4/30 Xena AMPS 197

KRams

KRams

Member Since 2019
Hi all, since her diagnosis and a complete switch to wet food (Friskies pate) Xena has been improving drastically!

But I'd really appreciate if someone with more experience could take a look at her chart; I'm only administering 0.25 U when her BG is above 200. I'm hesitant to administer more because sometimes that seems to be enough for her to drop very low.

I'm worried about two things:
(1) reliability of administering such a low dose. I'm using BD 1/2 unit syringes but I don't think it's particularly accurate when the dose is becoming quite so fine and I worry that some of her swings could be due to dosage variability. I know some folks use calipers to try to measure, but that still relies on lining up the syringe and calipers perfectly. Does anyone have an even smaller needle or know how to dilute Lantus properly (what solution is it dissolved in? I know it's suppose to be acidic).

(2) Any advice on if this is even the correct approach? When I initially was doing research, I had hoped to move from SLGS to tight regulation. With such fine dosing, I am extremely hesitant to do so, not wanting to risk hypo episodes when I'm not home and have just stuck to a guideline of not shooting unless BG is above 200.

TIA!
 
Hi there. First: Welcome! And second: don't dilute the Lantus in anything. It needs to be use as is.

I use calipers to get a more reliable draw each time. The dang syringes can be off by as much as .25 of unit. If you take the plunger and push it all the way in, the top of the plunger should line up with the zero line and then you know the syringe is marked fairly accurate. Maybe find all of those syringes in your box until you would get some calipers. If your dosing isn't consistent, it could have something to do with the swings, but that said, it's hard to know without any other test in the middle of the cycle. I am have attached a pictorial guide of what .25 looks like which might help without calipers.

Since Lantus dosing is based on how low the insulin takes kitty in a cycle, without those readings it's hard to know if some of the higher pre shot numbers are from going lower and then bouncing, for instance the 4/27 AM cycle started off in pink ( 300) The PM cycle the night before started off in yellow, 265. Did Xena go lower through the PM cycle and bounced up by morning. All data you can get will be helpful for knowing just how low the insulin is taking her. Also, the more data you can get then you can start to lower her "no shot" number. I would suggest to start with 150 as your "no shot" number on this dose and then evidently with data you will be able to shot anything over 50.

Keep posting and asking questions.

upload_2019-4-30_9-47-41.png
 
Bobbie And Bubba said:
Hi there. First: Welcome! And second: don't dilute the Lantus in anything. It needs to be use as is.

I use calipers to get a more reliable draw each time. The dang syringes can be off by as much as .25 of unit. If you take the plunger and push it all the way in, the top of the plunger should line up with the zero line and then you know the syringe is marked fairly accurate. Maybe find all of those syringes in your box until you would get some calipers. If your dosing isn't consistent, it could have something to do with the swings, but that said, it's hard to know without any other test in the middle of the cycle. I am have attached a pictorial guide of what .25 looks like which might help without calipers.

Since Lantus dosing is based on how low the insulin takes kitty in a cycle, without those readings it's hard to know if some of the higher pre shot numbers are from going lower and then bouncing, for instance the 4/27 AM cycle started off in pink ( 300) The PM cycle the night before started off in yellow, 265. Did Xena go lower through the PM cycle and bounced up by morning. All data you can get will be helpful for knowing just how low the insulin is taking her. Also, the more data you can get then you can start to lower her "no shot" number. I would suggest to start with 150 as your "no shot" number on this dose and then evidently with data you will be able to shot anything over 50.

Keep posting and asking questions.

View attachment 44645
Click to expand...
Thanks Bobbie
 
Hi and welcome to Lantus Land! Sorry I didn't respond earlier; I just now saw the tag.
Lantus is a depot insulin and is meant to be dosed consistently. Are you able to test during the day? If you're not able to because of work, are you able to change the times of the AM and PM shots so that you can get a test 2 or 3 hours into each cycle (although the AM and PM shots still have to be 12 hours apart)?
 
With SLGS, you should be doing a curve at least once a week, plus spot checks where possible. Currently we have no idea how low this dose is taking her. One mid cycle test a month is no enough. TR requires twice as much testing as you are doing now.

It is possible some of the lows you have seen are from syringe issues. I used BDs, and with calipers I found the lines could be out as much as 1/3 of a unit. When I was doing fine dosing, the bottom of the plunger would rest well under the zero line when I pushed it up. I highly recommend using calipers.

When you can monitor, try shooting lower numbers. You will find the cycles are much flatter with lower preshots.
 
Folks, thanks for all the replies and advice!

I was hoping you could point to some magic source of a finer-value needle but clearly that's not the answer. I'll give calipers a go!

You're certainly right about the curve- happily, I should be able to stick around home and do one today.

Regarding dilution of Lantus, I run a molecular biology laboratory, so I understand that Lantus can't just be diluted in anything (for efficacy and safety reasons). But if I knew what it was currently in, it wouldn't be difficult to dilute. No pharmacists with diabetic cats to help out?
 
If you look at the second Sticky Note down on insulin and syringes, you will see some comments about diluting Lantus. I think the answer is “talk to your vet”. Neko’s internal medicine vet diluted Humulin R insulin for finer dosing, so I know it's done.
 
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