Understanding Lantus

Status
Not open for further replies.
Steph

Steph

Member Since 2013
So, I just happened to go to the Lantus website. Can you experts please confirm these questions for me?

1) Do not refrigerate the pen after it is opened? (I have been.) It's been out of the fridge twice accidentally, but never got "hot."

2) Throw away Lantus after it's been open/used 28 days? That will be throwing away a lot of insulin. ????? I don't get that. Is this the case with ProZinc?
Finances are a consideration here and I need to maximize the product.

3) The solution is still clear, no particles--which I understand is correct.

3) Stubbie/Mick got injections today, but his numbers have been high, as though I didn't give him any at all. Suddenly.

Thank you for input, as always.

Steph
 
They only tested it for that long is why they say that.
For cats, experience has found that refrigerating extends its usefulness up to 6 months.

The high you're observing may be a bounce - an elevation in glucose due to compensatory hormones releasing a form of stored glucose when a large drop, a fast drop, or a drop to unaccustomed numbers occurs. The body reacts as if it is going too low.
 
All of those statements are geared for human use. The pen is marketed as a convenient portable carry it with you type thing, so the shelf life is based on it being carried around in your purse or pocket and not kept in the fridge. Odds are that a human would use it up in 28 days since they typical take more units per dose.
 
I dont think anyone here would say they were an expert.. way too much pressure for volunteers! ;)

Anyway

1) Do not refrigerate the pen after it is opened? (I have been.) It's been out of the fridge twice accidentally, but never got "hot."
Click to expand...
Thats for humans who get through the insulin really quick. You want to keep it in the fridge as much as possible (not the door) so you can get 6 months out of it.

2) Throw away Lantus after it's been open/used 28 days? That will be throwing away a lot of insulin. ????? I don't get that. Is this the case with ProZinc?
Click to expand...
Again this is for humans. If you keep it in the fridge it will last up to 6 months. (as long as you dont keep leaving it out. Every day its left out you probably lose a week or two)

3) The solution is still clear, no particles--which I understand is correct.
Click to expand...
yes. After 4 months start to watch for cloudiness or floaters etc as it may indicate the insulin is expiring. Also what the BG levels for wonkiness.

3) Stubbie/Mick got injections today, but his numbers have been high, as though I didn't give him any at all. Suddenly.
Click to expand...
Do you have a spreadsheet we can look at? It could be a bounce but the SS will confirm that

Wendy
 
Ok: the pen is back in the fridge. Lost a week, maybe...

Thanks for clearing this up, you amazing "experts." (Sorry: You are all really smart at all of this, and gracious with your time.)

How do I attach a spreadsheet in Google Drive?

Thanks.

Steph
 
Here's the link. Just did his preshot readings and he's back in the good range.

https://docs.google.com/spreadsheet/ccc ... sp=sharing

Very confused about yesterday, though.

You will see I tried to go from 3.0 to 2.5 when we were doing so well, but I am back to 3.0.

Wondering about which dose to use.

I can't test him more than once or twice during the actual day.


Steph
 
Hi Steph..and extra sweet Mick!

I haven't seen if you've posted before and so if some of these questions are repeated from earlier, please accept my apology.

1. What are you feeding Mick? We have a list of low carb wet foods (we suggest less than 10% carbs) that includes pretty much any food you can buy. Dry foods are too high in carbs, so it's important to know what you feed. If you haven't tried transitioning to the low carb wet foods, that could be keeping his BG higher just because of the carb content of the food he's eating.

2. What meter are you using?

3 units is a BIG dose to start out at, but it seems to be a popular number for vets to suggest to start....we suggest starting at 1 unit twice/day to start (sometimes less depending on how much your cat weighs)...You can always work your way up, but once the insulin is in the cat, it can't be taken out again..we want you to be totally safe. Giving too much insulin can keep numbers high just like giving too little can.

Lantus is a "depot" insulin...it can take up to 14 cycles when first starting therapy to "fill the depot" (some starts working quickly...some is deposited into the "depot" and released throughout the cycle). After that first 5-7 days, dose changes are generally held for another 3-5 days unless you get a result under 50 (80 for AlphaTrak) which earns a decrease in dose!

Dose changes are done in .25 units. Lantus is a powerful hormone, and if you make bigger changes, you could miss that "perfect" dose amount that works best.

There's a LOT of information we can share with you about how Lantus works, the protocol that members have used here (with a LOT of success getting kitties off insulin completely too!) but I'll warn you...the learning curve is steep and once we all get going on giving advice, it can come fast and hard...and we don't want to overwhelm anyone!

I'll go ahead and post the "rules" for the protocol most of us use, but don't let it confuse you. We're here to answer your questions and help you any way we can!

Lantus "Tight Regulation Protocol" (there's also a protocol called "Start Low, Go Slow" ...it all depends on how YOU want to manage YOUR cat!)

"General" Guidelines:
Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Reducing the dose:
If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.
If an attempted reduction fails, go right back up to the last good dose.
Try to go from 0.25u to 0.1u before stopping insulin completely.
 
Is it possible that yesterday was a "fur shot"? That is, it wasn't actually injected or he pulled away before it was all injected? If it were me, I would stay at the lowest effective dose and not change it from day to day based on just one or two BG readings (unless the reading is abnormally low). I've had some up and down readings with my Hairy but I haven't changed the dose and wouldn't unless significantly different (higher or lower) readings became a trend.
 
Lantus is better with consistent dosing, holding for 6-10 cycles unless you get a number <50. This consistent dosing helps to keep the insulin depot at an even level and not constantly draining and refilling with daily changes in the dose.

Other insulins are more amenable to daily dose changes, like Prozinc can be dosed this way.
 
You know, Nancy and Deb, I wondered about a "fur shot." But today, I had a fairly good number, and at 6.5 hours, it's 275 and climbing now. This cat is a "hard case."

????

Can you see my spreadsheet link above? (Not sure I did this right!)

Thank you!
 
I can see your SS (spreadsheet) link in your signature just fine.

The one thing I would suggest you do, is try to get a test at night, after the PMPS. We usually suggest "One last test before your go to bed". If you're not testing at night, you are missing half your data. Make sense?
 
I guess what has me confused is why you would up his dose to 3 with a pre shot of 138. Seems like that may have sent him into another bounce. I'm still new at this too though, so it's entirely possibly I'm missing something.
 
Yes, it makes sense. I am feeling a bit bogged down, and confused by his numbers all over the place. I also wonder if having the Lantus accidentally "out" three times (no fridge) has altered its efficacy. Silly me for not knowing this in the beginning. I guess the only way to know this is to open the other vial which has not been subjected to room temp.

?

I can get a pre-bed, but that makes four today. He doesn't love it.

Thank you!

Steph
 
I've left my vial out at least 5 times...sometimes for as long as 4 hours. You haven't even had yours for a month, and the testing they do says it'll be good for 28 days without refrigeration. (we just keep it cold so it lasts longer than 28 days!!)

I think it's too soon to worry about losing any effectiveness from being out of the fridge a few times.

Can you tell us what you're feeding? Depending on what it is, it could be holding his numbers up.

Also, Lantus needs to be given at the same dose, every 12 hours for at least 6-10 cycles. You've been going back and forth between 3 and 2.5 a lot.

Since I don't know where you got the dose advice to start at 3 units, I don't want to overstep my bounds, but I think I'd suggest you drop it back to maybe 1 unit and give it every 12 hours...and don't change the dose unless he drops below 50. He could have been started at too much...that will cause wonky numbers too!

Lantus dosing isn't based on that Pre-shot number...that number is important so we know if it's safe to give ANY insulin. The more important number for figuring the best dose is the nadir (the point in the cycle that the Lantus is working it's BEST)...this is usually around +4 to +8 but can vary from cycle to cycle.

I hope one of the more experienced members will come along and give their ideas too!
 
I will drop his dose now and work up.

He was dropped on a vet's doorstep, hot weather, taped in a box. The decision was made to use 3 iu, after he was on another unsuitable insulin. I flew him from Illinois and have had him for almost three weeks.

I am catching up.

Thank you, all.

Steph
 
Oh wow Steph!! How awful!! I will just never understand how people can do that!! Even if you're not a "cat nut", how anyone can do something like that to another living soul is just ...well...deplorable is the best word I can come up with.

I'm happy to hear you're going to go to a lower dose for now. Most vets seem to really like that 3 unit starting dose! (my own included, but I'd already found this board and told him I wasn't comfortable giving that much) Considering China only weighed a little over 8lbs at that time, and her body condition score was only a 2, I hate to think about what might have happened if I'd started that high. When she went back for a 2 month check, he was truly shocked that she'd been doing as well as she had at doses as low as .5 twice/day

I think a lot of us don't even go to our vets to manage the diabetes unless it's for the "usual" stuff like vaccinations and checkups...and of course if there's anything else going on that needs diagnoses or treatment.

You didn't say what dose you were going to give, so just remember to hold the same dose for at least 6-10 cycles...Unless you get a number during any cycle below 50 (80 if you use the AlphaTrak meter). If you do go under 50, you'd want to decrease by .25 unit and that 6-10 cycle timetable starts over again.

You need to get at least 4 tests per day if at all possible.

1. at AMPS and PMPS time...to see if the blood glucose is high enough to give ANY insulin (this is for safety)
2. anytime between +4 and +8 during the AM cycle and a "before bed" test at night (this is to find the "nadir" which is what's used to determine dose)

We're more than happy to help as much as we can, and if you have questions, please feel free to ask!
 
Good job on the SS. I also second and third what everyone said about dosing. Lantus works best on consistency, and as per the protocol Chris and China referred to above, you want to a new dose 3-5 days before making a change. this will allow the lantus depot to build up. Lantus is a depot insulin so it takes a few days to adjust in the cats system and see the true effect. However if at any point the cat drops below 50 you should drop by 0.25 immediately!

So lets see how the 1 unit goes for now.

Wendy
 
Hi there

I was looking at your SS and see you increased the dose. You might want to see if you can get some tests at nighttime as many cats drop low at night! Especially since he seems blue in mornings. Chances are the AMPS isnt the lowest he went overnight! He could well be dropping too low in which case you might even need to decrease the dose if he drops under 50.

Even if you can get a before bed test around PMPS +2 that would give you indication of whats going on at night because if +2 is less than PMPS then its likely he drops lower.

Wendy
 
Hi Steph,

I'd hold him on the 2u for a couple more days. He was hitting blues on the 1.75u so that's a good sign that the 2u might do the trick to bring him into greens/double-digits. If not, we can always raise the dose again. Try getting in some "before bed" tests if you're able and this will help us see if he's going lower at night.

If you want to, you can start posting on the Lantus specific board as there are more people there who will be able to help with dosing. You basically create a new "condo" (post) for each day with the subject line something along the lines of "9/13 Mick Jagger AMPS 296 - dosing question" and then a link to your last most recent post (check out a few of the posts for examples). You don't have to post every day. There are a ton of people who watch over those posts and should be able to help more specifically with Mick and his unique dosing needs since ECID! :lol: ;-)

ETA: I forgot to mention that renal threshold in cats is around 220-240, so the fact that he's going lower than that is great! :thumbup
 
Re: Understanding Lantus; a.m. conundrum

So, thank you everyone, especially Kay, my mentor. You're all so smart and kind.

Just tested him this morning, after those silly high numbers yesterday. Gave him 2 iu last night.

This a.m., preshot, no food after 9 hours, he was at 100. After eating, he is at 84.

WHAT??????? (is going on here?)

What should I do? This is so unexpected, but this is "how he is." Won't 2 iu this a.m. be too high?
 
Did you skip the shot this morning? If so, his numbers might be high again tonight. If not, how much did you give him?

Since you just started giving 2u yesterday and you already had a low AM, I would probably drop him back down to the 1.75. He might have just needed a little longer to get acclimated to the 1.75u. If it's still not enough after a couple of days, we can raise him back up and try the 2u again.
 
Testing right after eating doesn't show any effects of the food yet, according to my vet. So the post food shot may have just been a continuation of reaching the nadir for the cycle whether he ate or not.
 
Steph, in the future, if you get a pre-shot number that worries you, you should "stall" for 30 minutes. Don't feed anything, and use that 30 minutes to post and ask for help. There are times when you DO want to give insulin at low numbers, and there are also times when you DON'T, so if you're concerned, don't feed, post and add the ? along with the number you have and "Stalling"

Example 9/14 Mick AMPS 100 Stalling..dose advice please!! ....and add the ?

Also, if you come on over to the Lantus Board it'll be easier for us to keep track of you. You're always free to continue to post on the Health board, but it's a little easier to "get lost" because of the number of posts there.

Generally, we like for you to stall and retest in 30 minutes without feeding so we can tell if he's continuing to go down, or coming up. There are also times when you do give insulin with a dropping number, but before I'd do it, I'd ask for help too!!

One thing that would also help you (and us) is for you to start getting some tests during the PM cycle. Cats generally go lower at night, but since ECID, there's no way to know how low Mick might be going. Could you get a "before bed" test at night? It's important to get some tests during that cycle too!
 
NancyJac said:
Testing right after eating doesn't show any effects of the food yet, according to my vet. So the post food shot may have just been a continuation of reaching the nadir for the cycle whether he ate or not.
Click to expand...

Yep, it takes about a half hour before food starts to impact the numbers and it takes about 2 hours before the food impact wears off, which is why we recommend taking up food two hours before the next shot so it's not a food-influenced BG.
 
Great low number this morning. I will be interested to see where he is later today. Tonite you might want to test reducing the dose to 0.5 units for a few days (assuming tonite he is over 200)

Wendy
 
Status
Not open for further replies.
Back
Top