little bit of help? :-D

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horselo285

Member Since 2011
Hey everyone,

So, for those of you who do not know my story, I took over the care of my brother's diabetic cat, Louie a couple of months ago. My brother moved a while back and could not bring him with him. My father had taken over his care, but was not keeping him on a schedule or taking the diabetes thing seriously (ironic as he is diabetic) and Louie had lost a bunch of weight.

I took over to try to help him and although his numbers have not regulated yet, they are generally lower then they were and he has gained weight and seems healthier.

My goal is to get him as regulated as possible and as close to a healthy range as possible. He is currently on 1 unit of lantus twice daily. Typically, I check his bg levels before each shot and try and get spot checks (unfortunately, this is not always possible). There are some days when im working and my dad gives him his insulin blindly. I don't like this, but so far, he refuses to learn how to test him. Luckily though, I only work 1 or 2 days a week on average as I have two young children and went back to school full time this year.

I was wondering if I could get some advice on Louie's numbers and insulin dose. Although I am not an expert, I do not think he needs a raise atm- my main question has to do with the occasional time that I have lowered his dose to .5. I do not know if this was the right decision- but there have been some nights where he was lower then usual and I was afraid to give him a full dose as I cant really spot check at night. He gets fed at 10:30 am and 10:30 pm and between my children, school work and sleep, spot checking the pm cycle usually doesn't happen. He lives upstairs and he (as well as the family's other cats) has the run of the whole main part of the house (there is no where to lock him up easily). Whe I come up at night, I understandably have to be quiet- if he is nearby, he always hears me and comes running- but if he is upstairs, he doesn't hear me and I can't yell in the middle of the night.

Wow- I feel like ive thrown so much info into one post. Hopefully not too much. :-)

I am planning to spot check Louie tonight at +7 and +9 as it appears (from the last few days) that he is dropping lower sometime after +6. To pinpoint it- my main question at the moment is, if he drops into the blues and low yellows, should I still give him the 1 unit or should I reduce it (as I have done out of fear a few times) to the .5. I know that ideally I should try and get more spot checks and I really am trying to get them- but any advice based on what I have atm would be VERY GREATLY appreciated.

Thank you so much!
-Laura

(oh...fyi- Louie is on low carb canned food. All the varieties I get have 0-5 carbs total.)
 
Hi there,
Thanks for taking care of this kitty! :)
I think the biggest thing that jumped out at me was your statement that reducing to .5u was not successful. That would likely be due to the fact that it was too big a reduction. We have found that smaller reductions work better with Lantus, so you can try .25u next time. It's a bear to measure, but it should make a substantial difference in your increasing and decreasing responses. :)
Great job so far!

EDIT just realized I was unclear: when I said try .25u, I meant .25u increments.. so perhaps a dose of .75u would get you to a range you were both more comfortable?
 
Thanks for the reply!

Ok- so two questions.

One: how do you measure .25 to reduce it? That seems like so little? Tips would be greatly appreciated on that! lol

Two: At what number do you think a .25 reduction may be necessary? I know it varies from cat to cat- but would you suggest that if he under, like 230 to reduce? 220? more? less? I know it is probably hard to say, but any guidance would be very much appreciated! I tend to make a decision (like to reduce at 200 or 210) and then wonder if I made the right decision or if he is going to go too high now. Then there are the days where I give the full dose at 230 and I wonder if he is going to low. I am trying to get the spot checks, which I know will make it easier to decide when dose reduction is necessary. But any guidance until then is really appreciated!

Thank you so much!

-Laura
 
The general guideline is anything below 150 for new diabetics to either reduce or skip all together, but you also have to do what you are comfortable with. As already stated you can reduce by a 0.25 unit if you want. This can be accomplished by twisting the syringe plunger to squeeze out 2 or 3 drops from the 1.0u mark.

If you look at your spreadsheet where you have reduced, what have the results been in the next cycle?


Here is a general guideline that you may want to keep in mind as a goal overtime:

Not treated [blood glucose typically above 300 mg/dl (16.7 mmol/L), poor clinical signs]

• Treated but not regulated [often above 300 (16.7) and rarely near 100 (5.6), poor clinical signs]

• Regulated [generally below 300 (16.7) with glucose nadir near 100 (5.6), good clinical signs, no hypoglycemia]

• Well regulated [generally below 200-250 (11.1-13.9) and often near 100 (5.6), no hypoglycemia]

• Tightly regulated [generally below 150 (8.3) and usually in the 60-120 (3.3-6.7) range, no hypoglycemia, still receiving insulin]

• Normalized [60-120 (3.3-6.7) except perhaps directly after meals -- usually not receiving insulin]
Click to expand...

Numbers in the 100-300 ranges are nice regulation numbers and are a great goal. Most vets are often happy to see cats maintian in these ranges.
 
Just looking at his spreadsheet and seeing those high preshots and late nadirs has me wondering if 1u is too much for him. You might want to try dropping the dose just slightly like maybe try .75u for a few cycles, to let it 'settle' and then see where his numbers go from there. Be aware that his numbers might get a little strange for a couple of days and you will want to be testing for ketones if you do reduce.

But personally if he was mine I would try going down just a little bit in dose. If he doesn't start having better preshot numbers in about 3-5 days then you can always go back up again and then try the other direction.

Mel, Maxwell, Musette & The Fur Gang
 
Thanks for the replies!

Beth- im not sure if he can be considered newly diagnosed? He's had diabetes for years, but has only just switched to lantus- so I am not sure how that works.

It seems like he has decent numbers right b4 his pm insulin but by the am he has spiked up. I have been pondering whether this was because the .5 was too little or if it was because he dropped to low and bounced. frustrating! aaahh lol

Mel- I will try the .75 for a few days. The problem is that I have never been able to get his ketone levels. :-/ I don't really have anywhere to lock him up away from other cats without forcing him into my apartment; there are two issues with doing that. 1. he tends to pee when he is stressed out or sick and there are lots of spots in my apt where he could have a pee fest. 2. I have two dogs who he does not particularly like. I have tried getting him to come down here and he will come for a few mins here and there, but will not use the litterbox and placed down here in front of me and I am afraid to leave him alone for the reasons stated above. I feel like that aspect is a catch 22. He did have his ketone levels checked at the vet before we switched to lantus (I know...probably not too helpful) and they were fine then.
 
And with the other cats upstairs and your Dad refusing to learn to test there is not much hope of having your dad get a pee test is there? :-D

Well that would be in a perfect world, so if the best you can do just try to get a good whiff of his breath as long as he still smells like catfood and not nail polish remover you should be fine. And of course watch his numbers when you can you don't want him hanging up in the 400+ numbers for too long, but the problem with too much and too little insulin is they can both look exactly the same. So I would try going down if it doesn't work then switch gears and go the other way.

Mel, Maxwell, Musette & The Fur Gang
 
horselo285 said:
Thanks for the replies!

Beth- im not sure if he can be considered newly diagnosed? He's had diabetes for years, but has only just switched to lantus- so I am not sure how that works.

It seems like he has decent numbers right b4 his pm insulin but by the am he has spiked up. I have been pondering whether this was because the .5 was too little or if it was because he dropped to low and bounced. frustrating! aaahh lol
Click to expand...

He is on a new variety of insulin, so he is essentially starting over and based on you stated comfort level 150 might a a good place to put the cut off.

Keep in mind that this is a very long acting insulin. So you may be getting some overlap. And his liver also needs to learn that these new numbers are normal. Drop back to 0.75 for 3 days or so and let's see what happens.

What was his dose on the other insulin?
 
MommaOfMuse said:
And with the other cats upstairs and your Dad refusing to learn to test there is not much hope of having your dad get a pee test is there? :-D

Well that would be in a perfect world, so if the best you can do just try to get a good whiff of his breath as long as he still smells like catfood and not nail polish remover you should be fine. And of course watch his numbers when you can you don't want him hanging up in the 400+ numbers for too long, but the problem with too much and too little insulin is they can both look exactly the same. So I would try going down if it doesn't work then switch gears and go the other way.

Mel, Maxwell, Musette & The Fur Gang
Click to expand...

LMAO- yeah- The day my dad does that is the day that I win a million dollars (please...let that day come soon!!! hehehe) His breath def doesn't smell like nail polish- thanks for that tip, I will be keeping an eye on that!! I will try the .75 and keep everyone updated. :-)

e is on a new variety of insulin, so he is essentially starting over and based on you stated comfort level 150 might a a good place to put the cut off.

Keep in mind that this is a very long acting insulin. So you may be getting some overlap. And his liver also needs to learn that these new numbers are normal. Drop back to 0.75 for 3 days or so and let's see what happens.

What was his dose on the other insulin?
Click to expand...

I will start doing .75 tonight and will let you guys know what his levels do. :-D If his level is at 150 or below, should I cut to .5 or skip it, or just give the .75?

Thanks so much for your help (everyone)! I really appreciate it. :-D
 
Sorry :roll: I didn't read through your whole condo, yet.
J.D. is on a dose of 0.75. I just gave him his shot. I pull out more than one unit into the syringe, and then slowly push out insulin to the 1.00 unit mark, and then even slower push out insulin to what I think (yeah right) is about half way between the 1.00 unit mark and the 0.50 mark. I kind of try to judge by how much insulin is after the 0.50 mark. About the width of the mark itself or a little more. I'm sure it varies with syringe makers. Just try to be as consistant as you can.
I'll often make a sample syringe by taking a used syringe and marking it by painting finger nail polish on the end of the plunger, and then pull out air to my "new" or current dose, so that I can compare that sample syringe to the actual dose I'm measuring.

I have to go walk my cats, now. I'll come back later, and read through your condo :-D
 
For now if it was me I would just skip if he is below 150 at a preshot test, afterall 150 is the high end of normal. Until you are absolutely sure how he is going to react to that .75 anything below 150 would be my cut off. Or when in doubt post and ask for help.

Mel, Maxwell, Musette & The Fur Gang
 
Hi Laura,
Dyana gave you some great tips on getting the .75 right in the syringe. Just a couple things. When you squirt the insulin drops back out of the needle, make sure you aren't shooting them back in the pen. Just into a paper towel or the sink or something. Once the inuslin comes out of the pen, you don't want to put it back in. You also might push some air into the pen, and that isn't good.
Another way to get the right amount....use an old syringe, and get some food coloring and water. Draw the water into the old syringe past up to 1u, then a drop at a time, squeeze it out until you get the rubber stopper edge right between 1u and 1/2 u. That is now your "display model".. Next time, with insulin in a new syringe, make it look just like that one, lay them side by side. That is how you'll know it is the same dose every time. Put the cap back on the old needle too. Don't want to poke yourself with it!

Carl
 
Thanks guys!!!!!

Carl- I managed to get the .75 (I think) before reading you message (I have been working all night and this is my first time check fdmb in a while). I squirted the insulin back into the pen--I didnt know I wasnt supposed to. Is this going to hurt it? I really didn't know-- now I wish I had read this message first. ugh!

Thanks for the advice on making the "display model" using food coloring. I will def do that!
 
I didn't see it mentioned, maybe I missed it.... you have the syringes with half unit markings, yes?
I hope so, but if not, get some so that you will have an easier time measuring doses like .25 and .75
 
horselo285 said:
Thanks guys!!!!!

Carl- I managed to get the .75 (I think) before reading you message (I have been working all night and this is my first time check fdmb in a while). I squirted the insulin back into the pen--I didnt know I wasnt supposed to. Is this going to hurt it? I really didn't know-- now I wish I had read this message first. ugh!

Thanks for the advice on making the "display model" using food coloring. I will def do that!
Click to expand...

Don't sweat it, but don't make a habit of it in the future, just squirt it into the sink or trash can. If the numbers start to go all yucky, then we will just move onto the next pen. The main reason we don't reinject into the cartridge/pen is because it could break the hydraulic seal and cause leaks. You're doing great :)
 
Carolyn and Spot said:
The main reason we don't reinject into the cartridge/pen is because it could break the hydraulic seal and cause leaks. You're doing great :)
Click to expand...

I always read that it was because the silicon lining of the syringes could contaminate Lantus insulin. And that this was one of the differences I thought I had learned between Lantus and Lev because with Levemir (with similarly sealed pens) one can reinject. I re-injected all the time when we used Levemir. But, of course, I cannot even find the "do not re-inject" guidance on the Pets with Diabetes wikia, much less the reasoning for it.
 
This is something that I have wondered about since the Lantus Reference Guide says to leave the needle in the vial when removing air bubbles and shoot out the air bubbles into the vial and redraw the insulin in the syringe until you get the correct dose. Granted that is for a vial and for human use, so a human would be going through it faster than our cats.

Mel, Maxwell, Musette & The Fur Gang
 
Hi Laura -

As you get more comfortable with how Louie reacts to a certain dose you'll be able to tweak it, but a 'no shot' level of 150 sounds good for now.

ECID (each Bean as well), but some thoughts from my experience that might be helpful...

When Tiger was 1st diagnosed I used 200 as my cut off. (That was with a different insulin though, PZI, and she would drop pretty quickly on it.) Over the years, and after we switched to Lantus, that gradually moved lower. Eventually I was comfortable with a low 100's pre-shot for her. But I was never comfortable shooting under 100. She tended to have a late nadir with Lantus, and sometimes a double nadir, so if her pre-shot was borderline I often waited an hour and by then she was coming up enough to shoot.

The circumstances are also important to consider. When I had to board Tiger at the vet (not a 24-hour facility), I knew she would not be eating as much as normal. And she would not be able to graze as much whenever she wanted a snack, like she did at home. So I would cut her dose in half while she was boarding, and give them a higher 'no shot' level of 180. And they often needed to skip a shot. (She never showed even a trace of ketones, so I was comfortable reducing her dose for a few days. If she had been prone to ketones that would have been a different situation.)


As far as measuring small changes in dose, I found a trick that worked well for me. It's been a year now, so I don't remember the exact measurements, you'll have to play with it and see if/how it works for you. I found that rather than looking at the bottom edge of the rubber (toward the needle) I could sometimes use the top edge (toward the plunger) to line up with the next higher dose.

I was using syringes with 1/2 unit markings, so for example: For 0.75 units nstead of trying to line up the bottom edge half way between the 1/2 & 1 lines (where there is no mark), if I lined up the top edge at the 1 line (it might have been at the top edge of the line?) then I had a guide mark I could use to line it up accurately.

Let's see if I can 'draw' it...
The rubber plunger looks like this: {toward needle} || {toward plunger}
You normally measure using the bottom edge at the mark for the dose: =>||
Instead, measure using the top edge at the next higher mark: ||<=

I still have some syringes, so if it would be helpful I'd be happy to take some close-up pictures for you.
 
Venita and Ennis93 said:
Carolyn and Spot said:
The main reason we don't reinject into the cartridge/pen is because it could break the hydraulic seal and cause leaks. You're doing great :)
Click to expand...

I always read that it was because the silicon lining of the syringes could contaminate Lantus insulin. And that this was one of the differences I thought I had learned between Lantus and Lev because with Levemir (with similarly sealed pens) one can reinject. I re-injected all the time when we used Levemir. But, of course, I cannot even find the "do not re-inject" guidance on the Pets with Diabetes wikia, much less the reasoning for it.
Click to expand...

I doubt the silicone is an issue, since vial users are told to inject air into their vials, as well as reinject over-draws of insulin. I (off-topic slightly) often wondered if reinjecting into the vials caused a faster loss of insulin efficacy when I was using Lantus/Levemir vials, but never could find any data to back that up.

It's not advised to inject air into either cartridge due to the hydraulic function, but the Levemir ones are a wee bit more forgiving. It's the hydraulic, and they will leak - it's referred to as "the negative pressure principle".

Similarly, one can not re-use syringes with Lantus or Levemir because the insulin will break down almost instantly at that point. I remember once there was a member who was doing that and his insulin actually turned brown.
 
Carolyn and Spot said:
I doubt the silicone is an issue, since vial users are told to inject air into their vials, as well as reinject over-draws of insulin.
Click to expand...

Yes, vial users inject air into their vials before the draw, otherwise it is difficult to draw from the vial because of the negative vacuum. (When I forget to first inject air into Ennis's Adequan vial, I have a pretty tough time pulling the 30 units for his shot.) Personally, I would caution a Lantus user against re-injecting into a vial just as I would into a pen. I do not give the same caution with Levemir, pen or vial.

In any event, we agree that Lantus should not be re-injected into a pen, and most Lantus users here are using pens.
 
Hey guys,

So the verdict is that we should never re-inject lantus into the pen under any circumstances? What if there are air bubbles as you begin to draw up the dose or if you draw too much? In either case, should u dump the extra (or air bubble filled) insulin and start again?

Thanks so much for the help. :-)

-Laura

p.s.

Louie seems to be doing ok so far on this dose-- no ridiculous spikes (400's/500's) although still fairly high (high 300's at times). No blues so far, but was steady yellows and purples yesterday. He was a purple this am (have not added it in yet- but he was in the 300's) and I will be checking him when possible today. :-)
 
re: air bubbles
First, a pull the plunger all the way out of the syringe and give it a good pop. I don't KNOW this works, it's just something I do ;)
Second, push the plunger all the way back in as hard as you can. Some brands are worse than others with air bubbles but if you shove hard, that should eliminate *most* bubbles.
Finally, overdraw your insulin slightly, then remove from cartridge/pen. Then draw in some air, make sure the needle is pointing up, flick the cylinder a bit to get the air bubble to join the drawn air then.. and this is the fun part.. twist the plunger as if you're turning a screw until you get the leading edge of the plunger where you want it. Insulin will come out in drops rather than squirts so it takes a bit longer but it's pretty precise and you're almost guaranteed to get all the air out that way.

Hang tight on that dose for at least 1-2 more cycles, it looks like progress is coming :)
 
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