Are a few tiny air bubbles in the Lev pen ok?

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Bronx's dad (GA)

Bronx's dad (GA)

Member Since 2016
Is this ok, or time to toss it? I never shoot back into the pen, so what causes this? Pen was first used on 1/1. Also, what is the reason for the white plastic disc above the red piston? Thanks!
 
Not sure about the bubbles but with him seeing yellow last night I don't think it's an issue. Also, with the FS yesterday the cycle count should've started over but see you increased this morning. Be careful and now that you did increase and there was yellow I would hold the 10u for 6 cycles. He has likely had some NDW with every increase which doesn't allow you to see what the dose truly does IMO and the depot doesn't have a chance to stabilize.
 
Doodles & Karen said:
Not sure about the bubbles but with him seeing yellow last night I don't think it's an issue. Also, with the FS yesterday the cycle count should've started over but see you increased this morning. Be careful and now that you did increase and there was yellow I would hold the 10u for 6 cycles. He has likely had some NDW with every increase which doesn't allow you to see what the dose truly does IMO and the depot doesn't have a chance to stabilize.
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I tried to compensate for the FS by shooting an extra R mid cycle yesterday after seeing a black which confirmed the FS. I did not use any R this morn, maybe I should've now seeing a red show up. That yellow last night was unexpected but I am guessing the 1.5 of R helped cause it. I do plan on holding 10u for a while and adjusting R to try to get to yellows more consistently.
 
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The white disk comes into play when you use the clicker at the top. There is a plastic screw that is attached to the dial and it pushes down onto the white disk to even out the pressure on the stopper in the insulin. For our use, where we use a separate syringe it serves no purpose. Never heard of air bubbles and can't recall seeing them in any of my pens, and I've burned through a lot of them... darned high dose cat.

Be alert with the R insulin, Jack is acro and IAA. I think it is more the IAA that causes him to have a delayed reaction to the R. Frequently it affects the next cycle more then the one I am shooting. He also changes up how much the same dose affects him. Had a few cases where a large dose one day wasn't enough and soon after a smaller dose dropped him more then I wanted. I think it is a good tool to use, but even now when I use it, I test a lot just to play things cautiously.

Hope you start seeing some better numbers soon, I played the same game with Jack just going up and up forever it seemed.
 
He dropped a decent amount yesterday after the R shot, almost 2oo points. Not sure how bouncy he is, but the numbers this morning could be a small bounce. You want to be careful chasing bounces with R, it can lead to yo-yo'ing where more R leads to another bounce, you give more R, and get stuck in a loop.

Doodles & Karen said:
I'm not sure we can tell what Bronx's Levemir nadir is at the moment.
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I was thinking the same thing, somewhere between +6 and +11, not very precise.

I agree that a small R dose might help, but he also got an increase this morning. I was always encouraged not to give R right after an increase to prevent too big of a drop since he could react to the Lev increase.
 
Bronx's dad said:
Does R need to be shot with food like Lev?
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No and actually, I read that R responds better when they haven't had food for at least 30-60 minutes. Not sure how true that is or not. Also with Levemir, yes we feed for T/F/S but he doesn't have to have a "big" meal at shot time. Most of us feed multiple times during the cycle. It's easier on their pancreas and usually keeps the kitty happier. Not sure what your current feeding schedule is but if you're on 12/12 only feeding at shot time you might rethink that.
 
Bronx's dad said:
Does R need to be shot with food like Lev?
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You want food onboard, but it does not need to be shot with a meal.

With the Lev, I'd have to go try to dig up the thread, but even if a kitty is not eating, giving at least a token dose was recommended. A cat not eating and getting no insulin is at greater risk for DKA .
 
Doodles & Karen said:
No and actually, I read that R responds better when they haven't had food for at least 30-60 minutes. Not sure how true that is or not. Also with Levemir, yes we feed for T/F/S but he doesn't have to have a "big" meal at shot time. Most of us feed multiple times during the cycle. It's easier on their pancreas and usually keeps the kitty happier. Not sure what your current feeding schedule is but if you're on 12/12 only feeding at shot time you might rethink that.
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He is constantly eating so I try to spread the meals out, about 6-7 throughout the day & night using the feeder. Actually, first time this morn he wasn't so hungry, maybe due to low #'s he's not used to. But I did see some vomit and plastic tape material in it. No idea why he loves to eat certain types of plastic wrapping-type material and then pukes it up? Been doing that his whole life so I try to keep all that sort of plastic wrapping material away from him.
 
saltycat said:
You want food onboard, but it does not need to be shot with a meal.

With the Lev, I'd have to go try to dig up the thread, but even if a kitty is not eating, giving at least a token dose was recommended. A cat not eating and getting no insulin is at greater risk for DKA .
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What would a token dose be if he is on 10u?
 
Hi,

For your ''bubble'' just ''suck'' it with your syringe. Don't think you should worry about
it's effectiveness, it has done a good job on your SS. Had Lantus stick used up to the last
drop with three months in the meter still giving good services.

.
 
Photorecon said:
Hi,

For your ''bubble'' just ''suck'' it with your syringe. Don't think you should worry about
it's effectiveness, it has done a good job on your SS. Had Lantus stick used up to the last
drop with three months in the meter still giving good services.
.
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They are tiny bubbles, would be hard to suck em up. You're right though, I can judge what the meter says to know for sure. When I watched the training video on here about pulling insulin from a pen, the person said she was using a "bad" pen because it had air bubbles in it?
 
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saltycat said:
With the Lev, I'd have to go try to dig up the thread, but even if a kitty is not eating, giving at least a token dose was recommended. A cat not eating and getting no insulin is at greater risk for DKA .
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Here's one of the beauties of using Lev... one has until onset to get food on board. ECID, but onset when using Lev usually isn't until about +4, sometimes +5. That means you have all that time to either get the cat interested in eating on it's own or you can syringe feed the cat. In most cases I was able to shoot a full dose at shot time because I was confident in being able to syringe feed if worse came to worst.
Bronx's dad said:
What would a token dose be if he is on 10u?
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Since I didn't have a high dose cat, I'd defer to @Wendy&Neko to see what she thinks constitutes a token dose for a cat on a 10u dose of Lev.
 
Jill & Alex (GA) said:
a token dose for a cat on a 10u dose of Lev
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I'm not Wendy but depending on circumstances it could be anywhere from 70% - 50% of the current dose. In order to help drain the depot if it gets ahead of you typically we'd go with a 50% token dose. ECID and it's something you'll have to learn for Bronx. If this situation comes about it's best to post for advise.
 
In the context of giving insulin without food, I think it was 25% to 50% of normal dose, I searched a bit and could not find the discussion on giving insulin when a cat was not eating. A general token dose or "BCS" big chicken shot as we call it is generally more in the 50-75% range as others have mentioned. Jack likes closer to 75%, but it is all about figuring out how your cat responds to the dose. I tried the 50% and it wasn't enough so I slowly upped the dose until I found what worked best.
 
I had a Lev. pen once that didn't have bubbles, but always smelled like the insulin. I took it back to the pharmacy and they sent it back to the manufacturer. Eventually I received a new pen.
 
Jill & Alex (GA) said:
Since I didn't have a high dose cat, I'd defer to @Wendy&Neko to see what she thinks constitutes a token dose for a cat on a 10u dose of Lev.
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I think it depends on the circumstances and why you want to give a token dose. Remember than before anesthesia, most vets will suggest a 50% dose of insulin and that's without the cat getting any food. Insulin's job is more than helping the cells process carbs from food recently eaten. Various reasons for giving a token dose are anesthesia so can't eat, not eating/sick, insulin dose requirements dropping fast (due to acro or IAA changes), got a lower than used to preshot and cannot monitor or maybe even a combination of the above.

What I'd suggest as a token dose also depends on your ability to monitor, when/if you think you can eventually get food in, and what type of numbers you are seeing. What I loved about Lev is that Neko didn't onset until +5 and I was happy to shoot full dose if I could get at least 50% of her food in her. Worst case, turn to medium or higher carb food. If kitty is typically getting green nadirs on a dose, you wouild be more cautious than if you are celebrating seeing yellows.

So, what are the differences for a high dose cat? First and foremost, you have that extra large depot haunting you. First time you want to do a token dose and interrupt the following cycle, I would start with a 50% dose and see how it goes. You have to learn what works for Bronx. For Neko a 2/3 dose was a good one, Julie used 1/2 dose for Punkin. And you have to be able to monitor a good part of the cycle even with a 50% dose. Usually the first part of the cycle will still act the same as if you shot full dose because of the depot, and with Lev, that could still be 8-9 hours into the cycle.

And you also have the acro (in some cases IAA) changes that influence how much you give for a token dose for a high dose cat. If anything is changing such as tumour pulsing or IAA breaking, then caution is key. Some people have had to skip a dose. Especially with IAA present because it can prolong or delay action.

Oh, and yeah for yellow again!
 
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