat tolerates the new insulin and doesn't have an allergic reaction or something (very rare). If you shoot a big amount and he/she is allergic to some substance in the insulin it could lead to a big reaction, if everything is ok then you can begin with your current dose. Keep in mind that Levemir while longer in duration is somewhat less potent than Caninsulin so you will likely need to raise the dose after some settle time. Using a rapid acting (bolus) insulin with a basal (Levemir) insulin is the normal procedure in most human diabetics. R insulin is fast working and very short duration, the combination is well understood and has been practiced extensively so we pretty much can estimate how it will work. There isn't much experience with using a Lente (Caninsulin is a middle duration insulin) together with a long-time insulin, in addition with the current warnings about the possible unpredictability in duration of Caninsulin I would be even more untrusting of using it with anything or alone! Levemir has a duration of between 15-18 hours in most cats with the most "power" in the first 12 hours, the peak is not always predictable and can change throught the course of Tx, but typically occurs sometime between +6 and +12. R insulin is somewhat predictable it starts working almost immediatly (Levemir takes about 3 hours to start working after an injection) R has a peak working between 1-2 hours post injection and is almost completely finished after 4 hours. Caninsulin typically begins after 2 hours and peaks at +4 or +5 then has a short longer acting working until about +10 with a slow rise in BG during that time and a sharp rise in BG after +10 until Preshot. If you mix Caninsulin with Levemir you are going to have 2 insulins having thier maximum working overlapping which is grounds for a disaster. The Caninsulin will start working just before the Levemir and will be working MAX shortly after Levemir onset, it will still be working during the Levemir peak and could cause the BG to drop to fast and due to the longer duration of both could result in a prolonged hypoglycemia.

There is no need to mix your insulins in the beginning, you can start with Levemir 12 hours after the last Caninsulin shot, Your dose should be somewhere near your current dose ( I don't know your situation well enough to say exactly how much). I think you will be happy with Levemir it is easy to use. The R can be added in as needed to lower very high preshots once you have a start with Levemir. Have a look at some spreadsheets of people who use R to get a feel for what they are doing. Good luck!

And syringes bioth human insulins Levemir and R are U100 and use the same type of syringe (but don't mix them together in the same syringe). Caninsulin is a animal insulin U40 concentration and uses a different syringe (usually ones you get from the vet) those cannot be used with Levemir etc.
 
Hi there,
I'm so sorry I didn't make it back yesterday, I knew I was forgetting something and it was you. Ok here's your plan.

1. rub your hands briskly together, this is gonna be fun :)
2. no R until we get going with Lev.. maybe 1 week?
3. Lev dosing: You can do this a lot of ways, and they are probably all correct.

Caninsulin doesn't have the duration that lantus/levemir does, but there's evidence that it does build up, so I'd be cautious but not terribly cautious in the initial dosing. You want to start a little behind where you're at, but you don't want to start too far behind because he really needs insulin. I'd recommend 5-7u start dose on lev. After that, your increases are going to be 1/2u every 7th dose. Once you have a few cycles of history behind you, we can see how he's responding (or not responding) to the increases and then we start looking at 1u increases.

After a few days of Lev, we're gonna start introducing R if you see he's still flat during a curve. Levemir and Lantus don't work all that well from high/flat numbers so we'll start slow with a trial of a tiny amount of R on a curve day and then go from there. Here's my SS for Leo. http://spreadsheets.google.com/pub?key=pkwEJXZdhGd9dugnx-MrJPw&output=html You won't be shooting as much as I did, Leo was very very sick when I got him and had ketones when he was initially diagnosed so I was aggressive.. and I was home. It's not up to date but you can see how much insulin I needed to use with him in the beginning. Page 2 shows my R scales, first one is all the way at the bottom. Once we get his numbers moving, we can adjust or even remove R from the equation -- they become more responsive to both the levemir and the R once their resistance breaks. Leo now gets only the occasional R shot, and it's a small dose when he does.

What do you think you'd like to start at?
 
Great, you got some good explanations!

I noticed that you are seeing a lot more red preshot numbers lately. How is the transition to canned going? It would be nice if that was fully in place when you start lev so you have one less variable.

and ketone testing- any recent data for him there? I seem to remember that you saw trace a couple times. I'm guessing it would be good to know if he's neg for ketones before the switch.
 
Carolyn...37U twice a day!!! Seriously? I can't even begin to go there. I have to be realistic about what I can afford to spend on him as much as I love him:-/ What is he on now?
I still haven't heard from the vet with the results of the test. I'm thinking he should average around 25/26. So I'm still unsure if this weekend will be the one to transition him.
Ketones...I haven't been able to catch him peeing lately. Last week he was negative a few times and trace a few times.

As for the R isn't that supposed to help transition him? I'm a bit confused about the R now:-/

Canned diet...he seemed to be doing well but lately the numbers are creeping back up there. We've had a few HI's lately:-(

Not using the 2 insulins together makes sense to me. Thanks for explaining it to me.

Joanne
 
Just in case anyone is wondering this is not happening this weekend. Very lucky for me too as there is a snowstorm and the power has gone out several times.

Joanne
 
I guess I'll have to wait and see what this week brings. Was talking to the vet yesterday. The results of his fructosimine test was fair. I asked for numbers but was told that it is measured in terms of poor, fair, good and excellent. The vet at the college wonders if Bud is a very stressed out cat as this doesn't match the numbers that we see here. I've often wondered that too as he doesn't get outside much these days where i work all day and the weather hasn't been very good. He is a much happier cat in the summer. Anyway she wants me to decrease his insulin by 1U for 3 weeks and then do another Fructosimine test and see what we get. Needless to say I'm terrified. I decreased it by .5U so far. Maybe by Sunday I'll go down the full U. So if I start seeing drastic changes for the worse I'll be calling my vet about changing the insulin again.

Joanne
 
Hi Joanne,
Yup we actually got to 41 shortly after I quit updating his SS. He's now at 25u and I'm not sure but I think we have another decrease coming. You shoot the insulin to match the activity of the tumor. Sometimes you go up, sometimes you go down. I don't really consider cost. I am unemployed so yes, it's expensive, but this cat deserves a good life after what happened to him, so I'm gonna give it to him. He was a discarded cat, stray and thrown out declawed, for years. He gets treated like a king now, and that will be the way until he can no longer have a good quality of life.

You can use R during your transition, yes, BUT I wanted to see at least a couple cycles showing how the Lev works. If you're game you can start them both at the same time. I'd probably be inclined to start testing out R now, at .25u or even as low as .1u, so that you know how he will react to it when you pop over to Lev. I know I'm an absentee poster, but feel free to send me a PM when you've posted and I'll stop by and take a peek at how things are going.
 
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