Tracking Tuckers' BG w/o Humulin injections. Advice?

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Chris & Tucker

Chris & Tucker

Member Since 2012
Hello everyone.
As many of you suggested, I've discontinued Tuckers Humulin injections since last Wed. afternoon, to see where his BG levels are, after an 8 day stay at the vets and 6U injections. "Letting his body rest".
Tucker is eating well, strictly on LC canned food now. He weighs 10 lbs and is 14yrs old. Very alert.
I've tried to keep track of his daily levels on the SS.
Any preliminary suggestions from the experts?
Should I give it a few more days to see where his BG levels go, before considering starting him on Lantus?
 
ChrisJ & Tucker said:
Hello everyone.
As many of you suggested, I've discontinued Tuckers Humulin injections since last Wed. afternoon, to see where his BG levels are, after an 8 day stay at the vets and 6U injections. "Letting his body rest".
Tucker is eating well, strictly on LC canned food now. He weighs 10 lbs and is 14yrs old. Very alert.
I've tried to keep track of his daily levels on the SS.
Any preliminary suggestions from the experts?
Should I give it a few more days to see where his BG levels go, before considering starting him on Lantus?
Click to expand...

I would think by now that you have a good idea that he is in need of some insulin as you have stopped all insulin and been feeding LC wet food.

If you have the Lantus rx and your supplies, the U100 syringes with the 1/2 unit markings, KETOSTIX (I hope it's already been mentioned that you need to be testing Tucker's urine for ketones), it would be about time to start with giving him shots.

Humulin is a lousy and harsh insulin, and does not last anywhere near 12hrs, so Tucker would have been on a roller coaster of high numbers and then low numbers. You can follow the protocol for Lantus and Levemir in the tight regulation forum - most people start at 1u but others do start a bit lower with .5u.
I think by now that you are seeing numbers in the 300s, so you would likely be OK to go with the 1u dose.
 
I think I will need to go get another prescription for the Lantus pens. My vet unwillingly wrote me the prescription after I hounded him, and all he has on it is : "Lantus insulin 1 unit no refills" . I guess I should have read it!
Can you tell me what the prescription should say, so I can give it to the vet to write?
 
ChrisJ & Tucker said:
I think I will need to go get another prescription for the Lantus pens. My vet unwillingly wrote me the prescription after I hounded him, and all he has on it is : "Lantus insulin 1 unit no refills" . I guess I should have read it!
Can you tell me what the prescription should say, so I can give it to the vet to write?
Click to expand...

No refill on an insulin? Does your vet think being diabetic is like having an infection and one round of antibiotics will clear it up?

What about if you print out some documentation on the protocol and take it with you to the vet office?
What does the no refills mean? You can purchase one box of 5 pens and that's it?
 
Today, Tuckers 8AM BG was 179. (not on insulin yet)
I stopped at the nearby CVS to see what exactly I needed on the prescription. All my vet needs to write is "Lantus SoloStar" . Will go see vet during lunch and give him a copy of AAHA Diabetic Guidelines.
Shocked at the price of $285. ! Will start calling different places for prices.
 
I would give it just a day or two more before filling his script. Rebound hyperglycemia can last up to 72 hours, and that 179 this morning could mean that he's on his way back down on his own. If he's hovering mostly above 200 the next 24-48 hrs, I would would then start insulin.

Call and ask for the the price at Walmart and Costco. I know last time I had my script for the pens filled at Walmart it was $244, which came to $219 with the $25 dollar off coupon. http://felinediabetes.com/FDMB/viewtopic.php?f=15&t=36964. Have the vet write the script specifically for "Lantus Solostar Pens." Another option is to get the script filled at the pharmacy for now for the 10ml vial, which will be about $140-$170, and then get the solostar pen script from your vet and order the pens from Canada, where it's way cheaper than the US: https://docs.google.com/document/pub?id=1FCnrPxpYD02Gp5hWtEIbhLXm0VOyaZlAT_qeCjlx-Js&pli=1. You can hang on to the pen script and wait to see how Tucker's responding to insulin for a month or more before you fill it, just in case he's a lucky cat and the vial is sufficient to get him into remission within a few months. It's up to you, and what best works with your current money situation.

Make sure the vet gives you some refills on that script (my vet writes 2 refills for the pen)! You should not have to pay for a vet visit every time you need an insulin refill. Especially since you can give the (hopefully new) vet access to Tucker's BG via the spreadsheet. When Bandit was on insulin, he only went into the vet twice a year for his routine semi-annual exams, just like he does now. Every other Tuesday I had a 15 minute phone appointment with his vet where she would look at his spreadsheet, give me her input on his numbers and the dosing adjustments I had made in those two weeks based on Tight Regulation guidelines, and ask if there was anything else about his or Gabby's health that I had questions about. These were considered part of his follow up care and I was not charged for these phone consultations.
 
I forgot to mention that you definitely want to be testing for ketones, especially if his numbers start to creep back up into the 300-400 range again. If you need any advice or help getting started on that, don't be afraid to ask.
 
I would give it just a day or two more before filling his script. Rebound hyperglycemia can last up to 72 hours, and that 179 this morning could mean that he's on his way back down on his own. If he's hovering mostly above 200 the next 24-48 hrs, I would would then start insulin.
Click to expand...

Can someone please provide documentation that shows 'rebound hyperglycemia' is so long lasting, for 5days?
I do not believe you would have such a long reaction from the use of just humulin as your insulin.

As many of you suggested, I've discontinued Tuckers Humulin injections since last Wed. afternoon, to see where his BG levels are, after an 8 day stay at the vets and 6U injections. "Letting his body rest".
Click to expand...
If Tucker has had no insulin since last Wednesday, I would think that's plenty long enough to have allowed the cat to 'rest'.
And if current BG numbers are in the higher numbers, I think it's time to start pricing Lantus, get the rx for pens or cartridges, and purchase some Lantus.
 
Thanks Julia and Gayle for all the info. I did call Walmart regarding the pens and it is $245. and thanks for the coupon. It helps!
I did buy the Ketostix this morning. I'm off to the vet for a Lantus SoloStar script for future use.... I think I will get the vial for now, and check the online websites. have a great day!
 
Gayle Shadoe & Oliver said:
I would give it just a day or two more before filling his script. Rebound hyperglycemia can last up to 72 hours, and that 179 this morning could mean that he's on his way back down on his own. If he's hovering mostly above 200 the next 24-48 hrs, I would would then start insulin.



Can someone please provide documentation that shows 'rebound hyperglycemia' is so long lasting, for 5days?
Click to expand...


72 hours is 3 days, not 5. Tucker has had high numbers for a little more than 72 hours, and then he dropped down to 179 on his own this morning. I don't see any harm in getting a few more tests today to see if he stays below 200 or shoots back up into the 300 and 400 range. If he goes back up that high, then I agree insulin can be started immediately. If he continues to give numbers less then 200 today, I would hold off and keep testing. Counterregulatory hormones do wear off at different rates. While 80 hrs would be a bit longer than usual to see rebound hyperglycemia, stranger things have happened.

Either way, it's still a good idea to get moving on the insulin and supplies regardless. You don't have to pick it up from the pharmacy if you end up not needing it, but you do want to get it ASAP if you do need it.

Gayle Shadoe & Oliver said:
I do not believe you would have such a long reaction from the use of just humulin as your insulin.
Click to expand...

There is nothing that shows the type of insulin causing the low blood sugar has any effect on how long it takes the counterregulatory hormones to clear from his system afterwards. These are not going to clear any more quickly from a fast acting insulin than a slow acting insulin.
 
I'm ready to go with all the supplies, deciding to go with the vial for now ($135.88 FYI) Tuckers 3PM BG was 240.
I think I'm going to try my injections at 6AM and 6PM, once I do start. Let's see what happens at 6! Thanks....
 
Yes, I would wait and see what the number looks like at 6pm. If it's below 200, I would hold off a little longer.

It would be a good idea to read through the stickies in the Lantus TR forum: http://felinediabetes.com/FDMB/viewforum.php?f=9. There's a ton of helpful information there. One very helpful sticky to me when I first started out is the handling and storage sticky: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=151. Lantus is only guaranteed for 28 days, but you can extend the life much longer than that by handling it correctly (storing it at the right temperature, no shaking, rolling, or dropping the insulin, and not shooting excess insulin back into the vial and you're measuring the dose).
 
Sounds good...don't get discouraged if you still see high numbers tonight. Lantus is not like Humulin N--it needs to build up a depot (or "shed") under the skin before it goes to work lowering BG, so you probably won't see any action for a day or two. This is why we hold the dose for at least three days before making dose increases with Lantus.
 
Julia & Bandit said:
Gayle Shadoe & Oliver said:
I would give it just a day or two more before filling his script. Rebound hyperglycemia can last up to 72 hours, and that 179 this morning could mean that he's on his way back down on his own. If he's hovering mostly above 200 the next 24-48 hrs, I would would then start insulin.



Can someone please provide documentation that shows 'rebound hyperglycemia' is so long lasting, for 5days?
Click to expand...


72 hours is 3 days, not 5. Tucker has had high numbers for a little more than 72 hours, and then he dropped down to 179 on his own this morning. I don't see any harm in getting a few more tests today to see if he stays below 200 or shoots back up into the 300 and 400 range. If he goes back up that high, then I agree insulin can be started immediately. If he continues to give numbers less then 200 today, I would hold off and keep testing. Counterregulatory hormones do wear off at different rates. While 80 hrs would be a bit longer than usual to see rebound hyperglycemia, stranger things have happened.

Either way, it's still a good idea to get moving on the insulin and supplies regardless. You don't have to pick it up from the pharmacy if you end up not needing it, but you do want to get it ASAP if you do need it.

Gayle Shadoe & Oliver said:
I do not believe you would have such a long reaction from the use of just humulin as your insulin.
Click to expand...

There is nothing that shows the type of insulin causing the low blood sugar has any effect on how long it takes the counterregulatory hormones to clear from his system afterwards. These are not going to clear any more quickly from a fast acting insulin than a slow acting insulin.
Click to expand...

If Tucker has not had any insulin since WEDNESDAY and today is MONDAY, I am thinking that is more than plenty of time to clear whatever you are claiming is going on.

Wednesday to Monday is 5 days on my calendar.

Testing for ketones should be done daily, regardless of the BG numbers because they can occur at lower BG numbers.
The recipe for ketones is not enough food, not enough insulin, and possible infection. A cat who is prone to ketones does not need to have all three ingredients to develop a problem.

ETA: Please kindly advise which kind of counterregulatory hormones were being referenced, and the source for the length of time needed to clear a system. I am pretty sure that GH was not being implied
 
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