dosing a cat on glargine; half-units of glargine

[EllenD]

My cat, Max, is 21 years old, receiving sub-Q fluids for the past 2.5 years (75-100 ml each night). He was diagnosed with diabetes 3 months ago. We are still in the process of finding the right dose. The pharmacist kindly pointed out that the 5-pack Lantus (glargine) pen would be 50% savings over the vial. I bought the pens, since I didn't know or think about the fact that my cat might need half-units, or very fine dosing. Is there a low dose pen that does finer measurements. Does anyone have a method that allows one to use the less-costly pen but get finer increments of dosing (injecting into a syringe then administering that??). I also thought about drawing the insulin from the pen as if it is a vial but the way the pen works, there are no air pockets in the pen, which may be a factor in shelf life. My cat's urine readings have been very high on 2 units, then a string of negatives at 3 units. Although he seems alert and fine on 3 units I don't want to take the chance of him dipping too low. Thank you for your help! --Ellen

 

[Larry and Kitties]

Just use a regular insulin syringe with 1/2 unit markings. Instead of inserting the pen needle in the end of the pen, insert the insulin syringe needle and draw out the insulin.

 

[Lana & Yoyo]

The tip of the pen is rubber, just like the vial. Insert your syringe there -- instead of screwing the needle onto the pen. If the pen already has a needle tip, unscrew it and take it off.

Lana

 

[Vicky & Gandalf (GA) & Murrlin]

And do not inject air in to the pen. There is a rubber stopper which comes down as you draw out insulin to maintain the vacuum.

Also, if you need to do half units, it's helpful to use syringes which are marked with half units. Some of us buy them online, and I believe Wal-Mart's Reli-On brand has them.

 

[EllenD]

Thank you for your replies. So, if I draw the insulin out with a syringe, the rubber stopper at the other end will automatically keep the air locked out? I was afraid that this mechanism was controlled by pen use, i.e. when you administer a dose using the pen, "clicking" the pen cranks down the stopper.

 

[Christie & Willie (GA)]

Good morning, Ellen!

You've been given great information so far!

I typically will click the pen to push the stopper down to maintain the proper pressure, but no insulin will come out if you do.

Actually, the pen needles may be part of your issue with finding ther right dose. The pens are great for humans, who typically need at least 10u or so per dose. For doses under 5u, the pen needles are terribly unreliable in terms of the dose amount. Lantus/glargine needs consistency to work its magic, so it is possible that your cat hasn't been getting consistently the same dose.

For more information about Lantus, please feel free to check our our Lantus forum. There are stickies there with a wealth of valuable information, including details of the dosing protocol that a number of us follow. There are also instructions for handling the insulin, etc.

We also find that two keys for good regulation are feeding a low carbohydrate wet food diet and hometesting our cats' BG levels so we can understand how the insulin is working in their bodies and can then more appropriately fine tune doses for maximum effectiveness following a specific protocol.

Please feel free to ask additional questions! The folks here are wonderful and very generous with their time.

 

[squeem3]

. So, if I draw the insulin out with a syringe, the rubber stopper at the other end will automatically keep the air locked out?

Yes the inner rubber plunger keeps the insulin pressed up against the rubber stopper (the thing you insert the insulin syringe needle into) to keep air out.

Have you seen the pictures of how to use an insulin pen with an insulin syringe? http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=151

And:

Make sure to get U100 3/10 cc insulin syringes with half unit markings. The markings look like the scale on the left below:

Some pharmacists will insist that there is no such as thing as a half unit marked insulin syringe and may try to sell you 1/2 cc (50 unit capacity) instead :roll: If you buy the insulin syringes from a local pharmacy, be sure to check the package before you pay for it. The package will clearly say something like "half unit markings" or "1/2 unit markings" on the box. If there is nothing on the box, it may say so on the individual packets of insulin syringes. The insulin syringes themselves will have the half unit markings. I know that Wal Mart's Relion brand of 3/10cc insulin syringes come in half unit markings.

Many people here buy insulin syringes with half unit markings online so they can be sure that they will get the right product. Hocks.com and AmericanDiabetesWholesale.com are two places. BD, Monoject, and GNP are a few big name brands that have half unit marked insulin syringes.

 

[Randi & Max (GA)]

Hi Ellen
Welcome to the board. You are in a terrific place to get help for your boy.
I notice that you are using the trem "glargine" Do you happen to live in Canada?
If so city/province?
I am in Montreal if you need any help.

 

[Julia & Bandit (GA)]

Hi Ellen!

Everyone else gave you great advice about the syringes, but I just wanted to give you a few extra bits of advice about dosing with Lantus.

Have you considered blood testing at home with a glucose meter? The urine strips aren't as accurate in measuring blood glucose, and because we are using such fine doses the correct dose can be missed. Also, you can't always catch hypoglycemia with urine strips because a cat's liver will dump glucose into the blood if blood sugar is too low. You can use any human meter that you find at the store. Plus, I find blood testing far easier than urine testing.

Here is a link to the dosing protocol for Lantus: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581. It's been shown to bring 80+% of newly diagnosed cats into remission with a combination of home blood glucose testing and a low carb canned diet, including my own.

 

[doombuggy]

just wanted to welcome you to the board!!!

 

[Carl & Polly & Bob (GA)]

Hi Ellen, and of course you too Max!

You've gotten great advice and feedback about the syringe/lantus/pen issues, but there's something else I was wondering about after seeing your post.
First, incredible that Max is 21 years old! I had a female who lived to be 19, and she was the love of my life. You said that he has been receiving sub-q fluids every day for 2 1/2 years? Can you tell us what condition that is for? I have had to give Bob 100cc fluids 2 or 3 times a week for a couple months in order to raise his level of potassium, and just curious what Max needs them for.

Thanks, and welcome to FDMB!

Carl in SC

 

[EllenD]

Hi everyone and thank you again for all of these helpful replies! I will be getting those new syringes today.

Max has been on fluids for his kidney levels, which indicated compromised kidneys. Since starting the treatment his kidney values have improved slightly and then maintained the improved level.

He is currently on a home-made diet with low carbs. The recipe was provided by my vet at Wolf Rock Animal Hospital in Exeter Rhode Island. The main protein is ground dark turkey. A few green beans and a small amount of carrot is added in, along with psyllium powder to assist with bowel movements, which was the initial problem that led us to discover his kidneys were compromised. The rest of his feed follows supplementation as recommended by Dr. Pitcairn (cod liver oil, safflower oil, healthy powder, vitamin E and Taurine...I add the first three ingredients to his meatloaf before cooking, vitamin E, Taurine into the cooked mix). He receives a supplement called Renafood for his kidneys (this does have a small amount of sugar in it) as well as NuCat senior vitamins. He also receives a supplement called "Acetylator" that my holistic vet recommends for digestion. Canned wild salmon (no salt added!) helps it all go down a little faster.

Regarding blood glucose testing, I am interested in looking into this but one vet told me typical meters don't give the best reading...that a specific kind of meter is needed for cats. Anyone have experience with that?

Again, many thanks for your thoughtful replies!

 

[squeem3]

Regarding blood glucose testing, I am interested in looking into this but one vet told me typical meters don't give the best reading...that a specific kind of meter is needed for cats. Anyone have experience with that?

Any Human blood glucose meter will work. A Human meter can't tell the difference between Human blood and animal blood. You can buy supplies for the meter at any pharmacy unless you have a store specific brand (like Relion which is only sold at Wal Mart stores).

You don't need a pet-specific meter. Not only are the expensive, you can only buy test strips from the vet or directly from the company. Pet meters are no more accurate than a Human meter. Some people here have tested an pet meter against a Human meter with the same drop of blood and the difference between the resulting number is very small. Some people here do use a pet meter and keep a Human meter and supplies on hand as a back up.

 

[Larry and Kitties]

As I keep saying, BG readings taken with a human meter will be different when taken by a human meter and by a animal meter with the cat setting. This is because the glucose distribution between the plasma (liquid) and red blood cells is different between human and animal blood. However, the human meter is accurate enough for determine the insulin does for animals.

Species Glucose Concentration in RBCs Glucose Concentration in Plasma
Human ---------------42% ------------------58%
Canine ---------------12.5% ---------------7.5%
Feline ----------------7% -------------------93%

snip

Any Human blood glucose meter will work. A Human meter can't tell the difference between Human blood and animal blood. You can buy supplies for the meter at any pharmacy unless you have a store specific brand (like Relion which is only sold at Wal Mart stores).

You don't need a pet-specific meter. Not only are the expensive, you can only buy test strips from the vet or directly from the company. Pet meters are no more accurate than a Human meter. Some people here have tested an pet meter against a Human meter with the same drop of blood and the difference between the resulting number is very small. Some people here do use a pet meter and keep a Human meter and supplies on hand as a back up.