3/28 - Xander | AMPS 328, +2 358 | Some questions about switching to new vial, etc

[Brianna & Xander]

3/27/25

Hey everybody,

As some of you saw in yesterday's thread I'm starting to wonder about the efficacy of our vial of Lantus. It's been taken care of, but it's still the first vial I've had and have been using it since January 15th, so it's been a while.

It's possible he also just needs an increase, but the rate at which things are getting worse to me implies that maybe the vial itself is just also not doing very much.

Questions:
• If the problem is mainly that the insulin is old and not that the dosage is too low, would giving him the full 2.5 units from the new vial be dangerous because it will be more than he actually needed?
• Should I try yet another increase first before switching to a new vial, or should I just switch immediately?
• Is there anything else I'm missing/should know about when it comes to swapping out vials that I may not have thought of?

Happy Friday!

 

[Wendy&Neko]

A lot of people have used their vials for 5-6 months. Before I knew better and switched to cartridges, I used my one and only vial for a few months. Have you considered going to pens next? Less waste of insulin, and you can generally use it to the last drop.

We suggest that people do not increase and switch to a new source of insulin (vial, pens, cartridge) on the same cycle, just in case. FWIW, I think it's the cat, not the vial. I know you aren't able to manually test Xander, but experience with other members has shown that the Libre shows a lower number than a BG meter when under 100. This means you may be reducing before you should be, and as a result, reductions aren't holding and he's showing some glucose toxicity or used to higher numbers. The cure is to keep increasing until you break through.

You only barely saw blues, today is cycle 6, you can increase the dose any time now.

 

[Brianna & Xander]

A lot of people have used their vials for 5-6 months. Before I knew better and switched to cartridges, I used my one and only vial for a few months. Have you considered going to pens next? Less waste of insulin, and you can generally use it to the last drop.

I knew that they could last longer than the manufacturer says (which is why I've been using it this long), but I also knew that it wasn't necessarily a hard and fast rule that they'd definitely last that whole time. It's not cloudy or anything, but I've also had trouble with some needles in the past and worried that maybe I could have contaminated it by accidentally sending a little bit of insulin back into the bottle, or having knocked it over on the counter once or twice.

TBH I hadn't considered going to pens because I'd have to get a whole new prescription which would be a big hassle with the current vet situation and I haven't spent any time looking into the cost difference. At $35 for the last vial I'm not super concerned about wasting the rest of this one if I had to because it's lasted almost the entire time since diagnosis so far. I feel like we've gotten at least the $35 out of it.

We suggest that people do not increase and switch to a new source of insulin (vial, pens, cartridge) on the same cycle, just in case. FWIW, I think it's the cat, not the vial. I know you aren't able to manually test Xander, but experience with other members has shown that the Libre shows a lower number than a BG meter when under 100. This means you may be reducing before you should be, and as a result, reductions aren't holding and he's showing some glucose toxicity or used to higher numbers. The cure is to keep increasing until you break through.

I definitely wouldn't increase and change vials at the same time. I just wanted to know if it would be dangerous to not give a reduced first dose of the new vial in this case because if the insulin were the problem and not the dose, switching to a new vial would be an overload. (Trying to come up with another example: If you were struggling to open a door thinking it was stuck, but it was actually locked. If someone on the other side unlocked it at the same time as you tried to kick it down, you'd smash through the door because the amount of force you were using wasn't the problem. The lock was. You could have just opened the door and walked through once it was unlocked. Or... You know you need to floor it to get up to a certain speed in your current car but it might not be wise to floor it in a new vehicle that may accelerate more efficiently. Or something. lol I hope one of those made my point.)

I appreciate your thoughts as to what might be the problem! I obviously don't know, it just seemed to very rapidly deteriorate but only now that he's on the highest dose I've ever given him. FWIW, I haven't reduced for almost a few weeks, since he was in in the 30s or lower on the Libre. I definitely know that the Libre runs low at the low end and based on my comparison he was likely about 10 points higher, but even if I give more of a buffer than that it would still have been a decrease. I did purposely switch to TR so I could stop having to decrease under 90 though, that was getting very old. Since I can't manually test I've been following Elise's advice which was basically that I just need to take the decrease if he goes under 50 on the Libre because that's the number I have to work with. At least then he'd be safe but not stuck in SLGS. Trust me, if I could just manually this would be so much easier (and cheaper). I wish it were just a matter of not wanting to, but with Xander specifically it's not.

You only barely saw blues, today is cycle 6, you can increase the dose any time now.

My third question was basically whether I should try increasing one more time and then if that doesn't work then switch to the new vial, or to just switch to the new vial right away (without increasing), so it sounds like your opinion is the former. Thank you! I just wanted a few opinions about that.

ETA: I hope no one here ever thinks I'm being difficult or argumentative! I often need clarification and also just tend to over-explain things to avoid being misunderstood. I am endlessly thankful for everyone here's help and if I ever seem argumentative please know that I'm just explaining my thought process/trying to add more context or trying to understand better.

 

[Wendy&Neko]

No reason to reduce the dose when you switch vials. That would just deplete the depot. For safety's sake you could do the switch on a cycle you can monitor. FYI, I have seen people switch from repackaged insulin vials from vets to new insulin from the pharmacy and seen noticeable changes, but more of the line of more green, less pink. As long as your vial has been stored in the fridge, it should be OK. And you are right, at $35 a vial it isn't a big deal, it was when Lantus vials cost over $200.

2.5 units is still not what I'd consider a large dose. Insulin is a hormone, not like a regular medicine. You don't always see gradual improvement with dose increases. Sometimes it goes up and down, just keep increasing until you get where you want him to be.

No worries, I haven't been thinking you are difficult.

 

[Kobe (Dean and Lesley) MO]

ETA: I hope no one here ever thinks I'm being difficult or argumentative! I'm autistic and often need clarification and also just tend to over-explain things to avoid being misunderstood. I am endlessly thankful for everyone here's help and if I ever seem argumentative please know that I'm just explaining my thought process/trying to add more context or trying to understand better.

I enjoy reading your posts. The information you offer helps everyone to help you keep you cat safe. Plus you ask really great questions. Good for your cat, and good for all the other cats whose people read your posts.

 

[Briana + Binx]

It's so tough when things inexplicably start getting worse after they just started getting better Unfortunately, I can't give much advice but interested to see what happens over the next few cycles, whatever decision you make!
Good luck and you have our support Also, seconding @Kobe (Dean and Lesley) MO's note about great questions and helpful information!

 

[Brianna & Xander]

No reason to reduce the dose when you switch vials. That would just deplete the depot. For safety's sake you could do the switch on a cycle you can monitor. FYI, I have seen people switch from repackaged insulin vials from vets to new insulin from the pharmacy and seen noticeable changes, but more of the line of more green, less pink. As long as your vial has been stored in the fridge, it should be OK. And you are right, at $35 a vial it isn't a big deal, it was when Lantus vials cost over $200.

Great, thank you! I just wanted to make sure. No desire whatsoever to deplete the depot we worked so hard for! Absolutely yes, it would be worth it then. Endlessly grateful that it's so much more affordable now. It's probably the least expensive thing overall in the grand scheme of FD at this point (at least for us)!

2.5 units is still not what I'd consider a large dose. Insulin is a hormone, not like a regular medicine. You don't always see gradual improvement with dose increases. Sometimes it goes up and down, just keep increasing until you get where you want him to be.

I really need to get it through my head that it doesn't work like a drug and that dosages between hormones/drugs aren't really comparable. I think I'm also just nervous because it's the most I've administered at least, and the interim vet we'd been seeing said his max dose was 2 units (which clearly is not enough) and I feel a little like a criminal going over that. Our primary vet who diagnosed him (and is on personal leave), however, did initially say that he may even need 3 units, so I guess I have half-approval. lol

No worries, I haven't been thinking you are difficult.

I'm really glad to hear this, thank you!! I worry about that kind of stuff.

 

[Brianna & Xander]

I enjoy reading your posts. The information you offer helps everyone to help you keep you cat safe. Plus you ask really great questions. Good for your cat, and good for all the other cats whose people read your posts.

Hey, that's really nice of you to say! Thank you so much! I always worry that I come across as annoying or rude, but I just always feel better armed with more information. If that's somehow helpful to other people too that's amazing and makes my feeling awkward about it totally worth it! lol

 

[Brianna & Xander]

It's so tough when things inexplicably start getting worse after they just started getting better Unfortunately, I can't give much advice but interested to see what happens over the next few cycles, whatever decision you make!
Good luck and you have our support Also, seconding @Kobe (Dean and Lesley) MO's note about great questions and helpful information!

Yes!! And it was so drastic, too, which is why I wondered if it was more than just the dose. I guess maybe he was just needing higher doses at a faster rate than I was administering them and we got behind his needs.

I can't decide whether to just increase now or start the new vial. He's so high right now that both feel like a risk of just "sitting around" not helping. I think since Wendy thinks it's just the dose that I'll try one more increase. If it's the insulin it won't make much difference and I can just switch after a few days. I hate making these decisions lol

 

[Wendy&Neko]

FYI - you sound a lot like I did to start. But that was with my kitty going on much higher doses. I was constantly asking questions and asking why this, why that? It killed me there was no simple answer.

Regarding decisions, whatever you decide will be an opportunity to gather data. We don't all get it right each time, but we learn for next time. You aren't the first or the last to suspect the insulin. 99% of the time it's not. But there is that 1%.

 

[Briana + Binx]

Yes!! And it was so drastic, too, which is why I wondered if it was more than just the dose. I guess maybe he was just needing higher doses at a faster rate than I was administering them and we got behind his needs.

I can't decide whether to just increase now or start the new vial. He's so high right now that both feel like a risk of just "sitting around" not helping. I think since Wendy thinks it's just the dose that I'll try one more increase. If it's the insulin it won't make much difference and I can just switch after a few days. I hate making these decisions lol

I hear this 100% and it's so hard to know what the heck is happening!! Who knows if the increases weren't fast enough - you were following protocol after all. Binx was down to 1.75 units and we're now up to 3.00. What the heck! I think the attempt at one more increase before switching vials is a reasonable one. It'd be your next step anyways and like you said, you can switch vials if needed after a few days.

I think I'm also just nervous because it's the most I've administered at least, and the interim vet we'd been seeing said his max dose was 2 units (which clearly is not enough) and I feel a little like a criminal going over that. Our primary vet who diagnosed him (and is on personal leave), however, did initially say that he may even need 3 units, so I guess I have half-approval. lol

If it makes you feel any better at all, my vet didn't want to take Binx above 1.5 units and now that hasn't worked for him in months

 

[Tim & Pookey]

Just read this fresh from start to finish, no argumentative vibes at all, just great conversation and questions! Different cat and scenario but we’ve had our vial for forever, like 5 months. I like your plan though, eliminate a variable…

 

[Brianna & Xander]

FYI - you sound a lot like I did to start. But that was with my kitty going on much higher doses. I was constantly asking questions and asking why this, why that? It killed me there was no simple answer.

Regarding decisions, whatever you decide will be an opportunity to gather data. We don't all get it right each time, but we learn for next time. You aren't the first or the last to suspect the insulin. 99% of the time it's not. But there is that 1%.

I appreciate that, that makes me feel a lot better! You get it then. It helps so much just to know the reason WHY something is/should be the way it is. And yes, not having straightforward answers is so frustrating! I hate ambiguity.

I did decide to increase first! Having a not so great day today though so about to make a new post.

 

[Brianna & Xander]

I hear this 100% and it's so hard to know what the heck is happening!! Who knows if the increases weren't fast enough - you were following protocol after all. Binx was down to 1.75 units and we're now up to 3.00. What the heck! I think the attempt at one more increase before switching vials is a reasonable one. It'd be your next step anyways and like you said, you can switch vials if needed after a few days.

Thank you! It helps me to know that others agree with my decision. It really is weird. Especially since on one hand we know that too much insulin can be deadly, but then on the other hand in a week you might need to give double the dose you just got limes in.

If it makes you feel any better at all, my vet didn't want to take Binx above 1.5 units and now that hasn't worked for him in months

It does, thank you! We say this all the time, but it would be so nice if vets knew even slightly more than they seem to about FD!!

 

[Brianna & Xander]

Just read this fresh from start to finish, no argumentative vibes at all, just great conversation and questions! Different cat and scenario but we’ve had our vial for forever, like 5 months. I like your plan though, eliminate a variable…

Thank you so much, Tim! I appreciate the extra reassurance!

Wow, 5 months is great! And in an OTJ trial with it too. Guess the stuff really is hardier than they think!

 

[Briana + Binx]

Thank you! It helps me to know that others agree with my decision. It really is weird. Especially since on one hand we know that too much insulin can be deadly, but then on the other hand in a week you might need to give double the dose you just got limes in.

Exactly! All of that translates to me as - we are always stressed