Dose change Advice needed for lantus newbie

Status
Not open for further replies.
phlika29

phlika29

Member Since 2014
Hi everyone.

My cat remi has been on lantus since Saturday. I am not following the tight regulation protocol as such but have been trying to test as much as possible. I have posted a thread in the relaxed lantus forum asking for advice about a dose change. I wonder if members from this forum might be able to comment based on remi's BG readings. I know it is early days but from reading other threads remi's curve is very high and flat.

The thread is here:

viewtopic.php?f=32&t=126554

I mentioned in that thread that I am having spreadsheet problems and not all of he US numbers are displayed but the mmol ones are.

Many thanks

Sarah
 
Hi, Sarah.

Give how much you've been testing lately, if you wanted to give tight regulation a try, you'd be in good shape to do so. Frankly, the minimum number of tests for TR is your pre-shot tests plus one additional test during both the AM and PM cycles.

As for Remi's spreadsheet, I can offer a couple of thoughts. First, Lantus is a depot-type of insulin. What this means is that it takes several days for the depot to form. The depot is like an insulin storage box and it's what gives Lantus it's duration and it's gentle method of action. Usually, we encourage you to be patient for the 5 - 7 days that it takes for the depot to be established. There are several sticky notes at the top of this board. You may want to take a look at the note on the depot as well as on Tight Regulation. Even if you decide to not do TR (and there are several people who post here who do not use the TR protocol), the information in the starred, sticky notes will have you a solid foundation on how Lantus works.

Second, I'm not sure that you started on a high enough dose. You weren't seeing all that much activity on Caninsulin at 1.0u. With Lantus, there's a calculation for the starting dose:
Initial dose = 0.25 x ideal weight in kilograms​
Unless Remi is a tiny cat, most kitties wind up on approx. 1.0u to start out. So, it's likely you will need to increase the dose.

Please let us know if you have questions. We're here to lend a hand.
 
Sienne and Gabby said:
Hi, Sarah.

Give how much you've been testing lately, if you wanted to give tight regulation a try, you'd be in good shape to do so. Frankly, the minimum number of tests for TR is your pre-shot tests plus one additional test during both the AM and PM cycles.

As for Remi's spreadsheet, I can offer a couple of thoughts. First, Lantus is a depot-type of insulin. What this means is that it takes several days for the depot to form. The depot is like an insulin storage box and it's what gives Lantus it's duration and it's gentle method of action. Usually, we encourage you to be patient for the 5 - 7 days that it takes for the depot to be established. There are several sticky notes at the top of this board. You may want to take a look at the note on the depot as well as on Tight Regulation. Even if you decide to not do TR (and there are several people who post here who do not use the TR protocol), the information in the starred, sticky notes will have you a solid foundation on how Lantus works.

Second, I'm not sure that you started on a high enough dose. You weren't seeing all that much activity on Caninsulin at 1.0u. With Lantus, there's a calculation for the starting dose:
Initial dose = 0.25 x ideal weight in kilograms​
Unless Remi is a tiny cat, most kitties wind up on approx. 1.0u to start out. So, it's likely you will need to increase the dose.

Please let us know if you have questions. We're here to lend a hand.
Click to expand...

Many thanks for your reply

I had a couple of early low readings on the caninsulin that left me traumatized so have gone for the go slow, start low (is that right?) approach for now until I build my confidence up. But you are right I think the dose is not high enough. I also posted on the relaxed lantus forum and Mel has recommended that I begin to increase the dose, hold for a while and then increase again. My partner has managed to get BG readings which is great as he is there during the day more than I am.

Remi weighs just under 5 kg and so I think you are right 1 unit is probably going to begin to hit the mark . I have read the stickies but will go back and read them again. This forum is great for info and support :-D

I am going to start remi on 0.75 tonight and hold that dose until the weekend. If anyone has advice on getting a 0.75 dose from a BD micro +demi syringe that would be great.

Best wishes

Sarah
 
Hi Sarah - welcome to the TR forum. I also started out on Caninsulin - hypos are much more common on it that Lantus. You'll be happy you made the switch.

I too use the BD microfine syringes, as that's all that's available in Canada. There are a couple of methods for getting those in between methods (other than eyeballing). Take a look at the TR protocol sticky. About 5 paragraphs down is a PDF document titled Management of Diabetic Cats. On the 5th page of that document is a section entitled Administration of small doses of glargine and detemir, ... It describes the drop counting method, but also contains a link to a document used by the German Diabetes-Katzen forum that has rules for various smaller doses for use with the BD Micro-Fine+Demi syringes. There's a picture of how it's used a couple of pages later in the PDF.

I started out just eyeballing the in between doses, but I found that the BD's aren't the best at consistency and in the worst case found that there would be as much as a third of a unit difference in where the lines were located on the syringe. That's when I switched to using digital calipers.
 
Hi Sarah! We use the digital calipers too, whatever way you go a good magnifier is very helpful. We use a magnifying visor to keep the hands free.

To set the caliper find a syringe that looks accurate. The zero line should align w/ the plunger when it is pushed all the way in.(You'll find once you get a strong magnifier that the markings on the barrels are very inconsistent.) Draw up a 1 unit dose dose on this syringe and set the caliper so the top edge of the caliper aligns w/ the inner top of the barrel and the edge of the lower arm w/ the plunger top. Now you have a digital reading for 1 unit. You can divide that reading for quarter, half and three quarter unit doses. Keep that list (and save your "perfect" syringe as well) and when you need to adjust the dose reset the caliper according to the list.

To use a caliper align the edge of the top arm w/ the inner top of the barrel, then gently adjust the plunger until it aligns w/ the edge of the lower arm. It's the easiest way to get consistent dosing which is important for Lantus. I counted drops for a long time and the caliper is well worth it!

BTW after an increase there can be a weird phenomenon we call New Dose Wonkiness. Until the shed readjusts numbers can actually go up for up to 3 days. It still makes me nervous every time, but on the third day Tess suddenly has much better numbers. Some cats don't but a lot do or for a shorter period. My little one likes to take the full 3 days every time. :roll:
 
Wendy and Ann

You guys are the best. I had never even heard of digital calipers! :shock: . You are so right about the syringes not being the same. I had decided to use Mel's method of keeping one syringe marked at the dose I wanted to give but was surprised that when I compared this to the actual syringe I was going to use they looked quite different. The plunger wasn't even that straight, so who knows what dose I actually gave him :? .

I am going to read all those links tomorrow and will try to keep in mind the new dose wonkiness (love that phrase). I like the idea of the calliper rather than counting drops. I have already commandeered my mums magnifier and light thing as these syringes are so small. I really want remi's numbers to reduce soon as he still so high and I worry a lot about dk.

May I ask about air bubbles. They have been quite troublesome to me. My vet says that it is the result of the air that comes from the needle that gets pulled into the syringe when you draw the insulin. He doesn't believe the bubble to be a problem because as long as you don't flick the bubble to the top it will just end up back in the needle. So no insulin lost. But that bubble does seem to take up quite a lot of space. I have taken to drawing up more than I need and then flicking the bubble to the top and trying to expel it with the excess liquid. Is this the common practice?

Many thanks

Sarah
 
ah the dreaded bubble....

1) try pushing the plunger hard before you even put the needle in the vial. Sometimes it even helps to push it back and forth before.....but by pushing it before loading, it helps.

2) slowly pull back the plunger to decrease the air getting sucked in.....
if you pull too quickly, you will get extra air....

and as you've been doing....
overfill just a tad...and tap the bubble to center it...and try to expel it....
 
I suppose if the bubbles are always exactly the same it wouldn't matter. But on the tiny doses we give our cats it fills an awfully large amount of the dose. And even if it is at the against the plunger it could be expelled and insulin left in the needle.

Sometimes there is a tiny bit of needle sticking out in the barrel and it keep the bubble from centering. Once i get the bubble tapped to the top i draw in a little extra air and tap again lightly. When the 2 bubbles merge it is usually centered on the needle and can be expelled.
 
Take a peek here about how to take care of your Lantus so it will last as long as possible. The stuff costs as much as gold! About 1/2 way down the page there is a video i did on how to draw up your dose, including dealing with bubbles.

honestly some syringes are just bad for causing bubbles when you are drawing up the shot. I really liked these Terumos.

And welcome to Lantus Land! We'll be glad to teach you what you need to know about how to take care of Remi and keep him safe. I don't know how low Remi got when you had your traumatic experience on Caninsulin, but on Lantus, it's not uncommon for us to see 30's without symptoms. We immediately give carbs and it pulls up the blood sugar.

The pdf that Wendy referred to talks about how great the chances are for newly diagnosed cats who become "tightly regulated", ie, their blood sugar is pushed back into normal numbers (50-120 on a human meter) to become diet-controlled and go off of insulin. That's why we're so pro-TR. Everyone wants their cat off of insulin if possible, and cats are unique in their ability to have their pancreas heal and begin putting out insulin again. Even if a cat can't go off of insulin, keeping their body in normal blood sugar numbers protects their organs from the ravages of high blood sugar.

Glad to have you here! Ask away and we'll be happy to help you.
 
Thankyou everyone for your advice re the syringes/bubbles. I think I have cracked it now :-D I pushed the plunger down hard before inserting it into the insulin, pulled back really slowly, got the bubble to the top, and than as Ann suggested I drew in more air and then I think I managed to expel it all. I will have to carry on the BD micro + demi as I have just ordered a box of 100 but will think about switching afterwards.

I have also been looking at digital calipers. Does this one look okay? http://www.amazon.co.uk/150mm-ELECTRONI ... B007K7F04C should I be looking for a particular brand or a particular feature?

Will read through all the links posted.

Thankyou Rhainnon, Ann, Julie and Wedny once again. I feel much better equipped now :-D

PS sorry if I have missed anyone or called anyone by their cats name :razz:
 
Many people here purchase their calipers through Harbor Freight. Perhaps you could take a look and see how the ones you found compare.
 
Since you are using the BD syringes for now, one features you want to look for is the ability to measure tiny distances inside of things. The BD syringes have a collar on them, which get in the way of using the side of the calipers that measure around the outside of things, so you have to use the other side that measures inside distances. Many of the calipers I've looked at have fairly fat "arms" for measuring inside and you can't measure well under 2 mm. So look for slender ends. Other than that, the calipers you've linked look good. I don't know if Harbor Freight ships to the UK.
 
Status
Not open for further replies.
Back
Top