Please Help..Freaking out Overdose On Lantus This Morning

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I am so very new to this site, but I wanted you to know I was following Chicken's progress all yesterday, with hope & prayers for you all. It rattled me as a sugar kitty Mom and your courage & smarts to admit a mistake and ask for help here was a valuable lesson learned. All the out pouring and non judgemental comments were amazing to me and in my sleep deprived state moved me to tears more than once. I am so glad I came here. Big hug to Chicken and family, I am so glad for you all.
 
I am so very new to this site, but I wanted you to know I was following Chicken's progress all yesterday, with hope & prayers for you all. It rattled me as a sugar kitty Mom and your courage & smarts to admit a mistake and ask for help here was a valuable lesson learned. All the out pouring and non judgemental comments were amazing to me and in my sleep deprived state moved me to tears more than once. I am so glad I came here. Big hug to Chicken and family, I am so glad for you all.
Awe thank you and in my deprived sleep state I have tears in my eyes from your beautiful message : ). I am also very new to this site and feline diabetes but I know that a lot of these people are not and I knew that at least one of these wonderful people would of had experience with something like this and I got an absolute outpouring of advice, prayers and support that overflowed my heart!! This is a great place to be, I was so ashamed but I knew I had to post and ask for help. Chicken is doing well this morning after a very long and stressful day yesterday : ). Thank you all again so much!!
 
Thank you for the update. I'm so pleased to hear that Chicken is doing well this morning. :) I know how incredibly stressful yesterday must have been for you and I'm so happy that you found this site and were able to get the help you needed to keep Chicken safe. :) :bighug: :bighug:
 
So pleased it has all worked out all right. Don't worry you make a mistake....we all do at one time or another. The important thing is you acted on it immediately and took the advice given...that was smart! And Chicken is safe.
I think I called Chicken a he in an early post.....sorry Miss Chicken.
Before I give any insulin, I always check it again just before I actually give it....a hang over from my nursing days.....I once found I had drawn up 10.25 instead of 5.25 units and found it just as I had pulled up the skin and rechecked the dose!
Please keep posting and set up a Spreadsheet when you feel up to it! Here is the link
http://www.felinediabetes.com/FDMB/...te-a-ss-and-link-it-in-your-signature.130337/

Well done today.....
Thank you so much. I tried to set up the spreadsheet and I was having some trouble with it. I use a Mac so I don't know if that is the problem. Maybe I will try it on my husband's PC and see if I have any better luck. Thank you again for all of your support!!
 
I would not try to stick with the pen. I think you will be right drawing now that you've made such a huge boo boo, can't see you doing that again! My understanding is that the dose drawn by the pens is not very accurate when it is refrigerated - as we need to keep it for our kitties so it lasts the distance. Also 1 unit dose changes are too large going up or down (with the exception of high dose kitties) when using lantus.

We do have a saying better too high for a day than too low for a minute but it must be remembered that if the BG is too high for an extended period that will also kill your cat. So you need to be able to dose appropriately. I have a sample dose made up using coloured water (you can also use cold tea) and compare the dose I have drawn to the sample before I shoot. This avoids errors in dose and also helps me to be more consistent in dosing.

In case your vet didn't mention it - after an episode like this cats can be extra sensitive to insulin. Depending on her numbers you may want to skip the next dose, if she's okay to shoot monitor carefully. So glad your Chicken is okay. It would be great if you could get a spreadsheet up for her, the instructions are in the tech forum.
Thank you... I will try again to get the spreadsheet up... I tried a couple times and was not successful but I will try again : )) thank you for all the great information!
 
If you send a PM (start a conversation) to Marje&Gracie she's a pro with spreadsheets and can get one up in no time. I use a Mac too but both of my ss were set up by her as I did something wrong.

You are right that thus is the most caring group of people I've ever come across and I've had to be on several yahoo groups for two senior cats that gave had lots of issues.

How is Chicken's BG now?
 
I would not try to stick with the pen. I think you will be right drawing now that you've made such a huge boo boo, can't see you doing that again! My understanding is that the dose drawn by the pens is not very accurate when it is refrigerated - as we need to keep it for our kitties so it lasts the distance. Also 1 unit dose changes are too large going up or down (with the exception of high dose kitties) when using lantus.

We do have a saying better too high for a day than too low for a minute but it must be remembered that if the BG is too high for an extended period that will also kill your cat. So you need to be able to dose appropriately. I have a sample dose made up using coloured water (you can also use cold tea) and compare the dose I have drawn to the sample before I shoot. This avoids errors in dose and also helps me to be more consistent in dosing.

In case your vet didn't mention it - after an episode like this cats can be extra sensitive to insulin. Depending on her numbers you may want to skip the next dose, if she's okay to shoot monitor carefully. So glad your Chicken is okay. It would be great if you could get a spreadsheet up for her, the instructions are in the tech forum.

Vyktors Mom...HI first of all. :) I also did something similar to your idea with the coloured water, put onto a shiny surface to see what a dose looks like. It's a great idea.

One thing that I just wanted to make mention of was the dosing with the pen injector system. Ok, laugh if you want as I felt a bit insane in doing this but, I had heard the same rumour about the pen dosing being off by being in the refrigerator and had been using it that way. So, I sat with a syringe and, the pen dialed to the dose and I literally, put one dose (from an old pen, not quite finished) of insulin from both the pen dialed dose alongside the same dose drawn from a syringe and looked at the sizes. Actually, the one drawn up by the syringe, tended to be the most variable in sizes. It didn't matter how many times I did it, 9 out of 10 times, the syringe was the most variable (pen was cold from the fridge and both were withdrawn from the same pen). I was STILL not convinced because I figured perhaps my eyes couldn't tell (in spite of about a dozen tries). I called the manufacturer of the pen. They said that "the dosing mechanism is not affected by being in the fridge. It works exactly the same cold from the fridge as it does from the warm counter or wherever. The only reason for not keeping it in the fridge is for comfort of cold insulin being injected and it's intended for human usage at much higher doses. They admit that they know it's being used on cats but refuse to give out any information regarding cat or dog usage as it's intended for humans and that's what their clinical trials and info are basted on. But, I asked twice about the dosing mechanism being damaged by refrigeration and both times, I was told it does not damage it, dosing is still accurate but, either way (fridge or not) the insulin becomes ineffective after 28 days. yada yada yada

Laugh, but still not convinced, I talked to my vet who said.."use the injector...easier on you to not make a mistake".

I had a previous diabetic cat where I used syringes. The doses with drawing up to the marks, bubbles, being impatience, time factors, etc., are really not accurate either. I've used both the syringe and the injector pen and I was used more to the syringes. I found the injector more difficult at first but, now...I'm feeling more at ease with it and I feel a little more confident using it. I think it's all coming down to 1) partial doses (can't do that with the pen as it's whole units only) and 2) personal preference and what everyone is comfortable with. Neither way is totally "accurate" 100%.

Anyways, that's my experiments, research and experiences. I think everyone has to choose which way feels best for them.
 
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So what will you do if you need .25 more or less?

Obviously then, you have no choice but to use syringes. If I have to go to a half dose...I'd have to switch back to the syringes. :) I can do both. I'm just preferring that since I am on a whole unit and not partial units, I use the pen injector. It's purely preference at whole unit doses.
But, may I ask (I really don't know)...are there .25U markings on syringes for U100 types? Or, is everyone eyeballing it?

And, btw...I just wanted to add that I *think* (from my understanding anyways) one can't go from using syringes in the pen to the "dial-up method injector system". I think air gets put into the pen with the syringes and therefore, less accurate doses then. Not sure though.
 
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You can only get syringes with 1/2 unit markings. For smaller doses many of us use digital calipers. I got mine from Harbor Freight.
 
Thank you, Chris & China...going to watch that video as I don't know about callipers at all. :)

And, thank you tiffmaxee :) (your message came in as I posted to Chris & China. :)
 
A few things in response to some of the comments:

- Please continue testing because as Serryn (who is very experienced) mentioned, a cat that has been that low, or had a symptomatic hypo, could be more sensitive to insulin after the episode.

- If you look on this "Where Can I Find?" post, which was prepped specifically for use on the Lantus/Lev Insulin Support Group, in the lower part of the first post you'll see 2 links to cats that were accidentally overdosed. You want to be careful for at least a few days AFTER the episode happens. An extra 20 units is huge - I would not relax until several days are past.

- Diabetic cats have the potential to have their pancreas heal and for it to begin sputtering back to life and putting out insulin. If that happens, the dose that was "just right" before can become too much now. Home testing will let you know what you need to do with the dose - but unless a cat is kept in constant relatively high numbers, they will need dose adjustments. I'd highly encourage you to always test before each shot, and if at all possible, to get one test in the middle of the cycle (anywhere from 3-8 or so hours) after each shot. You will soon see that a cat's blood sugar doesn't remain constant. A tightly regulated cat might be constant, but you are not at that phase yet. Not every cat will be able to heal their pancreas, but some can and some go off of insulin because of it. There is a see-sawing quality of adjusting the dose downward if the cat's pancreas does begin to put out some insulin. As the cat's own body increases its amount, the amount injected decreases 0.25u at a time.

- Lantus dosing is based upon how LOW the dose can take the cat. The low point is typically, but not always, somewhere inbetween the shots. So in order to know what to do with the dose, you really need the information from the mid-cycle. What's most helpful is to have a spreadsheet, then sprinkle the tests in here and there. You don't have to test every hour, but if you think of the spreadsheet like a jigsaw puzzle, having only a stripe down the middle tells you far less than if the puzzle pieces are sprinkled around throughout the puzzle.

- I would strongly encourage you to use syringes. You can draw up a sample syringe, as Serryn described, and mark the 2u with masking tape, then always compare to it if you want. You won't make this mistake again - it's the kind a person only makes once, LOL. What we know with cats is that they respond to very tiny changes in the dose - you can change a cat's blood sugar even by "fattening" or "skinnying" a dose, not even a 0.25u increment. That's why the ability to accurately adjust the dose by less than 1.0u is critical. The variations that Louellen is talking about are likely because the syringe markings are inconsistent. We've found that to be true, so many people either use a sample syringe to compare for dosing, or use calipers. With both of those techniques, you ignore the syringe markings. If you compare 10 of your syringes, the markings will no doubt not all be same - looking at the distance down from the hub. On that same post I linked above, if you look for "Dosing with Calipers" you'll find instructions on how to do that. We don't usually suggest that to new people because it's overwhelming enough just starting, much less worrying about syringe markings, but since the topic has come up, I wanted to give you the info.

There is a lot to learn but fortunately, you've hit the jackpot with diabetic cat websites. There are many people here who can help you learn what you need. I'd encourage you to begin posting on the Lantus/Levemir insulin support group where you will find all Lantus/Lev users who can help you learn these finer points of how to take care of your sweet Chicken. You will learn a ton by reading other people's posts there as well.

So glad she's doing ok now. Hang in there. The beginning is overwhelming, but as you learn more, it all gets infinitely easier.
 
A few things in response to some of the comments:

- Please continue testing because as Serryn (who is very experienced) mentioned, a cat that has been that low, or had a symptomatic hypo, could be more sensitive to insulin after the episode.

- If you look on this "Where Can I Find?" post, which was prepped specifically for use on the Lantus/Lev Insulin Support Group, in the lower part of the first post you'll see 2 links to cats that were accidentally overdosed. You want to be careful for at least a few days AFTER the episode happens. An extra 20 units is huge - I would not relax until several days are past.

- Diabetic cats have the potential to have their pancreas heal and for it to begin sputtering back to life and putting out insulin. If that happens, the dose that was "just right" before can become too much now. Home testing will let you know what you need to do with the dose - but unless a cat is kept in constant relatively high numbers, they will need dose adjustments. I'd highly encourage you to always test before each shot, and if at all possible, to get one test in the middle of the cycle (anywhere from 3-8 or so hours) after each shot. You will soon see that a cat's blood sugar doesn't remain constant. A tightly regulated cat might be constant, but you are not at that phase yet. Not every cat will be able to heal their pancreas, but some can and some go off of insulin because of it. There is a see-sawing quality of adjusting the dose downward if the cat's pancreas does begin to put out some insulin. As the cat's own body increases its amount, the amount injected decreases 0.25u at a time.

- Lantus dosing is based upon how LOW the dose can take the cat. The low point is typically, but not always, somewhere inbetween the shots. So in order to know what to do with the dose, you really need the information from the mid-cycle. What's most helpful is to have a spreadsheet, then sprinkle the tests in here and there. You don't have to test every hour, but if you think of the spreadsheet like a jigsaw puzzle, having only a stripe down the middle tells you far less than if the puzzle pieces are sprinkled around throughout the puzzle.

- I would strongly encourage you to use syringes. You can draw up a sample syringe, as Serryn described, and mark the 2u with masking tape, then always compare to it if you want. You won't make this mistake again - it's the kind a person only makes once, LOL. What we know with cats is that they respond to very tiny changes in the dose - you can change a cat's blood sugar even by "fattening" or "skinnying" a dose, not even a 0.25u increment. That's why the ability to accurately adjust the dose by less than 1.0u is critical. The variations that Louellen is talking about are likely because the syringe markings are inconsistent. We've found that to be true, so many people either use a sample syringe to compare for dosing, or use calipers. With both of those techniques, you ignore the syringe markings. If you compare 10 of your syringes, the markings will no doubt not all be same - looking at the distance down from the hub. On that same post I linked above, if you look for "Dosing with Calipers" you'll find instructions on how to do that. We don't usually suggest that to new people because it's overwhelming enough just starting, much less worrying about syringe markings, but since the topic has come up, I wanted to give you the info.

There is a lot to learn but fortunately, you've hit the jackpot with diabetic cat websites. There are many people here who can help you learn what you need. I'd encourage you to begin posting on the Lantus/Levemir insulin support group where you will find all Lantus/Lev users who can help you learn these finer points of how to take care of your sweet Chicken. You will learn a ton by reading other people's posts there as well.

So glad she's doing ok now. Hang in there. The beginning is overwhelming, but as you learn more, it all gets infinitely easier.
Thank you so much for all of that very useful information. I have looked around the Lantus/Lev forum and I will go back. I am going to have my husband work on the spteadsheet or maybe I will go and try it on his computer. I understand the calipers and will look into getting some.
Chickens sugars today have been pre-shot AM 300 so I gave her the 2 units then her pre-shot PM was 289. Those are both pretty high for her... Which I am thinking may still be some residual from all the glucose she had yesterday.
Her Vet called me this morning to check on her because the vet from the clinic associated with hers that is open late and where my husband took Chicken last night called her and told her we had brought her in so she called to check up on her which made me feel good.
She ate well today and seems to be feeling good so we will keep our fingers crossed. You are right I will NEVER make that mistake again.
Thank you and have a wonderful night!!
 
Thank you so much for all of that very useful information. I have looked around the Lantus/Lev forum and I will go back. I am going to have my husband work on the spteadsheet or maybe I will go and try it on his computer. I understand the calipers and will look into getting some.
Chickens sugars today have been pre-shot AM 300 so I gave her the 2 units then her pre-shot PM was 289. Those are both pretty high for her... Which I am thinking may still be some residual from all the glucose she had yesterday.
Her Vet called me this morning to check on her because the vet from the clinic associated with hers that is open late and where my husband took Chicken last night called her and told her we had brought her in so she called to check up on her which made me feel good.
She ate well today and seems to be feeling good so we will keep our fingers crossed. You are right I will NEVER make that mistake again.
Thank you and have a wonderful night!!


Thank you for the update on Chicken. The last day or so has probably played havoc on Chicken's system with the high dose insulin and the IV dextrose, so it will be a few days before you see where she is actually "at". I am glad to see that Chicken is so resilient and seems not to have had any lasting effects from her adventure. At least now you can start the treatment plan and see how well she responds to the Lantus and then take it from there.

Having a preadsheet would be most useful, not only for members to be able to offer advise, but also for you to track her progress with the colour coding. I did handmade notes from the beginning, but after a few months when I finally got my spreadsheet going, I found it to be so much simpler to view, plus the link can be sent to your vet and they can view the progress as well.

You and your hubby are off to a good start, especially with already home-testing. :bighug:
 
Thank you for the update on Chicken. The last day or so has probably played havoc on Chicken's system with the high dose insulin and the IV dextrose, so it will be a few days before you see where she is actually "at". I am glad to see that Chicken is so resilient and seems not to have had any lasting effects from her adventure. At least now you can start the treatment plan and see how well she responds to the Lantus and then take it from there.

Having a preadsheet would be most useful, not only for members to be able to offer advise, but also for you to track her progress with the colour coding. I did handmade notes from the beginning, but after a few months when I finally got my spreadsheet going, I found it to be so much simpler to view, plus the link can be sent to your vet and they can view the progress as well.

You and your hubby are off to a good start, especially with already home-testing. :bighug:
I do write down her numbers and times etc and made a spreadsheet and printed it out for the vet but I would really like to start using the one on this site. I will go try it now on the PC instead of my Mac and see if I can do it, lol. :cat:
 
I do write down her numbers and times etc and made a spreadsheet and printed it out for the vet but I would really like to start using the one on this site. I will go try it now on the PC instead of my Mac and see if I can do it, lol. :cat:


Good luck. I ended up needing some help with the fine tuning and posting set-up so if you do have problems just ask and those in the know can help you out! :)
 
Good luck. I ended up needing some help with the fine tuning and posting set-up so if you do have problems just ask and those in the know can help you out! :)
YAY I actually did it!! At least got it set up, now I just have to input the numbers :). I'm getting there slowly but surely, thanks for the encouragement and the offerings of help :bighug:
 
WOOT! you got the spreadsheet done and I see tests in there! It is an invaluable tool for us - especially with Lantus since we look at the past several days to see what the overall picture is, not just at one number. Great job!

Another little bit of info - cats are often lower at night, some giving all their lowest numbers in the pm cycle (between the evening shot and the morning shot.) The morning amps (am preshot) is often higher because of something called "Dawn Phenomenon." People will consistently encourage you to get some test in the pm cycle because of this reason - since Lantus dosing is based upon the low numbers, catching the low numbers becomes very important.

I'd guess the higher numbers you saw yesterday were in response to the overdose. An increase in dose can cause "New Dose Wonkiness" in many cats - where the blood sugar rises and stays higher for a while after a dose is increased. It's also very possible that the last 2 days of high numbers are from what we call a "bounce," caused from Chicken getting into such low numbers.

There is an explanation of those 2 phenomena in this post. These are important to learn to recognize because they are 2 occasions when high numbers do not mean that a cat needs more insulin. It can take a while for most people to be able to "see" them in their cat's ss, so most new members ask for someone with experience to take a look at the spreadsheet if they are thinking about increasing the dose - just to be sure the cat really needs more insulin and it's not just passing high numbers that will resolve on their own.
 
I'm so glad chicken is doing well! That picture you have of her is great! She looks like such a sweet kitty.
Thank you so much! Everybody gives me a hard time about dressing my kitties but I have done it since they were babies, just to take them to the vet and for Christmas cards, lol. Have to use doggie clothes though, perhaps I should invent some Kitty Wear : )
 
Thank you so much! Everybody gives me a hard time about dressing my kitties but I have done it since they were babies, just to take them to the vet and for Christmas cards, lol. Have to use doggie clothes though, perhaps I should invent some Kitty Wear : )
I never had a cat that would let me dress them. I did have one when I was a kid but he would just flop down on his side if I put anything on him :).
 
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