BS too high, was told to roll Lantus - Help

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KeikosHuman

KeikosHuman

Member Since 2014
Should Lantus be rolled or not? 3 months ago, when I started giving kitty insulin I didn't roll it. After several weeks and still uncontrolled, I checked with the vet and online and both said to roll it. So I have. Kitty is still not controlled. I've seen posts here advising not to roll. Is that still the advice? If so, I may need to get a new vial (?) I've been rolling it for 2 months. The liquid seems clear.

Also, what is the advantage of a pen? Are they less expensive?
 
Hello and welcome to Lantus Land!

No, do not roll the insulin. The old insulins had to be mixed and therefore rolled to keep the insulin evenly distributed. Lantus and levemir should not be rolled. Here is more info on Proper storage and handling of Lantus and levemir.

The pens are not less expensive but they are more cost effective unless you have a high dose cat. I use levemir so I don't know the current cost of a box of Lantus pens but you get five 3-ml pens in a box and I'm guessing the price is perhaps around $250. The expiration dates are usually well in the future. You would probably use all the insulin in a pen before it would become ineffective as long as you store it and handle it correctly. We just had a member who used the same box of pens for 13 months (cat is on a very low dose). I find the pens easier to handle and they are encased in plastic in the event you drop them.

If you could do a Spreadsheet, it would help us immensely to help you. We see pretty good at deciphering SSs and helping caregivers get their kitties more regulated. You might also want to read the Stickys at the too of this forum. There is some great info including videos on how to properly draw from a pen or a vial.

Is Keiko your kitty? And may we ask your name?

Edited to add: could you please take the 911 off? We use it for emergencies like super low numbers. Thank you!
 
Good morning,

Marje is right - there's no need to roll the insulin.

I went back and read your first post on the Main Health board - http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=124392&p=1289513#p1289513. I'm so sorry you've been struggling with high numbers. I know that's frustrating.

You're absolutely in the right place for help. I came here back in January, and the wonderful people here (like Marje) helped me get Jersey into remission in just a few months.

If you can get the spreadsheet set up, like Marje mentioned, that will be super helpful. It's amazing how the experienced users here can look at the numbers on the spreadsheet and help us figure out what to do next. In fact, I relied on them for all of my dosing advice. (My vet wasn't very knowledgeable about feline diabetes and dosing, unfortunately.) If you need help with the spreadsheet, give a shout out. I'm not very tech-savvy, but there will be lots of people here who can help you set one up.

Welcome to LL (Lantus Land)!
Shelly
 
If that is the case, should I get a new vial? I am somewhat desperate since this non-regulation has gone on so long. Thank you for your patience with me!
Keiko is the Kitty and my name is Maria.I'll work on the spreadsheet. I'm not familiar with this so I don't know how long I'll take.
Thank you.
 
picgifs-welcome-2-566738.gif
to Lantus Land! The best place you never wanted to have to be!

Just wanted to say hi and let you know I am one of the LEAST tech savvy people I know....if you follow the instructions on the link that Marje provided, you will do just fine....I had to do a little tweaking to it and re-read the instructions a couple of times, but I got there!
 
Thanks again Shelly and Marje.
Do you think my current vial is ruined?
They are expensive but I can get a new one.
 
I rolled mine when I first got it, it has been dropped twice (thank goodness it didn't break)...it was opened in May 2014 and still going strong.....

How long have you had this vial for?
 
Lantus does not need to be rolled, in fact it should be handled as gently as possible. Older types of insulin were suspensions, they settle out when sitting and needed to be mixed. Lantus is a solution and does not settle. As long as the Lantus is clear it should be OK, but 3 months is on the long sid eof recommended use for an opend vial. Some members do go until the end though, if it is kept refrigerated and handled gently.

The pens are like mini vials of 3ml each instead of 10ml in a vial. We use them w/ a syringe just like the vials, but since they are less than 1/3 the size of a vial, less of your insulin is "opened" so the other pens in the 5 pack last much longer. You are also getting a total of 15ml of insulin, so the initial cost is more, but overall they are more economical.

Some members have found pharmacies that will sell single pens, I think several have had success at Target Pharmacy. There is also a "savings card", offered by the company. It is free to sign up, but some pharmacies will accept it for veterinary RX and some will not.

As for regulation, if it was your vet who recommended rolling the vial, he may not be up to date on using Lantus. It works much differently than the older types of insulin. It isn't simply a matter of swapping out the old for the new favored drug. Lantus is a depot insulin, it builds up a reserve in the body. Because of this it takes time for the reserve to build and every time a dose is adjusted , the reserve (we call it the shed or depot) needs to readjust. If you are adjusting the dose frequently, the depot never has a chance to stabilize and you can get "wonky" numbers. The initial dose is held for 5 to 7 days (unless the cat goes too low!) and every adjustment up to 3 days before reconsidering the dose.

ALSO, Lantus is dosed based on the lowest point during the cycle, the nadir, NOT on the preshot number as other insulins are. It means getting more tests in during the cycle to see how low the Lantus is bringing the BG. You do home test? It isn't hard and we can walk you through it. There may even be a member nearby that can come over to help.

Another BIG factor in getting a cat regulated is diet. Diabetic cats need low carbohydrate wet food (canned or raw)! DRy food by it's very nature is high in carbohydrates, it also leaves cats in pretty much a constant state of dehydration, which isn't good for any of the internal organs. One of the first things we recommend is switching over to a good canned food, not a vet Rx on, just a good quality low carb (LC) food. Here is a food list that a vet who is in the group put together. It's about 2 years old so there are newer foods not on it, but its a good start.

WE have a number of posts at the top of the list that will give you a lot of background on using Lantus, start withe the "New to the Group" one and post often. WE can walk you through the Sugar Dance. Unfortunately this is a Holiday weekend an many of our members are not online much.
 
Thanks again Shelly and Marje.
Do you think my current vial is ruined? What about Novelin? It's less expensive and does not require a prescription. What about Humulin? The pharmacy tech suggested these. I am trying to absorb everything - sorry for so many questions. The pharmacy tech said Lantus is one of the more expensive insulins.
 
Hi Maria,

welcome to lantus land!

I wouldn't get new insulin yet. Let's get you set up, take a look at Keiko's blood sugar numbers, and we can probably tell you within a few days if you need to get new insulin or not.

You want to stick with Lantus or Levemir. The other insulins don't last as long in a cat's body and simply don't control the blood sugar as well. Yes it's more expensive, but it's worth it. There are things you can do to bring down the cost.

There is a Lantus Savings Card. Make sure to indicate your "child" is 18 years old when you register.

You can buy your supplies from American Diabetes Wholesale - that particular link is to a good inexpensive syringe that many of us have used and like. Register first at http://www.mrrebates.com and you will get 4% back on everything you buy at ADW.

This little Needle Nipper saves you having to buy a sharps container and it holds a zillion needles, so you likely will only need 1 per year or two.

Insulin can be bought one pen at a time from different pharmacies - they cost maybe $50ish (I haven't bought for ages, so i'm not sure of the current price) per pen and the Lantus Savings Card will be accepted by some pharmacies for even one pen. There's no rhyme or reason to who will break open the box of 5 pens and sell one pen at a time - sometimes it's major pharmacies and sometimes it's local. Just call all the pharmacies near you until you find one. Often hospitals or pharmacies that sell to nursing homes will sell one at a time. I bought 4 boxes of pens (20 pens) for about $250 from a woman on Craigslist whose diabetic dad had passed away. I asked lots of questions about whether it had been kept refrigerated, had been opened, when the expiration date was, etc., and decided it was all legit. Met the woman, bought the pens, and they worked fine. If you go the Craigslist route, just aske enough questions that you are confident you're getting good insulin.

There is a PDF on the Tight Regulation Protocol page, about 5 paragraphs down from the top of the page that you have to download to read. It's called "Management of Diabetic Cats Using Long-Lasting Insulins." It talks about the benefit to cats of using the longest-duration insulins possible in order to control their blood sugar.

Not to overwhelm you, I"ll stop there. We can help you with Keiko and teach you what you need to know to get his blood sugar controlled and help him feel better. I hope you'll post every day/regularly so we can get to know both of you. We always watch out for new people and will tell you what we see - sometimes when you're new you don't even know what to ask. :-D

So . . . take a look at the video on the page that Marje gave you on how to draw up the dose. That'll tell you how to move ahead from this point on. Then get a spreadsheet going - if you need help with that, just say so. One of us can start it and turn it over to you if you need that. When we see the numbers on a spreadsheet, we can give you an idea of whether or not your insulin is ruined or working.

and breathe, you're now in the best place you never wanted to be. We'll help you. :YMHUG:
 
Maria

Lantus is not quite as fragile as originally thought. If your vial does not have any floating particles and is not cloudy, it's likely fine. How old is it? Have you kept it refrigerated in the correct temperature range? Most of us keep it in a cheese drawer in the frig. If you keep it in the door, it is constantly subjected to changing temps which could be more of a factor than rolling it or dropping it.

If you need help with the SS, please send me a private message by clicking on the PM box under my Gracies picture. It will take me literally less than a minute to do a SS for you to fill in the numbers. That will help us look and see any patterns. Sometimes too much insulin looks like too little.

I would not suggest Novolin or Humulin as a basal (or his normal) insulin. They are the same but Novolin is obtained at Walmart. They come in N or R. N has a duration of about six hours and R has a duration of four hours. While Lantus and levemir are more expensive, they are the gold standard. The protocol we use here is the only one based on scientific research published in a feline veterinary journal. The rates of dr mission for Lantus and levemir if these insulins are started within six months of the diabetes are quite high. They also have the potential to keep Keiko in much better numbers throughout the day.
 
Keep asking questions, Maria. We know it's overwhelming when you first start out. Look at your insulin - is it clear? Are there any floating particles in it? If it's clear and you don't see any floaties in it, it's probably still okay.

I actually started out with Humulin and then switched to Lantus. Lantus is one of the best insulins out there for our kitties. It's longer acting and gentler. (Levemir and Prozinc are also supposed to be good insulins, although I'm not very familiar with them.) Humulin/Novolin causes sharp, fast drops and then wears off quickly.

Have you started working on the spreadsheet yet? I had to write myself step-by-step instructions for doing it. I don't know if this will be more helpful to you than the link Marje provided, but just in case this helps.........

1. First of all, you’ll need to set up a Google account if you don’t have one already. Here’s the link for it: https://accounts.google.com/SignUp?continue=https://accounts.google.com/ManageAccount

2. Once you set up your account, make sure you are signed in to it. Then click on this link:https://drive.google.com/previewtem...U5BVEdyU1dGZmx5bnRvdG10OWc&mode=public&pli=1#

3. This will bring up the template that you can use. In the upper, left-hand corner of the page, it says “Use this template.” Click on that.

4. Now you have your own copy of the template. At the top, left-hand corner of the page, click on “File” and then choose “Rename.” You can now change the name of your spreadsheet (e.g., “Keiko's Chart”).

5. Once you finish entering the date, numbers, etc., you will need to publish your spreadsheet. Click on “File” again and then click on “publish to the web.” A little pop-up box will appear. You will want to make sure that the box that says “automatically republish when changes are made” has a checkmark next to it. Then click on “start publishing.”

6. Now, you need to make sure other people can see your spreadsheet. Click on the blue “share” button on the upper right-hand corner of the page. A pop-up box will appear. Where it says “private,” change that to “anyone with the link can see” and click save at the bottom of the box.

7. Now we have to add the spreadsheet to your FDMB account. First copy the web address that appears in the address bar on your spreadsheet. Come back to FDMB and click on “User Control Panel” at the top left-hand side of the page. Then click on the tab that says “Profile” Next, click on the tab that says “Edit Signature.” There’s a little “url” button at the top of the box where you write. Click on it. This is what will show up in the box:



Click in between the middle brackets and paste the web address for the spreadsheet that you created.

In the end, it will look something like this: https://docs.google.com/spreadsheet/.....[url] Hang in there, and keep asking questions! Shelly
 
Maria

A couple more things. First, many of us may post at the same time as each other or as you so it's important that you always scroll back and read through each post to be sure you got all the info. Sometimes things happen quickly around here and it could cause you to miss a post.

Second, I just read your health post. Your vet took Keikos dose up way too fast. Super fast. It is possible that he missed his fitting dose. We only increase increments of 0.25u or 0.5u depending on the numbers. Also, if you've only been testing at preshot (except the last few days when you did curves), you could easily miss a low number. We've seen cats start at 300, be 40 by midcycle, and 300 again at the next preshot. Without the midcycle test, you'd never know the kitty was low. Vets see that kind of data where the Preshots are high and they continue to raise the dose.

While there is no evidence of Somogyi in cats, there is rebound or bouncing. Here's very good bit of information on bouncing. Bounces can last up to 72 hours or six cycles. So if your curves were done within that timeframe, you might see nothing but high numbers.

I saw Larry suggested you switch insulins. That is not necessary. We like to see a kitty on Lantus or levemir at least six months. feline diabetes is a marathon not a sprint and if you haven't had a clear picture of what's going on, it muddies things even more.

We can help you :-D
 
aw, i just read your post on main health. it sucks when you don't know what's going on and how to help your sweet kitter. My punkin was a maine coon too - best cats ever! I can't wait to see a picture of Keiko.

We do feline diabetes 24/7/365. We understand it and can help you get him controlled so he's not laying by his water bowl and feeling like crap. It'll come. The learning curve at the beginning is overwhelming, but just keep asking questions and we'll keep explaining. It's hard for everyone in the beginning, but it gets infinitely easier.

Sometimes too much insulin can look like not enough insulin in blood sugar tests - but we can tease out the truth before long. :-D It cannot hide from us. ;-) :lol:

and Marje's autocorrect (hehe) said dr mission in the last part of her post above, but what she no doubt typed was that Lantus and Levemir have the best chance at getting a cat into remission. :-D i love autofill! :lol: They are definitely the best insulins for cats - not our opinion, but research-based. Cats metabolize insulin quickly, and the long-lasting insulins provide the best control.
 
I added the spreadsheet. Hope it is visible.
Where can you get syringes that show 1/4 or 1/5 unit doses? The ones I have shows 1 unit at a time. I can sort of eyeball a half unit but the accuracy(?)

So do I start over on 1/2 unit?
Thanks for your patience with me. :smile:
 
the link I gave you to ADW has 0.5u markings. No syringes have anything smaller than that. The Thinpro syringes have a skinnier barrel, though, so you can adjust by 0.25u increments without too much trouble.
No, don't change his dose yet. Let us look at the ss and ask you questions first.

and the first one is, how much does Keiko weigh now, and is he a healthy weight, or underweight? I saw you said he's lost weight - what would you say is a healthy weight for him?

is there any dry food in your house he could possibly be getting into?

how are his teeth?

any signs of bladder infection? peeing outside the box, on your bed, etc. that was punkin's way of telling me he had a UTI - pee in the middle of our bed. :lol:

great job with the ss - i'll go look at it.
 
Fantastic job with the spreadsheet! I don't give dosing advice, but the experienced users will be along soon to help you. Just don't hesitate to ask questions when you have them. And if we're overwhelming you with info, tell us to slow down. Sometimes we dump too much info on people all at once! ohmygod_smile :-D
 
Can you add all of these to the ss as well? Before you do, though, cut and paste your rows so the oldest date (june) is at the top, and the newer dates get added on below. It seems like a little thing, but we "read" the spreadsheet in chunks of about 3 days, from the oldest to the newest, and it's really, really hard to read them "backwards" from recent to older. It's like reading a book page starting at the bottom, for those of us that "read" the spreadsheets.

If that makes any sense at all. ;-) The point is we need the older dates above the more recent dates. You'll always add your new day's data at the bottom of the page.

KeikosHuman said:
Yes I can get the numbers. I do the testing at home except June 17 below. I stand corrected, his lowest number was 219 August 5. Sorry its so long. I appreciate any help/advice. Thank you.
1 time test:
June 3 2014 - 354, 1 unit

Curve June 8 2014 1 unit
8:40am - 350
insulin 8:55 am
10:25am - 348
1:15pm - 362
2:30pm - 363
4:30pm - 434
6:38pm - 414

Curve June 17 2014 2 units (he taken car of by my fiance when I had to go out of town)
8:58am - 543
insulin 9:16am
11:18am - 566
1:15pm - 405
3:30pm - 449
5:18pm - 441
7:30pm - 449

Curve 24 June 2014 (back home) 3 units
7:55am - 407
insulin 8:08am
9:57am - 416
12:10pm - 457
2:05pm - 464
4:08pm - 441
6:16pm - 440

Curve 2 July 2014 - 4 units
7:40am - 431
10:00am - 490
12:05pm - 482
2pm - 462
3:58pm - 451
5:42pm - 492

Curve 22 July 2014 - 5 units
7:43am - 467
insulin 7:45am
10am - 449
11:55am - 408
2pm - 404
3:58pm - 389
5:55pm 472
insulin 6:04pm

Curve 5 August 2014 6 units
7:30am - 219
10am -483
11:45am 465
1:55pm - 473
3:58pm - 421
5:50pm - 434
insulin 5:56pm

Post dental
twice daily checks, 1 unit (for some reason the vet did not ask for a curve on 1 unit)
13 August
8:32am - 530
5:04pm - 305
15 August
8:55am - 439
4:50pm - 310
17 August
8am - 530
4:32 - 370
11pm - 386
18 Aug
8:20am - 363
4:30pm 381
19 August
12:20pm - 421
4:45pm - 407

20 August 2014 twice daily checks on 2 units
7:50am 407
5:05pm - 346
21 August
8:35am - 420
5:05pm - 419
22 August
8:09am - 377
5:05pm 418
23 August
8:20am - 390
6:10pm 401
24 August
7:30am - 480
5:26pm - 472
25 August
7:30am - 462
4:30pm - 354
26 August
7:45am 529
11:45am 464
4:30pm 415
27 August
8:16am - 415
5:15pm - 349
28 August
7:25am - 512
4:37pm - 397
Click to expand...
 
A couple of additional spreadsheet (SS) "tips" (if you're not completely overwhelmed already...

  • We have the oldest dates at the top -- new test info is at the bottom. We're so used to reading the trends on SSs this way that if you put the new info at the top, most of us have a really hard time interpreting the information.
  • It's important to get at least one test per cycle in addition to your AM and PM pre-shot tests. Lantus dosing is based on the nadir (lowest point in the cycle). Getting spot checks helps to know how the cycle is going. Some of us are testaholics -- that''s not expected of everyone here. The only time we really push you to test is when numbers are running low and you need to steer the numbers to prevent them from going too low.
The smallest increment that syringes are available in are half units. I use Terumo Thinpro syringes and order them through ADW. ADW is having a promotion that ends today and it includes free shipping.
 
Be sure any syringe you get is U100, 0.3cc. Many of us use the 31g since it is a smaller needle that gets the job done.

Great job on the SS up. If you need any help getting the numbers flipped, just let us know.

We won't always throw so much at you in a short time. ;-) :smile:
 
I changed the spreadsheet with the oldest dates at the top.
Keiko is 17.5 lbs. This is about the same as his last vet visit in early August 2014. June 1 2014 he was 19 lbs, which was too heavy.
He had his teeth cleaned in early August 2014. Nothing remarkable found re: gums and teeth. In his mouth a very small lump was removed. Have not done a biopsy due to expense. Vet was not that concerned.

I've done some twice daily spot checks over the last few weeks.
Are these the right syringes?
'Terumo Thinpro Insulin Syringe 31G 3/10cc 3/8" 100/bx - Syringes: Insulin Syringes
Terumo Thinpro Insulin Syringe 31G 3/10cc 3/8" 100/bx offers you comfort and accuracy for your daily self-injections. These syringes are for use with U-100 insulin.

Features:
Half Unit Markings
Unsurpassed needle sharpness and smooth plunger movement help make injections more comfortable
Bold, clear scale markings help ensure accurate dosing
A wide range of sizes, including 31G, our smallest needle available
We may require the order of a physician for this item.'

Thanks!
 
That's the one!!

Thanks for changing the SS. When you have time to insert the other numbers that Julie asked for, that would be amazing. We don't just look at one or two cycles. We look at waves of action so the more days you have in there, the better. Thank you so very much.

The goal now is to be sure you always get a pre shot test.....morning and night. We don't shoot blind here because it isn't safe. So always a pre shot test. Instead of getting so many tests during the day when he's high, I'd strive for a +2 and then a mid cycle. At night, a +2 and a before bed. If you work, then you can get the PS, an out the door, and an in the door test and at night the PS, +2, and before bed. Does that sound doable?

Once we see his trends a little better, we might modify the testing times.
 
Those are the ones many of us use. Since there are no syringes w/ 1/4 unit markings many of us use a magnifying visor to see those tiny markings better. Also a digital caliper can be set for a dose and then just hold the syringe up to the caliper to make sure the dose is correct. The markings on the syringes can vary a lot. it doesn't matter for humans who take many units of insulin, but is pretty important for the small amounts we give to cats.
 
That schedule may not be doable. Some days I'm home during the day. I live in 2 places and leave kitty at the primary residence.
The last reading is the pre-shot due to my schedule.

I am blessed to have your help!
 
Many members work and we all do the schedules we can. It is important to get a preshot test to make sure that the BG is not too low. Another test mid cycle is important, but if you aren't there do them when you can. On nights you are in the same place as Keiko try to get that before bed shot. It could be at night that Keiko is going low, some cats do tend to have lower BG at night.

Are you able to keep a strict 12 hour shot schedule? Lantus works best if shot times do not vary by more than 10 or 15 minutes either way. Shoot early and it is like giving an increase, shoot late and it acts like a decrease. Then you have to start counting cycles to allow the shed to re-stabilize.
 
we all have lives and can work around whatever things you've got going on. Even people who work full-time figure out ways to make it work. You might need to skip a shot here and there if the preshot test is lower and you can't monitor afterwards. That happens and isn't the end of the world.

in general, for people who work during the day or are gone, they get more tests in at night. A Timed Feeder is a really helpful tool - it opens at times you have set the timer for. The link I just gave you is to one that many people like. When a cat has low numbers, we give it food to bring up its blood sugar. So when you have to be gone, you can sort of accomplish the same thing with a timed feeder. Someone recently said that they had 2 feeders and had them set to open every 1/2 hr during the night if they were worried about the cat maybe going low while they slept. i thought that was ingenious.

Anyway, it's a tool that might be helpful to you.

thanks for the info on his weight and teeth. good that his teeth are ok - that can be a problem with a lot of diabetic cats. punkin had a growth in his mouth, too. We thought it was cancer, and when it kept growing to the point where he was having trouble eating because it was getting in between his teeth, we had it removed. turned out to be just inflammatory cells, no cancer. *whew* we live near a university vet hospital and they removed it. they weren't too expensive at all. maybe Keiko's was inflammatory cells too - the vets thought it could even have been from a splinter.

edited to add: are you with Keiko today? In order to see what the dose is doing, it's going to be really helpful to see at least one mid-cycle test in each cycle if possible. If it isn't, just say so so we don't nag you! that's not our goal, but often there is so much that people forget, so we keep repeating ourselves. :lol: ya gotta work with whatever you've got.
 
Re: BS too high - Qs Help

Didn't sleep too well last night so I may be forgetting something.
I checked the Lantus and the liquid is clear. I have a fifth of a vial left. From what has been written by you guys it is still good (?)
I watched the shot video and need to make some changes to my technique. I do rub the injection site and smell my fingers to make sure I don't smell insulin so I know it went under his skin.
It's hard to be concerned at this point about low BS -his BS has never been low. He was in the 400s when diagnosed and remains in the 400s and 300s. I look forward to numbers below 300!
Do I start over with 1/2 unit and move up? He's on 2 right now.
A strict 12 hour schedule may not be possible for me every day. I feed K in the morning between 7-8am and evening between 5-6 and was instructed to give insulin with food. Do you feed every 12 hours here?
I'll add the twice daily (+4 and +8) numbers to the spread sheet when I can today. I'll have to be offline most of this morning.
Thanks again.
 
Test, feed and shoot are all done on a 12 hour schedule. Many of us don't give all of our kitties' food at shot time, though. For example, I feed Gabby at shot time, +1, and +2. By spreading out meals, you're putting less pressure on a pancreas that's trying to heal.

You want to feed at shot time. You don't want to feed within the 2 hours prior to shot time since food can inflate your pre-shot numbers and give you a false sense of security. Lantus is very particular about consistency. In part, this is because shooting early acts like a dose increase and shooting late, acts like a dose reduction. All of this is due to Lantus being a depot-type of insulin.
 
Looks like my earlier post did not go through.

What to do if I can't stick to an exact 12 hour schedule? I also hire pet sitters if I travel who may not be able to do so. Boarding is an option but it stresses Keiko.

I was not given clear information on whether or not to give 2 big meals or space them out so that helps. I do not feed within 2 hours of a shot. I'll check into the feeders. I have another cat who changed diet with Keiko (wet food only) and now his irritable bowel symptoms are gone and he no longer takes pills, so a victory.

I am waiting to hear something from my vet who is consulting with a specialist about what to do next. Should I insist on starting over on 1/2 unit and go up?

I put all the numbers I have in the spreadsheet. I thought I had more +4 and +8s than I do.
I am thinking positive to the time when I look at the meter and it says <200. I use an
AlphaTrac 2 meter. I may test it to make sure it's working properly. I have no reason to think it is not except for the crazy high BS numbers.

Thank you all for your help! It means a lot! I am keeping you and your kitties in my prayers.
 
I did answer you above about the dose, but I know that the posts can come fast and furious and it's very easy to miss things. Go ahead and stay with this dose for the moment. There's nothing to say it's too high, but as you get more tests in, it will become obvious to us if it is. I would not restart at 0.5u - that is extremely low and may leave Keiko in high numbers unnecessarily.

julie & punkin (ga) said:
the link I gave you to ADW has 0.5u markings. No syringes have anything smaller than that. The Thinpro syringes have a skinnier barrel, though, so you can adjust by 0.25u increments without too much trouble.
No, don't change his dose yet. Let us look at the ss and ask you questions first.
Click to expand...

There is a weight-based formula for starting a cat out on Lantus - it's 0.25u/kg of cat's ideal weight. Keiko's a hefty guy at 17.5lbs, so i did the calculator based upon 15lbs. That starting dose is 1.7u. So his 2u is in the ballpark.

Also, the fact that you're using an AT is very significant. That means that your test results are higher than most of what you're seeing on this forum. Most people use a human meter. In lower numbers, a 68 on an AT is equivalent to about a 50 on the human meters. As the blood sugar is higher, the difference between human meters and the AT increases, to somewhere about 30-40% when you're in higher numbers. Her numbers aren't as high as it looks - they are high, but a 400 AT is roughly 300 human meter, and a 300 AT is roughly 225 human meter.

Would you please add "AT" in bold and color, on both your signature line and the spreadsheet so we know the numbers are on an alphatrak. It would also be good to have his weight in your signature line.

We really need some night cycle tests to help us know how low Keiko is going. Whatever nights you're with him, would you get some tests in so we can see how he's doing - even one test 2 hrs after the pm shot will tell us a ton. Cats very often are lower at night. I'm sure that sounds ridiculous when we're looking at these high daytime numbers, but we do see cats that have completely different lower cycles at night. There is a thing called Dawn Phenomenon that causes higher morning blood sugar in all diabetics. I think it's likely that Keiko actually needs more insulin, but because so many cats are lower at night, I'm reluctant to just say increase when we can't see for certain that he isn't lower at night.

You have some flexibility with the Lantus scheduling. We do try to stick to 12 hr cycles, but if a cat is high, for example, you can shoot early. There isn't going to be a perfect solution for you - both Lantus and Lev are shot on 12 hr schedules. I think the best solution is for you to try out what you need to do and see how Keiko responds.

Most people break up the meals into at least 4 per day - i fed punkin 3oz at preshot and 1.5oz at +3. Sienne was saying above that breaking up the meals is easier on the diabetic cat's pancreas. It also spreads the carbs out to help even out their blood sugar. Typically, you want most of the day's food at preshot with some more given between then and about +4 or so.

If you can get a couple of consecutive evenings with a test at any point in the pm cycle, +2 or later, to help us be sure he's not going lower, then I'd say you should increase his dose. His nadirs are in the 200's on a human meter (328 8/30 = 240ish human meter) so if you learn from testing that there are no lower numbers in the evening cycle, you could increase by 0.25u.

Tight Regulation Protocol: (remember, these are in human meter numbers, not AT)
Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
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You may want to consider getting a human glucometer - there's a lot of translating that you'll have to do if you continue to use the AT. It's not impossible, but most people here find that it's so cumbersome to compare numbers, and with the cost of the AT strips being about 10x more than human glucometers, it's just easier to use a human meter. Most people buy Walmart brands and then get the strips from American Diabetes Wholesale. They have Arkray generic strips that will work with the Walmart meters - you do need strips and meters that go together. You can also get an Arkray meter & strips from ADW. Generic test strips are well less than 10 cents each, compared to $1 per strip for the AT. Plus you can only get the AT strips from a vet. With the number of tests that you'll end up doing, it's very cost-effective to get a different meter, but it's up to you.
 
Thank you. I'm working on absorbing everything I'm learning.

Human meter - I report results to my vet using the AlphaTrak. I'm open to using the human meter. Has anyone had issues with the veterinarian and the meter used? How do you translate human to cat numbers? You may have explained this; I'll look at it again it's not clear yet.
I have been paying $2.00 a strip and found a source at $1.00 a strip. The other concern is it seems the AlphaTrak requires less blood to get the BS reading than human meters, is that the case in your experience? Keiko is squirmy and being able to get the smallest possible drop of blood to work for testing makes the process successful. If I had to get a larger sample it would be a struggle and more stressful. With AlphaTrak some days I have had to stick him 2-4 times to get blood. Sometimes I waste strips when I can't get a large enough blood drop. AlphaTrak strips are sensitive and won't work a second time if you get too little blood the first time. Also, if you take too long to get a blood sample the meter won't work with the unused strip! I have found a way around this that seems to work where I don't activate the meter until I can see a good sized blood drop first. This time limit with the meter means I need to be fully and completely awake in the early morning to successfully get the sample and avoid multiple sticks and wasted strips.
I get samples from his ears; paw pads are a no go for him.

Here are some questions I had not yet answered:
I have not seen any signs of bladder infection. Also, he was tested about 3 1/2 weeks ago and was negative.
I bought the Lantus in early June, so that's about 3 months. It is clear with no particles and has been refrigerated the whole time. Until this week it was in the fridge door.

Clarification"
You'd like me to do the following tests: a daytime +2, daytime mid-cycle, night +2 and before bed (?) I can do that Saturday. If I do it this Friday I would have a night +4 or +5 but not a +2.
How many days?
Thank you again.
 
Hi Maria and welcome to Lantus Land to you and Keiko,

I've read your posts and the answers you have received from some of the very knowledgeable people here. I would just like to chime in on the meter issue. The Arkray meters that they sell at ADW are excellent and many of them require a very small blood drop. Here is a link to the one that Rusty uses (this includes 100 strips): http://www.adwdiabetes.com/product/arkray-glucocard-01-mini-blood-glucose-monitoring-kit_4042_1.htm

This meter is also sold at Walmart as the Relion Micro. The Arkray strips work in either. ADW also has a great deal on the strips for this meter: buy 4 boxes and get 1 box free (250 strips in all for $69.99):
http://www.adwdiabetes.com/product/arkray-glucocard-01-sensor-blood-glucose-test-strips_4050_54.htm

I hope you can convince your vet that the human meters are just as good as the AT for measuring blood glucose. Our spreadsheet here is set up for human meters.

Keep posting and keep asking questions.

Rusty says hi to his fellow Maine Coon Cat!

Ella & Rusty
 
Thanks! I'll look into the human meter and talk to my vet about it.
The vet wants to do a blood test for pancreatitis. I think that makes sense, do you?
I moved the cat carrier out so now Keiko is doing his best to hide! cat(2)_steam
Will post a picture soon. The one I used was too large so I need to modify.
Blessings.
M
 
Maria...the latest research I've seen shows that pancreatitis is a lot more common than previously thought, so if your vet thinks there's a reason to test for it, I'd say go ahead, but there are 2 tests

One is a "snap" test which can be done in the vets office if they have the right equipment, but it only really gives you a "yes or no" answer

The best test has to be sent to the lab to get the exact values to know how bad it is (if you get a "yes" on the snap test)

Now I don't remember right off hand, but I do think that to get the most accurate results, the cat needs to be NPO (no food) for 8-12 hours before the test though, so it's not quite as simple as just taking the cat in for a test.

Let us know how else we can help you!
 
i think you'll be really happy with one of the meters that Ella is suggesting. If you register first at http://www.mrrebates.com you can get a 4% rebate on everything you spend at ADW.

for the Spec fPL test, you want a minimum of 6 hrs fasting. I scheduled punkin's test as late as i could before his pm shot so that he was already without food for at least 6 hours. There is a great post on pancreatitis that marje put together. I'd take a look at it - she's got the most accurate, up to date infor on it there.

Here's a site that will shrink your picture so we can see what Keiko looks like: http://www.shrinkpictures.com/

Your lantus sounds like it's probably fine.

about the testing -
You'd like me to do the following tests: a daytime +2, daytime mid-cycle, night +2 and before bed (?) I can do that Saturday. If I do it this Friday I would have a night +4 or +5 but not a +2.
How many days?
Thank you again.
Click to expand...

I promise that none of us gets a commission for getting people to do night time tests! ;-) :lol: we push it so hard because Lantus dosing is based upon how LOW a cat gets to on a particular dose, and because we see cat after cat that has an entirely different, often lower, set of blood sugar numbers at night. It's not uncommon at all.

You're doing 2 things when you test - you're keeping Keiko safe by being vigilant to low numbers so you can give carbs if you get anything below 50, and you're seeing how low the dose takes Keiko, so you can make informed, appropriate dosing changes.

The more information you have, the more confident you can be that there are no sneaky low numbers at night, and that you're increasing the dose when you should, but not overdosing Keiko.

The purpose of the +2 test is that it can give you an idea of what's going to happen in the next few hours. Not too many cats go low by +2, although it can happen. It's primarily a tool to help you know what's coming next, and how fast it's coming. Cats are erratic on insulin before they get related - they can have a nadir at +3 on day and +6 another day. They have fast metabolisms and we know that absorption of the dose can vary by as much as 50% from one shot to the next. So even if you're doing the same thing over and over again, his body's responses are not going to be the same every day.

I'd just get what tests in that you can - if you understand the purpose of the testing, maybe that will help you figure out when it's going to work to test.

One thought - any chance of moving Keiko back and forth with you between the 2 houses? that might make things easier, and he'd be safer than being alone. Even if he had to be restricted into a room in his non-normal residence, you might be able to make it work. Cats can adjust to new things, especially if you give treats to make the change easier. :-D (i work that way too! ;-) ) Just an idea.
 
Hi,
I learned from the vet that Keiko has a significant case of pancreatitis. I know little about it except he has to eat low fats.
His PM +4 was 334 on 9/5/14.
Have a nice evening all.
 
If you haven't already read it, Marje wrote an excellent Primer on pancreatitis

There are treatment options listed as well as a wealth of other information about the disease.

How was it diagnosed? With just the SNAP fPL or was it sent out for the Spec fPL?

There are lots of others here that are dealing with some level of pancreatitis pretty much all the time, so you're definitely not alone. They've found that a lot of diabetics have some degree of pancreatitis whether it's diagnosed or not, so it's a lot more common than previously thought.

Good luck with her treatment and hopefully she'll be doing better soon!
 
i think the low fat rule may be out of date. Marje's post has the most recent research on it - take a look at it. You want to make sure he's eating enough, has subq fluids (did the vet give you any?) and he's getting some kind of pain relief. Pancreatitis is painful. Most people give buprinorphin, or what we call Bupe. Stay away from Meloxicam (aka Metacam) as it can cause fatal liver damage in cats.

Good luck - holler if you need help. we have lots of experience with pancreatitis. as Chris says, it's common in diabetic cats.

great job getting that pm test last night, too! it does help fill out the picture.
 
Hi Julie, Chris and everyone,
Thanks again. Your support means a lot.
The vet mentioned fluids; I can't remember pain meds but that could be me. Keiko does not appear to be in pain. He seems to be feeling better the last few days, returning to his favorite perch after neglecting it for a long time.
I will look at the pancreatitis article.
 
Since we know Keiko has pancreatitis, wouldn't he need a higher dose of insulin than first thought? (mor than 2-3 units?). Wouldn't half unit increases be too slow for him?
Thank you
 
Hi Maria. Welcome to LL. You've had a LOT of info thrown at you this past week, and I'm going to add one more: It helps us all to help you if you can do a new post every day. If you scan down the list, you'll see how we do it. We put the date and kitty's name in the subject line, plus BG and any questions, etc. That way, we don't have to scroll way down to get your latest info, and you don't have to scroll way down to see the responses.

Let me add that you are in the best possible place to help Keiko. My kitty, Cinco, was literally at death's door when I joined, and the vet was ready to give up on him. The wonderful people here that are helping you now saved his life. You will find more support and advice here than you can imagine. Hang in there. We've all been where you are.
 
Maria

It would be great if you could please start a new condo or thread in this group every day. This one is getting too long and we like to be able to keep things together on a daily basis :-D :-D :-D

All you need to do is, on this forum, click "new topic" and then in the subject line put "9/9 Keiko AMPS XXX" and then as you get more tests, you can add to that. It's also easier for us to help you with dosing if his SS is up-to-date. We need to be able to see a few cycles at a time and put it in context with his history.
The last numbers for him are on 9/5 and so I'm not comfortable suggesting a dose without knowing what he's been doing since then.

Also, unless a cat is a high dose cat (e.g. over 6u insulin twice a day), we wouldn't increase by more than 0.5u and we'd only increase by 0.5u if the nadirs, not the pre shots, were over 300 consistently with no nadirs below 300. Keiko might need an increase but until we see additional numbers, I would not be comfortable making a dose suggestion.
 
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