New to Lantus- Bubba and Jackie

[chubbabubba]

Hello everyone,

I am reading the posts and I am hoping you all will take this journey with Bubba and I. I see that there is a lot to learn since our last visit and to be honest my head is spinning.

Bubba's
complete backround is listed below, if you have a few hours, give it a read To bring you up to speed up until Nov 2012, Bubbas #'s have stayed well within normal range. When he ran a fever, etc they got up to 180's max but always came back within normal range. Has been otj for over two yrs.

Bubba is like a alarm clock and wakes me daily for his food. Last Sunday, he didnt which was odd so I tested him and he was 368. Rushed to the vet he had a fever
and vet thought he had a URI. Treated him for it, numbers came down for like a day, many visits for the next few days and fever dropped yet numbers did not. He didnt eat well for a few days, thanks to Halo treats ( I call them kitty crack) he is eating like a champ again)
Ranging from 200-323. We are running a few more tests as seen below but he may be going on Lantus by the end of this week so I could be with him and test test test


I am very confused...
a lot has changed from the insulin he was on before. I dont know if I would be able to follow the TR, due to my work hours
I am not home during the day to test and am so confused about such things as the nadar, warehouse etc? I am sorry maybe my brain is shot right now and on overload.
I think they will start him off on a small dose . I am all for the start small and low to see howwill react. Last time he was otj very fast and we had a few nights where his numbers were so low. His numbers are ranging from 200-290's by night. ( I will figure out the ss I promise) Would I be part of the " relaxed" board to start I have read many dont shoot if below 200? With the old insulin if he was within normal range you didnt shoot , kept testing and if by next dose time his numbers have gone past and up then shoot. I am so confused right up to the way the insulin is drawn ( again , very different.) dont put any backin the bottle, dont roll etc)
Boy, I have a lot to learn!! Please if anyone could break it down to me in easier terms ( sorry, I have gotten so little sleep over the last week its crazy)

If you cant test during work hours- My home testing (Alpha Trak 2) would be as follows
Morning before food at lets say 7am ( initial shot time)
Come home at 5pm test again, feed
7pm - test, food, (2nd shot)

10 pm and then midnight? I guess I am unsure on how the normal testing would be done? Granted if you didnt notice any other signs where you felt round the clock testing was required?


I am sorry for the 1000000 questions, I am sure I will catch on and Bubba and I will fit in Its just a lot to take in.
I just dont understand it all that well

Bubba is on a all wet diet (ff classic) and has no dry food at all since 2010. We home test with Alpha trak and now Alpha trak 2
Some of his numbers are posted on the main board. I will learn the ss and post it soon.

Thank you all again!
___________________________________________________________________________________________________________________________________________
Bubba is now 10 yrs old ( Tuxedo) and was the only kitten to survive in his litter ( stray born in my garage) Since he was 5 yrs old he has had asthma, Not knowing much he had shots of steriod about 2x per yr. Well in 2010 he got very sick and I was told he had diabetes. At that time he not only had diabetes that he also had fatty liver from not eating during regulation. He was yellow, and well dying. Went from 18lbs to 12lbs. Then rushed to emergency room here in NJ.Where he stood for about a week
Needless to say it was a rough road. They thought he would need a feeding tube but after a stimulante he started eating!
Bubba was put on insulin ( Humulin) back then 1 1/2 units for about two months. We switched his diet thanks to this board and his numbers were steady, for the last few yrs. Ranging 110-140. ( no insulin needed) We used the original Alpha Trak to test and ran blood work.
We went to the top hospitals with him the last being Philadelphia. We joined the asthma board as well and were given the Areo Kat from Philadelphia.

Bubba despite all the help, would not take to it, He would get so upset, he would end up having attacks on us.
I know I should have kept trying, ( tried for a month or longer) Could not get the proper dose in him. Bringing him back and fourth to the vet having him put in Oxygen was heart breaking. They moved away from the Areo Kat and gave him Terbutaline and it didnt control anything, only made him jumpy and hide.
Then gave him small doses of Prednisolone . He was taking it for over two yrs with no rise in bs.Minimal attacks

and we continued to run blood to check his levels. Right now, I feel 100 percent guilty for not only the numbers rising again but the weight gain.
I couldnt get the image of him on deaths row out of my head. I dont want anyone to think I dont love him to death, I do. I knew better yet I did what made him feel comfortable and didnt look at the big picture. Pred could have caught up with him ( now on backorder worldwide) he was taking a componded version- ( perhaps different, I dont know) Thats the only thing that changed. He was fine up until Nov ( end of) or its a combo of the URI, or teeth, or for the sudden change in numbers.

Again today I went to the vet and said I am very worried about his numbers and not eating. (Before going I stopped and got the Halo chicken treats for his food)
I asked if we could run the following- test ( Fructosamine ( although he is home tested, still want to know) and also a chest xray to see how his lungs are
His numbers are ranging from 200-300's and (two times in the 300's). I asked if we are going the insulin route what would be his insulin of choice for Bubba?
He said Lantus.

Last night after the vet visit he shot up to 332 ( around, I dont have his chart here) This morning after food he was at 252, tonight at 270 before food.
I gave him some FF with the Halo on top ( very little and he ate like a champ)

My questions are this- Is Lantus very different then what he was on before? If his numbers are between 200- 300 what dose do you think he will be given?
I know you need to test, eat, shoot ( over 200) I cant remember if thats the order? If when you test in the evening and his numbers dont call for it you do not shoot to prevent Hypo? ( that did happen to him before he went into remission)

I know Bubba and I have a lot to work on. My ideas are this

First regulate his numbers-
Get back to the Areo Kat ( even if I have to pay someone to help me this time)
Get his weight back down
Get him a cleaning

Tests ran- CBC, Urine at home to test for Ketones ( neg)

Original post below- First time numbers were up since 2010


Since its been over two yrs, and my memory is a bit rusty, if you have any info or suggestions on ways to help Bubba, please let me know. I have been a mess this last week or so and felt it was important to give you his entire history. __________________________________________________________________________________________________________-

 

[Anne & Zener GA]

Hi Jackie, welcome to Lantus Land. I'm sorry you need to be here but you're in the right place to get help for Bubba.

We like to see at least 4 tests per day (per-shot and mid-cycle). So if you test and shoot as soon as you get up in the morning, then test again before you leave for work, that would be fine. You can test and shoot when you walk in the door at night and then test before you go to bed. Does Bubba eat pretty well in general. Does he free feed? With Lantus, it's important to be consistent and give the shot every 12 hours.

I'm sure you have other questions, please don't hesitate to ask.

Liz, Zener's other mom (I sign my posts and Anne doesn't)

 

[Sienne and Gabby (GA)]

Welcome to Lantus Land!

Here's the link to Jackie's post about Bubba's from Health.

Tight Regulation isn't that difficult once you get into the swing of it. It is overwhelming in the beginning but I suspect that when Bubba was first diagnosed it was overwhelming. And, you mastered what you needed to learn and Bubba went OTJ. We're here to help you get it figured out. You can follow Tight Regulation or the Start Low Go Slow approach and post here. FWIW, many of us work and can't get tests during the middle of the day and still follow TR. If your schedule is as you posted, rather than shoot at 7:00, I'd suggest you thing about shooting at 6:00. That way, you'll be able to get a couple of tests in before you leave the house in the AM.

All the nadir is, is the lowest point in the cycle. With the insulin you were using previously, Humulin N, more emphasis was placed on your pre-shot values as a factor that influenced your dose. With Lantus, we look at the pre-shot value only from the perspective of whether it's safe to shoot. Beyond that, we look at the lowest numbers in the cycle. If the numbers drop below 40 (since Bubba's a longer term diabetic) once or if he drops into the 40 - 50 range three times, you reduce his dose.

When you mention "warehouse," I think you mean the insulin depot. With Humulin N, you could change Bubba's dose from shot to shot. This was because N is a shorter acting insulin. In comparison, Lantus is a long-acting insulin. In fact, technically it is considered a "depot" medication. This means a certain amount of every shot is stored under the skin in fat tissue. The storage aspect is what allows Lantus to have it's long duration. It also means that if you change your dose in a back-to-back fashion, you keep disrupting the amount that's in the depot and you can end up with wonky numbers. The depot is one of the harder concepts to wrap your head around.

You're right -- you handle Lantus differently than N. If you remember, N will separate when it sits for a while. You have to roll it so you put the insulin back into suspension. Lantus is a solution. It's a clear liquid that doesn't separate. Thus, there's no need to roll it. It's also a little more fragile than some of the other insulins which is another reason that you don't want to roll it. The reason you don't want to inject insulin back into the bottle is that syringes have a silicon coating on the inside. If you put insulin from the syringe back into the vial, you are putting some silicon back into the bottle. Also, if you are using a Solostar pen, they work on a reverse pressure system and you don't want to put air back into the pen. It will create too much pressure in the container.

For now, you need to:

• Figure out your starting dose and shot times;
• Plan to always get a pre-shot test and at least one test during the AM and PM cycles;
• Particularly during the cycles you're home, try to get a +2 test and other tests toward the middle of the cycle;
• Breathe.

Beyond the above list, we can help. Ask questions. The people here are incredibly generous with their time and their knowledge. We'll try to not overwhelm you.

 

[Marje and Gracie]

Welcome, Jackie, to you and Bubba. What a journey you've had. Hopefully, you will be able to get him back into remission. We are here to help you as much as we possibly can.

Once you have a spreadsheet up and running, we will be able to give you more specific thoughts about his dose. Typically when a cat is coming back from remission, we tend to be a little more aggressive with dosing so we can get him back off the juice as safely and quickly as possible.

Please continue to ask questions.

 

[chubbabubba]

Re: New to Lantus- Bubba and Jackie-

Thank you everyone for all of the info and support!
Thank you to Sue for helping me start the SS. Well, today I realized I only have three test strips left. I did order them and the tracking states Sat arrival but I am in a bit of a panic. So I am hoarding them and wont be able to test as I would like ( as much)
Anyway, I have listed as much as I could on the ss.

Bubba will return to the vet on Sat and it will begin his journey into Lantus Land.
I wanted to get him a quick check up, temp, lungs etc and talk to the Dr about his plan for Bubba.
I picked up the Lantus today ( 170) is that the normal price? (cvs) I really didnt shop around.
and the syringes. U100 . think they go up to 50 u. (are these ok?)

Let me ask a silly question- If he goes on 1 unit a day and then lets say the Dr reduces it
Is one unit like a drop? I was testing the needle with water to get comfortable with them today and thought hmm
Can you even get less then a unit? Stupid question I know, but it did cross my mind. Is half a unit the very first big line?

So if I understood some of the video, you do not roll the insulin, you draw out more then you need
check for bubbles, tap with finger to get out. Do not shoot excess back into the bottle yet squirt it out to desired dose.
Once the bottle has some air in it, you would then shoot air back into the bottle , tilt over and start to draw out the insulin.

The Dr did say he would be on 1 unit 2x per day to start. I know I dont have a ton of numbers to look back on
here, but I was wondering if that may be to much. really not use to Lantus so I wanted to start slow to start.
If starting slow, and new to lantus what is the (do not shoot #) What should be looking for? I know as time goes on I will have to be more brave and confident but I am just not there yet.

So I am off Sat and this will be his start day ( once th Dr see's him at 7am) I am a little nervous because that will be a late start time for him. ( going forward that is) What will I do since it should be as close to 12/12

Last question for now- Ok two Since I will be home, could you please tell me what you suggest as far as testing times? How far apart?
At least I could go crazy testing for the weekend.

Bubba will still need to be weened off of Prednisolone and it will take a bit as he has to take to the Areo Kat. He normally takes this med
around 730 am. I am worried with giving it that close to the insulin now. I am aware that it can raise his numbers,( amoung other things) but he needs to take it until we build up the AK in his system. Do I need to spread this apart? I will as my Dr as well
but you guys are amazing with all of this

I have been down this road with Bubba and although nervous ( very) I felt better knowing I had the Lantus in my home and we are on our way. I hope you dont mind, but I am sure I will be asking tons of questions. Thanks for reading all of this!

 

[Michelle & Scrabble (GA)]

Welcome to lantus Land! So glad you found us! There is a lot to learn and I remember when we first got here I was completely overwhelmed too but pretty soon you will get into the swing of things and it becomes second nature. There are plenty of us around to answer questions so ask away! Just remember to breathe! Welcome again and hope things go smoothly for you!

 

[chubbabubba]

thank you so much Michelle!

 

[Josie & Ripley (GA)]

I picked up the Lantus today ( 170) is that the normal price? (cvs)

Hello and welcome!
I'm relatively new, but want to share some info: I purchased my vial of Lantus at Costco for $137 (you don't need to be a member to use their pharmacy). The only other price comparison is from Walmart, which I was quoted at $150 for a vial.

Good luck and hang in there! You're in a good place, here, with so many helpful advice-givers!

~Josie

 

[Sienne and Gabby (GA)]

If you take a look at the New to the Group sticky, there are photos of doses smaller that 1.0u. Since you asked about syringe increments, I'm copying one of the photos.

The first line closest to the needle is the zero line. The next short line is 0.5u. The next line is 1.0. Hopefully, you got syringes that are in half unit increments. U100 3/10cc syringes with half unit markings are the best to use for fine dosing. BD, Monoject, GNP, and ReliOn are some of the brands available with half unit markings. Needle gauge and length is your preference. They come in ½ inch or 5/16 inch needle lengths. Needle gauges 29, 30 or 31 (31 being the thinnest). Most of us use 30 or 31 gauge needles.

There's no way to know if the starting dose is the best dose. There is a formula for calculating starting dose: initial dose = 0.25 x ideal weight in kilograms. Unless Bubba is very large or very small, the initial dose usually is in the neighborhood of 1.0u. We usually use a "no shot" number (well, actually a "post and ask for help" number) as below 150. If you look at the top of the board, there's a sticky that addresses what to do if you have a low pre-shot or other low numbers. That post is a good one to print out. If you are ever unsure of what to do, post and ask for help. There's usually someone around 24/7 or very close to. This is a busy forum and people are very willing to lend a hand.

In the beginning, it's important for you to gather data. We suggest that you get a "mini" curve -- testing every 3 hours. You want to be able to accumulate enough data that you begin to understand how Bubba responds to Lantus. You want to know when onset and nadir occur and what kind of duration he's getting.

I wouldn't worry about the pred. Certainly talk to your vet or talk to a pharmacist but I don't believe there's an interaction. There are any number of cats that need to be on steroids. We work the insulin dose around the other medication. If Bubba needs pred for his asthma, he needs the pred. Breathing trumps insulin and you can always adjust the insulin dose.

We love questions! The people here are committed to helping. I would encourage you to read and re-read the sticky notes. A lot of the information you're asking about are in there. (It took me several reads to realize just how much information is in those notes.)

 

[Amy & Papaya (GA)]

Re: New to Lantus- Bubba and Jackie-

Is one unit like a drop? I was testing the needle with water to get comfortable with them today and thought hmm
Can you even get less then a unit?

The doses are really tiny, aren't they? I wanted to SEE how big they were so I took this picture: Papaya's insulin doses illustrated.
As long as you're consistent, you will find a way to measure tiny differences - plunger at the bottom of a line, middle, or whatever. I just make myself a little diagram of what it should look like so I don't have to second guess myself when I'm shooting.

Best wishes!

 

[Marje and Gracie]

Jackie

Remember that it takes a while to fill the depot on lantus so don't be surprised if you don't see a big change right off the bat. Is hard to know how Bubba will react....sometimes cats coming back from remission jump right into the dance but more likely it will take a few cycles to see anything happening.