Semglee insulin question

Hello, I am very new here. I was trying to read up on a few sticky notes for the Glargine insulin. I had come across the video on how to fill syringes with insulin and dial in dosage.

I am a little distraught with the information my vet has given me & am now worried my insulin is no good!

She told us to insert the needle into the vial and pull the insulin into the syringe and then shoot whatever we didn’t need back into the vial. She also told us to roll the pen/vial to mix it. At this point I’m assuming our insulin is contaminated from the rubber and lubricant inside the syringe.

Do you think at this point we should purchase a new vial? It is only 2 weeks old.

Thanks, Amanda!

 

I doubt your insulin is bad this fast. Just don’t roll it or shoot it back any more. Please post an intro in main/health. Have you started a spreadsheet? If not please do.

 

Yes, I have a Spreadsheet going, hope I linked it correctly. I am still trying to figure all of this out. Thank you for replying. I will work on an intro!

 

Great. Looking at your spreadsheet I think your insulin is fine. You are getting great numbers.

 

I feel very confused. The last few days I am questioning all of his numbers now. We have been using the Alpha Trak 2 & keep getting mixed numbers. Like 116,197,176 all within a few minutes. I have the Relion meter and we may just start using that. It would save us on strips alone. Very distraught today.

 

Most of us use human meters and our methods were formulated using a human meter. Far less expensive as far as strips go and you will use a lot of them. Numbers bounce around a lot at first. Some cats bounce all the way to remission. Meter variance is 20% so getting 197 and 176 within a few minutes is within meter variance. I used the old Relion. My vet had never used a human meter but was fine with that.

 

Do you suggest we continue with the Alpha Trak 2 or transition to the Relion?
So far my entire spreadsheet is AT2, I would be kind of confused what to base things off for Relion. But I’m also concerned his AlphaTrak isn’t reading right now. Is there a way to test its accuracy?

 

I would switch. Bhooma can fix the ss for you. The Relion will read lower than the AT, especially when high or low. Reductions on an AT are under 68 and with the Relion 50. @Bandit's Mom

 

What do you mean read lower? Could you give a little more info on how to read the Relion. We just did his glucose and got 130, but a minute before we got 177 on his AlphaTrak so they definitely are not reading alike. I’m confused what his glucose is at now and makes me WAY MORE concerned for a Hypo. We usually dose him at 8am and 8pm. I’m home with him until 2pm and then he is alone until 7-7:30pm until it’s time for his next dose. I usually test amps and then do either a +2, +4 and a +6 or I’ll do a +3 and +6 and fed a couple tblsp at each check to make sure he steadies out while I’m gone. Oh & he also gets 3 oz Weruva wet pre-insulin. We try to test, feed shoot within 10 mins.

 

You can’t compare the pet meter with the human meter. Many have tried. You just need to ouck one and only use it. I prefer the human meter. Since it reads lower I feel like there’s a built in safety net. At low numbers it reads close to the pet meter. Normal bg on the human ones are 50-100. On the AT it’s more like 68-120.

You are doing EVERYTHING right! Looking at the numbers I think Comet is looking really good.

 

I guess I’m still not following & I apologize. Are you saying that the Relion reads typically lower then the AT2. So for instance a 160 would be more like a 130-140 on a Relion?

 

There is no formula to convert AT2 numbers to human meter numbers. People have tried using one meter of each kind to compare them, and not come up with consistent answers. In general the AT numbers are higher, but much closer in lower numbers.

 

Just FYI...I set it up for her. Amanda's been a member of the FB group for awhile now and I'm so happy to see her finally posting here!

@AmandaD ...if you change to the Relion, send me a PM on FB and I'll adjust the formatting for you

 

Hi Amanda! Welcome to the forum, you'll find lots of people to encourage and help you as you have already found out. I am using Semglee as well but my vet prescribed the pen rather than the vial. It's a little more money upfront but then you get more insulin with 5 pens than 1 vial. I use GoodRx app to find the lowest price among the local pharmacies. So far, I am happier using the pen. I used a vial when Bama was on Novolin N.

 

I guess I’m just worried now that we have been pulling and plunging a bit back into the bottle wether we should even use the insulin anymore or not & discard the bottle and get a replacement? We have been using/doing so with this bottle since the 2nd of October.
Could someone give me advice or insight on what they would do?

 

Your numbers look good--lots of blues. I think your insulin is fine. I would continue to use it unless and until the numbers go wonky and you're not getting good results. That would be a red flag to me and a reason to make a change. Someone else may be more cautious. Obviously, you don't want to continue the actions of pulling and plunging insulin back into the bottle. Right now it appears you "dodged the bullet" as they say as there doesn't appear to be any adverse effect on the insulin.

 

So I ended up calling the pharmacist and asking & he stated it would be fine. But his concern was the day we left it out for 12 hours then put it back into the fridge. He suggested getting a new bottle in a few weeks. I’ll use this one until right before the 28 days have been up and grab a new one. Now at least I have learned the do’s and don’ts

 

You're really worrying about something that just won't happen. There have been thousands (probably ten's of thousands) of members here over the years and I'd bet every single one of them left their insulin out at least once (I know I did...and more than once!) and a LOT of us didn't know that we shouldn't shoot insulin back into the vial or pen either....and our cat's were just fine.

It's just not that fragile. As long as the insulin remains clear with no floaties or cloudiness and Comet's numbers don't start creeping up without any else going on, there's no reason you can't continue to use what you have.

The people here are the most careful, paranoid, helicopter mom's you could find when it comes to their furkids. If we had any doubt about your insulin, we'd tell you!

 

Thanks Chris! I notice his Glucose had been going up and then down, up and down. I’m not sure if it’s normal to bounce around if I’m feeding the same food and same amounts at roughly the same time. Maybe he needs to go up to 1.5u? Or does it take a couple weeks to start noticing a good trend?

 

He's a cat....the word "normal" does not compute...LOL Seriously though, it's still very early in treatment and it's typical for the numbers to vary....also, all meters are allowed a 20% variance so even if you tested the exact same drop at the exact same time, you could get numbers that were different by +/- 20%

That depends on the dosing method you choose. Tight Regulation allows you to increase the dose as often as every 3 days if you're not getting the results you want. Start Low, Go Slow has you hold the same dose for at least 7 days before increasing. If there's any dry food in the picture, you can only do SLGS.

I personally like TR because it lets you adjust that often but does require frequent testing (and occasionally balls of steel). You test more than enough for TR (but I don't know about the other part...LOL)

With SLGS, no matter how high your cat's numbers are, you can only increase every 7 days but you don't have to test quite as much. It's totally up to you though! And if you choose one you can always change your mind later if it doesn't work for you.

 

Yeah I’ve been a basket case for sure. It’s just so hard with my job and the stress there, limited time and running on no sleep. I’ll probably just do SLGS until I have a bit more time or control. I just want to make sure I’m doing what’s right for him, but factoring in his various other health issues.

 

Wow! Your cat's numbers look great for an IBD kitty on pred! My Ruby is on pred too for SCL and her numbers are all over the place as a result. You're doing a great job. What dose of pred is he on?

 

Thank you! We started at 10mg 2x daily for awhile paired with Metronidazole. We then tapered down a few times. Right now he is on 2.5mg 2x daily & if all goes well next week we will be at 2.5mg 1x daily. Vet is not sure if he will need to stay on a low dose for good or not. He had a bit of looser stools the past few days, but we’ve done a few food changes since then & he seems to be doing better today.

 

That's terrific! Ruby is on the same dose of pred and she is not doing nearly as well as Comet diabetes-wise. She went from one drop of Lantus to now 2.5 and I might need to raise it again. Always hard to tell though what effect the steroid is having versus her tummy flares causing high numbers.

 

I’m hoping we won’t need to increase more to see lower numbers, but I guess only time will tell. How long has she had IBD and been in Pred?

 

She has small cell lymphoma, not IBD, but for a while we didn't know which one for sure until Ruby had an endoscopy in June of this year. Started pred in July and her numbers haven't been the same since. Take a gander at our spreadsheet. Ruby became tightly regulated within weeks of me joining the FDMB and then everything went a little cuckoo after she started getting really sick. The pred is helping her eat and gain weight, and we have our bad moments but it's mostly been good despite her glucose levels.

How long has Comet been on pred?

 

Comet was having bouts of vomiting and diarrhea for months. We finally did an ultrasound and his lymph nodes were swollen so they collected fluid to test for lymphoma & it came back negative, so they stated it as IBD. His intestines were inflamed and barely moving as well. Some days I wonder if the diagnosis was wrong. He was diagnosed and on Pred since May or June. Can I ask what your cats symptoms are for SCL?

 

The symptoms are nearly identical for both, so it's hard to tell them apart except through biopsy. They did an endoscopy on Ruby and did a biopsy and the radiologists had no doubt that it was SCL. Ruby was inappetent, vomiting all the time, and losing weight. She also has chronic constipation and spells of diarrhea. I had tried switching to raw food in case it was IBD, fed her lots of novel proteins and she didn't get better. I'm still feeding her raw as it's the best thing for her diabetes and her CKD, and it doesn't have additives that can inflame her insides, and the pred has made a lot of the other issues go away.

 

Have you discussed trying budesonide with your vet yet? Just something to keep in mind in case the IBD flares up or the pred dose isn't doing enough.

 

I mentioned it but could not remember the name of it. I have it written down and if he’s doing kinda iffy on Pred the next week still I’m going to bring it up with her.

 

One of my kitties has IBD. Gizmo was diagnosed by biopsy, as well. I'm not sure which flavor of Weruva you're feeding but you may want to consider novel proteins. My guys are fed ZiwiPeak venison or rabbit and lamb along with a raw diet. This is a wonderful website on Raw Feeding for IBD Cats. They also have a FB group. Regardless of whether you choose to feed a raw diet, the information on supplements is wonderful.

Comet's numbers look great! I would not get concerned about the insulin. Injecting back into the container is more of an issue with a pen than with a vial. The pens operate on a negative pressure system so you don't want to add air. The vials don't work that way. Like others noted, if you see the insulin has floats (crystals) or it looks cloudy or if Comet's numbers don't make sense, that may be time for new insulin.

 

Thank you!