ftsang said:
I was thinking the insulin might had lost its potency because someone told me Lantus insulin can only last for 28 days after used.
If you refrigerate and don't roll your
vial of Lantus, it can be good for as long as 4 to 6 months (sometimes even longer). The expiration date is for humans who usually don't refrigerate and have
much higher doses (think like 20 to 40 units a day or more).
ftsang said:
I got the test result on Tuesday April 16. It was almost 600, much higher than 503 (normal range is 145-450 µmol/L) that was tested on March 23. I called the Vet and she told me to increase the dosage to 1.5 units, twice a day and will have the blood test 2 week later. Finally, I decided to test her blood glucose level last night, 3 hours after the insulin injection. It was 296.
Lantus is a
depot insulin, meaning you need to hold the dose for a few days before you see a difference. Lantus also works in a "curve" format, which I've pasted a
typical example below for you:
Example of a typical Lantus curve:
+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.
As you can see, the lowest numbers usually occur around 5 to 7 hours after a shot. What you want to see are some lower numbers during this range (~60 to 150 on a human meter). If you're not seeing lower numbers during this time frame, then that's usually a sign that the dose needs to be increased.
ftsang said:
Can someone help me what to do? I don’t want to harm her kidney because of my negligence & ignorance.
It is recommended to frequently
test their urine for ketones to catch any complications that may arise from long-term high blood sugar (specifically
ketoacidosis). The faster you catch this happening, the faster you can treat it and the less likely more severe side-effects will occur. You can find ketosticks at most pharmacies for fairly cheap (IIRC, I think it only cost me ~$5).
ftsang said:
Besides, I am a full time worker and was unable to take frequent blood test during the day.
Many of us are. The most important tests each day are the pre-shot tests (AMPS and PMPS) and a before bed test. Throughout the week, I'll also sometimes use my lunch to grab a mid-day test to see how low he might be going on the current dose. On the days/nights you're able, you want to try getting some mid-cycle tests (between +4 to +8) and any other tests you might be able to grab to fill in missing data (i.e. a +2 to see how long it might take for food-influenced BGs to clear Jessica's system). We use
this spreadsheet to help us track our cats' BG numbers. Let us know if you need help setting it up or have any questions on how to use it.
ftsang said:
1) Is it possible that the Lantus that I am using now has no impact on her anymore, that means, I have to change another type of insulin?
Most likely not. It sounds like Jessica just may need a higher dose than 1.5u. That's one of the reasons it's so important to test them: so you can spot needed dose increases/decreases as they happen instead of having to wait two weeks before you go back to the vet. 1.5u is not a lot depending on a few factors: is she eating any dry food? how much does she weigh? is she on any medications or have any other medical issues?
See below for information regarding
dose increases (and decrease):
"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.
ftsang said:
2) How do I know that the new Lantus Solastar that I bought on last Friday has the potency that it supposed to have? May be the one that I bought has lost its effectiveness due to improper storage (too cold or too warm) since Lantus has to be stored under 36 to 46 F.
It doesn't
have to be stored at that temp, but it's guaranteed to last longer if it is. Lantus is not as delicate as it is made out to seem. I have dropped my vial a billion times, I rolled it mistakenly for the first 2 months I had it, I stored it in the door of my fridge instead of a drawer, pushed air bubbles back into it, sucked air out of it, I've forgotten and left it out for hours at a time, etc.... I have
not been gentle with my Lantus and I've still managed to get 4 months out of it (so far). Easiest way to tell if it's gone bad is that you will see cloudiness or particles in the vial.
ftsang said:
In the past, I was very nervous and stressful when taking the BC level test on my cat because I scared I could hurt her. Finally, I realized from last night experience that it was not that difficult so long as you warm her ears a little bit, not too hot, otherwise, you may scare her. I used the lancet device adjusted to middle depth. I got barely litter blood. I re-adjusted to middle high depth and took another shot. It was a success. I prefer using lancing device. It’s much easy for me than to prick her ear by hand.
Speaking from experience, as her
ears learn to bleed better, you'll want to lower the depth setting on the lancet pen. When I first started testing on Mikey, I had it on the highest setting. After a couple of days, I was able to lower it to the middle setting and get blood. By the end of the second week, it was on the lowest setting and has remained there since. (And this is with multiple lancet pens that I tried out: they all ended up on the lowest setting once Mikey's ears started bleeding better.)
ftsang said:
I do encourage all of you do the BC home test yourself if you are still hesitate to do so. I can do it then everyone can do it either. Just try by error and have the help from your spouse. Vets usually don’t encourage you to do your BC home test, because most of the Vets are business oriented. That is very unlucky for someone like me.
^This should be framed somewhere.
