Relapse...reckon we are back :-(

Status
Not open for further replies.
ebuckley

ebuckley

Member Since 2014
Posting for the record; and in case it helps others and in case anyone has insights to share.

It's been a bit over a year since Napa went OTJ.

But the last ~3 weeks there's been nagging signs of large litter clumps. Then straining in the litter box yesterday and drops of blood-tinged urine near her bed that turned nagging to action--we found the rice sock, dusted off the meter, and tested 297 on a just-expired Relion strip (expired 4/2015).

Back to the vet right away (holiday weekend ugh!). Definitely looks like she has bladder cystitis on ultrasound and glucose in her urine. Maybe the cystitis is causing the relapse, or it maybe its due to the relapse. We discussed our road to OTJ last year (and this message board!), got an antibiotic (just for fun...no signs of infection), and pain meds.

This morning she tested 156. Vet called in the afternoon with blood test results from yesterday--glucose in the 300s; Fructosomine was ~520 (can't remember the exact numbers). There's a stalwart >90% full vial of clear Lantus in the fridge that says it expires 6/15 (really?). After discussing this with the vet, she agreed to giving the old Lantus a try at 0.5 if over 300.

This evening I gave her 0.5 Lantus after she tested 352. Could have been a fur shot (I'm so rusty!), could be the old Lantus won't be very effective anymore, but I'm watching her, have printed out (again) the hypo help tips, and plan to test her again in a few hours. All the Ps are good other than increased urine input.

Will update our course in case anyone can learn from our experiences as much we have been comforted/learned from all the info that others have posted here.
 
It takes 5-7 days for the depot to "fill" with Lantus, so you're not going to see immediate results.

Hope your visit back here is short and she's back to OTJ soon!
 
You say that the Lantus vial is 90% full. How long has it been since it was first used as that may affect its viability, regardless of the expiry date on the label. If there is no budge in the numbers I'd suggest discussing the viability of the Lantus with your vet.

I also hope that Napa will soon be back in better numbers and then OTJ again very soon.
 
Thank you both. The depot--I had forgotten about that detail--thanks for mentioning. That's not going to make evaluating the old Lantus any easier--ugh. And her numbers today are yikes! high today.

Made the special trip to Walmart for new ReliOn Confirm strips today. They look slightly different--did they change the shape in the past year or so? If I don't open them I might be able to exchange them. I didn't see any closer options and the pharmacist wasn't much help.
 
Thanks so much for confirming the strips! Bleh, her poor ears "forgot" how bleed, tho past experience gives me confidence that testing will get easier again. Fortunately, her P's are looking pretty good so I think she's feeling better. Numbers are high (400s preshot), but staying patient--low and slow--a few more days before going to 1u or so. If they stay high I'll get new Lantus and sorta start all over. Really would prefer to get new Lantus now and eliminate that variable so will call the vet pharm tomorrow to check their cost. But vet bills are killing us the last 2 years (recently fronted one of the "neighborhood" cat's icu stay for crf +/- recurrent cryptococcous). I know many of you know that pain.
 
If you get a new script, get the Lantus Solostar Pens....each pen is like a little vial and hold 3ml each (300 units) instead of buying a whole vial of 10ml (1000 units) and having most of it get thrown away when it goes bad. The pens come in boxes of 5 pens, so total is 1500 units and that's enough to last most cats well over a year

You just pull the cap off and there's a little rubber stopper just like a vial

The pens are a little more expensive up front, but a LOT cheaper in the long run!

If you look at the last post in this "Insulin from Canadian Pharmacies" thread, you'll see my post about Marks Marine Pharmacy....there have been a LOT of us using them and not only are their prices 1/3 the cost here in the states, they really are great at customer service

Their pens are $144.99 versus over $460 here in the states
 
Ugh Hi last night, 572 this am. Someone vomited. Unsuccessful attempt to get urine to test for ketones.
On top of that her Civie sister had a seizure. Off to the vet to get a 1 month supply of Lantus. Debating giving 1 unit. I can be home to monitor through +6.
 
Last edited:
1 month supply of Lantus?? Lantus isn't supposed to be repackaged and re-sold...it's only supposed to be sold either in the 10ml vial or the pens (sometimes you can find a pharmacy that will sell an individual pen but they're usually pretty hard to find)

I'm concerned that your old insulin may have lost it's punch more than anything. You could go up to .75 now (we only go up in .25 unit increments so we don't go by what could be a "best dose" but when you get fresh insulin, we may suggest you go back down.

It's also important to start getting some testing done on the PM cycle...even just a quick test before you go to bed is really valuable since most cats go lower at night
 
I was surprised that they would dispense any volume. It is a very large and reputable clinic so I assume its ok. $35 buys me immediate peace of mind and time to order from the Canadian place. Will get some night numbers as soon as I can.
 
Hmmmmmm, I have also read that you should never buy repackaged lantus...

In relation to dose - how much does Napa weigh, and if not at ideal weight, what is his ideal weight? That will determine what the starting dose should be - starting dose is generally .25 per kg of weight, or of ideal weight if kitty is carrying a bit extra.
 
You might want to reread this sticky on your Lantus. Repackaged Lantus is a really bad idea.

With a cat coming out of remission, people typically have to be really on top of things (ie, aggressive but being safe with dosing) if there is any chance of the cat going into remission again. So sorry you're going through this.
 
Thanks Julie. I did go back and reread with your suggestion...guess it was too good to be true to get a reasonable volume of Lantus (and too much to ask for smaller syringes with half-unit marks).

In any case, I did order pens from Mark's Marine a few days ago per Chris's kind recommendation. I got the repackaged vet vial just to have something I could be more confident in than our 1.5 year old 10ml vial while we waited for new pens to arrive. My local CVS would not sell me one pen, unfortunately. Napa's bladder inflammation is *really* bothering her when the pain med wears off (Buprenorphine). Today she was passing ??small pieces of red inflamed bladder tissue?? in her urine...very disconcerting!

Her glucose numbers are so dang high but I am trying to stay patient with .25 u /week increases. Dubious insulin efficacy just really complicates things. I am feeling extra pressure to get her in a safe routine due to an upcoming 10 day overseas trip. I am considering being more aggressive. Right now I can be home most days to monitor nadir windows and testing is getting easier every day. She's about a pound underweight right now at ~8 pounds and just pushed to .75 u (or there abouts...just below the 1 u line). The Ps with the pain meds: playing, preening and pooping are good...extra urine and thirst, decreased food intake but eating/interested in food for several small meals throughout the day.

She's getting low on the pain med so I think I'll take her back for a follow up appt. Not really sure what they can do, but will get more pain meds, maybe a saline bag, and discuss medical boarding to cover while I am away.
 
Last edited:
If you live in the US, you can get syringes with half unit markings from WalMart

Please try to get those PM tests in...I doubt if she's going TOO low, but it's always a possibility....we've seen cats go from 400 to 40 and back to 400 in the same 12 hour cycle before...at least grab a test right before you go to bed at night and it'll help to figure out the puzzle name Napa
 
We're still chugging along...any thoughts from experienced eyes would be so appreciated.

The follow up vet visit 10 days ago turned up UT infection (not detected earlier). New antibiotics. Vet recommended going to 1u. Waited for the antibiotic to kick in and for new Lantus pens to arrive from Marks (ty Chris!) then did a curve and .25 dose increase up to 1u. Did a mini curve today due to the lower AMPS. Urinary tract symptoms got better (other than lots of urine some but not all days) and other Ps have been good until today.

Today she's been cranky, very, very hungry, eating more than usual, and there were a few suspicious, small puddles that had no smell in the general vicinity of the cats beds. Going to try to get an early am test in case she is dropping late in the pm cycle.
 
Sorry to hear about this relapse. I fear the same thing. Hope you can get puss back on track, with insulin and may eventually without.
 
Status
Not open for further replies.
Back
Top