New mum, Lantus costly, best way buy insulin, so much I don't know

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Hi Patricia,

You did great with the testing today! :cat:

I'm about to sign off and I don't think I'll be online tomorrow (not feeling so good). I'm tagging @Bron and Sheba (GA) [Australia] and @Bandit's Mom [India] to ask them to pop in if they come online while America's (mostly) asleep just to make sure you're doing OK.

Tip:

If you've posted for help on Feline Health and the board is quiet, you can always try posting on the Lantus/Basaglar and Levemir Board if you need assistance in a hurry (more footfall there). Here's a link to their board index in case you might need it:

https://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/

Wishing yourself and Maki Kitty a safe and smooth night.

:bighug:


Mogs
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Oh Mogs, sorry to hear you are not feeling well. Gentle hugs

Maki Kitty is doing well this afternoon, thank you for letting the others know to watch over us. That is so sweet and appreciated.
She is more energetic and inquisitive than she has been in weeks.

I will test, feed, dose, retest tonight, then am. Keeping spreadsheet open and I add data as I go.
Thanks for helping save and give our kitty a better life.
 
Ok. Best laid plans. Tried her 3 times for PMPS... Got nothing. Error codes on meter possibly due to too little blood or too slow uptake in strip. So stopped torturing her and gave up. Think I am just not skilled at the prick and milking it So no new BG.
1933 2/6 : Fed and gave 1.5 U lantus to play it safe? Gave her treats, 1/2 can of wet and 1/2 cup dry food. Am I feeding her too much food?
 
Patricia & Maki said:
Ok. Best laid plans. Tried her 3 times for PMPS... Got nothing. Error codes on meter possibly due to too little blood or too slow uptake in strip. So stopped torturing her and gave up. Think I am just not skilled at the prick and milking it So no new BG.
1933 2/6 : Fed and gave 1.5 U lantus to play it safe? Gave her treats, 1/2 can of wet and 1/2 cup dry food. Am I feeding her too much food?
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With the gaps in tests, it's a bit hard to say. But given the +9 value, I'd say 1.5 should be ok. I'd also just hold that dose for a few days for consistency (and until the tests are more reliable).

Same as yesterday, try for a +2/+3 test before bed.

I say let her eat as much as she wants, provided she's not overweight. In fact, that may also have saved you with that hypo. Most of our cats tend to be underweight because they don't process the food properly. Once we have some more solid data in the spreadsheet we'll look to transition her food to something more low carb, but for now just keep doing what you're doing. And be sure she has food available near nadir in case she does start to go low.

Edit: *Hold the dose unless you get a preshot below 200, or any test at all below 100. In that case stall and post here or in Lantus forum.
 
Edit: *Hold the dose unless you get a preshot below 200, or any test at all below 100. In that case stall and post here or in Lantus forum.[/QUOTE]

Uh oh. I already gave her 1.5U. Is there a problem?
 
Patricia & Maki said:
Edit: *Hold the dose unless you get a preshot below 200, or any test at all below 100. In that case stall and post here or in Lantus forum.
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Uh oh. I already gave her 1.5U. Is there a problem?[/QUOTE]
This is what I meant about having to make an educated guess - since you weren't able to get a preshot, we're not 100% sure where Maki was. It's also why everyone is a bit hesitant to recommend doses. This is completely normal when starting out with home testing! It's just tricky territory, but does get much easier once you find a groove with testing. Just takes time.

Since you had already given the shot, I was just saying that with the +9 being in the 300s, 1.5U should be ok. But really be persistent about the before bed test at +2/+3 and make sure she has food available.

My edit was just reiterating the general guidelines for people starting out, since I know you've had a lot of information thrown at you.
 
Maki is resting on her bed and I keep checking her to make sure no behavioral changes. I have left her food ball down for the night with the glycobalance dry food in it.

I tired a 1+ and got another error (E2 & E3). I am not getting enough blood in the strip. Bad news that used up my last strip. Can't find others. (We sold our house and are packing so things are 'missing'.)

That leads to a side question. I've tried searching on Kitty stress. With us packing and moving, Maki scans every room every day as more and more furniture and stuff disappears. Maybe this is a long shot, but does that possibly effect her BG?

Thanks so much for you continued dialogue with us.
 
Patricia & Maki said:
Maki is resting on her bed and I keep checking her to make sure no behavioral changes. I have left her food ball down for the night with the glycobalance dry food in it.

I tired a 1+ and got another error (E2 & E3). I am not getting enough blood in the strip. Bad news that used up my last strip. Can't find others. (We sold our house and are packing so things are 'missing'.)

That leads to a side question. I've tried searching on Kitty stress. With us packing and moving, Maki scans every room every day as more and more furniture and stuff disappears. Maybe this is a long shot, but does that possibly effect her BG?

Thanks so much for you continued dialogue with us.
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Those error codes are the band of all.our existence :arghh:

As for the blood drop, aim for a drop the size of the ball on a ball point pen for now. That'll be a bit more than you need, but a good gauge. It might take a bit of milking at the beginning. But as long as you're warming the ear and using the "sweet spot", it'll eventually get better. I actually can test along the whole ear now with no problem.

The other error code I think is from the strip sitting in the meter too long. Here's how I avoid that:
- Insert the strip only partially into the meter...if the meter turns on, you've gone too far. I've had no trouble pulling it back out so the meter turns off, then partially reinserting again but more shallow. The intent is two-fold - it gives me a bit more time, and then I can also use the meter one handed while the other holds the ear.
- When I have enough blood, I turn the meter on. It indicates to insert a strip, so I push the strip in the rest of the way. Then the meter indicates I need to take the sample, so I do.

I use a ReliOn Prime, so your meter might behave a little differently.

As for stress, yes stress can elevate BGs. It's hard to say if her numbers are high because I don't have past data to compare it to, but I will say the numbers you've gotten so far are good!

Can you make a run to the store in the morning?
 
Yes I plan to get strips and insulin tomorrow morning. I seriously thought I had a whole container of them. Voila.. No idea where.

Should I still feed and shoot 7 am? Stores won't be open until 9 ish. We live in a rural area of PA.
 
Patricia & Maki said:
Yes I plan to get strips and insulin tomorrow morning. I seriously thought I had a whole container of them. Voila.. No idea where.

Should I still feed and shoot 7 am? Stores won't be open until 9 ish. We live in a rural area of PA.
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Insulin? Was that a typo, or are you getting a new vial/changing insulin?

I really can't advise here...if it were me, I'd skip the shot and monitor for ketones because I'm too uncomfortable shooting without any data for the 15 hrs prior to the shot. Let me tag @Bron and Sheba (GA) and @Bandit's Mom to see what they think.
 
Hi Patricia
Regarding what to do about the dose tonight.......Does Maki have any history of ketones that you know of? The vet may have mentioned them at diagnosis.

Also you need to stick to the same dose and not chop and change it. Not sure why you started with 1.5 units then went to 2 units the next cycle. You need to stay at the 1.5 units for 5 to 7 days for the depot to fill and stabilise. Lantus likes consistency. If the BG dropped under 50 you would immediately drop to 1.25 units.
I would not give 2 units of Lantus if 2 units of Prozinc sent Maki into a hypo.
Bron
 
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Thank you for all guidance. I dropped to 1.5 cause I was worried she'd go low again. Since 2 put her in hypo, I've been nervous.

This morning she will not come to me. I think my multi sticks last night may have been a negative experience?

My vet talked very little with me about any of this. We had to give her to then in the parking lot (due to covid) and then they delivered her back to the car with a bunch of stuff in hand (Prozinc, needles, new wet and dry food). So literally her life flipped on a dime. No mention of ketones. What I have learned about those I got here from the files and posts. I have not tested for any.

Sorry team, I know I am probably making this worse with my inexperience and long learning curve.

Ok so now what? Do I feed her and then insulin 2U if she'll let me near her?
 
We understand, it's a lot to learn and very few vets actually do a good job helping us.

I would treat 1.5U as your standard dose for now, the general consensus seems to be 2U is risky given the ProZinc hypo at the same dose. This means if you get preshots above 200, to give 1.5U. Below that, post for help on Lantus board. And any time you get a "green" test (green on the spreadsheet) I'd ask for advice on the Lantus board as well.

Unfortunately without test strips, I can't recommend anything...it's your call if you're comfortable shooting without knowing her numbers. Just know the ketones are much more likely with insufficient insulin (such as reduced or skipped doses)... usually (but not always) combined with some sort of underlying infection and not enough food.
 
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It's probably about time to start reading through the stickies in the Lantus forum. Most of the recommendations we're giving here are from the stickies, just trying not to overwhelm you with too much info and links in the beginning.

Those stickies will help you understand the insulin itself, and why certain numbers are the recomended cutoffs. Also what to do in a variety of situations.
 
I am hoping this will make sense.
The Vet started Maki on 2U prozinc bid. The vet put her immediately on wet and dry Glycobalance. All this time I was very unsure when to feed, how much or not, snacks. It was a great deal of change all at once. After ~9 days she had the hypo attack and we nearly lost her. The emergency vet after the second day said no more Prozinc. So Lantus 1U is what they prescribed. They sent us back to our regular vet for a glucose curve and future management. Glucose curve was last Monday and the vet increased her to 2U bid. Through all this I came in knowing next to nothing about diabetes, testing, insulin, the whole gig. SO I scrambled to read, watch videos, learn any way I could fast. The vet left us with the impression that this should be nothing. Not suggesting we test or check anything, just give 2U bid after meals.

So my decreasing from Lantus 2 to 1.5U came as I got more nervous that the return to the 2U bid might send her hypo again. Meanwhile, I had started testing using my old contour meter. Then ran out yesterday of strips after multiple failed tests. This morning, we ran out in the snow and Walmart only had a Relion meter and strips. The contour shelves were bare. So got a premier relion and strips and picked up ketone test strips. Will watch video about Ketones now and figure out testing (why, when, how). Wasn't looking to buy a new meter as I purposedly went looking for AlphaTrak since it required less blood and some of my testing failures seemed to be due to insufficient blood. So the supplies is an area I am trying to navigate on a budget.

Along with this, the tiny special vial of Lantus the emergency vet had us get is running low. So I just started pricing and trying to find Lantus. Called the 'local' pharmacies and they did not have any Lantus vials. So tried again today but Walmart pharmacy not open yet today (Sunday, snow, rural PA). So have enough left for probably 2 days. I am not changing types of insulin, just needed a new vial of the Lantus to keep going.

2/7 Maki's AMPS=268 with the new Relion Premier. She ate from her food ball on and off all night and I got up every hour to check on her. She wouldn't sleep with us or even come upstairs which is very unlike her. Did all my stress and failed testing scare her or create a negative association? How do I keep that from becoming an issue?

She has not eaten her wet food as of 1030. Not sure if that's due to eating kibble throughout night or she is just not hungry due to stress? So I have not given her insulin this morning yet. Needless to say I am now all confused on what I do.
 
https://www.singlecare.com/?utm_medium=paid-search&utm_source=google-sc-branded&utm_campaign=11294466188&utm_adgroup=110828820677&utm_term=single care coupons&utm_content=471193154808&matchtype=e&pos=&device=t&mkwid=s|dt_pcrid_471193154808_pkw_single care coupons_pmt_e&segments=&gclid=EAIaIQobChMIzterh5XY7gIVSv_jBx0aQgm8EAAYASAAEgKJ8fD_BwE

Here is a coupon from single care , hopefully Walmart will have a vial in stock
Like others have suggested I would go ahead and buy the lantus pens from Marks Marine in Canada, 5 pens should last you a year. So you don't run out
Good luck finding it today :cat:
 
Yes, I understand. In my opinion the ReliOn is a better choice on a budget, as the AlphaTrak strips are $1 each. ReliOn much less than that. Additionally, the Lantus guidelines here were developed with the human meters.

As for the insulin, most of us order from Mark's Marine Pharmacy in Vancouver, MUCH cheaper. I'm in Ohio, it did take about 8 days to get here...so it won't solve your immediate issue. Hopefully you can source another small vial tomorrow when things are open.

And I'm sorry I'm really not experienced enough yet with Lantus to recommend anything in this situation (not eating, higher carb foods, shot delayed now and your schedule will be off, etc). You could try posting in the Lantus forum with a link to this thread.

As for the negative associations, just keep following the advice given earlier about making it as positive as you can. Eventually she'll settle down for you, but she's got a lot going on lately, poor girl.
 
Diane Tyler's Mom said:
You should really try to take away the kibble slowly, and just feed wet
But you have to monitor Maki thru the day , taking away the kibble will drop her BG
You want to make sure she isn't going to low
Is there any reason why you are not feeding Fancy Feast Classics Pate?
The Relion Premier is fine to use
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Diane, just a quick note -
We did let her know about the lower carb food, but the advice given on this thread was to not make food changes until the testing was more reliable (especially given the hypo), plus we knew she would be running out of strips soon.
 
Also @Patricia & Maki we suggest starting a new thread once it gets past 50 replies, and I see we're past that. I would start a new post in Feline Health to continue the conversation, just be sure to put a link to this thread for reference (and so you don't have to repeat yourself).
 
FrostD said:
Diane, just a quick note -
We did let her know about the lower carb food, but the advice given on this thread was to not make food changes until the testing was more reliable (especially given the hypo), plus we knew she would be running out of strips soon.
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Thanks for letting me know , I'm going to delete my post, thanks so much Melissa :cat:
 
I knew nothing about all this when it hits. When the vet put a bag of dry and case of wet food in the car and said feed her this. That's what I did. I would like to go back to FF pates as that was her regular favorite before FD. When I mentioned changing food this week it was suggested I wait since there are soooo many things in flux for us.

Ok. So now she ate half her usual morning wet food. I read the pages about schedule disruptions and trying to get back on 7/7. It's 1130 now. Do I insulin her? How much? No kibble all day? It's another of my confusions. She was a free feeder and wet in morning and food ball at night (throughout the night as she liked). Vet said that's fine keep doing that, but I don't think it's working. I seriously don't understand how I get her to gain weight with only 2x/day feeding of wet food?

Team, please do not give up on us. I feel like an starting to hear frustrations in some of your responses. I am literally reading articles, stickies, threads, tips, instructions as fast and often as I can. My head feels like it's going to pop. I am a challenged learner, will keep trying, just please don't give up on us.

Thank you!
 
No frustration! I just have a toddler bouncing off the walls all day, and often have to be quick in replies before she maims herself :confused:

At this point, totally your call. If you do give a shot, I'd keep it at 1.5U, now that we know she ate. The next one has to be about 12 hrs from now. With Lantus, you "walk it back" 15 minutes at a time...so the earliest you could give it is 11 hrs and 45 mins from now. If you choose not to give a shot, be sure to check for ketones. And give 1.5U at the regular time tonight, keeping the aforementioned safety guidelines in mind.

As for food, yes it's often better to do smaller meals. But right now, I free feed because Mr Kitty is not regulated and needs to maintain weight. So he gets 1.5 cans in the morning, and 1.5 cans at night (any more, and he just leaves it to go to waste). The data I have shows he doesn't drop during the day yet, but I just make sure he has food available on the very off chance he needs it.

So, to recap:
- Focus on getting testing down for now. Continue to give 1.5U unless the safety guidelines we've mentioned indicate otherwise. The PS tests and at least one mid cycle test (+4 to +7) are the critical pieces of data right now.
- Let her eat, especially since she's underweight. It's more important she has food on board in order to help guard against ketones and hypos. We'll worry about food transition after a week or so of solid testing
- Please start a new thread. I'd appreciate it if you could tag me in it so I don't miss it
 
Hi Patricia,

Just on a quick dip into the forum and wanted to check how yourself and Maki Kitty are doing. It's good that you were able to pick up the Relion meter, meter strips and ketone strips.

As Melissa rightly comments above, please do not make any changes to the mix of Maki's normal wet and dry food proportions at this time, Patricia.

You need to know more about how Maki's responding to the 1.5IU dose of Lantus.

Unlike an 'in-out' insulin like Prozinc, each successive dose of Lantus builds on previous doses to create a little 'tank' of insulin under the skin (the 'depot'). The insulin in the depot releases gradually and that is what gives Lantus better duration. It takes several days for the depot to fill, and only when it is fully established for the current dose will you be able to gauge the effectiveness and safety of that dose. If you were to start trying to reduce the dietary carb load at the same time you would have too many moving parts and it would increase the risk of Maki going into low numbers (and we don't want that!).

When you have more test data and have a clearer understanding of Maki's response to her Lantus, you can then consider adjustments to her diet.


Mogs
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Ok. This is my last post here as I have noted the requests to move to the lantus area, start a new thread and tag a person. All things I will learn as I shift over to new thread.

Thank you for explaining the Lantus depot. I read about it, but guess I didn't get it the first time reading it.

I did not shoot Maki today yet. It seemed late. So doing some spot checks on BG this afternoon and ketone check. Then PMPS, eat, shoot.. Hopefully back on track.

I don't know how some of you wonderful people do so much for your kitties (and families). Thank you for caring and juggling your lives while helping ours.
 
Patricia & Maki said:
I am hoping this will make sense.
The Vet started Maki on 2U prozinc bid. The vet put her immediately on wet and dry Glycobalance. All this time I was very unsure when to feed, how much or not, snacks. It was a great deal of change all at once. After ~9 days she had the hypo attack and we nearly lost her. The emergency vet after the second day said no more Prozinc. So Lantus 1U is what they prescribed. They sent us back to our regular vet for a glucose curve and future management. Glucose curve was last Monday and the vet increased her to 2U bid. Through all this I came in knowing next to nothing about diabetes, testing, insulin, the whole gig. SO I scrambled to read, watch videos, learn any way I could fast. The vet left us with the impression that this should be nothing. Not suggesting we test or check anything, just give 2U bid after meals.

So my decreasing from Lantus 2 to 1.5U came as I got more nervous that the return to the 2U bid might send her hypo again. Meanwhile, I had started testing using my old contour meter. Then ran out yesterday of strips after multiple failed tests. This morning, we ran out in the snow and Walmart only had a Relion meter and strips. The contour shelves were bare. So got a premier relion and strips and picked up ketone test strips. Will watch video about Ketones now and figure out testing (why, when, how). Wasn't looking to buy a new meter as I purposedly went looking for AlphaTrak since it required less blood and some of my testing failures seemed to be due to insufficient blood. So the supplies is an area I am trying to navigate on a budget.

Along with this, the tiny special vial of Lantus the emergency vet had us get is running low. So I just started pricing and trying to find Lantus. Called the 'local' pharmacies and they did not have any Lantus vials. So tried again today but Walmart pharmacy not open yet today (Sunday, snow, rural PA). So have enough left for probably 2 days. I am not changing types of insulin, just needed a new vial of the Lantus to keep going.

2/7 Maki's AMPS=268 with the new Relion Premier. She ate from her food ball on and off all night and I got up every hour to check on her. She wouldn't sleep with us or even come upstairs which is very unlike her. Did all my stress and failed testing scare her or create a negative association? How do I keep that from becoming an issue?

She has not eaten her wet food as of 1030. Not sure if that's due to eating kibble throughout night or she is just not hungry due to stress? So I have not given her insulin this morning yet. Needless to say I am now all confused on what I do.
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You don’t need the Lantus via. You can get the pen and use the syringe to draw from it just as you would with the vial
 
Hi Patricia,

Love the picture of Maki Kitty! She's a beautiful girl. :cat: You're doing very well with the near-vertical learning curve that is feline diabetes. :)

Patricia & Maki said:
Ok. This is my last post here as I have noted the requests to move to the lantus area, start a new thread and tag a person. All things I will learn as I shift over to new thread.
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Wishing yourself and Maki the very best over in the Lantus group. (I have PTSD. That board is very 'busy' and I find it overwhelming so I rarely visit or post on it.)

(((Patricia and Maki)))


Mogs
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Aleluia Grugru & Minnie said:
Hi Diane! Minnie has been doing amazingly well. My little Amazon warrior princess has even had a few encounters with a neighbors outdoor cat who decided he likes our backyard and she’s chased him off. Thank you for thinking of her auntie Diane! :bighug:
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Oh Ale I'm happy to hear Minnie is doing well. You go there Minnie, that's your backyard :p. Nice to hear from you Ale and give Minnie a kiss for me .
Hope you have a good day :bighug::bighug::cat:
 
Critter Mom said:
Could you not get one on eBay?

(I'll get me coat...)

;)

On a serious note, Ale, I am absolutely delighted to hear that Minnie is doing so well! :cat: You're great a kitty mama, you've done wonders looking after your girl, and she's blessed to have you. :)

(((Ale and Minnie)))


Mogs
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Awwww thank you so much Mogs. I was just talking to my sister and saying that as long as she’s herself and has quality of life, I don’t mind getting up at 7am on weekends and holidays to test and give insulin and give her all the other daily meds she’s on. I promised when she was a kitten that I’d take care of her not just when it’s easy, but when it’s hard too :bighug::bighug::bighug:

you guys are all amazing cat moms too and your cats are lucky to have you as well!!!
 
Patricia & Maki said:
Thanks for getting us to this point.
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Glad to help a bit, Patricia.

Final tip: try to get a PM+2 every night, firstly because to understand how the Lantus is working you need to get readings during the AM and PM cycles (and many cats run lower at night). Secondly, a +2 test may give an indication of how the rest of the cycle might go. In particular, if the +2 test is lower than the preshot then that's a signal that further testing is highly advisable because BG could potentially drop significantly by nadir.

Blessings to you both. :)

(((Patricia and Maki Kitty)))


Mogs
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Mogs,
Thanks for staying in touch. How are you feeling?

You explanations of what, when and especially why continue to educate and encourage. I didn't know day and night cycles could be different. I will test Maki again on 2+ and 4+ since we are a bit ahead of schedule this evening. Nighttime worries me so I keep getting up throughout the night.
 
I'm extremely tired, Patricia. Thank you for asking. Because of the PTSD my sleep is very disordered plus I've been trying to do more than I'm really able for so my body has taken the legs out from under me. (One of us needs sense! ;) )

Patricia & Maki said:
Nighttime worries me so I keep getting up throughout the night.
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As you gather more readings for Maki, you'll start getting a much better feel for her pattern of response to the Lantus. All going well, that should start to give you more peace of mind. You'll get lots of help on the Lantus board. Also, if ever you're worried about Maki's numbers being on the low side you'll be able to post for help. There is usually someone online in the Lantus group and they'll be able to support you and guide you on when to test and feed to keep Maki safe.


Mogs
.
 
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