First days on lantus dose 4/10, more questions?

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phlika29

phlika29

Member Since 2014
Hi everyone

I have just given Remi his first lantus dose and I have some questions about feeding and testing BG. At least I think I gave the dose. It was was so small I am not sure as the plunger hardly had to move ;-)

His AMPS WAS 24.8/ 448.2 (possibly a bounce from a steep drop last night). will update here and the spreadsheet throughout the day.

My plan was to test every two hours starting at +2 and then tomorrow starting at +1. Is that okay or should I be testing more often over the possible nadir so maybe +2,4,5,6,7,8, 10?

What about feeding-on the caninsulin I gave remi food at +0, 2,4 and that was it. I know you can free feed more. Do I just keep putting food down?

Should I expect anything new from remi? At the moment he is sitting with his ears back looking at me. It might be because I smell like a hospital having also managed to squirt some on my pyjamas :lol: I also got some Lantus on my hands when I got rid of the excess in the syringe that I had drawn down and seemed to have rubbed it near my eye. Going to wash my face but it isn't terribly dangerous is it?

If anyone could just keep an eye on me today that would be great. I am slightly paranoid as remi's low shot on his first and second shot when he first started.

Many thanks

Sarah and remi
 
Re: First lantus dose 4/10, questions

AMPS: 24.8/448 (fed and 0.5 unit lantus)
+2: 23.5/423 (fed)
+4 : 21.6/ 389 (fed at 4.5)
+6: 21.4/385
 
Re: First lantus dose 4/10, questions

I'm here hon,

Since this is his very first shot you really don't have much to worry about with him going too low, in fact you might not even see his numbers move that much at all today. You're going to have unlearn everything you learned about Canninsulin when it comes to Lantus. They are two VERY different actions. Caninsulin is an "In & Out" in that you give the shot, BGs drop, and it's gone from the system by the next shot time.

Lantus is a depot insulin, where each shot builds on the next one. It forms a shed or depot under the skin, when you first start giving Lantus most of it goes to form that shed.

Think of a funnel that you are trying to fill up but you can't plug the bottom hole, so the water keeps running out of the bottom. You're looking for a dose that keeps the water in the funnel just level with the top of the funnel. Pour too fast or too much and it over flows (Hypoglycemia), but if you don't pour fast enough, or enough then the top level drops (hyperglycemia). Pour just enough and at the right speed and the water stays level. But you have to get to that point first, because even if you'r pouring the right amount at the right speed you have to get the water to the top of the funnel in the first place, Right? Well that's what happening right now, most of the water (Lantus) is staying in the funnel (the shed) with only a little running out of the bottom to help Remi lower his BGs. A Lantus shed can take from 3-5 days to fully form in the beginning so today wouldn't worry much about it but any and all data collected is always a plus. :-D

Mel and The Fur Gang
 
Re: First lantus dose 4/10, questions

Thanks mel:). I hope you are feeling better as I read your had been unwell.

That's a great explanation. I tend to be like my dad and go at things like a bull in a china shop and want results straight away so this really is going to test me :lol: I think I will still continue to test today and up to +4 tonight partially because I can't seem to stop myself :roll:

I was reading another thread about ketones and ensuring that a cat with high blood glucose eats enough. I am not sure I have been doing that for remi as I was desperate for his BG to stay low on the caninsulin and therefore only gave a few meals and the calories he should normally have. But today I have been giving him between 30-45 g of food every two hours and he seems happier.
 
Re: First lantus dose 4/10, questions

Hi
we know how you feel. we all want immediate results but this sugar dance has really given all of us a go on learning patience.
good luck with your kitty. It takes a long while for all this to work so just be patient (boy do i know how hard that is)
Nadine
 
Re: First lantus dose 4/10, questions

Thanks Nadine. It's so reassuring to hear that others have been where I am.

So we have just completed the first 12 hrs on lantus. I have updated the spreadsheet but for ease will post the figures hear. I know it is early days but it interesting to see the difference from the caninsulin

AMPS: 24.8/448 (fed and 0.5 unit lantus)
+2: 23.5/423 (fed)
+4 : 21.6/ 389 (fed at 4.5)
+6: 21.4/385 (fed)
+8: 21.1/ 380
+10. 20.3/ 365

PMPS: 20.0/ 360 (fed and 0.5 unit)
+2. 20.0/360 (fed)
+4. 18.4/331

I must say that the lantus really hurts my eyes. Just that strong smell makes them sting and feel really odd. I can still smell it now half an hour later. I am pulling back more than I need and then flicking it to get rid of the air (if I can) and then shooting the excess into the air. But I get it on my hands, on the table and it is horrible stuff! Is there another way. Can I just carefully just draw up what I need? Can I shoot the excess down into a tissue rather than up into the air. I almost feel that I am slightly allergic to the stuff. Does that sound silly?
 
Re: First lantus dose 4/10, questions

i also draw up just a little bit extra- then hold the syringe up and tap on it to get the air bubbles to rise and then
i gently push the plunger in and let the excess go into the sink. Sometimes, you can turn the plunger and that expels
a drop at a time but it doesn't always work. I usually only draw up about an extra half a unit and then tap and expel the
rest so there is not alot of insulin wasted. I hope that helps.
 
Re: First lantus dose 4/10, questions

tibbs5 said:
i also draw up just a little bit extra- then hold the syringe up and tap on it to get the air bubbles to rise and then
i gently push the plunger in and let the excess go into the sink. Sometimes, you can turn the plunger and that expels
a drop at a time but it doesn't always work. I usually only draw up about an extra half a unit and then tap and expel the
rest so there is not alot of insulin wasted. I hope that helps.
Click to expand...

Thanks. I followed your advice but used a tissue folded up on the table and then quickly threw it away. I also made sure that I didn't get any on my hands and kept my face further away and it was much better. Bit still made my eyes sting for just a little while but not as bad.

Have updated remi's spreadsheet but he is basically hanging around the same numbers as yesterday. It's a little disconcerting as he is back to drinking more again and sitting under the bed a little but hopefully that will improve in a few days as the well fills :smile:
 
Re: First lantus dose 4/10, questions

HI Sarah,

Sorry to hear about your insulin woes. Lantus has a real hospital smell, doesn't it. If you slide the syringe plunger back and forth a few times before inserting the needle into the vial, it moves more smoothly. I find it helps when trying to express the excess insulin from the syringe.

Remi seems to have a very smooth response to the Lantus. If I have understood the posts here, I think that may be a good thing. Hopefully it will stay nice and smooth and gradually it will move down to regulated numbers as you refine the dosing. You're absolutely flying with the home testing! :-D

Sending Remi some feel-better-and-come-out-from-under-the-bed fusses ---> cat_pet_icon
 
Re: First lantus dose 4/10, questions

Hi Aine

Last night I thought I might be having some sort of allergic reaction to it as my skin and lips were tingling afterwards. I have rosacea and smells can actually make me flush so it was probably just that smell and my paranoia rather than an actual reaction :lol: . I has laser a couple of weeks ago and so my skin is hyper sensitive at the moment. Anyways it was better today and hopefully my technique will continue to get better.

The hiding under the bed is a nightmare. Remi has asthma and their are books and musical instruments under the bed that need dusting. When he hides if you try to get him out he just goes right into the middle and rubs his face along all the really dusty things. The only way I can get him out is to show him that both my hands are empty and lay on my back and pretend I am going to do some sit ups. That way he knows it is safe to come out and sit on my chest, his usual routine if I ever tried to exercise at home. :-D

Remi figures have just been hanging around the 20 mark all day so obviously it is still building in his system. He had a very soft poo today which I blame on the miralax I have been giving. When he was on dry food he really needed it but I don't think he has that problem any more! :shock: :? Since he switched to wet it is a lot more smelly. I hope that doesn't mean that the food isn't suiting him. Sorry I digress....
 
Re: First lantus dose 4/10, questions

HI Sarah,

Glad to hear the insulin wasn't as mean to you today! :-D My mum also had rosacea and her skin was extremely sensitive, too. Not fun.

What is it with cats? Never a geometry lesson in their lives and they never fail to park themselves slap bang in the centre spot under the bed. :roll: Hope the dust doesn't trigger Remi's asthma. Hearing about Remi sitting on your chest made me lonesome for Amadán: he used to love parking himself on my chest ...

What food are you giving Remi at the moment? Is there any change in the colour of his stools (more tan than brown, maybe?).
 
Re: First lantus dose 4/10, questions

Hi Aine

Yes I would say that they are slightly lighter in colour. I guess the combination of wet food and actually real chicken makes them different??

Everything seems to set remi's asthma off. I would say dust mites, dust, wool and feather. When my funds recover I think I will try an air purifier. Remi loves to sit on my chest when we first go to bed ;-)

I must say I am a little disappointed by tonight's +2 reading it is higher than it has been all day today. I don't think I missed the shot. I truly hope not as I Do worry about these higher numbers. I think I read that with lantus it can raise a little and then drop??
 
Re: First lantus dose 4/10, questions update 5/10

So what do people think has happened here? Remi spent most of Saturday and earlier today sitting around the 20mark with his new lantus but tonight he is higher after his evening shot. Back up to 22 and 23 at +4. Could this be a bounce or do you think I missed the shot? It didn't feel like I did but the dose and needle are so small it's really hard to tell.

I am concerned that if Imissed the shot his deposit won't be filling up like it should :sad: and he will sit at the higher numbers than necessary. Or maybe I am wrong to expect the smooth downward trend that I had been seeing?

Cheers

Sarah
 
Re: First lantus dose 4/10, questions update 5/10

Hi Sarah,

Remi sounds like my Amadán. Ammie would sleep beside me using my outstretched arm as a pillow, but in the mornings he would sit on my chest and nuzzle me to wake me up. I miss him so ... :cry:

The +2 rise on Lantus is common (from the pre-injection feed). I don't have enough experience to be able to offer any useful opinion on the increase in Remi's numbers. When we switched to Lantus, I think Saoirse's BG was influenced for the first couple of days by Caninsulin carryover and I needed to adjust her dose after that. Hopefully more experienced members will be able to give you a better idea of what might be going on with Remi. Do you keep the syringe in place for a few seconds after you have depressed the syringe plunger? I'm not sure, but I think it might be more important to do that with smaller doses to ensure the insulin dose is delivered properly.

How is Remi doing in general given the reduction of his steroid treatment?
 
Re: First lantus dose 4/10, questions update 5/10

Hi Aine

Amadan does sound very similar to remi. Remi used to love to spoon when he was feeling better. Hopefully this will return again.

Remi seems okay without the steroid. I think the main difference de is in his asthma. He is more chesty and I would like to address this in the future. Other than that it's hard to tell as he is moving about so slowly. He does have a little arthritis in his back leg but again I can't really tell at the moment.

Again his level has marginally gone up at +2. Not quite as much an increase as last night but still higher than the preshot. As you say he gets fed just before his shot. I would love it if someone can comment on this. How is it best to fed a cat on lantus. Smaller and more often or does it not matter? Remi is having three meals all of about the same size usually at shot time, +2.5 and +5. I must say the longer remi stays this high the more worried I am getting about ketones.

I have tried to keep the injection in. Last night I whipped it out quickly but tonight I let the tent go and then waited and pulled it out but would love to hear the best technique to use.
 
Re: First lantus dose 4/10, questions update 5/10

Hopefully the snuggling will return as Remi's numbers lower again. Saoirse has started snuggling up beside me again at night and I'm thrilled! :-D

I can't remember where I saw it written but the recommendation with Lantus is to feed smaller frequent meals because it is longer acting and the nadir can be later than for Caninsulin. I feed Saoirse mini meals about every two hours. Timed feeders are very much the way to go. The Petsafe 5 is a favourite for many members. I've got some Cat Mate 20 and Petpod twin feeders. The Petpods are useless when appy stimulants are in play - too easy to burgle - but the Cat Mates are relatively tamper-proof. If you're looking to get some, the link below is for the best price I could find on Cat Mate 20s but it might be worth double-checking on Ebay to see if there are any cheaper offers. Kettering Koi and Pond delivered really quickly and they are very helpful.

http://www.ketteringkoi.com/pet-mate-c20-automatic-cat-pet-feeder/

To get more responses to this thread, it might be a good idea to go back to the opening post and editing it to add a question mark to the subject.
 
Thanks Aine

I think I will invest in a timed feeder however remi is almost deaf now and since unwell he sleeps really heavily and I do have my concerns that he would actually wake up to feed but I guess in the end he would. At the moment I am getting my partner to put down food as he is often home in the morning and then my mum to pop in at lunchtime. It would be nice to know that there is another option. I wonder if I am putting too much in one go then. Again his reading is higher tonight after his injection :!: .

Have edited the title so hopefully someone will chip in but as ever you are so helpful and kind to me and I am so grateful. I hope your little Saoirse is doing well.

Hugs

Sarah.
 
You might try splash googles.
Maybe draw it up under the range hood with the exhaust fan on.
 
Thanks to the flu I'm very late to the party.

But a typically Lantus curve is


+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number. You'll probably see an active cycle if the +2 is the same/similar or lower than the preshot number. Continue testing!
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (one of the quirks of Lantus/Levemir: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.

Hope this helps.

Mel and The Fur Gang
 
Mel

That's a really useful breakdown hour by hour.

Remi is on the second cycle of the increased dose of lantus-0.75 and I am beginning to see the effect. I just took a +10 reading and he has dropped right down into the yellow zone ( 12.4 mmol / 223) from 22.3/ 401.

Could this be the slight BG drop that can be noted at +10? I whilst I want to see the yellows does this mean that if he starts off lower on his preshot he could end up with the same type of drop tonight and go right into the blues or even greens? Or is it more likely that he gets a rebound or perhaps things settle down.

Feeling slightly panicky about this development :?

Sarah
 
Note: that breakdown is approximate!
Cats' glucose levels often vary, so home testing helps you Id what your cat's pattern is ... once there is one. The first week or so, numbers can be rather erratic as the body gets used to having insulin again and as you narrow in on an optimal dose for your cat.

Yes, with a depot insulin, dose introduction or change may be accompanied by 5-7 days and 3-5 days respectively, where each day is a slightly greater amount of change.

Being prepared in case numbers go lower than ideal will help you be more confident. Have on hand an extra package of test strips, extra lancets, some high gravy food and/or Karo syrup, a teaspoon, an oral syringe, and locations(s) of the nearest 24 hour emergency vet.

When you get a test lower than 50 mg/dL, re-test and intervene
- feed 1 to 2 teaspoons of high carb gravy
- wait 20-30 minutes
- re-test
- repeat as needed
- start adding in regular food as the numbers come up
Note that gravy wears off fast. You want to be past nadir and rising 3 times in a row.
 
Thanks BJM.

I have shot a reduced dose tonight a little later than usual because remi still had a low reading. I feel a little out of my depth, especially about what to do tomorrow morning.

I started an urgent thread in the tight protocol lantus thread as I thought it was more likely people were online so please can people have a look and comment

viewtopic.php?f=9&t=126633

Cheers
Sarah
 
It may help if you use 4 Oct 2012 or MM/DD/YYYY dates.
Some of us may misread it as an April date and skip your post.
 
BJM

Yes i have to mentally change around the dates that I see on the forum to make them make sense to me :lol: I will try to write the date out differently for my US cousins.
 
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