How to tell when to replace vial/pen?

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Girlface

Girlface

Member Since 2013
Hello,

I am still in the process of trying to optimize my cat, George's, insulin dose with his internist, and his current values have been very erratic. My question is how do you know when your current Lantus vial/pen has stopped working, and to use a new one? I know they can be used past the 28 day expiration date, but what are the signs from my kitty's numbers that I should use a new pen?

Thanks,
~Whitney
 
You try a new pen/vial when you:
- no longer see the BG drops that you expect
- the insulin is no longer clear. like it is cloudy or hat particles in it.
 
Are you keeping it in the fridge (not the door)? Are you careful with it (no shaking or rolling)? If so, you can expect up to 6 months out of it.

But that might not be the issue here - he might be bouncing or need a dose change - cant tell without more data.. Can you update your SS and we can take a look?
 
Can you get a few more tests in the next few days?

Specifically, preshot but also a before bed test (a few hours after the PMPS) and a midday or mid night test?

I am trying to ascertain how low he drops and how well the insulin is working . The curve yesteday is good but I want to know if he is doing that every day, 3 days data will suffice with data as I mentioned above, curve isn't necessary . If he keeps the pinks and reds all the time then he might need a dose change. I have seen cats always show pink preshot and drop to green mid cycle.. Even too low a green!!

How is his pancreatitis? Is he finished the antibiotics?
 
I am keeping the insulin in the fridge. I will do my best to get some extra tests today, especially since the internist has raised his dose to 4 units today, and also said to spot check him.

He has been urinating more in the litter box, but still 2-3 times outside the litter box and polyuric and polydypsia. He finished his antibiotics a while ago, has not been reassessed by the internist for his pancreatitis. She is trying to optimize his insulin dose right now, pretty aggressively I might add.
 
a couple of observations:

1) you are raising the dose by 1 unit increments - how about raising instead by 0.25 or 0.50 increments instead. It is possible that you are skipping past the ideal dose by a 1 unit raise.

2) as Wendy mentioned, more tests are needed to see just how low he is dropping - if you can get more tests in that will help to see what is really happening and just where he needs to be insulin dose wise.
 
1) I have updated the spreadsheets with today's values, including a spot check at +6. I will check him again before I go to bed.

2) I am only doing what my internal medicine specialist has told me to, she specifically said raise it to 3 units, and then 4 units.
 
have you read the stickies (starred) information on the lantus forum? may i suggest you read that and also if you want, you can post on there too - as the people who are most familiar with the insulin are there and can help you.

and honestly regardless of what the vet said - raising by 1 unit at a time is not the best thing to do - you can always add more insulin, but you can't remove it once it is shot.

personally, I would increase in smaller increments .25 or .50 and see how that works --- and honestly, everyone on this board will tell you the same thing

remember you are in control, you hold the needle, not the vet, not me.....you need to stop fearing the vet and do what makes sense. it is up to you, I am giving safe recommendations not aggressive ones
 
It's great you are getting more tests in, it tells us so much more. Is your specialists looking at these too?

I think tonites preshot was the lowest he has had hasn't he? Definitely get a before bed test , and if he drops into blue I would set the alarm to see how he is at +6. Be great to see him have a blue ...

Looking forward to seeing the next test!!

Wendy
 
Thank you guys for following his case, I know he is a tough one. If the internist wants to go up another dose, I will ask if we can only go up 0.25 or 0.5, since the last increase looks to have improved him a lot. I did update his spreadsheet, and the internist is checking it. She is pretty great. I will be curving him again this weekend.

~Whitney + George
 
Just to let you know, you CAN raise the dose by LESS than what your vet suggests, or raise it more slowly. You are the one there taking care of your cat.
Some people show up here after following their vet's advice right into a hypoglycemic crisis. Every Cat is Different, and even the most well-intentioned vets do not know what is exactly right for every cat.
 
Most diabetic cats never need a dose as high as 4 units, so I think you may want to lower that dose until you are able to do a curve .... test every 2 or 3 hours between 2 shots. You need to know how low he is going somewhere mid cycle.
 
Wednesday is my really long day, when I am gone from 6:30 am till 10 PM. He was 237 this morning! I will test him a few hours after his PM dose. I have seen no signs of hypoglycemia.
 
Sorry, have been really really busy with school. He's been doing fine, still working with the internist, still between 250-350.
 
re: being gone from 6 am to 10 pm

How do you manage the Lantus shots? It works best shot every 12 hours. Did you reduce the evening shot due to the short time between evening and morning?

If you are giving Lantus on inconsistent times (ie not every 12 hours), this will affect the glucose levels. It also may set you up for a hypo if the time between 2 shots is small enough.
 
BJM,

My boyfriend helps me, he is very good at giving the injections but not as good testing him. His injections are given as close to 7am and 7pm every day, whether by me or by boyfriend.
 
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