Ollie, Thread 2: adjustment 25 May

[Ollies Mama]

Previous Thread 1: https://www.felinediabetes.com/FDMB/threads/ollie-libre-wbc-and-dental-22-may.277792/#post-3074200

New Thread after massive drop to below 5 (I'm in Australia) for about 5-6 hours after 1UC of Caninsulin.
Advised to get smaller syringes, skip dose if under 200 (11) maintain SS, and maintain. Exhausted after 30 min naps, testing, food in bed, testing, nap - repeat. Thanks to experts here who help me immeasurably. Cath.

 

[Ollies Mama]

I just logged into Libre View and attach this screen snip for your consideration.

I can see now that Ollie has had TWO hypo, because of the 1UC - yesterday at noon, and overnight. I have sent these to my vet too.

Data is fascinating and a sound measure when my heart is full but my head is tired.

If you have any other interpretive analysis from this data, i'm here for it.

Cath x

 

[Ollies Mama]

 

[Bron and Sheba (GA)]

Hi Cath,
Thanks for starting a new thread.
I’m so glad @Suzanne & Darcy has given you dosing advice for Caninsulin.
I can see by the above charts that Ollie has been dropping low for a couple of days. We don’t call dropping to 3 (54) a hypo. A hypo is when it drops lower, sometimes into the 30s (1.6) and has hypo symptoms.
So I would change your subject line and remove the post hypo bit.

You mentioned somewhere but I can’t find it now, that he seemed very hungry and was watching you eat, when he dropped into the lower numbers. This is very common and can be a red flag for you to check the BG if he seems unusually hungry.

When you get the new syringes, can you post them here for us to check please before using them.
When you buy them, ask if you can return them if they are not the correct ones.
Hopefully you can get 3/10 ml U40 insulin syringes.
If you can’t get any suitable U40 ones, you can get the U100 3/10ml, 30 or 31 gauge, 6 or 8 mm insulin syringes and we can show you how to use the conversion chart when drawing up the caninsulin (U40 insulin)

I see you gave 0.25 U at AMPS with a preshot of 194
I would still monitor this cycle closely.

 

[Ollies Mama]

Hi Cath,
Thanks for starting a new thread.
I’m so glad @Suzanne & Darcy has given you dosing advice for Caninsulin.
I can see by the above charts that Ollie has been dropping low for a couple of days. We don’t call dropping to 3 (54) a hypo. A hypo is when it drops lower, sometimes into the 30s (1.6) and has hypo symptoms.
So I would change your subject line and remove the post hypo bit.

You mentioned somewhere but I can’t find it now, that he seemed very hungry and was watching you eat, when he dropped into the lower numbers. This is very common and can be a red flag for you to check the BG if he seems unusually hungry.

When you get the new syringes, can you post them here for us to check please before using them.
When you buy them, ask if you can return them if they are not the correct ones.
Hopefully you can get 3/10 ml U40 insulin syringes.
If you can’t get any suitable U40 ones, you can get the U100 3/10ml, 30 or 31 gauge, 6 or 8 mm insulin syringes and we can show you how to use the conversion chart when drawing up the caninsulin (U40 insulin)

I see you gave 0.25 U at AMPS with a preshot of 194
I would still monitor this cycle closely.

Thank you Bron. An edit though, the first pre-shot was 194, and because it was under 200, refrained.

Then I checked at 922 am, and it was 12.6 (224) so I gave him more food and a tiny shot. I retested 30 mins after, it is 11.4 mmol. Going down. Will retest at exactly 60 mins, 10.22 post-shot and input data on SS. outcome; 8.7 mmol +1

 

[Bron and Sheba (GA)]

Then I checked at 922 am, and it was 12.6 (224) so I gave him more food and a tiny shot

Cath, when you test for preshot BG (AMPS or PMPS) are you refraining from feeding for the 2 hours before you test for the preshot?
We recommend that so the preshot BG is not food influenced. After the test, you feed, wait 30 minutes then give the shot.
If the preshot is not high enough, you can stall, don’t feed, and test again in 20 minutes to see if the preshot is rising and high enough.

Any more tests after the +1?

 

[Ollies Mama]

hi. Yes, the pre-shot was in bed, before we were up, and before new food is down. High carb food out of sight as I dont want him munching on it while I'm asleep.

I just got home 12.45 from getting 0.3 ml syringes ready to do another test, and low BG alarm went off. Went to find him, he's laying on the censor in the sun. Tested anyway, 3.4 mmol.

I have read that laying on the censor can inhibit an accurate reading, so I've straightened him up, give it a second and will re-test.

Second test reads as: 4.1 mmol. I'm going to give him some food and get his rate up to 5.

Bron, how do people hold down work and do this?

To ensure I'm recording accurately, I'd like to share what I have. And then ask you to advise on what goes into the ss - is that ok?

4.05 am - 7.9 mmol
7.22 am - 10.8 mmol (pre-shot, pre-food) because it was under 11, I didn't shoot.
9.15 am - 12.6 mmol (because it was over 11, I gave food, metacam and a tiny dose .25 at a guess until I get syringes today.
9.52 am - 11.4 mmol (I leave the house to get syringes and other stuff)
12.45 pm - 4.1 mmol. (I give him food)
1.05 pm - 3.3 mmol

Seriously. My anxiety is going through the roof. What am I doing wrong!

Cath

 

[Ollies Mama]

 

[Bron and Sheba (GA)]

hi. Yes, the pre-shot was in bed, before we were up, and before new food is down. High carb food out of sight as I dont want him munching on it while I'm asleep.

I just got home 12.45 from getting 0.3 ml syringes ready to do another test, and low BG alarm went off. Went to find him, he's laying on the censor in the sun. Tested anyway, 3.4 mmol.

I have read that laying on the censor can inhibit an accurate reading, so I've straightened him up, give it a second and will re-test.

Second test reads as: 4.1 mmol. I'm going to give him some food and get his rate up to 5.

Bron, how do people hold down work and do this?

To ensure I'm recording accurately, I'd like to share what I have. And then ask you to advise on what goes into the ss - is that ok?

4.05 am - 7.9 mmol
7.22 am - 10.8 mmol (pre-shot, pre-food) because it was under 11, I didn't shoot.
9.15 am - 12.6 mmol (because it was over 11, I gave food, metacam and a tiny dose .25 at a guess until I get syringes today.
9.52 am - 11.4 mmol (I leave the house to get syringes and other stuff)
12.45 pm - 4.1 mmol. (I give him food)
1.05 pm - 3.3 mmol

Seriously. My anxiety is going through the roof. What am I doing wrong!

Cath

You aren't doing anything wrong.
Ollie is obviously needing less insulin.
With that drop to 3.3mmol/L (59) he has earned another reduction.
Have you given him some high carb food and honey to get him up over 5 yet?

I see you have bought the U100 syringes. That means you will have to use the conversion chart. But it also means you will be able to give smaller doses much more easily.

 

[Ollies Mama]

hi Bron, I'm sorry for pestering you again. I feel very needy of you and I hate that. I am about to give him some high-carb food, and honey again. I also just made a post on the facebook group to give you a break x

he's has a smudge of honey on this cheek, a teaspoon of high-carb food and some minced chicken too. (1.20pm) will re-test in 20 mins.

I went to the chemist with the 3/10 U40 noted down from the forum. She gave me that box of 0.3 ml as a freebie, (mis-ordered for them) but said I should go to the vet, so they can be absolutely certain about appropriateness.

 

[Bron and Sheba (GA)]

Please don't feel you are pestering me...you are not. We are here to help caregivers.
You will get better advice here than on the fb page. They are great over there, but most of the people there, apart from the admins and mods, are not as experienced as the people here. And the fb page is not supposed to give dosing advice.

 

[Ollies Mama]

Please don't feel you are pestering me...you are not. We are here to help caregivers.
You will get better advice here than on the fb page. They are great over there, but most of the people there, apart from the admins and mods, are not as experienced as the people here. And the fb page is not supposed to give dosing advice.

Thanks Bron. Maybe he's experiencing some insulin resistance with his infection. I dont know, I'm just focusing on getting him to 5. Thanks so much as always for your steady hand.

On the flip side, my neighbour did my lawn while I was out. He knows i'm struggling with the cat. That's kind huh.

 

[Bron and Sheba (GA)]

On the flip side, my neighbour did my lawn while I was out. He knows i'm struggling with the cat. That's kind huh.

What a kind person!

Maybe he's experiencing some insulin resistance with his infection.

If he had insulin resistance, he would need more insulin.
More likely he is needing less insulin because the infection is being treated. We see this a lot after infections are treated, especially teeth.
Keep us updated with any BG results please

 

[Ollies Mama]

You are the voice of reason, Bron. I'll test every 30 mins and post on SS. Chris R on the FB offers good advice. Talked about 'bounce' which is normal. The relationship between infection, antiobiotics and his response is smart. Thanks so much.

 

[Bron and Sheba (GA)]

Chris R on the FB offers good advice

Chris is great. She is on here as well but is mainly kept busy on the FB page.

 

[Ollies Mama]

4.42 pm - 8.9 mmol, on the SS too. Ive taken the food away.

I note he had that micro-dose at 9.22 am.

What would your advice be for his next dose?

cheers
Cath

 

[Bron and Sheba (GA)]

I note he had that micro-dose at 9.22 am.

What would your advice be for his next dose?

Did he get the am dose 3 hours late?

 

[Ollies Mama]

Yes. Not until 9.22 am. Not until he was above 11.

 

[Bron and Sheba (GA)]

Yes. Not until 9.22 am. Not until he was above 11.

OK. Lets see how he goes over the next 4 hours. Don't feed him for the 2 hours preshot.
I am going to copy and paste the conversion chart for U40 insulins when using a U100 syringe.
You will need to reduce the dose further as Ollie dropped under 90 again so the new dose is 0.1 U of caninsulin.
If you look on the conversion chart, they don't have a conversion for that small amount.
The smallest conversion is 0.25 U of a U 40 insulin.
I will speak to a couple of others and see what they think the 0.1 U40 dose is when using the U100 syringe. I will be around 0.2U using the U100 syringe but I want to talk to others to confirm.

 

[Ollies Mama]

Thank you.

 

[Ollies Mama]

Update. 6.30pm, three hours before pre-shot.

no ketones, nice wee in the tray.
Updated spreadsheet. +9 libre is 8.6 mmol
One protein snack eaten despite pain of gums.
One teaspoon of minced roo.
Pre-shot due in 60mins 722pm
Shot due at 922 pm

Cath.

 

[Bron and Sheba (GA)]

Pre-shot due in 60mins 722pm
Shot due at 922 pm

I think you might have this all mixed up.
The preshot is taken 30 minutes before the shot is due, not 2 hours before.
You stop feeding 2 hours before the shot is due so that the preshot is not food influenced.
So your preshot BG is due at 8.45 pm if the dose is due 9.22 pm.

 

[Ollies Mama]

Ah ha! Yes, I had it wrong.

I thought for a shot at 6am, I had to get up at 4am.
Thank you.

we are about to cease all food for two hours, and preshot is at 845pm. Got it.

I think I have just struggled to absorb the information in a stressful space. I have other stressful things happening which should resolve soon too. That will help.

 

[Ollies Mama]

Add it: I have an added complication to consider.

he has to fast from midnight as he’s due for dental and pre-sedation bloods at 8am.

this means any snacks to keep blood sugar okay need to be before midnight to reduce aspiration risks tomorrow.

745pm: he is yelling at me for food. It’s going to be a long 60 mins! BG: 10.45 mmol. I told him to blame you, Bron. Xx

 

[Ollies Mama]

Pre-shot as at 8.45pm is 12.1

that’s high enough to feed.

then I wait 30 mins for the shot.

Bron, did you land on the dosage?

thanks,
Cath

 

[Bron and Sheba (GA)]

Noone has got back to me yet Re the dose… people are asleep on the other side of the world.
I didn’t realise he was having the dental tomorrow. That puts a spanner in the works if he can’t eat after midnight.
I think I would be inclined to skip the dose tonight and in the morning and then he can have some insulin after the dental. He doesn’t have ketones so that is good. I am concerned if we give him any insulin now, he might drop low and if you had to feed him, it would jeopardise the dental tomorrow morning. I don’t like skipping but he is needing so little now. We usually say a half dose when fasting for the morning dose but I think a skip again would be safer as he is needing so little.

If the vets give him insulin tomorrow, you need to tell them he needs 0.2 U using the U100 syringe.
I will explain how to get that dose later
How do you feel about this plan. ?

 

[Ollies Mama]

Hi Bron,

I understand about the sleeping friends. I had seen three people viewing my spreadsheet and thought they were mates of yours.

I am happy with this plan. It makes logical sense.

his post-eating BG is due in 10 mins. I will update SS with scores.

thank you always.

 

[Ollies Mama]

This score of 12.1 is 30 mins after eating.

No shot given fasting and dental surgery tomorrow.

Will BG after one hour of food to measure.

 

[Bron and Sheba (GA)]

I heard back from @Sienne and Gabby (GA) and she agrees that skipping is a good idea.
She said to make sure you test the BG after he gets home because the anaesthetic can drop the BGs. You may also need to skip the pm dose, depending on the BGs.
Please let us know how things go tomorrow

 

[Ollies Mama]

Many thanks to you @Bron and @Sienne and Gabby (GA) for your time and wisdom.

I can't say I'm not relieved to have a night off.

Is there any high score that I should watch for instead? and if so, what should I do?

Cath

 

[Bron and Sheba (GA)]

I am going to give you a photo of tiny doses using the U100 syringe.
If you look at the photo below you will see three U100 syringes. The bottom one is the one you need to look at at the moment.
To give the 0.1 unit of Caninsulin using the U100 syringe you need to draw up just a tiny bit less than the 0.25 U picture. We are aiming for 0.2 U.
The writing above the photos says 0.2=fat zero with daylight over the the line.
When you draw it up for the first time, please take a photo of it and post it for us to see.
It’s only a couple of drops of insulin but you would be amazed at the difference a drop can make.
if you have a magnifying glass, I’d use that.
does all that make sense?

 

[Ollies Mama]

Yes it makes sense. Thank you so much for the visual. I will use a magnifier.

 

[Larry and Kitties]

Note that the Libre can be significantly different that BG obtained from an ear stick and meter.
Yesterday Merle's AM ps was L 237 and relion 143, PM PS L 240 and relion 149. Recently a friend got: Libre 85, Alpha 121, Relion 126.
Thus, a Libre can be higher or lower than earstick. Thus, it is importent to also test with earstick so you can better understand what the Libre BGs mean.

 

[Ollies Mama]

Ollie Update 27 May - post dental.

His WCC was reduced to a number that was clinically significant enough to do the x-ray of his mouth.

The vet showed me every x-ray, and he had two missing teeth entirely, and one lesion underneath a partially broken tooth. This was removed and he was cleaned up. I also asked them for a sinus check to rule out anything else, but I was right - the hyper salivation was caused by the dental trauma. And it's reducing now that he's had the infection treated and the lesions removed.

She was happy with the spreadsheet (which Vet now has live access to). His skin sores are also healing with the fur growing back slowly. I was told 'soft food, and he may not eat for 24-48 hours,

She would prefer I remain on 1UC, and not muck with the dose. I explained my nervousness and the significant drop. She said it's less about the daily numbers than a weekly/two weekly theme of glucose management - an average, that she's keen on. She said she is 'worried' at 1, not 3.3, when she pointed out the dips in the Libre View Graphs I shared. I told her that I was doing half hour obs, and honey, etc until 4 am. Her worry is probably desensitised than mine in the context of her knowledge and occupation, and experience in this space and my embryonic state in comparison!

She also spent significant time with me converting the 0.3 ml syringes in case I don't follow her advice. I thought that was mature and kind to protect Ollie. She went over and above explaining every little detail, every tooth, the lip line, the gums, his sinus pictures and said she's so happy to find an owner that really wants to learn, and asks lots of questions over other diabetes care-giver that are not invested and she knows the cat will suffer. She showed me the biopsy of his skin-sore under the microscope and what ringworm looks like under the scope. I sat with her at her computer for about 45 mins while she explained the clinical markers and compared results from last time to current time.

I have been however, giving him slightly less than 1UC, and he's doing well. I also have been giving him snacks +4 and +6 as per Bron's advice and that's definitely keeping him levels. His levels are doing well.

Regarding the 'not eating bit' or the 'he'll be wobbly' - none of that happened. He went straight to his food station and gave me a little meek meow. I gave him some chicken broth I'd made, and some pate and he ate voraciously - like he hadn't been fed in a month. Then he took his 8.30 insulin 30 mins after, some metacam and slept solidly in a new bed I bought him.

I gave him a snack about 11 pm to keep him going, a crunchy biscuit or two cut into quarters and a piece of chicken which he wolfed down. I have no doubt these snacked kept him level until this morning when he received his next dose.

i think I've covered it all. Apologies for the delay in updating. A few of my other life-things have been put on hold and I am trying to catch up now that I can see his recovery.

I also want to write to the other vet and tell them where to go, or at least provide them an update on what they couldn't resolve.

xx

 

[Bron and Sheba (GA)]

Thanks for the update Cath. I’m very glad Ollie is doing so well post dental.

She would prefer I remain on 1UC, and not muck with the dose. I explained my nervousness and the significant drop. She said it's less about the daily numbers than a weekly/two weekly theme of glucose management - an average, that she's keen on. She said she is 'worried' at 1, not 3.3, when she pointed out the dips in the Libre View Graphs I shared. I told her that I was doing half hour obs, and honey, etc until 4 am. Her worry is probably desensitised than mine in the context of her knowledge and occupation, and experience in this space and my embryonic state in comparison!

I am quite alarmed to read that the vet wants to keep Ollie on 1 unit when 0.25 U is dropping him down to 74.
Saying it’s less about the daily numbers than the weekly /two weekly theme of glucose management just doesn’t make sense at all. Our first and main priority is keeping the cat safe. You can’t keep a cat safe for two weeks if the dose of vetsulin is continually dropping Ollie down to the 70s. There is just no logic in that at all.
Please don’t go back to 1 unit. Ollie could even need less insulin than the 0.1 dose now that the dental has been done.
I am going to tag @Suzanne & Darcy ti comment on the dose

 

[Ollies Mama]

I understand and I don't disagree with you.

I am giving him less than the 1UC, but writing 1UC on the spreadsheet (as they view it) now for BG.

I appreciate any and all links to other lived experience experts.

Thanks Bron.

 

[Bron and Sheba (GA)]

I know it can be hard to disagree with vets. You can just nod and then do what you need to do. Difficult if they have the link to the SS though.

What syringes are you using now?
If you are using the U100 syringe, how much insulin are you drawing up in that syringe?

 

[Ollies Mama]

I am still using the 1 ml syringe but not going to the first line which is 1UC.

The vet showed me how to use the .3 ml syringe, and how either to the 2nd or 3rd line is the equivalent to 1ml syringe first line.

So, if I want to give smaller doses, I can simply use the .3ml syringe and draw to 1st, 2nd line to get less than 1UC equivalent.

I'm still monitoring numbers and will make the decision at the time that keeps him safe even if that means defying the vet.

 

[Bron and Sheba (GA)]

I am still using the 1 ml syringe but not going to the first line which is 1UC.

The vet showed me how to use the .3 ml syringe, and how either to the 2nd or 3rd line is the equivalent to 1ml syringe first line.

So, if I want to give smaller doses, I can simply use the .3ml syringe and draw to 1st, 2nd line to get less than 1UC equivalent.

I'm still monitoring numbers and will make the decision at the time that keeps him safe even if that means defying the vet.

Cath, please have a look at the conversion chart I sent you in post 19 of this thread.
The vet showed me how to use the .3 ml syringe, and how either to the 2nd or 3rd line is the equivalent to 1ml syringe first line.
This statement is very vague...how can either the 2nd or 3rd line on the 0.3ml syringe be equivalent to 1ml syringe first line? They can't both be.
That is saying that 2 or 3 units of the insulin (caninsulin) in the U100 0.3 ml syringe is the same as 1U on the U40 syringe.
In fact 2U on the U100 0.3ml syringe is just a fraction over 0.75 U of caninsulin
3U on the U100 0.3ml Syringe is a fraction under 1.25U of caninsulin.
That may not sound a lot but that 0.5U of caninsulin (which is the difference between the 2nd and 3rd line) is a lot of insulin if the cat is already dropping to 74 when he was only getting 0.25U (am cycle 25 May).
I don't want to stress you, I just want to keep Ollie safe. At the end of the day Ollie is your cat and you hold the syringe. You would not be defying the vet. You are paying her/him for advice. It is up to you, if you think that advice is sound, if you want to follow that advice.

 

[Ollies Mama]

Sorry. I rushed this update and should not have written 'either' she showed me how the same dosage looks on both syringes.

She said if I were to lessen 1UC, I would use less than the 3rd line on the .3 ml syringe. I have had a look at the conversion chart. I showed the vet too to ensure that I had it right.

I am giving just a smidgen under 1UC, using my original 1ml syringe, not the new ones. That is, rather than the black line being exactly aligned, I'm pulling it a mm less.

I am closely monitoring him and he's doing ok with snacks to keep him up, has been steady.
Keeping SS updated accurately. I completely understand how even a drop of insulin is powerful.

Sorry I was confusing. I'm trying to catch up from my study that I missed and study algebra for an exam Monday, and I rushed my post.

I know that you dont want to stress me, and that you want to keep Ollie safe. He is honestly, the best I've seen him. I have not seen him below 5 or above 12 for a day or more because I've been giving him snacks, and monitoring BG, adjusting. I think I finally have the swing of it, and the timing is much improved.

Cheers
Cath

 

[Ollies Mama]

 

[Bron and Sheba (GA)]

View attachment 66924View attachment 66924

Which syringe is this Cath?

 

[Ollies Mama]

Which syringe is this Cath?

hi, that's the 1ml, U40.

 

[Bron and Sheba (GA)]

hi, that's the 1ml, U40.

Ok. I wondered because it didn’t look like any of the U100 syringes.
I see he’s dropped to 72 again. You really need to look at reducing the dose.

 

[Ollies Mama]

Yes I agree. Giving him snacks as we speak.

 

[Ollies Mama]

Proposed new dose as per instruction above. This syringe is U100, 0.3 ml - to draw smaller doses of Caninsulin.

Drawn to first line. (this is water in the syringe) due at 8.30 pm.

Bron writes "To give the 0.1 unit of Caninsulin using the U100 syringe you need to draw up just a tiny bit less than the 0.25 U picture. We are aiming for 0.2 U." Post #31. This is what I have followed on the picture.

Bron writes" You will need to reduce the dose further as Ollie dropped under 90 again so the new dose is 0.1 U of caninsulin." Post # 19.

So, are we are aiming for 0.2 U, or 0.1 U?

 

[Bron and Sheba (GA)]

Proposed new dose as per instruction above. This syringe is U100, 0.3 ml - to draw smaller doses of Caninsulin.

Drawn to first line. (this is water in the syringe) due at 8.30 pm.View attachment 66925

Bron writes "To give the 0.1 unit of Caninsulin using the U100 syringe you need to draw up just a tiny bit less than the 0.25 U picture. We are aiming for 0.2 U." Post #31. This is what I have followed on the picture.

Bron writes" You will need to reduce the dose further as Ollie dropped under 90 again so the new dose is 0.1 U of caninsulin." Post # 19.

So, are we are aiming for 0.2 U, or 0.1 U?

Are you able to print off the conversion chart for using U40 insulins with a U100 syringe that i posted in post 19?.
Its important you don't get things mixed up.
If you look at the conversion chart you will see that the 1 unit you have drawn up on the U100 syringe above is equivalent to just under 0.5 Units of caninsulin.
To get 0.1U of the caninsulin you need to draw up 0.2U on the U100 syringe.
If you look at the syringes I posted in post 31 you will see there is one for 0.25 units, which is 1/4 of 1 unit.
You need to aim for that dose or just a smidgen less.
I would draw up the amount you think it is (in water if you like ) and post it for me to check.
You can then keep the other syringe as a sample one.
Does that all make sense?

 

[Ollies Mama]

i think thats what i have done,

drawn to this line pictured,

 

[Bron and Sheba (GA)]

i think thats what i have done,

drawn to this line pictured,View attachment 66926

The line you have indicated is the zero line.
The line you have drawn up to on the U100 syringe is the 1 unit line.
Each line in the U100 syringe is 1 unit

 

[Bron and Sheba (GA)]

It is confusing because the photos are using 1/2 unit syringes which we done have here in Australia.
So you need to mentally divide each of those 1 unit spaces into 4 to get 1/4 of a unit