Re: 11/14 Beau - amps/479 - still dropping - shoot anyway?

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alicia.1771

alicia.1771

Member Since 2011
Yesterday 11/13/11 http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=56405

Last night:
PMPS - 349
+2 - 202 :shock: that's a 42% drop in 2 hours!
+3 - 184 = 47% drop from PS
+5 - 292 - zooming up already

Today:
AMPS - 479 - I was hoping he won't be so bouncy on Lantus :sad:
+5.5 - 354 = 26% drop from PS
+11 - 322 = 33% drop from PS

Question on dosing:
-- I thought it takes a few days for the shed to fill, I was quite surprised by the big drop at +2 last night, does this mean his shed was full already and I'm dosing too high? Last night was only our 3rd Lantus dose.
-- due to syringe air bubble issue and residual insulin left on tip of needle and inside syringe after injection I encountered with Ulticare syringes, I estimate I drew yesterday's doses closer to 1.25 to make up for the space difference. This morning I shot a fat 1.0 because I switched back to Relion syringe and wasn't sure how it will handle the Lantus solution. He seems to be riding a bounce today. Any advise on tonight's dosing appreciated as I'm very new to Lantus. Thanks!
 
Re: 11/14 Beau - amps/479 +5.5/354 - need help on dosing

The shed isn't full. The depot or "shed" is inherent in the pharmacology of whatever the drug is. It takes roughly 5 - 7 days for a sufficient amount of microprecipitates to form. It's just the way the insulin works. It's not going to happen in the space of a day or less. It's not that unusual to see a response when there's a change from another insulin. It may be a matter of the overlap between the two kinds of insulin or a cat's body adjusting.

With regard to dose, what is key is that you remember that Lantus likes consistency. Keep your dose as consistent as you can.
 
Re: 11/14 Beau - amps/479 +5.5/354 - need help on dosing

hello again,

I'm going to join the "consistency" chorus. If you dose hop with Lantus, you are likely to get wonky numbers. Consistent dosing, both in amount and timing is key to success.
Be patient and follow the TR protocol. I'll bet in a couple weeks you'll see a big difference in Beau. :-D
Remember,Lantus dosing decisions are based on nadir values, with only some consideration given to PS numbers.

There are folks who have bubble eliminating techniques and would be happy to share them with you, you may want to ask over on Health.
 
Re: 11/14 Beau - amps/479 +5.5/354 - need help on dosing

Hey Alicia:

Jumping on the consistency bandwagon and patience.....

Check out Weezer's and Champ's SS for a good lesson in patience.....their beans are just following the protocol to get to the fitting dose. Hang in there...keep asking questions!
 
Re: 11/14 Beau - amps/479 +5.5/354 - need help on dosing

stopping by to say hello!

and Ella ,Rusty & Stu (GA) has a great syringe technique...you might send her a pm...

Celi
 
Re: 11/14 Beau - amps/479 +5.5/354 - need help on dosing

Hi Alicia & Beau and welcome (a little belatedly) to Lantus Land (Rusty had a busy weekend, so I didn't get to many condos).

I agree with what everyone has said: you need to hold the dose and be patient. Lantus is a great insulin, but it doesn't like to be pushed around!!

Now, with regard to the bubbles. The Monoject 31- gauge syringes (available at American Diabetes Wholesale) are the best ones I have tried for eliminating bubbles. They have a nice, flat plunger and good lines, easy to line up:
http://www.americandiabeteswholesal...t-ultra-comfort-insulin-syringes_2552_178.htm

Here's my procedure for getting the air bubbles out of syringes. Hope it helps. Celi said you needed this!

1. work the plunger back and forth a few times to loosen it up.
2. push the plunger all the way in FORCEFULLY and hold it there.
3. still holding the plunger all the way in, invert the insulin cartridge (pen; vial) and insert the needle, ease up on the plunger, and SLOWLY draw out more insulin than you need.
4. with the tip of the needle over a paper towel, slowly TWIST the end of the plunger until you reach your correct dose. (Twisting is easier and more accurate than pushing).
5. give the shot.

The key here is step #2, forcefully holding the plunger all the way in. This expels any air that might be hiding in the syringe and doesn't allow any additional air to get into the syringe.

I hope this will help.
I saw in your yesterday's condo that you were also having trouble getting Beau's avatar the right size. There is a website that does this for you with excellent results: http://www.shrinkpictures.com/create-avatar/
The size you need is 90.

Welcome again. Lantus is a good insulin and you'll be glad you switched.

Ella & Rusty
 
Re: 11/14 Beau - amps/479 +5.5/354 - need help on dosing

Hi Alicia, welcome to LL!

We started on ProZinc, used it for 3 months. Lantus does produce much flatter curves, but you need to have patience and give it a chance to work. Many cats don't flatten out for a while. Feel free to look at our SS....the insulin switch is on the page with last year's data.

We used Relion 31 gauge syringes. They were the best for bubbles that I have used. My suggestions for bubbles....First, move the plunger back and forth several times to spread out the lubricant, the plunger will move more smoothly. Then push the plunger all the way in, and keep pressure on it while you insert the needle into the pen. Draw the insulin, be sure to draw about a unit more than your dose, allowing time for the insulin to move into the syringe....it moves slowly with high gauge needles. Remove the needle, if you pushed the plunger in with enough pressure, and allowed time for the syringe to fill, there should be almost no air in the syringe. Draw some air in to allow the bubbles to collect at the top, then push as much air out as you can, until the insulin starts to come out of the needle. THEN flick if there are still bubbles clinging to the sides or plunger of the syringe...if you flick when there is air in the syringe, it just makes the bubbles worse! Draw more air in again to allow the bubbles to collect at the top, then push the air out. Twist the plunger to dial in to your dose.
 
Hi everyone -- thanks for all the response. I gather that "consistency" is what I should aim for so I will go ahead and hold the dose.

Ella -- thanks for sharing the trick in overcoming the air bubble and for the avatar link. I will try it out later to see if I can upload a better pic of Beau. I switched back to Relion 31Ga syringe this morning and it definitely has helped with the air bubble issue. I am still going to buy some Monoject syringes though just in case.

Laurie -- thank you also for sharing your experience, especially the part about expelling air BEFORE flicking the syringe. I did it the other way which made matters even worse...hahaha...

Anyway, just did a +11 check on him and he's at 322, which is LOWER than his +5.5 of 354. He seems to be dropping still (late nadir?). Do I shoot anyway if PMPS is still dropping? I know in Prozinc we wait until a rising number before shooting. Please advise asap as shot time is coming up in 30min. Thanks!
 
PMPS - 342, rising# so went ahead and shot.

As a general guideline for Lantus protocol, do we also not shoot if the PS is still dropping? What if the number is just comparable to nadir? If I hadn't gotten a +11 tonight and only PMPS, it is almost the same as the +5.5, should I went ahead and shoot?
 
Alicia: if you account for the 20% variance that meters can have, then he wasn't really dropping between 354 and 322. It just seems like it ;-) ;-) :-D He's actually just flat.

It's important to recognize the difference between a dropping number and the second dip that lantus often provides. A dropping number is one in which the kitty started much higher earlier in the day and just drops all day long with no discernible nadir but is at the lowest number at the next PS and that number exceeds the meter variance. This is the kind of thing you need to be very careful about shooting and usually occurs when the kitty is clearing a bounce.

However, lantus gives a second dip in many kitties and in order to catch it and make sure it's a dip and not a dropping number, you'd have to be doing other tests between +5.5 and +11 to see if he went up and then came back down. A second dip will result in a number that is not lower than the nadir. It is fine to shoot a second dip although even with a second dip below 150, we encourage newbies, who have not yet shot that low, to not feed, post first, and let us walk you through the options.

IMHO, if a PS is as high as Beau's tonight but is truly dropping, I would still shoot it and get the insulin in the kitty and then be sure and monitor closely to make sure he starts to come back up before he onsets. Where you can really get into trouble is shooting a low dropping number especially if you do not have the data, do not know what your cat will do, do not have adequate supplies on hand, or cannot test.

Please let me know if I've confused you or if you have any other questions.
 
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