? Dosing Advice for Petsitter

[Anela]

Hello, I’m going out of town Friday-Sunday and I’m concerned about Kekoa’s low dose and his pet sitter dosing him properly. She said shes comfortable with it and I offered to take pictures. But last time she sat for us Kekoa was at 0.5 which was new for her and she sent me a pic luckily before dosing him and it was wrong.

Question...can I pre-fill 2 days of syringes so I know he’s getting the right amount?

Another question...my vet was advising me last week that I should try to dose Kekoa once a day at 0.25. She said she knows it’s not supposed to be once a day Insulin but saidnsome people have had success with it and that she was concerned that he was going too low. Advice?

 

[Tricia Cinco(GA) & Harvey]

my vet was advising me last week that I should try to dose Kekoa once a day at 0.25. She said she knows it’s not supposed to be once a day Insulin but saidnsome people have had success with it and that she was concerned that he was going too low. Advice?

Since Lantus works on a 12 hour cycle, dosing only once a day can result in some "wonky" numbers due to the instability it creates in the depot. I wouldn't recommend it, but it's your cat and you have to take your vet's knowledge and experience into consideration.

can I pre-fill 2 days of syringes so I know he’s getting the right amount?

Not a good idea. I believe the manufacturer recommends against this.

Will the sitter be there all day and night and able to monitor closely? If not, I'd be tempted to recommend you skip the insulin altogether while you're gone. Kekoa's numbers are excellent right now and I would be more afraid of a hypo than of his numbers going up. Friday through Sunday is not that long, after all. Better a day too high than a minute too low.

 

[Anela]

I haven’t had him off insulin more than two doses (when attempting a OTJ). A few months back he was off for three days after a major surgery and wasn’t eating, he was hospitalized for hyperglycemia... but he was on 2 units a day and eating prescription wet and dry food so totally different from today.

 

[Juliet]

I haven’t had him off insulin more than two doses (when attempting a OTJ). A few months back he was off for three days after a major surgery and wasn’t eating, he was hospitalized for hyperglycemia... but he was on 2 units a day and eating prescription wet and dry food so totally different from today.

I went away five days and prefilled for my petsitter for same reason. Was fine. I also asked a couple of pharmacist friends of mine and they said prefilling is NOT a problem despite what many people here say about the insulin breaking down or syringe affecting the insulin. So long as the insulin is not cloudy I was told by two different pharmacists and a nurse that there would not be an issue. I trust their expertise and therefore plan to prefill for my three week trip away in September.

 

[Juliet]

From Web MD

If you cannot prepare an insulin dose but can give the injection, you may need someone to prepare your insulin dose for you. A family member, friend, or health professional can prefill insulin syringes for you. If you prefill syringes:

• Store prefilled syringes in the refrigerator with the needle pointing up to prevent insulin from blocking the needle opening. Syringes filled with one type of insulin (rather than mixed insulin) will keep for about a month. Read and follow all instructions on the label.

 

[Shawna & Davidson (GA)]

Great info here, as I'm going away in May for 17 days and if Davidson is not in the greens and OTJ then I was also considering prefilling the syringes. I will ask my pharmacy and Vet as see what they say, but it appears it would be okay.

 

[Juliet]

Great info here, as I'm going away in May for 17 days and if Davidson is not in the greens and OTJ then I was also considering prefilling the syringes. I will ask my pharmacy and Vet as see what they say, but it appears it would be okay.

Silver didn't come to any harm and insulin still effective for the time I was away. I'm more concerned that my petsitter couldnt test so I halved the dose and she shot blind. Ok for five days but not 18 which is how long I'll be gone next. Does your petsitter test @GECKO ?

 

[Shawna & Davidson (GA)]

Luckily my pet sitter gave a dog insulin years ago, she sleeps here and leaves for the day so she is willing to do it. I’m going to buy food colouring and put it in a jar with water, and she can practice drawing the dose into the syringe and seeing where the mark is with the colour. She even said she’d test, but that will require some training in her part which I have time to do, and at least try to do the am/pm tests......by the time I go I will figure Davidson’s ups and downs and be able to guide her.....still glad to know it works even for just a few days.

 

[Juliet]

Luckily my pet sitter gave a dog insulin years ago, she sleeps here and leaves for the day so she is willing to do it. I’m going to buy food colouring and put it in a jar with water, and she can practice drawing the dose into the syringe and seeing where the mark is with the colour. She even said she’d test, but that will require some training in her part which I have time to do, and at least try to do the am/pm tests......by the time I go I will figure Davidson’s ups and downs and be able to guide her.....still glad to know it works even for just a few days.

My petsitter is diabetic herself but testing a four legged cat thats not your own cat is a little harder than yourself I am guessing. I think I made her nervous standing over her!

 

[Jill & Alex (GA)]

Lantus specific information on pre-filling syringes:
http://care.diabetesjournals.org/content/diacare/26/9/2665.full.pdf

Scroll down to page 3 "Prefilled syringe stability" (Lantus specific).
Four different types of syringes were prefilled with Lantus and tested.

Results:

(visual appearance at 41 degrees F/5 degrees C)

• By day 3 the Lantus was turbid in all 4 syringes.
• After day 2, the Lantus no longer met specifications in the Walgreens syringes.

(visual appearance at 77 degrees F/25 degrees C)

• Lantus became turbid in ReliOn syringes by day 2
• Lantus became turbid in the Walgreens and BD Ultra-Fine syringes by day 3
• After 6 days, the Lantus in Walgreens syringes did not meet specifications

(content, byproducts, filtration, and pH)

• For each syringe type, the Lantus solution complied with specifications

(m-Crescol content)

• For each syringe type, the Lantus solution complied with specifications

Summary:

• Aventis Pharmaceuticals (the manufacturer of Lantus) does not recommend prefilling syringes with Lantus and storing for any period longer than needed for application.
• In addition BD states the following: “BD does not recommend that any of our syringes be prefilled more than a few minutes in advance of the injection. There are no conclusive studies to determine the safety or risks associated with this practice.”

That said, we have seen Lantus users prefill syringes for a time, usually limited to a couple of days, without any apparent loss of efficacy.


Just throwing this out there...

 

[Sienne and Gabby (GA)]

Based on the research in the article that Jill referenced, I'm never comfortable with suggesting someone pre-fill syringes given that someone took the time to investigate the question and found out the the insulin, at least in some syringes, breaks down. At the very least, it's risky.

I will be very curious to see how Kekoa does tonight since you skipped the PM dose. At least with the Tight Regulation protocol -- and I'm not sure which dosing method you're using -- if a cat is in mostly normal numbers for a week, you can reduce the dose. You could try "some" insulin. This translates to pushing down as hard as you can on the syringe plunger, inserting the syringe into the insulin, then releasing the plunger. This will give you about a drop of insulin. It may be worth attempting that amount. Or, as Wendy suggested, see how Kekoa does tonight and consider skipping the shot over the weekend.

 

[Juliet]

"There are no conclusive studies to determine the safety or risks associated with this practice.”

This same article also states Lantus manufactures strongly advise not using Lantus vial longer than 28 days once opened. Which we all know we go much much longer with a vial.

Hence me happy to go with the pharmaceutical and medical practitioner's statement that it's fine.

 

[Shawna & Davidson (GA)]

Well, that settles that. She will have to just do it herself, which is not rocket science since we all learned to do it at once time, some of us a second time around and it’s not that difficult when given no alternative.

 

[Juliet]

Well, that settles that. She will have to just do it herself, which is not rocket science since we all learned to do it at once time, some of us a second time around and it’s not that difficult when given no alternative.

I'll be prefilling as before. No option when my petsitter is over 75 and I will not risk her overdosing because she can't see the dose.

 

[Jill & Alex (GA)]

"There are no conclusive studies to determine the safety or risks associated with this practice.”

Ha! No surprise the manufacturer of BD syringes made that statement.

I'll be prefilling as before. No option.

Of course, like everything else pertaining to feline diabetes, it's your prerogative to prefill syringes with Lantus for your 3 week trip, but a better idea might be to provide the sitter with sample syringes for comparison and a good magnifying glass or set of magnified reading glasses.
Just sayin'...

 

[Juliet]

Ha! No surprise the manufacturer of BD syringes made that statement.

Of course, like everything else pertaining to feline diabetes, it's your prerogative to prefill syringes with Lantus for your 3 week trip, but a better idea might be to provide the sitter with sample syringes for comparison and a good magnifying glass or set of magnified reading glasses.
Just sayin'...

I only wish she could manage. She is old - her hands shake and I do not trust that she would get it right. Far more likely she'd overdose or drop the insulin vial as I have done and my hands dont shake. That is a far far bigger risk that a bit of possibly cloudy insulin. Better ineffective insulin than none at all. Just sayin too.

 

[Bobbie And Bubba]

If you don't think your pet sitter can accurately measure the lower dose and /or compare to a sample syringe you left with colored water, I think in lieu of the info from the manufacturers of Lantus, I would not prefill syringes any longer than 1 day.

This same article also states Lantus manufactures strongly advise not using Lantus vial longer than 28 days once opened. Which we all know we go much much longer with a vial.

This information is assuming that the vial is NOT refrigerated during that 28 day period. . With refrigeration, the Lantus pen will easily last 6 months. The pens were manufactured for people who are on much larger doses than our kitties and need to take the pens in their pocketbooks, briefcases, etc to work to dose BID.

QUOTE="Juliet, post: 2154486, member: 20963"]No option when my petsitter is over 75 and I will not risk her overdosing because she can't see the dose[/QUOTE]

I would find a younger pet sitter who has better vision.

 

[Juliet]

If you don't think your pet sitter can accurately measure the lower dose and /or compare to a sample syringe you left with colored water, I think in lieu of the info from the manufacturers of Lantus, I would not prefill syringes any longer than 1 day.



This information is assuming that the vial is NOT refrigerated during that 28 day period. . With refrigeration, the Lantus pen will easily last 6 months. The pens were manufactured for people who are on much larger doses than our kitties and need to take the pens in their pocketbooks, briefcases, etc to work to dose BID.

QUOTE="Juliet, post: 2154486, member: 20963"]No option when my petsitter is over 75 and I will not risk her overdosing because she can't see the dose

I already HAVE left her last time I went away with prefilled syringes for ten days. No issues at all. I have NO ONE else I can ask. She is my only option and I have no choice. Quite happy with my decision.

The article I read talked about refrigerated vials not un refrigerated pens.