New to insulin- Questions!

[Haley&Diane]

Hi. Getting ready to start my kitty on insulin this month. I'm trying to get everything ordered. I plan to do the first curve on July 28th. I plan to use lantus...starting with 1 unit likely. Diane has been diagnosed four years, but no insulin yet. She has been managed via diet to the point that she was not clinical so the vet did not feel the need for insulin. She's never had issues since the very beginning and has no typical symptoms. We have a new vet now, and after new bloodwork with her liver values slightly elevated for the first time, she suggests we start insulin.

I plan to use the lantus pen and order from a Canadian pharmacy.

1. What needles should I use? I don't understand the needle/syringe language... What does U-100 mean? 1/2 cc? I do know how to tell the gauge at least...Just trying to understand what it all means. I want 1/2 increments. I want something I can use with the lantus pen.

2.) If I order the pen, how long does that usually last? Can I draw insulin from the pen easily with my syringe?

3.) Can I use needles twice? I worked at a boarding facility and some owners insisted we use the needles twice. Wasn't sure the pros/cons of this.

4.) Does 1 unit seem like a good amount to start with twice a day? Her levels are usually around 375. I don't want to start too high...was wondering if half a unit would be wise to start with.

5.) How much does relion typically differ from alphatrak? I have both, but can't afford the AT strips. Was thinking of buying more though just to compare the two brands to determine the difference so I can safely use relion in the future.

6.) Once I get her managed and settled into insulin, do I need to test her blood every time I give a shot? Obviously, I will make sure she eats a full meal (she loves food, so that shouldn't be an issue).

7.) What do you all think the chances of remission are? Had I known from my vet at the time that remission was so likely when first diagnosed, I would've started insulin. But I was given bad advice and the new vet says the chances are slim to none at this point. i'm still doing lantus though just to give her the best and also hope a miracle happens.

Any help would be so greatly appreciated!

 

[CandyH & Catcat]

I'm relatively new but can answer some of your questions -- others will chime in and expand or give additional info

1) U-100 syringes go with Lantus, it's a U-100 insulin (measure of 100 units in each milliliter); U-40s are used with Caninsulin/Vetsulin and ProZinc
get 3/10 ml syringes (.3) .. then the unit marks are far enough apart you can dose precisely; yes, ask for 1/2 unit markings

2) some have been able to keep a pen safely for 6 months (once initially used) if refrigerated and not jostled about; some have reported being able to use it all up
there are videos and pictures here showing drawing with syringe -- actually easier than a vial since pen is internally pressurized

3) use a fresh needle each time, they develop burrs and rough edges if reused (there are pictures here) -- applies to lancets too

5) ReliOn and Alphatrak -- it's not so much apples and oranges, more like oranges and tangelos, using different reagents, each is FINE, you pick and use the same one and don't try to compare the results because there's no mathematical way to "translate" -- most here use human meters, most vets use the pet meters and try to get you to ...

6) ALWAYS test before you give a shot -- you need to know if it's safe and appropriate -- the "full meal at shot time" is not absolutely necessary, many of our sugarcats either graze or get small meals frequently

7) remission? only the cat goddess knows and she's not talking ...

 

[AmandaE]

Hi Haley!

I @CandyH and Catcat has given you so much valuable information already but I thought I would share the link to Zazzys post as she is also starting Lantus soon so you might be able to learn some things from comments on her condo as well ( a Condo is a members post )

In that post I put some of my thoughts around information I had learned from other members here when I started Lantus! It might help you out when you start posting on the Lantus forum

Good luck with everything, definitely ask as many questions as you need. You’ll want to ask someone with a bit more experience than me but I believe a typical starting dosage for a cat new to insulin who is also on a wet food diet is 0.5u. If there is any dry then 1u

 

[AliceMeowliss (GA)]

@CandyH and Catcat already answered all of your questions so well! So I just want to add a link to the Lantus ISG (insulin support group), where at the top, you will see “stickies” that are links with information. You may try the “new to Lantus?” sticky you find there.
http://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/

Also here are the lancets and syringes I buy at Walmart—about $15 total. You should never re-use syringes or lancets, and the clients you had in the past asking you to reuse needles were probably sadly missing information on why it mattered.
FYI, you may want to start with a larger gauge lancet than 30, as your cat builds up more capillaries for pokies. Eventually it gets easier and a smaller gauge can be used.
I also recommend purchasing some Neosporin with pain relief for the ears.


You should expect to ideally test a minimum of 4 times a day. That minimum allows for a test before each shot to determine if it is safe to give the shot, and a test each mid-cycle, but we recommend getting more tests than that where possible. Most of us use human meters, the strips are cheaper, and you are looking for trends, not just the exact numbers. So finding those patterns can be done with any meter really. Most of our protocols are designed off of use with human meters, so when we say hypoglycemia risk starts at 50, that’s with a human meter, versus alphatrak which is a risk around 70. Candy is right though there is no perfect math to translate the numbers, but over time you get a sense of what they mean for your cat. Time and practice!

I’m glad you are here and learning!

 

[Myrtlesmum]

Hi and welcome. The others have already given you some excellent advice. The only thing I wanted to add was regarding testing. Definitely test before each shot to make sure it is safe to shoot. It’s great if you can get some testing in between shots to see how much she drops and when in the cycle she hits her lowest bg point. However, if you are like me and work, I tend to work really long hours so can’t test during the day and sheer exhaustion makes it hard to wake up in the middle of the night especially when you have to get up again at the crack of dawn. If this is the case try to get some extra testing in on the weekend or your days off. The only thing you really have to do is your best - everyone’s circumstances are different and you can only do what you can do - take it one step at a time. Wishing you all the best.

 

[Tomlin]

Welcome! Everyone has given great advice. If you go into the Lantus Forum, there are "stickies" at the very top. I read & then finally printed them off so I could highlight important info & I created a small binder to keep them in along with the BG Diary.

Everyone is extremely supportive & great about responding to questions &/or referring you to threads, stickies etc. to get you to the info you need.

As far as the "slim to none" chance of remission, I say never say never ! There are always exceptions in medicine, whether it be human or cat

 

[Kelsey & Lilly]

I recently made the switch to Lantus, and the information in the stickies and in the Lantus forum will answer all your questions and more, including questions you didn't know you had! Super helpful, albeit a bit overwhelming. Digest what you can, take breaks, and return later.

Regarding the expensive Alpha Trak strips, I use the AT meter with Freestyle InsulinX strips. I usually find them for $15-20 for 50 on eBay. I keep a vial of AT strips around, just in case I need the accuracy in a hypo episode, but otherwise stick to the Freestyle strips. In my humble opinion, using two different meters is going to give you vastly different results and drive you CRAZY comparing the two. (That's what I did in the beginning.) Also, switching back and forth from a human meter to a pet meter has different ranges, even though the true amount of glucose in the blood is exactly the same. For example, you might think she had a "spike" if you test with the human meter and then the pet meter, or you might think she was improving if you switched in the other direction. I'd stick with just one, if I were you.

And, just for emphasis on earlier points, NEVER RE-USE NEEDLES -- there are some gruesome pictures in some of the files around here that will convince you otherwise. And ALWAYS test before each shot. If you have a look at my Lilly's spreadsheet -- she's almost always in the pinks, but every now and then I'll get a random "green" before her shot, and that could be literally deadly if you overdose on insulin. I'm not trying to scare you, but being realistic and stressing the importance of testing each and every shot!

Good luck and you've got this!