? 5-27, Learning Lantus, many questions

Hi all,

We are new to Lantus having just switched from Caninsulin on May 18, and I am still taking in all the information.

Coming up right now, if the preshot is lower than normal, by about 100 what do I do? It's 243 on the Libre right now, she ate about an hour ago. Just retested and it's going down, at 230 right now. Have not given the shot yet.

I am waiting. This is totally messing up the scheduling. I needed to get us earlier not later...


Thanks!

https://www.felinediabetes.com/FDMB/threads/new-member-may-2-2023-lantus-dose-changes.277877/

 

Here’s your previous post for continuity.

https://www.felinediabetes.com/FDMB...on-one-emotional-support.277805/#post-3074732

When there are multiple posts we don’t get the full picture and also if one gets too long. A new post is not needed each day on main. When it gets long you just start a new one and link the old one.

The bg is not low. You can shoot any bg 200+. Reducing would be a mistake. Your +10 is 239. Nice and safe to shoot. Add the pmps when you get it if not 200+.

 

I messed it up. I can't believe it. Again a fur shot. And she was lying still all relaxed purring, I slipped the needle in easily, but it must have come out the other side somehow because the insulin was all over her fur.

This is getting insane!

It was going so well. How much will this mess up the process with the depot and everything?

 

Try and take some deep breaths. Maybe sing something soothing as you inject. That might sound silly but it helps many. I get it’s scary. It was for all of us. But if you follow advice here and have all the necessary supplies it will become second nature.

When you start a new thread put the date of the new thread in the subject bar or people will think it’s an old post.

 

If I keep messing up shots like this we'll never get anywhere. Now her BGs are going up of course. She's going to be so uncomfortable tonight. And she'll be kicking her Libre bandage more.

How much will this alter the Lantus progress?

I get nervous more than anything about missing the shot, but also about not scaring her because the calmer she is the easier it all is. it was perfect, she barely felt it, and she stayed still, happily purring. But the position and angle wasn't right. That needle is so small you just can't tell where it is. And she has so much long fur.

I was already tense to begin with waiting to see if it was ok to give the full amount. And other things are making me tense around me here at home. Maybe I felt rushed too because it was late. So, that's how it went.

Also, I still don't feel confident holding the syringe and getting the trajectory right and pulling up the skin just the right way without freaking her out...sometimes it goes well, other times not. Not consistent enough yet.

I'm so upset right now. I was so happy we had done it in a relaxed easy way. It seemed so perfect. All I can do is wait until the next shot. I guess I can't anticipate that either, right? I mean by a half hour or an hour since we got so late.

 

But the date is there under the title, isn't it? If I put the date in the title (that's what you mean, right?) then what about the new member date, isn't that too many dates?

 

What is the length of the syringe needles you’re using? I feel like this is more likely to happen with long needles. I like to use the shortest possible which is 6mm. And are you using a light source aimed at the spot so you can see where the needle is going? Also try to get it in at as close to a 45 degree angle as you can so the needle is aimed down a bit. Lastly, make sure you have pulled enough skin and have a good tent there for the injection.

you can’t shoot again so the only thing you can do is start fresh tomorrow. She’ll have higher numbers because of the skipped shot. It’s happened to all of us and with practice it should happen less and less frequently

 

You can move up the shot since you missed, yes. That’s actually the best opportunity to move up the time of the shots. I would guess you don’t have enough light if you’re saying you can’t see the needle going in. I became so obsessed with never doing a fur shot again that I hold a small flashlight in my mouth aimed at the spot. Some folks here will use one of those hiking forehead lights. Also to try to part the fur with your fingers till you see the skin and then inject on that spot. Some folds here will have their vet shave a small spot so they can see better when they’re giving the shots. Maybe something to consider.

 

Hi Stefania what Elise means is that when you do a new post like this one the Date above should be 5-26 because you are talking about the tests you did today/tonight
You can go back if you want and put 5-26
To do this look to the right and you will see the word Thread Tools click on that ,then click on Edit Title. Delete May 2, 2023 and just put 5-26 then tap Save or Done

Now when you post tomorrow you will put 5-27 in your title
and then link your last post you did which will be this one which will be _5-26 once you fix the date up top

To find your previous posts you would click on your picture of Jessi then click on
Profile Page and then click on the word Postings you will see all your posts that you did so just look for the one from the previous day
When you see it just copy and paste it to your new post

It will be the post all the way up top in that long line above that pic of that cat on the left hand side just copy and paste it to your new post

You would do this every day so if members want to read your previous post rather than searching for it all they have to do is click on it

I hope this helps
@Stefania S

I know it must be around 4:30 AM in Italy so you can correct it tomorrow when you get up

 

I had a headlamp on and I did what you are saying, parting the fur and seeing the skin. I did see the needle go in. What I didn't see was that the needle must have gone through the fold of skin to stick out the other side, you see? It definitely went in, but the angle was wrong so it poked out through the fold of skin and squirted onto her fur. I do need to practice the angle more.

As I think about it more, I realize that almost every time I missed a shot, unless it was because she suddenly jerked away, it was when I was trying to shoot in a different area, like on the side, instead of on top just under the shoulder blades, which works every time.

Sometimes I'm able to do it, the shot goes well one the side, (I'm talking about on the side just behind the front leg or shoulder) but often those are the times when something goes wrong.

Conclusion? Don't try to vary the location? Or just keep practicing until you get better at it? Or maybe wait until things are more stable and you've gone the 7 days before trying to vary the shot location?

 

I went from hating the spreadsheet to being obsessed with it! I keep wanting to plug in all the numbers. LOL!

Still so freakin nervous though. Nervous when they go up, nervous when they go down fast... What kind of a crazy roller coaster ride is this y'all?

Anyhow, shot went well today, thank goodness. Numbers dropping fairly quickly so I'm watching: 163 @+3

The sensor is my savior. I know you recommend ear pricking and I have that in mind as a goal one day, but right now, without the sensor I would be lost. Once the shots are consistent and I'm feeling more confident about that, and once I have a much better sense of how Lantus moves through her system, I may turn my attention to ear pricking, but for now, I need this little machine to keep working! It gives me time to learn, study, practice, learn....so much to learn!

Yeah, I definitely need to work on the injection technique more. I'm thinking I should practice on her with a capped syringe in calm moments far from injection time instead of waiting until the adrenaline rushing moment to practice.

I am using the Microfine BD U-100 .3ml syringes, always have even for Caninsulin. Should this go in my signature, or on the spreadsheet?

 

Questions about Lantus:

Feeding: How often and how much? I thought with Lantus free feeding, or feeding frequent small meals, 4-6, would be ok but I see some people saying meals should be more limited. I always leave at least 4 hours of no food before shots. But Jessi seems to do better with frequent small meals, overall I was doing 4 a day before changing to Lantus, now I'm doing more.
Because I usually feed her at around +5/+6 that probably affects the nadir, right? I'm pretty cautious so I would prefer to feed her during that time, aside from that she is usually hungry by then. But should I try not feeding and see what happens? Is there a benefit to that?

Why when a preshot number is lower than normal does it say to not feed and just wait? What's wrong with feeding to get the preshot up more?

Should I be including meals and snacks in the spreadsheet? times and quantities?

scheduling: it says not to change more than 15 minutes at a time. Will something bad happen if we move the time a half hour or and hour?

nadirs: what is a good nadir with SLGS? Above 90, below 200?
If nadir goes below 90 we decrease by .25 but what if it goes much farther like to 50? decrease even more?

I still don't get the depot and how that translates into my cat's glucose numbers. I read the bit about it in the What is the Insulin Depot page but it's not enough for me to fully understand. I guess hands on experience will be the real teacher. It kind of scares me because it feels unpredictable. I welcome any deeper insights into the inner workings of Lantus.

 

Are these the ones you are using if so they are fine to use you don't have to put it anywhere only if you want to ,if you can fit it in your signature fine

One other on your spreadsheet up top above where it asks you what insulin can you get rid of 1.5 and put the date diagnosed that you have in your signature 4-11-2023

 

I'm going to tag Elise and Ale for you only because I stink at explaining certain things
@tiffmaxee @Ale & Bobo & Minnie (GA)

 

I can tell the length of those needles but a quick Google search makes me think they’re 8mm. It’s not terribly long if that’s the case but the 6mm are even shorter. Yes, I understood what happened the first time and it’s happened to me before but because I didn’t have enough light. I agree best to stick to the positions and angles you know are working right now until you get more practice in.

 

I can’t tell the length of the needles, can you?

 

You can feed as much as you want and as much as she needs. The only rule is no food at least 2 hours before the preshot tests. It’s also a good idea not to feed a lot after the nadir at +6 since Lantus will start to wear off usually after the +6. I always just did small snacks so they wouldn’t go too long with no food after +6.

The reason for stalling and not feeding and retesting in 20 minutes is to see if the bg is going up on its own without food. It’s it is, even though it’s a lower preshot you can feel fairly safe to shot. When this happens, you should post and ask for advice. You want to indicate in the thread title the lower amps number and say you’re stalling and need help.

No need to include info about food unless it’s for your own records. I would enter that under notes when Bobo had a low bg number so that I could remember what types of food helped bring it up and note that for next time.

the reason for not adjusting by more than 15 minutes increments is because again, Lantus requires consistency in dosing and timing. A late shot functions as a reduction and an early shot functions as an increase. You don’t want that.

the ideal range you want your cat at for as long as possible is the healthy range so you’re aiming for 70-120. A good nadir is typically in the green range which is under 100 and above 50. Again, all dose adjustments are done by 1/4 unit so no, you don’t decrease more if the cat goes under 50. Under 90 in SLGS, cat earns a 1/4 reduction. It doesn’t matter what that number is as long as it’s under 90.

I don’t know as much about the depot so I’ll let someone else explain it. It’s not something you need to worry about. I think of it as a reserve the cat’s body can draw from if needed like when a shot is skipped for example. Like fat stored in your body for the winter

 

Yes 8mm maybe that's all she can get since she's in Italy
@Ale & Bobo & Minnie (GA)

 

@Ale & Bobo & Minnie (GA)
Thank you

 

I did a search on our group and found this posted by some members
Maybe this will help to explain the depot

I copied it for you
Lantus naturally creates a 'reserve or depot' it does this at whatever dose you are at. So when you reduce from say 1.25 to 1. For up to 6 cycles the depot that was created at the 1.25 is still at play. It takes a little time for it to 'drain' to the new lower reserve of new lower dose. Does that make sense? I'm sure there is a better way to explain but best I could come up with LOL

Here is how another member explained it
I’m trying to think how to explain why the need for consistency. Think about the depot. Every time you shoot a lower dose, the depot is depleted a bit. Then you shoot a little more and the depot starts to rebuild- then at night you shoot a little less again— but the depot still influences at least the first part of the cycle anyway.

 

In response to your questions:

Feeding: Aside from feeding at shot time, you can feed when it makes sense for your cat and as much as she needs to maintain a healthy weight. As you are collecting data, the numbers will help guide you. For example, with Lantus, most cats experience onset (when the insulin starts to work) at about +2. Nadir is in the neighborhood of +6. However, some cats routinely have an early or late onset and nadir. My cat had an early onset and nadir. As a result, I front loaded her food -- she had her pre-shot meal and then I fed her at +1 and +2. Her nadir could have been as early as +3. Your cat is likely to be different so you can base when you feed Jessi on what the pattern of her numbers tells you and if Jessi likes to graze.

Scheduling: What you read about scheduling may not have been the full picture. If you need to change shot time, you can move the time by 15 minutes at each shot time (i.e., twice a day) or by 30 minutes once a day. If you've missed a shot, like with a fur shot or because numbers were too low to shoot, you are not bound by that rule. You will likely notice that there are posts about daylight savings time beginning or ending. This affects most of us in the US. Those are times when we make sure people, especially those using glargine or Levemir, have ample time to move their shot times due to the time change.

Nadirs: There isn't a good or bad nadir. The nadir is the point in the cycle where you see the lowest number. The reduction point is not exactly the same as the nadir. When you are referring to a 90 on SLGS, that's the point at which you take a reduction. It doesn't matter if the numbers go lower. Once Jessi's numbers drop below 90 on SLGS (or 50 with TR), you reduce the dose by 0.25u. As a general rule, the amount that numbers drop doesn't affect the size of the reduction.

Depot: This can be a hard concept to wrap your head around! The way glargine works, every time you give a shot, the insulin forms microcrystals that are deposited in the fat tissue. Over the course of the cycle, most of these crystals slowly dissolve. However, not all of the crystals completely dissolve. As a result, not only does this give glargine its long duration, it also creates overlap between the cycles. The depot is constantly being depleted over the course of the cycle and restored every time you give a shot. As a result, you don't always see the effect of a dose reduction or increase during the cycle where you made the change because the depot hasn't yet caught up to the dose change.

 

Honestly, I have no idea what you all are telling me to do. Elise, it sounds like you (and others) are saying I shouldn't have too many posts and I don't need to start a new post each day and then, Diane, you are saying I should start a new post each day with the new date and link the old one so the posts don't get too long...these seem like the opposite actions to me, please clarify. I am having to spend a lot of time on housekeeping which takes away from learning the essentials and taking care of Jessi. If things like this could wait until I have gotten important questions answered, I would really appreciate it.

But if not, then please state this in a way that I can understand and that doesn't seem as opposite instructions to me. thanks!

 

No more than one condo each day.
You can post as many times as you want but use the same condo. If you have more than one condo in a day no guarantee all will read them all.
You can post for more than a day on that condo but if it gets too long no guarantee anyone will read all the posts.
That’s as simple as I can make it. Make sense? Now I need to continue with my day.
I hope this helps.

 

There are different posting guidelines for the different forums. What Elise is explaining goes for the main health forum which is where you want to post until you know what you’re doing a bit more.

once you start posting on the specific insulin forum, which for you will be Lantus, then you’re asked to post once a day and indicate the actual date on the title, something like 5/26 Bobo AMPS 72 and so on and so forth. Don’t worry about this now since you’re not there yet.

just a gentle friendly reminder that we all have busy lives in addition to taking care of our own diabetic cats and helping all the other new members here. We’re all going to explain things differently because every person is different just like our cats, but we still took the time to do it. This is a collective of volunteers. Thank you!

 

I think @tiffmaxee , Elise explained it perfectly
What I was trying to explain is if you have a totally different question then I would start a new thread or if you want to call it a post and put the Date then Jessi and ask your question in the title and then you would link your previous days post to it.
I myself like to put the Date no matter what forum I posted on
We are all just trying to help you
Elise also explained it in her post #4 which was

When you start a new thread put the date of the new thread in the subject bar or people will think it’s an old post.

 

YoYo numbers today at nadir time

What’s going on?

I don’t even know how to enter all this in the spreadsheet

Maybe I’m just over-scanning, but I usually do this around nadir time and I haven’t seen this before.

 

Thank you and there is no need to remind me. It sounds like you are saying I am not appreciative enough. Which is not the case. I have thanked and thanked and thanked again people for helping me. Just because I experience overwhelm and confusion, trying to sift through all the information and all the different styles of communication, doesn't mean I am not appreciative.

 

Yes, there is a need to remind you because some of your posts read like you’re directing your frustration at us and I can’t speak for everyone else but I don’t appreciate it. I thought it was just a beginners thing but you keep doing it so it’s clearly a you thing. They sound like someone taking to people they’re paying to do a job and that’s not at all the case here. I have way better less irritating ways to spend my time so here’s what’s going to happen, I’ll leave it to others to help you moving forward.

 

I do feel the same way that @Ale & Bobo & Minnie (GA) feels.