? NEW MEMBER- Lantus Insulin Prefill the Syringe

[AnneforMarley]

Lantus long acting insulin: The Drug insert states can be okay for 3 days but have chosen to recommend not to prefill syringes. What are your thoughts, as I may need to prefill for a relative NOT comfortable with drawing it up occasionally.

Day 3 today on lantus insulin Oh 12, and all is well. I don’t think Marley even notices I am giving the insulin while he is eating because I have a very food focused cat, gentle and sweet and tolerant of anything so easy to manage but trying to make him less sweet.....blood sugars that is!


I am so impressed with the dedication, knowledge, support, and brilliance of this group. What a find, and I thank each and every one of you.

 

[Deb & Wink]

Hi Anne and extra sweet kitty boy Marley.

There is a lubricant in the insulin syringe. If you pre-fill the syringes, that lubricant can interfere with the effectiveness of the insulin.

Here is a link from a scientific paper on pre-filling syringes with Lantus.
Pre-filling Syringes with Lantus (see page 3) is NOT recommended.

So what insulin syringes you use, and how far ahead of time can make a big difference in the stability and thus the effectiveness of the insulin. A big difference between a couple of hours and a couple of days.

Day 3 today on lantus insulin Oh 12, and all is well.

HUH?!? Sorry, did not understand what you were trying to say here. The "Oh 12" did not make sense.

 

[AnneforMarley]

My apologies-
oh12 means a shot every 12 hours.

 

[Deb & Wink]

Is there any other information you would like Anne?

 

[AnneforMarley]

Is there any other information you would like Anne?

So kind of you to ask. Not at present.
Feeling blessed that Marley doing so well and drinks appropriate amounts, pees less, is less drowsy, no more tracking of kitty litter etc. The change in diet for 5 weeks then the added insulin has made a vast improvement -so very happy.
The biggest struggle will be to attempt 2 feeds a day as he is soooo food focused! Always has been.
Have a good week, Deb and great article that helped me understand the research behind the recommendation. Much appreciated.

 

[JL and Chip]

The biggest struggle will be to attempt 2 feeds a day as he is soooo food focused

Not only do cats naturally tend to to “graze” throughout the day, many diabetic cats do much better on multiple small meals rather than two meals a day (smaller meals are less of a hit on the pancreas). I think the “two meals a day” was more old-school thinking and has perhaps perpetuated forward despite evidence to the contrary — I’m not really sure why vets stick to that line of thinking but it’s unfortunate.

In any event, I had this exact discussion with my university vet and she ultimately agreed that smaller more frequent meals is preferable. Also, a cat who is used to eating at will can be a bit stressed by the sudden change to two meals a day and stress can elevate blood glucose (BG). Finally, a cat whose BG is dropping low will often instinctively seek out food to help bring their glucose levels back up, so it can be advantageous to have food available.

One of my diabetics was so good at self regulating his food intake that I continued to free feed him with great success. Every cat is different, but they are smart little creatures so it’s sometimes wise to tune it to what they’re telling us.

Are you hometesting BG values? Not all vets encourage it or even mention that it’s possible. I found it absolutely invaluable in managing my cat’s health and keeping him safe, as well as honing in an ideal insulin dose. It also helped me know when his insulin needs dropped dramatically, thus saving us from a medical emergency and expensive trip to the ER. Just food for thought in case you weren’t aware of the option.

edited to add: As for your original question... it’s not ideal to prefill syringes, but sometimes it’s the lesser evil. More than one pet sitter has accidentally filled an insulin syringe to the wrong line and that can be life threatening. I have prefilled syringes on occasion for a family member or friend with no real ill effect. Just maybe use common sense and don’t make it standard procedure, and try to do it as close to when the syringe will be used as possible.

 

[Deb & Wink]

Feeling blessed that Marley doing so well and drinks appropriate amounts, pees less, is less drowsy, no more tracking of kitty litter etc. The change in diet for 5 weeks then the added insulin has made a vast improvement -so very happy.

Happy cat and Happy caregiver are very important. Sounds like you are already seeing some good improvements in the symptoms. Return to normal or closer to normal, with the 5 P's (peeing, pooping, purring, playing, preening) and the appetite tell you that you are doing things right.

Hope that Marley is doing well with his weight. Many diabetic cats lose a lot of weight and need to regain some back. Not too much, only so they are back at their "ideal" weight.

As JL mentioned, more than 2 meals a day can work better for a diabetic cat. It's something to think about.

 

[AnneforMarley]

Not only do cats naturally tend to to “graze” throughout the day, many diabetic cats do much better on multiple small meals rather than two meals a day (smaller meals are less of a hit on the pancreas). I think the “two meals a day” was more old-school thinking and has perhaps perpetuated forward despite evidence to the contrary — I’m not really sure why vets stick to that line of thinking but it’s unfortunate.

In any event, I had this exact discussion with my university vet and she ultimately agreed that smaller more frequent meals is preferable. Also, a cat who is used to eating at will can be a bit stressed by the sudden change to two meals a day and stress can elevate blood glucose (BG). Finally, a cat whose BG is dropping low will often instinctively seek out food to help bring their glucose levels back up, so it can be advantageous to have food available.

One of my diabetics was so good at self regulating his food intake that I continued to free feed him with great success. Every cat is different, but they are smart little creatures so it’s sometimes wise to tune it to what they’re telling us.

Are you hometesting BG values? Not all vets encourage it or even mention that it’s possible. I found it absolutely invaluable in managing my cat’s health and keeping him safe, as well as honing in an ideal insulin dose. It also helped me know when his insulin needs dropped dramatically, thus saving us from a medical emergency and expensive trip to the ER. Just food for thought in case you weren’t aware of the option.

edited to add: As for your original question... it’s not ideal to prefill syringes, but sometimes it’s the lesser evil. More than one pet sitter has accidentally filled an insulin syringe to the wrong line and that can be life threatening. I have prefilled syringes on occasion for a family member or friend with no real ill effect. Just maybe use common sense and don’t make it standard procedure, and try to do it as close to when the syringe will be used as possible.

 

[AnneforMarley]

There are so many conflicting recommendations out there. It just did NOT make sense to me that strict twice daily meal plan with a long acting insulin. Also, the

Not only do cats naturally tend to to “graze” throughout the day, many diabetic cats do much better on multiple small meals rather than two meals a day (smaller meals are less of a hit on the pancreas). I think the “two meals a day” was more old-school thinking and has perhaps perpetuated forward despite evidence to the contrary — I’m not really sure why vets stick to that line of thinking but it’s unfortunate.

In any event, I had this exact discussion with my university vet and she ultimately agreed that smaller more frequent meals is preferable. Also, a cat who is used to eating at will can be a bit stressed by the sudden change to two meals a day and stress can elevate blood glucose (BG). Finally, a cat whose BG is dropping low will often instinctively seek out food to help bring their glucose levels back up, so it can be advantageous to have food available.

One of my diabetics was so good at self regulating his food intake that I continued to free feed him with great success. Every cat is different, but they are smart little creatures so it’s sometimes wise to tune it to what they’re telling us.

Are you hometesting BG values? Not all vets encourage it or even mention that it’s possible. I found it absolutely invaluable in managing my cat’s health and keeping him safe, as well as honing in an ideal insulin dose. It also helped me know when his insulin needs dropped dramatically, thus saving us from a medical emergency and expensive trip to the ER. Just food for thought in case you weren’t aware of the option.

edited to add: As for your original question... it’s not ideal to prefill syringes, but sometimes it’s the lesser evil. More than one pet sitter has accidentally filled an insulin syringe to the wrong line and that can be life threatening. I have prefilled syringes on occasion for a family member or friend with no real ill effect. Just maybe use common sense and don’t make it standard procedure, and try to do it as close to when the syringe will be used as possible.

Not only do cats naturally tend to to “graze” throughout the day, many diabetic cats do much better on multiple small meals rather than two meals a day (smaller meals are less of a hit on the pancreas). I think the “two meals a day” was more old-school thinking and has perhaps perpetuated forward despite evidence to the contrary — I’m not really sure why vets stick to that line of thinking but it’s unfortunate.

In any event, I had this exact discussion with my university vet and she ultimately agreed that smaller more frequent meals is preferable. Also, a cat who is used to eating at will can be a bit stressed by the sudden change to two meals a day and stress can elevate blood glucose (BG). Finally, a cat whose BG is dropping low will often instinctively seek out food to help bring their glucose levels back up, so it can be advantageous to have food available.

One of my diabetics was so good at self regulating his food intake that I continued to free feed him with great success. Every cat is different, but they are smart little creatures so it’s sometimes wise to tune it to what they’re telling us.

Are you hometesting BG values? Not all vets encourage it or even mention that it’s possible. I found it absolutely invaluable in managing my cat’s health and keeping him safe, as well as honing in an ideal insulin dose. It also helped me know when his insulin needs dropped dramatically, thus saving us from a medical emergency and expensive trip to the ER. Just food for thought in case you weren’t aware of the option.

edited to add: As for your original question... it’s not ideal to prefill syringes, but sometimes it’s the lesser evil. More than one pet sitter has accidentally filled an insulin syringe to the wrong line and that can be life threatening. I have prefilled syringes on occasion for a family member or friend with no real ill effect. Just maybe use common sense and don’t make it standard procedure, and try to do it as close to when the syringe will be used as possible.

REPLY:
THis so makes sense to me, and glad you agree. It is encouraging to see how you were able to free feed and have great success, and yes, every cat is different!
Yes, I am learning to home test, and so far results betweeen 6-10 range 5 hours post insulin lantus 1 unit. I need more practice, but I am committed to just testing PRN unless S and S or issues. I am so impressed with the complexity and dedication of many members on this site. Thank you fosr your wise sharing.

 

[Deb & Wink]

Ok, I get the PRN (as needed) but what does S and S mean? Signs and symptoms? Betting you are in the medical world, either veterinary or human medicine. Or a scientific field.

If you could set up some information in your signature for us, that is very helpful.

Also, we have a very nice color coded spreadsheet you can use, to record the test data. There is a template you copy, no need to "reinvent the wheel" I tell new members. Easy to set up.
Directions on how to do that on a pc, tablet or smartphone are here: FDMB Spreadsheet Instructions

What it means is here. FDMB Spreadsheet Instructions

It was part of this link >>>> New? How You Can Help Us Help You!

 

[AnneforMarley]

I will need help with the last step as the URL does not turn blue for me. I am free tomorrow if someone can help me. Thank-you.

 

[AnneforMarley]

Oh, wow! I see that it did work. DISREGARD ABOVE. When I pressed on MARLEY SPREADSHEET, THERE IT WAS! You can see that I had my first episode of hypoglycaemia with Marley , and I could not stay up past midnight to check blood sugars, as I had to work the next morning, so I gave Marley some higher carbohydrate food. And yes, I apologize for the medical lingo. I will make an effort not to use. Yes, S and S was signs and symptoms.

 

[Deb & Wink]

When a cat gets BG levels that low, like Marley did on 2/24/20, they can be more sensitive to insulin.
A low of 3.1 (55.8) earned Marley a dose reduction according to the protocols we use here for dosing Lantus insulin. Please reduce his dose to 0.75U.

And yes, I apologize for the medical lingo.

No apologies for using medical lingo. We certainly have plenty of feline diabetes lingo. Have you seen our FDMB Glossary?

Yes, S and S was signs and symptoms.

Just wanted to confirm what you meant by S and S. No worries.

So, we strongly recommend getting a pre-shot BG (blood glucose) test at the start of every 12 hour dosing cycle.
That is so you know your cat Marley's BG levels are high enough to give insulin.

Once you shoot the insulin into your cat, you can't take it back out. You have to manage the low numbers to prevent hypoglycemic symptoms.

Those hypo symptoms can be very subtle and hard to see. We don't want to ever see a cat that has a symptomatic hypo (seizures, coma) and needs to be rushed to the emergency vet.

Please, let us know what other questions you have. Lots of people to help you here with feline diabetes. We may only be laypeople, but we know more about the day to day management of a diabetic cat then most vets do. The common thread that runs through members on this message board, is that we have all had a diabetic cat at some time, and wanted to learn more to help our cat. Some people even have several!

p.s. Not usually on this late. But couldn't sleep well and when that happens, I check the message board for a bit.

p.p.s Winnipeg is a beautiful city.

 

[Deb & Wink]

One analogy we make is, you would not give yourself insulin without testing your blood glucose levels first. Nor would you give medication of any type to one of your patients, I'm sure.

We feel the same way about our cats. That they need to be tested before each dose of insulin.

 

[AnneforMarley]

When a cat gets BG levels that low, like Marley did on 2/24/20, they can be more sensitive to insulin.
A low of 3.1 (55.8) earned Marley a dose reduction according to the protocols we use here for dosing Lantus insulin. Please reduce his dose to 0.75U.


No apologies for using medical lingo. We certainly have plenty of feline diabetes lingo. Have you seen our FDMB Glossary?

Just wanted to confirm what you meant by S and S. No worries.

So, we strongly recommend getting a pre-shot BG (blood glucose) test at the start of every 12 hour dosing cycle.
That is so you know your cat Marley's BG levels are high enough to give insulin.

Once you shoot the insulin into your cat, you can't take it back out. You have to manage the low numbers to prevent hypoglycemic symptoms.

Those hypo symptoms can be very subtle and hard to see. We don't want to ever see a cat that has a symptomatic hypo (seizures, coma) and needs to be rushed to the emergency vet.

Please, let us know what other questions you have. Lots of people to help you here with feline diabetes. We may only be laypeople, but we know more about the day to day management of a diabetic cat then most vets do. The common thread that runs through members on this message board, is that we have all had a diabetic cat at some time, and wanted to learn more to help our cat. Some people even have several!

p.s. Not usually on this late. But couldn't sleep well and when that happens, I check the message board for a bit.

p.p.s Winnipeg is a beautiful city.

 

[AnneforMarley]

I HELD his insulin this morning as 7.7=139. Thank you for the recommendation of the decreasing dose to .75U. What PMPS should I aim for regarding the evening dose? I am so impressed with the knowledge and dedication of you experts. Yes, I have seen lingo sheet as many new abbreviations for me.

 

[Deb & Wink]

Anne, would you please add the insulin used and the meter you use for testing to your signature.
Helps us to help you quicker.
Signatures are "magically" attached to all posts you do.
When this info is in the signature, we don't have to go back through posts hunting for it.

 

[Deb & Wink]

With the limited amount of test data you have for Marley, the skipped dose was a good decision.
When people are first starting out, and may not know how their cat reacts to a particular dose of insulin, we have them use what we refer to as a "shoot/no shoot" BG number. Also called a "threshold" or "stop and think about what to do number" or a "decision point" number.

For Lantus insulin and for new members on the message board, that "threshold" BG level is 200.
When you start posting over on the Lantus ISG (Insulin Support Group), or even perhaps when you are still on the Main Forum, that "threshold" BG level is set at 150.
As you gain experience and gather more BG (blood glucose) test data, that decision point number drops lower and lower. It's how we get cats regulated and even to remission.

There are 3 options for when you get a pre-shot BG test that is lower than you expected.
Stall, reduced dose, or skip. See this document for an explanation.
Sticky Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)

Lantus insulin has what we call a "depot" or storage area and the dose you give in one cycle, will take some time to fill that "depot" area. Lantus forms crystals underneath the injection site, and then is slowly absorbed and gets into the bloodstream. It's why Lantus has that nice shallow curve and longer duration than some of the in-and-out insulins. It's also why you do not want to rub the injection spot after the dose of insulin is given.

Needed to talk about that "depot" so you would understand the next part.

When you change the dose, by skipping the shot, reducing or increasing the dose, it takes a bit of time to see the full effect of that dose change. Some of the insulin given goes into that "depot" area and it takes time to fill the depot with dose increases. Conversely, even if you have skipped the shot of insulin, there is still some insulin being released from that "depot" storage area.

So, even with a skipped shot, like this morning, you should do some BG testing in this AM cycle if you are around to do that. A +2 or +3 would be good to obtain. Another test around the +6 time frame would be good. Maybe a +5 or +7 one cycle, a +4 or a +8 another cycle.

Testing at night is important too, as many cats are more active then. They "burn off" or use up some of that glucose in the blood stream as energy, and often drop lower at night than they do during the day.

Cats nadir, or reach their lowest BG levels at different times. The nadir does not always stay at the same time either, from cycle to cycle.

So testing, to see when your cat Marley has his nadir is important. ECID Every Cat is Different, Every Cycle is Different, Every Caregiver is Different.

We know that people have full and busy lives, between work and all their other responsibilities. So if something we said is not possible for you to do, let us know and we will suggest alternatives.

There are some wonderful "Sticky" posts over in the Lantus ISG forum. They are all located at the top of the forum and can help you with a more in-depth understanding of what I have said.

Hope I did not give you too much information (TMI). There is a lot to learn. We'll help you all we can.
p.s. Forgive me for oversimplifying some. There are lots of people that "lurk" or watch behind the scenes before they join the forum or create their own first post.

 

[AnneforMarley]

I am home today, but working Fri Sat. His accucheck now is +4 is 171. Yes, I had read about the depots- very interesting. Yes, this is a learning curve and every cat is different.
Also, He really dislikes his Purina DM, so I have had to add little amounts of Fancy Feast shrimp/fish or a sprinkle of Purina DM kibble mashed in. Not ideal. His activity level is low in the winter and probably not much different day/night at present. Thank you!

 

[Deb & Wink]

Yes, many vets do "prescribe" the Purina DM food for diabetic cats. Unfortunately, many do not like to eat it, or if they do eat it in the beginning, they stop eating it after a while and then you are stuck. Diabetic cats need to eat when they are getting insulin.

There are a lot more options for food choices for a diabetic cat. The Fancy Feast pate style foods are a good low carb choice. Many people here also feed the Friskies pate styles.

Have you discovered the Food Chart we use most often?
Our recommendation is that you look for foods on this wet/canned/pouch food chart that are <= 10% carbs.
https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

That chart will also help you find medium (11-15%) and high (16% and up) carb choices for your hypo tool kit.

(2018) AAHA Diabetes Management Guidelines for Dogs and Cats
says 12% or under, but the 10% or under carbohydrate content is so ingrained here, you are swimming against a flood tide to say differently.

171 at +4 is a good number for skipping the shot this AM.

p.s. Insulin doses change so frequently, that having that info in your signature is not needed. I always look at the SS anyway for the dosing.

You came here with a question about pre-filling lantus insulin syringes and we have overloaded you with all this other info.