Newbie needs dosing clarification

Hi All,

So, I am about to start administering Lantus to my 9 y.o. cat, who was dx in January, but went on an 8-month remission after switching him to Janet&Binky's wet food. He had a relapse about 10 days ago with his numbers hovering in high 200s-up to 390 every day. Still trying to figure out if perhaps dental issues could have caused the relapse...

My vet is not knowedgable about dosing Lantus, but agreed to work with me. I am home-testing regularly.

I read all the info in stickys and on the Lantus board, but am still confused as to dosing rules. Here are my questions:

1. I know to start at 1u every twelve hours. I found a rule for newbies not to shoot at bg =200 and lower, but looking through people's spreadsheets I noticed that many ppl do shoot lower #s from the very beginning. Is it better to do fixed dosing and skip a shot entirely at bg=200, or is it better to lower the dose instead of skipping?

2. What does it mean that a "skinny" or "fat" dose was given? How does that look like on the syringe?

3. I read somewhere that before drawing insulin one should inject an air bubble to the vial that is equivalent to the dose one will be using. But that sounds counterintuitive- don't vials go bad faster when they have air in them? Any pointers/links on appropriate drawing technique from a SoloStarPen?

I will appreciate all advice, especially that I am largely going at it on my own. My vet, as I mentioned, has very outdated knowledge about FD.

Thank you,

Eva

P.S. And one more question- no shaking, mixing, or rolling with the SoloStar pen, right? Just draw from it as it is?

 

You will be better off coming over to the Lantus forum, more experienced eyes on your questions. http://felinediabetes.com/FDMB/viewforum.php?f=9

I'm not a dosing expert, but I can answer a few of the basic questions:

• 1. I'm not touching this but others can go into it, except we like to have a lot of data (BG tests) before we shoot low. We post and ask for help in these situations when we are new.
  2. "skinny" or "fat" dose is just shaving a little off the dose or adding a hair, not a full .25unit. There are pix in a link in the new to Lantus sticky.
  3. It depends if you are using a vial or pen/cartridge. vials yes, or you can get negative pressure; pens/cartridges no because they are pressurized.
  4. No shaking!!!

Don't go it alone! Come to Lantus Land. It's a great bunch of peeps and there is nearly always someone there to answer a question.

 

Lantus is dosed in combination with the nadir and preshot in the beginning. It all depends on where your kitty's low point is in those first few cycles. If you will be home to test and feed in case they drop low, then shooting a little lower than 200 in the beginning might be a possibility. If you do a preshot test and they are lower than 200, but higher than 100, you wait 15-20 min and test again to see if they are rising or still falling. If rising, then a shot can be given (in general of course). It is always better to give a big chicken dose rather than skipping the shot all together. BUT all of this can change and be adjusted according to your specific situation. There are no dosing rules set in stone by any means, and everything should be understood with the caveat that *every*cat*is*different*! :mrgreen:

Skinny or fat accounts for slight dose changes that do not equal a complete 0.25u increase or decrease. Those markings on the spreadsheet can also be tracking the times that insulin was pulled into the syringe and an exact 0.25u couldn't be achieved - so if any new pattern crops up in that cycle, the bean can have an idea of what could have caused it.

It is not recommended to inject air into a vial or pen. Lantus is a delicate insulin and injecting non-sterile air into the vial can shorten its life span. Also, flex pens work with a vacuum system inside the cartridge. Some people have noted that once you get toward the last bit of a 10ml vial of Lantus that it can be hard to pull the insulin out due to the low liquid volume left. At that point, I have read of some injecting air in the vial to make the insulin easier to draw - but I would only do this if you are noticing a difference in pulling insulin out.

Lantus is not an insulin that is suspended in any liquid, so it does not need to be mixed or rolled before dosing. Doing so could cause the insulin to go bad early since it is fairly fragile.

 

Ann and Kelly,

Thank you so very much for your answers.

Is it OK to post "general" questions on the Lantus forum?

E

 

Yes, most of the posts are updates on our cats but there are general questions asked. Especially util you get up and running.

 

It is OK to post any kitty health questions, general or not in this Feline Health forum.