? 05/03 Hercules AMPS 131 Has he earned his reduction or is it just my fault?

Hercule's mum

Hercule's mum

Member Since 2020
Last conversation: https://www.felinediabetes.com/FDMB...s-52-6-218-dose-increase.243642/#post-2748495

Morning everyone,

We had another little surprise last night, and I know I am supposed to reduce his dose... but I am not really sure how to this and besides it, it does not feel right.... If you have the time can you hear me out and give me your opinion?

We have been stumbling in lime greens in the past few weeks and decreasing the dose steadily. I've been using calipers, so I have been decreasing in mm. In my current syringe I estimated that 0,25U was about 0.2mm, so i started reducing by 0.2mm, then by 0.1 mm. This is how I ended up with the funny 0.12U.
In most syringes the plunger is just on the zero line at his current dose. But I have checked and there is plenty still squirting out... Should I try going down by 0.05mm this time? It probably mean we will be beyond the zero line but I trust there would still be some juice. I am unconfortable with the drop dose method...After so much work trying to be precise, seems very inprecise:oops::rolleyes:

However, my big concern about droping his dose, is that his SS is looking more yellow every time I drop the dose. Sure, we are still stumbling in greens here and there, but to my naive eyes it does not look good at the moment, or for a cat ready to be in a drop dose. When he was at 0.75U (just 2 weeks ago!) he was solid blue and green and it felt more appropriate.

Further to the argument above the last few times he went into lime green always felt like my fault.... because I wasn't looking carefully enough. This is where I really have trouble following protocol (yes, I know, I am a pain...): If i wasn't so greedy for sleep last night, and have woken up half an hour earlier as planned, he wouldn't have slipped under 2.8 and I wouldn't "have" to drop his dose. He still had a meal to go, and needed that. I just thought given how high he was, it was Ok to leave him for 3 hours...:arghh: So is he really earning these last reductions, or am I just tired and dropping the ball?

Any thoughts on how to adjust his dose or anything else about my rant, much appreciated!
 
Hugs to you Karen! :bighug:
I find it a bit odd you have pinks and otherwise great numbers o_O

I don't think you're dropping the ball here, just human like the rest of us! :bighug::bighug:
 
Thanks Bhooma! I do feel that my change in food schedule has some responsability here... so it would be great to get some suggestion from Gill.

Do you have any thoughts on the dose adjustement?
 
I think I would be inclined to ignore that 49 and hold this dose longer. See if feeding the curve - especially in the PM cycle - can flatten him out some. Would mean sacrificing sleep but who knows, it may only be a short while (anti-jinx)!
 
Bandit's Mom said:
ee if feeding the curve - especially in the PM cycle - can flatten him out some
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Yes. I think this is what I need to sort it out. I started reducing the food in the begining of the cycle, but is hard to know where to put most of the food.
I tried to give him a 50 g portion at +4 and he threw up.... I think he lost his abilty to eat bottomlessly....
 
Hercule's mum said:
Yes. I think this is what I need to sort it out. I started reducing the food in the begining of the cycle, but is hard to know where to put most of the food.
I tried to give him a 50 g portion at +4 and he threw up.... I think he lost his abilty to eat bottomlessly....
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Darn that's a lot! Mauer gets her big meals at shot time, and that's 25g :woot:
 
Hercule's mum said:
I started reducing the food in the begining of the cycle, but is hard to know where to put most of the food.
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Feed him a main meal at shot time.

I would schedule the next feeds for +2 +4 +6 try that for a while. He doesn't need to be getting a snack on the hour every hour.

He's had a late nadir the a few times in the last 10 days or so, but that has been when he has a bounce clearing cycle, that is,he drops steadily through the cycle, he doesn't have a recognisable curve as such, just more of a slide.

in the last 10days he's been having nadirs more where we would expect them for Lantus.

The midcycle feeds should be mini meals.
try 75g for main, 25g for mini. (does that add up to his normal food quota?)




.
 
by +2 you have fed him PS and also a +1, (so he has had 40-50g/ depending on the day?)
I'm seeing a food bump from the PS meal of 20-30 by +1 3/2 ;2/25 ;2/23 cycles where he has not started a bounce, I think what you are refering to as a big food bump at +2 are a late onset, combined with not getting much overlap, and a bounce starting. We usually look for the food bump at +1 not +2, think about when we give HC, or the two hour window before shooting so that the PS value is not influenced by food. The +2 is not being influenced by what you fed at PS, but by what you fed at +1.

I think he has a tendency to onset between +2 and +3, though he sometimes does it earlier and that is when you get a more active cycle.

Don't worry about the food bump, when he onsets he will come down.
Try it and see what happens, when he has an active cycle it will be good that he has enough food in his system to level him off. It might see you have to go up in dose, but I think it will help level him out. You won't know unless you try.

How are you measuring your micro doses? are you using calipers?
 
Gill & George said:
How are you measuring your micro doses? are you using calipers?
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Yes. That is how I ended up with this funny dose... I reduced the last two times by 0.1 mm, which got me basically at the bootom of the zero line in most syringes. I suppose next drop I could continue this way? I am tempted to hang out here for a while though, see if we get some more considtent blues and greens? what do you think?
 
Wonderful and very thorough instructions by Marje! It's good to watch the videos again.

Personally I had a very tough time lining up my calipers to the syringes. My hands aren't steady enough. I ended up using the information to make a mental note of the distance between the top of the plunger and the top of the syringe barrel and then eyeballing it for future doses.

Karen, I know what you mean about the concept of a 'drop'. Because a drop is not something you measure in the syringe, it's a visual of the insulin outside of the syringe! And of course that's no good. And all the doses under probably 1 unit will look like a drop. It's a matter of the size of the drop. I ended up experimenting quite a bit with an old pen of insulin to see where I need to place the plunger to at least get some insulin out consistently. I have noticed the word 'some' for this small dose as well.

It might be worth it to experiment a bit and see if you can get a consistent amount for plunger placement.

Here's some different size drops and what the drop dose looks like for me:

insulin_drops_syringe.JPG
 

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When I measured 0.25u it was more like 3 drops.
(1 drop for 0.25u seems a little on the low side to me/ have you tried counting the drops in 0.5u? are you getting all the air out of the syringe?)
0.1u was 2 (maybe 1 1/2)
and a drop dose/some insulin, is the really easy one to measure, you squeeze the plunger down firmly, insert into vial/pen and let go of plunger, it springs back and you will find it gives you a drop.
 
Gill & George said:
When I measured 0.25u it was more like 3 drops.
(1 drop for 0.25u seems a little on the low side to me/ have you tried counting the drops in 0.5u? are you getting all the air out of the syringe?)
0.1u was 2 (maybe 1 1/2)
and a drop dose/some insulin, is the really easy one to measure, you squeeze the plunger down firmly, insert into vial/pen and let go of plunger, it springs back and you will find it gives you a drop.
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Hi Gill! My point was just that the concept of a drop is a relative thing. The surface tension of the insulin will continue to form drops when squeezing insulin out of the syringe even at larger doses. So it's impossible to measure how many 'drops' in 0.5 when there is no way to specify the size of the drop. What I could do is to repeatedly measure out what I use as a drop and then do a 0.5 next to it. But then it's just a visual comparison and not accurate either. Because one of squeezed out measurements may be higher and not as wide a base. It would be very difficult to judge.

Unfortunately on my syringes (Monoject and also Branzig) the squeeze technique didn't really work. Sometimes there would be a tiny bit of air and I couldn't be sure that I was getting something consistently.

For me I'm comfortable that I'm getting 'some' insulin out at the moment for what I use as a drop dose. And that it is less than what I used for 0.1. I wish they made a more diluted version of Lantus for use in kitties. Or teeny, tiny syringes. Maybe a gap in the market.

Here's my measurements for larger doses:

largerdrops.jpg
 

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I think maybe the fact that I'm using a 29G needle might be why I'm getting more varied drop sizes than if I was using a thinner needle. Also might explain the air pockets in the needle. Unfortunately with Buddy's scarred skin I need a tougher needle.
 
The syringe I use has a hard lip, which is the begginig i tought it was a pain, until @PerfumedCatMom suggested using the inside of the lip, and then it became much easier:

dose.jpg

That is why I was thinking it would be easier to continue to reduce on the calipers instead of attempting the drop dose technique.

But I am getting way ahead of myself, because I am not convinced this dose is working, and we are likely not going down but up.... we'll see (are you listening Hercs!)

btw Mariette, I see your point!
 

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When we talk of drops we talk of them, as the 'cling' on to the needle, rather than being squeezed out onto a surface.

You gently slowly press the plunger and drops squeeze out and drip from the needle. I doubt you would be able to squeeze out just one drop in that manner for 1u. I have some syringes and insulin still, so I will do an experiment.

The drops, as long as you are slow and steady pressing the plunger, form consistent sized drops.

The diameter of your needle would affect the size of your drop.
 
Gill & George said:
When we talk of drops we talk of them, as the 'cling' on to the needle, rather than being squeezed out onto a surface.

You gently slowly press the plunger and drops squeeze out and drip from the needle. I doubt you would be able to squeeze out just one drop in that manner for 1u. I have some syringes and insulin still, so I will do an experiment.

The drops, as long as you are slow and steady pressing the plunger, form consistent sized drops.

The diameter of your needle would affect the size of your drop.
Click to expand...

I agree. I was not implying that I could squeeze 1u out as a single drop :eek:
I just wanted to show what the size of the doses looked like on the same sticker back surface because you thought the 0.25 dose looked low. It's just hard to judge the volume when the insulin is in drop form.

Maybe it's my needle size or unsteady hand, but when I repeatedly let the drops form on the needle I get a varying drop size. And letting them form like that on average looks to me (on a surface) closer to the 0.1u than what I'm using for drop measurement. I'd be interested to see if you can get consistent drops with your experiment. I think I'm very much in the minority with my 29G needle.
 
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Just to make sure I understand.... The point of the "drop dose" was to go smaller than 0.1 when all someone has is the marks in the syringe, correct?
Since I have the calipers, if I ever need to, it makes sense to just keep reducing the dose based on the calipers, right?

and don't you know, we may have got a smile today on Hercs curve!
 
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