Lantus dosing

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Hi Julia,

Welcome to FDMB! :-)

I see that you have Pepper's spreadsheet set-up and are home testing. We follow 2 dosing protocols here - TR (Tight Regulation) and SLGS (Start Slow and Go Slow). The information on both can be found here: https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

You could choose either depending on what works for you. TR is more aggressive, requires more testing than SLGS and that the cat not be eating any dry food.

I see that you increased Pepper's dose to 1.25 in the AM cycle on 7/16 but have shot only 1 unit in the PM? Is there a reason for that or it that a typo in the SS? Also, while it prima facie looks like Pepper needs more insulin, Lantus dosing is based on how low the dose takes Pepper in the cycle. To ascertain that, some testing in the PM cycle would also be needed. Would it possible for you to get some tests in before bed?

Lastly, this is the forum for Lantus & Levemir (https://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/). There are several senior members here who could help you with Lantus dosing and any other questions you may have!

Please feel free to ask any questions that you may have!
Bhooma
 
Hi Julie and Pepper and welcome to Fdmb.
It’s great you have got your spreadsheet and signature done. That’s very helpful.
I see you started out on 1 unit and have increased to 1.25 units. I’m pleased to see you are now testing during the am cycle. It is important to test during the cycles to see how low the dose is taking Pepper as that is the deciding factor in dosing. I would encourage you to also test during the pm cycle as well. It is just as important as the am cycle and cats often drop lower at night.
If you can get a before bed test in every night that would be good. If that test is lower than the preshot number I would set the alarm and test later to see Pepper has no dropped too low.

I see Bhooma has just given you the two dosing methods. Have a good look at them and choose which one suits you better.
Lantus likes consistency so don’t chop and change the dose unless you are decreasing the dose or increasing it.
Now that you have increased to 1:25 units you need to stay with that dose for at least 6 cycles if you decide to do the TR method or 7 days if you decide to do the SLGS method. Don’t give a different dose am and pm. Lantus is a depot insulin and if you chop and change the dose it will mess up the depot and you may get wonky numbers.

Ask lots of questions...we are happy to help. Pepper is gorgeous!
Bron:)
 
Morning Julia question you gave 1.25 units in the morning(7-16-20) but only 1 unit in the PM on (7-16-20)
You should have given 1.25 in the PM also on (7-16-20)
Both cycles

About copying the URL from the day before to your new thread
First off I want you to go to Forums and look for where it says
Lantus/Basaglar and look for 7-17 TYLER AMPS-174
Click on that , that is my post for today.
Do you see above where I wrote everything in black
the Blue thread from the day before, if you tap on that it will bring you to my 7-16
Post so if a member wants to see the information from the day before they just have to tap on it rather than hunt for it
I want you to do that first just so you can see where I put it for my thread for today 7-17.
Let me know when you see it :cat:
 
Julia PM me, I moved it over to here. Good morning Diane,
Sorry Tyler woke you up at 3am! I’m sure our cats are aging us prematurely.
I gave 1 unit last night because I started a new vial of Lantus. My other vial was over 3 months old and I thought that it might be losing its efficacy. I want to see if his numbers go down with the new batch. If not, I’ll follow your advice resume the 1.25 units. His BG is already a little lower this morning that it’s been recently.

https://docs.google.com/spreadsheets/d/15i72Z2LvNSLGJAwb2G-QSZOd6E3Ft3H2Uo4s28ra4co/edit?usp=sharing
 
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Diane Tyler's Mom said:
Good morning Diane,
Sorry Tyler woke you up at 3am! I’m sure our cats are aging us prematurely.
I gave 1 unit last night because I started a new vial of Lantus. My other vial was over 3 months old and I thought that it might be losing its efficacy. I want to see if his numbers go down with the new batch. If not, I’ll follow your advice resume the 1.25 units. His BG is already a little lower this morning that it’s been recently.

https://docs.google.com/spreadsheets/d/15i72Z2LvNSLGJAwb2G-QSZOd6E3Ft3H2Uo4s28ra4co/edit?usp=sharing
Click to expand...
Julia could you fill in your SS with today's AMPS please also in the remarks column note why you went back to 1 unit
 
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  1. Alicia Deb suggested you increase to 1.25 units

  2. Deb & Wink
    Joined:
    Jan 31, 2013
    Pepper. Curve. Dose change.

    Tests every 2-3 hours, that is close to a curve, Julia to give us an idea of what is happening. Life happens, and you have to grocery shop, do the laundry, go to work, pick up the kids, get dinner ready and all those other life responsibilities.

    Yes, I think that Pepper does need a dose increase. So the dose increases that we recommend are usually 0.25U and sometimes 0.5U.
    For now, I think you can safely increase Pepper's insulin dose to 1.25U. Start that increase on the next cycle, if you would please.
 
Diane Tyler's Mom said:
Julia PM me, I moved it over to here. Good morning Diane,
Sorry Tyler woke you up at 3am! I’m sure our cats are aging us prematurely.
I gave 1 unit last night because I started a new vial of Lantus. My other vial was over 3 months old and I thought that it might be losing its efficacy. I want to see if his numbers go down with the new batch. If not, I’ll follow your advice resume the 1.25 units. His BG is already a little lower this morning that it’s been recently.

https://docs.google.com/spreadsheets/d/15i72Z2LvNSLGJAwb2G-QSZOd6E3Ft3H2Uo4s28ra4co/edit?usp=sharing
Click to expand...

See #8 Deb advised you to increase to 1.25 units.
Concerning private messages we like to post everything publicly so that everyone can see them and give their advice. This is just the way we like to do things so that everyone can give their advice on Pepper. :cat:
 
Bandit's Mom said:
Hi Julia,

Welcome to FDMB! :)

I see that you have Pepper's spreadsheet set-up and are home testing. We follow 2 dosing protocols here - TR (Tight Regulation) and SLGS (Start Slow and Go Slow). The information on both can be found here: https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

You could choose either depending on what works for you. TR is more aggressive, requires more testing than SLGS and that the cat not be eating any dry food.

I see that you increased Pepper's dose to 1.25 in the AM cycle on 7/16 but have shot only 1 unit in the PM? Is there a reason for that or it that a typo in the SS? Also, while it prima facie looks like Pepper needs more insulin, Lantus dosing is based on how low the dose takes Pepper in the cycle. To ascertain that, some testing in the PM cycle would also be needed. Would it possible for you to get some tests in before bed?

Lastly, this is the forum for Lantus & Levemir (https://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/). There are several senior members here who could help you with Lantus dosing and any other questions you may have!

Please feel free to ask any questions that you may have!
Bhooma
Click to expand...
Thank you so much for the warm welcome and tips, Bhooma. Pepper's BG numbers had been steadily increasing over the past couple of weeks and I was advised to increase his Lantus dose which as you see, I did. It then occurred to me that the vial of Lantus I'd been using could be losing its efficacy since it was over 3 months old. I purchased a new vial last night and was concerned about giving him the new increased (1.25) dose in case my hunch about the loss of efficacy was right. His BG number was lower this morning than it's been in a while.
By 'checking his BG more often at night', do you mean after his pm pre-dose? I have stayed up until midnight to check it (2 hours after pre-dose) but it's a little difficult for me to stay up much later. I'm already bordering on sleep deprivation. Unfortunately, I don't have anyone to help me with Pepper and I work full time. It has been quite a challenge, which I'm sure you can relate to.
Thanks again for your support!
 
About copying the URL from the day before to your new thread
First off I want you to go to Forums and look for where it says
Lantus/Basaglar and look for 7-17 TYLER AMPS-174
Click on that , that is my post for today.
Do you see above where I wrote everything in black
the Blue thread from the day before, if you tap on that it will bring you to my 7-16
Post so if a member wants to see the information from the day before they just have to tap on it rather than hunt for it
I want you to do that first just so you can see where I put it for my thread for today 7-17.
Let me know when you see it :cat:
 
Hi Julia and welcome!

yes, Bron means testing the +2 after your pmps. Would moving the shot time to an earlier time be an option? If you’re staying up until midnight, does that mean you’re giving the insulin at 10? Can you maybe start to move it up by 15 minutes increments to an earlier time? I don’t know your work hours so wondering if that’s doable. I shoot Minnie at 7:30am and pm so I can do her +2 at 9:30 before going to bed at 10pm. I get needing to sleep. I’m one of those people who can’t function if I don’t get at least 8 hours and my guys wake me up at 6:30 and every day :banghead::banghead::coffee::nailbiting:
 
@Aleluia Grugru & Minnie Hi Ale I copied this from her previous thread . I give him his shot between 9 and 10 pm. I can't be more consistent than that because of my work schedule. I work 9-5 on Sundays and 1:30-9:30 all other days. I feed him Fancy feast canned wet food with between 1 and 6 mgs of carbs. I do keep the Lantus in the refrigerator, and I don't see any white floats in it. I'll test him again before I go to bed tonight, at around 11:00


I hope I'm replying to people's posts in the correct place. I give Pepper his shots at 8:30am and 9pm on Sundays and at 10am and 10pm on all the other days.
Thanks, and have a good night.
 
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Aleluia Grugru & Minnie said:
Hi Julia and welcome!

yes, Bron means testing the +2 after your pmps. Would moving the shot time to an earlier time be an option? If you’re staying up until midnight, does that mean you’re giving the insulin at 10? Can you maybe start to move it up by 15 minutes increments to an earlier time? I don’t know your work hours so wondering if that’s doable. I shoot Minnie at 7:30am and pm so I can do her +2 at 9:30 before going to bed at 10pm. I get needing to sleep. I’m one of those people who can’t function if I don’t get at least 8 hours and my guys wake me up at 6:30 and every day :banghead::banghead::coffee::nailbiting:
Click to expand...

I leave for work at 8:30am and return at 5:30 on Sundays and leave at 1:00pm and return at 10:00pm Mon-Thurs. I give Pepper his Sunday doses at 8:30am and 9pm on Sundays and 10am-10pm Monday-Saturday. I'm glad you get the sleep thing. I could rule the world if I were able to get 8 hours of sleep! As it is, I get 6 or 7 hrs of broken sleep. It really puts a damper on one's physical and mental health.
 
Julia78 said:
I don't see a 'remark' section on the ss
Click to expand...

Scroll all the way to the right on your spreadsheet

upload_2020-7-17_11-43-31.png
 

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Diane Tyler's Mom said:
About copying the URL from the day before to your new thread
First off I want you to go to Forums and look for where it says
Lantus/Basaglar and look for 7-17 TYLER AMPS-174
Click on that , that is my post for today.
Do you see above where I wrote everything in black
the Blue thread from the day before, if you tap on that it will bring you to my 7-16
Post so if a member wants to see the information from the day before they just have to tap on it rather than hunt for it
I want you to do that first just so you can see where I put it for my thread for today 7-17.
Let me know when you see it :cat:
Click to expand...

@Julia78 I didn't hear back from you about this so I posted your last thread for you #16

When you want to start a new thread go to the previous day, your URL is all the way at the top right above the picture of the cat that's on the left.
It will say http://www.felinediabetes.com/FDMB/threads
I am using a tablet, you just press on that , you will see the word copy, hit copy
Then go to your new thread , and put it in the section where you would begin to write something and press down and the word paste will come up, then hit paste, it will then appear, then continue to write what you want to.
So next time you want to start another new thread you go back to the days before.
 
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Diane Tyler's Mom said:
@Julia78 I didn't hear back from you about this so I posted your last thread for you #16

When you want to start a new thread go to the previous day, your URL is all the way at the top right above the picture of the cat that's on the left.
It will say http://www.felinediabetes.com/FDMB/threads
I am using a tablet, you just press on that , you will see the word copy, hit copy
Then go to your new thread , and put it in the section where you would begin to write something and press down and the word paste will come up, then hit paste, it will then appear, then continue to write what you want to.
So next time you want to start another new thread you go back to the days before.
Click to expand...
Ok, thanks Diane.
 
Diane Tyler's Mom said:
@Julia78 I didn't hear back from you about this so I posted your last thread for you #16

When you want to start a new thread go to the previous day, your URL is all the way at the top right above the picture of the cat that's on the left.
It will say http://www.felinediabetes.com/FDMB/threads
I am using a tablet, you just press on that , you will see the word copy, hit copy
Then go to your new thread , and put it in the section where you would begin to write something and press down and the word paste will come up, then hit paste, it will then appear, then continue to write what you want to.
So next time you want to start another new thread you go back to the days before.
Click to expand...
I don’t know why Diane, but most of your posts have been doubled or tripled...?
 
Aleluia Grugru & Minnie said:
the server is slow to post and I get impatient and hit “post reply” more than once or multiple times.
Click to expand...

BINGO! I've noticed since we moved to the new server that sometimes my posts just "sit and spin" (for lack of a better term) and I'll hit "post reply" again and again (like that's going to help move it)

Finally one seems to load and then I go back and refresh the thread and there are 3 duplicate answers.
 
Aleluia Grugru & Minnie said:
I noticed it happened to me a few times if the server is slow to post and I get impatient and hit “post reply” more than once or multiple times. Then I have to go in and delete the dupes :rolleyes:
Click to expand...
Hey Ale I think that's exactly what happened , I got impatient and kept hitting reply, this site has really gotten slow, then late afternoon couldn't even get on I'll delete the duplicates that I find.
 
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I'm afraid it doesn't look like the expired Lantus was the cause of Pepper's recent high BG numbers. I was hopeful this morning but his BG has been over 300 for the past two readings. Could it take time for the newer batch of insulin to kick in?
 
Aleluia Grugru & Minnie said:
It takes time for cats to get regulated. As we like to say around here, feline diabetes is a marathon not a sprint. I’m wondering, why did you go back down to 1?
Click to expand...
Good morning Ale,
Thanks for responding. I felt comfortable heeding Diane's advice re: increasing Pepper's dose, but when I started the new vial of Lantus I was worried that if Pepper's BG numbers had been rising due to exhausted Lantus, 1.25 units from the new vial may be too much (I thought the new Lantus could be a lot more potent.) I wanted to see how Pepper's numbers would react to the fresh batch of Lantus at the dose he had been on originally. I see now that his increasing BG likely had nothing to do with the old vial of Lantus being exhausted. Pepper's BG was over 300 last night (ps) and this morning at 4:30 so I started him on the recommended 1.25. I hope I am doing the right thing. Thanks again.
 
Julia78 said:
Good morning Ale,
Thanks for responding. I felt comfortable heeding Diane's advice re: increasing Pepper's dose, but when I started the new vial of Lantus I was worried that if Pepper's BG numbers had been rising due to exhausted Lantus, 1.25 units from the new vial may be too much (I thought the new Lantus could be a lot more potent.) I wanted to see how Pepper's numbers would react to the fresh batch of Lantus at the dose he had been on originally. I see now that his increasing BG likely had nothing to do with the old vial of Lantus being exhausted. Pepper's BG was over 300 last night (ps) and this morning at 4:30 so I started him on the recommended 1.25. I hope I am doing the right thing. Thanks again.
Click to expand...
I totally get you. I’m playing that game with Minnie now too. It just goes to show you that even though I’ve been at this a lot longer, I still have my chicken moments. I think it’s the right move so let’s see what happens :)
 
Aleluia Grugru & Minnie said:
I totally get you. I’m playing that game with Minnie now too. It just goes to show you that even though I’ve been at this a lot longer, I still have my chicken moments. I think it’s the right move so let’s see what happens :)
Click to expand...

Thanks Ale. This is so difficult. I don't know about you, but Pepper has not been himself since he was diagnosed. Actually, he hadn't been himself for a few weeks prior, and that is why I brought him to the vet. The change was subtle. My first moment of dread was when he wouldn't chase a piece of string. I use that as a barometer of health. It breaks my heart to know Pepper isn't feeling well. Does Minnie act differently than she did before the onset of diabetes? I think there are other things going on with Pepper. The internist at the animal hospital said he had inflammation around his kidneys, discovered when he had an ultrasound. And a cyst of some sort. She later said the antibiotics Pepper was on resolved the issue, but this was when she was starting to get annoyed with my questions and I suspect she was just placating me. I spent nearly $4,000 at that hospital and I'm not happy with them. The internist kind of 'dropped me' when I started asking about testing Pepper's BG at home. She was emphatic that I continue with Pepper's insulin regimen based on his behavior and urine strip results. 'Just keep giving the insulin as long as the test strips indicate there's glucose in his urine.' She said by pricking him and checking his BG it would stress him out and destroy his chances of going into remission. She said the stress would have a very negative affect on his pancreas and kidneys. Sorry to ramble on. I'm upset for Pepper and I feel like I'm losing him. It's so depressing. Thanks for listening to me vent.
 
Julia78 said:
Good morning Ale,
Thanks for responding. I felt comfortable heeding Diane's advice re: increasing Pepper's dose, but when I started the new vial of Lantus I was worried that if Pepper's BG numbers had been rising due to exhausted Lantus, 1.25 units from the new vial may be too much (I thought the new Lantus could be a lot more potent.) I wanted to see how Pepper's numbers would react to the fresh batch of Lantus at the dose he had been on originally. I see now that his increasing BG likely had nothing to do with the old vial of Lantus being exhausted. Pepper's BG was over 300 last night (ps) and this morning at 4:30 so I started him on the recommended 1.25. I hope I am doing the right thing. Thanks again.
Click to expand...

It will take time for the insulin depot to fill, so you won't see the full change immediately, about 5 days or so, just keep checking him
 
Julia78 said:
She said by pricking him and checking his BG it would stress him out and destroy his chances of going into remission. She said the stress would have a very negative affect on his pancreas and kidneys.
Click to expand...
If I had a nickle every time I've read this sort of statement, I would supply EVERYONE here with whatever they need indefinitely. sigh
If they ever say that to you again ask them, "Would you shoot insulin into your child, without knowing where his numbers were first?"

Julia, we do Venting very well. ;):bighug:
 
Julia78 said:
Thanks Ale. This is so difficult. I don't know about you, but Pepper has not been himself since he was diagnosed. Actually, he hadn't been himself for a few weeks prior, and that is why I brought him to the vet. The change was subtle. My first moment of dread was when he wouldn't chase a piece of string. I use that as a barometer of health. It breaks my heart to know Pepper isn't feeling well. Does Minnie act differently than she did before the onset of diabetes? I think there are other things going on with Pepper. The internist at the animal hospital said he had inflammation around his kidneys, discovered when he had an ultrasound. And a cyst of some sort. She later said the antibiotics Pepper was on resolved the issue, but this was when she was starting to get annoyed with my questions and I suspect she was just placating me. I spent nearly $4,000 at that hospital and I'm not happy with them. The internist kind of 'dropped me' when I started asking about testing Pepper's BG at home. She was emphatic that I continue with Pepper's insulin regimen based on his behavior and urine strip results. 'Just keep giving the insulin as long as the test strips indicate there's glucose in his urine.' She said by pricking him and checking his BG it would stress him out and destroy his chances of going into remission. She said the stress would have a very negative affect on his pancreas and kidneys. Sorry to ramble on. I'm upset for Pepper and I feel like I'm losing him. It's so depressing. Thanks for listening to me vent.
Click to expand...
In addition to all the great advice you’ll get from folks here, we’re also here to listen because sometimes it is overwhelming and it is heart breaking and infuriating too!

So, let me tell you a bit more about Minnie’s journey because it may help you feel better and more hopeful. Minnie was diagnosed March 2019. I no longer see that vet because the only right thing she did was get her on Lantus. Every time I asked about a curve her answer was that there was no need. She never even said Lantus needed to be 12 hours apart just twice a day so at first I was giving her shots less than 12 hours apart. I spent months trying to get her regulated based on the vet checkups only and increasing the insulin by a full unit each time. In the meantime, she developed neuropathy that got progressively more and more severe. It’s common with unregulated diabetes but suddenly my cat had no energy, could barely walk 2-3 steps without having to rest, couldn’t jump or even get in and out of the litter box. When my bday rolled around in September 2019, I didn’t even want to celebrate because I though I was going to have to end her misery soon. By a miracle somehow, she got regulated enough to start recovering from the neuropathy at the end of last year. I found this forum and a new vet and started home testing. She has since then recovered completely from the neuropathy. She can walk, jump, use the litter box - the first day she jumped on my bed to wake me up in the morning, I knew she was herself again and I cried like a baby. I also cried when she could finally hold herself through pooping without having to plop down on it! This year has been tough with new challenges. 2 hospitalizations because of IBD, pneumonia and cardiomyopathy. She had a feeding tube on for 2 weeks and the only thing that kept me sane through May and June is this forum and our family here. The bills pulled on but once again, she fought through it all and recovered. These guys here will tell you that it didn’t seem she oils get through it, especially after the 2nd emergency trip to the hospital, but my little Brazilian Amazon warrior kitty did. I got lucky with the specialty emergency hospital a friend referred me to. The staff there is amazing, caring and knowledgeable. I really owe them her life. This long ass story has really 2 main points that I’m trying to make: 1) they’re a lot more resilient than we give them credit for and yes, sometimes they need to get worse before they get better. But we have to stay hopeful and support them the best way we can. Sometimes that means going into credit card debt :banghead::banghead::banghead: 2) if you have mixed feelings about your vet, don’t hesitate to find a new one. I wish I had done that sooner because it could have spared Minnie from her a kid of unnecessary pain :(
 
Aleluia Grugru & Minnie said:
In addition to all the great advice you’ll get from folks here, we’re also here to listen because sometimes it is overwhelming and it is heart breaking and infuriating too!

So, let me tell you a bit more about Minnie’s journey because it may help you feel better and more hopeful. Minnie was diagnosed March 2019. I no longer see that vet because the only right thing she did was get her on Lantus. Every time I asked about a curve her answer was that there was no need. She never even said Lantus needed to be 12 hours apart just twice a day so at first I was giving her shots less than 12 hours apart. I spent months trying to get her regulated based on the vet checkups only and increasing the insulin by a full unit each time. In the meantime, she developed neuropathy that got progressively more and more severe. It’s common with unregulated diabetes but suddenly my cat had no energy, could barely walk 2-3 steps without having to rest, couldn’t jump or even get in and out of the litter box. When my bday rolled around in September 2019, I didn’t even want to celebrate because I though I was going to have to end her misery soon. By a miracle somehow, she got regulated enough to start recovering from the neuropathy at the end of last year. I found this forum and a new vet and started home testing. She has since then recovered completely from the neuropathy. She can walk, jump, use the litter box - the first day she jumped on my bed to wake me up in the morning, I knew she was herself again and I cried like a baby. I also cried when she could finally hold herself through pooping without having to plop down on it! This year has been tough with new challenges. 2 hospitalizations because of IBD, pneumonia and cardiomyopathy. She had a feeding tube on for 2 weeks and the only thing that kept me sane through May and June is this forum and our family here. The bills pulled on but once again, she fought through it all and recovered. These guys here will tell you that it didn’t seem she oils get through it, especially after the 2nd emergency trip to the hospital, but my little Brazilian Amazon warrior kitty did. I got lucky with the specialty emergency hospital a friend referred me to. The staff there is amazing, caring and knowledgeable. I really owe them her life. This long ass story has really 2 main points that I’m trying to make: 1) they’re a lot more resilient than we give them credit for and yes, sometimes they need to get worse before they get better. But we have to stay hopeful and support them the best way we can. Sometimes that means going into credit card debt :banghead::banghead::banghead: 2) if you have mixed feelings about your vet, don’t hesitate to find a new one. I wish I had done that sooner because it could have spared Minnie from her a kid of unnecessary pain :(
Click to expand...
You've been through so much, Ale. Thanks for sharing your and Minnie's story. I'm so happy you found a decent place to bring her where there are knowledgable, caring staff.
 
Hello friends,
I hope you are all well.
It’s time for me to purchase more insulin for Pepper and I can’t find the thread where someone told me how to get it for less than the $200 I’ve been spending. Can anyone help me, please?
Thank you! : )
Ps
I probably should have started a new thread.
 
Buying from Marks Marine Pharmacy is where most of us go but a 5 pack of pens is $190 (including shipping)...but that's enough insulin to last most cats at least 1 year and some up to 2 years.

When you started on Lantus, did you just buy one pen? Or did you buy a vial? Just trying to figure out why you need insulin already since you just started in May (or is that just when you started testing?)
 
Hi Chris, I have purchased two vials of insulin since I started giving it to Pepper and each vial cost 200.00. There is a lot left in the current vial but I was told it is only good for two months. I haven't used the pens yet, but aren't they supposed to last longer than the vials? Are there any downsides to using the pens? Thank you for your help. Also, Pepper's glucose numbers have been high and I don't know if he should be getting a higher dose of insulin. I just wish the numbers would go down.
 
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