5/23 Meadow AMPS 405 PMPS 479

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Amber & Meadow

Amber & Meadow

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Wow. I didn't look at yesterday's post until just now. I've already increased the dose to 5.5 this morning. The vet had told me that the bottle of Lantus would last 6 mos at least. I mentioned to her that it could lose potency after 28 days & she said that ALL vet schools teach this is not true. It's just a way for drug companies to make money. Anyway, I think I will get a new bottle or cartridge tomorrow and start with 2 units again. When I was researching Acro, I looked at info on Cushing's & Meadow has every symptom (at least from the list I viewed). PetAlive sells a product called Cushex drops that when used in conjuction with insulin, can eliminate the symptoms of Cushing's and help lower the BG's. Anyone use this before? Also, to clear some things up. A lot of people have mentioned that I am missing days earlier on with testing. Well...that specialist told me that there is no reason to test every day. You only test for the curves until you find the right dose, and then you don't have to test anymore after that. Sounds to me like a way to go hypo, but I didn't know any better at the time. She's the Doctor, right? So, what does everyone think about a some new Lantus and starting at 2 units?
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I agree with you - what the specialist said sounds like a very good way to have to deal with a hypo. When someone asks about the rationale for testing, my logic is that if this were a child, would you recommend not testing before every shot? Or to not test to know when a dose needs to be changed. I don't think there is a pediatrician who would tell a parent to not test.

There has been a fair amount of discussion about how long a vial or pen of Lantus will last. There isn't one "right" answer. If you go to the Tilly Protocol, there note that members of the forum have been able to use Lantus for up to 6 months. For whatever reason, most of the people here do not get that duration of use. My vet told me the same thing but my vet also didn't know that Lantus was available in pens or cartridges. I tend to think that you may get better duration from the pen/cartridge style of packaging since there isn't air in the container. (They also end up being more economical.) You can use a pen until Meadow's numbers start doing odd things or until you see "floaties" in the container and use that time as when to switch out to a new pen. As I mentioned previously, Gabby really doesn't get more than 28 days and then her numbers start doing weird things.

I'm not sure what to tell you about reducing Meadow's dose back to 2 units if you start with new Lantus. Exactly how old is the vial?
 
~~ Sienne, I'm pretty sure the insulin is just is over 2 months old ~~

Of course it's ultimately up to you Amber, but I personally think it would be wise to start over at 2units.
You can always increase the dose if you don't get good results.
And it would be so great if that's the problem!

Don't feel bad about the not testing earlier on - or feel as though anyone is giving you a hard time...
How could you know?
Lots of us have been in the situation where our vet hasn't supported or even discouraged testing... But you are spot on in thinking that is "a way to go hypo"!
Good for you for deciding to start testing again.

In my opnion, you should give the fresh insulin a chance before you plan any further testing - Meadow may in fact have Acro or Cushings... but lets rule out the insulin first. It's just a few days...
We can help you through all of this - even if it turns out that she has something more -- just hang in there.
 
Amber --

Did you start using the Lantus 2 mos. ago or did you buy it 2 mos. ago. The unopened shelf life can be a year or two. Once opened, is when we begin counting the age of the Lantus.

Yes, you use the syringes. The measurement on the pens is not small enough for our purposes.
 
I would like to add a different perspective. I don’t think you need to reduce the dose that much when you get new insulin, especially not cutting the dose in more than half. Usually we don’t reduce the dose when switching to a new cartridge, but if you think the insulin was toasty and you want to reduce, I would reduce by maybe 0.5 units (back to 5 units) and do it on a cycle when you can test a lot just in case. If you reduce by too much, then it takes that much longer to work back up to the dose where you are.

Here’s why I say that: Meadow has been high/flat on every dose. Also, if you look at the few days Meadow was on N, she was still high/flat on 4 or 5 units of N. N doesn’t have a shed like Lantus does, so you really can’t say the dose hadn’t settled yet. 4 or 5 units of N should have done something, unless that was too little insulin for her. A cat who was that flat on 4-5 units of N most likely needs more than 4-5 units of Lantus.

Then you switched to Lantus, started over at 1 unit, and worked your way up the dosing scale. In my mind, that answered any questions about whether Meadow was in chronic rebound on N. Her numbers have remained high and flat on each dose. Sure, there is a possibility that some low numbers have been missed at night, but the consistency of the high numbers makes me think probably not. There were a couple of dose increases that were questionable because they were done without spot checks – the increase from 3.5 to 4 and the increase from 4 to 4.5 did not have spot checks, so we don’t know for sure that Meadow didn’t go blue or green on those doses. But I still think we’re looking at a cat who hasn’t reached her good dose yet. Just my opinion, of course, in the end you have to do what feels right to you.
 
I opened & started using the Lantus on 3/19/10. Now I don't know what to do. If the current bottle of Lantus is bad, and I get a new bottle, but still keep the dose at 5 units, couldn't she go hypo while I'm at work? Should I wait until next weekend to use the new bottle? I'm confused.
 
I don't want to get in the way of dosing advice, but please be sure you test for ketones, particularly if you lower the dose significantly.
 
It's unlikely that Meadow's numbers will drop precipitously with a new vial or pen of insulin. We all start new pens routinely. Sometimes there's some additional activity with a new pen but sometimes not. Also, as long as you are testing, there is little chance of a symptomatic hypo. If you look at Gabby's numbers tonight, you'll see that despite some low numbers, she was not symptomatic. The first few times, low numbers are scary. Remember, BG level needs to be below 50 to earn a reduction.

Libby's point about the use of Humulin N is an important one to consider. N doesn't work like Lantus. It's a much shorter acting insulin. It doesn't require the building of a depot. As a result, the effect of N is immediate. It's in and it's out of a cat's (or human's) system. If Meadow didn't respond to the dosing of N at the amount you were giving, it's unlikely that she will respond to the same amount of Lantus. (It would just take longer for the dose of Lantus to be effective due to the need to build a shed.)

If you want to slightly reduce the dose of Lantus with a new pen, that's fine. It's unlikely that the Lantus you are using is totally dead. Usually when Lantus is toasty, it's effect is uneven. If you start back at 2.0u, it will take a while to get the dose back up to what may be the effective range. I think that is Libby's point.
 
Amber, please listen to Libby over me.
As I said, I was just thinking out loud yesterday when I dissected what I thought I was seeing on your SS.
I certainly don't want to be the source of any of your confusion and if they have been working with you previously then they would know more about what has been going on than I do.
I hope you don't mind that I continue to watch and offer you support though!
 
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