? 10/15 - Apollo. PMPS 314, +3 = 281, How do folks give accurate small doses?

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Mile Hi Dave

Mile Hi Dave

Member Since 2020
I was happy to see him where he was this AM, even though it was still high, it allowed me to shoot. His +2 was 301 and, just now, his +4 is 258. Will continue to check it every 2 hours til his PMPS, in search of his nadir. Is checking every 2 hours ok to check for nadir, or do I need to take tests more often?

Thanks again for any help! You folks are awesome!!
 
Mile Hi Dave said:
I was happy to see him where he was this AM, even though it was still high, it allowed me to shoot. His +2 was 301 and, just now, his +4 is 258. Will continue to check it every 2 hours til his PMPS, in search of his nadir. Is checking every 2 hours ok to check for nadir, or do I need to take tests more often?

Thanks again for any help! You folks are awesome!!
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Me myself I would get a +5 and a +6 and maybe a+7 then continue with the 2 hour testing.
I am a neurotic when it comes to my cat. Lol

I only suggest that because the nadir might not be at exactly +6, could be at 4 or 5 at least you will get an idea
Take a look at mine if you want to
It was great that you could shoot this morning :cat:
 
Down to 219! I know folks say not to focus so much on commonalities but from +2 to +4 was about a 40 point drop, as was the +4 to the +6 reading I'm just happy he is kind of leveling out. It's looking like moving to .75 was the answer. We'll see what + 8 brings... do I hope it's still going down? Or should I be wanting it to go up at+8? I understand all cats have a different nadir, but the assumption that it comes close to half way between shots seems to make sense.
 
Mile Hi Dave said:
We'll see what + 8 brings... do I hope it's still going down? Or should I be wanting it to go up at+8? I understand all cats have a different nadir, but the assumption that it comes close to half way between shots seems to make sense.
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I don't know about "hope" or "want" here, I don't think there's a good or bad answer, really... I'd expect for most cats they'd start going up again by +8, but only Apollo knows what he's planning here, and he did pull that super-low pre-shot the other day! We can explain that one by the fact that he was breaking a bounce at the time (cats can pick up quite a lot of downward momentum when bounce-breaking), but it also may turn out that he's a late-nadir cat. We shall just have to see!
 
So, the +8 went up to 279, so today Nadir was between 6-8 hours. Will be doing the same thing tomorrow. Then on Saturday, I'll do it for the PM hours to see if it's the same. It should be, right? Question, assuming everything continues this way, how long do we keep the dose the same before adjusting it??
 
And, back over 300... 314 Way better than 400!! :) Hopefully, the start of some consistency. Gonna get a +3 and +6 then, hopefully get 6 hours sleep, depending on the readings. Then, tomorrow, get a couple more pre PMPS tests, and do like I did today, tomorrow evening do +2, +4, +6, and +8, a 4 hour catnap, then I'll have decent data started. I really wanna give Apollos ears a break after pokes every 2 hours all day. :D Hope that sounds like a decent plan. Is there a way to get the vial out of a Lantus pen, or does everyone just keep it in the pen?
 
Looking good!

Mile Hi Dave said:
Is there a way to get the vial out of a Lantus pen, or does everyone just keep it in the pen?
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Do you mean the clear cartridge of insulin? I don't think there's any way to separate them when you buy the pen as a single unit. I actually took an old one apart once, because I had bought the cartridges rather than pens and I found them inconvenient to store in the fridge (no cap or other protection for the part you poke the syringe into). I wanted to see whether the cartridges (which are made for a reusable pen device) could be fit into the old disposable pen casing-- no such luck! In any case, I don't recommend taking them apart with insulin you want to use still inside, it was quite a process...
 
Nan & Amber (GA) said:
Looking good!



Do you mean the clear cartridge of insulin? I don't think there's any way to separate them when you buy the pen as a single unit. I actually took an old one apart once, because I had bought the cartridges rather than pens and I found them inconvenient to store in the fridge (no cap or other protection for the part you poke the syringe into). I wanted to see whether the cartridges (which are made for a reusable pen device) could be fit into the old disposable pen casing-- no such luck! In any case, I don't recommend taking them apart with insulin you want to use still inside, it was quite a process...
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I was just thinking it was sooo wasteful and bad for the environment to keep getting pens, and storing them, the cartridge, in the fridge would be easier and take up less space. But, you're right, the insulin is well protected in the pen.
 
Not a huge drop, but it's a drop. It's so tough to get exact dosage right. I really don't know if I gave him enough. So, I thought, "wonder if they have a diluting agent". They do make them, just not for Lantus, for children under 4, a U-10 insulin that's diluted. This is a great NIH article about the challenges of delivering smaller doses: https://tinyurl.com/y4yvouth
The reason is, I have a hard time splitting the 1/2 units to get to .75 and, if the dose isn't always the same, these numbers aren't really accurate. Folks, we are shooting as little as .10 because of a cat's metabolism, these doses have to be far more precise for the spreadsheets to really give us accurate data. Data based on guesswork is BAD data and just isn't at all as reliable as is really needed/required.
 
Mile Hi Dave said:
No thanks, The folks on that forum aren't to welcoming... I don't go to that forum anymore. Folks here are friendlier and more focused on helping than complaining when a new person misformats a title. They succeeded in chasing me out and I won't go back there!
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Across the board, we ask members to be kind and this post isn’t.

The posting requirements in the LBL ISG are there because of the number of posters we have. It helps to keep track of each kitty and what’s going on. Experienced members can look down the list at subject titles and see if a member needs help.

You don’t have to post there although you will get more experienced eyes regarding Lantus advice. Many of the same people offering advice there also offer advice in this forum.

The bottom line is whether this is about you or your kitty and what’s best for him :)
 
Mile Hi Dave said:
Not a huge drop, but it's a drop. It's so tough to get exact dosage right. I really don't know if I gave him enough. So, I thought, "wonder if they have a diluting agent". They do make them, just not for Lantus, for children under 4, a U-10 insulin that's diluted. This is a great NIH article about the challenges of delivering smaller doses: https://tinyurl.com/y4yvouth
The reason is, I have a hard time splitting the 1/2 units to get to .75 and, if the dose isn't always the same, these numbers aren't really accurate. Folks, we are shooting as little as .10 because of a cat's metabolism, these doses have to be far more precise for the spreadsheets to really give us accurate data. Data based on guesswork is BAD data and just isn't at all as reliable as is really needed/required.
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We don't recommend using an at-home diluting agent. I would be extremely worried about contamination of the insulin.

Some of the things we do recommend for the tiny doses:

-making up a "sample syringe" for your current dose, using a colored liquid, for comparison.
-using digital calipers to precisely measure a dose amount

For both of these, the goal isn't so much precise measurement of units as it is precisely consistent measurement from day-to-day. That's really the most important thing for lantus. You're totally correct about this:

Mile Hi Dave said:
Folks, we are shooting as little as .10 because of a cat's metabolism, these doses have to be far more precise for the spreadsheets to really give us accurate data.
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0.1 vs. 0.2 is extremely hard to "eyeball", but it's a doubling of the dose, so it can be important to a cat's body! It's a good thing to be thinking about these issues and how to address them.

In addition to the other things I mentioned, some people also use magnifiers (even cheap "reader" glasses can help) and bright lights to help measure doses. Whatever works!
 
Mile Hi Dave said:
Not a huge drop, but it's a drop. It's so tough to get exact dosage right. I really don't know if I gave him enough. So, I thought, "wonder if they have a diluting agent". They do make them, just not for Lantus, for children under 4, a U-10 insulin that's diluted. This is a great NIH article about the challenges of delivering smaller doses: https://tinyurl.com/y4yvouth
The reason is, I have a hard time splitting the 1/2 units to get to .75 and, if the dose isn't always the same, these numbers aren't really accurate. Folks, we are shooting as little as .10 because of a cat's metabolism, these doses have to be far more precise for the spreadsheets to really give us accurate data. Data based on guesswork is BAD data and just isn't at all as reliable as is really needed/required.
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Well....all I can really say is “been there done that”.

As long as this board has existed, this has been a known issue. You might want to read Dosing with Calipers. As a scientist, it’s a method I developed which enables me to dose down to 0.05u. And yes, that degree of accuracy is correct.
 
teresazu said:
if a sticky was all we needed, there would be no need to post. that's why the data on the SS is so important, to treat and advise according to the individual cat, not some text book theory
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I have no issue with going and reading the sticky. Had I stayed on the Lantus forum, I probably would have seen and read it. I printed it out now for reference. While all cats aren't the same, it gives a good general idea of how things work.
 
Yes... the reason we point to the stickies in the insulin-specific groups is because, even though we're here in Feline Health, we generally try to stick with the same dosing methods as are used in those groups. There are some small differences in implementation and the general approach to advice in this forum, but we don't have Feline Health-specific dosing methods. We refer "out" to the documents in the ISGs for background reading, but we're still here to guide the application of those methods and answer questions about them.
 
teresazu said:
if a sticky was all we needed, there would be no need to post. that's why the data on the SS is so important, to treat and advise according to the individual cat, not some text book theory
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I don't dispute for one minute that there is a need for specific advice and also that spreadsheet data is vital. However, in this instance the opening poster asked a general question and I endeavoured to help by pointing him to where he could find a comprehensive answer to his query.

As a general note, the forum stickies are a very valuable resource. In addition to the education they provide about different topics, there may be times when one needs help but there's no-one online to answer posts. In such an instance, if one has built up a reasonable level of familiarity with the content of the stickies when all is running smoothly then it can make finding relevant, helpful information easier when the need is urgent.


Mogs
.
 
Mile Hi Dave said:
I was happy to see him where he was this AM, even though it was still high, it allowed me to shoot. His +2 was 301 and, just now, his +4 is 258. Will continue to check it every 2 hours til his PMPS, in search of his nadir. Is checking every 2 hours ok to check for nadir, or do I need to take tests more often?

Thanks again for any help! You folks are awesome!!
Click to expand...
you don't have to check every 2 hours unless you're doing a curve which is only necessary minimum 7 days at same dose, but for daily checks as long as you check preshot and around +6 is fine.
 
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