Introduction: Miles

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debrachicago

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Thanks everyone for making this such an informative list. I've been lurking for a little while, trying to learn as much as possible.

My cat Miles was diagnosed with diabetes in late June 2010. He's been on Lantus, currently on 6 units BID. I test him at home, and just switched his food from Purina DM (at his vet's recommendation), to Innova 95% chicken and turkey (all wet food). At some point I'll get his curves into a chart to post. When he was first dx'd I put him on Wellness CORE, first the dry, then the wet. His numbers have gone down considerably with each food change. He's been pretty difficult to regulate -- each time it seems he's in good shape, his numbers get all screwy again.

A couple questions:

1). Tonight I dropped his lantus. It fell in the water bowl. I picked it up right away and cleaned the top off with an alcohol swab. There was a bubbly skim at the top of the insulin. Could it be bad? I've been told you can damage the insulin by shaking it. The bubbles are mostly gone, but there are still a few floating at the top. Any thoughts? The Lantus instructions advise to discard the insulin if you see particles in it --- I wonder if these bubbles are actually particles?

2). Is there anyone on the list from Chicago, and, in particular, the Northeast side of Chicago, who might want to compare notes in person and maybe do a catsitting exchange?

3). I've had bad experiences with the Solostar pens -- twice in a row they seem to have gone bad by the 4th pen (his numbers would start creeping up mid-way through the 4th pen, for the 2nd time in a row. According to Lantus, if they ever exceed 46 degrees F., they expire in just 28 days, whether or not they've been used. I don't know what temperature my fridge is, but it seems likely that either during transportation to the pharmacy or to my house, or even in the fridge, that they would have exceed this temp. Have others had problems with the pens becoming ineffective by the 4th pen in a package? I had Lantus replace my first package since it was so clear the pen wasn't working, but it happened with the replacement package, even though I brought it home in a cooler. I wonder if this is a common phenomenon. Technically, a package should last 6 months.

Thanks for any feedback!

Debra Michaud
 

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Welcome, Debra and Miles!

I'm pretty new, and don't have answers to your questions... but I'm curious as to the answers to both! Just wanted to say welcome! :)

Christie and Willie
 
Lantus users question

Hi Debra, and, of course, you too, sweet Miles,

I don't have an answer either. Have you posted your question on the Lantus forum here (think it's called insulin support groups...)? They will probably have more answers and insights...

I just wanted to welcome you both and say that Miles is incredibly handsome! And, Nikki is now completely jealous because Miles has a box with a lid. She has a thing for cardboard boxes, too...

Welcome to the place you never wanted to be, but will be blessed for having found, kind of hugs,
Deb and Nikki -- and Giz, forever whispering in my heart...
 
Welcome to the site.

First thing to catch my eye is your dose: 6u BID of Lantus. That's alot of insulin, a bit higher than most, but I'll get back to that..

OK I did use Lantus for awhile then switched to Levemir, but I am sure your pens should last till the expiry date on the pen if it has not been pierced. Lantus is guaranteed for about 28days, and Levemir 42days I think, but that's from the first piercing of the pen/cartridge. What was the expiry date on your pens?
Also, if they temp affected your package of pens, why did it affect only the pen you used 4th? If the first one worked, then the entire box of pens should have been alright. Many people use their pens right to the last drop, so if you are questioning the pens going bad, I am again thinking of insulin resistance as a possibility. I kept thinking the same thing in the past.

I wish I could comment on the handling of Lantus; I honestly can't recall at the moment but there will be many others who will know. If you could post over in the Lantus group on this board, you will be able to get Lantus specific support.

I am so glad to hear that you are home testing Miles; if you could provide some of the test results you are getting, it will go a long way to help others to help you. The guys over in the Lantus group will ask for your ss because they go by numbers. See my ss for my two cats in my signature as examples.
I am not sure if this link is the most current:
Spreadsheet setup instructions

Here are some links for you on Lantus and the shed that you can read if not already read by you. It will help you understand Lantus.
Tight Regulation Protocol
Lantus & Levemir – Insulin Depot –AKA- Storage Shed
Lantus & Levemir – Data Ready to Shoot Low Numbers

If you can confirm Miles is eating only wet food now, that question won't be asked of you.
Binky’s Food Lists
Feeding Your Cat: Know The Basics of Feline Nutrition

Also, how was Miles' current dose reached? What was his starting dose and how were the increases decided? Many times, cats are started at a dose too high so regulation won't be likely, but sometimes, the high dose is due to insulin resistance as my two cats have. Be prepared for a few queries on the dose as it will play into the picture for Miles.

If you have any questions at all, please do not hesitate - just ask.

To know the road ahead, ask the man coming back. Or walking alongside you.
 
Thanks for all of the helpful info and links Gayle!

He's on wet food. The starting dose was 2 units. We had to progressively increase with each curve (by 1 unit BID) because his numbers were going down, but only in small increments. I recently tried to lower him to 5 units, and that was too little (he started to go back up to the mid to upper 200s). I'll get the charts up asap, have to transcribe them from various emails to the vet, and am running off to work.

With the Solostar pen, you can only decrease by a min. of 1 unit. Now that I've switched to the vial, we can experiment with .5 unit changes. I'm going away for a week so that won't happen until my return, plus, I just switched his food AND the vial of insulin (thinking the last insulin was bad), so I want to do a curve in 10 days to see how those things may be affecting him.

Re: Solostar pens: Lantus says they expire 28 days after warmed above 46 degrees F, even if they haven't been pierced. That's not very warm, pretty cold in fact. So, in transportation, or perhaps if I was cooking and opened the fridge door one too many times --- they could possibly have reached that number. This would explain why the 4th pen showed signs of inactivity --- that would be 3 months old at first piercing (the others were within the acceptable date range even after piercing). While Lanutus says they expire 28 days after piercing or warming, veterinarians say 3 months in the fridge is fine. Does that make sense? The pens were more than a year within their expiration. When I changed the insulin, I also changed his food to EVO 95% (highly recommended if you can afford it at only 0.47% carbs!), and his numbers dropped by about 100 throughout the day. Hard to know if it's the food or the insulin or a combination of both! What I know for sure is that his numbers have crept up steadily twice when I reach the 4th pen in a package, so I am pretty convinced that the pens are just too temperature sensitive to really last the full 6 months (i.e., one month after piercing each of 6 pens, not 6 mos. per pen!).

Good idea, I'll post over in the lantus section as well.

How does one treat an insulin-resistant cat??? That must be very difficult!

Miles developed neuropathy a few months after diagnosis, and its severity depends on his numbers on any given day. I can tell when he's high because he starts walking on his hocks. He's on a whole bunch of supplements also on the advice of an integrative vet. It seems that while he's not totally insulin resistant, perhaps he's lost some of his insulin receptors? Can those come back, if they go away?

Thanks!

Debra & Miles
 
debrachicago said:
Thanks for all of the helpful info and links Gayle!
With the Solostar pen, you can only decrease by a min. of 1 unit.

You can use syringes with the cartridges/pens. Just put the needle into the little rubber thingy at the
top of the cartridge. Don't use the pen itself.

You can then use syringes with 1/2-unit marks.
 
Re: Introduction: Miles (and NE side of Chicago)

Hi Debra! Welcome! I see you are getting a lot of help already so I'll just respond to the location question.

Moochie and I are on what you might call the Northeast side of Chicago. We're at Devon and Western. I'm not sure you would want to pet sit for Moochie but I would be happy to talk to you and meet. I'm at work right now and will leave town tomorrow through Sunday but if I can help you out I'm happy to :-D
 
As to your picture. You will need to shrink it to I think like 90 x 90 but then you can use it as your avatar. I did it with the paint program on my computer to get max up as my avatar.

Mel, Max & The Fur Gang
 
The neuropathy issues can be treated easily. I have no experience but it seems that many treat with B12 and the problem is resolved, so no need to let Miles suffer. Others can give you the specifics of which B12, etc.

It will be very good to see your ss once you have it set up and see the numbers. I don't see if you mentioned that you are home testing. With such a high dose, it will be very important to be testing. and recording.
If you are not home testing, you can pick up a regular blood glucose meter at the pharmacy, pick up some ketostix as well so you can test Miles' urine for ketones.

There is a big difference between regular feline diabetics and others with insulin resistance - the first have poorly functioning pancreas, but the latter have perfectly functional pancreas. How do you treat it? Differently, but also the same.

When you read over the protocol for Lantus dosing, you will see that increases and decreases are done in .25u and .5u increments. While you decreased from 6u to 5u was too much, if you are home testing, you may have found that maybe 5.75u or 5.5u would be better for Miles.
 
Re: Introduction: Miles (and NE side of Chicago)

Susie and Moochie said:
Hi Debra! Welcome! I see you are getting a lot of help already so I'll just respond to the location question.

Moochie and I are on what you might call the Northeast side of Chicago. We're at Devon and Western. I'm not sure you would want to pet sit for Moochie but I would be happy to talk to you and meet. I'm at work right now and will leave town tomorrow through Sunday but if I can help you out I'm happy to :-D


Hi Susie,

I'd love to meet. I'm in the Uptown/Andersonville area, not too far from you, and I drive. What is the protocol here for exchanging info? Should I not display my email address publicly on the list?

I'll be traveling during the holiday, back on Jan 1st. Maybe we could set something up the next week?

Debra
 
PeterDevonMocha said:
Also Sienne and Gabby are in Chicago, but I don't know where at .. but she is really good at this stuff!

Ok, thanks Peter! Sienne and Gabby, if you're out there, please chime in! I'm looking for Chicago area folks to possibly share notes in person, maybe even exchange catsit. I'm on the Northeast side of the city.
 
Oh you are pretty close :). I will send you a PM - private message - with my phone number. You'll see up top by "User Control Panel" that you have a message.

Cheryl (Sienne & Gabby) is very good with Lantus BTW. I think she lives down near Navy Pier.
 
Hi Debra. Susie let me know you had posted. I spend most of my time on the Lantus board. Susie's right -- I'm down by Navy Pier. I'll send you a PM with contact info.

Could you provide the link for where you found the temperature info on Lantus? If you read the info on the box with the pens, they will tell you that the pens do not need to be refrigerated once opened. I doubt that most of our homes are below 48 degrees. I think you are seeing the temperature range for storing Lantus in the refrigerator. The pens were developed so that human users would have insulin that did not require refrigeration which was hugely important if you were diabetic and had to travel. What I do suspect is that your Lantus may have been mishandled. I had a similar situation and saw the less than competent person at the pharmacy repeatedly smash the box of pens against the counter.

Most boxes have about a 2 year window from the time of purchase to expiration if the pen is not opened. There are people who are able to use their Lantus for 6 mos. I consulted with a veterinary pharmacist from the vet school at UIUC.Their feeling was to follow the manufacturer's recommendation and not use either a vial or pen after 28 days. There are people on the Lantus Board that use their insulin well beyond that point and others, like me, who has a cat that seems to be able to count to 28 and I end up switching out her insulin after about a month.

This is from the National Institute of Health website and may help to clarify:
What storage conditions are needed for this medicine?

Store unopened insulin glargine vials and cartridges in the refrigerator. Never allow insulin glargine to freeze; do not use insulin glargine that has been frozen and thawed. Never heat insulin glargine to warm it. Unopened refrigerated insulin glargine can be stored until the date shown on the company's label.

If no refrigerator is available (for example, when on vacation), store the vials or cartridges at room temperature and away from direct sunlight and extreme heat. Unrefrigerated 10-mL vials or cartridges can be used within 28 days or they must be thrown away. Unrefrigerated 5-mL vials can be used for 14 days or they must be thrown away. Refrigerated 5-mL vials can be used for up to 28 days. Once the cartridge is placed in the OptiPen One Insulin Delivery Device, do not refrigerate. Throw away any insulin that has been exposed to extreme heat or cold.
 
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