Seeking Review - Artemis Vetsulin/BG Update!

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Artemis has been doing quite well with his blood glucose numbers recently. It seems like he's telling me that even 3 units is too high.

Had some hectic life stuff last week and a half so I haven't been able to follow-up for input along the way.

On our end, we're having an issue with timing and repeatable duration of vetsulin. Hope to switch to generic insulin glargine soon as I understand that is a more evenly distributed control. I found a goodrx coupon at Target CVS for $90 a vial.

Can the community provide feedback on the numbers? I've been given token shots when he's lower and just starting to go up.
 
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Can you remove the GA from your subject like please. It means guardian angel or gone ahead and means the cat has died.

Twinkleboots said:
Can the community provide feedback on the numbers? I've been given token shots when he's lower and just starting to go up.
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Hi @Twinkleboots
It is not a good idea to jump all over the place with doses as you have been doing, especially from 1 unit to 2.5 back to 1 unit then 2.25 Units...and even 3 units
You need to find a dose that you can consistently give for both cycles.. having to skip doses because the preshot it too low, means the dose is too high..
And anytime the BG drops under 90, you should be reducing the dose.
I would also strongly recommend getting at least 1 test in every pm cycle as well as cats often drop lower at night.

If you want to switch to lantus insulin I would recommend you stay with the vetsulin for another week and give 1 unit consistently (unless the BG drops under 90 in which case you would reduce the dose to 0.75 Unit), so we can see what that dose is doing to the BG. It is not safe to just randomly swap to another insulin unless you have a reliable dose from the previous insulin.
And with lantus it is not recommended to jump about with the dose as it is a depot insulin.

With the vetsulin, are you feeding the main meals 30 minutes before giving the insulin?
Are you giving snacks during all the cycles?
Looking forward to hearing back from you:)
 
Bron and Sheba (GA) said:
It is not a good idea to jump all over the place with doses as you have been doing, especially from 1 unit to 2.5 back to 1 unit then 2.25 Units...and even 3 units
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Dose isn't jumping back and forth, I just gave the 1 unit token doses. The rest are decreases from the rules. I had a typo on one for 1.5. These token doses seem to have kept him from bouncing really high as much, no?

............ How about the actual BG numbers?

Bron and Sheba (GA) said:
getting at least 1 test in every pm cycle as well as cats often drop lower at night.
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At this point I do understand cats drop lower at night....... I also sleep at night. Sometimes fairly quickly after I've completed my tasks and have to collapse. It's just not always realistic to get these pm BGs unfortunately....... So I'm doing the best I possibly can. Maybe not good enough for perfection, but I'm not sure I can attain perfection....... Especially when I'm sitting around waiting to retest after being too low to shoot...... Are you suggesting I just skip the dose altogether instead of retesting and waiting?

Bron and Sheba (GA) said:
And with lantus it is not recommended to jump about with the dose as it is a depot insulin.
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Not jumping around the dose...

..... as mentioned above, giving a token dose mentioned in guide.

Bron and Sheba (GA) said:
With the vetsulin, are you feeding the main meals 30 minutes before giving the insulin?
Are you giving snacks during all the cycles?
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Yes always feeding the big meals before insulin, and yes plenty of snacks. Artemis eats a lot.

Bron and Sheba (GA) said:
If you want to switch to lantus insulin I would recommend you stay with the vetsulin for another week and give 1 unit consistently (unless the BG drops under 90 in which case you would reduce the dose to 0.75 Unit), so we can see what that dose is doing to the BG. It is not safe to just randomly swap to another insulin unless you have a reliable dose from the previous insulin.
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I'm not randomly swapping................. I'm planning for when the other half of this vial runs out.

Why would I go all the way down to 1......... when he's only "earned" a reduction to 2? Who's rules am I following here?
 
Twinkleboots said:
Dose isn't jumping back and forth, I just gave the 1 unit token doses. The rest are decreases from the rules.
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These are the last 6 days doses
Am. Pm
1 unit 3 unit
0 unit. 3 unit
1 unit. 0 unit
2.5 unit. 0 unit
1 unit. 2.5 unit
2.5 unit. 2 unit
I would call this jumping around with the dose. If you are following a dosing method, this should not happen.
Are you following the SLGS dosing method?

Twinkleboots said:
Why would I go all the way down to 1......... when he's only "earned" a reduction to 2?
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I suggested 1 unit as there is no evidence that 2 units is a good dose. Yes he did drop down to 81 today on 2.25 but as the dosing has been all over the place, I would rather recommend 1 unit to be safe until we see how he goes on a consistent dose. There is no testing in the pm cycle so we have no idea what is happening at night, except for 4 tests on 2 days from +8 to +11 which indicate that your cat dropped lower overnight.

Twinkleboots said:
Especially when I'm sitting around waiting to retest after being too low to shoot...... Are you suggesting I just skip the dose altogether instead of retesting and waiting?
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Of course you can stall, dont feed and retest in 20 minutes. But if you are having to give token doses because the preshots are too low, it is better to lower the dose so you can give a consistent dose moving forward.
I understand it can be hard to test at night. What time do you give the pm dose? Are you able to get a before bed test in each night.
I will tag @Suzanne & Darcy
 
I think what Bron is getting at is if you're having to skip doses because your pre-shot number is lower than expected, you may want to consider reducing the dose. By reducing the dose, it should allow you to give a shot twice a day rather than skip. The goal is to be able have a dose that allows you to give insulin twice a day.
 
If you do switch to Lantus
Lantus is the major brand name glargine the USA you can get generic/biosimilar glargine at very reasonable prices using GoodRx coupon. Most members use the generic because Lantus is to expensive.
https://www.goodrx.com/lantus?label...d-pens-of-100-units-ml&quantity=1&slug=lantus
Make sure that the Match your prescription pull down menue says generic glargine 1carton of 5 3ml pens.
There is no wait time test, feed, give insulin
Lantus usually doesn't kick in until 2 hours after the shot
Let us know if the vet writes the script for you because you will need U-100 syringes with half unit markings , I can tell you which ones you can use
We buy the pens but use the syringes to draw out the insulin because if you use the pen you can only adjust by full units


Also
The 5 pens will last about a year, we use the pens just like a vial, you would just insert the syringe it the gray rubber stopper on the pen and draw out your insulin
Its generic lantus



Or this one also

I see some members will call CVS, Rite Aid, Costco, Walgreen's, to get the price for 5 pens
Posted by another member
One members posted this
. I paid $175 for a box of 5 pens at Walmart pharmacy, but GoodRX coupon says you can get it for around $90 if you have a Rite Aid pharmacy near you.

Just call around for the best price

A member just posted this
Allie was using the Lantus and I just switched to the generic and using the GoodRX I got 5 pens for $81.30 at Walgreens. GoodRX has a 1-800 number to assist you in using their services to get your pets prescriptions filled if the pharmacy gives you any issues.

I think I found it for you
GoodRx / Customer service

1 (855) 268-2822
49823063143_3437e9e997_o.jpg


You can read all about Lantus here, all the yellow stickys
https://felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/
Just take the cap off the pen and use a U100 syringes and pull the insulin out of the pen! You will see a small gray rubber stopper, insert the syringe there
syringe-in-pen-pic-jpg.45006
 
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Hello. I see that you have been doing a good job of testing in the a.m. cycle and have been getting some tests done in the latter part of the p.m. cycle. I see how you have been having to make a lot of dose adjustments in order to keep him from dropping too low (when you've been having the lower pre-shot numbers). I think (as Sienne suggested) that you should consider lowering the "base dose" so that you can shoot more consistently and hopefully have less skipped doses. You do have good instincts about when you need to reduce the dose though, that is very good. I see that you are interested in switching to Lantus or generic glargine insulin. That would be a different ball game. The doses for depot insulins like Lantus are given much more consistently (same dose) with less consideration given to preshot numbers -- because of the way the insulin depot works. Your not there yet, but I just mention this (as others before have, I believe -- although I haven't read through this entire thread.)

As for the night time tests.... what hour do you shoot at night and what time (how long) after that do you go to bed? You don't shoot and then go immediately to bed do you? A test that is very important to get in the evening cycle is what we sometimes call the "before bed" test. This could be around +2 or +3. This test can be a very good indicator of whether or not it looks like your cat needs monitoring in the evening cycle -- so that you can set an alarm to wake up and do a spot check later in the cycle. Are you feeding snacks in the evening cycle, either by leaving food out or by using a timed feeder?
 
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