High readings Lantus all of a sudden

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Vicpug

Vicpug

Member Since 2022
Penny has been well controlled on 1U Lantus twice a day. Occasional spot readings on Alphatrak show she has been between 6.5 and 10 mmol. Last few spot checks show she has risen to 15.8, 16.9 and 18.7 this morning after a 1U at 4am. We are trying to get her to lose weight and moved to more high protein low carb wet diet. Tiki Luau Chicken is high protein 15% and close to zero carbs. Is Zero carb diet a problem? Is the Lantus Pen becoming less effective? Using only 2U per day means a 300U pen can last for 150 days. We keep the pen in the fridge and it has expiry date of 01 2024. This has been in use for about 60 days.
 
If you follow the instructions (which are precise) , the SS is ok (I think). Makes sense. Phew, nice to hear from FDMB'ers.
 
It looks like you've been holding the same 1.0u dose at least since April. A cat's insulin needs can vary. We recommend that you get a minimum of 4 tests per day. You want to always test at pre-shot times so you are sure that numbers are in a safe range to give insulin. You also need to get a test close to nadir (lowest point in the cycle) during both the AM and PM cycles since Lantus dosing is based on how low the numbers go. If the insulin dose isn't bringing your cat into closer to normal range, it's possible that glucose toxicity has developed -- in other words, your cat's body is treating the higher numbers as the new "normal." If you look at members' spreadsheets, you'll note that most people here keep a daily record of their cat's blood glucose readings.

We also do not recommend using the pen to dispense insulin. You can only adjust the dose in 1.0u increments and you have to waste insulin by priming the pen. We recommend using U100 syringes since dose changes are made in 0.25u amounts.

As long as you don't see any particulates floating around in the insulin, the pen should be fine.

The Tiki Cat food is fine. Some cats do better with a bit of carbohydrate in their diet but many do just fine on a low or no carb food. If you recently switched to the new food, it could take a week or two for your cat's system to adjust.
 
I have added one row in spreadsheet for February. This is a 14 day average which I pulled out of the Freestyle Libre 2. It is very difficult to get graphical info out of Freestyle Libre 2, so I have used the 14 day graph from the smartphone app. We are noticing the cat has mild diarrhea now. She never had diarrhea with dry food, but now she is on more wet food. Can wet foods cause this to happen, or is this food she is eating simply rubbish?

I have noticed that when injecting Penny, sometimes I am not sure if I have penetrated the skin layer or not. Sometimes I can feel the 'click' of piercing the skin and sometimes not. I think the 4mm Lantus syringes are too short.
 
Vicpug said:
I have added one row in spreadsheet for February. This is a 14 day average which I pulled out of the Freestyle Libre 2. It is very difficult to get graphical info out of Freestyle Libre 2, so I have used the 14 day graph from the smartphone app. We are noticing the cat has mild diarrhea now. She never had diarrhea with dry food, but now she is on more wet food. Can wet foods cause this to happen, or is this food she is eating simply rubbish?

I have noticed that when injecting Penny, sometimes I am not sure if I have penetrated the skin layer or not. Sometimes I can feel the 'click' of piercing the skin and sometimes not. I think the 4mm Lantus syringes are too short.
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Hi I hope you can get your girls #s back down. Something that helps me keep my boys #s straight is I write the time & his BG # down in a notebook & than I put it in his spreadsheet. Good luck with your girl, they are super knowledgeable on here! I trust them 100%
 
Victor, would you mind putting that you are using Lantus insulin into both the SS and the signature please so we can tell what type of insulin you are using. Thanks.the 4mm syringes may be too short. This 6 or 8mm ones are better.
Are you using the U100. 3/10 30 or 31 gauge insulin syringes with the 1/2 u it markings?
Do you think you could soupy and paste a photo of the syringe you are using into here please so we can see?

Also it is really important that you always test before every shot to see it is safe to give the dose. Do you think you are able to do that?
 
Image attached of the pen and 4mm syringe tip.
 

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Vicpug said:
Image attached of the pen and 4mm syringe tip.
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Thanks for posting the needle. I thought you are talking about a syringe needle. I don’t think you can so change the pen needle.
Have you thought about swapping to a syringe to give the insulin. You can give smaller doses with a syringe. And that is what we recommend. Penny will not always be staying on 1 unit. She will either go up or down in dose.
And you would be able to use a more suitable needle.
The syringes you need are U100 3/10 30 or 31 gauge, 6 or 8 mm insulin syringes with 1/2 unit markings.
You can still use the insulin from the pen you have. I will show you how.
upload_2022-6-5_16-57-34.jpeg
 

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The problem with using an average blood glucose is that you have no idea how low your cat's numbers have dropped. Without knowing how low the numbers have gone, you don't know whether to reduce the dose. Based on the dosing methods we use, your cat would have needed a dose increase. However, we increase doses by 0.25u. You can't do this when dispensing insulin from the pen. We recommend U-100 3/10cc syringes with half unit markings with a needle length of 1/2 or 5/16 inch.

The food you're using is fine. Many cats can experience a GI upset with a change in diet. If you want to add a probiotic to Penny's diet, S. boulardii is very good for the treatment of diarrhea. The diarrhea should resolve on its own unless your cat has an allergy to certain proteins.
 
Many thanks for all the great advice. My long term plan for Penny was predicated by seeing a very well controlled 14 days in February with the Freestyle Libre 2 sensor and 1U twice per day via Lantus pen. Her weight had dropped from 7.4kgm back in October last year to 6.7kgm now, but frustratingly she has not moved any lower. So I was using ad hoc BG tests with Alphatrak to see if there was any changes in BG. I think testing Penny 4 times a day (twice in each ear) would be very difficult. Just a one ear jab per day puts her into high stress mode. I am tempted to put her onto another 14 day Freestyle sensor. The recommended U-100 needles appear to not be easily available in Australia.
 
Vicpug said:
The recommended U-100 needles appear to not be easily available in Australia.
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I live in Australia Victor and the U100 syringes are readily available.
Any pharmacy can order them for you or you can order online.
U100 3/10 3 or 31 gauge 6 or 8 mm insulin syringes. We can’t get the 1/2 unit ones here though.

Here is a link to buy onlinehttps://www.medicalaestheticsupplie...MI1vDAgpaY-AIVmJJmAh0_WgRuEAQYAiABEgJoCfD_BwE

Or this one from Pharmacy Direct https://www.pharmacydirect.com.au/b...MIysX4xZaY-AIVvZpmAh1bbAQAEAQYBSABEgItrfD_BwE

Just make sure it is the U100 3/10 syringes and no others.
 
Vicpug said:
Yes I have the NON 1/2 unit syringes. Thanks for the info.
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If they are the 3/10 syringes you should be fine. That is what I used for several years. You just have to eye ball the amount. If you are wanting to draw up 1.25 units you have to imagine the amount between the 1 unit and the 2 unit marks is divided into 4. Then draw it up to the first imagined 1/4 mark. I mfound a magnifying glass invaluable.
 
Vicpug said:
I have added one row in spreadsheet for February. This is a 14 day average which I pulled out of the Freestyle Libre 2. It is very difficult to get graphical info out of Freestyle Libre 2, so I have used the 14 day graph from the smartphone app. We are noticing the cat has mild diarrhea now. She never had diarrhea with dry food, but now she is on more wet food. Can wet foods cause this to happen, or is this food she is eating simply rubbish?

I have noticed that when injecting Penny, sometimes I am not sure if I have penetrated the skin layer or not. Sometimes I can feel the 'click' of piercing the skin and sometimes not. I think the 4mm Lantus syringes are too short.
Click to expand...

Hi Victor, welcome to the FDMB. Penny is a beauty. I am a new member here myself and user of the Free Libre 14 days (not the Libre 2). With the Libre 14 days, I have the reader (i prefer it to my phone) and I connect the reader to my libre app via cable. Then in the app I can download libre data in excel since the begging of time. The download shows BG reading for every 15 min (as long as you scan at least every 8 hrs). Not sure about the Libre 2 but there has to be a way to view the data (maybe not on your phone but your libre link app on the computer). So you would not need to average anything. Tagging @alio as I know she uses the Libre 2 and may have more tips for you.
 
Sadly the Free Libre 14 day is no longer available in Australia. Also I see that a much smaller device is on the market Freestyle Libre 3 , but it will take years before Vet approval. Getting the data of the phone is not possible
. Abbott really need to fix such a simple problem.
 
Vicpug said:
Sadly the Free Libre 14 day is no longer available in Australia. Also I see that a much smaller device is on the market Freestyle Libre 3 , but it will take years before Vet approval. Getting the data of the phone is not possible
. Abbott really need to fix such a simple problem.
Click to expand...

I agree with getting data off the phone. I suspect they did it so we buy their expensive readers. They also have a reader for the Libre 2. Looks like it works the same as my reader. Plug it to the computer and get downloads. Maybe worth looking into for peace of mind and tons of trend data. I am looking forward for the libre 3 as well.

https://www.freestylelibre.com.au/freestyle-libre-2-reader.html
 
I've been using the Libre 2, but, my understanding is that it's mostly identical to the Libre 14 day (the only difference is the Libre 2 has alarms for lows / highs).

I don't have a reader, I use the phone app, so, I can only really comment on how that works and what it offers. The phone app is syncing the data up to the cloud. You can log into https://www.libreview.com/ with the same credentials as the app and access your data and reports. You can also download the raw data and see every single reading the sensor has collected on its own every 15 mins (stored/historical/continuous) and the readings you have scanned ad-hoc with your phone (it separates the two types). The website also has a number of reports you can look at to see trends over time, similar to the app.

I originally had the app setup on my phone, but, this wasn't great for when I was out because DH couldn't scan. Only one phone can be "connected" to the sensor at once, but the real annoyance is that even if you signed both phones into the same account and hot-swap which one is connected to the sensor, the phone app will only ever show you the data you scanned. It still syncs it to the cloud where you can see all the data from both devices, but, there just isn't a way to get the data DH scanned on his phone onto my phone. Not a big deal, just annoying.

In the end I just dredged up an old phone and now Cinna has his own phone. No sim, it just connects to the wifi and has the app.
 
Yes, thankyou alio, I can get this to download data, and yes I can see reports etc on the libreview. Also, I can upload the csv to a Tidepool account and get more information.
 
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