Airboble in levemirpen

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Charlotte & Prop

Charlotte & Prop

Member Since 2011
The family im helping with their cat Pelle can see there is an airbuble inside the levemir pen. It wasn't there when they got it, but since they have taken insulin out with a syringe they think maybe accidentially they have pushed a buble inside. Is that going to do anything to the insulin?

The reason they worry is also because after a few days where Pelles number have been around 220 most of the time they test the bg, his number are now rising, lie if the insulin is not working.

12.12.11
Amps 319, dose 0.5 unit. But he had no insulin the night before because we didn't know if his numbers were going up or down.
+11 238
pmps 212 dose 0,2 unit
+5 220
12.13.11
amps 263 dose 0.4 unit
pmps 232
+3 216
+5 212
12.14.11
amps % dose 0.4 unit
pmps 248
12.15.11
amps 272 0.4 unit
Pmps 285 0.6 unit
+4 300 why is he going up here, shouldnt he be falling?
12.16.11
amps 290 0.6 unit

It seems like it is not working at all for him anymore.
But is it normal for the numbers to begin to rise after they have been pretty good or could it be the airbuble making the insulin not work?
 
Sometimes when changing a dose, the BGs do not do what you would expect, sometimes it goes up a little rather than go down. It is one of the reasons it is best to wait 3 or 4 days at least after changing a dose to see how it's going to work. Things should settle for him by then.

The bubble is normal in the pens after drawing some insulin out with syringe. The top plunger doesn't come down like it would if you use the pen with the screw on needles and dial the dose, then click it to push the insulin out. The bubble will get larger and they will see a red stopper like piece come down in to the barrel. That is also normal when using the pens this way.

Great questions, by the way!

He is doing pretty good, they did right to raise the dose.
 
Air bubbles are OK. My current pen has about half the space full of air (it is half empty) because the red stopper isn't working correctly. It has come down a bit (it works by vacuum as near as I can tell).

It is too soon to tell if raising the dose was the right thing to do or not. So, as Vicky said, give it a few days to see what is happening. He could need a bit more insulin, but he may also need less and that is making the numbers start to swing again.
 
12.12.11
Amps 319, dose 0.5 unit. But he had no insulin the night before because we didn't know if his numbers were going up or down.
+11 238
pmps 212 dose 0,2 unit
+5 220
12.13.11
amps 263 dose 0.4 unit
pmps 232
+3 216
+5 212
12.14.11
amps % dose 0.4 unit
pmps 248
12.15.11
amps 272 0.4 unit
Pmps 285 0.6 unit
+4 300
12.16.11
amps 290 0.6 unit
pmps 134 no shot
12.17.11
amps 300 0.6 unit
+4 299
+6

So once again you were right, and a good thing they didn't raise the dose after his numbers went up yesterday. Today at pmps he was 134, and with no test during the day its hard to say how low he went. I told them no shot tonight and tomorrow to keep the dose on 6 units if his numbers are above 220. If under, then only .4 units. And then several test since they are home tomorrow. Does that sound ok?
 
I hope you mean POINT 6 units, not 6 units! Right?

That all sounds OK. The 134 could have been a low point (so not lower before hand). He may be higher tomorrow am since they skipped the shot. But that will probably just mean a .6u dose.

In the future, can they test again in an hour and see if he is rising, falling or staying stable? If rising or staying the same, I would say give insulin. They might want to reduce a bit, in this case to .4u, so that he is getting some insulin. Even the tiniest amount will help. And, of course, if they shoot an hour late, then next shot needs to be 12 hours after that one. They can bring hm back to the right time by cutting 15 mins off each 12 hour cycle until he is back on schedule.

Have they gotten the u100 syringes yet? That should help with smaller doses. If they had those, they could probably practice and find .25u pretty easily. That small amount could be given if he is low at PS, but rising or staying stable an hour latter. It is always better to shoot every 12 hours and find the lowest dose that works for that instead of shooting higher and having to skip shots when he is too low to shoot comfortably.

However, if there is any doubt it is probably better to not shoot if they can't get a small enough dose, or won't be there to test him and monitor him. They have very little data, as you point out, to know how he will react to any amount of insulin on a lower number.

Make sense?
 
Thanks and yes it make sence.
And yes i mean .6 Unit :)
The problem are the few bg test and not knowing for sure if they can get a test at all. But they get better all the time, but still not liking it to much.
Pelle got diabetes after a long treatment of steorids. Will that do anything to his chances of going into remission at some point?
They havent got the syringes, but are counting drops. There are 5 drops in 1 Unit, so they Can pretty easy get .2-.4-.6-.8 units.
 
I am sure that steroids effect the chance of remission, but it probably varies with every cat. How long was he on steroids?

My cat, Beau, was on steroids for about 2-1/2 years from the age of 3 to 5. He didn't develop diabetes until he was 8, but the vet has said, at the time, that diabetes was a possibility. I actually think the dry food I was feeding was more of a cause than the steroids. Beau was on caninsulin for over 2 years and then I switched him to levemir and he went into remission about 3 months later. It surprised all of us here.

If Pelle can go into remission, they are doing everything they can to make that possible. For Beau, what probably helped in into remission was finally getting his BGs to as close to normal (70-120) for as much of the day as possible. It seems like ending the glucose toxicity helps the pancreas to heal and start functioning like normal again. That is another reason to not skip shots whenever possible.
 
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