LANTUS PENS ARRIVED WARM-HELP!

[Deena and Malby]

Hello,
I just purchased 2 packs of Solstar Pens from Marks Pharamcy (FYI they've gone up in price).
I paid more for the styrofoam packaging. I was upset to see that they had only used one ice pack for the 2 boxes and they arrived at room temperature. The order was received exactly 3 days after purchasing.
Did I just waste $350?! I read that after Lantus hits room temperature that the "28 day clock starts ticking."
Can I still use this? My previous box was from Marks and also arrived at room temperature. Malby is currently taking 6 units and I can't get his numbers down- is it because the insulin might have gone bad?
Also, once I start using a pen, do I put in back in the fridge or leave out at room temperature? I go through a pen every month since he is taking so many units every day. I've read both ( however Lantus website says an in-use pen should NOT be put back in the fridge) want to clarify which is correct!
HELP!

Thanks,

Deena

 

[Wendy&Neko]

Put the insulin in the fridge right away. Once you start a pen, put in back in the fridge - as long as you are using syringes and not the pen needles. What you read on the Lantus website is for people who typically use pen needles with their pens.

Malby is currently taking 6 units and I can't get his numbers down- is it because the insulin might have gone bad?

Or it could be that Malby has a high dose condition that means he needs more than 6 units. One in four diabetic cats has acromegaly, which is one of those high dose conditions.

It'll really help you get to a better dose faster if you can consistently increase Malachai in a safe manner as fast as possible. You can only do that if you get a test before every preshot and at least one test somewhere else in the cycle. With the high dose conditions, you need to stay on top of increases. Since Malachai is on 6 units, that's the point at which we suggest people talking to their vets about getting testing done for acromegaly (IGF-1 test) or IAA (insulin auto antibodies). The blood is drawn and sent to MSU (Michigan State Universtiy) for those tests.

 

[Deena and Malby]

Hi Wendy,
Thanks for the response! I really do appreciate it. I've been meaning to ask for help here again since I feel somewhat lost and frustrated with trying to get him regulated.
I try my best to get tests in. Could you take a quick peak at his SS? Sometimes I wonder if I missed a correct dose since I haven't gotten many AMPS since he's been on 4 units and sometimes I wonder if he's bouncing? HOWEVER, the one thing I've got going for me now is that he has always been pretty consistent with his curve, starting off high, Nadir is between +5 and +7 and then he goes back up. I think if his correct dose was lower, I probably would have seen some lower numbers at some point, right? I can't imagine I missed his correct dose. I'm barely getting him into yellow. Can I get your thoughts on this.
Also, I know everyone here says to go up in 1/4 increments (which I was doing for so long) however my vet pushed me to start increasing in larger increments since he's nowhere even close to low numbers. Would you still increase in small doses or do you think it's safe to go up in .5 increments (until I get to lower numbers)?
I'm 100% getting Malcahai tested shortly for Acromegaly and I've already discussed my concerns with the vet. Malachai hasn't had new blood work in 9monts. Do u think I should have a basic blood panel done first to see if there is something new that we haven't caught or would you just have the vet Test for both at the same time? I'm not sure how expensive the IGF1 &IAA Test are. Would you rule out everything else FIRST or just do it?
Any suggestions or guidance would be appreciated. I can't stand that he's still not regulated 9 months after being diagnosed! He's just depressed and lays around all day

Thanks Wendy!

 

[MyTitan (GA)]

HI Wendy and Malachai, Titan and us started out on bad footing just after he was DX with diabetes. Long story short we found FDMB and had him tested. Titan was positive for acromegaly so after many conversations on here especially with Saint Wendy&Neko we started a fast track where we increase .5 unit (1 unit/day) every four cycles. As Wendy says stay on top of the testing, we are just coming thru 6.5 units and he is starting to stay in the Reds and out of Black. Check out the SS. Good luck!

 

[Wendy&Neko]

Over 5 units total dose, we suggest 0.5 unit increments, so you are correct in the size of changes you are doing. I did look at his SS earlier, hence my comment on you not getting the tests needed to keep him safe. One day it's possible you'll wake up to a blood sugar number that is too low to shoot, but without testing, that can turn bad quickly. Also without the preshot testing and at least on other each and every cycle, it's hard to know how he is really doing on this dose. I would recommend trying to get those 4 tests a day for the next three days on this dose, then we can reassess what to do.

As for high dose condition testing, I would get a full blood panel and the high dose condition tests done at the same time. That way you only have to pay for one blood draw. And get both IAA and IGF-1 tests done. Cats can have one or the other, or both like my Neko.

He will feel better once you get him into good numbers, we just need to do that as quickly as it is safe to do so.

 

[Sienne and Gabby (GA)]

The Lantus pens were developed so refrigeration wasn't required. We encourage refrigeration to allow the insulin to last longer.

I want to echo Wendy's comment about getting pre-shot tests on a regular basis. While Lantus dosing amounts are not based on the pre-shot numbers the way some other insulin is, the pre-shot test allows you to be reassured that it's safe to give a shot. The last thing you want to do is give your kitty insulin if numbers are way too low and that's the risk of not getting a pre-shot test, especially since the earliest you've been testing is +2. Pre-shot and before bed tests are crucial with respect to keeping you cat safe.

 

[Deena and Malby]

Over 5 units total dose, we suggest 0.5 unit increments, so you are correct in the size of changes you are doing. I did look at his SS earlier, hence my comment on you not getting the tests needed to keep him safe. One day it's possible you'll wake up to a blood sugar number that is too low to shoot, but without testing, that can turn bad quickly. Also without the preshot testing and at least on other each and every cycle, it's hard to know how he is really doing on this dose. I would recommend trying to get those 4 tests a day for the next three days on this dose, then we can reassess what to do.

As for high dose condition testing, I would get a full blood panel and the high dose condition tests done at the same time. That way you only have to pay for one blood draw. And get both IAA and IGF-1 tests done. Cats can have one or the other, or both like my Neko.

He will feel better once you get him into good numbers, we just need to do that as quickly as it is safe to do so.

Hi Wendy,
If diagnosed an Acro cat, what treatments do most people give their cats? I've only read about surgery and radiation... I wouldn't be able to afford the radiation. Are there other medications and/or supplements that are given to help after diagnosed?

Thanks!

Deena

 

[Chris & China (GA)]

they arrived at room temperature.

When I originally found Marks, it happened to be the end of June so my first order was at the beginning of July....great timing considering they had their Canada Day holiday on July 1st and we had 4th of July so my first order ended up taking 10 days to get to me....and this was July in Missouri where every day was 90+

I was able to use every last drop of all 5 pens, so please don't worry about it.

however Lantus website says an in-use pen should NOT be put back in the fridge) want to clarify which is correct!

They say that because humans use the pens as directed....they don't want them refrigerated because it can interfere with the mechanism in the pen. Since we use regular insulin syringes and pull the insulin out of the pen (instead of the pen needles) we don't have to worry about that.

 

[Wendy&Neko]

There is a new drug under trial called cabergoline that some people with acros are trying. There is another medication called parireotide that has had some success but it is very expensive. The treatment the majority have done to date is to get them to an insulin dose, safely of course, where they spend the majority of time under renal threshold.

 

[Deena and Malby]

Over 5 units total dose, we suggest 0.5 unit increments, so you are correct in the size of changes you are doing. I did look at his SS earlier, hence my comment on you not getting the tests needed to keep him safe. One day it's possible you'll wake up to a blood sugar number that is too low to shoot, but without testing, that can turn bad quickly. Also without the preshot testing and at least on other each and every cycle, it's hard to know how he is really doing on this dose. I would recommend trying to get those 4 tests a day for the next three days on this dose, then we can reassess what to do.

As for high dose condition testing, I would get a full blood panel and the high dose condition tests done at the same time. That way you only have to pay for one blood draw. And get both IAA and IGF-1 tests done. Cats can have one or the other, or both like my Neko.

He will feel better once you get him into good numbers, we just need to do that as quickly as it is safe to do so.

Hi Wendy,
If diagnosed an Acro cat, what treatments do most people give their cats? I probably wouldn't be able to afford the

When I originally found Marks, it happened to be the end of June so my first order was at the beginning of July....great timing considering they had their Canada Day holiday on July 1st and we had 4th of July so my first order ended up taking 10 days to get to me....and this was July in Missouri where every day was 90+

I was able to use every last drop of all 5 pens, so please don't worry about it.



They say that because humans use the pens as directed....they don't want them refrigerated because it can interfere with the mechanism in the pen. Since we use regular insulin syringes and pull the insulin out of the pen (instead of the pen needles) we don't have to worry about that.

This is very reassuring! Thankyou!!!
-Deena

 

[Wendy&Neko]

See my previous post above yours.

 

[Deena and Malby]

Hi Wendy,
Can you clarify what Renal threshold means? Also, I'm wondering if getting the IGF-1 and AAI test done will just be more of "well now I know" sort of thing since I probably wouldn't do surgery or radiation. Although I am curious about the pereotide medication depending on cost.
I've read that acro cats can be in pain due to growth, have you heard of any cats on FDMB That are given pain meds for this?
His face has definitely has broadened so I'm assuming he would test positive...
Thanks again for your help!

 

[Wendy&Neko]

Renal threshold is the point is the point at which there is so much sugar int he blood that the kidneys can't keep up with processing it and spill it into the bloodstream. It makes the kidneys work harder. Acromegaly is hard enough on kidneys already. The point is ECID but it's usually upper blue/low yellow. Ketodiastox can be used to determine the point.

Getting testing done may also impact dosing strategies. I found I was relieved to have answers too. And knowing you have an acro can impact medical decisions. The growth hormone does things to their bodies. Neko almost had a tooth extracted by her regular vet but the dental specialist, knowing she was acro, saw soft tissue growth and filed a tooth instead. That's just one example.

Neko had bad arthritis, she was on daily buprenorphine her last three years. Plus doing acupuncture and getting Cartrophen for her joints.