23/2 Chik AMPS 311, +7 257, PMPS 257

Hi everyone! I’m new here so wanted to ask for advice

My Chik was diagnosed this February and we’ve been on 1u Lantus for 5 days but his numbers aren’t that different from what I took before starting the injections.

I wanted to start increasing the dose to 1.25 but the syringes I bought are so tiny that it won’t be possible to position the plunger tip between 1u and 0.5u.

I’ll try to buy other syringes tomorrow yet I don’t know whether it is OK to increase his dose? I read the protocol at tillydiabetes and it seems I do need to increase. What bothers me is that at our first visit to the clinic the vet told me to keep Chik in 252 (14 mmol) range but she’s not responding on the phone and after all the purchases I can’t afford another visit to the vet until March.

I would really appreciate any advice and opinions on our case

 

Hi and welcome! You are in the right place. I'm still new (2 weeks) and can't answer your specific question, but wanted to share what I've discovered with syringes here in the US. Most often you find either U-100 3/10cc syringes that are

• 29G (thickness of the needle) and 1/2 inch (length of the needle) that have 1u markers, e.g UltiCare
  
• OR 31G and 5/16 inch (shorter needle) that have 0.5u markings e.g. Surecomfort from adwdiabetes.com

I found the shorter length needles more difficult to use. I had to search for a long time to find the longer length needle with 0.5 markings but eventually found these online, waiting for them to be delivered.

• 29G and 1/2 inch long that have 0.5u markers. I ordered these SOL-M Insulin U100 Syringe with HALF UNIT markings - bags of 10 or box of 100

I see you are in Ukraine so these websites might not be convenient for you but wanted to share what I learned. The shorter needles were too difficult for me to use!

Good luck!

 

Welcome! First post I see! Great job getting your signature and spreadsheet set up already.

Oh the vet. My vet was happy with anything under 16 mmol, so I understand why you are so bothered because I was too! I personally decided to take the advice of experienced people here rather than listen to my vet because I want butters to be in healthy, normal numbers. Folks here have decades of expertise with diabetic cats and they always will put safety first when suggesting anything relating to dosing. Chik is your kitty so it really is your decision what you want to do. You certainly don't have to listen to the vet. Many of us just tell our vets what we are doing on a "need to know" basis. I have a new vet now and he is very supportive of how I'm managing Butters and I just share my spreadsheet with him every now and then.

I encourage you to read this post on dosing methods and have a think about whether you'd like to follow Tight Regulation (similar protocol as the one on Tilly's site) or Start Low Go Slow. You can post your numbers daily if you wish, and people will help you. Another one, if you haven't read already is this sticky: new to the group? start here. It addresses topics such as the definition of "regulation', what a typical cycle looks like on Lantus, and other useful topics.

Syringes with 1/2 unit markings on them are the best you're going to get. None exist with .25u markings. If you can, I'd recommend getting a good magnifier and bright lighting. Although not necessary, many people on here (me included) use calipers for dosing. You don't really need to worry about the lines if you use calipers. Just a thought, perhaps to consider later once you are more comfortable.

As to whether you should increase, I don't give dosing advice but I have a few observations about your spreadsheet, for you to consider:
-It's great to see you are testing before every shot! That is critically important.
-You need more data (BG numbers), especially at night when you have none. Monitoring the nighttime cycle is at least as important as the daytime cycle, maybe even more important because many cats go lower at night. Start filling in the holes in your spreadsheet with data so that we start to get a fulsome picture of what the dose is doing to Chik's BG numbers throughout the cycle. Example: one cycle, I might get a +2, +5, +8. The next cycle, maybe a +4 & +7.
-Could you get into the habit of getting a+2 on each cycle? The reason is: Lantus onsets around +2 for most cats. A +2 should give you good data on how much more you'll need to test each cycle:

If the +2 BG is lower than the preshot, it will likely be an active cycle meaning kitty will drop lower so you will need to test more.
If +2 is similar to preshot, it will likely be a typical lantus cycle and there should be a nice, slow dip and then a slow rise.
If +2 is higher than preshot, kitty may be going into a bounce and this will be a cycle that likely does not require much testing at all. ​

-For nighttime cycles, we often recommend a+2 and then a before bed test at the very least. You'll be able to tell from those numbers whether you'll need to stay up and test more.

These are my initial thoughts. I'll tag @Wendy&Neko and @tiffmaxee and @Gill & George . if they are around, they may offer opinions on what to do with Chik's dose, or whether you should hold and continue collecting some more data first.

 

Hi Anastasia, and welcome to the Lantus forum! You've landed in the best place for you to get help to make your adorable Chik feel better. Lyla did a great job explaining the importance of testing and how it can help you with dosing. I also had a lot of trouble seeing the tiny lines on the syringe and found the following image and magnifiers to be of great help:

 

Welcome to LLB, the best place for a diabetic cat and CG. You need to hold the starting dose for 7 days to build the depot no matter which method you follow. Many cats drop lower at night so some night checks are essential. The first time you see a +2 lower than the PMPS it’s a good idea to get a before bed test and if still decreasing set an alarm for a test at +6-7 to see how low the bg is going at night. It’s great you are testing. A few extra tests will give a better picture of how dose is working. Keep asking questions. Reading the info Lyla suggested will help but there’s a steep learning curve. So probably the more you read the more questions you will have.

 

Hello and welcome to you and your sweet Foldie.

What brand of syringe are you using? If the BD Ultraine (which are common in Europe, and also Canada where I am) there is a paper ruler you can use to help you measure smaller doses. Insulin ruler template for use with BD syringes: https://www.diabetes-katzen.net/insulinruler.pdf

The starting dose of Lantus is help 5-7 days to build the depot. In that time you want to see how low the dose is taking the cat. Spot checks and/or a curve are helpful to determine what that is. As the others have said, we don't have quite enough information yet to see how low he is going, and those night time tests might help us figure that out. If you want to follow what is at tilleydiabetes site, that is what our Tight Regulation Protocol describes.

 

Thank you all for the replies!

Yes we do have BD syringes here but they are called micro fine. The ones I bought are 0.3 cc (ml) BD Micro-Fine plus, there were no 1 cc (ml) at the pharmacy. I’ll try to get 1 cc (ml) ones.
The reason I’m not testing him that often is because he’s such a notorious kitty it takes 2 people to restrain him to test the BG He is that type of kitty who wakes up and leaves even if you just go and sit next to him on the couch. So the whole process is very stressful for him
I’ll try my best to get some data after the pm shot for a better insight. +3 is the latest I can do, so I guess I’ll do +2 the one day and +3 the next day. As for the daytime cycle, I can test him in the first half of the day only on weekends

 

This is the one you want. It is a 30 unit (0.3ml) capacity and has 1/2 unit markings on the barrel. You don't need the 1ml ones.

 

Thank you, Bandit's Mom! Those syringes are exactly what I bought