? 12/05/2021 Whiskey AMPS 227 (12.6 world)

[stannarp]

Hi all, advice please...long post!

First off, for reasons here, for the next week I can test at most 2x a day (am and pm ps). In summary, she has an ear infection and is terribly sensitive about her ears which I have to clean daily with Opiotic (more on this later). Paws are a no go area.

https://felinediabetes.com/FDMB/thr...-and-shot-full-dose-0-75.256153/#post-2884034

I'm using u100 syringes with my Lantus, and realised in retrospect that I was using them with vetsulin too, essentially under dosing her with that, queue face-palm emoji here.

So, she was essentially on 1u of vetsulin in a u100 syringe, which the vet thought was 1u in a u50 syringe.

When he changed me to Lantus he was assuming I was still using the same type of syringes as previously (u50) and he had move to 1u Lantus, but 1u in a u50 syringe is 2u in a u100 one.

She initially tested low on Lantus so we moved her to 0.75u. Now she's testing in the 12's (220's). However, I am not sure the Opiotic isn't interfering with readings, and it is all over her ears

Opiotic ingredients: "Water, propylene glycol, lactic acid, Spherulites, docusate sodium, salicylic acid, PCMX, dimethicone, fragrance and FD&C blue #1. Lactic acid and salicylic acid are present in encapsulated (SPHERULITES) and free forms. Chitosanide is present in encapsulated form."

The question is what do I do while we are sorting out the ears?

1. Maintain dose on account of the 220's?
2. Decrease dose as a precaution (in case the opiotic is messing with my readings).
3. Increase it on account of the 220's.

It's only 2 days since she's been on a steady 0.75u Lantus, so no proper depot yet).

ps, she's perfectly OK in herself, eating well and same level of activity, so I don't see any signs I'd put as hypoglycemia and I'm watching her very carefully.

 

[Sienne and Gabby (GA)]

One thought is to ask your vet whether they could attach a Freestyle Libre to Whiskey. If you are not familiar with this, there's a sensor that they attach (with a glue) to a shaved area on your cat. You can use either a reader or phone app (which may not be available for all versions of the Libre) to test the BG levels. These are relatively new devices that are in the category of "continuous glucose monitors (CGM)" that are approved for humans but quite a few vets are suggesting them for cats. They don't always stay on especially since cats can be rather clever about not wanting to have one affixed. It may be a good temporary solution since you can't easily home test given the ear infection. (I'm guessing you're not in the US and I don't know how available a CGM is where you're located.)

I don't see anything in the ear medication that would have an effect on Whiskey's numbers. Often ear medications have a steroid in them and this doesn't. It's actually not a prescription ear cleaner so it should be fine.

Failing the CGM, I suspect that holding this dose will be OK and that you will be able to test in sooner than a week. I would hope that the medication helps to alleviate her discomfort sooner rather than later. I would try to get at least one additional test per cycle so you have some idea if numbers are dropping low on this dose.

If I may also make a couple of observations. Vetsulin is a U40 insulin and you should have been using U40 syringes, not U50. The "U" number reflects the concentration of the insulin and the syringe needs to match that concentration. Lantus is a U100 insulin.

Once you are able to do so, please get at least a "before bed" test every night. With Lantus, dosing is based on the nadir (lowest number in the cycle). If you don't test in the evening, you risk missing dose reduction and you're missing half of your data.

 

[stannarp]

Thanks for this.

Usually she's grumpy about testing, but it is doable, so I'll not do the Freestyle, which is pretty pricey, and I'm not sure the vet would do it anyway.

We are 3 days (of 7 into the ear treatment), so I'll have to carry on as I am with pre shot tests morning and evening for a few more days, after which I can try to get a curve and see what is actually happening.

The problem with the ear meds interfering with the tests is that it makes it almost impossible to get a bead of blood...it doesn't bead but almost smears because of the film they leave on the ear. This results in me having to prick many many times to get blood. The fingernail trick doesn't work, the blood smears too much for the strip to pick it up. Vaseline doesn't seem to work either (it is designed to dissolve ear wax after all!) I was also worried that the ingredients themselves might be combining with her blood on her ear and skewing the results. Needless to say the testing grumps increase exponentially with each unsuccessful prick.

Treating her ears is hell, she lacerates any part of me she can reach, so cleaning it off for tests more than once a day is not going to happen, as I'd have to do the ears more often.

Yes, I also read it was a U40 not a U50, I'll have to find a diplomatic way to tell the vet they are giving the wrong syringes for Caninsulin /Vetsulin.