11/6 Kusha AMPS 98 +6 70 Should he be OTJ?

[LilaKusha]

My two kids Lila & Kusha (12 yr old Tonk siblings) were both diagnosed late August. Spreadsheets attached. Lila's bg is more variable, but both came down very quickly from over 300. Having just done some more reading, I'm wondering if Kusha should even be on insulin. What do others think? I plan to reduce his dose at the very least.

Two more questions about Lantus: (1) should it be mixed at all, and if so, how? The vet told me the bottle should be rolled; (2) accidentally dropped the bottle this morning. It had bubbles in it when I picked it up. Is one such incident likely to do serious damage to its potency?

Thanks for input.

 

[Ann & Tess GA]

Hi and welcome to LL. Kusha is very well regulated on 1 unit from what I understand on your SS. That is a long way from being ready to go OTJ how ever. You would be see

We follow the tight regulation protocol here. The relevent section on reductions :

Reducing the dose:
If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit.

Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

If an attempted reduction fails, go right back up to the last good dose.
Try to go from 0.25u to 0.1u before stopping insulin completely.

Kusha seems to have been in normal numbers for over a week so it should be a good time to try a reduction. I hope one of the really experienced dose gurus will confirm this. HOWEVER, at this dosage level we only reduce by.25u at the most, many of us at this point just skinny the dose by taking a drop out. (I notice you have been adjusting doses in .5u steps, this is too great a change.) If after 6 cycles (3 days) his numbers are elevated the reduction is considered failed and should be returned to the last good dose

 

[Ann & Tess GA]

Having got that out there a few house keeping items.

You are doing great w/ two FD kitties. As for the handling of Lantus, it does NOT need to be mixed. Older forms of insulin were "suspensions" that needed to be mixed. Lantus and Levemir are solutions and need no mixing, they can be damaged by rough handling. I've dropped my insulin pens too, it doesn't automatically mean that the insulin will go bad, but you should be extra diligent to look for cloudiness and/or "floaties" , which are signs of the insulin breaking down. Read the Proper Handling and Storage stickey at the top of the postings list.

There is a lot of information in the Stickies (permanent starred posts at the top of the list) Especially important are the New to the Group and the Tight Regulation Protocol and also the Storage Shed has a great explanation of how Lantus builds up a reserve in the body.

It's great that you have your own SS, but most of us use Google Docs. That way anyone who needs to look at your SS doesn't have to keep downloading it to their computer to look at it. There are step by step instructions in the Tech Support Forum on how to set up and publish your SS

I know it's a lot to get through, but you are already well on your way with you two furkids. A few other answers will help too. How old is your insulin and what are you feeding? Low carb/ High protein wet food makes a world of difference for FD kitties.

 

[julie & punkin (ga)]

ann did a great job of giving you lots of information - as far as OTJ, you want to keep him on insulin as long as possible to let the pancreas heal. reduce by .25 or shave the dose until you're just giving a drop. when you get to a dose of .25 and need to reduce, holler on here and someone can tell you how to measure less.

the reason for doing that is that it gives the best chance of success for staying OTJ. what any of us would like, of course!

the video in the "how to handle lantus" will give you some information on how to help it last as long as possible. you'll know it's bad if you see the floaties that ann mentioned, or if you start seeing higher numbers and can't figure out why.

we had one vial that we'd traveled for a week with, and even though it wasn't that old and was being refrigerated and/or in a cooler, being in and out of the fridge did it in. we could tell because it developed a zillion tiny bubbles that we couldn't get out of the syringe, as well as the numbers started to go up.

 

[LilaKusha]

Thanks for all the great info. I'm so impressed by the collective wisdom here - much more than can be gained from a vet!
Re diet, Lila and Kusha have been on a raw diet for the last seven years (Lila developed hypercalcemia in 2004 and after a conventional vet specialist told us there was nothing they could do for her and that she would die within a year or so, we took her to a holistic vet, who did acupuncture and suggested the raw diet; her calcium levels were back to normal within a month of the treatment/diet change, and have been normal since). They used to be on Bravo ground venison with supplements, but I have recently switched them to Primal, which is more complete. They also get a little salmon oil and probiotics. Unfortunately, when we first put them on the raw diet, we didn't take away their dry food, so they are both overweight. Since being diagnosed, they have been on a strict raw diet, and are losing weight slowly.

The insulin is only a couple of weeks old - I asked the vet for a new bottle because I was afraid I had been mishandling it by not mixing properly and injecting air into the bottle (which is something I just read that you SHOULD do on the BD site!) There seems to be so much contradictory info out there - I was told to keep the insulin in the refrigerator, but the BD site says let it warm up for an hour or so before injecting. The kids don't seem to mind it cold.

I will read more in this forum, but can anyone tell me where to get syringes with the half-unit scale? The syringes we bought online (Terumo U100, 3/10cc, 29G x 1/2") seem to be variable in terms of their zero point. Before I fill the syringe, I check where the fully depressed plunger stops, and it doesn't always go right to zero, which makes it hard to be accurate with the measurements.

Sorry about about the SS. I will read about how to use GoogleDocs.

 

[Sienne and Gabby (GA)]

I would need a great deal more information (i.e., BG test data) to make any observation about whether your cat is in remission.

As far as syringes, this info is in the New to the Group sticky:

U100 3/10cc syringes with half unit markings are the best to use for fine dosing. BD, Monoject, GNP, and ReliOn are some of the brands available with half unit markings. Needle gauge and length is your preference They come in ½ inch or 5/16 inch needle lengths. Needle gauges 29, 30 or 31 (31 being the thinnest).

Recently, people have been less than enthusiastic about the BD syringes. I've used both Monoject and GNP. The latter is only available through Hocks since it's their "store" brand. Many people purchase the Monoject syringes through ADW. They do require a prescription for the syringes whereas Hocks does not -- or at least they have never asked me for a prescription from my vet. (Some states require an Rx for syringes.)

You may want to spend some time famiiarizing yourself with the starred sticky notes at the top of the Board. There's a great deal of information there.

 

[Ann & Tess GA]

Ugh! The board is really slow tonight.

Syringes: I like the Monoject, don't like BD and haven't tried the others. As Sienne said, it may depend on where you live, I'm in CA and ADW doesn't require a Rx for syringes from me. These are the syringes i use Tess barely notices the 31 gauge needle.

Insulin; officially lantus has a useable life of 28 days once the seal is breached on a bottle. Many here have good luck using it longer. For the vial it is recommended to inject an equal amount of air int the vial as the amount of insulin you wish to draw out. This prevents a vacuum from forming. On the pens DO NOT inject air in because they are pressurized.

Most of us use the pens which are more economical. It is more costly initially initially, but you get 50% more and each pen has a 28 day useable life (or more) once opened. Kind of an "all you eggs in one basket idea." You can get a prescription from the vet and shop around. I got the best deal at Costco, $179 for 5, 3ml pens.

The mfg actually calls for the pens to be kept at room temp once opened.We keep ours cool, it extends the viability. The cold from the small amount we gives our cats isn't a problem. Humans get much more and that is probably why they recommend warming. It isn't a good idea to warm and cool the insulin repeatedly. Also don't keep it in the refrigerator door. Too much jostling.