Newbie, Trying to find the right dose - Lantus

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Aimz123

Aimz123

Member Since 2023
https://www.felinediabetes.com/FDMB...-skipping-dose-was-right.282325/#post-3112418

Hi all just continuing the convo here in a new thread for the day:
@Bron and Sheba (GA) @Sienne and Gabby (GA) @Diane Tyler's Mom

Waiting to test Ernie for his AMPS at 9.30am so he can have his insulin at 10am. Trying to reduce the glucose needle jabs so I can do some tests during the day.

Hopefully he stabilizes today.

Have ordered the syringes and will speak to my vet to get a prescription for the JuniorStar so we have that half increment insulin on hand for mum to use more so if needed. Anything under 1 unit I’ll have to draw up in a syringe when I get it.
 
That is a great idea to get the JuniorStar pen for you Mum to use.
Will it just draw up 1/2 unit?
Remember it can take more than a few days to stabilize. Some cats read the rule book and comply and many others dont!
 
Bron and Sheba (GA) said:
That is a great idea to get the JuniorStar pen for you Mum to use.
Will it just draw up 1/2 unit?
Remember it can take more than a few days to stabilize. Some cats read the rule book and comply and many others dont!
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Unfortunately it doesn’t do 0.5. 1 unit is the minimum it does but it can do 1.5, 2.5 etc. if it’s a low dose I’m going to have to draw some up in a syringe. It’s not ideal but she really is trying but she gets frustrated easily so I want to make it as smooth as possible so she’ll help out a bit so I can get away even for a day.
 
Aimz123 said:
Unfortunately it doesn’t do 0.5. 1 unit is the minimum it does but it can do 1.5, 2.5 etc. if it’s a low dose I’m going to have to draw some up in a syringe. It’s not ideal but she really is trying but she gets frustrated easily so I want to make it as smooth as possible so she’ll help out a bit so I can get away even for a day.
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I understand and I think your plan will work. It is great your Mum is willing to help...well done her!
 
Update for his AMPS is that he is at 17.8. I’m guessing the full 2.0 units is the way to go this morning?
 
Aimz123 said:
Update for his AMPS is that he is at 17.8. I’m guessing the full 2.0 units is the way to go this morning?
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I am thinking until you can get the JuniorStar and the syringes, we might end up staying with the 2 units am and the 1 unit pm, providing the preshots are high enough.
I would like to see how he goes on 1.5 units twice a day but that is not doable until you get the supplies which hopefully will be soon.
So yes 2 units this morning and I would give a snack at +1 to see if we can slow down the drop. He is not as high as yesterday am so he may not drop as fast or as much...only time will tell.
And he might need another snack at +3. Lets see what the BGs are...
 
Bron and Sheba (GA) said:
I am thinking until you can get the JuniorStar and the syringes, we might end up staying with the 2 units am and the 1 unit pm, providing the preshots are high enough.
I would like to see how he goes on 1.5 units twice a day but that is not doable until you get the supplies which hopefully will be soon.
So yes 2 units this morning and I would give a snack at +1 to see if we can slow down the drop. He is not as high as yesterday am so he may not drop as fast or as much...only time will tell.
And he might need another snack at +3. Lets see what the BGs are...
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Today as I’ll be working I won’t be able to test as much as yesterday I was planning to schedule about 2-3 tests today. This is manageable between my meetings and requirements for work.

I have a Telehealth with my vet at 12.15 so I’ll ask for the JuniorStar prescription and see what he says. But definitely need more pain killer.
 
Aimz123 said:
Today as I’ll be working I won’t be able to test as much as yesterday I was planning to schedule about 2-3 tests today. This is manageable between my meetings and requirements for work.

I have a Telehealth with my vet at 12.15 so I’ll ask for the JuniorStar prescription and see what he says. But definitely need more pain killer.
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Surely the vet will not object to you getting the JuniorStar pen. The only reason I can think of is if he only wants you to go up or down in 1 unit increments, which is what a lot of vets think, but we have shown that cats do much better with smaller increments. And it will make it so much easier for you and your Mum.
 
Bron and Sheba (GA) said:
Surely the vet will not object to you getting the JuniorStar pen. The only reason I can think of is if he only wants you to go up or down in 1 unit increments, which is what a lot of vets think, but we have shown that cats do much better with smaller increments. And it will make it so much easier for you and your Mum.
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Update from the vet call and last test. He was 14.7 at 2+ so not a major drop compared to yesterday.

The vet’s plan is:
  • Remove cerenia
  • Keep Zofran/Odansetron day and night
  • Add back in Buprenorphine (am/pm)
  • Use Mirtazapine ever second day
If the above isn’t working Gabepentin will be added and the Buprenorphine faded out and removed. He thinks Ernie is still really stressed with the whole needle and vet visit situation so just needs a bit of time. My next in person appointment is Monday next week so they’ll reassess then.

With the Lantus he’s all for the JuniorStar but he can’t seem to find where I would buy that from so he’s going to call children’s hospital to see where we can get that if at all. It must be available as I can see skins sold to decorate the pen for kids and it’s sold in Australia.

He also has changed the dose to 2 units (am) and 1 unit (pm). Just till we can sort out the half dose situation as I think he wants to dial it to 1.5 both doses like you have suggested.

Going to go pick up the meds later in the day so hopefully this all works out. I’ll try a test again later at the +6 mark if I can get away.
 
Bron and Sheba (GA) said:
Just saw you gave 1 unit at PMPS. Try and get a before bed test in if you can
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Hi Bron

Sorry I’m unable to test again tonight. I feel quite defeated and hit rock bottom so just need to really try to decompress.

Tried to find a supplier for the JuniorStar pen but chemist warehouse said Australia doesn’t get that pen nor can they order it. I spoke to the company that makes the pen but am waiting for an email back they weren’t able to tell me that it was available either just that they’d look into it. Just feels like the walls are closing in more and more tonight. Even with syringes on deck it’s pointless if I need to be away due to mum really being resistant to using them and being unable to see the dose well enough. That and all his other ailments atm it’s just a bit much. Sorry I sound like a whinger trying to see a light at the end of the tunnel but it’s becoming quite overwhelming right now.
 
Ale & Bobo & Minnie (GA) said:
Bron, did you catch that her vet is having her give different dose am and pm?
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Is this not normal for the dose to be 2 in the am and 1 in the pm? I think he was looking at the pattern how he was low at night and then a bit higher in the morning and that he might hypo if given 2 units at night.
 
Bron and Sheba (GA) said:
@Ale & Bobo & Minnie (GA) Aimee only has a pen atm and not syringes, which have been ordered. Once she gets them the plan is to hopefully go to 1.5 U for both cycles.
@Aimz123 it is better to have the same dose for Lantus if possible because it is a depot insulin. How are things this morning?
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Hi Bron

Haven’t had a chance yet to check Ernie this morning will do at AMPS. I think the vet was of the mindset that the syringe which can’t show the half increment options would be dangerous because guessing where that point is would be inaccurate. Particularly for my elderly mother who can barely see tiny writing as it is.

Like I’ve read in other posts about vets he wants to use the whole unit rather than 0.5. But I’m still set on trying to source this JuniorStar. My last hope is calling the Children’s Hospital today to see if they order it in and if I can access that via prescription. You’d think they must have it if there’s an instructional video on their website about how to use it!

Im concerned if I need to go away for the weekend that if I were to switch to syringe mum just can’t read it and is being difficult about it so it’s not going to happen. She’s barely ok using the pen but that’s easy so she’s ok doing that atm.

My options are:
  • Source a JuniorStar pen which will solve a lot of issues
  • Source syringes with at least half increments so that I can at least give him his 1.5 when I’m here and will just have to stick to the pen if mum has to do it
  • Or just stick with the SoloStar pen as is in whole units
I know this is not ideal with the last two points but I need to find a workable arrangement. Everyone’s situation is different as they say and I’m trying my hardest to come up to speed and implement as much as possible. It’s difficult because being home bound separates me from my partner (who is about just over a hour drive away). While it’s not a new relationship (6 years) absence puts pressure on any partnership. Particularly also because when covid hit the world I was diagnosed with the breast cancer so we did not see each other for months because of my compromised state and the restrictions, the paranoia of my mum and me about catching covid while on treatment. It was just a lot to deal with. Sorry to vent.
 
Update is he is 19.5 this morning I’ll give the 2 units as planned.

We’ll update on the JuniorStar it’s just not available in Australia at all. Called Children’s Hospital and they referred me to their pharmacy Woods. They had the diabetes educator standing there so he asked her and they don’t stock that in Australia at all. That if I needed that I’d have to go direct to Sanofi but that would mean it would be difficult to get restock when needed.
 
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Aimz123 said:
Haven’t had a chance yet to check Ernie this morning will do at AMPS. I think the vet was of the mindset that the syringe which can’t show the half increment options would be dangerous because guessing where that point is would be inaccurate. Particularly for my elderly mother who can barely see tiny writing as it is.
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While not ideal…not having the half unit syringes…I used them for years and used to give 1/4 unit increments. So I would not agree with your vet on that. It is not hard to get 1/2 unit doses on the syringes at all. You can have a sample syringe (marked, and not used to give the dose, just as a sample) made up with a dark liquid to refer to if needed. I used a magnifying glass as well. So don’t let that put you off. And in the meantime I will try and source an overseas place for you to get the 1/2 unit syringes.
Let me see what I can do here. Would you be willing to pay the postage if I could get someone to buy some for you overseas?
Aimz123 said:
We’ll update on the JuniorStar it’s just not available in Australia at all. Called Children’s Hospital and they referred me to their pharmacy Woods. They had the diabetes educator standing there so he asked her and they don’t stock that in Australia at all. That if I needed that I’d have to go direct to Sanofi but that would mean it would be difficult to get restock when needed.
Click to expand...
A pen would last for some time, so it might be worth pursuing if you only needed to go through the process every so often.

Aimz123 said:
Im concerned if I need to go away for the weekend that if I were to switch to syringe mum just can’t read it and is being difficult about it so it’s not going to happen. She’s barely ok using the pen but that’s easy so she’s ok doing that atm.
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If you need to go away for the weekend we could work out a dose your mum could give on the pen.
Aimz123 said:
I know this is not ideal with the last two points but I need to find a workable arrangement. Everyone’s situation is different as they say and I’m trying my hardest to come up to speed and implement as much as possible. It’s difficult because being home bound separates me from my partner (who is about just over a hour drive away). While it’s not a new relationship (6 years) absence puts pressure on any partnership. Particularly also because when covid hit the world I was diagnosed with the breast cancer so we did not see each other for months because of my compromised state and the restrictions, the paranoia of my mum and me about catching covid while on treatment. It was just a lot to deal with. Sorry to vent.
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I totally understand where you are coming from and it must have been so hard having the breast cancer and being separated from your partner and having Covid and your mum to worry about.
We will work this out. There is always a solution. It may not be always ideal but you have to live your life as well.:bighug:
 
Bron and Sheba (GA) said:
While not ideal…not having the half unit syringes…I used them for years and used to give 1/4 unit increments. So I would not agree with your vet on that. It is not hard to get 1/2 unit doses on the syringes at all. You can have a sample syringe (marked, and not used to give the dose, just as a sample) made up with a dark liquid to refer to if needed. I used a magnifying glass as well. So don’t let that put you off. And in the meantime I will try and source an overseas place for you to get the 1/2 unit syringes.
Let me see what I can do here. Would you be willing to pay the postage if I could get someone to buy some for you overseas?

A pen would last for some time, so it might be worth pursuing if you only needed to go through the process every so often.


If you need to go away for the weekend we could work out a dose your mum could give on the pen.

I totally understand where you are coming from and it must have been so hard having the breast cancer and being separated from your partner and having Covid and your mum to worry about.
We will work this out. There is always a solution. It may not be always ideal but you have to live your life as well.:bighug:
Click to expand...

Hi Bron

Thanks for understanding I wasn’t sure how people on this forum would be when there’s added complexity about the half dose process. It’s definitely not from wanting to do it but the ease of showing mum.

I am happy to pay for all of it the syringes and postage but I’m worried that long term how to source it myself so I don’t need to depend on others. It’s a shame pharmacists here can’t get them. Do you remember what brand and type of half marking syringe you were ordering before they became unavailable?

Im going to follow up with Sanofi I’ll give them a day or so then will call back to see where it got to. The hospital think if I asked them for a pen and insulin they would be able to just give me a couple so that might be ok.

Thanks for being so supportive it’s a flurry of overload atm. Also mums being difficult with the whole thing which isn’t helping at all. I think it’s a bit of a language barrier communication wise and just not wanting to deal with it mentality because it breaks from her routine.

All very frustrating and draining. Many tears and just not seeing a solution atm.
 
Aimz123 said:
Thanks for understanding I wasn’t sure how people on this forum would be when there’s added complexity about the half dose process. It’s definitely not from wanting to do it but the ease of showing mum.
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We all totally understand what it is like in the beginning especially when there are other issues involved. So you need never worry about us not understanding.

I’m going to ask a friend of mine if she can buy some 1/2 unit syringes for you and send them. And in the meantime I will try and find someone who will import them. I have phoned a few places then got caught up with life!

I know it seems insurmountable at the moment but there will be a solution.
 
Bron and Sheba (GA) said:
We all totally understand what it is like in the beginning especially when there are other issues involved. So you need never worry about us not understanding.

I’m going to ask a friend of mine if she can buy some 1/2 unit syringes for you and send them. And in the meantime I will try and find someone who will import them. I have phoned a few places then got caught up with life!

I know it seems insurmountable at the moment but there will be a solution.
Click to expand...

Thanks Bron for keeping me in check. I contacted Diabetes Victoria and apparently the JuniorStar is sold in Australia so there must be a certain way to access it that’s not mainstream. They’re giving me a call tomorrow. I’m not sure whether to disclose it’s for a cat or just pretend it’s for a child.l

I think atm the tablets, Buprenorphine and the insulin and blood checks are too much for mum to even comprehend. She was ok with the blood check and insulin but when I told her about the other stuff I think it then became overwhelming and now she’s taken a big step back with the helping part. Will just need her to calm down again sigh. Accessing that JuniorStar pen will be a big game changer. I think you’re right that he needs 1.5 for PM as the 1 alone yesterday still made him high in the morning on his reading.

Sorry I didn’t get around to testing during the day. All the backlog at work from me being at the vet non stop finally caught up with me so I’ve had to knuckle down.
 
Update at PMPS is 12.6 so will give 1 unit as per vets instruction.

Had to give him the Mirtazapine at 2pm because he hadn’t eaten barely anything. Was hoping to use it every second day but looks like it needs to be daily for now.
 
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