Experienced Lantus Users - Pic of Fitzel Up Finally

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Shai and The Pirate Fitz (GA)

Member Since 2012
I'm posting here instead of Relaxed Lantus as I know more eyes visit here. I've noticed a very strange pattern with Fitzel's numbers and I'm wondering if anyone else using Lantus has run into this situation.

Fitzel is on .25u 2x/day - she seems to go in cycles of getting her shots, then three or four days later, throwing numbers which warrant no shot. Then she climbs back up - her shed drained? - and she's back on her .25u - then she crashes into hypo warry numbers. Yesterday she threw a 31, and she ate a good breakfast. I watch her, so I know. These low numbers can start as early as +3. If Fitzel didn't throw big numbers when the Lantus works itself out of her system - I'd almost think this cat didn't need insulin.

I realize I may not have enough numbers for some to want to comment and I completely understand this. As do we all - I'm doing the best I can with the circumstances of my life.

But, if anyone is willing to take the info available and let me know if they've ever seen anything like this... dealt with anything like this - I'd be very, very appreciative.

As she just tested at 50, I'll be testing her again in about an hour. I'm concerned she's on her way down again.
Shai
 
Re: Experienced Lantus Users - Need Help

Hi,
Is she showing any symptoms of hypo?

I want someone better than I to tell you for sure but 50 or less, is a dose reduction ....

Do you have a high carb (HC) food with gravy? You need to start giving her a couple of spoonfuls of gravy, and need
to stay with her. You will be continuing to do this and continue testing to get her numbers back up.

Those numbers in the 30's., yesterday... No symptoms??
 
Re: Experienced Lantus Users - Need Help

And yes. you are on your way off of the insulin.
I didn't want to stop to type more until we get you feeding the gravy.....

and new numbers.
You want to purposefully cause the numbers to go back up....
 
Re: Experienced Lantus Users - Need Help

Hi Rhiannon: no symptoms yesterday - odd as that is. She was hiding in a new spot and the only time she explores new spots to hide is when she's not feeling well.

I fed her some HC gravy food right after I got the 50. Now I'm waiting a bit to see if her numbers go up - or what?

Fitzel is not showing any signs of hypo now either, but she was behind a bookcase she's never shown interest in before. So I tested. Thank God.

This seems to be a developing pattern with her. I have considered shooting less that .25u, but I have no idea how to draw that tiny amount into a syringe marked with half units. Have you ever had reason to do this? If so, how were you consistent in your dosing. Since that might indeed be where I'm headed, I'd love to find out how to do this.
Shai
 
Re: Experienced Lantus Users - Need Help

Many cats headed to remission need to be weened slowly off insulin with microdosing. That hypo incident yesterday warranted a decrease to .1u of insulin.

Cats do not have noticeable hypo symptoms until the hypo is severe--so, if you have a mild hypo incident then you won't know the cat is had the hypo unless you get a mid-cycle check like you did yesterday and today.

I know I was bugging you a while back to get some daily nadirs, and this is exactly why...we don't know if she was dropping too low mid-cycle on .25u and needed it reduced already, and that's what was causing her high blue/low yellow preshot numbers on the .25u.
 
Re: Experienced Lantus Users - Need Help

Shai,
There are tricks to getting less than .25 in the syringe. I'm going to ask people who've done it to chime in.

Carl
 
Re: Experienced Lantus Users - Need Help

Here is what .1u of insulin looks like:
01unit-1-1.jpg
 
Re: Experienced Lantus Users - Need Help

You can also "skinny" or "fatten" up doses if .1u is not enough and .25u is too much. A "fat" .1u would be .1u plus a drop or two, and a "skinny" .25u would be .25u minus a drop or two.
 
Re: Experienced Lantus Users - Need Help

73.

I'll test again in an hour.

I'm very willing to reduce her dosage. How does one measure .1u with any consistency? Is there a syringe available with .01u marked?

Shai
 
Re: Experienced Lantus Users - Need Help

It's good that she's not having any symptoms but her wanting to hide may indicate she senses she's a bit over the top.
Every cat is different so a hypo number for one may not be the number for another.

It's just once you get to 50, you have to change course and intentionally raise the numbers until you are far enough along in the cycle that it is time for the numbers to increase again.
You're home for the next many hours, right?

You want two consistent rises in bg and you probably want to be past the +6 since you don't have that many test numbers
on the chart yet.

You will have to get the new dosage from more experienced eyes, but here is a link that shows you micro-dosing.
Scroll down to the pictures of syringes....

http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=18139

I'm about to go down too.
You find consistency by picking a spot on the syringe ( in the number you are shooting) and try to always get it right there on that spot. For instance, I've been shooting .9 , or really it's a skinny 1 unit. So the line for 1 unit , I'm a hair less.
So when I see the black of the plunger covering the 1 unit line exactly. That's what I've been doing.
 
Re: Experienced Lantus Users - Need Help

Julie - thank you for the pic.

It looks like what I've been calling .25u. I've been trying to cut the 1/2u mark with the depth of the plunger disk to where I can see a glimmer of insulin.

Maybe I've been giving her .1u and not .25u.

Shai
 
Re: Experienced Lantus Users - Need Help

No syringes for .1 unit.

I want a barbie syringe too. :-D

the best I've found is some lab rat syringes ( thanks to Phoebe) but the syringes are glass.
One is $35.
The needles are separate, and it's $40 ish for that and I don't even know if you get 1 or some quantity.

But they have a negative about them, a dead space where the needle attaches.

so. you're stuck with what we have.

It will help you to take an old syringe and practice with colored water. Try to keep loading the same amount.
 
Re: Experienced Lantus Users - Need Help

Thank you Rhiannon. I agree, no glass syringe.

I'll put a drop or two of vanilla in some water and practice. But, I really do believe I've been dosing at .1u already.

Shai
 
Re: Experienced Lantus Users - Need Help

okay.
I just went and got one of my syringes.
I pull the plunger to the zero mark and there is still a tiny empty space where you can push the plunger and if there were
anything in it. a few drops would come out. probably 2.
and that's at zero.

So you are just on the greater side of the zero mark?
 
Re: Experienced Lantus Users - Need Help

Rhiannon - that sounds good. I can do that.

Now, the question is - when do I start the new dosage? Tonight? What if her numbers climb - let them and continue dosing at the new amount?

What would be considered an ideal result of the new dosage in terms of expected numbers in the beginning?

Shai
 
Re: Experienced Lantus Users - Need Help

Rhiannon - okay, just realized you were asking me a question. Yes, I've been just on the slim side of Zero. But, not as close to Zero as what we're talking about now.
Shai
 
Re: Experienced Lantus Users - Need Help

This is what .25u looks like:

025unit-1-2.jpg


And this is what less than .1u looks like (some insulin):

someinsulin-1.jpg


If you really think you've been shooting .1u instead of .25u, then you have two choices. You can shoot "some" insulin for a week or so and see how she does, or just start an OTJ trial now. With as low as Fitzel dropped on .1u (if you're sure it was .1u and not .25u or a skinny .25u), then I would probably start the trial.

+2 and +4 tests are very revealing in an OTJ trial, because they can show if her blood sugar is lowering on its own the way it should be after she eats.
 
Re: Experienced Lantus Users - Need Help

I shoot Cini Mini at <0.05 (which, for me is what's left in the hub of the syringe and the needle once you push the plunger gently back down all the way), literally a drop.

The AM/PM PS numbers are the last to come down. You will get low nadirs during the day and then kitty will go back up over 100 by AM/PM PS.

What you might have to do is feed kitty some MC at +2 to prevent the dive at that time.

Remember, you want a nice flat curve so managing with food may be a good approach for you.
 
Re: Experienced Lantus Users - Need Help

The way I micro dosed and determined the amount, was I drew up the insulin to what I figured .25, .1, etc would look like to me and called it that number, the trick is to keep consistent with whatever it looks like to you.

for me .25 was as close to the middle of the 0 line and .5 line,

then as I went down the scale - say .2, I went to my .25 line and took a drop out, and to get to .15, I took two drops out and for .1, three drops removed.

At this point it's such a small amount that you need to guesstimate what looks right to you and then carefully squirt out one drop at a time to lower it down to what you call .1

The pics are helpful, but it's not an exact science when you are trying to do it yourself and it's hard to match the pics. Try not to get too hung up on matching the pic, rather be consistent in the amount you draw, squirt out, etc and call it.

And in case you haven't realized it, this is where the real fun begins!

And Rhiannon is correct there is insulin in the neck of the syringe that is below the plunger line.

Maybe practice with water and a used syringe until you get comfortable with pushing out one drop at a time.

just my 2 cents.....
 
Re: Experienced Lantus Users - Need Help

112 - yeah - she's on her way out of the slide.

Thank you Hillary, Cini Mini's Mom, Rhiannon, Julia, Carl, Sherry, everyone -

I'm so glad I posted this event as I've learned some valuable information - When I thought I was shooting .25 I put the bottom of the plunger on the 1/2u mark. That looks very much like the pic of .1u. I agree this is not a science - more like a theory or guidelines - but they're valuable theory's and guidelines.

I think what I'll start tonight is the 'some' insulin and see where she goes. I'll keep her SS updated (I do it at night and put in all the day's readings - unless there's an event, like today)

She's sitting next to the computer, cleaning herself with a vengeance, sending furr storms floating down onto the keyboard. Some normalcy. Finally.

Shai
 
Re: Experienced Lantus Users - Need Help

I have had that same experience with 3 different cats, including Ricky, who is my current sugar kitty. My vet would not believe me even though I provided my readings. They did not believe it until I had to board Witn and Spot with them for a week and I required the to test each cat with my meters. I am not sure why it happens, but I can expect it to happen every few days. Unfortunately it does not happen in a consistant number of days to determine the exact pattern. It just happens at least once a week with my cats
 
Re: Experienced Lantus Users - Need Help

Shai

Rhiannon asked me to pop over from the Lantus TR ISG. Sorry I wasn't around a little earlier but everyone gave you great info.

We like to keep them on insulin as long as safely possible in order to ensure a successful OTJ trial and remission. I do see a couple of dose reductions that you missed. When she was in the 40s on a.m. cycle of 7/17 and you shot .5u that morning....you should have taken a full reduction to .25u. And you should have taken a reduction yesterday after the 30s.

But because we really like to see them below 100 the majority of the time before you take them off, I think shooting "some insulin" is a good idea to see where she is headed.

She's still bouncing a bit off those low numbers and hopefully on less insulin, she'll flatten out a bit more. I'd also recommend that you try and get a +10 or +11 test in your PM cycle so you can see if she is dropping or not
when you get the AMPS. And if possible, a mid cycle test at night would be good so you can see how low she is going.

I think she's on a mission ;-)
 
Re: Experienced Lantus Users - Need Help

I want to go back to the point that Julia made. By not testing during the PM cycle, Fitzel may have been dropping into low numbers overnight and may have been earning dose reductions. You finally caught that reduction yesterday. As Marje pointed out, there were some other reductions you missed.

It sounds like a plan to shoot "some" insulin. I would encourage you to get at least a before bed test every night.
 
Re: Experienced Lantus Users - Need Help

Thank you Marjorie and Sienne - I just got back online to update Fitzel's SS and thought I'd let everyone know in case they wanted to see her latest BG.

Re: PM cycle tests - this is probably more info than anyone asked for - Right after Fitzel's PM shot, I have to spend time connected to medical equipment for several hours. I need to do the same thing every morning. It limits what I can do and when I can do it. Fitzel's not even allowed in the room when I'm doing this. None of our cats are.

I completely understand that PM tests are just as important as Afternoon and AM tests. If things were a bit different with me, I could get them now, as Fitzel and I have come to an understanding about BG tests. She hates them - I do them. And, just like everyone assured me, her ears have become much more cooperative in giving me blood to test.

I'm so grateful to everyone on this board for rallying to help. There just are no words in the English Language which properly express the gratitude I'm feeling.

I'm going to start the 'some insulin' tonight and hope she levels out. I'll be posting her numbers in case you'd like to follow her for a bit. I know I certainly won't mind the hand holding.

Shai
 
Re: Experienced Lantus Users - Need Help

Shai,
It sounds like your plate was full before taking this on. You are doing an amazing job with how far you have come
so quickly for Fitzel. :YMHUG:


I will be watching for those updates.
 
Re: Experienced Lantus Users - Need Help

Shai: I am so proud of you and the progress you have made with Fitzel. I look at your spreadsheet almost every day to see how you are doing and am so happy to see those low numbers. Keep up the good work. All the best to your family! PS: I wish you would add a picture of Fitzel so we can see her. Would love to see what she looks like. :)

Melanie
 
Fitzel's markings are soooo BEAUTIFUL!!!!! I love the one of her sleeping! Thank you for letting us see her.

If you want to add Fitzel's picture to your profile (so her picture shows up whenever you post), it is easy:

1. Click on “User Control Panel (top of this page, under the picture of the cat)
2. About midway on the page, there are some blue tabs. Click the one that says “Profile”
3. On the left side of the profile tab, click on “Edit avatar”
4. Upload the picture from your computer (click “browse” button, locate photo on your computer)
5. Hit “submit” button
 
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