My lantus has gone bad (I think), so what do I do?

Ramon's mom

Ramon's mom

Member Since 2018
I have fresh Lantus coming via mail by Monday but my current insulin seems to not be working for my kitty Ramon. I'll post the backstory below, but I really want to know if there is any danger to him if I 1) keep giving the possible bad Lantus or 2) stop any insulin completely until Monday (negative on ketones). My cat Ramon has been doing very well for over a month on Lantus (switched on May 1 from Prozinc). All of a sudden in the last 2 days his numbers have zoomed. Nothing has changed in his diet (primarily raw) or insulin dosage. The only change has been extremely hot, humid weather (but I do have AC). Earlier in the week I accidentally left the insulin out of the fridge for 6 hours and it kind of looks a little foggy. So I am guessing it has gone bad. I ordered new insulin from Canada last week but it won't arrive until next Monday. What should I do? I upped his dose but it isn't making a dent. His numbers so far are in the high 200's (up from the low 100's). I checked ketones in his urine but it is negative. So is it ok to just keep going like this until I get the fresh stuff on Monday? Is there anything I should worry about happening to him while we wait? Thanks in advance for advice on this!
 
I don't think it's the insulin, I think he's bouncing from some lows. On the 3rd, you tested him at 64 at +3.5 after a steep drop, then there was no further testing to make sure he was safe, and I'm guessing he went even lower. Then the bounce began after that. You compounded things by increasing his dose on the evening of the 4th. You should not have increased. We base our dosing decisions on the lows (which would be that 64 or however much lower he got that day), not the highs. After the increase you saw some New Dose Wonkiness. I would go back to 1.5 units, and wait for the bounce to clear.

I encourage to read the sticky notes, including the one on dosing methods. Decide which of those methods would work best for you and your lifestyle. One of the dosing methods (Start Low Go Slow) would say that 64 earned a reduction down to 1.25 units. If you had tested later that cycle, you might have hit the reduction point for Tight Regulation.
 
Wendy&Neko said:
I don't think it's the insulin, I think he's bouncing from some lows.
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He has not done any bouncing before on Lantus (only when he was on Prozinc) so I assumed it was not a bounce. Frankly I went up to 1.75 because he not only went high into the 200's but had stayed there and it seemed clear that the insulin was not doing anything about his numbers. I have read everything here and am following them as I understand the suggestions, with alterations that work for my cat. I am not doing daily curves because he was fighting me on it and his ears are sore. I am tracking nadir points and pre-shot points which seems to have worked fine until now. Earlier when I dropped the dosage due to lower nadirs he would just bump his numbers back up instead. At this point he certainly isn't "earning" lower dosages. I was asking here if it was dangerous to give him potentially bad insulin while I wait for the fresh stuff to arrive. So far he is tolerating it. But thanks for the response.
 
I do think Ramon has been bouncing on Lantus. The pink numbers in April are bounces. Numbers do not need to be sky high for them to be a bounce. Some of the cycle when he went from a green to a yellow (and you didn't have subsequent tests) may be bounces, as well. Bounces do not need to last long. The more your cat is used to lower range numbers, the faster the bounces clear.

Which dosing method are you using? Like Wendy, I really can't tell if you're using TR or SLGS to guide your dose decisions. One thing to keep in mind irrespective of which dosing method you opt for is that with Lantus (unlike Prozinc) the dose is based on the lowest number in the cycle, not on the preshot number. You do not slide the dose the way you can with Prozinc. If you make too frequent dose adjustments, you don't give the depot time to stabilize and you end up with wonky numbers.

If your insulin isn't clear and appears to be cloudy, there's a good chance it isn't going to be as effective. You did see a drop last night, though.
 
Sienne and Gabby (GA) said:
I do think Ramon has been bouncing on Lantus. The pink numbers in April are bounces. Numbers do not need to be sky high for them to be a bounce. Some of the cycle when he went from a green to a yellow (and you didn't have subsequent tests) may be bounces, as well. Bounces do not need to last long. The more your cat is used to lower range numbers, the faster the bounces clear.

Which dosing method are you using? Like Wendy, I really can't tell if you're using TR or SLGS to guide your dose decisions. One thing to keep in mind irrespective of which dosing method you opt for is that with Lantus (unlike Prozinc) the dose is based on the lowest number in the cycle, not on the preshot number. You do not slide the dose the way you can with Prozinc. If you make too frequent dose adjustments, you don't give the depot time to stabilize and you end up with wonky numbers.

If your insulin isn't clear and appears to be cloudy, there's a good chance it isn't going to be as effective. You did see a drop last night, though.
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I think Ramon's spreadsheet is confusing people. He was on Prozinc through to the end of April. On May 1 I switched to Lantus. So bounces in April do not reflect the steadier times on Lantus. I also stopped the Tight Regulation I used with the Prozinc once I realized that Lantus was less bouncy. TR made me way too stressed out all the time.

He has a complicated case because of other medical conditions and meds so that is why I am not asking for advice on dosing. I know what I'm doing in that respect plus I now have good guidance from a good vet. (The sudden jump into the 200's is not related to dose increases (it came before the increases). I just wanted to know if anyone knew if its dangerous to use potentially poor insulin. At this point nothing bad has happened so I am treading water until I get the fresh stuff on Monday.
 
You're correct. I didn't know when you switched. Would it be possible for you to insert a line that indicates when you switched to Lantus? Many people who have switched will put in a line that they color so it's easy to see when a switch was made.
 
On 07/03 You noted you gave crumbled temptations on top his wet food. Temptations are high in carbs and can cause higher numbers for longer than HC wet (dry takes longer to metabolize).

Glad you got your new insulin. Be sure to test frequently with the first few doses JIC.
 
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