BG 97 +4 hours...Freaking out

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Val9955

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This is my 2nd day injecting my Spanky. He is on ProZinc. The vet told me to give Spanky 3U BID, but this morning I gave him 1 U. I tested him at 6pm, BG 241, and injected him with 1U, the syringe is horrible, so he may have gotten up to 1 1/2U. He is now 4 hours out and his glucose is at 97. I tested at 2 hours out and his BG was 149...What do I do?
 
Breathe. He is going down but we don't intervene until we see 40s. You will need to get another test in a an hour or so. If you want, you can give him a little snack of LO carb food.

This is good news! He is responding well. And you saved his life by not giving the vet's 3 units. At that dose, you would be dealing with a hypo.
 
In between tests, can you explain "the syringe is horrible"......what is it about the syringe that is making things hard for you? We can probably help with that if you can explain.
Carl
 
The U-40 1/2cc syringes have marking for 20 units. To give just one unit seems difficult to tell if all the air is out and it is truly one unit that is drawn up. I work in the medical field and typically if you are working within a 1-10unit marking the syringes are smaller and marked with 1/2 units or even 1/4 units. I feel the syringes are too large for drawing up such a small amount. This may be another "standard" that my vet said I would need. Do they make diameter syringes that include 1/2 or 1/4 markings for the U-40 insulin?
 
They make u40's with 1/2 unit hash marks, but they are hard to come by. I believe Lori (newbie kits) said she had some though. Look at this thread, and PM her maybe? Ask if those are what you are looking for?
http://felinediabetes.com/FDMB/viewtopic.php?f=15&t=58148
Some people use u100 syringes with 1/2 unit markings, but you have to use a conversion chart to get the dose right.....In a u100 syringe, using u40 insulin, you would need to draw up to the 2.5 mark with the u40 prozinc. There's a chart if you might be interested in doing that. Lori has both types with the 1/2 unit marks though.

Carl
 
Outside of that, though.....how is Spanky doing?

Carl
 
Val9955 said:
The U-40 1/2cc syringes have marking for 20 units. To give just one unit seems difficult to tell if all the air is out and it is truly one unit that is drawn up. I work in the medical field and typically if you are working within a 1-10unit marking the syringes are smaller and marked with 1/2 units or even 1/4 units. I feel the syringes are too large for drawing up such a small amount. This may be another "standard" that my vet said I would need. Do they make diameter syringes that include 1/2 or 1/4 markings for the U-40 insulin?
Click to expand...

Many of us using ProZinc use a conversion table based on the following:
U-100 means 100 units per mL
U-40 means 40 units per mL; this is a 40% lower concentration per mL
If you use a U-100 syringe to dose U-40 insulin, the mark on the U-100 syringe should be multiplied by 0.4 to get the dose of the U-40 insulin actually being given
so:
U-100 syringe mark of 1.0 * 0.40 = 0.4 units of U-40 insulin
U-100 syringe mark of 2.0 * 0.40 = 0.8 units of U-40 insulin
U-100 syringe mark of 3.0 * 0.40 = 1.2 units of U-40 insulin

If the syringe measures half units, you can calculate in 0.2 units of U-40
ie:
U-100 syringe mark of 0.5 * 0.40 = 0.2 units of U-40 insulin
U-100 syringe mark of 1.5 * 0.40 = 0.6 units of U-40 insulin
U-100 syringe mark of 2.5 * 0.40 = 1.0 units of U-40 insulin

I'm using U-100 3/10 cc 5/16" long needle syringes with half unit markings from WalMart .
 
Also, if you push the syringe plunger in and out a few times before filling, it seems to work better.
 
I appreciate the info on the syringes. I will attempt to hunt the syringes down bc I want to be more accurate. Spanky is laying beside me. He seems ok, not purring like he usually does. He did eat a little more Fancy Feast. Thank you for the location and calculations for the better marked syringes. I will be picking those up tomorrow.
 
You said he ate a little more of the FF, and that was between +4 and +5, right?
You're just going to have to watch him for the next couple of hours. You don't want to overfeed, because you want him to be hungry in case you "need" to give him some more to bump his BG up a little bit.
Do you have any "gravy" style canned food available?
Carl
 
Hi Carl, and Sparky's person,
You guys are doing well, and you should have some high carb food around in case the numbers start going a bit too low.
Any of that around?
Gravy canned food?
I think you probably got more that just 1.5u into him don't you?
Lori
 
Hi Lori!

Val, Just so you know.....Lori and I have "done this" a few times, so you're in good hands, especially since there are plenty of people around. The numbers you are seeing are actually a good thing. Just stressful the first time you see them. No worries, ok?

Carl
 
I sent Sue and Oliver a pm to help you set up your Spread Sheet ok? I saw you asked for help with that in your previous thread.
Maybe she'll help you on the phone to make it really easy.

So.....how's everything?
:Lori
 
I work in the medical field, so I know how to draw up meds. I really do not think I injected more than 1U into him. I'm putting this on myself as human error by saying it could have been a little more, but I really feel it was extremely close to 1. I would even side with it being less than 1 bc I was concerned with a bubble. Today is the 1st day Spanky has every received insulin. I will be contacting the vet 1st thing in the morn to go over these blood glucose level and I will be buying the more accurate syringes as well. The vet just diagnosed Spanky on Monday and told me to inject 3 U morn and night. I'm just so happy I did not listen to them.
 
VAl,
Spanky is probably happy you didn't go with 3u too!
 
No gravy foods around, as I didn't ever want to confuse the wet foods and give him a high carb food. I'm learning by being thrown into the fire. I bet you tomorrow I will have that gravy food around the house. After getting through tonight, where do I start? I'm getting the smaller syringes, so if Spanky has an elevated glucose in the morn, how much insulin should I give?
 
It isn't so much an accuracy issue as an application issue. U-40 seems to be used in veterinary insulins and they don't seem to understand that dose requirements aren't going to be in full units due to the species being smaller.

If they'd describe insulin as concentrations per mL, rather than units, and say to dose X mL of Y concentration, I think it would simplify the dosing. (And then where would the math geeks go?)
 
Val,
I would stick with 1u in the AM. And talk to the vet and let him know what kind of numbers you saw today. He might revise the thinking on the 3u dose. Best to stay with one dose for at least 2-3 days until you gather sufficient data.
Carl
 
hey let's go one step at a time.
If sparky needs higher carb food...do you have anything in the house you could give him...like yogurt or ice cream...bread soaked in milk.....something carbie or sweet?
 
On the gravy foods....just stick them in a different cabinet so they are there when/if needed, that way you won't grab the wrong can.
 
glucose . drop . time
241 .... - .... PMPS
149 .... 92 .... +2
97 .... 52 .... +4
68 .... 29 .... +5

data so far. The rate of drop is slowing (middle column of numbers). If he hits his lowest at 6 hours out (the average time to hit the nadir, but it may vary either earlier or later), he'll start coming up at +7, Once you've got 2 or more rising numbers, you can relax a tiny bit.
 
Val,
As you can see, BJ is obviously our resident "math geek"... :mrgreen: And she did all that off the top of her head!

Hi BJ!
 
BJM said:
glucose . drop . time
241 .... - .... PMPS
149 .... 92 .... +2
97 .... 52 .... +4
68 .... 29 .... +5

data so far. The rate of drop is slowing (middle column of numbers). If he hits his lowest at 6 hours out (the average time to hit the nadir, but it may vary either earlier or later), he'll start coming up at +7, Once you've got 2 or more rising numbers, you can relax a tiny bit.
Click to expand...


I can't wait. Its almost done!
 
Val9955 said:
This is my 2nd day injecting my Spanky. He is on ProZinc. The vet told me to give Spanky 3U BID, but this morning I gave him 1 U. I tested him at 6pm, BG 241, and injected him with 1U, the syringe is horrible, so he may have gotten up to 1 1/2U. He is now 4 hours out and his glucose is at 97. I tested at 2 hours out and his BG was 149...What do I do?
Click to expand...

Val,
After that test....
You said this is his 2nd day on insulin.... and you gave him 1u this morning, and tonite. Did he get 3u yesterday or 1u? And do you have the BG reading numbers from his previous shots?

Just trying to see the "whole picture" even though it's only been a crazy 36 hours or so....
Carl
 
Val, are we prepared for the possibility of a lower than desired number?
 
carlinsc said:
Val9955 said:
This is my 2nd day injecting my Spanky. He is on ProZinc. The vet told me to give Spanky 3U BID, but this morning I gave him 1 U. I tested him at 6pm, BG 241, and injected him with 1U, the syringe is horrible, so he may have gotten up to 1 1/2U. He is now 4 hours out and his glucose is at 97. I tested at 2 hours out and his BG was 149...What do I do?
Click to expand...

Val,
After that test....
You said this is his 2nd day on insulin.... and you gave him 1u this morning, and tonite. Did he get 3u yesterday or 1u? And do you have the BG reading numbers from his previous shots?

Just trying to see the "whole picture" even though it's only been a crazy 36 hours or so....
Carl
Click to expand...

This morn, fasting glucose 344, I gave him 1U and went to work. My husband said he slept all day, but he did not test his glucose. This evening 241 before meal and injection of 1U
 
+6 BG=57
We're slowing down. Thank goodness. Hoping for the increase to start. Thank you so much for sticking with me and Spanky through this. Y'all are wonderful!
 
pretty good number. does he have his regular low carb food around to nosh on?
I would suggest a lower dose in the am. maybe a skinnier unit.
like .75
he still has the potential to drop for another hour.
 
lori and tom (GA) said:
pretty good number. does he have his regular low carb food around to nosh on?
I would suggest a lower dose in the am. maybe a skinnier unit.
like .75
he still has the potential to drop for another hour.
Click to expand...

He does have his usual low carb food out to eat. I will be calling the vet in the morn and lowering his dose. I would prefer him to be a little bit high than worry like this again. Thank you for all the advice.
 
I'm agreeing with Lori on the .75 if you can guess-timate that on the syringe in the AM.
OK, so the AM 344.....PM 241.
It could be that his BG was not rising at PM shot time, which may have caused this drop tonight.
Definitely, if he's around the same numbers tomorrow morning, I'd go with the smaller dose Lori recommended.

This might be a short dance for you and Spanky. Sure did have a trial by fire though! At least you now know what to do with it, so that's a great thing!

Carl
 
Of course Val, your never alone here. I won't be around for another whole hour....do you want to get a 1/2 hour test to see if he's done dropping?
Do you feel you can feed him something high carb in your house if you need to?
Lori
 
carlinsc said:
... And she did all that off the top of her head!...Hi BJ!
Click to expand...

Hi Carl

No, I copied the data into Excel and arranged it, then copied it back over here. Excel did all the math! I have to sign off now so I can get up in roughly 7 hours.
 
Get some sleep, BJ, and thanks for helping out!

Carl
 
Did another glucose. We are at 68...Coming up! I have to go get rest too, but setting alarm to test in an hour. You guys are awesome. My own husband wouldn't stick by me right now. I can not tell you guys enough how much I appreciate each one of you.
 
OK. 1 last post!
Val9955 said:
...We're slowing down. ...
Click to expand...

glucose drop .. time
241 .... - ..... PMPS
149 .... 92 ..... +2
97 .... 52 ..... +4
68 .... 29 ..... +5
57 .... 11 ..... +6
68 .... 29 ..... +7

Yup. only 11 points between +5 and +6 and +7; not significantly different, due to the FDA-permitted 20% variance in meter accuracy. FDA says meters must be within 20% of the 'true' value, so add 20% to the lower value and subtract 20% from the upper value. If the ranges overlap, the numbers could be measuring the same level.
57 * 1.2 = 68.4 <- fast way to add 20%
68 * 0.8 = 54.4 <- fast way to subtract 20%
 
P.S. sleep cycles are usually in multiples of 45 minutes. Set the alarm for 45 minutes or for 1 hour 30 minutes & it may be easier to wake up.
 
Val,
When these sorts of things happen, we don't leave till you say "when".... nobody who jumps into one of these "crisis" threads will just leave you hanging. At least one of us will stick with you. It's just "what we do", so no sweat.

If you get a lower number in an hour or whenever, holler.

OK, did you leave a little food out? If so, should be okay, but if you have any other trouble, post immediately, ok?

Carl
 
get some rest Val, you did really good. so did spanky.
it's great actually that he responded so well to the insulin.
never answered my question tho'....so I can sleep easier.
do you have anything high carb you could give spanky if he needed it.
sometimes little balls of bread soaked in milk is high carb enuf.
Lori
 
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