syringes + Q on U-40 & U-100 dosing

Discussion in 'Lantus / Levemir / Biosimilars' started by julie & punkin (ga), Mar 8, 2011.

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  1. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    Feb 17, 2011
    I want to get new syringes - i've used 30 of this box of Vet One and punkin seems to be hurt by them. We had an initial box that worked fine, but the vet didn't carry them anymore. I'm going to go swap out the 70 remaining i have left, but am wondering if people have any input.

    One kind is Nipro, another is Intervet. Any experience with either of those?

    I read the syringe comparison on the sticky on Lantus info and am wondering if the problems people experienced in 2009 with BD is still happening.
     
  2. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Dec 28, 2009
    Re: syringes

    I order my syringes through Hocks and I use their GNP brand. I've never heard of the brands you've mentioned.
     
  3. Michelle and Mannie (GA)

    Michelle and Mannie (GA) Well-Known Member

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    Dec 28, 2009
    Re: syringes

    hi - I too have not heard of the brands you mention. I buy mine through Hocks.com and currently use the Monojet brand. This is what I use currently: http://hocks.com/hocks-healthcare/hocks ... 40030.html I personally prefer the shorter needle. I use to use the BD brand, which are also ok, but have found the Monojets to be more consistent in their markings: ie, line width, and the accuracy if the 0 mark. These are a fine gauge, and do not seem to bother Mannie at all. Good luck!
     
  4. Jason & Belle (GA)

    Jason & Belle (GA) Member

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    Mar 29, 2010
    Re: syringes

    I use the Relion brand from Walmart. They have half unit markings. I use the 1/2" long needle because I'm more comfortable that I'm getting the shot in correctly. Belle didn't mind them, but Gracie flinches. They are 29 gauge, and they carry 5/16" short needles in smaller gauges. They've been fine for me, and cheap, and Walmart always has them.
     
  5. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    Feb 17, 2011
    Re: syringes

    ah, what they called Intervet is Monoject - same as i was using. so i got some, but i am interested in suggestions still.

    i also am confused about the U-40 vs U-100. I've been using U-40 but I would like the 1/2 unit needles, which i gather you have to have U-100 for. is that correct? is your dosing amount the same between the 2 types?
     
  6. Jason & Belle (GA)

    Jason & Belle (GA) Member

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    Mar 29, 2010
    Re: syringes

    Lantus uses U100 syringes. There is a conversion to/from U40, but 1u U100 and 1U U40 are NOT the same. Someone more knowledgeable will explain in detail.

     
  7. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    May 30, 2010
    Re: syringes

    You definitely should use the U100 syringes or else you will have to convert from U40 which is a hassle. I have used the relion, BD, and the same monoject that Michelle uses and I think the monojects are superior by far of those three.
     
  8. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    Re: syringes

    hmm, well i'll wait for someone to explain about the U-40/U-100 thing. I've been using U-40 all along.
     
  9. Jason & Belle (GA)

    Jason & Belle (GA) Member

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    Mar 29, 2010
    Re: syringes

    You should probably change the title to reflect the U100/U40 question. This is from the FAQ:

    Q3.4. What kind of syringe should I use?

    A3.4. Most people here have been satisfied with BD Ultra-fine U100 3/10 cc, Monoject Ultra Comfort (available from diabeticpromotions.com), or Walmart ReliOn Ultra Comfort. The latter two measure half-units, are manufactured by the same company with different branding, and are less expensive than B-Ds, with ReliOns being less expensive than the Monojects. Get the finest needle possible, which is 31 gauge. Some people have difficulty with the longer (1/2 inch) needles and recommend the 3/8 inch needles to avoid shooting "through the tent"; others experience the opposite problem with shorter needles not delivering the insulin properly, so experiment to find out what's right for your cat. If you're giving a U-40 insulin, either use the appropriate syringe, or use a conversion factor for giving U-40 insulin in a U-100 syringe.

    http://www.felinediabetes.com/insulin-conversions.htm

    Are you supposed to be giving 3 units of Lantus? If so, that seems like a high starting dose and if you're drawing 3u on the U40, it looks like that's equivalent to 7.5u. Since your vet gave you the needles and prescription though, I'd assume he would know better. I'd suggest you buy U100 syringes and confirm with your vet exactly how many units, based on U100, and how often they should be given.



     
  10. Libby and Lucy

    Libby and Lucy Senior Member Moderator

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    Re: syringes

    You're using Lantus in a U-40 syringe and drawing to the 3 unit line, is that correct?
     
  11. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    Re: syringes

    yes, exactly, libby. that's the dose he's been on most of the time. 3 units in a u-40 syringe.
     
  12. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    Feb 17, 2011
    Re: syringes

    oh gosh - i just looked at that conversion chart - and at the bottle.

    the bottle says "each mL of Lantus contains 100 IU insulin glargine, blah blah" so in essence, his dosage that everyone said was a high dosage when we came on, is in fact, more like 7 units BID?
     
  13. Libby and Lucy

    Libby and Lucy Senior Member Moderator

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    yes, it is 7.5 units of Lantus.

    His numbers don't look too bad, so I would like to spend some time studying Punkin's spreadsheet before making a recommendation. Do you have any numbers from before you came to Lantus Land or when you were on Prozinc?
     
  14. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Dec 28, 2009
    Re: syringes

    The difference between a U40 and U100 syringe is the concentration of the insulin. You are best advised to use a syringe that matches the concentration of your insulin. A U40 insulin means there are 40 units of active insulin in each milliliter of liquid. A U100 insulin means there are 100 units of insulin per milliliter of liquid. This means that the same volume (liquid amount) of a U-100 insulin has 2.5 times more insulin in it than a U-40 insulin. Or, the U-100 insulin is 2.5 times stronger than the U-40 insulin.

    3.0u of Lantus drawn in a U40 syringe is equivalent to dosing 7.5u of Lantus. See this chart for more detail.
     
  15. Ella & Rusty & Stu(GA)

    Ella & Rusty & Stu(GA) Well-Known Member

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    Jan 11, 2010
    Hi Julie. That 7.5 units bid seems like a high dose! It reminds me of when Stu (GA) began Lantus after the original PZI Vet was discontinued. His vet didn't know that much about Lantus then and started him out at 5 units bid (in U 100 syringes; he had been getting 5 units of PZI in U 40 syringes); the vet decided that his bg numbers were too high (they were up in the 300s) and raised his dose to 7 units bid. His numbers tanked, but he was peeing all the time, getting rid of the excess insulin. And he looked and acted horrible. With the help of the people here I was able over time to get him on a realistic dose. I don't know how Punkin is feeling or acting, but 7.5 units of Lantus bid seems high. I hope that Libby and Sienne can help you figure out a good dose.

    By the way, Nipro is a U-40 syringe. Stu used them when he was on PZI Vet. They are intended for animals using U-40 insulin.

    Ella

    p.s. I like the U-100 Monoject syringes, 30 gauge, 3/10cc, 5/16 inch needle with 1/2 unit markings. You can get them online from Hocks.com (click on the icon at the top of the FDMB pages.)
     
  16. Libby and Lucy

    Libby and Lucy Senior Member Moderator

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    Dec 28, 2009
    Ok, I spent some quality time with your spreadsheet and have talked it over with another member just to be sure I’m thinking clearly. Obviously we have an unusual situation, learning tonight that Punkin’s dose has been quite a bit higher than we all realized. Normally when a cat changes to Lantus from another insulin, we suggest a starting dose slightly lower than their last dose of the old insulin. Most of the time they end up needing more than their dose of their previous insulin, but we start lower so we can work up to the correct dose and be sure. If Punkin’s last Prozinc dose was 4 units and his numbers weren’t great, I probably would have suggested a Lantus starting dose in the neighborhood of 3 units, even knowing that the dose would probably need to be increased from there. You inadvertently started Punkin on 5 units of Lantus, and have since increased to 7.5 units. Anyway, that is water under the bridge and there is no sense in worrying about it now. Let's just figure out where to go from here.

    First, can you please update your spreadsheet with the actual doses you have been shooting (the 7.5 units)? You can add a note in the Remarks about what happened so people who look at your spreadsheet in the future don’t question why you were at that high dose. Second, if you haven’t already done so, please stock up on high carb wet food (stuff with gravy, and I would go ahead and get quite a bit of it – for my high dose cat I keep at least six 5.5 ounce cans of Friskies with gravy in the pantry, and more than that would not be a bad idea). Also stock up on test strips and never let yourself run too low on them.

    There are a few ways we can go from here.

    • 1. You can reduce the dose, maybe to half of this dose, and see if Punkin is able to maintain his great numbers on a lower dose. Pros – you will be more certain that Punkin is safe from hypo because you will be starting at a lower dose and working up to his breakthrough dose systematically, like the rest of the cats here do. You will have more confidence that your dose is safe because you will have worked up to it, instead of working down from a higher dose. And if it turns out that you do have to keep increasing Punkin’s dose and you end up back at 7.5 units or more, at least you will know for sure that he really needs that dose. Cons – Punkin’s spreadsheet actually looks really good at his current dose. Reducing the dose significantly could result in him losing momentum and going back to high numbers. Once the cat starts spending a lot of time in high numbers, sometimes their insulin resistance builds and it takes longer to build back up to a dose that will cause a breakthrough. If Punkin really is a higher dose cat, taking the time to reduce the dose and work upward could possibly result in him needing an even higher dose of insulin to get back to these good numbers again. Also, if you reduce Punkin’s dose this drastically you will need to be diligent about checking his urine for ketones. Has Punkin ever had ketones?
    • 2. You can keep the dose where it is and let Punkin earn dose reductions when/if he needs them. If you choose this option, PLEASE promise that you will keep posting in Lantus Land regularly (daily) so we can help keep an eye on Punkin’s numbers. Pros – Punkin will maintain the pretty blue and green numbers he has now. He is currently running mostly below renal threshold and not bouncing too dramatically. It is possible that 7.5 really is a good dose for Punkin, and if so then holding this dose will probably be his fastest path to regulation. Lots of people work very hard to get numbers like these, and you already have them. :smile: Cons – it is also possible that this dose is too high. If so, it is possible that one day Punkin will have a major breakthrough. If his dose is much too high and his number goes low, it could be very difficult for you to keep his numbers up. Where you see other people feeding a tsp. or two of high carb gravy to bring their cat’s number up, if Punkin’s dose is too high he might need a lot more, or he might need karo syrup instead of gravy. You would need to be prepared with lots of high carb, syrup, and test strips just in case you find yourself in that situation. Also, many of our cats go into a phase where their pancreas starts to heal and they start racing down the dosing scale. If Punkin’s dose is too high and then his pancreas starts to heal too, his trip down the dosing scale could be a very, very fast one. It seems from your spreadsheet that you have good availability to test during the day, so this can help you keep Punkin’s numbers under control.
    • 3. There are some conditions that cause cats to need higher than usual doses of insulin. Read this link for more information. Usually if we see a cat needing 5-6 units or more of Lantus, we start to think about the possibility of these conditions. That being said, usually the cats in Lantus Land that are on high doses have already worked their way up the dosing ladder according to protocol, so we know they really do need a high dose. With Punkin and the way he arrived at this dose, I’m not yet ready to say “Julie, you need to have Punkin tested for acromegaly and IAA.” If you want to test, though, the tests are relatively inexpensive (except FedEx charges!) and would tell you for sure if this dose might be in the ballpark. When I acquired Jazzy as a foster, she was on 7 units BID of PZI and not responding much. Her dose had not been arrived at systematically, so her situation wasn't really very different than Punkin's, but I went ahead and did the tests anyway just so I would know what I was working with. It gave me a lot of peace of mind, but I know I'm not like most people. :lol:

    Whatever you want to do, we’re here to support you. We have helped people through dropping the dose and starting over, we have helped people with cats with acromegaly and IAA, and we have also walked people through the wild ride down the dosing scale. We had one cat who went from 6 units BID to OTJ in a little over a month!

    Questions? Concerns? What feels right to you?
     
  17. Libby and Lucy

    Libby and Lucy Senior Member Moderator

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    Dec 28, 2009
    ps: You're not the only one who has done this. Here is Tracy/Pumpkin's spreadsheet from a couple of years ago. Tracy chose to reduce the dose, and after a couple of false starts Pumpkin did well on a lower dose. The decision is up to you!
     
  18. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    Feb 17, 2011
    wow, well i admit i feel absolutely sick about this. i definitely will talk to the vet tomorrow - this was a huge, huge error on his part. my neighbor has a diabetic dog and goes to the same vet, and he told her to go to his partner because the partner is better with diabetes. sigh.

    but from here on . . . i think #2 "feels" best to me. I'm not working at the moment, so can work everything around him. My greatest fear about this choice is about nights. if his pancreas begins to heal and he starts to plummet, i've seen how quickly these numbers can go down . . . i guess i'm assuming he could die overnight while i'm sleeping. The cats sleep downstairs in our house and we sleep upstairs - so they don't wake us up at 5am.

    i don't know if he's ever had ketones or if the vet even tested him for them. i haven't. when he got sick the last week of November, i would say his breath did have a bizarre smell to it that might have been that. Clearly I need to get the supplies and test him. he is a "secret pee-er" and he's seemed pretty well, so i hadn't felt an urgency to it. now i do. i'll try the litter box of lentils with test strips handy and just see how it goes.

    i have read the stuff on Acromegaly and IAA, just in reading other people's posts. i'll reread it.

    and i thought the diagnosis was overwhelming. :shock:
     
  19. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    just saw your last post - i'll look at Tracy & Pumpkin's SS.

    so libby, which direction would you go if Punkin were your cat?
     
  20. Libby and Lucy

    Libby and Lucy Senior Member Moderator

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    :lol: I knew you would ask what I would do! When I brought Jazzy home, she was on a dose of 7 units of PZI. I knew some of her history (she is a foster kitty for a rescue with which I volunteer, and I had tried to help her previous foster with dosing but he wasn't a very good listener!). I knew she hadn't been tested much, but I also knew she had been on doses as high as 10 units without much change in numbers when they did decide to test. On the other hand, she was living in a group environment, caged at night and out in the open with up to 20 other cats during the day, and she hates other cats. I knew there was a chance her numbers were high because of stress. Really I was fairly sure she was an acro cat, but those other factors gave me just enough doubt that I wanted to be sure her dose was ok.

    What I did was switch to Lantus, reduced her dose to 3 units, then increased her dose aggressively until I saw some movement in her numbers. I increased by 0.5 unit every 4-6 cycles until her numbers started moving. The big difference between Jazzy and Punkin is that Jazzy's numbers weren't good, and Punkin's are. Either answer is fine, really. If you do reduce the dose, then be aggressive about increases if the numbers start to backslide. If you hold the dose, be aggressive about testing so you can learn to anticipate any lows and deal with them before they become problematic. We can help you with that.

    I also want to be sure you understand that I'm not saying that any of these scenarios WILL happen. You just need to be aware of what CAN happen. We often have cats come in here on high starting doses. Some keep the dose, some reduce the dose, but they have all turned out fine because we work hard to be sure people understand what is going on with their cat.
     
  21. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Most of us do sleep at night! Maybe not all of the night and sometimes it's not the best sleep but we manage. When a cat is going down the dose ladder, you do have to make some sacrifices in order to keep your kitty safe. That said, you will learn what the signals are when Punkin's numbers are running low. For example, Gabby will follow me into the kitchen and stare at her bowl, at me, at her bowl, etc. until I get the message. You'll also know when to test in order to catch those drops. While it sounds scary, you'll learn how to steer numbers using HC food. We all do it and it really does become second nature. What you can't do is shoot low and go to sleep.

    Definitely pick up some Ketostix. An acetone/alcohol smell on a cat's breath is a sign of ketones. Ketones are not something to be messed with since they can be life threatening.
     
  22. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    haha, it's good to be predictable! i knew i'd have to ask you that - because when you are new and someone else is experienced, you're a fool not to ask them what they would do!!!! i did notice you didn't answer! :D or maybe you did - when you said you dropped Jazzy's to 3. I guess i was thinking of the 1 unit that most people start with as a "new" beginning shot.

    somewhere in the past few weeks i read the details of the Roomp Australia study - and i do recall seeing some cats went as high as 10 units BID. I noticed it because everyone was reacting here to him having 3 units BID (supposedly 3) and I thought that seemed odd because of what i'd read in the study. i'll look again and see if i can find it.

    he's turned into a maniac about the shots. not sure what to do about that - he's mad before we even start. how do you burrito a cat when you need to get at their body? tonight he jerked again after i started giving it to him and the needle came out. i regrouped and put it in again, and he did it again. i suspect the last of the insulin didn't go in him.

    i think i'll carry on tonight and tomorrow morning and have a convo with the vet in the morning.
     
  23. Libby and Lucy

    Libby and Lucy Senior Member Moderator

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    I'm not answering the question because I don't really know what I would do. A lot of it is gut, combined with what we have learned from experience with our own cat and with others' cats. Now that I know my gut was correct with Jazzy, and she DID actually need the high dose, if I had it to do again I would probably trust my instinct more and stay with the higher dose. Most of us don't have the benefit of hindsight, though, and I had only just gotten Jazzy so I didn't know her at all. My gut says Punkin is ok at this dose for now, but that you could be in for a wild ride. I'm known for being aggressive, though. ;-) He's your cat, so pay attention to what YOUR gut says too.

    FWIW, in Lantus Land we are not as afraid of 3 unit doses as some parts of the board. We have plenty of cats on that dose and higher. We DON'T usually start at that dose, though, we work up to it. But I wouldn't reduce Punkin all the way to 1 unit. You would lose too much progress that way, IMHO.

    Bedtime for me, but I'll check in tomorrow for your questions. Good night!
     
  24. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    Feb 17, 2011
    Sienne, i missed your post earlier. I feel very "in tune" with punkin. all cats are lovable to me, but some cats you have a special-ish bond with. He's like that. The only thing that makes me a little nervous is that when he dropped to 34 last week he showed no hypo symptoms at all. I don't know if there'd be any way i'd know what was going on with his BG except by testing unless it dropped even lower.

    Punkin does act like he wants more food - a lot of the time. i don't have a clear picture of whether or not the 3 cans a day of fancy feast is enough for him. i've held him on the human scale and think he's still around 13-14 pounds, but am thinking maybe i'll run him to the vet's tomorrow just for weighing. in general, he seems fairly normal - what i would've said was normal pre-diagnosis.

    i reread the stuff on Acro, IAA and Cushings - he doesn't have any of the red flags for the 1st & 3rd - the IAA doesn't mention symptoms so i don't know about that one. other than the diabetes and the previous occasional bladder infections he hasn't had any illness and doesn't have any weird symptoms. i've always had a cat, and while i'm not a cat expert, he behaves normally for his age as far as i know cats.
     
  25. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Dec 28, 2009
    I'm so glad you're doing lots of reading! If you take a look at Dr. Lisa's site on feline nutrition, she gives a formula for calories per day in the section on obesity. That should help guide you in terms of how much to feed. There's calorie counts on Janet & Binky's list for most of the commercial foods.

    Most cats don't demonstrate symptoms of hypoglycemia when their numbers drop into the 30s. Gabby's been in the high 20s and been completely asymptomatic. I wouldn't want to leave her in those numbers for any length of time but it's happened. If you read the note on handling low numbers, you'll see that we do have you testing a good amount in order to insure that you don't inadvertently leave your cat in a situation where numbers would drop.

    There are two things that give you control over low numbers -- testing and food. It's why Libby was stressing that you always have plenty of strips and HC food on hand.
     
  26. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    Feb 17, 2011
    i'm reading ad nauseum. seriously, i've read everything on Dr. Lisa's site on feline nutrition - and according to calories he should be having 4 cans a day of the Fancy Feast to support 14 pounds. He seemed like he was getting heavier.

    i've read the notes on handling low numbers & shooting low numbers - they're attached to my sig line in case i need to find them quickly.

    going to test him now. i'll start a new condo for the day.
     
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