03/28 increased insulin last night from 1U to 1.5 per vet. Amps was 465!

Hi all, I need input if this might be a “ normal” occurrence? Bear is 4 yrs old , diagnosed in February, BG was 453 at diagnosis. He has been on 1U of Lantus for almost 4 weeks now. I have been keeping the chart since 3/12. I use alpha trak 2 device and strips. As you will see in the chart that his numbers were typically in the 300’s and 200’s. I sent to the vet and he thought we should increase to 1.5. When I tested last night at 10pm he was 234. At 6:30 this morning he was 465! My heart sank to the floor! He has had 2 tests since then at 320 and 325. He is fed Fancy Feast pate classic varieties, no dry food. Also, is there a picture on line that shows accurately where 1.5 Units is on a U100 syringe? Thanks for your help!

 

Hi,

I’m just one who gets advice and am not an expert by any stretch but I can tell Dora had wild swings for months when she first started on insulin . Only now that I have been more aggressive is she coming down. But the AlphaTrack also will swing more widely and read higher than the human meters just because it always reads higher by design.
Have you read up on SLGS and TR? I’ve learned you shouldn’t hold a dose too long when the bg isn’t coming down enough at that dose.

Also they do make syringes with half unit markings. They’re hugely helpful. Good luck! And I’m sure someone can answer more throughly. I’ve seen the pictures on the Facebook group but don’t know where to find them.

When I used to post posts like yours, someone told me this is a marathon, not a sprint. And with Lantus, you have to give a new dose several days before it starts to help.

jane

 

Jane, thank you so much for your reply and words of encouragement! I really appreciate it! My name is Jane too but I go by Janey

 

I saw the name, partly why I had to respond! Your cat is young for diabetes, do you know why he has it? Dora is six, but she was diagnosed almost a year ago. No idea why, other than she’s been trouble since we got her!

Good luck with Bear - you’ll probably end up needing a couple of increases until you get to the right number. The guidelines on this board say to raise by 0.25 at a time. That’s even harder to gauge on the syringe!

 

We don’t know why he has it. All other readings on his blood panel were ok per the vet. I think I will need to ask the vet for a better syringe. My daughter and I both give him injections and it just leaves too much up to chance when you aren’t quite sure where to draw to.

 

I use BD but I understand Relion makes one with half unit markings too. Right now I’m using the ones without. I got the good ones from Amazon but they won’t sell them to my state anymore.

Dora has had a couple of episodes where she doesn’t eat, mostly before diagnosis but also just in January. Other than that and a heart murmur, no issues.

 

If you look at the Sticky Note: Insulin Care & Syringe Info: Proper Handling, Drawing, Fine Dosing there are pictures of what a half unit looks like. What brand of syringes are you using now?

As for today's numbers, I rather suspect he went lower than 234 last night and is now bouncing. The definition of bouncing is in the New to the Group Sticky Note if you haven't read that yet - I recommend you spend some time reading all of them, lots of good into there. If you see a +2 or +3 test that is quite a bit lower than the preshot test, then it is likely they will continue to go quite a bit lower that cycle. Which means either making sure he has lots of food out to keep him safe, or setting an alarm and testing later on that cycle. It's likely he hit some numbers below 200, which he isn't used to yet - the thing that causes bouncing.

 

Wendy, thank you so much for this advice. I am using VetriJec u100 syringes. The vet tec at that first visit said that 1 unit was pulled to the very first long black line. I just have a feeling that can’t be right? This would make 1.5 units right in between that line and the next short line. I did try on a used one, I squirted water onto a paper towel and it does appear to be a good amount. But I just want to be extra sure we are giving him enough.

 

Any chance you could load a used syringe with coloured liquid and what you've been giving as 1.5 units, take a picture, then copy it over here?

 

Yes, I can do that . Give me about 5 mins. He just had his PMPS and it was 270.

 

Wendy, the one on the left had the red dye but it’s really hard to tell where it is. The one on the right is the before pic. For 1 unit we had been drawing past that first long line and then back to it for 1 unit. For 1.5 is it right in the center before the small 2 does line? Do they make syringes that show 1.5 units?

 

Yes, you can buy syringes with 1/2 unit markings. From the Sticky Note on Syringe info:

• U-100 3/10cc syringes with half unit markings are the best to use for drawing Lantus, Basaglar, or Levemir from vials, cartridges, and pens.
• BD Ultra-Fine, CarePoint Vet, Monoject, GNP, UltiCare Vet Rx, Sure Comfort, and ReliOn are just some of the brands available with half unit markings.
• Syringes come in ½ inch or 5/16 inch needle lengths. Needle gauges are 29, 30 or 31 (31 being the thinnest)

Relion can be purchased at Walmart. These are how you measure:

 

Wendy, looking at the syringe diagram it looks like that first large line is “zero” and the first small line is 1. This means that for the last 3 weeks we have been giving him practically no insulin?? If we now go to 1.5 units will that be too much too soon? I’m so confused now and really annoyed with my vet.

 

If you are seeing numbers below 300, we make changes by 0.25 units at a time. And yes, you have to eyeball that between the 1/2 unit/full unit marks.

 

Hi Janey, welcome!

One thing I discovered - the brands listed in the sticky are 31gauge needles/8mm=5/16in long (the BD is even shorter). Looks like your current syringes are 29gauge/12mm long.

I found it a bit difficult to inject with the shorter needles, so I searched and found U100 syringes with half unit markings, 29 gauge/12mm=1/2in long:

• SM-10016 SOL-M Insulin U100 Syringe with HALF UNIT markings 3 ml with 29 x 1/2 from calvetsupply.com
• Monoject Ultra Comfort U-100 Insulin Syringes 29G 3/10cc 1/2" 100/bx from adw.diabetes.com

 

Wendy, but is 1 unit at the first small line, not the first large line as we were told? I feel like we were not instructed correctly and now I’m really annoyed with our vet. Out poor cat has probably only been getting .5 unit?

 

Liz, thank you. I’m going to look for these. It will be much easier to give the correct amount.

 

Your syringes look like the ones on the right of the picture I posted. Push the plunger all the way in - it should line up close to that first large line, which we call the zero line.

 

Are those 1/2cc syringes (which hold up to 50 units)? If so, you’ll have much better luck with dosing 0.25 and 0.5 increments if you get 3/10cc syringes (hold up to 30 units).

Can you provide the info that’s on the box or bag of syringes, please?

 

Syringes with half unit marks are also available at WalMart, if you have one near you. Their Relion brand 3/10ml (3/10cc), 30 or 31 gauge, 6mm or 8mm insulin syringes all come with half unit markings and are only $12.58 for a box of 100 (although a lot of them don't realize they DO come with half unit markings!)

 

Hi, thank you for posting the photo. I found out today that we are going to keep Bear at 1 unit for awhile longer as I wasn’t giving him the correct dose to begin with. So frustrating.

 

Everything can be confusing at first, and frustrating. But as you move on it will all get less intimidating. 1 Unit is a good place to start. It takes a little while for any new dose to settle in. Lantus is what we call a "depot" insulin--not an in-and-out insulin. It needs to build the "depot", which reflects the size of the dose and contributes to the stability Lantus is known for. So, when you begin Lantus it will take a few days to establish the depot. While this is taking place some of the insulin is going into building the depot. Therefore not all of it is going into actually working on the blood sugar. You may see wonky numbers, so don't worry. Just try to be consistent. In the future, whenever you make a change in dose (always following the guidelines), the depot re-calibrates itself to reflect the new dose, and, again, the process takes a few days to settle in. It can be an adventure! But it's worth it.
Good luck to you and Bear.

 

Hi, I am back to this again. Do you need a prescription from the vet to buy these syringes at Walmart?

Bear’s mom

 

It may depend on your state. Up until recently, I could order syringes via Amazon without a prescription. But as of Jan 1 either the laws changed or they started enforcing existing laws, and they will no longer ship to New Jersey. I looked into it, and laws about syringe sales vary by state. For some there's no prescription needed, for others you have to have one (but in some cases only under a certain number of syringes at a time). So check the laws for your state, I guess.

 

Varies by state. Here’s a link that provides info about requirements in different states/countries:
https://childrenwithdiabetes.com/insulin/prescription-laws-and-resources/