Lost and No Time (Qs re. meter, dosing)

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bambinaki

bambinaki

Member Since 2010
Hello again everyone and thanks to those of you who have already helped Maxi and me.

I am doing my best but am lost and a big problem is a lack of time. My aunt's funeral was yesterday, memorial today, I might take my sister to the ER today (we are very scared about what might be wrong with her), and I have a medical procedure Friday, plus I do actually have to work full time to survive. All of this alone is overwhelming and now combined with Maxi's diagnosis and the enormous amount of information (which I search but can never seem to find clear answers) is just too much. I have quickly looked through different sources of info, including this huge website, and when I get a chance, I will carefully read everything, but for now I am hoping for some fast answers.

Maxi had a unit of Vetsulin Monday morning and another Monday night. By yesterday morning I was scared to overdose him (I changed his food and he stopped the excessive drinking immediately + I had a cat who became "undiabetic" just with a diet change), so I gave him 1/2 unit and same last night. This morning I tested him with the AlphaTrak meter and his number was 451 about 20 minutes after eating and then I gave him a unit of Vetsulin. I am going to the pharmacy now to buy Lantus and to Walmart for a human test kit (ReliOn Premier is what you recommend, right?), and to the vet to get his urine test result from Monday and will post them later today. Attached are his results from last October and this past Monday.

My immediate questions are:
When I test him with the Alpha Trak, under 80 and over 120 is bad, right? I mean is the normal glucose range 80 -120?
What about when I test him with the ReliOn Premier that I'm going to buy today? I understand that the numbers are different.
How often and when (with relation to eating times [he eats twice a day]) should I test him?
When should I give him insulin with relation to eating times?
How do I figure out how much insulin (Lantus) I should give him?
I'm *vaguely* aware of curving, titer, etc., but is there a succinct step-by-step list of what to do? Like: (1) test (2) if number is this or that, then give this or that much insulin (3) feed (4) test again in X minutes, etc.

Thank you all for your help and support.
 

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You will need u-100 insulin syringes for Lantus.
(Lantus is a different “strength” than Vetsulin so requires different syringes.)

Walmart carries Relion brand. At the pharmacy, ask for 3/10 cc u-100 insulin syringes with 1/2 unit markings. A box of 100 was around $12.60 last I checked.

edited to add: once you switch to Lantus, use a black sharpie to label the old u-40 syringes as “vetsulin only” and put them in the back corner of a remote cupboard where you won’t see them. If you accidentally use an old u-40 syringe with Lantus, you’ll be overdosing your cat.
 
bambinaki said:
My immediate questions are:

When I test him with the Alpha Trak, under 80 and over 120 is bad, right? I mean is the normal glucose range 80 -120?
What about when I test him with the ReliOn Premier that I'm going to buy today? I understand that the numbers are different.
How often and when (with relation to eating times [he eats twice a day]) should I test him?
When should I give him insulin with relation to eating times?
How do I figure out how much insulin (Lantus) I should give him?
I'm *vaguely* aware of curving, titer, etc., but is there a succinct step-by-step list of what to do? Like: (1) test (2) if number is this or that, then give this or that much insulin (3) feed (4) test again in X minutes, etc.
Click to expand...

1. Not that simple to say over 120 is bad. Normal BG for non-diabetic cat is Under 100. Alphatrak reads a bit higher there are no conversions to tell you what exactly the differences are.
2. Normal BG for non-diabetic cat with human meter is <100 What is Regulation?
3. Depends on the insulin you are using. But always at pre-shot and again at nadir (mid-cycle)
4. depends on which insulin you are giving
5. Based at least partially on what previous dose of other insulin
6. No. step by step is not available. We are not WIKIHow. Depends on what insulin you are using and what dosing protocol you choose.

For Vetsulin, read this It's in the Caninsulin/Vetsulin and N/NPH ISG
Beginner's Guide to Caninsulin (Vetsulin)

Go to the Lantus ISG and read the first sticky
The Basics: New to the Group? Start here!
then this one
Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)
Yes, one of the Relion premier meters or the Relion Prime


p.s. I had one of those weeks last week. Feel for you.
 
When you have time, set up a spreadsheet. I know time for you is difficult. Believe me, we understand. But no one is going to want to give you dosing advice without a spreadsheet, as it's too dangerous.
I am not familiar with Lantus, so I will let someone else guide you with that.
With all insulins, yout test, then feed, then inject. I believe with Lantus you should test, feed, then wait 30 minutes (Nope, Deb tells me the 30 min wait is for Vetsulin.), then inject. It is normal to inject twice a day, every 12 hours.
A general starting dose is on the low side, such an 1 unit. But I would wait for a member who knows Lantus more before you go with that.
With a human meter, to start out, don't inject if the BGL is under 200. That will help keep you safe from hypo events.
With a human meter, under 50 BGL is a cause for concern. Under 30 is an immediate emergency.
Since you are changing insulins, some mid-cycle tests would be a very good idea. Injection time +3 hours, +5 hours, +7 hours, when you can. I know you have a lot going on.
Please consider feeding many small meals through the day and night instead of just 2 times a day. Just be sure to pull up food 2 hours before shot time. You can leave some food out for your cat, or consider getting a timed feeder.

I'm sure more experienced Lantus users will be in to help, but I hope this helps a bit.
 
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bambinaki said:
I just tested again and it was 367.
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367 in relation to what? Pre-test shot? so many hours after a shot? Before a shot?

AMPS and PMPS are hour 0, +1 1 hour after, +2 2 hours after, +3 3 hours after and so forth.

Are you stalling?

She is using Vetsulin for the moment, until she can pick up the Lantus.
 
"I believe with Lantus you should test, feed, then wait 30 minutes, then inject. It is normal to inject twice a day, every 12 hours."

No Juls, with Vetsulin it's test, feed, wait 30 minutes, shoot. Food needs to digest first to counter act the quicker onset of Vetsulin.

With lantus, test, feed, shoot in a period of 15 minutes or so. Shorter time period if you are quick enough.
 
If the lantus is too expensive for you, it usually is .
Are you getting the vial or a pen
there is a supply closet here that members sell insulin when their kitties have passed. I see right now there is some one selling the Lantus Pens for 30.00 each plus shipping. One pen can last 6 months depending on the dose you are giving. I myself have bought Lantus pens from the supply closet, If you are interested I can give you her name
 
Photo attachments are too blurry to read. There is a tab on the SS once you set it up, where you can record the lab results. You need to add columns, the first one being the reference ranges for the lab that was used. These vary from vet to vet.
 
Deb & Wink said:
Photo attachments are too blurry to read. There is a tab on the SS once you set it up, where you can record the lab results. You need to add columns, the first one being the reference ranges for the lab that was used. These vary from vet to vet.
Click to expand...
I can read the images fine although I had to turn my head for some.
Ecept for glucose I find nothing of note except:
  • the eosinophils (type of white blood cell) are a little high) for both Oct and Jan
  • Urine specific gravity (USG) was only 1.015 in Oct which is low and Creatinine was also at upper limit of 2.4. In January not urine results were included but creatinine was only 2.0. The low USG indicate some kidney deficiency as does the relatively high creatinine
 
Diane Tyler's Mom said:
If the lantus is too expensive for you, it usually is .
Are you getting the vial or a pen
there is a supply closet here that members sell insulin when their kitties have passed. I see right now there is some one selling the Lantus Pens for 30.00 each plus shipping. One pen can last 6 months depending on the dose you are giving. I myself have bought Lantus pens from the supply closet, If you are interested I can give you her name
Click to expand...
If the prescription is for the vial, ask for one for a package of pens. If you are in the US, ask for two prescriptions. One for a single pen and another one for the package of 5 pens. The single pen script you can take to any pharmacy so you can get started using it. For the one for the package, many members in the US order it from Mark's Pharmacy in Canada. It is cheaper than trying to buy Lantus in the US. Depending on your dose, on pen will provide enough insulin for 2 months or more. A package of pens could easily provide enough insulin for about 10 months.

The reason you do not want the vial is the insulin starts losing its effectiveness from the first time it is used. So even though you have a lot in the vial, it usually becomes ineffective for controlling glucose levels around 3-4 month and you will end up throwing most of the insulin away. That is why we recommend the pens. Each pen will be used like a mini vial and you will be able to use almost every drop before it becomes ineffective.
 
Larry and Kitties said:
I can read the images fine although I had to turn my head for some.
Ecept for glucose I find nothing of note except:
  • the eosinophils (type of white blood cell) are a little high) for both Oct and Jan
  • Urine specific gravity (USG) was only 1.015 in Oct which is low and Creatinine was also at upper limit of 2.4. In January not urine results were included but creatinine was only 2.0. The low USG indicate some kidney deficiency as does the relatively high creatinine
Click to expand...
Lisa and Witn (GA) said:
If the prescription is for the vial, ask for one for a package of pens. If you are in the US, ask for two prescriptions. One for a single pen and another one for the package of 5 pens. The single pen script you can take to any pharmacy so you can get started using it. For the one for the package, many members in the US order it from Mark's Pharmacy in Canada. It is cheaper than trying to buy Lantus in the US. Depending on your dose, on pen will provide enough insulin for 2 months or more. A package of pens could easily provide enough insulin for about 10 months.

The reason you do not want the vial is the insulin starts losing its effectiveness from the first time it is used. So even though you have a lot in the vial, it usually becomes ineffective for controlling glucose levels around 3-4 month and you will end up throwing most of the insulin away. That is why we recommend the pens. Each pen will be used like a mini vial and you will be able to use almost every drop before it becomes ineffective.
Click to expand...

Lisa,
Thank you.
So, can I use the needles that I would use for the vial with the pens? Or do I use the pen itself to inject the insulin? If I use the pen to inject, will I be able to measure precise doses like .5 units?
 

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Use insulin syringes to withdraw insulin from the "pen" or mini-vial.
No, you will not be able to withdraw smaller doses if you use the "Dial a dose" feature of the pen.

Video on how to do that here.
How to Draw Insulin from a Pen or Vial With a Syringe (Video from Julie & Punkin)

Hopefully you got 3/10 cc U100 syringes with 1/2 unit markings on the barrel. To use with the Lantus. Caps are orange instead of red.

p.s. Please change your signature when you change to Lantus.
Also, make a big note on one of the rows on your SS that you have switched from Vetsulin to Lantus. And put the date you did that change across the row, just below the last time you gave Vetsulin.
 
Thank you, Deb.
So, to confirm, I *can* insert the U100 syringes into the pens to withdraw insulin from the pens?
 
Yes, but after you use the insulin syringe on the "pen", you can no longer use the dial-a-dose feature. It will screw up the pressure within the pen. It's worth it though, since the dial a dose feature needs to be primed before each use, and you waste up to 2 Units of insulin each time your prime the pen. Plus our kitties need such small doses, the dial-a-dose feature doesn't work well for increasing/decreasing the dose by 0.25U at time.

Store the pens in the fridge too. They'll last longer. Much longer than the "28 days" they were tested for.

p.s. Hope your sister is ok.
 
Maxi is still on the Vetsulin. I wasn't able to get Lantus pens today, only the very expensive vial. I'm worried. His glucose is still so high and I want to bring it down before more damage is caused to his body.
Today (Wed., Jan. 29) at 10am, 15 minutes after eating and 10 minutes after a 1/2 unit of Vetsulin, his glucose was 451 using the AlphaTrak meter.
At 11:30am, glucose was 367 on AlphaTrak.
At 1:15pm, it was 358 on AlphaTrak.
At 10pm, it was 315 on AlphaTrak.
At 10:30, it was 283 *using the ReliOn meter*.
At 10:30, he ate. He ate less than normal and slower than normal. After he ate, he went back to the water bowl a couple times (unusual for him before).
After eating, at 10:45, he got 1 unit of Vetsulin.
At 12:30am, his glucose was 380 using the AlphaTrak.
At 12:50am, it was 254 *using the ReliOn meter*.
At 2:40am, it was 255 on AlphaTrak.

Thursday, Jan. 30 at 6:15am, it was 187 with AlphaTrak.
At 6:20am, he ate a half portion (on purpose by me because of my schedule - he'll get the other half around 10:30 with anther test and insulin if over 200)
At 7:25am, it was 314 with AlphaTrak.
At 10:35am, it was 286 with AlphaTrak.

I read about "go Slow..." but do you think I should give him 1.25 units of Vetsulin tomorrow morning? I'm anxious about waiting a week and letting the diabetes hurt him more.

I hope to start him on Lantus tomorrow evening.

Thanks

PS: I will attempt a spreadsheet over the weekend.
 
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I'm not experienced with Vetsulin, but while your numbers are high, they aren't crazy high. My gut feeling is not to raise his dose the day you are about to switch insulin types. Give him his one unit in the morning, then switch to the Lantus for the evening shot. And Lantus, being a depot insulin, is very different. It will be best to start low and go slow, and you'll need that spreadsheet set up so the experienced Lantus members can really help you with dosing. Be patient, and don't be tempted to up the dose on the Lantus without giving it some cycles to build that depot. I'm sure experienced Lantus members will be able to provide you with more informed advice.
 
Stalling is like this. Say you have a no shoot number of 200. It's preshot test time, and the cat's BGL is only 170. Too low to inject, but at the same time, you don't want to skip insulin if you don't have to. So you decide to wait (stall) without feeding and see if the BGL comes up enough to shoot. You don't feed, wait 20 minutes, and test again. If it's over 200, huzzah! You inject the insulin and then feed. If it's not over 200, you could decide to skip the dose, stall again, or do a small or drop dose.

With some non-depot insulins, this might not effect your next shot time. An in and out insulin like Vetsulin, or an insulin that doesn't last as long, like Prozinc, will be out of the system by the next shot time. With a depot insulin like Lantus, stalling might mean you have to do the next shot later as well, 12 hours from the time you actually injected after a stall.
 
Juls and Billy said:
Stalling is like this. Say you have a no shoot number of 200. It's preshot test time, and the cat's BGL is only 170. Too low to inject, but at the same time, you don't want to skip insulin if you don't have to. So you decide to wait (stall) without feeding and see if the BGL comes up enough to shoot. You don't feed, wait 20 minutes, and test again. If it's over 200, huzzah! You inject the insulin and then feed. If it's not over 200, you could decide to skip the dose, stall again, or do a small or drop dose.

With some non-depot insulins, this might not effect your next shot time. An in and out insulin like Vetsulin, or an insulin that doesn't last as long, like Prozinc, will be out of the system by the next shot time. With a depot insulin like Lantus, stalling might mean you have to do the next shot later as well, 12 hours from the time you actually injected after a stall.
Click to expand...

Thanks, Juls.

Where does the "no shoot number" come from?
Is 200 the general rule?
 
The no shoot number is different for every cat, depending on various factors. Sienne and Deb are right, there's tons of support on the Lantus section of the forum. You really should make a post there.
 
Deb & Wink said:
Yes, but after you use the insulin syringe on the "pen", you can no longer use the dial-a-dose feature. It will screw up the pressure within the pen. It's worth it though, since the dial a dose feature needs to be primed before each use, and you waste up to 2 Units of insulin each time your prime the pen. Plus our kitties need such small doses, the dial-a-dose feature doesn't work well for increasing/decreasing the dose by 0.25U at time.

Store the pens in the fridge too. They'll last longer. Much longer than the "28 days" they were tested for.

p.s. Hope your sister is ok.
Click to expand...

Deb, how long will the pen be good if I store it in the fridge?
Thanks
 
Good until the last drop is what I've heard from other people. I've never needed to use up an entire pen, and passed it along to someone else when I didn't need it anymore.

So if you used 4 units a day (2u AM, 2u PM) a pen would last you 75 days,give or take.
 
Deb & Wink said:
Good until the last drop is what I've heard from other people. I've never needed to use up an entire pen, and passed it along to someone else when I didn't need it anymore.

So if you used 4 units a day (2u AM, 2u PM) a pen would last you 75 days,give or take.
Click to expand...

Thanks
 
Hi Deb-

You said: Alphatrak reads a bit higher there are no conversions to tell you what exactly the differences are."
But it looks like my AlphaTrak is reading a lot higher:

I switched from using the AlphaTrak to ReliOn to measure Maxi's glucose per the advice of folks here. However, when I reported this to my vet, and when I told her that his numbers were significantly lower with the ReliOn than the AlphaTrak, she said she trusts the AlphaTrak more.
In her office Monday, his glucose was 455mg/dL (range: 74-159).
Tuesday at home, his glucose before eating was 315 with AlphaTrak and 283 with ReliOn.
2 hours later, it was 380 with AlphaTrak and 254 with ReliOn.
Today, 2 hours after eating, it was 390 with AlphaTrak and 298 with ReliOn.

I'm worried that the ReliOn is giving numbers that are inaccurately low and will later cause me to give too little insulin.

What do you think?

NB: I didn't do the accuracy check with control solution with either meter. (Need to figure out how vs. lack of time has kept me from it.) The ReliOn that I got didn't come with the solution. The AlphaTrak did. Do I need to do that?
 
bambinaki said:
Hi Deb-

You said: Alphatrak reads a bit higher there are no conversions to tell you what exactly the differences are."
But it looks like my AlphaTrak is reading a lot higher:

I switched from using the AlphaTrak to ReliOn to measure Maxi's glucose per the advice of folks here. However, when I reported this to my vet, and when I told her that his numbers were significantly lower with the ReliOn than the AlphaTrak, she said she trusts the AlphaTrak more.
In her office Monday, his glucose was 455mg/dL (range: 74-159).
Tuesday at home, his glucose before eating was 315 with AlphaTrak and 283 with ReliOn.
2 hours later, it was 380 with AlphaTrak and 254 with ReliOn.
Today, 2 hours after eating, it was 390 with AlphaTrak and 298 with ReliOn.

I'm worried that the ReliOn is giving numbers that are inaccurately low and will later cause me to give too little insulin.

What do you think?

NB: I didn't do the accuracy check with control solution with either meter. (Need to figure out how vs. lack of time has kept me from it.) The ReliOn that I got didn't come with the solution. The AlphaTrak did. Do I need to do that?
Click to expand...
I know that those readings seem like they are super far off, but they’re really not. You could test twice with the same exact meter and get 283 the first time and 315 the next time, because meters are allowed up to 20% variance. The two meters are basically telling you the same thing: 283 is high and so is 315. 380 is high and so is 254.

Too high is too high, and too low is too low, although the meters do tend to read more similar in lower numbers. What really matters is the trends you are seeing in the numbers and the number you need to intervene at. I tried to compare the meters at first when I switched and it honestly just made me crazy. Sometimes I got almost the exact same numbers, and other times they were off. The best thing to do is to pick the one you’re comfortable with and can afford and stick to that one
 
Sarah&Soph said:
I know that those readings seem like they are super far off, but they’re really not. You could test twice with the same exact meter and get 283 the first time and 315 the next time, because meters are allowed up to 20% variance. The two meters are basically telling you the same thing: 283 is high and so is 315. 380 is high and so is 254.

Too high is too high, and too low is too low, although the meters do tend to read more similar in lower numbers. What really matters is the trends you are seeing in the numbers and the number you need to intervene at. I tried to compare the meters at first when I switched and it honestly just made me crazy. Sometimes I got almost the exact same numbers, and other times they were off. The best thing to do is to pick the one you’re comfortable with and can afford and stick to that one
Click to expand...


Thank you, Sarah.
I'm still trying to understand all this.
It's not clear to me what determines a dose of 1/2 unit vs. a dose of 1 unit, for example. I thought the higher the glucose, the more insulin needed. It seems that's not right, though.
??
 
Some points to consider.
  • Stress induced readings at the vet can be 80 points higher or more. I'll link a study in for you if you like, where cats were given a bath and BG readings tested along the way. It's where the 80+ point rise in BG's that I referred to comes from.
  • Did you test from the exact same blood drop when you did the tests between the Alphatrak and the human meter? I did for a couple of weeks back in 2013 when there was a member here trying to see the "difference" between the pet and human meters.
  • Can you afford the cost of test strips for the Alphatrak vs the human meter? At least 4 tests a day if your schedule allows. 2 pre-shot tests to make sure the BG numbers are high enough to give insulin and one each 12 hour cycle around the +4 to +7 hour time frame to determine when the nadir may be for YOUR cat. ECID. More tests at the beginning of this journey may be needed as you are trying to find the onset, nadir and duration for the insulin you are using for your cat. Could be 10 tests a day or more.
  • Curve at least once a week at home (testing every 2 hours for 12 hours or every 3 hours for 18 hours) or take your cat into the vet for curves.
  • With BG readings, High is high, low is low. You are looking for ranges, not absolutes.
 
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bambinaki said:
It's not clear to me what determines a dose of 1/2 unit vs. a dose of 1 unit, for example. I thought the higher the glucose, the more insulin needed. It seems that's not right, though.??
Click to expand...

Heck no. At least not when you are first starting to give insulin unless you want to risk overdosing your kitty with insulin and risk a hypo. Safer to increase slowly in 0.25U increments. "Start low and go slow" or "Start low and stay safe."

Lantus has a "depot" effect and that little storage area builds up slowly, takes about 6 cycles (12 hours is a cycle) to fill before you "see" the full effect of any dose on your cat. Lantus is like steering a huge cruise ship. Need to plan ahead to keep from hitting the reef around those Caribbean islands.

Please read the "Stickies" or pinned posts at the top of the Lantus forum. Especially that first one.
 
bambinaki said:
Thank you, Sarah.
I'm still trying to understand all this.
It's not clear to me what determines a dose of 1/2 unit vs. a dose of 1 unit, for example. I thought the higher the glucose, the more insulin needed. It seems that's not right, though.
??
Click to expand...
That is the short version yes, but with lantus especially you want to make sure the dose has enough time to establish before you make changes, and that you are testing enough to really be sure that the dose should be increased. For example, if you see one high number that could be from anything really; your cat saw a bird, they needed to use the litterbox, they were angry, they dropped too low and were bouncing, etc so you wouldn’t want to give more insulin based on that one single reading. But if you see high numbers for several days, then it’s likely accurate. Also, insulin is a hormone, not a drug so it’s not as simple as, say, taking two aspirin to fix a headache. The body responds differently depending on many factors and the need for insulin can change over time, which is why it’s important to be methodical about it.

It can definitely be confusing at first, but sticking to the protocol you choose and posting on the lantus forum for dosing advice will help and eventually it will start to make sense :cat:
 
Too little insulin? "Better too high for a day, than too low for a moment." Once you inject the insulin, you can't take it back out. You can increase the dose over time. 0.25U at a time. With good information like home testing.

See the "sticky" or pinned posts at the top of the Lantus ISG.
 
Deb & Wink said:
Some points to consider.
  • Stress induced readings at the vet can be 80 points higher or more. I'll link a study in for you if you like, where cats were given a bath and BG readings tested along the way. It's where the 80+ point rise in BG's that I referred to comes from.
  • Did you test from the exact same blood drop when you did the tests between the Alphatrak and the human meter? I did for a couple of weeks back in 2013 when there was a member here trying to see the "difference" between the pet and human meters.
  • Can you afford the cost of test strips for the Alphatrak vs the human meter? At least 4 tests a day if your schedule allows. 2 pre-shot tests to make sure the BG numbers are high enough to give insulin and one each 12 hour cycle around the +4 to +7n hour time frame to determine when the nadir may be for YOUR cat. ECID. More tests at the beginning of this journey may be needed as you are trying to find the onset, nadir and duration for the insulin you are using for your cat. Could be 10 tests a day or more.
  • Curve at least once a week at home (testing every 2 hours for 12 hours or every 3 hours for 18 hours) or take your cat into the vet for curves.
  • With BG readings, High is high, low is low. You are looking for ranges, not absolutes.
Click to expand...
Thank you, Deb. But I still don't understand what determines the amount of insulin dosed. I'm scrambling right now, but I will spend as much time as possible today and tomorrow reading the website, and I guess this question will then be clarified.
 
Over simplification. WAY oversimplifying, the dose is determined by the nadirs or how low a particular dose and insulin takes YOUR cat. ECID. Every Cat is Different.

p.s. Know you are having an absolutely horrible and jam packed week. Sending you hugs as you are yet being overwhelmed by circumstances beyond your control. :bighug::bighug::bighug:

Doing a lot of "mindfulness breathing" myself as dealing with some personal health issues.
 
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