23/5, Jazz, AMPS 18.1 (325.8) - Newbie here!

[Missy & Jazz]

Hi everyone,

Sorry if this is a little long! I joined the board a while ago and have been posting in the main forum, but this is my first post in this group as I've only just transferred all my figures/info over to a Google docs spreadsheet (link in signature - hope it works!).

I think most of the relevant info for Jazz is also in the signature, but if there's something I've missed, please let me know!
I do home-test - before every shot and at about +6 (sometimes more often, and have been doing curves occasionally).

As you can see from the SS, her numbers have been kind of all over the place - that is mostly my fault I think (not getting all the insulin in every time) - I know from about the 14th-17th May, I missed a few shots consecutively unfortunately, which I feel really awful about :sad: Hoping we are getting back on track now! (I have been trying every different injecting method I can think of!)

I hope this is the right group to post in (relaxed vs. tight) - I would like to do the tight protocol, but cannot get syringes with 1/2 unit markings on here in Australia, and I'm pretty sure our dosage logic to date doesn't match up with the tight protocol instructions... :lol:

Jazz started on 1 IU BID, and has mainly stayed on that dosage, as you can see. There was a short period of trying a 1.5 IU dosage, but that resulted in a too low number. When her BGs dropped very low, I have generally been skipping the next insulin dose to be safe, but after discussing this with the vet, we have recently been going with the following (vet recommended) dosage:

If pre-shot BG is 10 or over (180 or over), dose = 1 IU
If pre-shot BG is 7.5 - 10 (135 - 180), dose = 0.5 IU
If pre-shot BG is under 7.5 (under 135), skip dose.

I feel confident enough measuring out the 0.5 IU dose with the syringes I have, but trying for a 0.25 dose is not something I feel confident about doing accurately and consistently!

If anyone would be kind enough, I would love to hear your thoughts and opinions on Jazz's BGs and our current dosage method. My main aim so far has been to try and get her numbers down to reasonable levels more consistently (she tested over 31 [558] at the vet when she was initially diagnosed! :? ), but I am happy to consider changing the dosage method/amount... whatever is best for her. I would like to fine-tune it so I can try and make sure she's sitting in a safer, more normal range throughout the day. I think I'm rambling now, so will leave it at that, but thank you very much for reading!

 

[cjleo]

Hi Missy and Jazz and welcome to the "Relaxed Lantus" board.

Got a question for you. What size syringe are you using 1/2 or 3/10? If you are able to get the 3/10 cc syringe, we can help you microdose.

I've been an insulin dependent human diabetic for 36 years and I currently have 5 diabetic cats. When I use the 1/2 cc syringe it is hard to do half units, but with the 3/10 syringe it is much easier. Even if the syringe doesn't have half unit markings.

Welcome again and good luck with Jazz

Claudia

 

[nckitties3]

No advice from me, I leave that to the more experienced members.

Just wanted to say Welcome to the board. :YMHUG:

 

[Missy & Jazz]

Thank you both for your replies and welcomes!

Claudia, wow, that's amazing! You must be incredibly dedicated and compassionate to care for so many diabetic cats! I bet you're awesome with them, being diabetic yourself - I can't imagine having to do all the diabetic care for myself as well as the cat/s though!! Kudos.

I am using these syringes:
BD Ultra-Fine insulin syringe 0.3 mL, 0.33 mm (29G) x 12.7 mm - the ones for use with U-100 insulin (matches the Lantus we are using).

This is the best link I can find for more info on these syringes - if you scroll down the page, the ones I am using have the code 326103.
https://www.medshop.com.au/products/bd- ... 26103.html

I *think* the 0.3 mL translates as 3/10 cc for those members in the US/elsewhere? (we don't generally use that measurement system in Australia, so I am not totally sure).

The half units I feel comfortable doing with these syringes, but 0.25 units would be a struggle for me... :shock:
I know there are syringes available elsewhere with the half units marked (which I think would make it easier to measure 0.25 units) but they are not available here and I doubt I'd be able to import them unfortunately. Any help with microdosing (good term!) with the syringes I have would be excellent - thank you! We are currently dosing (usually) 1 IU BID, so it's not something I need to do right away (tiny doses) but I would love to have that flexibility in adjusting the dosage for her.

Nckitties3 - thank you! Everyone's so friendly and welcoming here, it is really lovely :smile: (I know what you mean too - being a newbie here I am reluctant to reply to others' messages for fear of giving daft/wrong suggestions!! definitely learning so much already though!).

All the best to both of you with your own diabetic kitties

As a quick update, I have just updated Jazz's SS and must have got the AMS in (YAY) as her BG at +6 is now 4.9 dancing_cat Hoping I can continue this trend now!

 

[Deb & Wink]

Hi Missy,

See you have left Feline Health and started posting over here in Relaxed Lantus. Nice group of folks here, but it does tend to be a bit quieter here, epecially since Mel of MommaofMuse lost her internet connection at home.

If you have a question or a health emergency and want more eyes, please post over in Feline Health or on the Lantus Tight Regulation forum. Those are the busiest forums on this board.

Looking at your spreadsheet. With that 4.9 (88) at +6 today, you certainly want to hold this dose for a bit more. I'm seeing some bouncing to high numbers as Jazz's body compensates to pump out some more glucose and hormones to keep the organs and brain safe. Her body has gotten used to those higher numbers, so when it gets a low number, you'll get some highs for a while. Usually, a bounce takes up to 72 hours to clear.

Would it be possible for you to get a test at night before you go to bed? This additional test is very helpful for us to see what is going on. Many cats drop lower at night.

Yes, you folks in Australia don't seem to have access to those insulin syringes with the 1/2 unit markings. The best way to do the smaller units, is to practice with a used syringe and some colored water, trying for consistency and eyeballing what you think is 0.5 or 0.25.

Twisting the end of the plunger, will slowly squeeze drops of insulin out of the syringe and help you to practice measuring those smaller amounts. Once you get some consistency in the number of drops you push out with 1 unit, cut that in half and try for only half those number of drops for the 0.5U increment. Mark your 'reference syringe' with a fine point black marker at that new 0.5U mark.

Do the best you can. You are trying for consistency on the amount.

Long day for me. If my explanation on creating the 'reference syringe" does not make sense let me know. I'll try to explain it better.

 

[Missy & Jazz]

Thanks for the great info Deb - I appreciate that. I can't get over how kind and helpful all you ladies (and gents!) are here... I mean, I know there are lots of nice people out there :lol: but it seems like they are all concentrated here!! lol

Thanks for the tip - very handy to know. I did think it seemed a bit quieter here, so I'll keep that in mind.

This morning AMPS she was 11.1 (+0) - which sounds like a good PS number to me?? I am still working out the kind of numbers that seem ok for her - that is, the daily trends that mean she's hitting reasonable, healthy numbers but not dropping too low. TBH, I think that those trends are (I hope!) still establishing...

Thank you for the clear explanation of the bounces - great to have a good description as I've seen the term around but not fully understood it before. I did think some of the higher numbers could be her body compensating for the lower numbers that are still apparently considered 'not normal' by her body, but didn't realize that was the term.

Yes, I can do a test at night :smile: What kind of time would be good? Shot time is approx. 7 pm (+0) so I could do +1, +2, +3, maybe +4... what would be best do you think? (would prefer to make it just 1 extra test if possible to minimize hassle/stress to her). I intend to do another curve soon too, sometime this week so I'll add the results to her SS.

My concern with the 11.1 this morning is that if that is her +12, do you think her nadir during the night would have possibly been dangerously low? I know I can test that in the night obviously, but it's hard to know to do that beforehand, when I only get her +12 number in the morning. Hope that makes sense.

I have saved a used syringe (to practice with), and the coloured water idea is great! I did read about using apple juice somewhere, so might try that. Good point with the drop counting and using a marker to make a reference syringe (definitely made sense, thanks!). I do the twisting of the plunger to get the right amount, and can do the 1 IU and 0.5 IU without drama, just worried about trying for 0.25 IU (though it's not a concern right at the moment!).

Thanks again for all your good tips and I hope you have a better weekend and get to relax a bit

 

[Deb & Wink]

If you are willing to do that one more test at night, I'd prefer one just before you go to bed usually. I'm guessing that would be around a +4. There is flexibility there, so if you go to bed early one night a +3 would be fine. If you are up a little bit later another night, a +5 or +6 would be fine.

My concern with the 11.1 this morning is that if that is her +12, do you think her nadir during the night would have possibly been dangerously low? I know I can test that in the night obviously, but it's hard to know to do that beforehand, when I only get her +12 number in the morning. Hope that makes sense.

That 11.1 this morning is a nice blue number. Below the renal threshold (~13.88/250) which spills excess glucose into the urine, not too low into hypo territory. Since many cats do drop lower at night, getting that +4 before you go to bed test will give us some clue as to how far she is dropping at night. That is one reason I asked if you were willing to do one more test.

Do you know when Jazz's nadir is in the cycle? Most cats on Lantus nadir around +5-7 but ECID. Wink always nadired around +4.

I intend to do another curve soon too, sometime this week so I'll add the results to her SS.

Curves can be informative in helping to see the nadirs. Sometimes though, you can get as much useful information by doing some random tests at the 'neglected spot check' times. These are usually the +10 and +11. If you are up early enough some morning, you may want to get those numbers occasionally. These random spot checks help to fill in the picture, across several days. A curve is only how Jazz is doing on a single day.

Here is what very experienced member Jill & Alex said to someone in TR on May 20:

regarding the curve - don't focus or think about it. it honestly isn't necessary. If you can get tests in during each cycle you don't have to do a curve. really there is no rule that says you have. Look at Maui's chart, I never did one.

Good info, Hillary!

Doing a curve with a long-acting insulin is highly overrated. A curve with the long-acting insulins such as Lantus or Levemir will only give you a single snapshot in time.... on that day. One can actually get a better idea of what a particular dose is doing by getting random spot checks throughout the week.

For example: If you happen to do a curve on a day kitty is bouncing from a low number... you'll probably see high numbers. If you increase the dose based on that single curve you could easily over dose kitty and inadvertently cause a hypoglycemic episode. :shock:

When obtaining random spot checks you want to look for:

• Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose

• Peak/Nadir - the lowest point in the cycle

• Duration - the length of time insulin continues to lower blood glucose

Like Hillary, I've never intentionally set out to do a curve. Random spot checks at different times will yield much more information with the long-acting insulins.

Once you get the consistency down with the 0.5U and squeezing out drops, it's time to practice squeezing out half the drops to find that 0.25U mark. You'll have the 0.5U marked on your reference syringe so that will help you to practice for the lower dose. It doesn't have to be exact every time. Just try for consistency.

Thanks for the good thoughts on a relaxing weekend. Unfortunately, I work weekends and since Monday is a holiday, Memorial Day, i will be working that day too. At least I don't have to get up at 4 AM. :shock: I only do that for the things I love like the bird banding I do on Fridays in spring and fall. Only one more Friday and then the spring bird banding season is at an end. Then, I only need to be concerned about the early morning kitty wake up calls and those usually don't start until 5:30 - 6 am. ohmygod_smile