1/22/13 GOBBLES PMPS 356

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TheBowHuntress

TheBowHuntress

Member Since 2012
Yesterday's Condo including vet report & a ? re: Lantus being left out overnight:
http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=87412&p=936683#p936683

8:30 AM update: One hour post shot he went into hiding under the bed, probably because his sugar is high. He had done this several times when his numbers are over 300. Eating less than usual (even lower appetite than with his usual high BG's). He picked at Friskies Special Diet Turkey at 7, 10 am & Noon, 2 pm. He is still picking at his food--somewhat unusual for him. Moderate amount of pee and soft, formed pee. Drinking is slighter than usual. AM-Keytones: Negative. Hiding after AM shot 2x after tests. Eating less than usual, even with high BG's. He seems depressed.. Lots of sleeping this AM & PM. 180 degree turn from yesterday's improvement.
 
Re: 1/22/13 GOBBLES AMPS 343

copy and paste of unanswered question from yesterday's thread:
Take a look at Gobbles' SS and keep in mind that I LEFT HIS LANTUS OUT OVERNIGHT. The +7 reading was taken in the vet's office and Gobbles was so scared/stressed that the vet (and I) was impressed with his AlphaTrak reading of 234 (my ReliOn tested side by side @203) and we both agreed that those numbers were highly likely much higher than if I would of taken his BG at home, when he is not at all stressed. I was very worried that the insulin had lost potency/was no good because it was left out for 12 hours at 71 degrees. So is the the low AM +7 number indicative that the lack of refrigeration overnight (12 hours) did not necessarily lower the potency of the insulin? Or would I not know until PM (his evening shot was given at 7:15 pm EST) and his PMPS this evening was 390???????
Click to expand...

*most* cats' numbers do run higher at the vet's office due to stress. however, you can't come to a conclusion based on one test number because not every kitty responds to stress with higher BG numbers. some kitty's numbers remain unaffected. others actually drop when stressed. it depends on the cat. i've seen alex's numbers rise by over 200 points when taken to the vet. ECID.

there's no reason to worry about loss of potency with insulin left out for 12 hours. unrefrigerated lantus in guaranteed to last for 28 days.

the +7 number is not indicative of anything. i'm not sure why you're calling the +7 a low number. it's pretty much the same as gobbles +5 of 218 because of the allowable +20%/-20% variance. gobbles didn't drop. he was surfing the lower 200s.

because unrefrigerated lantus is good for 28 days, numbers in the PM cycle don't have anything to do with your vial being left out for 12 hours.


as far as the potency of your insulin after leaving it out for 12 hours...
like the others mentioned yesterday, you won't see anything more than the possibility of insulin not lasting a full six months like you would expect of refrigerated lantus.


an excerpt from the STICKY: LANTUS & LEVEMIR - INFO, PROPER HANDLING, & STORAGE:

HOW DO YOU KNOW WHEN YOUR INSULIN IS NO LONGER GOOD?

  • When you lose regulation for no reason.
  • If you see any hint of "floaties"/"tiny particles"... discard the insulin.
  • If insulin is cloudy or discolored, or if rubber stopper is cracked... replace insulin immediately.
  • The manufacturer of Lantus recommends discarding the insulin after 28 days of use (in-use, unrefrigerated, for humans).
    However, many Lantus users have been able to use a vial/cartridge/pen for as long as six months.
  • The manufacturer of Levemir recommends discarding the insulin after 42 days of use (in-use, unrefrigerated, for humans).
    Many Levemir users have been able to use a vial/pen for four to six months... some to the last drop.
  • Opened Lantus and Levemir vials, cartridges, and pens can last longer than many FDMB members seem to think. Some caregivers of diabetic cats have used Lantus/Levemir down to the last drop. Lantus users from the German Katzen Forum have reported using opened Lantus for up to six months and Levemir up to four months if kept refrigerated and handled properly. Lantus is NOT as fragile as we once thought.


  • From two of the leading researchers in the field of lantus use with feline diabetics, Jacquie S. Rand BVS, DVS and Rhett D.Marshall BVS (University of Queensland, Brisbane, Australia):

    "Glargine should be refrigerated because it has a shelf life of 4 weeks once opened and kept at room temperature. We have found that opened vials kept refrigerated can be used for more than 6 months. If using an insulin pen, the manufacturer recommends that once a vial of insulin is used, the pen be kept at room temperature because temperature changes associated with refrigeration alter the volume administered by the pen."
    http://www.uq.edu.au/ccah/index.html?page=43599&pid=0

    We use U100 syringes to draw Lantus from cartridges and pens. We do NOT use needle tips which can be attached to the pens to administer insulin. Therefore, refrigeration will not alter the volume administered by the pen apparatus. Refrigeration combined with the use of syringes to draw insulin (versus using the needle tip made for the pen) from the opened pen has been found to extend it's life well beyond the 28 days suggested by the manufacturer.
  • Unopened Lantus is good until the expiration date stamped on the box if refrigerated and handled properly.


i noticed you had questions about lantus pens in yesterday's thread...
seriously, make time to read through the information provided in the Stickies (starred posts) at the top of the forum. the Stickies provide tons of info to help you guide gobbles on his diabetic journey than what i copied & pasted above. you'll be glad you did!


have a good day! :mrgreen:
 
Re: 1/22/13 GOBBLES AMPS 343

Hi guys .. sorry that gobbles is so high this morning and not feeling well .. fingers crossed he works his way back down today and has a nice evening cycle for you .. have a great day guys!
 
Re: 1/22/13 GOBBLES AMPS 343

Also note that the color coding is somewhat arbitrary - its meant to give you a visual clue for patterns.
It could just as easily be color coded based on hypo possible, normal range, renal threshold, etc.
 
Re: 1/22/13 GOBBLES AMPS 343

BJM said:
Also note that the color coding is somewhat arbitrary - its meant to give you a visual clue for patterns.
It could just as easily be color coded based on hypo possible, normal range, renal threshold, etc.
Click to expand...
Based on your posting (which I appreciate--makes great sense!), can you take a look at his SS? Today's numbers, so far, are close to some cycles in the past. What do you think?
 
Re: 1/22/13 GOBBLES AMPS 343 +5~297 +6~258 +8~330

I would like for someone to give me your thoughts re: today's BGs and Condo. Please see today's Condo at beginning of post.
 
Re: 1/22/13 GOBBLES AMPS 343 +5~297 +6~258 +8~330

kat, could you please be more specific? i'm unclear as to what kind of advice/info/suggestions you're looking for.
thank you!
 
Re: 1/22/13 GOBBLES AMPS 343 +5~297 +6~258 +8~330

Jill & Alex said:
kat, could you please be more specific? i'm unclear as to what kind of advice/info/suggestions you're looking for.
thank you!
Click to expand...
Well, it seems to me that today's numbers/colors look somewhat like yesterday. The big difference, however, is that he's hiding, eating sparse and seems depressed; somewhat lethargic. I would like someone to interpret his SS...and give me your thoughts re: if dosage should be adjusted, possible reason for today's condo...it's just that yesterday's numbers are close to today's, but his condo is different. And I know our aim is to get him in the blue and green...
 
Re: 1/22/13 GOBBLES AMPS 343 +5~297 +6~258 +8~330

TheBowHuntress said:
Jill & Alex said:
kat, could you please be more specific? i'm unclear as to what kind of advice/info/suggestions you're looking for.
thank you!
Click to expand...
Well, it seems to me that today's numbers/colors look somewhat like yesterday. The big difference, however, is that he's hiding, eating sparse and seems depressed; somewhat lethargic. I would like someone to interpret his SS...and give me your thoughts re: if dosage should be adjusted, possible reason for today's condo...it's just that yesterday's numbers are close to today's, but his condo is different. And I know our aim is to get him in the blue and green...
Click to expand...

thank you for explaining what you're looking for. being specific helps us help you.

dosing...
looks to me like you have a failed reduction.

from the STICKY: LANTUS & LEVEMIR - TIGHT REGULATION PROTOCOL:

  • If an attempted reduction fails, go right back up to the last good dose.

if i were in your shoes, i would take the dose back up to 1.75 unit if i could monitor carefully. i don't know gobbles feeding schedule, but a mini-meal fed prior to nadir will probably keep him from dropping below 50 and earning another reduction as quickly as last time. if you can keep him from earning a reduction the higher dose will help to pull the numbers down on either sides of his nadir.


hiding, eating sparse and seems depressed; somewhat lethargic...
he's probably not feeling too well in higher numbers.


have i been of any help or are you looking for something else?
 
Re: 1/22/13 GOBBLES AMPS 343 +5~297 +6~258 +8~330

I guess, by reviewing Gobbles' SS, and the (limited) amount of data I've collected thus far, his nadir would be +6, agree?
 
Re: 1/22/13 GOBBLES AMPS 343 +5~297 +6~258 +8~330

TheBowHuntress said:
I guess, by reviewing Gobbles' SS, and the (limited) amount of data I've collected thus far, his nadir would be +6, agree?
Click to expand...
generally speaking, i would agree with his nadir occurring sometime between +5 and +7, but looking at known data he's shown us he can nadir between +3 and +12. nadirs can and do change.



edited to add:
if you're looking to experiment by feeding a mini-meal prior to nadir, start off assuming his nadir is at +6 (mini-meal at +5). you can always adjust the time of the mini-meal accordingly based on the data you collect.

if he starts to nose-dive prior to the scheduled mini-meal at +5, feed sooner. sometimes a little mini-meal or snack will slow them down just enough to keep them from dropping too low, but won't send them sky high. it's a balancing act. you might have to fool around with the timing until you find what works for him.
 
Re: 1/22/13 GOBBLES AMPS 343 +5~297 +6~258 +8~330

Jill & Alex said:
TheBowHuntress said:
I guess, by reviewing Gobbles' SS, and the (limited) amount of data I've collected thus far, his nadir would be +6, agree?
Click to expand...
generally speaking, i would agree with his nadir occurring sometime between +5 and +7, but looking at known data he's shown us he can nadir between +3 and +12. nadirs can and do change.



edited to add:
if you're looking to experiment by feeding a mini-meal prior to nadir, start off assuming his nadir is at +6 (mini-meal at +5). you can always adjust the time of the mini-meal accordingly based on the data you collect.

if he starts to nose-dive prior to the scheduled mini-meal at +5, feed sooner. sometimes a little mini-meal or snack will slow them down just enough to keep them from dropping too low, but won't send them sky high. it's a balancing act. you might have to fool around with the timing until you find what works for him.
Click to expand...
I will attempt to try this, however, he is a grazer. I have been assuming that since he is a grazer and always has been a grazer and will continue to be a grazer, his BG levels are most certainly affected somehow, one way or the other...I hope I'm making sense...
 
Re: 1/22/13 GOBBLES AMPS 343 +5~297 +6~258 +8~330

all you can do is try. after all, we're dealing with cats and they have a mind of their own. :mrgreen:
 
Re: 1/22/13 GOBBLES AMPS 343 +5~297 +6~258 +8~330

Jill & Alex said:
all you can do is try. after all, we're dealing with cats and they have a mind of their own. :mrgreen:
Click to expand...
I forgot to tell you, you did answer my question and gave me information that I can use. Thank you. Yup, Gobby definitely has a mind of his own!!!
 
Kat

I just wanted to add a bit here. Before Gracie was dx, she was a "grazer" in that we just fed her small portions of canned food whenever she wanted it all through the day. But I found, for her, that feeding her on a schedule helped to manage her FD better. That might not be true for every cat, but it is for her....and she adjusted very well. In fact now, it's like she has a little alarm clock on her adorable little paw and when it's one of her scheduled feeding times....she's waiting. :-D ;-)
 
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