"New Member" Insulin Dosage Help

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Renee & Mikey

Renee & Mikey

Member Since 2020
Hello All. So happy I found you. I think the hardest part of Mikey's diagnosis was getting a glucose reading. But after MANY failed attempts I am finally doing it successfully. My main concern is if I have the right dosing for his insulin shot. On my spreadsheet in the comment section, I have his dosing that was recommended by his vet. I am hesitant for his next dosing at 8:30pm but would love to hear anyone's thoughts. My vet recommended 3 units this morning but I chose to do 2 units.

Thank you
Renee
 
Was that 3 units his starting dose? Thats a lot of insulin. I'm no expert but I'm glad you deferred to 2. Hold on for more replies ok?

I see you are a new member. WELCOME! You've already are ahead of the game with a spreadsheet. GOOD FOR YOU!
 
Renee & Mikey said:
Thank you! so happy to find this group

3/24-3/31: 1 unit // 3/31-4/9: 2 units
4/9 vet recommended 4 units, but I decided on 3 units // 4/9-4/16: 3 units
4/17 increased to 4 units for morning and evening doses but saw him sleepy and hiding
4/18-4/20 went back to 3 units
4/20 60 glucose reading
4/21 2 units
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I second that! I’m also no expert and let’s see what everyone else will say, but I I have a feeling they’ll recommend adjusting in smaller increments instead of full units, like going from 2 to 2.5 or 2.25 even.

Good for you for catching the low 60 and adjusting. Your instincts are right! Do you have half unit syringes? Those help a lot.
Welcome!!!! :)
 
Hi Renee and Mikey. Good for you on getting home testing and getting the spreadsheet started! :)

For the syringes, the half unit ones are best. Which country do you live in? That'll give us an idea what syringes are available where you live.

Glargine is indeed Lantus. At some point you can pop over to the Lantus/Basaglar/Levemir forum and read the yellow starred Sticky Notes to find out more about Lantus. We also have recommendations for syringes in one of those Sticky Notes.

Since you've just started testing, and just shot 2 units today, and Lantus (glargine) is a depot insulin - meaning we find it likes stable dosing, why don't you stay with 2 units for now. Gather some data with home testing, and we can go from there once we have a better idea how Mikey is doing on this dose. We determine how to change the Lantus dose based on the low points or nadirs.
 
Hi Renee!

Wendy already gave you some good information. Let me add to that a bit.

We usually only recommend changing the insulin dose by 0.25U increments. That differs from many vets, that like to increase/decrease the dose in full 1U (unit) increments.

Good thing you reduced when you got that 60 on a pet meter. With a pet meter, you really don't want a BG (blood glucose) number below 68 mg/dL (3.7 mmol/L). For the Feline Health forum, we suggest you do not give insulin if the BG level is <200 when you are just starting out. That number is lowered over time, and there are techniques such as stalling that you need to learn about. Good idea to read the "Sticky" or pinned posts at the top of the Lantus ISG (Insulin Support Group) forum. Decision point pre-shot test in the lantus ISG is >150 mg/dL to begin.

Would you do a change on your spreadsheet (SS) for us please? Enter a row for each day, even if your don't have any test data. It helps my mind to see better what is going on, if days are not skipped on the SS.

p.s. Got the PM Jeanne. Was helping a couple of people over in the Prozinc ISG forum.
jt and trouble (GA) said:
Deb is good with gargline I think thats the insulin
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I know the basics on most insulins, just enough to be helpful sometimes. ;) Lantus and glargine are the same insulin, simply different names in different countries.
 
Johnny is the tan one. He crossed over the rainbow bridge this time last year of intestinal cancer at the age of 11. They are only a few months apart in age, so I know Mikey misses him as much as I do. Darla is in the middle and she is a year younger than the boys. She is probably taking this the hardest because I have to isolate Mikey for now. She misses both of her buddies.

I have adjusted my spreadsheet Deb, thank you for the advice and suggestions. Wink is adorable! Another thing I love about this forum is getting to meet all the adorable cats on here. I am an animal lover in general, but I do have a soft spot for cats.
 
Renee & Mikey said:
I live in California, United States. My gut is also telling me to stick to the 2 units for now. I agree that I need more testing to make more confident decisions. I will also adjust my spreadsheet. Thank you so much everyone. Mikey is the black and white sugarbaby in my profile pic and we both appreciate all of you.
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I’m in Los Angeles, CA. Nice to see another member from my hood :)

My late cat Deanna also passed of intestinal cancer. It’s not an easy journey. I’m very sorry for your loss :(
 
Wendy&Neko said:
I love the markings on Mikey's back! How different.

In California, if you can get out, Walmart's Relion syringe's may be your fastest way to get 1/2 unit marked syringes. ADW is otherwise a good source.
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I just figured out the reply function. Thank you Wendy, my sister and I are do for a grocery run soon and I will get them. We used to joke that Mikeys markings in his back are the bullseye to my heart. I just love him so very much! And you have a long haired beauty:cat:
 
Wendy&Neko said:
I love the markings on Mikey's back! How different.

In California, if you can get out, Walmart's Relion syringe's may be your fastest way to get 1/2 unit marked syringes. ADW is otherwise a good source.
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Wait Walmart carries relion syringes? It’s not on their site... is it store only? And no prescription needed? We need prescription for the syringes here :woot:
I don’t see a ReliOn syringe do you mean this?
https://www.walmart.com/ip/Becton-D...yringe-Tip-Cap-Non-Sterile-50-Count/706028556
 
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Alessandra Franco said:
I’m in Los Angeles, CA. Nice to see another member from my hood :)

My late cat Deanna also passed of intestinal cancer. It’s not an easy journey. I’m very sorry for your loss :(
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Thank you Alessandra and I am sorry for your loss of Deanna. It was definitely not an easy journey and what I wouldn't do to get one more prrr and hug from him. And yes I am in your hood, I am in Orange County.
 
Why is Mikey isolated from Darla?

p.s. Thanks for calling Wink "adorable." He would have loved that. I tell people he's the reason I'm still here, paying it forward and helping other diabetic cat parents learn what they need to know to treat this disease. He's been gone for 3 years now.
 
Deb & Wink said:
Why is Mikey isolated from Darla?

p.s. Thanks for calling Wink "adorable." He would have loved that. I tell people he's the reason I'm still here, paying it forward and helping other diabetic cat parents learn what they need to know to treat this disease. He's been gone for 3 years now.
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Oh wow Deb, I am so sorry to hear that. I hope Johnny and Wink get to meet up in heaven. And I will do the same. I have had plenty of cats in my life and this is my first diabetic one. I will learn as much as I can and also pay it forward.

I have Mikey isolated in the hallway and bedrooms so I can closely monitor his food intake, urine, stools and vomiting. I want to be confident with my answers when my vet has questions. But I do let him out in the living room area supervised for a little while to say Hi to everyone else. These stay at home orders are bitter sweet for me, the upside is that I get to stay with Mikey 24 hours a day right now and I have not had to furlough or lay off any of my employees.
 
All these syringes have half unit markings (very important when you're doing microdosing) and are the correct syringes for U100 insulin and are available from ADW online:
UtiCare
Monoject
Carepoint
Sure Comfort
B/D

They're also available at WalMart if you have one near you. Their Relion brand 3/10ml, 30 or 31 gauge, 6mm or 8mm insulin syringes all come with half unit markings and are only $12.58 for a box of 100 (although a lot of them don't realize they DO come with half unit markings!)

Relion syringes.jpg

If your state requires a script for syringes, you'll have to have a script to get them at WalMart (or ADW)
 

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Chris & China (GA) said:
All these syringes have half unit markings (very important when you're doing microdosing) and are the correct syringes for U100 insulin and are available from ADW online:
UtiCare
Monoject
Carepoint
Sure Comfort
B/D

They're also available at WalMart if you have one near you. Their Relion brand 3/10ml, 30 or 31 gauge, 6mm or 8mm insulin syringes all come with half unit markings and are only $12.58 for a box of 100 (although a lot of them don't realize they DO come with half unit markings!)

View attachment 52916

If your state requires a script for syringes, you'll have to have a script to get them at WalMart (or ADW)
Click to expand...
Thank you Chris!
 
Chris & China (GA) said:
All these syringes have half unit markings (very important when you're doing microdosing) and are the correct syringes for U100 insulin and are available from ADW online:
UtiCare
Monoject
Carepoint
Sure Comfort
B/D

They're also available at WalMart if you have one near you. Their Relion brand 3/10ml, 30 or 31 gauge, 6mm or 8mm insulin syringes all come with half unit markings and are only $12.58 for a box of 100 (although a lot of them don't realize they DO come with half unit markings!)

View attachment 52916

If your state requires a script for syringes, you'll have to have a script to get them at WalMart (or ADW)
Click to expand...
Chris, if you have a link to it and can insert it that would be awesome. Thanks!
 
Renee & Mikey said:
Oh wow Deb, I am so sorry to hear that. I hope Johnny and Wink get to meet up in heaven. And I will do the same. I have had plenty of cats in my life and this is my first diabetic one. I will learn as much as I can and also pay it forward.

I have Mikey isolated in the hallway and bedrooms so I can closely monitor his food intake, urine, stools and vomiting. I want to be confident with my answers when my vet has questions. But I do let him out in the living room area supervised for a little while to say Hi to everyone else. These stay at home orders are bitter sweet for me, the upside is that I get to stay with Mikey 24 hours a day right now and I have not had to furlough or lay off any of my employees.
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I feel the same way. I tell all my friends if they know anyone with a diabetic cat, please have them reach out to me so I can help, but mainly direct them here :)

at my last vet check up she said to me, have you had other diabetic cats? You know a lot about feline diabetes. The joke is I didn’t know nearly as much as I do now and I know nothing compared to the wonderful @Deb & Wink

At the end of the day we love our babies and will do anything for them even when that means becoming a full time nurse.
Btw, the folks here should also have a psychology degree and they’ve pulled me off the ledge more than a few times. Welcome again and you’re in the absolute best hands!!!

:kiss::bighug::kiss:
 
Alessandra Franco said:
I feel the same way. I tell all my friends if they know anyone with a diabetic cat, please have them reach out to me so I can help, but mainly direct them here :)

at my last vet check up she said to me, have you had other diabetic cats? You know a lot about feline diabetes. The joke is I didn’t know nearly as much as I do now and I know nothing compared to the wonderful @Deb & Wink

At the end of the day we love our babies and will do anything for them even when that means becoming a full time nurse.
Btw, the folks here should also have a psychology degree and they’ve pulled me off the ledge more than a few times. Welcome again and you’re in the absolute best hands!!!

:kiss::bighug::kiss:
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Thank you Alessandra, I already feel a sense of calm finding this wonderful group. I trust my vet, but I also want to feel confident as I am now indeed, happily his full time nurse. I will keep you posted if I am successful in finding the recommended syringes.
 
Wendy&Neko said:
Hi Renee and Mikey. Good for you on getting home testing and getting the spreadsheet started! :)

For the syringes, the half unit ones are best. Which country do you live in? That'll give us an idea what syringes are available where you live.

Glargine is indeed Lantus. At some point you can pop over to the Lantus/Basaglar/Levemir forum and read the yellow starred Sticky Notes to find out more about Lantus. We also have recommendations for syringes in one of those Sticky Notes.

Since you've just started testing, and just shot 2 units today, and Lantus (glargine) is a depot insulin - meaning we find it likes stable dosing, why don't you stay with 2 units for now. Gather some data with home testing, and we can go from there once we have a better idea how Mikey is doing on this dose. We determine how to change the Lantus dose based on the low points or nadirs.
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Hi Wendy. I just got a 122 pre insulin shot reading, should I not give him any tonight?
 
Sorry, I was off eating my own (late) dinner. Looks like you skipped, which is fine for the data you have now. How about trying 1.5 units tomorrow? Can you eyeball half way between the lines until you get new syringes? It can help to fill an old one with coloured liquid (tea, juice) so you have a sample to compare against. If you don't think that's possible, maybe do 1 unit?

One more questions, was there any mention of ketones or DKA when Mikey was diagnosed?
 
Wendy&Neko said:
Sorry, I was off eating my own (late) dinner. Looks like you skipped, which is fine for the data you have now. How about trying 1.5 units tomorrow? Can you eyeball half way between the lines until you get new syringes? It can help to fill an old one with coloured liquid (tea, juice) so you have a sample to compare against. If you don't think that's possible, maybe do 1 unit?

One more questions, was there any mention of ketones or DKA when Mikey was diagnosed?
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It is totally ok, I appreciate your support Wendy. I understand, my question is definitely during after hours. I joined yesterday and have been navigating through all this great information. And after reading some, I decided to hold off on the insulin tonight.

I took a closer look at the syringes that I have and they do have the 1/2 unit markings. So excited about that.

Mikey tested negative for ketones and negative for pancreatitis. The rest of his blood work and xray came back normal. His ultra sound showed that he had an enlarged or thickening of the intestine and they recommended to do a biopsy once I control his diabetes.
 
Alessandra Franco said:
If you find them, will you please let me know. I just searched the Walmart site up and down and nothing comes up for ReliOn syringes. On google also nada.
Thanks!
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Alessandra I double checked my syringes and I had the 1/2 units the whole time.
I got them from my vet.
Advanced Veterinary Internal Medicine
2965 Edinger Ave
Tustin CA 92780
(949)653-2846
IMG_4800 (1).jpg
 

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Renee & Mikey said:
Alessandra I double checked my syringes and I had the 1/2 units the whole time.
I got them from my vet.
Advanced Veterinary Internal Medicine
2965 Edinger Ave
Tustin CA 92780
(949)653-2846View attachment 52919
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That’s awesome!!! Those are the same I have, but I still want to get to the bottom of the Walmart ReliOn ones. They’re should be more cost effective but I didn’t see it on their site anywhere. Hope it hasn’t been discontinued... :nailbiting:
 
Wendy&Neko said:
Sorry, I was off eating my own (late) dinner. Looks like you skipped, which is fine for the data you have now. How about trying 1.5 units tomorrow? Can you eyeball half way between the lines until you get new syringes? It can help to fill an old one with coloured liquid (tea, juice) so you have a sample to compare against. If you don't think that's possible, maybe do 1 unit?

One more questions, was there any mention of ketones or DKA when Mikey was diagnosed?
Click to expand...

Wendy what does this mean...
THE USE OF PET-SPECIFIC METERS IS DISCOURAGED BECAUSE REFERENCE NUMBERS ARE FROM BLOOD GLUCOSE METERS CALIBRATED FOR HUMANS

I am using AlphaTrak2, do I have to convert my readings?
 
There is no conversion. Simply put in your spreadsheet whatever the actual test results are that you get from your meter.

All our documentation here is written with the idea that people are using human meters. We've been around since 1996, decades before there were pet specific meters. We have developed a ton of documents over the decades, and all the BG numbers you see in those documents are from human meters. You will see the number 68 and Alphatrak used together, as a reduction point for TR (Tight Regulation) protocol used for lantus insulin.

We simply do not have enough test data to know what the pet meters read vs a human meter. The only time it matters, is when the BG's are low. Then the pet meter reading of 68 (like on your Alphatrak) is treating like a BG reading of 50 on a human meter.

Too high is too high. You adjust based on what is written in the protocols, no matter what type of meter you use.

Does that clarify things for you?
 
Deb & Wink said:
There is no conversion. Simply put in your spreadsheet whatever the actual test results are that you get from your meter.

All our documentation here is written with the idea that people are using human meters. We've been around since 1996, decades before there were pet specific meters. We have developed a ton of documents over the decades, and all the BG numbers you see in those documents are from human meters. You will see the number 68 and Alphatrak used together, as a reduction point for TR (Tight Regulation) protocol used for lantus insulin.

We simply do not have enough test data to know what the pet meters read vs a human meter. The only time it matters, is when the BG's are low. Then the pet meter reading of 68 (like on your Alphatrak) is treating like a BG reading of 50 on a human meter.

Too high is too high. You adjust based on what is written in the protocols, no matter what type of meter you use.

Does that clarify things for you?
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Deb as far as the below:

Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?

A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.

  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options: a.) give nothing; b.) give a token dose (10-25% of the usual dose); c.) feed as usual, test in a couple of hours, and make a decision based on that value.
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
  • In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
  • Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.
Would I be able to use the above numbers in reference to my AlphaTrak2 readings?
 
Renee & Mikey said:
Would I be able to use the above numbers in reference to my AlphaTrak2 readings?
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Yes.

But be aware, that those decision point BG readings in the section you quoted have been updated and revised for several of the dosing protocols. As you gain more test data, you will be able to shoot much lower numbers than those numbers quoted in that section you copied.

As an example, @Susan & Claudio shot a 54 today, with a bit of stalling to see if the number was rising. Her Claudio gets 5U of insulin currently, each cycle. She did ask for some feedback from people here, on what she should do, before she went ahead and gave her cat the dose of insulin.
 
Deb & Wink said:
Yes.

But be aware, that those decision point BG readings in the section you quoted have been updated and revised for several of the dosing protocols. As you gain more test data, you will be able to shoot much lower numbers than those numbers quoted in that section you copied.

As an example, @Susan & Claudio shot a 54 today, with a bit of stalling to see if the number was rising. Her Claudio gets 5U of insulin currently, each cycle. She did ask for some feedback from people here, on what she should do, before she went ahead and gave her cat the dose of insulin.
Click to expand...

I read that thread and was wondering why she was shooting with such a low number and what I missed. Thanks for clarifying! :)
 
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