? Bacardi’s pattern - going from black to green/blue twice a day. Is he bouncing?

Hi guys, I am once again seeking some advice of more experienced sugar kitty parents. After another very low night value 3 days ago we adjusted Bacardi’s dosage again, by 0.5 unit. His pattern has stabilised, but in an awkward way - super high levels both AM and PM preshot and low around nadir (I haven’t done his curve, so +6 is not necessarilly his lowest).

Now my mum and I have a dilemma - after reading your forum I think Bacardi may be bouncing due to too low BG around +6 and I am leaning towards lowering his dosage even more. My mum, however, is hesitant and tends to keep the dosage the same (and I suspect she secretly wants to give him more again to avoid those red and black morning & evening values).

I updated Bacardi’s spreadsheet for you to have a look. Your thoughts would be very appreciated.

 

I suggest you leave the dose at 2.5 u for now and do a full curve to see what the BG looks like over the whole cycle. Test BG every 2 hours between AM and PM shots. Feed normally. There might be lower numbers in there causing those high PSs. Regardless, the lows are given much more importance when assessing a dose.

 

So I have been testing every two hours today and it looks like there are no extremely low numbers. I can already see how he is going to go back up to reds/blacks before his PM shot. So my mum is probably right. Do you think he needs more insulin again? I hate seeing him so high. Is it very bad for him to be that high for such a long time? Is it hurting him? I only want him to feel good.

 

The highs are related to the Caninsulin action and his body's reaction to BG dropping from black to blue within a few hours. It's called "bouncing" and there's not much you can do. Getting down into blue for a part of the day is beneficial though so try to look past the PSs. It's the low numbers that are important. I'd increase to 2.75 u tomorrow. Always get a +2 after a dose increase.

 

I understand that if I give him too much, his lows would be too low. So is it really either too high for hours or dangerously low in the middle of his cycle? I was really hoping to get his BG more stable Do you think that it will get better over time? Or maybe if I asked our vet for a different insulin brand? Or should I just get comfortable with that?

 

The lows if they're too low can be dangerous. He'd have to be high day in and day out before that would be a problem. Many people find that a depot insulin like Lantus (a human insulin) can help to even out the hills and valleys. Some cats will still be more volatile on it though but likely better than on Caninsulin. ProZinc, a cat insulin, would be somewhere in between. So much depends on the individual cat's response.

 

Thank you again Kris. I was not sure about how long he can be in reds and blacks before it damages his little body - always thinking about worst scenarios, scared as every beginner.

What makes me happy is that Bacardi hasn’t dropped to “too low” for a couple of days in a row. I’ll try to relax more about the preshot highs and try to stay consistent for now, testing him at different times of the day and let you know in a couple of days again, does it sound like a plan for now?

 

just tested his +10 and it read HI already I feel seriously bad about it and my lack of power to help him.

 

Yes.

 

So we moved houses - no more kibble stealing from other cats! Also, Bacardi's nadir values have been maybe too low for two days (and his preshot values are getting lower, slightly). I just tested 3.2 (+4), so I fed him and will test in an hour. Do you think it's time to lower his dosage slightly? He's on 2.5 units, so should I give 2.25 (eyeballed, I just have 1 unit marks on my syringes)

PS: he's looking good, ate well and is currently grooming his fur - unlike his last hypo episode, when he had similar values and already had symptoms of hypo

 

He's very bouncy and that makes dosing a challenge. My guy is like that. Those greens are very nice but a little too low for Caninsulin - better to aim for about 5 mmol/L at nadir so you have more of a cushion with this strong acting insulin. I'd try 2.25 u. Half unit dose changes are too large for a volatile kitty. If your syringes have half unit marks eyeballing 2.25 u isn't that hard to do.

 

Unfortunately not, just have 1 unit marks (but when I run out I'll get them for sure). I lowered his dosage, first day today but nadir is still quite low. I also stopped giving him dry kibbles completely, which is imho making a big difference for the better. I'll continue with 2.25 for a couple of days and if his BG is still this low I might go to 2 units. I understand that I should alter his dosage slowly and always keep going for a couple of days, right?

 

I would lower to 2 u next dose. Those nadirs are nice but a little too low for comfort when giving Caninsulin. You make an immediate dose reduction if nadir is too low. Otherwise you hold a dose for 4+ cycles to see what it can do.

 

OK, I gave 2 units. Lets see what happens Thank you for your constant support, I really feel SO MUCH safer with you around. Getting more confident every day. Today, for the first time in a very, very long time Bacardi came and purred in my lap!

 

Glad to help! There's so much trial and error in this dosing thing. The forum and the spreadsheet are so very helpful.

 

Indeed - without the spreadsheet I'd probably freak out if i saw values as low as 4 out of nowhere.

After giving 2u yesterday Bacardi's morning test was a beautiful 11.7! I was so happy until he managed to escape before I injected him, so I am now afraid that the majority (if not all) of his morning insulin went in his fur only..I now don't know what to do, most of people here suggest not to inject again. I'll test him around nadir, but I what if his values are too high? Should I still wait all day and give him his PM shot only? I probably ruined his what was supposed to be his " I feel good today" day

 

Yes....but if he's running really high, you could shoot a little early.....Like if it's over 300 at +11, you could shoot that early as long as it wouldn't interfere with your ability to shoot 12 hours later.

 

Ok, that's what I'll do, thank you. (still hoping that at least a little bit went in, but not sure..the little furry thing is getting slippery, I need to hold him better

 

One more thing: I gave him 2u yesterday evening (immediate reduction from 2.25, as we discussed) and tested 4.6 at +5. That is still under 5mmol/L. Do you think it might be a sign that even 2u might be still too much? (This morning his BG was the best in some time - less bouncy. Unfortunately I can't test now because I gave him a fur shot - a lot went out, but he still tested reasonably low @+4). So, I guess for now I will just continue with 2u and see what it does, would you agree?

 

I agree. Keep the 2 u dose for today and tomorrow then we can assess. If he drops very low, though, the dose can be reduced sooner. Keep posting here.

 

It's looking OK - he's definitely less bouncy on a lower dose. He tested 6.6 and 8.8 mmol/L around nadir (night and day), thats OKish for now, isn't it? My instinct is telling me to keep going with 2 u for at least couple of days, and see how he's going. (EDIT: at least I don't have the constant urge to feed him to bring him up a bit, so it's really good for his diet too). But of course I'd love to hear a second opinion of someone more experienced.

Two good news: I can see that Bacardi is feeling good. He plays, grooms, purrs and comes for cuddles (non of which he did very often before I started giving him wet food only. To what extent is he calmer and happier thanks to the fact that he's not sharing a house with 9 cats anymore, I don't know. But I am happy happy ). And his new favourite sleeping spot is right under the radiator - yay for prewarmed ears!

 

Keep 2 u for tomorrow and see what he does. It might be time to try 2.25 u again on the weekend. I'm glad he's feeling better - and you are too!

 

I am not sure yet..his AMPS was 14 (yay!) and after giving him 2 u I just tested +5 and it was 2.9 mmol/L only. Bacardi is just eating some higher carb (hopefully, I still don't know how to calculate it) canned meal with a bit of raw meat (for a treat, as he is a huuuuge meat eater). Will test him in an hour again, to make sure he's higher. Does it qualify as an immediate reduction again?

Bacardi is not feeling great, he's hissy again..I better get his BG higher...

 

Update: 5.2 @+6. All good now. It's incredible how the little rascals tell us how they feel. @ +4.5 Bacardi was lying in his "I don't feel so great" corner and was hissy, then I fed him @+5 and @+5.5 he came, all chatty, lied on his back and said "why are you so concerned, I'm fine" I already knew that I did not even have to test him again. I would not be surprised by black value at PMPS...his usual bounce. We'll see.

Should I give 1.75u?

 

Yes, that 2.9 is far too low for Caninsulin.

 

So, we are going lower and lower...just having a bit of a pre emergency Posted here: http://www.felinediabetes.com/FDMB/threads/preventing-hypo.207327/ . Should I still continue lowering his dosage by 0.25?

 

Yes!

 

So I did and he was under 5 again (all the way down from 32.4 in the morning). His PMPS was only 15.7, so I am afraid that he will drop too low again tonight. Is it yet another reduction, if he goes under 5 at +5?

 

Reduced to 1.25 u this morning and now we're +4 and his BG is 3.1 again (just feeding him a higher carb wet snack)...going to give him 1 u tonight - does he really need so little insulin? I'm baffled, after a long time being on a crappy diet and 3 units is his body finally recovering so quickly after a diet change? Or am I misinterpreting the spreadsheet?

Also, I am worried that he's going to put on more weight until I manage to get his insulin right, I need to feed him very often now to keep him from falling too low. But I guess preventing hypo is more important than his weight at the moment, right?

 

Yes, reduce to 1 u. He might be a kitty who will become diet controlled but it's too soon to tell. Some of what you're seeing (steep drops and rebound to high PS) is because of the action of Caninsulin. Feeding him low carb wet food as needed is fine for now. Your immediate goal is to get him to a dose level where he's doesn't drop too low. Once there you shouldn't have to step in with high carb food very often.

Every time you have a low nadir, drop his dose by 0.25 u.

 

Reducing to 1u tonight is a good plan. Maybe he's competing for the best bouncer award (look out Teasel!) which may in part be due to the steep drops but it also looks like he may be burning through the dose relatively quickly and not getting a full 12 hour effect. Feeding as needed is fine. It's unlikely he's going to gain a lot of weight until he's better regulated. I agree with Kris.......he may be on a mission to become diet controlled.

 

Oh thats my dream! He got 1 u tonight, we’ll see. The two little guys Bacardi and Teasel sure are bouncy kitties! We still need to get to Teasels much lower numbers though A long way to go

 

Just got 10 new vials of Caninsulin, but thinking about asking my vet about changing it to Lantus if I am not able to get Bacardi regulated. So far I think we are still have some room to reduce, then if he’s still bouncy I’ll do that. Oh I’m so glad that I found this forum!

 

I have three years on you though!

 

Hi there. I have a little update. Bacardi's BG has pretty much stabilised, but not where I wanted it to be. So off we went to the vet to consult a possible change to Lantus or similar. I booked an appointment with an animal endorcinologist and this is what she suggested:
1) she said that Lantus is stronger than Caninsulin. When she does the switch, she usually begins with 1/3 to 1/2 of the amount of Caninsulin
2) BUT! Bacardi is already on 1.25 units of Caninsulin only, which she said is an unusually low dosage for a cat his weight. Plus, she said that Bacardi's pattern shows that the insulin works very well - lowering his BG nicely.

So, she wants to try 2 things now:
1) put Bacardi OFF insulin completely for at least 3 days. This is to test if 1.25 u of Caninsulin is overdosing him and causing those horrid bounces to over 30 mmol/l. There is a slim chance that he might not need insulin at all anymore. I believe this is a good idea - it either proves her theory to be right (fingers crossed), but if not, she will prescribe Lantus
2) she said that there is a chance of Bacardi having a chronic pancreatitis. It is supposedly very difficult or almost impossible to diagnose, unlike acute one. But, if it's the case, then I need to switch his diet to higher fibre food - she told me to stop feeding low carb (and low fibre) wet food and put Bacardi exclusively on Hills W/D for at least a week, so that we see how he reacts. I am willing to do it, but I am scared - it's over 30% carbs!

I am going to do what she told me - starting with Hills W/D tomorrow for a week and putting Bacardi off insulin Sunday to Tuesday. My next appointment is on Wednesday, when we are going to asses his values. I really hope it will shed some light on what is going on with him...

What are your thoughts about it? Is it going to work?

 

ECID, but Rhubarb became diabetic on w/d. You will be keeping an eye on him, and he is dealing with other issues too, so all should be well

 

My first thought is that putting Bacardi onto 30% carb food will no doubt raise his BG to the point where the whole experiment of keeping him off insulin to see if perhaps his dose is too high, will be a total waste of time. They cancel each other out because he'll probably need more not less insulin on the WD diet. Switching to a 30% carb diet makes no sense for any diabetic cat unless you are in a critical situation where its the only thing the cat can or will eat.

I would not describe Lantus as stronger than Caninsulin. It is a different long lasting insulin that has a much gentler action and that alone could improve what appears to be major bouncing. Bacardi is experiencing steep, significant drops in BG with the Caninsulin and is spending little time in good numbers. Lantus should smooth out the curve and last longer through the cycle. I also wouldn't reduce the dose of Lantus to 1/3 or even 1/2 of the Caninsulin dose given Bacardi's numbers. If you switch I think a dose of 1u might be a good place to start. That is something you could ask about in the Lantus forum. Weight while often considered for initial dose calculation, doesn't necessarily dictate how much insulin a cat ultimately needs. There are tiny cats regulated on large doses and huge cats regulated on tiny doses.

 

I know! It's not a good food carb wise. Plus, Bacardi just got off dry kibble a couple of weeks ago and his need for insulin went drastically down, which was a great success. So I don't feel very good about it. I would be much happier if we just changed ONE thing at a time - going off insulin to begin with, and see what it does. Then, I would try the diet change to see if it's the chronic pancreatitis. But if I change both things at the same time and his BG goes high again, how should we know if it is due to no insulin or the Hills W/D...

 

EXACTLY my thoughts!!! Should I just go the same diet + no insulin? Maybe thats all he needs...

 

Sorry, I got my foods mixed up. She was Hills M/D not w/d. Too many letters!

 

I am no expert on diabetes, but I fought a long hard losing battle with chronic pancreatitis ( and something else discovered at necropsy) with my Smith. NO, I would NOT put your diabetic cat on Science diet kibble, period. Vets are often given scholarships by Hills and they then recommend that food regardless how terrible it is for the animals health.

What is he doing that makes the vet suspect chronic pancreatitis? Refusing to eat? Lots of vomiting? Lip Licking? Laying in position with legs tucked under him and head up?

Edit to add: Another thing I would remember is that the reason a lot of us have diabetic kitties in the first place is bad advice from Vets about feeding dry instead of wet in the first place.

 

Exactly my thoughts. You also don't want to undo the effort put into transitioning Bacardi to the wet diet particularly if he was very fond of his kibble. Did the vet specifically say to feed the kibble? I believe there is a wet version of W/D that is lower in carbs than the kibble although by how much I'm not sure.

Has the vet ever done a snap test for pancreatitis? While chronic pancreatitis can cause difficulty regulating a cat and is difficult to diagnose unless in a flair, I was under the impression that you might not see the dramatic BG drops if that were the case. I could be wrong on that but I too was once told my girl might have chronic pancreatitis but her numbers were pretty much flat as a pancake throughout the cycles at the time. Has Bacardi shown any nausea, lack of appetite, vomiting, diarrhea?

If you decide to withhold insulin for a few days, make sure you keep checking for ketones especially if his numbers stay high but a good idea to check even if they do come down a little.

 

I am sorry to hear about Smith's problems..from what you are saying, I must say no, nothing like that - Bacardi would eat a horse if I put it in his bowl..he throws up from time to time, but that does not worry me, as he sometimes eats a napkin or so (but that's been the same his whole life). Lips licking - not at all. And his sleeping position looks like he's really comfy - belly and chin up, paws straightened as much as he can go. Plus the vet did not even ask about any of that. I believe she just got the idea from his spreadsheet, as one of the reasons Caninsulin is not working as it is supposed to be. She did not suggest Hills as the only food, more like only food they had available - her advice was "he needs something with more fibre, if it is a chronic pancreatitis".

I wonder if there is any low carb, but higher fibre food that's suitable for diabetic cats. Probably not, right? These two things are kind of exclusive, aren't they?

 

No, she said she wouldn't mind wet W/D. But they did not have it available, plus it's really expensive. So she gave me what she had.

No, no testing has been done. She said that she can test it, but exactly as you are saying - the numbers would most likely not be elevated, unlike if it was an acute flare.

Not at all. Since we switched to wet food only, he literally looks like a heathy cat. He is interactive, talkative, playful, always hungry, pooping nicely, back to his fat self...

Thank you for emphasizing that. I bought urine tests today and am going to start testing. I am almost decided now not to switch his diet, just do the no insulin test to start with.

 

Just checked on the wet W/D and it's 24% carbs so also NOT a good alternative. There may be some low carb wet food a bit higher in fibre than others but I always thought it was low fat rather than high fibre for pancreatitis. It should be food that is easily digestible and fibre generally wouldn't be considered easy to digest. What food is Bacardi currently eating?

 

I think your vet is grasping at straws with no evidence of what she is claiming. If you are not noticing any of the signs your cat is nauseated and in pain, he is very unlikely to have pancreatitis. Like I said before, Vets have an ulterior motive for prescribing Hills Science Diet, a financial one.

Besides, it is LOW FAT that is critical for cats who genuinely do have pancreatitis, and good luck finding a low fat premade cat food. I had to make my own.

Smith ultimately did not make it, in large because the vets he saw refused to even consider pancreatitis until it was way too late because they wanted to believe it was lymphoma even though NO biopsy said it was. They simply wouldnt look elsewhere.

I had necropsy done because I knew they were wrong and he had a stricture at the opening of his gallbladder. Not Lymphoma. But.......... while they were insisting lymphoma there was a trial going on at University of Tennessee Vet School. Coincidence? Or them wanting a guinea pig I paid for? I know what I believe.

Bottom line, vets do not always know the right thing, sometimes they arent even operating from honorable motives at all.

Not saying that is the case in your case, but be aware that authority figures are fallible, human, and sometimes not perfectly moral.

Edit to add;

Sorry if I sound bitter. I am. I loved that cat more than anything in the world and he died a long lingering painful death and the vets not only would not help but in fact HURT him by overdosing him with a steroid which harmed his heart. And then they refused to accept that his heart recovered so the poor cat took tons of pills while sick, it was just horrific. All of it. (Necropsy said his heart was fine and no lymphoma.)

Vets

 

@AlysonE I am crying for your poor kitty now, fly high little Smith. We all love our four legged rascals, I can not even imagine what you and Smith went through. It must be hard for you to trust vets ever again after what happened - you have a reason to sound bitter, I don't blame you. Thank you for telling me your story, what I can take from it is that Bacardi does not have any of Smith's symptoms - you would hardly tell he's ill if you saw him, just his BG is not looking good. My vet even did not say that Bacardi does have a chronic pancreatitis, she just said it could be one of the causes for his unusual blood glucose pattern. So, for now I won't feed Hills, and just try the no insulin test to start with.

 

Hmm, that's what Alyson said too. Low fat is important. You know, he might and might not have chronic pancreatitis, but the thing is that if I do two changes (no insulin AND high carb food), I have no way of knowing which affected what. So, I will not do that.
He is currently on Animonda wet food only (I am in Europe, so no Fancy feast here unfortunately). He likes it and it's around 7% carbs. So, that's what I am going to feed him during the no insulin test.

 

Without any symptoms now or previously of pancreatitis, that does seem a long shot explanation for Bacardi's BGs. My bet is that his numbers will flatten out with insulin withheld resulting in lower pre-shot BGs (non food influenced readings even without insulin) but be higher mid cycle telling you he still needs insulin. This still leaves the question of how much insulin he needs up in the air. I think it's the action of Caninsulin and not the dose of insulin that is causing those significant highs and lows and a switch to Lantus would be a good next step.

 

Sorry I got so emotional. It was one of two worst experiences of my life, I would not wish it on anyone. Thank you for your kind thoughts. <3

Back to the issue at hand, I am so glad you decided to wait. If the solid real issue is "having a hard time controlling a diabetic cat" then it seems very counterproductive to put that cat on a high carb diet based on a vague suspicion and no relevant symptoms. Best of luck to you and handsome Bacardi The Great. [/user]

 

Yes, that is exactly what my vet said - and is probably waiting for - a flatter curve. She was more worried about switching him to Lantus right away, because she was unsure about the initial Lantus dose (she said that with his nadir numbers so low she was afraid of sending him to hypo with the switch) - so, it will either be as you said (lower preshot numbers but higher nadir) and then he'll get Lantus, or the unlikely case of him going into remission.

 

Thank you! I'd love you to hang around if you want, I am going to update this thread from time to time

 

I absolutely will keep checking back to see how you both are doing

 

I totally agree. I'd start him at 1 u of Lantus every 12 hours.

 

So, we are in the middle of Bacardi's insulin withdrawal test and it's going terribly. Instead of "higher nadir and lower preshots" situation we have just "high all over the place" one. The vet told me that we need at least 3 days to see the real effects, but I am afraid I am already hurting him. He begs me for food all the time, so I think he's uncomfortably hungry. I am considering calling it off...I don't know. The vet is in later today, so I'll give her a call.

 

I hope your vet tells you to call off this no insulin trial. There's really no need to have any sort of wash out period when switching insulin. It's obvious he doesn't feel well in those high numbers and they put him at risk for ketone development.

 

I agree with Kris. Withholding insulin is just making Bacardi feel poorly. Caninsulin is an in and out insulin so no need for a "wash out" period. Hope your vet agrees it's time to get Bacardi back on insulin.

 

We have 14.8 now! I was expecting HI to be honest. Well, at least a partial relief. Will call her anyway, she wanted to make sure that he still does need insulin (no surprise he does). I can’t wait for our Wednesday appointment, where I will finally (hopefully) get Lantus for the little rascal.

 

How stressful that must have been. I get upset and emotional when my pets act like they are suffering. You were brave, but I am glad for you both that Lantus is coming soon.

 

Hi again guys. So, more bad news today. I went to the vet to finally get my Lantus prescription. I was told that there was a shortage of Lantus in pharmacies and walked out with two prescribed insulins: Lantus Solostar (a prefered one) and Toujeo Solostar (which my vet told me is what I most likely would be able to get). All good. BUT!

1) I was told to start him at 1 unit, but just in one shot per day. (from what I've read I think it would be better to give him 0.5 in the morning and 0.5 in the evening, right?)
2) a huuuuge problem! They ONLY sell prefilled pens of Lantus in my country (and Toujeo as well). Those pens only do 1 unit increments, which I don't want as we are talking about 0.25 u increments in the SLGS protocol. I asked the pharmacist about other insulins that they do sell in vials, so that I can ask you about the best alternative for Bacardi, but she refused to answer and told me to tell the vet to do the research. But my vet did not even know that they only make Lantus pens, because she told me to get 100u injections. So, as much as I respect my vet, I am sure that she is not as educated about feline diabetes as the collective brain here

So, we're back on caninsulin until I figure out what to do now. The question is: should I get those pen cartridges and draw from them? Is that even possible? Would they be airtight once I "damage" them? Or do you know about some insulin, that I might be alble to get in vials (this is a hard ones as I believe every country is different). Whyyyyyyy does it have to be so complicated? I was really hoping that we would start Lantus tomorrow morning!

 

WHOA on the TOUJEO! DON"T USE IT! It is highly concentrated Glargine triple the dose per ml that Lantus is.

 

She told me only to get it if I can get 100U.I/mol - warned me about the 300. But I am not going to get it, as they do have Lantus in the pharmacy. The problem is - they only have pens..no vials

 

Sorry I didn't mean to leave you hanging .....I'm monitoring another low kitty and just wanted to be sure you didn't end up with a major catastrophe.

As for the pens, you can buy syringes and use the pen like a vial but you don't need to inject air into it. You need 3/10ml 31 gauge, 8mm syringes with half unit markings. There is a picture somewhere of how to use the pen in this way but I'll have to look for it. The pens are a far better value for our cats anyway because with a vial you often end up with a pile of waste due to the small doses we use. If you need further help with the syringes, just holler.

 

As for dosing, Lantus works better when given in a consistent dose twice daily so you would start Bacardi off with 0.5u twice daily every 12 hours. There has been the odd cat only getting one dose per day but they are generally already regulated and it's still rare.

Other insulin options for Bacardi would be Basaglar (glargine under a different brand name) which I believe is a bit cheaper than Lantus and Levemir which is a different but somewhat similar long acting insulin. Someone here is trying out Tresiba but there is little experience with it in cats at this point in time.

Don't be concerned that your vet may not have all the details about the different insulins. They are human insulins and they just don't have the experience with them yet. My vet had to research when I wanted to switch from Lantus to Levemir due to my cat's high dose condition (different PH for comfortable shots). TA this point in time, they are coming out with all sorts of different human insulins but vets just don't have any reason to keep up with those new human drugs under most circumstances.

 

Finally found the info re: drawing insulin from the pen HERE. Hope that helps because I think you and Bacardi will be happier with the Lantus.

 

@MrWorfMen's Mom awesome, thank you! So that means that the problem is solved, and I'll go get Lantus today. Yay! Hopefully it will help us to finally get Bacardi regulated!

 

Do watch the excellent video on that page. It makes very clear the differences between drawing from a vial and using a pen. I found it a huge help when I recently switched to a pen.

 

@Tom & Thomas Thank you Tom! It's really very helpful, I am confident we are going to make it now. Going to get those pens today.

 

Merry Christmas to you all from Bacardi & me

 

Hi guys, for those who are ineterested I post a new thread in the Lantus board - Yay, we're on Lantus starting from today Thank you all for your support!