04/15 Dosing advice needed - while transitioning from Insugen to Lantus

[Nimi S]

Hope it’s fine to start a new thread. Wasn’t sure on the protocol on asking new questions in a few days old thread.

Links to earlier posts:

1. https://felinediabetes.com/FDMB/thr...steroid-induced-diabetes.276271/#post-3063299
2. https://felinediabetes.com/FDMB/thr...te-on-insugen-30-70-40iu.276361/#post-3063548

We’re done with 4 days of twice a day dosing with 1U of Insugen 30/70 40IU; the 5 days before that were at 1.5U once daily.

With some luck, I may get the u-100 syringes with half unit markings by Mon 17th Apr and make the switch from Insugen to Glargine. With Glargine I don’t know what the starting dose would be (the vet suggested 2.5U twice daily ), so I’ve held off on buying a Lantus pen, in the event that I need to go lower after starting at 1U.

Any advice on increasing current Insugen dose?

Since learning that Insugen isn’t recommended for cats, I haven’t had too many expectations from it. I was hoping that adding the wet food back to Shen’s diet would make a tiny bit of an improvement to his BG numbers but the 1U seems to be working for hardly a couple of hours before his BG starts going back to his AMPS / PMPS values. So far the numbers don’t look too encouraging but maybe 4 days is too few to make a difference? He’s been eating and drinking well. Ketones on a ketostix strip turned up negative the last 2 days - will be checking for a few more days, while his BG numbers are still high.

I read that in the SLGS method, the dose shouldn’t be increased until it’s been tried for at least a week. I know I should be more patient but I want to try increasing the dose by the next suggested increment just to see some improvement. But I also don’t know what the impact of switching from 1U versus 1.5U of Insugen twice daily to the recommended dose of Glargine would be (I don’t know if this sentence made any sense but to give an example, what would happen or what would be different if he were on 1U of Insugen and changed to 0.5U of Glargine versus if he were on 1.5U of Insugen and changed to 0.5U of Glargine).

I feel conflicted between wanting to wait his current dose out for a few more days and wanting to try seeing some positive change by increasing his current dose.
I assume that there’s no point in doing a 12 or 18 hour curve while he’s on Insugen since he will anyway be getting off it in a few days?

I’ve been going through the SSs of some members, especially their early days, and while I wouldn’t call it a relief, it makes me worry a tiny bit less about his numbers at this moment, knowing that most of us had started the same way and that it will take time.

Acromegaly

I went down the Acromegaly rabbit-hole today after reading a post about snoring and have been trying to figure out if Shen’s a candidate. I’m yet to figure out how he’d be diagnosed if he does have it but I read that the guideline is to be on insulin for at least 72 days to be tested for Acromegaly or else it gives false negatives. I spent half a day googling images and symptoms and I’m nowhere close to figuring it out.

Unrelated to this, I also came across the term skin tag for the first time and googled it to realize that Shen has two of them - one has been around for a few months, the other I noticed a day ago. The last time I went to the vet (Tue) I showed the older one to her and she said it’s a lump but not to worry about it.

I think I’ve spent the better part of the last 10 days shadowing Shen everywhere and checking his body parts randomly for any signs of non-existing illnesses. Does anybody else do this? He gave me a scare today by going to sit inside the cubby house of the cat tree, which he has 100% ignored for all 5 years of its existence. Even though he’d had a nice meal sometime before that, I couldn’t help but feel that he was hiding because he was in pain or feeling ill. He lasted there for all of 10 mins before proceeding to sleep on the floor but not before giving me a panic attack . If it’s not the BG, it’s something else. Phew!


I’m sorry for rambling

I just wanted advice on whether I should increase the Insugen dose from 1U twice daily to 1.5U twice daily for the last few (3-4) days of its usage before I switch to Glargine. Would any drop in BG caused by this increased dosage help with the transition to Glargine or would the effect be too transient to make a difference? (I know that the drop in BG I'm perceiving is not guaranteed )

 

[Bron and Sheba (GA)]

Nimisha, I have been talking to @Bandit's Mom and we think you could start introducing more low carb food and decreasing the dry to see how that goes, before increasing the dose. Are you happy to do that?
More later...I have just got visitors

 

[Nimi S]

Yes, I’ll start making the change to his diet. He likes the wet food so it won't be a problem. He's been having slightly looser stools ever since adding back the wet food so I'll have to keep a watch on that.

 

[Bron and Sheba (GA)]

Yes, I’ll start making the change to his diet. He likes the wet food so it won't be a problem. He's been having slightly looser stools ever since adding back the wet food so I'll have to keep a watch on that.

Try adding some plain cooked pumpkin to the food for the looser stools. About 1/2 teaspoon 3 times a day and see if that helps.

 

[Nimi S]

I think the AM shot was mostly a fur shot. He'd been hiding in the cat tree and wouldn't come out for the shot. I lured him out with a treat but he got away just as I tried to shoot and some (or all) of the solution spilled on to my finger. I was being hasty since it was getting late.
I should not reattempt another shot before the PM shot, right?

Will try the pumpkin for his stools. Thanks!

 

[Bron and Sheba (GA)]

I think I’ve spent the better part of the last 10 days shadowing Shen everywhere and checking his body parts randomly for any signs of non-existing illnesses. Does anybody else do this?

You are not on your own there!. I think we have all done it. Have you heard of helicopter parents? I think when you are anxious, everything seems to be worse.

I just wanted advice on whether I should increase the Insugen dose from 1U twice daily to 1.5U twice daily for the last few (3-4) days of its usage before I switch to Glargine. Would any drop in BG caused by this increased dosage help with the transition to Glargine or would the effect be too transient to make a difference?

I would see how the change to more low carb food goes first, and see how it effects the BGs
When you get the syringes, we will tell you what the best dose is to start on with the lantus. We take into consideration the dose of the previous insulin.

 

[Bron and Sheba (GA)]

I should not reattempt another shot before the PM shot, right?

Correct! Never give another dose if you think some did not get in. Its better to be high for a few hours than having to deal with a hypo!

 

[Nimi S]

Have you heard of helicopter parents? I think when you are anxious, everything seems to be worse.

I would see how the change to more low carb food goes first, and see how it effects the BGs

Never would have imagined that I'd be a helicopter parent some day

For the low carb food, right now I'm just increasing the amount of wet and reducing the dry. I have a couple of other lower carb wet foods but I don't want to add them to the mix right now since it might worsen his stools.
I can try adding a spoon or less of the other wet food over time to transition. Would that work or would I be adding too many variables for right now?

Also I think I pricked myself too. I don't know if any of the insulin went inside but the skin on my finger is slightly red, raised and irritated/itchy, but lesser so than when I first realized it.

 

[Bron and Sheba (GA)]

For the low carb food, right now I'm just increasing the amount of wet and reducing the dry.

Good.

For the low carb food, right now I'm just increasing the amount of wet and reducing the dry. I have a couple of other lower carb wet foods but I don't want to add them to the mix right now since it might worsen his stools.
I can try adding a spoon or less of the other wet food over time to transition. Would that work or would I be adding too many variables for right now?

I wouldn't add too many varieties to the mix if he is having tummy issues. You could try swapping one low carb for the other.

Also I think I pricked myself too. I don't know if any of the insulin went inside but the skin on my finger is slightly red, raised and irritated/itchy, but lesser so than when I first realized it

It should not be an issue apart from maybe infection. We have all pricked ourselves at one time or another.
If you think some of the insulin went in, give your self something sweet to eat or drink...I doubt that amount would be a problem though.

 

[Bandit's Mom]

But I also don’t know what the impact of switching from 1U versus 1.5U of Insugen twice daily to the recommended dose of Glargine would be (I don’t know if this sentence made any sense but to give an example, what would happen or what would be different if he were on 1U of Insugen and changed to 0.5U of Glargine versus if he were on 1.5U of Insugen and changed to 0.5U of Glargine).

I'm not sure I understood you correctly, but when switching insulins we consider the dose the cat was on (of the prev. insulin) and how it was doing at that dose. From the SLGS dosing sticky:

"Starting Dose:

• 1u BID if kitty is not on a wet/canned low carb diet
• 0.5u BID if kitty has been switched to a wet/canned low carb diet
• If the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration"

I feel conflicted between wanting to wait his current dose out for a few more days and wanting to try seeing some positive change by increasing his current dose.
I assume that there’s no point in doing a 12 or 18 hour curve while he’s on Insugen since he will anyway be getting off it in a few days?

I agree with Bron about transitioning the food first rather than increasing the insulin dose. You are getting enough tests to know how low he is dropping so a curve is not needed. And like you said, you will be changing insulins soon.

I went down the Acromegaly rabbit-hole today after reading a post about snoring and have been trying to figure out if Shen’s a candidate. I’m yet to figure out how he’d be diagnosed if he does have it but I read that the guideline is to be on insulin for at least 72 days to be tested for Acromegaly or else it gives false negatives. I spent half a day googling images and symptoms and I’m nowhere close to figuring it out.

Do not worry about this for now. It's only when cats get to 6u that we consider other conditions that could be causing insulin resistance. In Shen's case it looks like he just needs to get off the carbs and to a good dose on a good insulin

I think I’ve spent the better part of the last 10 days shadowing Shen everywhere and checking his body parts randomly for any signs of non-existing illnesses. Does anybody else do this? He gave me a scare today by going to sit inside the cubby house of the cat tree, which he has 100% ignored for all 5 years of its existence. Even though he’d had a nice meal sometime before that, I couldn’t help but feel that he was hiding because he was in pain or feeling ill. He lasted there for all of 10 mins before proceeding to sleep on the floor but not before giving me a panic attack . If it’s not the BG, it’s something else. Phew!

I think I would beat you hands down in a competition of helicopter moms. My sis thinks I need to get a job so I can stop obsessing over these two brats!

Is he having tummy issues with the same low carb wet food he was on a few days back? The one that you stopped and restarted?

 

[Nimi S]

If you think some of the insulin went in, give your self something sweet to eat or drink...I doubt that amount would be a problem though.

His +3 BG post the AM fur shot was 331 (down from 439) so maybe it was a partial shot.
I think I got away with a prick after the insulin was injected / had spilled out.

I'm not sure I understood you correctly, but when switching insulins we consider the dose the cat was on (of the prev. insulin) and how it was doing at that dose.

I agree with Bron about transitioning the food first rather than increasing the insulin dose. You are getting enough tests to know how low he is dropping so a curve is not needed. And like you said, you will be changing insulins soon.

That answers my question. Sorry I wasn’t clearer!
Tweaking the food and checking is a better idea, I agree too.

I think I would beat you hands down in a competition of helicopter moms. My sis thinks I need to get a job so I can stop obsessing over these two brats!

My mom can give your sis some company. In my case, I’ve been on a break and I actually do need to start looking for a job I’m grateful for the time I have right now to be able to do all this. It would have been crazy difficult if I were working right now.

Is he having tummy issues with the same low carb wet food he was on a few days back? The one that you stopped and restarted?

It’s the same brand but the flavor is different. Earlier it was Whiskas Chicken in gravy, now it’s Tuna in Jelly. But I’ve increased the overall quantity of the food he’s been getting since I wasn’t doing it right the first 4-5 days. I think the upset tummy is because he’s not used to getting so much wet food since I’ve been giving my cats wet food only as a treat so far. I gave him some boiled pumpkin with his +3 snack. Will see how it goes.

I’ve gone from only 70g of Obesity dry food per day to 35g of dry + 2 pouches of Whiskas per day (85g each). (50:50 dry:wet)
From today, I’m changing it to 15-20g of dry + 2.5-3 pouches of wet per day. (20-30% dry, rest wet)
Trying to feed around 250 kcals per day for his current weight.

Do not worry about this for now. It's only when cats get to 6u that we consider other conditions that could be causing insulin resistance. In Shen's case it looks like he just needs to get off the carbs and to a good dose on a good insulin.

Thank you for saying this. I really needed some optimism right now.

 

[Bandit's Mom]

It’s the same brand but the flavor is different. Earlier it was Whiskas Chicken in gravy, now it’s Tuna in Jelly. But I’ve increased the overall quantity of the food he’s been getting since I wasn’t doing it right the first 4-5 days.

To add to the fun (?!), Whiskas seems to have changed it's product composition. Its wet food in gravy is no longer high carb - it seems. I looked at the GA values of Salmon in Gravy and Chicken in Gravy and they work out to 5% carbs. I checked the UK low carb food list and they also list Whiskas 1+ in Gravy as 5.8% carbs!
https://docs.google.com/spreadsheets/d/1J5JpMe6TDXrHq_aTl9hUtHy6Gs9oRBqlz4nPGKxtySA/pubhtml

Thank you for saying this. I really needed some optimism right now.

Hang in there. In the beginning it will feel like nothing is going right. We have all been where you are.

 

[Wendy&Neko]

I went down the Acromegaly rabbit-hole today after reading a post about snoring and have been trying to figure out if Shen’s a candidate.

My girl had acromegaly. She didn't snore but her non diabetic buddy did. Neko's only symptoms were excessive hunger and one teary eye. Eventually her dose got up to 6 units and we did the testing for it. She never got skin tags. Since Shen has been seeing some lovely numbers in the 100's so far, and not on the best insulin, I would plug that rabbit hole.

 

[Nimi S]

My girl had acromegaly. She didn't snore but her non diabetic buddy did. Neko's only symptoms were excessive hunger and one teary eye. Eventually her dose got up to 6 units and we did the testing for it. She never got skin tags. Since Shen has been seeing some lovely numbers in the 100's so far, and not on the best insulin, I would plug that rabbit hole.

Shen has been a light snorer for a few years now - I chalked it up to his weight. During his last vet visit, the vet did use a stethoscope to listen to his heart but made no comment, so I wasn't worrying much.
He's also been a heavy eater and while he doesn't have teary eyes, he's had an allergy to something that leaves his eyes red and inflammed.

I won't read too much into it and will just look forward to his BG improving when he makes the move to Lantus soon

To add to the fun (?!), Whiskas seems to have changed it's product composition. Its wet food in gravy is no longer high carb - it seems. I looked at the GA values of Salmon in Gravy and Chicken in Gravy and they work out to 5% carbs. I checked the UK low carb food list and they also list Whiskas 1+ in Gravy as 5.8% carbs!
https://docs.google.com/spreadsheets/d/1J5JpMe6TDXrHq_aTl9hUtHy6Gs9oRBqlz4nPGKxtySA/pubhtml

Good for me! Sticking to Whiskas for now. Shen didn't enjoy the Felix Salmon in Jelly as much.

Try adding some plain cooked pumpkin to the food for the looser stools. About 1/2 teaspoon 3 times a day and see if that helps.

The pumpkin didn't help much - he had darker, looser stools yesterday, but otherwise he's good.
Is there any other source of fiber that I could try? Or just increase the amount of pumpkin?
Will give him a few more days to adjust to the wet food.

Transition to Lantus possible from tomorrow (04/17)
I'm picking up the u-100 syringes tonight but I have to head out some time before his PM shot.
I can't rely on folks at home right now to inject him, so is it ok if I shoot him around +10:30 or +11 today? (PM shot is around 9:15pm, I need to leave by 8:00pm).
He'll get his +1.5, +3 snacks if I'm not back by then to do it myself.

Suggestions for Glargine injection (brand)
I'm inclined to buy the Lantus injection vial (10ml) but was worrying that I would be wasting most of it since it says that it can be used only for 28 days post opening.
Does that hold true for cats too?

I found this on one of the stickies for insulin care and syringe info:
How long will my insulin last?

• The manufacturers of Lantus and Basaglar recommend discarding the insulin after 28 days of use. However, with proper handling and refrigeration, many Lantus and Basaglar users have been able to use a vial/cartridge/pen for six months and longer. Some use pens and vials to the last drop.

I've read a couple of posts saying they've been using a vial for 6-12 months with no issues.
If it is recommended to change it more often, I'd buy another brand which sells smaller vials (5ml - Biocon Basalog or 3ml - Wockhardt Glaritus).
Can cartridges meant for pens be used with syringes too? Asking since they're available in 3ml sizes.

 

[Bron and Sheba (GA)]

Can cartridges meant for pens be used with syringes too?

yes

Asking since they're available in 3ml sizes.

These are the ones to get.
Ill tag @Bandit's Mom as she will know more what is available in Mumbai.

Or just increase the amount of pumpkin?

I would try increasing the amount of pumpkin

I'm picking up the u-100 syringes tonight but I have to head out some time before his PM shot.
I can't rely on folks at home right now to inject him, so is it ok if I shoot him around +10:30 or +11 today? (PM shot is around 9:15pm, I need to leave by 8:00pm).
He'll get his +1.5, +3 snacks if I'm not back by then to do it myself.

Is shooting late going to stuff up your schedule or are you OK to wind it back over a few days?

How long will my insulin last?

If kept in the fridge it will last for 6 months. Unopened cartridges will last until the due date.

 

[Bandit's Mom]

I'm inclined to buy the Lantus injection vial (10ml) but was worrying that I would be wasting most of it since it says that it can be used only for 28 days post opening.
Does that hold true for cats too?

Yes. A vial holds 1000 units and not many cats can use that much before it starts to lose efficacy and you end up throwing a lot of it away. Also, if you drop a vial it's going to break and you have nothing. If you drop a pen, you're much less likely to break it, although cartridges can break from a fall. We use pens (and cartridges) just like a vial - you pull the cap off (of the pen) and there's a rubber stopper just like on a vial. You use regular insulin syringes and pull the insulin out of the pen. The only difference is that you inject air in the vial before drawing insulin but you don't do that with pens.

I found this on one of the stickies for insulin care and syringe info:
How long will my insulin last?

• The manufacturers of Lantus and Basaglar recommend discarding the insulin after 28 days of use. However, with proper handling and refrigeration, many Lantus and Basaglar users have been able to use a vial/cartridge/pen for six months and longer. Some use pens and vials to the last drop.

What I've read is that insulin pens manufacturers tested insulin pens to see if they will last 28 days without refrigeration because something about the pen mechanism doesn't work well (or something like that) when refrigerated. I've never had insulin go bad. I've used both pens and cartridges and stored them in the fridge and used them to the very last drop. Store them inside the fridge and not on the door. On the door there is more movement and greater exposure to outside temperature. A pen usually lasts me around 3 months.

If it is recommended to change it more often, I'd buy another brand which sells smaller vials (5ml - Biocon Basalog or 3ml - Wockhardt Glaritus). Can cartridges meant for pens be used with syringes too? Asking since they're available in 3ml sizes.

You can buy either cartridges or pens. And any brand of insulin glargine. Lantus or any biosimilar. I started with Lantus and then switched to Basalog.


@Bron and Sheba (GA) will psyllium husk or S boulardii help with the diarrhea? Or is this just a temporary tummy upset from the food transition and it will resolve in a few days?

 

[Bron and Sheba (GA)]

will psyllium husk or S boulardii help with the diarrhea? Or is this just a temporary tummy upset from the food transition and it will resolve in a few days?

Either of those could be used. You could use s boulardii with the pumpkin but probably not the psyllium husks.
Hopefully it is just a temporary upset from the food transition.

 

[Nimi S]

Is shooting late going to stuff up your schedule or are you OK to wind it back over a few days?

No, it'll be fine if I have to shoot him a bit later once I'm back. I'll bring it back up over the next few days.

Either of those could be used. You could use s boulardii with the pumpkin but probably not the psyllium husks.
Hopefully it is just a temporary upset from the food transition.

I'll try increasing the pumpkin for a day or two more and if it still doesn't get better, then I'll try s boulardii.

We use pens (and cartridges) just like a vial - you pull the cap off (of the pen) and there's a rubber stopper just like on a vial. You use regular insulin syringes and pull the insulin out of the pen. The only difference is that you inject air in the vial before drawing insulin but you don't do that with pens.

What I've read is that insulin pens manufacturers tested insulin pens to see if they will last 28 days without refrigeration because something about the pen mechanism doesn't work well (or something like that) when refrigerated. I've never had insulin go bad. I've used both pens and cartridges and stored them in the fridge and used them to the very last drop. Store them inside the fridge and not on the door. On the door there is more movement and greater exposure to outside temperature. A pen usually lasts me around 3 months.

You can buy either cartridges or pens. And any brand of insulin glargine. Lantus or any biosimilar. I started with Lantus and then switched to Basalog.

Thanks. I went back to one of your earlier replies for the Lantus pen video link and realized that you'd mentioned that pens and cartridges can be used in the same way as vials.
I'm getting the Basalog One pen (3ml) as of now.

 

[Nimi S]

Happy to share that I'm armed with the u-100 syringes and a fresh Basalog One pen (3ml).
Can I make the switch starting tomorrow (Mon 17 Apr)?

Please guide me on the starting dose.
Shen's current weight is 14 lbs (6.35kgs)

I'll go through the stickies on the Lantus ISG and acquaint myself with any new pieces of information.
Is there anything else I need to be prepared with?

Shen's PM dose was delayed by 2.5 hours. I did wait for an hour post his PMPS meal to shoot.

 

[Bron and Sheba (GA)]

Yes you can start with the Lantus tomorrow.
I think you should start with 1 unit twice a day.I’ll tag @Bandit's Mom ti see what she thinks.
You will need to hold the dose for a week so that the depot can fill.
If you are still feeding any dry food you will have to follow SLGS dosing method until you get rid of all the dry. Then you can follow TR if you want to. You are testing enough to do that.
With SLGS you hold the dose for 7 days and then do a curve. If you are testing plenty, you will not need to do a curve. Then you can see if you need to increase the dose. If the BG drops under 90, you reduce the dose.
So with Lantus, you test, feed and shot one after the other. There is no need to wait any time after feeding. The onset of Lantus is not for 2 hours so the food has time to get into the system.
As the depot fills the full effect of the dose will be felt. Don’t be concerned if it takes a few days for the insulin to look as if it is working.
I would get a +3 and a +5 to start with to see how the effect is on the BGs. You can swap it around as you go.
Continue to test for ketones.

 

[Bandit's Mom]

Happy to share that I'm armed with the u-100 syringes and a fresh Basalog One pen (3ml).

Wow! That was quick! Which brand of syringes? ReliOn? Friend had no issues with TSA/Indian customs?

I think you should start with 1 unit twice a day.I’ll tag @Bandit's Mom ti see what she thinks.

Yes. I agree.

So with Lantus, you test, feed and shot one after the other. There is no need to wait any time after feeding. The onset of Lantus is not for 2 hours so the food has time to get into the system.

And this may have been mentioned before, but you do not feed in the 2 hour window before the shot so that you don't get a food-influenced PS test.

How is the diarrhea?

 

[Nimi S]

If you are still feeding any dry food you will have to follow SLGS dosing method until you get rid of all the dry. Then you can follow TR if you want to. You are testing enough to do that.

I am giving him a little bit of dry food - will try to take it zero by the end of this week.

With respect to the testing, are paw pokes any good for measuring BG? I feel like I've gone a bit overboard on his ears the last one week and if possible I'd like to give his ears a break.
He does kick his legs away when I try to grab a toe so I'm not sure how successful I would be with this.
But now that he's switching to a new insulin I'm afraid I'd want to keep measuring his BG more often, at least for the first couple of days while I try to figure out his cycle. So wanted to see if I could switch between his ears and paws for testing. I read a suggestion to switch between the two ears every 3-4 days and to do a rainbow of sorts on the edges of the ears to avoid pricking the same spot.

So with Lantus, you test, feed and shot one after the other. There is no need to wait any time after feeding. The onset of Lantus is not for 2 hours so the food has time to get into the system.

Are the suggestions the same as before for his other meal/snack times? Feed at +1.5, +3, +5 and additionally avoid feeding in the 2 hours before the shots ?

Wow! That was quick! Which brand of syringes? ReliOn? Friend had no issues with TSA/Indian customs?

Yes! ReliOn from Walmart. I got very lucky. My friend did have to rush last minute and buy from a couple of different Walmarts since there was a limit of 2 boxes per person per purchase. No difficulties with TSA or Indian Customs. Her flight was delayed yesterday night so she offered to courier them from Pune (where she was eventually headed to) but since I was eager to switch I went and got them yesterday itself.

How is the diarrhea?

It was better yesterday than the day before but still a mix of loose and formed. Will stick to the pumpkin for today and see how it goes.

 

[Bandit's Mom]

With respect to the testing, are paw pokes any good for measuring BG? I feel like I've gone a bit overboard on his ears the last one week and if possible I'd like to give his ears a break.
He does kick his legs away when I try to grab a toe so I'm not sure how successful I would be with this.

The ears should not hurt. Avoid the marginal vein. I've never tried paw pads. I don't think Bandit will let me and I'm too scared it will hurt. I also worry about them getting infected - which might not be a valid concern.

Are the suggestions the same as before for his other meal/snack times? Feed at +1.5, +3, +5 and additionally avoid feeding in the 2 hours before the shots ?

To begin with, this looks good. As you understand how he fares on Lantus, you might need to change feed times.
Using Food to Manipulate the Curve

 

[Nimi S]

The ears should not hurt. Avoid the marginal vein. I've never tried paw pads. I don't think Bandit will let me and I'm too scared it will hurt. I also worry about them getting infected - which might not be a valid concern./QUOTE]

I usually have to milk the droplet out but I hit something big yesterday and ended up with a lot (comparatively) of blood oozing out, which did stop after applying some pressure, but nevertheless wasn't great to see. Trying to be more gentle with his ears now.

I also have the same worries about his paws getting infected since he does step into his pee sometimes and otherwise too there's a lot of dust in the house from the playground facing our apartment.

To begin with, this looks good. As you understand how he fares on Lantus, you might need to change feed times.
Using Food to Manipulate the Curve/QUOTE]

Yay! More reading for me

I was nervous using the u-100 syringes today. The needle is smaller in length compared to the u-40 one and felt like it'd come out if he moved even a tiny bit. I think feeding while shooting is the way to go.

I forgot to ask before but is it ok to keep the insulin pen out for some time before the shot (20-30 mins) and then use it? I used to do it with the Insugen since I read that being injected with cold insulin is painful.
The Basalog One user guide mentions a few times NOT TO refrigerate the pen after opening, so I was a bit confused but back into the fridge it went.

Another query I have is what is the way forward for posting? Do I post in the Lantus/Biosimilars ISG or is it ok to post in the Welcome/Main forum? Will start a new thread next time I have a query since the purpose of this one is more or less resolved.

 

[Nimi S]

Sorry, my replies are embedded within yours. Not sure why it's happening, tried correcting it a couple of times.

 

[Bron and Sheba (GA)]

Are the suggestions the same as before for his other meal/snack times? Feed at +1.5, +3, +5 and additionally avoid feeding in the 2 hours before the shots ?

Good question. I would change the snacks to +3 and+5 and see how that goes. Once we can see when the onset of insulin is you might want to change it around a bit.

With respect to the testing, are paw pokes any good for measuring BG? I feel like I've gone a bit overboard on his ears the last one week and if possible I'd like to give his ears a break.

Are you using all around both ears. That is what I used to do with Sheba. Not just the sweet spot.
I've never used the paws.

 

[Nimi S]

Good question. I would change the snacks to +3 and+5 and see how that goes. Once we can see when the onset of insulin is you might want to change it around a bit.

Oops. I just gave him a snack at +2, lost track of time at +1.5. I'll feed him next at +5.

Are you using all around both ears. That is what I used to do with Sheba. Not just the sweet spot.
I've never used the paws.

Yes. All around the ears, except for the bottom 1/4th near the base of the ear. I think I have a couple of misses per day where I press too lightly and very little to no blood comes out and then I have to try another spot.

 

[Bandit's Mom]

I too have to milk the ears sometimes to get blood and sometimes it gushes out. It doesn't hurt them, don't worry. I believe they have fewer nerve endings on the edge of their ears. As their ears "learn" to bleed, getting blood will be easier. Do you use a lancing device? If yes, experiment with the depth of the poke (setting 1 to 5).

Cold insulin can sting but it should not be a problem at lower doses. Rather than leave the pen out, draw insulin into the syringe 15-20 mins before the shot and let the insulin in the syringe come to room temperature.

ETA: the reason pen manufacturers say not to refrigerate is because refrigeration might ruin the mechanical operation of the pen. That's what I read somewhere. We don't care about that since we use syringes to get insulin out.

 

[Nimi S]

I do use a lancing device at a penetration depth of 2.5. The 2.5 doesn't work on his paws as the skin might be thicker there but I haven't tried again by increasing the penetration depth.

Thanks for the tip for the insulin. I should have asked sooner.