? 6/26/19 Zoe AMPS 349 pmps 368 starting a new bottle of lantus

[Sybil and Zoe]

Well Zoe likes to toy with me and she teased me with a little yellow enough to get my hopes up after her previous trip to the vet last week. But a tease was all it appears to have been, for she is back solidly in the pinks. And they are high pinks. In looking back at her ss it seems she was at her best at lower dose.

I have decided to open the new bottle of lantus from Canada tonight (started her pen I have been using around the first week of June so it is nearing the 28 day mark) and I am a little nervous about giving the full amount just because I have only been using pens from a previous owner that came through the mail and were not insulated or cooled. They may have been fine and based on Zoe's response to the Vetsulin which was negligible and when she started the Lantus too, they probably were perfect. But, I am just apprehensive that maybe this insulin will be full powered and send her zooming downward. I am just looking for a little reassurance that it is highly unlikely. Has anyone had an issue with using insulin to the last drop (past the 28 days) and found the new bottle/pen dose caused a reaction? I put 911 because I need to dose her in the next 15-30 minutes.

 

[Sybil and Zoe]

I'm chicken so I am going to go ahead and give her dose from the pen so she can go outside and lay on the porch in the warmth. I removed the 911 from the title, though I still want a little advice for when I do use the new bottle (I did uncap and puncture it). Its just that she will be due for another increase in dose coming up by the TR protocol and I still feel anxious about the new brand new bottle.

 

[Krystina & Nelli]

Well Zoe likes to toy with me and she teased me with a little yellow enough to get my hopes up after her previous trip to the vet last week. But a tease was all it appears to have been, for she is back solidly in the pinks. And they are high pinks. In looking back at her ss it seems she was at her best at lower dose.

I have decided to open the new bottle of lantus from Canada tonight (started her pen I have been using around the first week of June so it is nearing the 28 day mark) and I am a little nervous about giving the full amount just because I have only been using pens from a previous owner that came through the mail and were not insulated or cooled. They may have been fine and based on Zoe's response to the Vetsulin which was negligible and when she started the Lantus too, they probably were perfect. But, I am just apprehensive that maybe this insulin will be full powered and send her zooming downward. I am just looking for a little reassurance that it is highly unlikely. Has anyone had an issue with using insulin to the last drop (past the 28 days) and found the new bottle/pen dose caused a reaction? I put 911 because I need to dose her in the next 15-30 minutes.

Just now seeing your post
Unless you see floaties (visible)... I am usually into month 2+ when I finish last drop. I don’t understand, am not following you when you refer to use new, brand new bottle.

 

[tiffmaxee]

I used mine to the last drop and never noticed any change when I switched to a new pen.

I saw you were concerned about overfeeding but said she’s not gaining weight. If she’s at her ideal weight keep feeding her. Once she is regulated she won’t be as hungry most likely.

 

[Sybil and Zoe]

Just now seeing your post
Unless you see floaties (visible)... I am usually into month 2+ when I finish last drop. I don’t understand, am not following you when you refer to use new, brand new bottle.

Sorry I wasn't clear about what I was asking. When I finally changed Zoe to Lantus in May from Vetsulin, I ordered the medication from Marks Pharmacy in Canada (I'm in the US and its close to $300 for a 10 ml vial here). Her numbers were high and I didnt want to wait a couple of weeks for it to be received before starting her on the Lantus, so I purchased a couple of pens from a member who could get it to me quicker. It was early May and we had a heat streak so the temps were high 80's low 90s during that stretch and they came through the snail mail and were not packaged in any coolant or insulation, so I had no idea if in the mail process they had been exposed to high temps. It was only two days but I just wasn't sure. Zoe with her typical non response to ever increasing doses, I always wondered in the back of my mind, could it have degraded by the heat exposure? It is perfectly clear and no floaties, so I have no other reason to question it except because she still sits in the 3-400 BS range. I have been holding on to the "new" 10 ml vial from Marks in the refridge. She was never exposed to Lantus before, so I have nothing to compare to...I was just a little anxious about giving her 6.5 units of fresh Lantus. If it were 1 or 2 units I would be less anxious, but it is 6.5 and I am due to increase her to 7 in the next day. For most cats thats a huge dose, so its the worry wort in me saying what if you give her the new insulin at this dose and it sends her screaming to low numbers while I am at work.

It is probably irrational to worry, but because she has not come even close to being regulated and I had such high expectations when I switched her over to Lantus from Vetsulin, I'm like "what if..."? I was just asking if any of the longtimers had ever had an experience where they were dosing their cat from a vial at 4-6 months old and then started a new one and had a glucose drop.

 

[Krystina & Nelli]

I am with you now, completely
Ok now a few questions...
When you switched from vetsulin to Lantus back on May 2- I am wondering why you dropped the dose down 3 1/2 units. Were you guided by someone to do this?
Have you had a dosing expert on the Lantus site guide you/ help you with dosing?
Before I give you my thoughts and opinion I will wait to get these questions answered from you

 

[Sybil and Zoe]

I was instructed by the Vet. Many here say he started her too low since she actually had been up to 6 u on the Vetsulin but had been dropped back to 3 u when kenneled for a few days with him before switching insulins. (3,6,or whatever dose, it just never budged her.) And, I didn't know any better. I was petrified the first day starting her on Lantus that she would go hypo so I actually stayed out of work to do a curve on her and it was flat and no big deal. Sigh. I’m afraid I am going to become complacent with her lack of response that one day she will snap me out of it by surprising me with a blue or green number and scaring the bejezus out of me!

 

[Wendy&Neko]

TR suggest dose increases every six cycles for pink nadirs, but only if you can get a mid cycle test each cycle. Both yesterday and today, I see no tests during the day. For that reason, plus the fur shot on the PM of the 23rd, I would have held this 6.5 unit dose another day. Plus, you don’t want to open a new vial/pen on the same cycle as an increase, just in case there is a difference in efficiency of the new one vial.

Did you shoot tonight? I see nothing in the spreadsheet units cell.

Having said all that, and as I stated in your previous post here (linked for continuity) http://www.felinediabetes.com/FDMB/...eems-to-be-making-a-dent.215915/#post-2394551
Zoe got to six units of Vetsulin, so it's not surprising she needs that much or more of Lantus.

When kitties get above six units of insulin, we suggest getting them tested for a couple of high dose conditions, specifically acromegaly and IAA or insulin auto antibodies. It is the nature of the resistance with these conditions that a dose can look good one day, then you need more insulin. My Neko had both of these high dose conditions. One in four diabetic cats has acromegaly, caused by a benign pituitary tumour that puts out excess growth hormone.

 

[Krystina & Nelli]

Many here say he started her too low since

Count me in
I agree with wendy on not opening a pen on same cycle as an increase. I notice, Nelli notices a fresh pen. I think many others would agree. It’s not that the last one was marginally bad it’s just that it had been exposed to one poke after one poke after another causing it to get a little tired
The more you post, the more questions you have, the more attention you and Zoe will get .
You need guidance- we all did at one time .
You are doing a good job... Keep it all up and… Keep coming back here

 

[Sybil and Zoe]

TR suggest dose increases every six cycles for pink nadirs, but only if you can get a mid cycle test each cycle. Both yesterday and today, I see no tests during the day. For that reason, plus the fur shot on the PM of the 23rd, I would have held this 6.5 unit dose another day. Plus, you don’t want to open a new vial/pen on the same cycle as an increase, just in case there is a difference in efficiency of the new one vial.

Did you shoot tonight? I see nothing in the spreadsheet units cell.

Having said all that, and as I stated in your previous post here (linked for continuity) http://www.felinediabetes.com/FDMB/...eems-to-be-making-a-dent.215915/#post-2394551
Zoe got to six units of Vetsulin, so it's not surprising she needs that much or more of Lantus.

When kitties get above six units of insulin, we suggest getting them tested for a couple of high dose conditions, specifically acromegaly and IAA or insulin auto antibodies. It is the nature of the resistance with these conditions that a dose can look good one day, then you need more insulin. My Neko had both of these high dose conditions. One in four diabetic cats has acromegaly, caused by a benign pituitary tumour that puts out excess growth hormone.

I updated her ss, and yes I gave a shot from the old pen. I put the new vial back in the refrige. That was my concern for the efficiency of the vial. I will finish out the pen since there is only about a ml left. I can't usually get midcycle during week day while at work except int he eveing if I can stay up to do one ( shooting at 6pm means staying up til midnight and I try not to stay up that late during weekdays.) --unless I see indication the levels might differ.

I do plan to have her tested for the high dose condtions. I am just not sure when that will happen.

 

[Wendy&Neko]

Even a test from +2 to +4 in the evening is valuable information. It doesn’t have to be exactly in the middle, just whenever you go to bed. Many cats haven’t read the rules that says Lantus nadirs are typically at +6. Mine sure didn’t.

Nice spot of yellow again tonight.

 

[Sybil and Zoe]

Yep. As sure as I get frustrated with her high numbers and come on the board with questions...She throws me a yellow!