Shattered Lantus - need dosing advice for tonight

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Sarah Mc

Sarah Mc

Member Since 2017
http://www.felinediabetes.com/FDMB/...ransitioning-to-wet-food.171373/#post-1875438

I got home tonight to give Samba's PM Lantus dose, and I dropped the vial...it shattered. I am trying to find a Walmart pharmacy open past 9. No luck yet. Would I be able to give him Novolin N just tonight, possibly tomorrow morning? I think the pharmacy reopens at 7. He was previously taking Novolin before starting the Lantus, and I still have a lot left in good condition. Conveniently, his alphatrak just showed up in the mail tonight, but I was gonna save that for curves and get him a Relion. I have yet to check his BG at home. I can test tonight, but it would be my first time. He did just eat a can of FF because I was about to give the shot, but I could test a few hours after the shot tonight if that would be helpful. His diabetes isn't controlled yet...his BG on 1/14 at the vet was 426, and he is still urinating a ton. Can't believe I dropped a vial worth $288. I will be buying something to cushion the next one. Any advice is greatly appreciated. Thanks so much.
 
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Sarah Mc said:
I got home tonight to give Samba's PM Lantus dose, and I dropped the vial...it shattered. I am trying to find a Walmart pharmacy open past 9. No luck yet. Would I be able to give him Novolin N just tonight, possibly tomorrow morning? I think the pharmacy reopens at 7. He was previously taking Novolin before starting the Lantus, and I still have a lot left in good condition. Conveniently, his alphatrak just showed up in the mail tonight, but I was gonna save that for curves and get him a Relion. I have yet to check his BG at home. I can test tonight, but it would be my first time. He did just eat a can of FF because I was about to give the shot, but I could test a few hours after the shot tonight if that would be helpful. His diabetes isn't controlled yet...his BG on 1/14 at the vet was 426, and he is still urinating a ton. Can't believe I dropped a vial worth $288. I will be buying something to cushion the next one. Any advice is greatly appreciated. Thanks so much.
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What would be even better is if I could order the Lantus from the Canadian pharmacy or anywhere cheaper while using the Novolin and testing in the interim, but I don't want to risk his health..it isn't worth it if that is a bad idea. His diabetes has yet to be controlled with either insulin, but he just got diagnosed 12/31. Money very tight right now
 
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Sarah Mc said:
What would be even better is if I could order the Lantus from the Canadian pharmacy or anywhere cheaper while using the Novolin and testing in the interim, but I don't want to risk his health..it isn't worth it if that is a bad idea. His diabetes has yet to be controlled with either insulin, but he just got diagnosed 12/31. Money very tight right now
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Apparently Walmart pharmacy doesn't open until 9am which is my work start time, so I would need to give him Novolin tonight and again in the AM and pick up more Lantus after work tomorrow. Just hoping for confirmation that is okay to do...because I don't know where else to get Lantus right now...can't afford other pharmacy prices. thank you!!
 
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What dose of Novolin was he on? I see he was on it only a week so you really don't know a lot about how he reacts to it.
 
3 units twice daily for 3 days followed by 2 units twice daily for 4 days. Now he is on Lantus 2 units twice daily
 
This is really like starting over with such a short time on Novolin and no blood glucose testing going on. All the BG numbers you have are high and were done at your vet's. "Vet stress" can make their BG higher than it would be at home and if the vet decided on a dose based on those inflated numbers the dose is likely too high. Three units of Novolin is a high starting dose, as is 2 units of Lantus. Too high dose can have the paradoxical effect of making BG go high because of processes involving the liver that act to raise BG to overcompensate for the glucose lowering effect of too much insulin.

The recommended starting dose for insulins we use here is 1 unit twice a day. If it was my cat, I'd give 1 unit of Novolin twice a day and start testing BG right away. The testing routine we promote is AM and PM before feeding/injecting (no food at least 2 hours before these tests) to see if the planned dose is too high and at least one other test in the middle part of the cycle (the 12 hours between does) to see how low the BG is falling. Without testing you're shooting blind and the doses you've given are fairly high.
 
Okay. I will give him one unit of Novolin tonight. Since he ate around 8:50pm, I will attempt to test his BG now for the first time and post my result. How many hours after the shot tonight should I test again? I will set my alarm. Thank you so much. I really appreciate this.
 
Sarah Mc said:
Okay. I will give him one unit of Novolin tonight. Since he ate around 8:50pm, I will attempt to test his BG now for the first time and post my result. How many hours after the shot tonight should I test again? I will set my alarm. Thank you so much. I really appreciate this.
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Good luck with the testing!
He should have food in him before you give Novolin because it can sometimes act quickly. Here's a suggested schedule:
  1. Now - test and post result
  2. Feed a small meal and wait 20-30 minutes for food to get into bloodstream
  3. Inject 1 u of Novolin
  4. Retest around 3 or 4 hours after injection.
I recommend that you set up a spreadsheet like the one we use here. It's viewable by all members and that's the way we can see what's going on before offering advice.
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
 
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Kris & Teasel said:
Good luck with the testing!
He should have food in him before you give Novolin because it can sometimes act quickly. Here's a suggested schedule:
  1. Now - test and post result
  2. Feed a small meal and wait 20-30 minutes for food to get into bloodstream
  3. Inject 1 u of Novolin
  4. Retest around 3 or 4 hours after injection.
I recommend that you set up a spreadsheet like the one we use here. It's viewable by all members and that's the way we can see what's going on before offering advice.
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
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That was a battle, but we will get better. 509 on the alphatrak. I will feed him now. Continue with one unit of Novolin?
 
Sarah Mc said:
That was a battle, but we will get better. 509 on the alphatrak. I will feed him now. Continue with one unit of Novolin?
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Hurray for getting that first test done! That's a high number but I'd still give only 1 unit of Novolin because you don't have any info about how he reacts to it. Did your vet do a BG curve since his diagnosis?

Notice in the list I made I said to feed a small meal and wait 20-30 minutes. He needs food on board before you give a potentially fast-acting insulin like Novolin.
 
I see that you're transitioning Samba off the dry food. Thank heavens you're testing now because his BG could drop a lot just from the move to wet food only. All the more reason to reduce the insulin dose!
 
Kris & Teasel said:
Hurray for getting that first test done! That's a high number but I'd still give only 1 unit of Novolin because you don't have any info about how he reacts to it. Did your vet do a BG curve since his diagnosis?

Notice in the list I made I said to feed a small meal and wait 20-30 minutes. He needs food on board before you give a potentially fast-acting insulin like Novolin.
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No, I'm supposed to return to the vet on 1/28 and then do a curve from home. The vet was going to show me how to home test on the 28th. Will it be harder to test with the Relion or about the same? I was thinking of picking one up tomorrow after work when I get more Lantus. He is eating now.
 
Kris & Teasel said:
I see that you're transitioning Samba off the dry food. Thank heavens you're testing now because his BG could drop a lot just from the move to wet food only. All the more reason to reduce the insulin dose!
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It's been slow over the last week, but yes, yesterday & the day before he only had 1/8 cup of dry food, and today, only about 15 pieces. I was gonna stop dry food completely after today.
 
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Sarah Mc said:
Will it be harder to test with the Relion or about the same?
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The Relion is a very easy meter to use but you still have to get that precious blood drop!! But a lot of people don't realize how little they really need to get....when using the Confirm or Micro, you only need to get a blood sample of 0.3

Here's what that looks like:
blood drop size.PNG
 
Sarah Mc said:
It's been slow over the last week, but yes, yesterday & the day before he only had 1/8 cup of dry food, and today, only about 20 pieces. I was gonna stop dry food completely after today.
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I will give the Novolin in 20 minutes and test again at 3am. I will make a spreadsheet now. I will have to do all of this again prior to 8am when I leave for work even though it won't be 12 hours later... Is that okay?
 
I assume the vet wants to see how Samba is doing on a dose of 2 u twice a day of Lantus, right? Does the vet know you're transitioning off dry food? I strongly suggest that you post over on the Lantus forum and ask about the 2 u dose in light of the switch to wet low carb food, testing begun only recently, your vet's plan to wait to do home testing, etc.
Sarah Mc said:
I will give the Novolin in 20 minutes and test again at 3am. I will make a spreadsheet now. I will have to do all of this again prior to 8am when I leave for work even though it won't be 12 hours later... Is that okay?
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Do you normally dose this late in the evening or was the delay because of the accident with the Lantus? Your AM dose will be too close to this one and it's hard to know what to do. The safest thing would be to skip it tomorrow AM. Don't bother with the 3 AM test because he'll be OK on this much lower dose I think. Tomorrow you'll be getting more Lantus, correct? You really need the expertise of the people on the Lantus forum to guide you in dosing. Tell them your insulin use history, the dose of Lantus you're giving, and so on. You can post there right now so you have an idea of what to do tomorrow night.
 
Hmm. Regarding new insulin.

You might have read that we usually recommend ordering the Lantus pens rather than the vial. I am wondering if you might want to call Mark's Marine Pharmacy tomorrow to see how long it would take pens to get to you, and to be sure that the weather between them and you is warm enough to even ship it now (they won't ship if it could spend any significant amount of time where it is below freezing).

Because the pens will last longer and be less expensive than a new vial. Since you have Novolin you can use in the meantime and you are newly diagnosed, I think that personally I would just go that route (assuming that they CAN get it to you).

What do you guys think? It's a tough one, but that is the way I think I am leaning.

Sandi.
 
Kris & Teasel said:
I assume the vet wants to see how Samba is doing on a dose of 2 u twice a day of Lantus, right? Does the vet know you're transitioning off dry food? I strongly suggest that you post over on the Lantus forum and ask about the 2 u dose in light of the switch to wet low carb food, testing begun only recently, your vet's plan to wait to do home testing, etc.

Do you normally dose this late in the evening or was the delay because of the accident with the Lantus? Your AM dose will be too close to this one and it's hard to know what to do. The safest thing would be to skip it tomorrow AM. Don't bother with the 3 AM test because he'll be OK on this much lower dose I think. Tomorrow you'll be getting more Lantus, correct? You really need the expertise of the people on the Lantus forum to guide you in dosing. Tell them your insulin use history, the dose of Lantus you're giving, and so on. You can post there right now so you have an idea of what to do tomorrow night.
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Okay, I will post there. It was only this late because of the accident. I normally give at 8am & 8pm. I will get more Lantus after work tomorrow, yes, and then come home to test, feed, give. Thank you for all of your help tonight.

The vet recommended that I switch to wet food and dose at 2 units twice daily after a reading of 426 in her office on 1/14. Prior to that he was still on the same dose but eating Royal Canin Glycobalance.
 
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