Newbie...Introducing Gracie to Lantus...need help please

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Marje and Gracie

Marje and Gracie

Member Since 2010
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First, Gracie and I would like to thank all of the experienced people here who take their time to help others.

Gracie is a 4 year old who had a brief stint with steroid-induced diabetes in May. In fact, at the vet, we never even got a BG over 109; a UA indicated she had 3+ glucose so I ran her over for a BG to Antech and it was normal but the fructosamine was 477 so we know she spiked somewhere. We kept checking her urine and it got back to normal quickly. I have been periodically checking her urine and it has been normal. A few weeks ago, she had conjunctivitis; my vet spoke with opthamalogist because she felt the neopoly dex with .1% dex was best for Gracie but was concerned about the steroid in it; they decided she'd be ok for a short course. But a little more than a week after stopping the drops, she was acting very lethargic so I checked her urine and it showed alot of glucose. Took her to vet and BG through Antech was 409. That was Sept 7. Vet was hoping this was transient again and had me start giving her 50-75 mls subq LRS daily and watch BG. I had her to a different vet we use for nutrition (she's detoxing Gracie from Aluminum) and her glucometer was 174. Checked at my vet on 9/11 and her glucometer showed 325. Yesterday on her glucometer it was also 325. Gracie has not shown any clinical signs at all other than lethargy and being grouchy (unlike her). Lori is sending me a newbie kit. Vet wants to start Gracie on Lantus. She wants me to just check her BG levels at home before meal, an hour after meal, three hours after meal, just to see what Gracie's BG is doing at home. Gracie weighs 8.6 lbs and vet calculated she would get 1 unit (I'm assuming 1 unit bid). However, Gracie is VERY sensitive to every med and so because her BG is not horrible (she's thinking if it's 325 at her office when Grace was obviously stressed, that it's probably lower at home..maybe 250 but that's why we're doing different checks before we start insulin). IF Gracie's BG at home w/o insulin is in fact under 300, Vet wants to start her at .5u and to be able to do that and get the correct dose in a syringe, she's thinking it is best to have the lantus taken to a compounding pharmacy where they will use a dilution factor so we can use the really low-dose syringes to be most accurate. My vet is so super that when I told her about you all, she said, by all means, see what their thoughts are on this. She's all for the "go low go slow" esp knowing Gracie and how her body reacts to everything...and I do mean,she is sensitive. Of course, I'll be monitoring her, staying in touch with my vet, staying in touch with you all. I have been reading your lantus info and will get the spreadsheets, etc ready. I have to say I am scared half to death of putting her into hypoglycemia but my vet said if I am monitoring her every two hours at first and then start seeing it drop, I should start monitoring every hour until it starts to go back up and to have the hypo emergency sheet and my supplies on hand.

I would appreciate ANY thoughts, advice, help, anything you can give as we start this esp on how to be sure we keep her from becoming hypo. We'll probably start the lantus on Friday so I can do some pre-insulin start BG at home tomorrow. Thursday is too chaotic a day...I have a meeting that I cannot get out of but after that, my husband and I are home on vacation for three weeks and we'll be there to watch her.

Thank you all so much.
 
welcome to Lantus Land, Marjorie and Gracie!!!

Lantus cannot be diluted. From the manufacturer's website:

Do NOT dilute or mix Lantus® with any other insulin or solution. It will not work as intended and you may lose blood sugar control, which could be serious. Lantus® must only be used if the solution is clear and colorless with no particles visible. Do not share needles, insulin pens or syringes with others.

However, you can buy syringes with 1/2 unit markings. Here is one example, but there are lots of others. WalMart has syringes with 1/2 unit markings, and they are only about $13 per box.

0.5 units sounds like a nice, conservative starting dose. Be sure to read the stickies at the top of the Lantus forum for more information about handling Lantus and how we handle dosing. I hope to see you posting often! It sounds like you have a good start on things, and I think you and Gracie will be fine.
 
Welcome to Lantus Land!

I would not recommend trying to get Lantus compounded. It's a very fragile insulin. Most of us get pretty comfortable with using U100 syringes that have 1/2 unit markings. I get mine from Hocks -- the only difference in the syringes I use and the ones Libby linked are that I use a thinner needle (a 31 gauge). If you read some of the condos or look at spreadsheets, you'll see not only do we dose in 0.25u increments, we use fat and skinny doses. I suspect you'll do fine with a standard syringe. (Although, I'll admit to using reading glasses and some of the folks here will use a magnifying glass to make sure their dose is accurate.)

You're vet sounds like he's done his homework. A dose of 0.5u is conservative and takes your cat into consideration.

Please ask questions, visit our threads (we call them condos) and let us know how we can help.
 
Libby

Lantus cannot be diluted. However, you can buy syringes with 1/2 unit markings. Here is one example, but there are lots of others. WalMart has syringes with 1/2 unit markings, and they are only about $13 per box. 0.5 units sounds like a nice, conservative starting dose. Be sure to read the stickies at the top of the Lantus forum for more information about handling Lantus and how we handle dosing. I hope to see you posting often! It sounds like you have a good start on things, and I think you and Gracie will be fine.
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Thank you so much for that info. I don't think my vet has ever had a cat she had to give less than 1 unit to. She will be happy and so am I...less expense.
Where is a good place to get Lantus that is not so expensive? Walgreens wants $100 but I'm not sure how much that is...probably not a lot and at .5 unit bid, I think I'll end up throwing some out before it expires. I need to also read up on the best place to buy the 31 g needles...is that what most everyone uses or do you all use 29 or 30? Gracie is not a big kitty but she has very, very plush fur.
 
Glad to see you here, gracie & marjorie...i was hoping you hit the Lantus Land forum!
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Thanks, Celi. Any encouraging words are appreciated since you and Binks are walking down this new road, too.
 
Sienne

Your Gabby is precious...what a beautiful calico girl.

If you read some of the condos or look at spreadsheets, you'll see not only do we dose in 0.25u increments, we use fat and skinny doses. I suspect you'll do fine with a standard syringe. (Although, I'll admit to using reading glasses and some of the folks here will use a magnifying glass to make sure their dose is accurate.)
Click to expand...

So how in the world do you dose correctly if you are dosing down to .25u increments? My vet said one drop difference can be substantial at that low
of a dose. I pray for the day that I am as relaxed with this as you all :smile: I also hope Gracie will forgive me...we've always been so bonded and
I'm worried that all the ear pricks will make her avoid me. She's doing ok with me giving her subqs (which we will stop once we get her BG a little regulated) but she's not felt well and she's been really hissy when I try to hold her sometimes. So not like her.
 
There will be a ton of people to allay your fear of Gracie avoiding you due to ear pricks. It's odd but it seems to create even more of a bond. Gabby doesn't seem to mind at all. Many of the cats here will race to their test spot and purr. Just remember to give treats, no matter how successful or unsuccessful the test is. Cats will "work" for treats!

We routinely have people who are dosing at 0.1u. We have pictures!!

Walgreens prices are crazy! It sounds like your vet prescribed a vial of Lantus. Most of us use the Lantus Solostar pen or cartridges. The vial is 10ml. The pens (or cartridges) each hold 3ml and are packaged 5 to a box. There is less waste with the pens/cartridges. You still use a syringe to draw the insulin. I would check at Costco or Sam's Club. Someone here mentioned that RiteAid has good prices if you have their pharmacy discount plan. Some places also discount with a AAA card. I'd also check with local hospitals. Often their outpatient pharmacies will sell single pens, rather than a box and they often have competitive rates. (Most places won't sell single pens, only the box of 5.) Take a look at the sticky on the care and handling of Lantus. It will give more information on the differences in the way it's packaged.
 
Hi and welcome! Kind of jealous to hear about your up-to-date and cautious vet.

I'm a bit new around here to give you much advice, but I can sympathize with the mini-dosing confusion and worrying over the ears. My girl has many rules and regulations about where you can and can't touch her, but even though we still struggle sometimes with multiple pricks to get a drop, it doesn't really seem to bother her at all.

You're off to a great start and you've come to the right place, I'm sure you'll do great!
 
Marjorie, get out your reading glasses and a magnifying glass if you don't find U100 syringes with the half unit markings :lol:
also, get the pens of lantus so you won't waste any. someone here should explain what the pens are. they are not vials. they won't start to expire.
Looks like your off to a good start.
Have you joined the VAMPIRE CLUB yet? have you gotten a test yet?
Lori
and tomtom too!
 
i'm only relaxed because these folks have very graciously guided me on my stumbling way...some of my days have been wildly confused, silly, terribly excited...but this forum has guided me thru each of them...and the humor aint hard on the nerves, either!

you'll get the hang of it...

celi and binks
 
Walgreens prices are crazy! It sounds like your vet prescribed a vial of Lantus. Most of us use the Lantus Solostar pen or cartridges. The vial is 10ml. The pens (or cartridges) each hold 3ml and are packaged 5 to a box. There is less waste with the pens/cartridges. You still use a syringe to draw the insulin. I would check at Costco or Sam's Club. Someone here mentioned that RiteAid has good prices if you have their pharmacy discount plan. Some places also discount with a AAA card. I'd also check with local hospitals. Often their outpatient pharmacies will sell single pens, rather than a box and they often have competitive rates. (Most places won't sell single pens, only the box of 5.) Take a look at the sticky on the care and handling of Lantus. It will give more information on the differences in the way it's packaged
Click to expand...

So we learned a hard lesson!! One question...if the pens are 5 to a box and 3 mls to a pen then that's 15 mls....do the pens last longer? If I'm just dosing .5 u bid won't I have more waste or is the price so much cheaper that it won't be a big deal? When I called Walgreens to see if they would take it back because we haven't even opened the bag (they wouldn't), I mentioned the pens and she said they are $200 so I definitely hope Costco is much less. We have one nearby.
Thank you!!
 
Do Lou and I want to welcome you to Lantus Land you are certainly at the right place for guidance they have held my hand many a time when I needed it for Do Lou :-D The stickys at the top of the page have a lot of information that will help you along the way so read them over and over when you have spare time, I use a magnify glass to measure out small increases to me its the only way to see between the lines on these syringes. cat_pet_icon Hope to be seeing you each day with a condo we love getting to know one another :mrgreen: :mrgreen:
 
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