8/10 Oberon no am shot; new Lantus for PM; PMPS 404, +2 326, +4 330

yesterday: https://www.felinediabetes.com/FDMB...-416-3-353-6-331-9-362-pmps-370-2-377.233386/

I'm virtually positive that the Lantus has gone bad. Waiting for a call back from the vet for a new prescription. So I'm holding off on this morning's shot, hoping I'll be able to get the new stuff soon and start it this morning. I think that makes more sense than giving him the current ineffective stuff right now at his usual time.

My plan is to start back with 0.5 U; I had just bumped up to 0.75, but since I don't know how he'll react to fresh juice I don't want to take the risk.

 

Makes sense! I hope you get that prescription soon. It will definitely be interesting to see how he reacts to the fresh juice.

 

If you think you won't be able to get the new Lantus today, I'd still shoot him with the stuff you have tonight. If the Lantus was completely ineffective I don't' think you would have seen his #s move at all. His #s did move 85 points yesterday so, smthg's happening. Better to have smthg than nothing in this case. Just my 2 cents Maybe you'll get some more thoughts from the board.
Be good Oberon
Have a great day Lisa

 

I wouldn't wait for a new prescription - better to have some insulin on board - even if it has lost it's effectiveness...which I have never have happen...I saw the discussion yesterday.

If it's been refrigerated the entire time and not allowed to freeze or perhaps left it in the car where it got very hot - it's most likely still good. I have seen however many times when the cat just needed more insulin...and as it turned out the insulin wasn't to blame. I've used all of my vials and pens to the very last drop and have never had one go bad...and I've been through a lot in nearly three years...Lantus and Levimer are now very stable - not like in the old days or some other more volatile insulins. People who take Lantus and Lev carry it around in their purses and pockets for a month - and mistreat it awfully...but then they only have it for a month and either use it all up or toss it...but cats require so much less, we want it to last a whole lot longer.

So generally Lantus will last for quite a long time refrigerated...please Oberon his insulin...he needs it...Skipping doses isn't good unless it's due to a very low number and then it's about safety. Did you get a test this morning?

 

Thanks! I still haven't heard back from the vet, but I called the pharmacy to confirm that they have it in stock, and they'll split up a pack of pens. My plan is to get two pens so I have a backup, and then when I eventually start on the second pen, order the next batch from Canada.

It's now 3 hours past the scheduled 9 am shoot... at this point even if I got the new stuff right now I think it would make more sense to start in the evening so I'm not on a 12 am/12 pm schedule, so I've just skipped the morning shot (unless you think I should go ahead and shoot the old stuff this late). But I'd like to move the time up so I have more time to monitor between postshot and bedtime (12ish). I know the usual protocol is to move no more than 30 min/day or 15 min/cycle, but in this case I feel like I'm starting from scratch. Do you think I could start right off with a 7 pm shoot and then stick to a 7am/7pm schedule? That way I'll be able to monitor until at least +5 overnight (and stay up later if it becomes necessary, of course).

 

Sue, we posted at the same time! I got a BG at what would have been +1 and it was 360. He's been running in the mid 300s for the past few days. Should I shoot now, this long after the usual time? If so, his usual 0.75 U?

 

Shooting now will make it difficult to shoot tonight anywhere near your usual time. If this is going to cause difficulty for you (it would for me)...then it's really too late to shoot now.

 

I can shoot him that late, but staying up to follow up would be difficult.

 

Skip now. Start at the earlier time tonight and then you'll have your new schedule underway....

 

Sounds good. I held off this morning because I was hoping to get the new stuff quickly (hah) and didn't want his first dose of the new vial to be at his usual evening time when it would be harder to track overnight.
Next question: Do I go ahead and give him 0.75, or should I back off to 0.5 since I don't know how much stronger the new vial might be?

 

Your usual dose should be fine.

If the old insulin truly has lost it's potency you may not see any results for a while...changing the dose isn't recommended by your protocol based on switching insulin pens...

Is there a reason (freezing or overheating) that you believe the insulin has gone bad?

 

It's about 8 months old, we lost power for two days (fridge stayed cool but not cold), and I dropped the vial on the kitchen floor. Since then I've pretty much only gotten numbers in the mid 300s. I'm not totally convinced it's bad, but figured the best way to test that would be to get new insulin and see how he reacts to it. In retrospect, I should have used the old stuff this morning, but I was overly optimistic that the vet would get back to me quickly.

 

Yes, we all make mistakes when we have expectations of others it seems. Chalk it up as a lesson learned.

With emergencies, and heaven only knows what going on at the vet's office, there's just no way anyone could expect that getting your prescription called into the pharmacy would be the first thing on their to-do list today...I've had the same happen to me more times that I care to recall...not just with vets but with a variety of servicemen, physicians, pharmacies, etc.

I also highly doubt that dropping your pen on the floor has any effect on the insulin - ask someone who's taking insulin (A human) how carefully they carry their insulin - I know someone who's on Lantus and they toss it around like it's nothing...in the truck...sheesh...with the new chemical makeup of Lantus/Lev - shaking and dropping have no effect whatsoever. As for the fridge - if it did indeed warm up to unacceptable temperatures there's a possibility that affected it - but I left my first vial out on the counter overnight (although it was in my home which wasn't warm, it was room temperature) and it had no effect on it whatsoever. It wasn't until the next day that I found out that it was supposed to be refrigerated at all times...duh...what did I know? I was overwhelmed with Luci's new diagnosis and the price I'd just paid for that insulin and giving her the first shot (at the wrong time of day, no less)...2:30 in the afternoon...so just goes to show you...we all learn...takes time...I'd still hang on to that other insulin before I'd throw it out...just in case...

 

Heard back from the vet at about 5 and he called in the order for me. Picked it up and got home just in time for my target of 7 pm. PMPS was 404, so now we'll see what happens. I also grabbed my calipers from the lab, finally, so now I can measure to estimate what I've actually been shooting (probably not exactly 0.5 or 0.75) and get better measurements moving forward.

 

Paws crossed this is what Oberon needed. Are you using BD syringes too? I ask because I think you saw the posts on Lyla and Butters condo on how to measure with those buggers. I'm sure you've read the calipers sticky written by Marje. I just want to make sure you're comfortable. But, I'm not very helpful with the BDs so I'm kinda useless there....BAAAHHH BDs!!!

 

Glad to hear you've gotten the calipers! Sounds like someone sure does need her insulin...she needs to come down from the stratosphere...

Hopefully soon she'll show you some better numbers!

Have a great evening!

 

Yep, I'm going to reread all that tonight so I'm ready to give it a shot (see what I did there?) tomorrow morning! Using BD syringes marked in half units. If I want to go full geek mode I might take a syringe to the lab later so I can actually weigh out the volume being dispensed and get a really good measure of what I'm giving.

 

Oh yeah....super geek mode!

 

Off we go... down some at +2 and +4. I'm so annoyed with myself for not giving this morning's shot, though.

 

You learn from these experiences. Don't beat yourself up

 

Not too much, but maybe a little. But if the Lantus was still good I can't figure out why his BG went up and stayed up that consistently after I upped his dose. Aargh. And now I'm trying to figure out what the missed dose does to the SLGS protocol... do I start the cycle count over again?

 

Yes anytime there's a missed shot than the cycle starts over.
Just chalk it up as a furshot.(missed shot).

 

Phooey. On the positive side, since I'm starting with fresh Lantus now I won't be constantly second guessing and wondering if my 8 month old stuff has finally gone bad. Better to get that out of the way now, probably.

 

No you're right. No question on the viability of the insulin now. Second problem to tackle...proper dosing with calipers. You're going to get it and do just fine!! Well off to bed for me.
Goodnight and have a great evening Lisa.
Be good Oberon

 

Good night, and thanks!