? re Toujeo, insulin pens, Libre

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Yvonne & Simon, Mar 30, 2021.

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  1. Yvonne & Simon

    Yvonne & Simon Member

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    Mar 30, 2021
    Hi all.
    New member here. My cat Simon was just diagnosed with diabetes last week.
    History: 15 yr old Siamese, neutered male. Had one high blood sugar (33) discovered incidentally during vet appointment 2 yrs ago. Vet felt stress induced. I checked his BGs carefully at home and the BG normalized after three days. Has been normalish since (BGs ranging 4-8) on human meter. Oh, and I am in Canada so use SI BG monitoring units.

    Has been vomiting for years, increased frequency over the past year. Vet did ultrasound and diagnosed inflammatory bowel disease. Started him on Budesonide (steroid with the least systemic effects) with some trepidation on my part. She felt that since it should have a fairly localized action in his digestive tract, this would lower his chances of getting steroid induced diabetes.

    Bloodwork done at this time and was surprisingly good for a 15 yr old cat. Just mild renal impairment, normal thyroid, and liver enzymes mostly normal.

    Went home and over the next week gradually titrated the Budesonide dose up, and at a full dose the vomiting resolved and he was clinically looking and feeling better. Gaining weight (a good thing).

    Unfortunately, five weeks later, I noted increased lethargy, excess drinking and urination, and then significant wt loss and dehydration. Checked BGs and yup they were elevated (about 18-20).

    Took him to vet the next day where he was started on insulin and received IV fluids (ringers) for two days. Budesonide stopped. Sent home with twice a day insulin. BGs still in their 20's at the time of discharge.

    My issues:
    Put on Toujeo (concentrated Lantus) in an insulin pen, which of course will only do full units at a time

    Cat is a SUPER SUPER fussy eater. Will only eat kibble. After his first high BG two years ago, I tried for a full year to convert him to canned food. Tried everything. 100s of varieties, raw and plain protein sources (hard no!), etc. After he nearly starved and lost 2 lbs body weight (and he wasn't overwt to begin with) I realized he is so stubborn he'd rather die than change foods. So transitioning to canned has been incredibly unsuccessful. Vet has given me Purina DM canned. No way. Trying Hills m/d dry. He'll nibble a bit. Did eat some canned C/D. But intake has been quite poor since the onset of the diabetes.

    Unfortunately vomiting has just started again :(

    BGs have been quite labile and trending high. He was started on 1 unit of the Toujeo twice a day and has now been upped to 2 twice a day. BGs ranging around 20.

    I am monitoring with a human meter (One Touch Verio) anywhere from every 2-6 hrs. I did a curve by checking every two hours a couple days back and see that nadir for him appears to be about 8 hrs.

    I realize that a human meter reads low compared to an Alphatrak but prefer not to go that route if I don't have to as am hoping with steroid withdrawl his BGs will normalize again. So ideally would prefer not to have to make the investment in that meter which vet has advised me will be about $150 with $2/each per strip, especially at the rate I’m currently checking his BGs.

    Each time I bring cat in to clinic, I have checked my meter to theirs and it has consistently been running about 20% less than their Alphatrak.

    Since I just joined this group this morning, I have not had time to create a google spreadsheet as recommended here, but till now, have been monitoring everything very carefully with my meter and its associated data gathering ability/spreadsheet/graphs etc. No real firm trends can be evidenced yet as far as I can see. But as soon as I get a chance, I’ll do up the spreadsheet as recommended.

    Vet is optimistic that if we get his BGs down, he will hopefully go back into remission. I had been checking his BGs right up to when he went on the Budenoside and they were normal right up to the the month prior. He was on the steroids for approx 6 weeks, only.

    My questions are:
    1. Is anyone using Toujeo insulin?
    2. Is anyone using insulin pens on their cat? Or does the fact that they have too little adjustment ability (since are only in 1 unit increments) preclude their use? Frankly I do prefer this method as compared to drawing it up with a syringe and as I understand, the dosing tends to be more accurate.
    Addendum: I did a search through the site and see that for half doses folks are using the pen as a vial and using the small insulin syringes to draw up in half unit increments. I can certainly do that if necessary.
    3. I am interested in trying the Freestyle Libre continuous glucose monitoring sensor on my cat, and have purchased one. Brought it to the vet clinic and was told by them that they wanted no part of using it. Has anyone tried it, and if so what was your experience, and any words of wisdom?
    4. Anyone else had experience with Budesonide withdrawl and how long did it take?

    Sorry for the lengthy story!
     
    Last edited: Mar 30, 2021
  2. Larry and Kitties

    Larry and Kitties Well-Known Member

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    Dec 28, 2009
    See these previous threds:
    https://felinediabetes.com/FDMB/threads/toujeo-anyone-experienced.223825/
    https://felinediabetes.com/FDMB/threads/lantus-v-toujeo-pen.173102/
    https://felinediabetes.com/FDMB/threads/toujeo-insulin-from-lantus-maker.156324/
    I used a pen for my high dose cat (25 units twice daily of Levemir) 1-unit increments were fine. For low dose frequently less than 1-unit increments are required. Also, priming the pen wastes 1 or 2 units each time. Further, I found that my thump on the pen button was far away from the needle which made it awkward to inject using the pen.
    Yes, see:
    https://felinediabetes.com/FDMB/threads/results-of-using-libre-on-my-badger.212928/
    Subsequently I used two sensors on my wiggles but those only lasted 9-10 days.
    No, on all cats I used it on they were on it till the end.
    What does your vet say?
     
  3. Yvonne & Simon

    Yvonne & Simon Member

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    Mar 30, 2021
    Re the pen
    I am not too fussed about wasting insulin priming the pen, as the majority of it will outdate before it ever runs out.

    Thanks for the info on using the sensor. Haven't had a chance to read that post yet, but will definitely do so.

    As for the Budesonide Withdrawl time. My two vets weren't sure. Frankly, they were really shocked that he became so hyperglycemic on it since it really isn't supposed to have that systemic of an action. I definitely know that his high BGs were due to it as I had been checking his BGs routinely prior to it being started, and they had been fine. I had been doing this as was pretty sure he was "pre-diabetic" due to the fact that he had one very elevated BG 2 years ago (33 mmol/L) on a random check. Vet thought maybe due to stress. I monitored him after and it took three days for them to return to normal. They have been ok since, but I was very cognizant of this when the steroids were started.
     
  4. Yvonne & Simon

    Yvonne & Simon Member

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    Mar 30, 2021
    Thanks for the link. Very interesting. Certainly did a nice job of monitoring the BGs and allowing you to see the trends. Interesting the rise at the end.
    Poor kitty looks like it had a pretty sore spot from where the sensor was removed. Was it from too much glue, do you think? Was the skin as irritated the next time you tried it?
     
    Last edited: Mar 30, 2021
  5. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    The reason we like to use syringes with half unit markings is because we increase
    or decrease by 0.25 or 0.5 units at a time
     
  6. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    I would definitely swap over to using 1/2 unit syringes and only increasing in 1/4 unit increments.....EDIT please see Wendy's post below (post 9) to clarify which pens and syringes to use with Toujeo. The syringes used for Lantus are not used for Toujeo.

    I have only seen a couple of people use Toujeo insulin so I am not familiar with it at all but it is my understanding it is much more concentrated than Lantus so I don’t understand how to you can be giving 1 unit then 2 units if that is the case.
    I will tag @Sienne and Gabby (GA) as she has an understanding about this insulin.
     
    Last edited: Mar 31, 2021
    Reason for edit: corrected the information about the use of syringes for Toujeo insulin
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  7. Yvonne & Simon

    Yvonne & Simon Member

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    Mar 30, 2021
    Hi, it is more concentrated than Lantus but because of its make up and tissue action, is it more slowly absorbed and less of it is absorbed, giving it a more level action curve with less of a spike and also decreased risk of hypoglycaemia.

    It is dosed exactly the same as Lantus insulin. Eg if someone is changed from Lantus to Toujeo, they would be started on the exact same dose of toujeo, that they were on of Lantus.
    Thus the 1 unit of it that I am giving to my cat, is equivalent to 1 unit of Lantus (not triple the Lantus dose as one would assume when first looking at the strength). Keeping in mind that the one unit of Toujeo is smaller in volume than the one unit of Lantus.

    It only comes in a pen so one is limited to using that. And of course the drawback is the pen only does full units.

    Upon doing further research, it is a very low volume insulin with a pen specific to it. So one cannot use regular syringes to administer it, as 1 unit of Toujeo is not the same size/volume as 1 unit of Lantus. Eg if I used a regular syringe to draw up the Toujeo out of the pen, I would indeed overdose my cat!
    (Someone please feel correct me if I’m wrong here)
     
    Last edited: Mar 31, 2021
  8. Yvonne & Simon

    Yvonne & Simon Member

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    Mar 30, 2021
    I think this is a good synopsis of Toujeo vs Lantus (see below)

    My vet, located in Kamloops BTW, chose this as it has a more gradual consistent mode of action, and less risk for hypoglycaemia.

    “Both Toujeo and Lantus are long-acting insulins that contain glargine, however Toujeo is more concentrated containing 300 units per mL of glargine, compared to Lantus’s 100 units per mL.

    Researchers discovered that concentrating insulin makes it last longer in the body with less variability in blood levels over time. This translates to a lower risk of hypoglycemia (low blood sugar levels), especially at night. Some reports have stated the risk of hypoglycemia may be up to 30% less with Toujeo compared to Lantus.

    However, it is important to realize that concentrated does not mean stronger, it just means that there is more insulin per volume of liquid. Because the pen has been calibrated in such a way as to draw up smaller volumes, the dosage conversion from Lantus to Toujeo is still 1:1. For example, if your doctor prescribed you 22 units of Lantus and you changed to Toujeo, your initial dose would be 22 units of Toujeo.

    In reality, though, some people may require dosage changes when switching products because it takes a while for your body to adjust to new insulin medication. In clinical trials, many people switching from Lantus to Toujeo required a higher dose of Toujeo compared with their previous Lantus dose”
     
  9. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Toujeo is a U-300 insulin, there are no U-300 syringes, hence the need to use pens which limits finer dosing.

    We still wouldn't do an increase of 1 units to 2 units with Lantus, even if the concentration means the dosage conversion means it's the same as Toujeo.
    Cats aren't people and usually have different insulin usage profiles. For example, people take Lantus once a day, but because of their faster metabolisms, it's twice a day for cats. We also don't see many hypos with Lantus as long as the person started with a reasonable dose, tests regularly, and does safe size increases.

    Here is the link to your other post where some of this has been discussed: New member - lots of questions
     
  10. Larry and Kitties

    Larry and Kitties Well-Known Member

    Joined:
    Dec 28, 2009
    If you drew up Toujeo to the 1-unit marking in a U100 syringe you would be drawing up 3 units of Toujeo
     
  11. Yvonne & Simon

    Yvonne & Simon Member

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    Mar 30, 2021
    Hi. Actually I think it would be the other way around. If I drew up 1 U of Toujeo with a regular syringe, it would be the equivalent of three units of Lantus.

    I actually just did a little experiment showing 1,2 and 3 unit sized doses of a regular vs Toujeo insulin. They are indeed significantly different in size and clearly a regular syringe cannot be used to give the Toujeo. I have posted the photo on this site to show the difference as I think it is important for folks to see and know.

    thanks for your help, very much appreciated
     
  12. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Thanks @Wendy&Neko for clarifying the use of syringes with Toujeo. I will edit my above post to refer to your information.
     
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  13. AmandaBrook

    AmandaBrook New Member

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    Mar 30, 2021
    My cat is wearing the Libre. Brooklyn wears hers just below her shoulder blade. You must shave the area but don't use the alcohol pads (cats hate the smell). I use 3 small drops of Vetbond don't use too much. When you press the sensor onto the kitty don't cramp it hard, no need for that. It will make loud noise and hold it there for 30 seconds then slowly lift up. There should be a cloth backing under the sensor. So simple. Ours always last 14 days. Removal is trickier. I actually get the sensor off then leave the backing until my cat is in a good mood. I use acetone to loosen the glue. It smells but does the trick without ripping thier skin.
     
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  14. Yvonne & Simon

    Yvonne & Simon Member

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    Mar 30, 2021
    Thank you so much! Any chance you can post a photo of where the sensor is located on your cat? Much appreciated
     
  15. AmandaBrook

    AmandaBrook New Member

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    Mar 30, 2021
    It won't allow me to upload a photo.
     
  16. Yvonne & Simon

    Yvonne & Simon Member

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    Mar 30, 2021
    I ran into the same issue earlier. Turns out I could actually copy and paste a photo right within my post.
     
  17. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    There is an issue with uploading photos. Try copying and pasting a photo.
     
  18. AmandaBrook

    AmandaBrook New Member

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    Mar 30, 2021
    You can see it right under her shoulder. Oh and the tape I left ... she got it off. Her skin doesn't look wrecked either.
     

    Attached Files:

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  19. Yvonne & Simon

    Yvonne & Simon Member

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    Mar 30, 2021
    Thanks so much for posting the photo.
    Oh wow - so your cat just left it alone when it was there? That is very cool that it worked for you and that your kitty was such a wonderful subject! Very pretty too.

    I bought a Libre sensor for my cat. I am hoping to try it, once we get his BGs sorted out just a bit better.
     
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  20. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Dec 28, 2009
    Your vet is wrong or s/he is quoting studies in humans. There is one article that was published this month in Domestic Animal Endocrinology (vol. 75, April 2021). The study compares Lantus and Toujeo in a sample of 7 cats. Both insulins had a duration of much less than 24 hours - there was no significant difference in duration regardless of the concentration. The curve on Toujeo was flatter. Unfortunately, the pdf of the study is not yet available online and the abstract does not provide sufficient information to appreciate all aspects of the study. (It doesn't even indicate if the cats they used were diabetic.) In looking at the articles that were cited in this study, they are primarily based on human research. I would be hesitant to extrapolate from humans to cats and this report is the first I've come across comparing the two concentrations of glargine.

    The biggest issues are the practical ones.
    • Remember, Lantus has not been approved for use in any other animal except humans. It's use in cats is off-label. This is even more the case with Toujeo. There's just no research on Toujeo in cats.
    • It is SO easy to overdose your cat using a U300 insulin when there are no U300 syringes (i.e., syringes that are calibrated for the insulin concentration). You would need to be using 1/3 of the amount for a comparable dose of Lantus. Since dosing with Lantus is changed in 0.25u - 0.5u increments, I haven't a clue how you would be able to consistently dose in such small amounts.
    • Personally, I would be terrified to use the pen to increase the dose. The pens are not uniformly accurate -- if they are "off" by a small amount it may have a negligible effect on a human. It could be life threatening in a cat.
    • The best researched dosing protocol for Lantus utilized dose changes in 0.25u - 0.5u increments. You can't do that with a pen.
     
    Last edited: Apr 4, 2021
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  21. Yvonne & Simon

    Yvonne & Simon Member

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    Mar 30, 2021
    Thanks.
    He’s been changed to Lantus now.
     
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  22. AmandaBrook

    AmandaBrook New Member

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    Mar 30, 2021
    Brooklyn is on Tujeo currently. How is your kitty doing w/ the switch to Lantus? Are your costs better for the amount you purchase?
     
  23. Yvonne & Simon

    Yvonne & Simon Member

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    Mar 30, 2021
    Hi Amanda
    I feel MUCH better in having switched Simon to the Lantus. There was just too little adjustment ability with the Toujeo. One unit was not enough for him, and two was too many.
    Although his BS are still very labile right now, I feel we are on a better track with his getting 1 1/2 U of the lantus bid, which we had no ability to do with the Toujeo. And I like the fact that I can increase or decrease it by 1/4 U increments.

    Cost wise, I am not really sure. It is a bit hard to compare. I got the first disposable Toujeo pen from my vet and it was $80. Way more insulin than I would ever use and is supposed to be discarded after 42 days of being used. So cost would be $80 every 6 weeks. It would likely be less if purchased from a pharmacy too. The pen needles are $0.30 each so $0.60 per day.

    I bought the Lantus from Costco. You can only buy the 5 pack of 3 ml cartridges - no ability to buy one cartridge at a time. The 5 pack cost me $100. . These need to be discarded after 30 days of use. However the unused cartridges can be kept in the fridge so have good dating. So technically, this insulin is cheaper on first glance as will cost $20/mo.
    A 10 ml vial would have been cheaper at $60 but I elected to go with the cartridges as the unopened cartridges can be kept in the fridge and had better dating than the vial once opened.

    However with the Lantus, one also has to factor in the cost of buying syringes or a pen (in case full doses can be given) and I already had both of these at home, so don't know the added cost of them. I think that I might have paid about $50 for the box of 100 syringes but really can't remember now (I bought them several years ago, as we use them for our horse breeding operation). But based on that, at two syringes/day @ 0.50 each, that adds $1/day, so $30/mo for syringes.

    So I guess they are probably both somewhat similar in price. The Toujeo would be about $58 /mo (insulin and pen needles) - with the adage that it might be less if insulin bought at pharmacy and not the vet. And the Lantus with the syringes, $50/mo.

    But IMHO, the ability to do finer titrations with the Lantus, totally outweighs any little bit of cost difference!
     
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  24. Yvonne & Simon

    Yvonne & Simon Member

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    Mar 30, 2021
    I see you are only giving your cat one fairly sizeable shot of Toujeo a day. When my vet put Simon on it, they made it clear that although it is a "once a day" insulin for humans, because of the faster metabolism of cats, it would need to be given twice a day.

    I am VERY new to all of this so am not in a position to give you any advice at all, however there are many on here who have a great deal of experience and can weigh in on this. However they will need to see your post in order to do that. So I suggest that you start a new posting thread of your own, asking your specific questions about the Toujeo. This way, if it is a new thread started by you, your questions won't be buried here in with mine and you should be able to get information individualized for you.

    Pay special attention to the third post below. In it, I show the difference between a unit of Lantus and a unit of Toujeo. Know that regular 100/1cc syringes CANNOT be used to do finer dosing of Toujeo insulin!

    But in the interim, you can see the other questions that I asked about the Toujeo here:
    https://www.felinediabetes.com/FDMB/threads/re-toujeo-insulin-pens-libre.245467/
    https://www.felinediabetes.com/FDMB/threads/new-member-lots-of-questions.245480/
    https://www.felinediabetes.com/FDMB/threads/toujeo-insulin-unit-size.245532/
    https://www.felinediabetes.com/FDMB/threads/simon-update-re-toujeo-advice-please.245590/
    https://www.felinediabetes.com/FDMB/threads/help-dosing-advice-for-simon-needed.245677/
     
  25. AmandaBrook

    AmandaBrook New Member

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    Mar 30, 2021
    Yes, I've been running a post on Brooklyn w/ some great feedback. Nice to get info from someone who was also on Tujeo. Her Vet was on fence about twice a day. Since she's not dropping I'm going to put her on 2 units twice a day to see how she is then ask Vet to switch her to Lantus. Tujeo cost $150 here in CA so I am in search for less expensive after all the recent Vet bills.
     
  26. Yvonne & Simon

    Yvonne & Simon Member

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    Mar 30, 2021
    Hi Amanda.
    I see now that you have started a separate posting for your kitty and that you are getting all sorts of good advice there. That is good.

    I empathize with you regarding wanting to follow your vets directive, especially when they are adamant about what they are recommending. Puts you in a very difficult position. You want to do what is best for your cat, but not ruin your working relationship with your vet either. A very delicate balance.

    Although this article does not pertain specifically to Toujeo, I think it is helpful in that is professional recommendations regarding diabetes managment, and does outline the need for twice a day dosing of glargine. Perhaps you could give it to your vet?
    https://www.aaha.org/globalassets/02-guidelines/diabetes/diabetes-guidelines_final.pdf

    Also, thanks for the info re the Libre sensor (I hadn't put two and two together that it was you who did both postings - so many people and so much info here, it gets a bit overwhelming!).
    I think given my cats current labile BS, I need to bite the bullet and apply the Libre sensor to him (I bought it and have it anyway). But like you, have butted heads with my vet who fortunately has been quite receptive regarding most of the other suggestions that I have made, but for some reason was extremely resistant to the use of this product. Again, puts one in a rather awkward position... But in the end, I have to do whats right for my kitty. So maybe I'll watch some youtube videos today regarding application of them!
     
  27. SashaV

    SashaV Well-Known Member

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    Apr 25, 2020
    The discard after 30 days is meant for human use, they bring their pen with them out of the fridge. We keep it in the fridge between shots and use every single drop. So the 5 pen could easily last you a year or more.
     
  28. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    A couple of items on costing of Lantus - Sasha has already pointed out one of them. Keep the opened cartridges in the fridge too - they are good to the last drop. Depending on the dose your cat is one, I used to be able to get between 14 days and 90 days out of one. Neko's dose varied quite a bit due to some secondary conditions. The second item is syringes, $50 per box is too much. Check out Costco, Real Canadian Superstore or Safeway pharmacy was surprisingly the cost winner in the lower Mainland. I paid about $35 for a box of 100 syringes.

    There are a couple posts in the Think Tank forum that talk about the Libre, with pictures. You might want to do a search there for Libre.
     
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  29. AmandaBrook

    AmandaBrook New Member

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    Mar 30, 2021
    Just looked at your SS. The up & down is so similar to Brooklyn. Def pushing for Lantus. Sad I will have to waste Toujeo.
     
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  30. Yvonne & Simon

    Yvonne & Simon Member

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    Mar 30, 2021
    Thanks for the price info on the syringes. I bought them a couple years ago for our horse breeding operation and since I was at a little locally owned pharmacy getting something else, I just bought them from there.

    However with this little diabetes journey with Simon, I have been doing more careful costing out.

    I checked our local Rexall and the Freestyle Libre sensors were $100, and a box of 100 pen needles, $50.

    At Costco the Libre was $89, the pen needles $35 and I think the cartridges of Lantus were less too.

    When I use up the old box of syringes that I have, I’ll definitely get the next lot from Costco.

    My bad. I’ve been leaving the Lantus pen out at room temp as didn’t want to inject it cold.

    Interestingly enough, although I can see the injection site (sans hair) better with the syringe, the cat seems to feel it more going in, than he did with the pen. Or maybe it is because there is slightly more volume with the Lantus? But he completely ignored the pen, but does react a bit with the syringe.
     
  31. AmandaBrook

    AmandaBrook New Member

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    Mar 30, 2021
    Yesterday I did 2 units Am then 2 units Pm - I don't see much difference in her numbers doing this once. Her curve looked better w/ 5 units so maybe I will try 3 AM & 2 PM. However, you are all saying Lantus may be better at lowering her numbers. She's been 300-400 for 5 weeks on record. Who knows how long prior to that. Do I just go ahead and make the Vet call and insist on Lantus? I know her Vet was def not wanting twice a day but no idea why.
     
  32. Yvonne & Simon

    Yvonne & Simon Member

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    Mar 30, 2021
    Hi Amanda
    Since you’ve started a new dosing regimen for your cat, I’d start a new post again as your posts will likely get lost here buried in the topic that I started. And which is now outdated as I’ve changed insulin type myself.

    I can’t help you at all with dosing etc as I basically going through the same as you, at this time. Making changes and trying to figure out what works with my cat.
    If you start a new topic again, you should be able to get new helpful information geared specifically towards you and your cat, for right now,
    Cheers and best of luck - I definitely feel your pain!
     
    Last edited: Apr 5, 2021
    Reason for edit: Missed info added
  33. Tomlin

    Tomlin Well-Known Member

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    May 30, 2019
    :)
    Just an FYI....the full 8 page article is available online. You just have to purchase it through ScienceDirect. It is a crossover design with healthy cats utilizing the gold standard isolglycemic clamp. In addition to this study, there is another isolglycemic clamp study that looked at Tresbia vs Toujeo from 2019. Each provides some additional detailed info regarding the insulin. Both studies &/or info from the studies have been presented quite a bit at meetings over the past few years & therefore, Toujeo is beginning to be used more in cats because of the available info and some clinical experience by endos with it. However, with that being said, the decision to use it in a specific cat is always based on multiple factors & of course, a specific cats needs.

    I wanted to make sure that anyone who is interested in the info and/or searches “Toujeo” and reads this thread knows they are in fact able to get the study if they want it.
     
    Last edited: Apr 5, 2021
  34. Yvonne & Simon

    Yvonne & Simon Member

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    Mar 30, 2021
    Thanks for posting this. I’ll see if I can get it through our hospital library. Would be interesting to give it a read over.
     
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  35. Tomlin

    Tomlin Well-Known Member

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    May 30, 2019
    You are welcome.
     
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