Buying Lantus in the UK/dosing questions

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phlika29

phlika29

Member Since 2014
Hi everyone

My cat remi has been on caninsulin for just over a week but win are hoping to get the ok from my vet to switch over to lantus in the next week or two. :smile:

Unfortunately (stupidly) I don't have insurance for remi and so all the treatment has to be funded by myself. I am therefore looking for advice about the likely dose that remi will be using (he weighs 5kg), the best way to buy the Lantus (vial or pen), the sort of price I should expect to pay and if possible where best to buy it from. Is it okay to buy it online and have it sent in the post? Are some brick pharmacy's cheaper than others.

Ideally I am looking to purchase it within he uk as I have previously been stung for import duty when buying his asthma meds from New Zealand.

I have found it here at a online pharmacy I have used many times before:
http://www.pharmplexdirect.com/lantus-i ... 58708.html

Any help would be gratefully appreciated.

Best wishes

Sarah
 
Hi Sarah,

The standard starting dose of Lantus per the TR protocol documentation is ¼ IU per kg of ideal body weight, and dosing is usually 12/12. Doses are adjusted in small increments (0.25 IU).

The starting dose guidelines are a starting point. Your vet will take into account how sensitive Remi is to Caninsulin when determining the starting dose. (For example, according to the guidelines Saoirse should have started on 1 IU BID, but because of her previous high sensitivity to Caninsulin our vet started her on 0.5 IU BID. After starting the TR protocol her dose never exceeded 0.75 BID and that was only for a few days.

Even with the insulin wastage taken into account, unless Remi turns into a high dose cat unexpectedly that 10ml vial should last for months as long as it's refrigerated/handled properly.
 
The pens can be more cost effective as you generally can use all of a pen before it becomes weaker/ineffective. Some places may sell pens individually, though you'll have to check around.
 
Thanks BJM.

I have phoned a local Tesco supermarket pharmacy and they have both the 10 ml vials and the 3ml pens/cartridges :-D

The price for 5x 3ml pens is £59.80
The price for the 10ml vial is £42.22

I must say I am pleasantly surprised by these prices as I thinking it would cost a lot more.

So if I go for the 3ml cartridge/pen it will be more economical wont it? Say if remi has 1 unit a day how long will 3mls last? The pharmacist also wanted to know if I wanted the pen or just the cartridge. I said I would check. He thought the pen would be better overall (better protected?). Is that correct?

Cheers

Sarah
 
Greetings Sarah

Personally I like the cartridges better as they are just the inside of the pen without the plastic case around it. But that is really a personal preference I just like that I can store the ones I'm not using in a smaller section of the fridge.

On average a single pen last me (although mine are on Levemir, but same amount in both pens) about 3 months when I was only shooting one at approx. 1u bid or 2 units total for the day.

Mel and The Fur Gang
 
Lantus is a U-100 insulin, meaning it has 100 units per mL.
A pen contails 3 mL, or 300 units.
At 2 units per day, that gets you 150 days or roughly 5 months.
At 3 units per day, that gets you 100 days, or roughly 3+ months.
 
Hello Sarah,I bought 5 x 3ml cartridges last week from Sainsburys for £52. You only buy the cartridges,the syringes you will need are bought online from VetUK. These have 1/2 unit scale markings for increasing the insulin dose by 1/2 units.
The syringes you need are. BD Micro-fine + Demi 0.3ml
Good luck with the Lantus,it seems to be a much better insulin for cats than Caninsulin.
 
MommaOfMuse said:
Greetings Sarah

Personally I like the cartridges better as they are just the inside of the pen without the plastic case around it. But that is really a personal preference I just like that I can store the ones I'm not using in a smaller section of the fridge.

On average a single pen last me (although mine are on Levemir, but same amount in both pens) about 3 months when I was only shooting one at approx. 1u bid or 2 units total for the day.

Mel and The Fur Gang
Click to expand...

Hi Mel

Thanks for your reply. Its nice to know what other people buy and how long it lasts and have been making sure that I ask for the price for the cartridges. I am guessing that remi too will be on 1 unit twice a day.

I am surprised that the price varies a lot depending on how much the pharmacy's add on to issuing a private vet prescription.

I am hoping to switch over to Lantus in the next week or so and looking forward to joining the relaxed forum :smile: When deciding the dose do I just go on remi's weight or do I take into account how he has been doing on the caninsulin?

Many thanks

Sarah and Remi
 
Looking at his spreadsheet personally I'd start him at .5 and work up. There is a formula on Tight Regulation using weight to calculate starting dose of Lantus. Although its never worked for any of mine. But then mine are kinda different kids lol

I also find it easier to start them lower than ideal and work up than to start possibly too high and chase down.

Mel and The Fur Gang
 
Critter Mom said:
Hi Sarah,

The standard starting dose of Lantus per the TR protocol documentation is ¼ IU per kg of ideal body weight, and dosing is usually 12/12. Doses are adjusted in small increments (0.25 IU).

The starting dose guidelines are a starting point. Your vet will take into account how sensitive Remi is to Caninsulin when determining the starting dose. (For example, according to the guidelines Saoirse should have started on 1 IU BID, but because of her previous high sensitivity to Caninsulin our vet started her on 0.5 IU BID. After starting the TR protocol her dose never exceeded 0.75 BID and that was only for a few days.

Even with the insulin wastage taken into account, unless Remi turns into a high dose cat unexpectedly that 10ml vial should last for months as long as it's refrigerated/handled properly.
Click to expand...

Hi Aine

I have just asked Mel about dosing and sensitivity. If you look at remi's spreadsheet re caninsulin do you think that he is as sensitive as Saoirse? I think he reacts quite strongly to it.
 
BJM said:
Lantus is a U-100 insulin, meaning it has 100 units per mL.
A pen contails 3 mL, or 300 units.
At 2 units per day, that gets you 150 days or roughly 5 months.
At 3 units per day, that gets you 100 days, or roughly 3+ months.
Click to expand...

Thanks BJM that's really good to know. I have found that most of the physical pharmacies stock the cartridges and am definitely going to to go for that. I was imagining that the cost was going to be the same as remi's asthma meds but its a lot better :smile:
 
BaileyUK said:
Hello Sarah,I bought 5 x 3ml cartridges last week from Sainsburys for £52. You only buy the cartridges,the syringes you will need are bought online from VetUK. These have 1/2 unit scale markings for increasing the insulin dose by 1/2 units.
The syringes you need are. BD Micro-fine + Demi 0.3ml
Good luck with the Lantus,it seems to be a much better insulin for cats than Caninsulin.
Click to expand...

Many thanks for your reply. I have been ringing around and so far have found that 5x3m cartridges are:
Tesco pharmacy £59.30
Asda £59.76
Rowlands £69
and today Sainsbury quoted £43.75! Not sure if that will be the same price when I go in but that is what I was told over the phone.

Will go ahead and order the syringes as I already use these for the caninuslin (he was put on a lower dose than usual).
 
MommaOfMuse said:
Looking at his spreadsheet personally I'd start him at .5 and work up. There is a formula on Tight Regulation using weight to calculate starting dose of Lantus. Although its never worked for any of mine. But then mine are kinda different kids lol

I also find it easier to start them lower than ideal and work up than to start possibly too high and chase down.

Mel and The Fur Gang
Click to expand...

Hi Mel

I like the way you think ;-) I would be happier starting low and then working up.

At the moment I am weaning remi off 0.5 mg steroid EOD and so wanted to make sure that was all out of his system before I switched to lantus as I am finding that his pre shot levels do seem to be affected by the prednicare. Having said that I am finding the deep drops and varying levels found with caninsulin quite stressful. For example yesterday evening his preshot level was much less than it had been previously and I was unsure of what to do or how safe it was to give the 1 unit. I am hoping that the Lantus removes some of this.

My other concern is that whilst my vet has agreed in principle to write out a script for Lantus he may change his mind or more maybe want me to try a higher dose with the caninsulin first. I hope not as I do think that a higher dose still wont hold him down for lon enough and increases his risk of a hypo.
 
You my dear are absolutely correct, Canninsulin is an "In and Out" insulin or in other words, you give it,it does its job and gone by the next preshot. Giving more doesn't extend duration it only drops the BGs lower. Not sure why that is a difficult concept for vets to grasp.

Lantus is a depot insulin and it forms teeny tiny crystals under the skin that slowly dissolve. This extends its duration greatly but it is also a more frustrating insulin to work with in the beginning because nothing happens quickly with it. Because if you have a higher than normal preshot you can't just give more to yank the numbers down. Because what you give in the morning isn't always what they are using, what they are using can be from last night, yesterday morning and the night before. Confused yet? ;-)

Mel and The Fur Gang
 
Mel
I am very easily confused:) and to be honest I have been confused since Remi's diagnosis. It's a real roller coaster of a journey and it sounds like lantus will keep that going! :lol: I am just so pleased that I found the forum and we don't have to go through it alone.
 
LOL then your in the right place. Actually Lantus is fairly easy insulin to figure out and by far easier to work with than what you're using its just different. It requires a good set of handcuffs (not literally) and a closet full of patience pants. Because dosing changes are done off the nadir (lowest point) and about all preshots tell you is they are high enough to give insulin to in the first place. What you don't get are those steep heart stopping drops and rockets back up again. It curve should be a very gentle smiley face.

Now Start Low and Go Slow and Tight Regulation get there in two very different ways. SLGS start very low and work up very slowly giving his little body a chance to adjust to each level of BG change. TR raises quicker but they also test more than we do over here. I personally and I think most of us in Relaxed Lantus kind of do a hybrid of the two protocols. When we can test a lot we do and raise doses faster, when we can't test a lot or we are getting into low stable numbers tend to slow down on both testing and dosing changes.

I guess you could say we are the Island of Misfit Toys :lol: :lol: :lol: We kind of fly by the seat of our pants sometimes because our life schedules and our Sugarcat schedule don't alway sync up nicely with either protocol.

Mel and The Fur Gang
 
Mel

This all sounds good to me. My plan is to email my vet again saying that I would like to definitely change to lantus as I am concerned about the steep drops I see with caninsulin (I didn't sleep well at all last night as I was worried about remi) and the longer duration that I can get on Lantus. Ask that he write out a script for 5x3ml cartridges with a starting dose of 0.5 unit.

I will wait till Saturday morning so I am home for the weekend to monitor him and by then he will have been off the steroid for 5 days and it should be out of his system. I do plan to use the SLGS approach and so will have to go and find my patience pants and make sure I wear them for the 7 days and keep taking readings. During that time I will endeavour not bombard the forum with increasingly panicky posts but I am afraid I can't promise that ;-)

That's the plan but no doubt things will happen to change it.
 
hi
don't worry about posting alot. that's what we are here for and we have all been where you are so post as much as you want and ask all the questions you want. welcome.
nadine & tibbs
 
Mass panic, chaos and disorder....YAY my job is done...lol

No Nadine is absolutely right, in the beginning we all go through those panic attacks...Boy I know I was a wreck 4 years and 6 sugarcats ago. We here to hold that light at the end of the tunnel and show you the passage is safe. Everyone of us here has or is right where you are now. Actually you're ahead of the curve because you have testing down. Good Lord I use to shake like a leaf just thinking about giving shots and testing. And I had been giving my own vax for years prior to my first diabetic kitty.

And my first near hypo...roflmao my poor cat probably had a sugar rush for days I carbed that poor girl up so much because I was terrified of her going too low. But with time and practice now I can look at a 34 on the meter, calmly pick up kitty, stroll to the kitchen, crack open a can of food and feed, wait 30 min, test, rinse and repeat. If it meows I can get blood even if that means as with my last foster, wearing motorcycle gloves and wielding a towel like a matador's cape to prevent having fangs sunk into my hand...lol

The only question that is stupid is the one that goes unasked. I don't care if I just answered the same thing 10 seconds ago or have answered it 300 times that day. And yes, sometimes that answer is "Heck I don't know, let me go track down someone that might...give me a few minutes"

Mel and The Fur Gang
 
phlika29 said:
I have just asked Mel about dosing and sensitivity. If you look at remi's spreadsheet re caninsulin do you think that he is as sensitive as Saoirse? I think he reacts quite strongly to it.
Click to expand...

Hi Sarah,

As you know, I've not got the experience to give any dosing advice. That said, both my vet and myself agreed that Saoirse was very sensitive to insulin and because she had had a very good response to Caninsulin my vet recommended 0.5 IU as a starting dose. This also suited me because I prefer a very conservative approach wherever possible for all of Saoirse's treatments, and when it comes to insulin dosage, that urge be conservative is stronger by several orders of magnitude.

It is worth noting that Saoirse experienced significant dose carryover when on Caninsulin, and I think carryover was also in play when she started on Lantus. I wasn't expecting any substantial drops when she started on Lantus because of its gentler action, but she had some quite precipitous drops during her first few days on the new insulin.

One thing i would recommend is starting on Lantus when you have a completely free weekend and to do a fair bit of testing (including some full PM cycle curves): (a) to make sure you catch any Caninsulin-influenced BG drops during the early part of the switchover; and (b) so that you can start building up a picture of how Remi responds to Lantus during the night (where he seems to run lower on Caninsuln).

Hope that helps a bit.
 
tibbs5 said:
hi
don't worry about posting alot. that's what we are here for and we have all been where you are so post as much as you want and ask all the questions you want. welcome.
nadine & tibbs
Click to expand...

Thanks Nadine for the reassurance. Last week I did feel like I was overtaking the forum with questions :lol:
 
MommaOfMuse said:
Mass panic, chaos and disorder....YAY my job is done...lol

No Nadine is absolutely right, in the beginning we all go through those panic attacks...Boy I know I was a wreck 4 years and 6 sugarcats ago. We here to hold that light at the end of the tunnel and show you the passage is safe. Everyone of us here has or is right where you are now. Actually you're ahead of the curve because you have testing down. Good Lord I use to shake like a leaf just thinking about giving shots and testing. And I had been giving my own vax for years prior to my first diabetic kitty.

And my first near hypo...roflmao my poor cat probably had a sugar rush for days I carbed that poor girl up so much because I was terrified of her going too low. But with time and practice now I can look at a 34 on the meter, calmly pick up kitty, stroll to the kitchen, crack open a can of food and feed, wait 30 min, test, rinse and repeat. If it meows I can get blood even if that means as with my last foster, wearing motorcycle gloves and wielding a towel like a matador's cape to prevent having fangs sunk into my hand...lol

The only question that is stupid is the one that goes unasked. I don't care if I just answered the same thing 10 seconds ago or have answered it 300 times that day. And yes, sometimes that answer is "Heck I don't know, let me go track down someone that might...give me a few minutes"

Mel and The Fur Gang
Click to expand...

Mel

Love you sense of humour. It really helps to laugh about is situation at times it has been sooo stressful. I am very lucky with remi he has never done anything other then sit in resignation at my amateur attempts to get medication into him, give him his inhaled asthma meds and now poke him in the ear. I have got he funniest photo that I will try to find at the weekend where me and my mum concocted a box that I could sort of strap him in when I first had to give him flixotide for his asthma. I thought I was so clever. This box had straps that gently held him in position. What I hadn't figured on was that he could just duck his head down between the straps and I could reach him anymore. So the only way around it was for my poor old dad to drive over at 6.30 every morning and night for a few months to help hold him until I could get used to doing it alone :lol:

That second night when remi's BG went very low my hands were shaking so hard I am surprised he left me anywhere near him. I ended up resorting to a sterile needle which was much larger and poked him right in the vein :oops:

You and all the other members are obviously very dedicated to helping sugar cats. I followed how you helped Aine the other night and how BJM helped me and made sure I didn't feel alone. This is a very special place. I am in awe that you have taken on other sugar cats.

I have emailed my vets today and asked that he write out a script for lantus and sent him a link to the go low method that I want to follow. Fingers crossed I hear back tomorrow.
 
Aine :smile:

I have taken note of everything you said and my plan is to start if possible on Saturday morning and stay around all weekend and then my partner will be home on Monday. So hopefully that will be three days to see what is happening. I am going to start at 0.5 as both you and mel have mentioned this as a good place to start.

Will keep an eye out for carry over. As always will keep my spreadsheet up to date and ask others to look over it.
 
When you have been in rescue as long as I have you quickly learn that if you can't laugh at yourself and the a stressful situation you will drive yourself crazy. Yes this is a serious disease and we are giving a hormone that if done wrong can kill your precious furry friend. But it isn't doom and gloom, heck Diabetes is so much better than the ten thousand other things it might have been, and this we have control over. So much of what can go wrong with our beloved animals that all your doing is buying a little more time to say good-bye, give me a dx of diabetes any day over cancer, acute renal failure etc.

Oh and yes, we are just slightly crazy, but the good funny crazy not the scary dangerous crazy. We're serious when we need to be, but we still know how to have a good time as well. Because laughter is truly the best medicine you can prescribe to a care giver.

So can't wait to see the picture of the box..lol That sounds about like something I would do, with about the same results.

Mel and The Fur Gang
 
Message from your cat If you have not seen nor read this, it really is a must read for everyone just starting out. ;-) In fact I suggest to print it out and keep it handy for the first several months and then periodically go back and reread...It just keeps getting funnier the long you and your kitty dance together.

Mel and The Fur Gang
 
MommaOfMuse said:
... heck Diabetes is so much better than the ten thousand other things it might have been, and this we have control over. So much of what can go wrong with our beloved animals that all your doing is buying a little more time to say good-bye, give me a dx of diabetes any day over cancer, acute renal failure etc.
Click to expand...
When I took Saoirse back to our previous veterinary practice to insist on diagnostic testing (I suspected diabetes - or possibly Cushings) her abdomen was very distended. After examining her abdomen they told me she might have fluid accumulation, that it was probably "nothing good" and that we might have only "months, maybe a year" left together. Most of my blood ended up in my ankles and I nearly threw up.

Turns out my suspicions were more on the money than the vets'. One blood test and one urinalysis later, the preliminary diagnosis of FD was given. An ultrasound 2 days later confirmed that the suspected fluid accumulation was non-existent (she just had a very full bladder due to polydipsia). The ultrasound showed pancreatic abnormalities but nothing worse.

Whenever the going gets tough with Saoirse's treatment, I remind myself of the relief I felt when I found out she had a treatable condition. As hard as it can be sometimes (especially with the pancreatitis), diabetes is something I can do something about to help my beautiful girl. I am very grateful for that.
 
Hi Sarah,

phlika29 said:
I have emailed my vets today and asked that he write out a script for lantus and sent him a link to the go low method that I want to follow. Fingers crossed I hear back tomorrow.
Click to expand...

Fingers and paws crossed in the Shire for you and Remi. :smile:

To get an idea of how the carryover affected BG levels for Saoirse when we did the switch, have a look at her spreadsheet for 19-21 August. It's a bit nerve-wracking doing the change because in some ways it's like going back to the starting blocks data-wise. I was able to ramp up Saoirse's dose fairly quickly because I'm at home to monitor her all day. If I had had to leave the house, I would have held doses for longer before increasing so that I could get more data.
 
Good news. I will be picking up my prescription for Lantus after work today and all being well get it from the pharmacy tonight :-D

Remi's first dose will be tomorrow morning. I have agreed with my vet that remi will start on 0.5 units. I just need to check where that is on the U100 BD micro-fine+demi 0.3ml syringes that I have. At the moment I am using the same syringes with the caninsulin and so have been converting the dose over. As Lantus is meant to be used with the U100 syringes I know I don't need to do that but am super paranoid about getting the dose right. So can I confirm that on the U100 syringe I am pulling up the insulin just the tiniest bit-to the first demi mark on the syringe? that is so tiny!

Aine

Will have a look at Saoirse spreadsheet. I do find looking at other cats spreadsheets useful.

PS haven't forgotten about that photos. Will dig it out tomorrow ;-)
 
Okay I'm assuming your syringes have half unit marks, Right?

So if you are holding the syringe in front of you with the needle pointing up, first heavy black line is Zero, the first little tick mark on the left is your .5, next line on the right is your 1u and so on. Your half units are on the left and the whole units on the right. And yes its a teeny tiny dose but there are actually many smaller doses below that you have to eyeball. :roll: So if don't have it already I highly suggest a good magnifying glass. You don't even want to know what I go through to draw up a .1u since my with my eyesight I only know that it is an E at the top of the eye chart without my contacts or glasses is because it's always an E. :lol:

Mel and The Fur Gang
 
phlika29 said:
So can I confirm that on the U100 syringe I am pulling up the insulin just the tiniest bit-to the first demi mark on the syringe? that is so tiny!
Click to expand...

To improve dosing accuracy, you could draw up more insulin than you need (e.g. 2 units), remove the syringe from the vial, flick to dislodge any bubbles then express the air and excess insulin into the sink.

BTW, there might be a difference between the BD 0.3 demi syringes on this side of the Pond. All the graduation marks on mine are on the one side. I've tried to find a source for the ones that Mel described (which I would far prefer as they are much easier to read), but I've not had any joy.

Wishing you both good luck for the switchover! :smile:
 
MommaOfMuse said:
Okay I'm assuming your syringes have half unit marks, Right?

So if you are holding the syringe in front of you with the needle pointing up, first heavy black line is Zero, the first little tick mark on the left is your .5, next line on the right is your 1u and so on. Your half units are on the left and the whole units on the right. And yes its a teeny tiny dose but there are actually many smaller doses below that you have to eyeball. :roll: So if don't have it already I highly suggest a good magnifying glass. You don't even want to know what I go through to draw up a .1u since my with my eyesight I only know that it is an E at the top of the eye chart without my contacts or glasses is because it's always an E. :lol:

Mel and The Fur Gang
Click to expand...

Hi Mel

Yes they have the half mark but they are all on the same side. Still I understand what you mean and confirmed the dose with my vet today. The insulin is in the fridge ready to go. I also gave remi a vit b injection tonight as it had been about a month.

I can't believe you draw up such a small amount! I struggle with the .5 and I am using my mums magnifier light. No matter what I do I still get the smallest bubble. My vet felt it was probably just the little bit of air that is in the needle before you draw the insulin up and in effect unless you dislodge it to the top it will just end up back in the needle and so in effect you aren't losing any insulin.

I have watched the video on using lantus. I know you don't push the excess back into the vial. Am just worried I will ruin the whole lot on the first go. Remi's current dose of caninsulin seems to be having less and less of an effect so I hope that I do see some movement with the lantus (not too much though) but know I have to be patient.

Best wishes

Sarah
 
Critter Mom said:
phlika29 said:
So can I confirm that on the U100 syringe I am pulling up the insulin just the tiniest bit-to the first demi mark on the syringe? that is so tiny!
Click to expand...

To improve dosing accuracy, you could draw up more insulin than you need (e.g. 2 units), remove the syringe from the vial, flick to dislodge any bubbles then express the air and excess insulin into the sink.

BTW, there might be a difference between the BD 0.3 demi syringes on this side of the Pond. All the graduation marks on mine are on the one side. I've tried to find a source for the ones that Mel described (which I would far prefer as they are much easier to read), but I've not had any joy.

Wishing you both good luck for the switchover! :smile:
Click to expand...

Hi Aine

Yes Like you my syringes are marked down one side only so will just go to the first half mark. As you suggest I will draw up more than needed but in the past I have never managed to get those pesky air bubbles to dislodge no matter how many times I flick.

I am beginning to feel a little nervous about tomorrow. What to expect?! I am not really sure what a good result will look like or maybe it will be too early to tell anything for the first few days.

Hope Saoirse doing okay still.
 
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