Luna update for caturday

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fredrika

fredrika

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HI All,

i have more numbers in Luna's spreadsheet but the curve isn't very curvy. it is because i am feeding small meals spread out?

and speaking of feedings. this morning is a typical day except that im not at work. but at 5am we started with a lovely breakfast of Evo. she had just over a half a can spread out over 45 minutes or so. after this current BG at 8:20 she had another few tbsp and still wants more. I think Jen once suggested i leave food out for her one day when her numbers were low, but i'm not sure at what point something would be "left". typically i have to go to work so the feeding stops, but at times like now, i'm on vacation for a week... do i keep feeding?

her numbers don't have much of a curve on the sheet is that good? is it because of the feedings?

thanks!!!
 
Good morning Jen :)

Lantus is different from the old insulins we used to use when you had your first diabetic kitty. We don't want a curve that is steep, but the numbers you have yesterday and today are not very good. But... give it time, keep her at this new dose for a few more days and let's see what happens. She might be filling her shed, the Lantus insulin doesn't work the same as the old PZI's and Humulins, it does not get utilized immediately. First a shed or storage depot get filled (others can explain that better than me). Once filled the rest of the insulin will start to be utilized.

You should have your package soon. I'll send you the tracking number if you'd like. Once that comes put the new insulin in the fridge and charge the USB meter. There's also a regular meter which you can use immediately. The USB will take about 10 minutes to charge. Try one of those meters going forward.

If we don't see changes in the next few days I might want to think about using the fresh insulin. Lantus is best used if you do not over draw the insulin into the syringe and then push back the extra back into the cartridge or vial. Introducing particles into the Lantus degrades it. Since we don't know exactly how this insulin was stored before, maybe we start there.

As for food, I feed my own cats 4X per day, small meals except at night, I give a little extra that can stay out so Kiki can munch when she needs to. I feed on a set schedule because I work. I feed at shot time, about +6 and again at about +10, then another feeding maybe at +2 after the PM shot, but again, I do that because of my schedule.

I have found with my own diabetic cats that feeding small meals helps their own pancreas produce insulin. It's part of the digestive process. For me, I like to encourage the pancreas to make an appearance :) Others might have some great ideas on feeding while you are home.
 
i definitely do that with the Lantus, i had no idea. i over draw and then push back to try to get the bubbles out. a little bit of air in their is impossible to get out, so i shouldn't worry about it?

i also read you are supposed to gently rock the insulin to circulate the particles? is that right????

oh dear.

ya, my past experience was nothing like this one fer sher! but it's all good because they didn't know anything then - the vet never even thought remission was possible, or if he did, he didn't tell me.

should i just start with the new one then? how do you draw into the syringe without bubbles?

should i start new insulin AND a new meter at the same time? maybe i can get two drops at the same time and see if both the new and old meter get the same number.

thanks!
 
Good Morning Jen,
When I read this a little while ago, I saw a couple things that "clicked". When I used PZI on Bob, the instructions said to "gently roll the vial in hands prior to using". I think some other types of insulin, you do the same thing. However, with Lantus that is apparently a "no-no".. Another thing is he squirting it back into the pen or cartridge. That's not recommended either.
The good news - (I always look for a bright side. There's always one there if you look in the right place!). Today when you start using the new meter, you can start using the new insulin too!
What I am hoping is that with the fresh pen, you'll start getting better numbers soon too.

I am attaching one of the Lantus forum "stickies" about proper handling and storage of Lantus. You'll see that is says not to shake or roll it, and explains why you shouldn't squirt the overdrawn amount back into the pen. It's due to the possibility that the lubricant inside of the syringe may contaminate the insulin in the pen. It also says you should just squirt that into a paper towel and discard it. Some other good stuff on storing it too.

http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=151

Hope this helps!
Carl
 
ok, good to know, and thanks so much for the link!!! i should have looked for one of those.

with any luck, it's just that simple, fingers crossed. I'm all for bright sides.

hey, do you know how to make the google spreadsheet into a chart? i like pretty pictures better than numbers.

thanks so much!
 
Jen
If you click on the SS link and go to googledocs, you can select "File", then "Download As...." and one of the choices is "Excel". That will put in on your hard drive as a regular .xls file. Then you can open it as if it were any old Excel spreadsheet, assuming you have MS Office on your PC. If you can do charts and graphs and pie charts like it sounds that you know how to do, then you can do that in Excel. However, what "we" see will be just the normal googledocs sheet that's out there in cyberspace someplace. You will be able to manipulate it on your machine to see anything you want with the data. Does that help?

Carl
 
FYI -

3pm BG

new meter - 248
old meter - 259

I'm thinking it's very likely the new insulin is of better quality and maybe i should be shooting a .25 tonight just in case? depending on the pre-shot of course... ?????

Here is Ms. Thing! it's not a great one, she was still a bit hungover from her cat nip extravaganza!!!! I'll get a better one for 'marketing' purposes. ps: i'll get a cameraman too! it's hard to record yourself playing with the cat!

thanks guys!

http://www.youtube.com/watch?v=1JrDQ92_xbg
 
Hi Jen:

Carl asked me to pop over from Lantus Land and give you some thoughts about the dose considering the insulin issue.

I'm glad he sent you the sticky on proper handling: you should keep lantus in the frig at the correct temps shown in the sticky...best to keep it in a crisper drawer where the temp is not so influenced by opening and closing of the frig door. No rolling, shaking, etc. If you are using a pen, definitely do not inject air or insulin back into the pen. The pen is already under pressure and doesn't need air into it like a vial does. Syringes have silicone coating in them so if you
reinject insulin back into the pen, you could get the silicone into the insulin.

However, if the pen does not have any floaties in it, is not cloudy, is less than 30 days old, etc. then it may be ok.

IMHO, I would not change her dose tonight or when you get the new pen. Just be sure you monitor her closely once you get the new pen and start using it just in case it has a little more ooompf to it than the old one. We always highly recommend that you get a +2 and make sure it is close to your preshot. If it is lower, then you need to be extra vigilant.

If you scroll down on the link that Carl sent you about proper handling/storage, there is a great video made by one of our LL members that shows how to draw the dose from a pen and a vial.

Good luck with the new pen and the new meter.
 
Thanks so much for jumping in, Marje!

i read all that stuff and watched all the videos (i think, the ones on the link above and the links on the link....there was one about how to properly fill a syringe that was really good!

I already gave her BG and shot before i read your message.

she had been at a .25 dose as recently as yesterday morning.
and the new meter is giving a very different reading at the 5pm than it even did at the 3pm.

PMPS 5pm
old meter 350!!!!!!
new meter 282

oddly, i did a control sample on the old meter, the new meter and the backup meter Jen sent me. it's a contour, but not a USB.

control:
old meter 128
new meter 125
back up meter 125

so i went with the readings on the new meter and since they were much lower and using newer, possibly stronger insulin i stayed with the .25

i will check her at the +2 just in case too.

Here she is looking all angelic before ripping the scratching post to bits... :)
 

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Jen

You're welcome! Just a couple things. Meters have a 20% variance so if you take 350 x 20% = 70. 350-70 =280 so the 282 is within 20% of 350....barely but it is. The thing to do is pick one meter and stick with it through thick and thin or
until it dies :-D

With lantus, you shouldn't dose hop. Lantus forms an insulin depot or "shed" and when you change the dose frequently, you start to get wonky numbers from adjustments to the depot/shed. So with the sk.5u, you're trying to fill the shed which can take several cycles, and then you just drained the shed somewhat by shooting a lesser dose. That's why I had you leave the dose where it was.....because she was still filling the shed.

Good to get that +2. She is adorable.
 
then my question is which is the best dose for the numbers. whichever numbers are correct? we had been working down to .25 and there had only been two shots at the .5's, skinny ones at that.

next potential shot is at 5am.

thanks!!!
 
Jen,
the primary reason for the reduction to .25 was because there was some question about whether or not the old pen of lantus was still "good". So the .25 made sense to do. That's fine.

Unfortunately, you won't know the answer to that question until the cycle runs its course. I think, and I will qualify this by saying that I have never used lantus, that the prudent thing to do would be to use the same dose, the .25u dose, at the 5am shot.

The likelihood of someone being here to answer an "either/or" question at 4:45 or 5:00 in the morning is pretty slim, and I would rather choose the safe option for the morning shot.

This time tomorrow, we'll have 2 cycles worth of information on what the new pen is doing for Luna. It would be easier to evaluate that much data than it is to figure it out based on just the time that has passed since you first used the new lantus.

See if anyone else has an opinion, but that is mine.

And yes, I agree, Luna is quite the adorable kitty!
Carl
 
we'll have 2 cycles worth of information on what the new pen is doing for Luna
Click to expand...

I think it's going to be difficult to tell if it was the pen or not enough insulin :-D

There have been so many dose changes that it's hard to tell what is a good dose. There's only been frequent testing in the last 3 cycles so there's alot of data missing that could probably help us
figure it out.

At this point in time, I'd leave her on the .25u for six cycles (the first one starting tonight's dose) UNLESS she earns a reduction. After six cycles, then it's time to reassess her dose. She earns a reduction if
her BG goes below 50.

One thing we say in Lantus Land is don't get married to a dose. :-D It isn't a bad thing if she has to go up to come back down.
 
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