New here- questions on Lantus Pen

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renateo

renateo

Member Since 2013
Hi everyone, thank you for this amazing resource. I have been caring for my 11 year old male diabetic for over 6 months, and am trying to better educate myself on his needs. I have been using the Lantus Solostar pens. I have 2 questions that I haven't been able to find the answers to:

1. Is there a reason I should NOT use the needles that screw on to the pens? This is so much easier and convenient, but it seems like everyone on here draws the insulin into a needle to inject.

2.I applied online for the Lantus discount card but got an error message that said the info I submitted did not match with their records (?) and that I should call. Has anyone had better luck with this?

Thanks so much!
 
The reason most people do not use the pen tips that screw onto the end of the pens, is because you can only use the dial a dose feature which delivers in 1U dose increments. We've found that making dose changes in 0.25U doses is better for the cat, and is less likely to bypass the good dose or to give too much and drop the BG (blood glucose) levels too low.
 
Ok that makes sense. My boy is on 4 units, 2x per day, and is still running quite high with BG numbers in the low to mid 300s every time he has been tested (by myself or vet). He weights 11 pounds and eats an all wet, grain-free diet. I know that is just about the max dosage of insulin. I have not done a curve yet, which the vet has recommended as the next step to figure out how to address these high levels. I wanted to make sure that the screw on needles were not the reason his numbers weren't going down.
 
Are you home testing? Most of us test before each shot and then try to get a test about mid way in the 12 hour cycle. It is not always possible, but by testing just before bed, just as you are going out the door to work, just as you come home - well you get the idea. This series of tests over a few days will give you a better idea of how the insulin works in your cats body.

The other thing I don't think you mentioned is your feeding schedule. Most diabetics do best with several small meals spread through the day. Many of us use timed feeders so that the cat gets a small snack every 4 hours. This can also help to even out the bg.

Bg tests at the vets are not as accurate as your home numbers. Stress raises bg and so the numbers at the vet are often higher than what you would get at home.
 
Ok, some questions for you, so we can help you figure things out.

Which specific food are you feeding? Grain free does not necessarily mean low carb. We may be able to tweak the food to a lower carb option to bring down the BG's.

Which meter are you using for testing?

When are you testing in relationship to the shot?

What numbers were the dose changes based on? It should have been the nadirs, not the pre-shot tests since you are using Lantus.

How quickly were the doses raised and in what increments? Whole units, I believe, since you are using the pen tips and not an insulin syringe to withdraw from the pen.

You may have bypassed the appropriate dose, by raising the dose in whole units. The Lantus Tight Regulation protocol we use, shows that 0.25U increment dose changes are better in most circumstances.

If you would set up our standard format spreadsheet, we would have a better idea of what is going on and be able to help you better. Here are the directions. How to Get a SS and Link in your Signature *updated 2/13/12 The one thing the directions forget to tell you, is you need to "Share" the google doc "With anyone with the link". That allows us read only access.
 
Thank you very much, I will work on setting up a spreadsheet. Here are the questions I can answer now.

He is eating Merrick Purrfect Bistro Chicken Pate, 1 and a half to 2 cans per day. 2 meals, 12 hours apart. I wasn't aware of feeding several small meals through out the day, something to think about.

I was testing him 4 hours after his shot with an AlphaTRAK meter. The dosages were changed based on this number, over the course of about 2 weeks. Basically every time I tested he was still very high so I increased by 1U until we got to 4, and then the vet said not to go any higher. But his numbers never went down past low 300s. (They were in 500s when we started). I should also mention he is a rescue cat found on the street about 8 months ago, so I have no idea how long he was diabetic and not being treated before that. Vet has also noted his liver is enlarged.

Can you clarify when I should test for the spreadsheet? Before the shot, then about 6 hours after.. What other times should I aim for? I apologize if there's a link somewhere that explains it, lot of info on here! Thanks so much!
 
You should test, feed then shoot. By testing before food and insulin, you will get more accurate numbers and know if it is safe to give the insulin dose.
 
renateo said:
Can you clarify when I should test for the spreadsheet? Before the shot, then about 6 hours after.. What other times should I aim for? I apologize if there's a link somewhere that explains it, lot of info on here! Thanks so much!
Click to expand...

If you are using Lantus it is recommended to get some tests in at +1 +2 and +3 when you can, maybe not every cycle. These numbers can give you an idea of how the rest of the cycle will go. For example, if my cat is going to drop really low, really quick, I can see typically that in his +2 test. But if that number is pretty close to the pre shot test, his cycle is pretty uneventful. Every cat is different though, that is why they say somewhere between +1 & +3.
 
Ok, thanks for the answers to my questions.

Lantus w/ Alphatrak so the numbers you are getting are about 30% higher than what we are used to on a human meter.

Merrick Purrfect Bistro Chicken Pate. Are those the 3 oz cans or the 5.5 oz cans? The ingredients look ok to me, but I'm not sure what the carb content is on this food. Perhaps someone else knows. We recommend <10% carbs, <8% if possible. For example, the Fancy Feast pates are all really low in carbs, <5%. See this food chart for other choices, column C <10%.

When each cat nadirs or hits their lowest point in the cycle varies, with most cats getting their lowest BG number between +5 to +7 hours after the shot. Some cats nadir earlier, some cats nadir later. My Wink always nadired around +4, but that is not as common. Testing at other times, especially during that +5 to +7 timeframe may give you a better idea of when the low is for your cat.

You raised the dose really quickly, going from 1U to 4U in only 2 weeks. You might have bypassed an appropriate dose, and need to decrease. On the other hand, you may need to increase, to break past any possible insulin resistance. Not sure which situation we have going on here. It's really hard to tell.

Why does your vet not want to give more than 4U of Lantus?

My foster cat Wink is a rescue also. His owners dumped him at a shelter, untreated diabetic for months. Then he was transferred to another shelter and started getting insulin, but still very uncontrolled numbers. He is currently a diet controlled diabetic so it's possible for your rescue kitty to get better control with the BG numbers.

First, I think we really, really need to see that spreadsheet when you get a chance.

Second, I think you may need to increase the dose, (not sure on this yet), but slowly, so you will need to get insulin syringes so you can measure doses in lower amounts than the 1U increments the pen is allowing you to give.
 
I think Dale and Chip uses those- they are around 5% carbs i think. Let me ask him.

I usually recommend 3-4 tests a day

- always before the shot - this is mandatory as you don't want to shoot when too low. As a newbie this too low number is 200 but is reduced over time once you have the data to know if its safe.
- mid cycle - 5-7 hours after morning shot depending on your schedule. This is to see how low he is going. The low point "nadir" is what you base dose changes on since you don't want him dropping too low (under 50).
- before bed (2-3hours after Pm shot) to get an idea of what his overnight plans are. If this number is less than the pre shot test number you may want to set the alarm for a test a few hours later as this implies an active cycle.

Wendy

PS there could be chronic bouncing going on - a spreadsheet will let us see the trends to see if thats the case.
 
The Merrick Purrfect Bistro Pates are almost certainly low carb.

I switched Chip to those several months ago from Fancy Feast Classic Pates. Very pleased with the Purrfect Bistro Pate. Less food spike than FF Classics which are 3-5% carbs.

And Chip loves it, as does everyone else.
 
Thanks for the helpful responses. I'm going to get testing and work on the spreadsheet. I will plan on getting the insulin syringes too, as I do have some but they also only have 1U increments. Do you order them online or get from pharmacy?

The reason the vet said no higher than 4U was that, with him only being about 10 to 11 pounds, she thought any more would be potentially dangerous. She said that was just a really high amount for a cat his size and any more would probably make him hypoglycemic. It looks like that may not necessarily be true though, from what I'm hearing!
 
renateo said:
Thanks for the helpful responses. I'm going to get testing and work on the spreadsheet. I will plan on getting the insulin syringes too, as I do have some but they also only have 1U increments. Do you order them online or get from pharmacy?
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I bought my syringes with half unit markings at CVS. They may not be the best syringes, a few people recommend syringes from Walmart (ReliOn brand I think), they may be better syringes.
 
I believe all these have half unit markings

For U-100 syringes (Lantus, Levemir), get 3/10 cc, half-unit marked, short needle, 30-31 gauge ie Relion 3/10cc 30 & 31 gauge short, BD Ultra fine 3/10cc short, Terumo Thinpro Insulin Syringe 31G 3/10cc, Kroger 0.3cc 8mm, 31 gauge.

Dose varies by cat - my Bailey can have a hypo on 0.25 units. Meanwhile Tiggy is a high dose cat and is fine on 6 units. But he has a high dose condition.

Wendy
 
Wendy, thanks for the specifics on the syringes. Do you mind me asking what a high dose condition means?

Testing him is quite the production, so I'm having a hard time getting a lot of data, esp in AM when I'm short on time. Will be able to monitor more closely over the weekend.
 
A high-dose condition mean that the kitty needs a high, like more than 5 units twice daily. My MurrFee is one such kitty, he gets 11 units of Levemir two daily. This compares to 1.2 units Lantus for my Thunder, 2.1 units Lantus for my Patches and 4 units Lantus for my Lightning.
 
Thanks for your patience everyone. I've posted Penn's spreadsheet in my signature. I was very surprised to see yesterday that his BG was in the 200s. Today he is back to the range of numbers I'm used to seeing- 300s to low 400s.
 
Hmm he could be bouncing. Next time you see him dropping like he did on the 15th I would keep testing until he starts to go back up. You need to know how low he is going because if he goes under 80 then he should get a dose decrease

ie on the 15th he went from 282 to 199 in a few hours. A test a couple of hours later would show if 199 was the lowest he went or if he kept dropping.. which is likely. If he dropped under 80 he might then be bouncing off it which would cause high numbers for a few days.

Wendy
 
MERRY CHRISTMAS all you wonderful folks....i have updated Sonnys SS and would appreciate any input...thank you....Beth Anne and Sonny
 
This dose is looking pretty good on him from what I can see. It looks like Sonny might have had a couple of bouncy days and on the 13th, he even might have gotten a fur shot (or a "faux shot" as I like to call them where I thought it wasn't a fur shot but the numbers show otherwise :lol: ), but other than that, he is leveling down pretty nicely with those yellow pre-shots and double-digit nadirs. How have his numbers been these last couple of days?
 
I went and did a search on the board for the Merrick food and it seems they changed the formula. Here is the info from that thread http://www.felinediabetes.com/FDMB/...126874&hilit=merrick+purrfect+bistro#p1126874

Marje and Gracie said:
Mike went shopping yesterday for more Cowboy Cookout for Gus and the person at the pet food store told him Merrick had decided to totally eliminate Cowboy Cookout...even the new version. So I called Merrick and they said nothing could be further from the truth. Since I had them on the phone, I asked if they had gotten any as-fed results for their new foods. They have gotten the as-feds for Cowboy Cookout and Surf -n- Turf in their new Purrfect Bistro Line:

Cowboy Cookout
Moisture: 78.2%
Protein: 11.04%
Fat: 3.67%
Carbs: 4.49%
Ash: 1.8%
Fiber: 0.8%
Phosphorus: 0.28%

So, using Janet's Calculator, the % calories from carbs is a whopping 18.9% (I remember a member tried it and it raised their kitty's BG and now I know why)! The phosphorus is 294 mg/100kcal. Quite an increase in the %calories from carbs as it used to be 5%.

Surf -n- Turf
Moisture: 79.4%
Protein: 11.2%
Fat: 6.12%
Carbs: 1.28%
Ash: 1.7%
Fiber: 0.3%
Phosphorus: .67%

That puts the %calories from carbs at 4.9% (was 3%) and the phosphorus at 638 mg/100kcal!!!! Holy Cow!!!

Of course, I'm happy for anyone to double check my math (or call Merrick and see if you get the same numbers) but all I did was plug it into Janet's Calculator. I'm very surprised at the increases, especially the phosphorus on Surf -n- Turf, especially because the lady told me she did not think the formulas had changed much.

She was not sure when the rest of the as-fed numbers for the other foods would be out.
Click to expand...
I think I would be rethinking Merrick till all the values are found out.
 
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