How long before insulin needs to be replaced?

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lolacat00

lolacat00

Member Since 2013
Hello,

I am concerned about my cat Lola. Her BGL has been rising fairly rapidly the past few days. She was diagnosed two months ago so I am still pretty new to this. This morning she was at 242 before her shot. I increased her dose to 1 unit up from 1/2 a unit. We are unable to test during the day on most days because we are at work. Before her PM shot today, her level had gone up to 320. Last night her numbers increased from 225 to 240 4 hours after her PM shot. She has only been back on insulin for about 6 days. Before this her numbers were in the low 100s with no insulin for about a week.

The insulin we have been giving her is Lantus in a 10 mL vial. It is two months old now and it seems to me that it is not lowering her BGL. How long does insulin typically last before it needs to be replaced? It says on the vial to discard by 10/2014. Also, does anyone know if it would be possible to get a smaller, cheaper vial? We were charged 200 for the 10mL and have used less than 1/4 of it.

Finally, is it typical for a a cats numbers to rise this much for no apparent reason? I am assuming that there is something else going on, but I am pretty clueless as to what it is.

Thanks,

Art
 
Less money than a 10 mL vial is the Lantus solostar pen. Like a mini vial, only 3 mL and can be used to the last drop. You still need to use an insulin syringe to withdraw the insulin, since the pen needle tips and dial a dose feature only allows dosing in whole unit increments. These pens usually come in a pack of 5, so you need to find a pharmacy that will break up a pack or buy a pack and split it with other diabetic caregivers. Some people have had success at Target, a hospital pharmacy, some Wal-marts, local independent pharmacies with getting a single pen. You'll need to call around.

If you have been keeping the insulin stored properly, it should still be good after only 2 months. People here usually get 3-4 months, with a few people reporting up to 6 months use out of a large vial. sticky on insulin storage and handling.

Please remember, that the insulin depot with Lantus can take a week to fill. It's only been 6 days. Lets' see how things go before we consider your lantus vial to be 'toast'.

Causes for BG's to go up:
1. infection or inflammation, especially hidden like teeth or digestive.
2. steroid use
3. change in diet.
 
This may be useful.

Here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first. Numbers in parentheses are for non-US meters. Numbers in curly braces are estimates for an AlphaTrak.

< 40 mg/dL (2.2 mmol/L) {< 70 mg/dL for an AlphaTrak}
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL (2.8 mmol/L) {< 80 mg/dL for an AlphaTrak}
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50 (2.8).
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.

= 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- no shot limit for ProZinc, PZI, or other non-depot insulins

> 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1 mmol/L) {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins (Lantus, Levemir, and ProZinc) as data collection shows it is safe

180 - 280 mg/dL (10 - 15.6 mmol/L) {may be 210 - 310 mg/dL for an AlphaTrak}- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL (15.6 mmol/L) {may be >=310 mg/dL for an AlphaTrak}, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.
 
thanks for the replies. we are concerned because Lola's BG levels have been pretty low since dx, but over the last week have increased significantly. we just got ketone strips and will test for that as soon as we can, and will take her to the vet if BG continues to rise - but we also are worried about vet costs (she just had blood work done a few weeks ago and everything turned out normal - see previous posts) we wanted to know what anyone else on the board had any other thoughts.. thanks again!
 
Most people are able to use a vial 2-3 months before it begins to become ineffective. However, that can change from vial to vial. I had one that lasted almost 6 months.

I would be better if you could switch to the Lantus pens instead of the vial. Even though the initial cost is more than a vial, because they are packaged in smaller containers, you are able to use almost every drop. You get 5 pens in a package. With your current dose, a package of pens should give you enough insulin to last almost a year. So it the long run, it is actually cheaper to buy the pens.
 
Likely due to the cat and not the insulin. I have three cats on Lantus. Sometimes the insulin drawn from the same pen seems to work well for two of them and not really working on the other one.
 
Tested for ketones (at least we think it was a successful attempt - we were able to dip the strip into some urine immediately after it landed in the litter). The test came back negative, so that is good, but also perplexing. BG continues to rise. We will be taking her into the vet either tomorrow or Saturday, depending on how she is tomorrow AM. And will look around for the lantus pens - will we need an entire new prescription for the pens, or can we just bring in our current rx?
 
There are two main types of strips for testing the urine.

One type of urine test strips only checks for ketones, so being negative on ketones is a good thing. Ketones are toxic and can quickly build up to dangerous levels necessitating a long stay at the vets. Life threatening. No ketones is good!!!!

The other type of urine test strips test for glucose only. They are one way to monitor the glucose levels, but are giving a fuzzy picture of what is going on with the BG since the results can vary based on how long it's been since the last urination, how concentrated the urine is, how much water intake, etc. The urine glucose results are also several hours old, telling you what the BG was hours ago.

There are also urine test strips that test both the ketone level and the BG level.

The vets usually write the insulin prescription for the insulin for the 10 mL vial so you will need a new prescription for the pen. Some people have had success having the prescription written for a single Lantus Solostar pen at a time. That way, the pharmacy will need to split up a box of 5 pens in order to fill the prescription as written. Otherwise, some pharmacies insist they can not split up a box of 5 and say they can only sell you a whole box at a time.

You might try signing up for the Lantus Savings Card program, to help you save money. You need the age to be 18 to use this, so make sure to make your cat old enough.
 
Try a new vial but I would also watch her closely or take her to the vet she could have a UTI, ear infection, or something going on. Any infection will spike blood sugar.

No way she could have gotten any contraband? Did you change her food? no dry?

Wendy

PS is she still falling over at times?
 
Lola saw the vet this morning. No signs of illness or infection, but she received an antibiotic injection, and if her BG levels are still high in a few days we are going to replace her insulin. Her balance has been totally normal, and still no signs of ketones. Pretty certain she hasn't gotten into any contraband. Still on a strict lo-carb wet food diet (we've been mixing the wellness lo-carb options with the tiki cat zero carb chicken). Feeding her four 2 oz meals daily.

She's quite the mystery kitty.
 
Was it Convenia? That has a black box warning for cats due to the potential adverse reaction of kidney damage!
 
I don't know, I can find out, but why would a vet give our cat a medicine that was harmful to cats? I don't understand what you mean.
 
Did you change the wellness food flavour? Does she get to go outside?

it still seems odd to me that her BG would suddenly go up that much.

Wendy
 
Same food and she is an indoor cat. I tested myself with her monitor/strips and they appear to working normally.

We don't know what to think either. :YMSIGH:
 
Lola is a bit of a puzzle.

Did the vet check over Lola's mouth really well at the last vet visit?

When did Lola last have a dental done, if ever? Sometimes, the mouth and teeth problems are hidden and are the cause of the spike in BG's. Here's hoping the antibiotic brings Lola's numbers back down.

I do notice on your SS that you went very quickly from 0.5U to 1U. We recommend staying at a dose for a minimum of 3-5 days or 6-10 cycles if you are using the Lantus Tight Regulation protocol. It's a very aggressive method of treating diabetes in cats, and you need to give the insulin depot time to fill or drain before you will see the full effects of the dose changes. We also recommend only making dose changes in 0.25U increments, so that you do not bypass the correct dose for your cat.

Sometimes, too much insulin can be the cause of high BG's.

You said you were also mixing the Tiki Cat with the Wellness. You could try a food trail, feeding only one food at a time, to see if one of the foods spikes Lola's BG's more than the other food.

Whatever you end up doing, make one change at a time, so you know which change is having an effect. Making too many changes at once, and it's really hard to determine which change is making a difference.
 
Lola's BG continues to rise :( She seems to be hungrier and peeing a little more as well. We haven't been able to catch her in the act for a ketones test the past couple of nights.

I wasn't able to reach our vet yesterday, but I will today. I really like our vet but they have an extremely busy practice.

Does anyone have ideas on what our next steps should be? A more thorough physical exam? Are there any specific tests / lab work we should ask our vet about? My hunch is that it is not insulin related; we don't have a ton of data but her BG levels do seem to drop in between shots. But who really knows?

Deb & Wink said:
Sometimes, too much insulin can be the cause of high BG's.
Click to expand...

Would this be due to her BG going too low at nadir, and her body overcompensating? Do we need more curves to rule this out?

I'm starting to feel really anxious about Lola. Worried that we won't be able to figure this out, or that she is going to get really sick again before we do.

-Rachael
 
Lola does look like she is bouncing. That bounce can simply be from a number her body is not used to, doesn't even have to be a really low number. Bounces can take up to 72 hours to clear. So you need to hold steady with the dose. I think that is only part of the reason for the high numbers.

I see from the SS, that you have raised the dose yet again, to 1.25U. Per the TR protocol, you need to stay at that dose for a minimum of 3 days or 6 12 hour cycles, unless your cat drops below 50 mg/dL on a human meter. Better yet, would be to hold the dose for 5 days or 10 12 hour cycles, to give the bounce time to clear as well as give the insulin depot time to level off.

Looks to me, like every time you raise the dose, Lola's BG numbers go up and up. That's why my gut is saying you've increased too much, too quickly. Since the vet has not found any issues of infection or inflammation, said her teeth were good, clean bill of health, that looks like a less likely cause of the higher BG levels. Personally, if Lola were my cat, I'd drop her dose back down to 0.75U and slowly work the dose up or down.

Yes, more test data would be helpful. It does not need to be a curve, testing every 2 hours. Just getting some other tests at random times during the cycle would be useful. I know you probably work during the day, but is there a possibility of you testing right before you leave for work, or right when you get home? Maybe a +2 one day, a +4 another day. Those +2 numbers can give us a good idea of what is going to happen during the Lantus cycle. It would help to fill in some of the holes in your test data.
 
Yes, we thought since her levels were not decreasing at 1u and it had been several days that we should increase to 1.25u.

So would you suggest that we immediately bring her down to 0.75, or wait 10 cycles on 1.25 before making another change?

Thanks for your feedback Deb.
 
Lola's vet wants us to give her 2u tonight, and continue 2u if her BGL is above 300 tomorrow AMPS. Which, obviously directly conflicts with the protocols here.

He reiterated there's no indication of physical issues but offered to take another look at her if I bring her in.
 
I would stay at 1 1/4 units for two more day and then see if an increase is warranted. You saw a 100 point drop at +4 the last two days which is a sign the insulin is working.
 
Lola's vet wants us to give her 2u tonight, and continue 2u if her BGL is above 300 tomorrow AMPS
Click to expand...

Many vets are more used to the NPH type insulins or Prozinc, where the dose changes are based mostly on the pre-shot numbers. It's sounding to me like your vet is trying to make dose changes with the Lantus insulin the same way, based on the pre-shot tests.

Lantus insulin dose changes are not based on the pre-shot tests, but are based on what the nadirs or lowest numbers in the cycle are. Your vet telling you to dose 2U based on the pre-shot numbers, is definitely contrary to the protocol we use here as you know and stated. The protocol we use here, is a modified version of the Roomp and Rand protocol, which is a very aggressive dosing protocol. Your vet telling you to increase from 1.25U to 2U is even more aggressive than that Roomp and Rand protocol.

If that is the way you decide to go, please try to get a +2 this evening. If the +2 is lower than the pre-shot test, it's likely to be an active cycle, with the BG numbers dropping even lower than you are used to. In that case, I'd get a +4 and then a +5 or +6 test, to make sure the numbers do not drop too low.

If the numbers drop too low, please post here or in the Lantus TR forum for help.

I would not increase Lola to 2U from 1.25. You have 2 different suggestions, to either stay at 1.25U for a longer period, up to 10 cycles to see what the trends are or to drop to the lower 0.75u dose where she seemed to be doing better. It's a tough call, and I'm really torn on which way to go. I'm leaving the decision up to you, you hold the needle and the ultimate decision is yours. You know better how Lola is responding and are there to watch over her.

Some cats need longer to settle into a dose, a week or more. Lola could be one of those cats.
 
We are going to keep her at 1.25 for now, and test more frequently. Thank you everyone for all of your help, it is really appreciated.
 
Ok so if you don't see any blue or green by end today I would consider increasing her to 1.5 as per the protocol tomorrow morning (assuming you can still keep getting those tests in) http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581 i.e.

Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 (blue green) before increasing the dose by 0.25 unit.
if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 (yellow) increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 (pink red black) increase the dose by 0.5 unit.
Click to expand...


Wendy
 
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