Bubbles in insulin vial
- Thread starter Hosanna
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I wouldn't worry about it. If you're using a pen, as long as you don't inject air into the pen, it's fine. I've had that happen, too.
I don't know how to more strongly implore you to get some spot checks during the cycle. You could be putting Martha at considerable risk by not getting any mid-cycle tests.
I don't know how to more strongly implore you to get some spot checks during the cycle. You could be putting Martha at considerable risk by not getting any mid-cycle tests.
Anne & Zener GA
Member Since 2011
Hossana, I defer to Sienne in all things FD. If she says you need spot checks during each cycle, then you need spot checks in each cycle. We are more than anxious to help you work through any issues with getting the checks. After all, we are the crazy cat ladies and will do whatever we can to help.
Liz
Liz
Hosanna
Member Since 2012
Spot checks
Thank you for setting my mind at ease about the bubbles. As far as the spot checks, i do not understand the necessity of them. I don't want to put Martha through any more than I have to, she has already been through so much, and the extra stress of these tests is not good for her heart. Her cardiologist advises against it. Perhaps if I understood better why they are necessary.
Thank you for setting my mind at ease about the bubbles. As far as the spot checks, i do not understand the necessity of them. I don't want to put Martha through any more than I have to, she has already been through so much, and the extra stress of these tests is not good for her heart. Her cardiologist advises against it. Perhaps if I understood better why they are necessary.
rhiannon and shadow (GA)
Member Since 2012
I notice air bubbles , tiny little stream going up into vial when I have a bit of air in the syringe.
I generally squirt it out into the air and make sure the plunger is pushed several times.
I generally squirt it out into the air and make sure the plunger is pushed several times.
Angela & Blackie & 3 Others
Member Since 2010
Sienne's right, Hosanna. You DO need spot checks, especially since you're new to this. The spot checks help those experienced (Sienne, for example) to see how your kitty is doing, and if there's a situation that you may not be able to see, but she or someone else can, they can help you through it. If you don't get spot checks during each cycle, you could be putting your kitty at risk. You won't know if her BG is too low, and if it is, it could be dangerous for your kitty. I, too, urge you to do the midcycle spot checks. For what it's worth... Wouldn't you want to know how your kitty is doing with each shot? I know I would. Your kitty's ears will toughen up, and if you gently insert the lancet at an angle instead of straight through, you'll be able to close the wound better. Use a bit of Neosporin with Pain Relief to help heal the wound, and it'll help to make your kitty feel better. 
So, please do them for your kitty's sake. Ok?
So, please do them for your kitty's sake. Ok?
Anne & Zener GA
Member Since 2011
Dosing on Lantus is based on the nadir, the lowest BG of the cycle. Some kitties can drop rather dramatically from the preshot BG to the nadir, even from the 400s to the 40s, and from the 300s to the 40s is quite common. In fact, Hershey did that today. Below 50 is hypoglycemic numbers and is risky for a kitty to stay there for very long. At the beginning, I thought testing was pretty stressful too but then I realized that a little poke in the ear is nothing compared to the long term damage to internal organs of high blood glucose or to the short term damage of a hypo incident. Some cats BGs are all over the place and others are more stable. You don't know unless you test. Please get those spot checks so that you (with some help) can determine the best dose for Martha.
Liz
Liz
Hosanna said:
The following is from the New to the Group sticky:
Why do spot checks and/or curves?
Meowzi surprised her caretakers one night! Luckily, they caught the low by doing a simple spot check.
PMPS 241; +4~132; +7~20; +7.25~31; +7.5~47; +8~89; +9~93
There are some types of insulin where dose adjustments are based largely on the pre-shot number. Lantus and Levemir are NOT among these types of insulin. Dose changes are based on the lowest number in the cycle -- the nadir. This usually falls somewhere in the middle of the cycle although this varies for each cat and the nadir is not always at the same time. If you think testing will stress Martha out, think about what hypoglycemia will do to her heart. That's the risk. I cannot, in good conscience, give you any recommendations about dose changes without spot checks. I will not be responsible for endangering the life of your cat. IMHO, not having data upon which to base a suggestion about dose is dangerous. It's your choice if you want to take your cat to the vet's office for curves or for fructosamine tests. However, you cannot follow a Tight Regulation approach if your dose decisions are going to be based on data that's collected once a month at the vet's office when BG test results are often skewed due to stress. We've seen any number of cats who end up being overdosed based on BG numbers collected at the vet's office. Following TR is unsafe if you are not home testing. Please review the Tight Regulation Protocol sticky to understand the assumptions that are necessary to follow this protocol. If you opt to follow Start Low Go Slow, you will still need to get more than your pre-shot tests if you continue to use Lantus.
If you want me to further underscore the importance of spot checks/testing, take a look at Gabby's spreadsheet on the evening of 9/5. Her PMPS was 194. Her +2 was 35. That's why I test.
There are several cats here that have cardiac issues. Testing has not effected their heart conditions. Most cats are not stressed by testing. If you give a positive reinforcement (i.e. a treat) when you test, the testing becomes associated with something positive. Vets often assume that testing is stressful because cats are, in fact, stressed at the vet's office.
Angela & Blackie & 3 Others
Member Since 2010
I get those, too. I don't worry about them as much. I do worry about the bigger ones, which I get rid of, of course.
Just an added paragraph to my post on here earlier to you with regards to midcycle testing: I will give you an example of what happened to me this evening. I tested my cat, Blackie, at PMPS +3, she had dropped 65 points from 104 to 39 in a matter of 3 hours. Had I not tested her at that time, there's a good chance that she would've continued to drop. Now, I'm working to get her # above 50, which means staying up to do this. I do regret not having to do a midcycle test during the day, though. My DH is off on vacation, and we're normally out doing things. My intent was to do a later midcycle on her, but that didn't happen. As you can see, midcycle testing is very important to do. Cats are resilient. They'll learn that it's part of a daily routine, and will accept it as such.
Just an added paragraph to my post on here earlier to you with regards to midcycle testing: I will give you an example of what happened to me this evening. I tested my cat, Blackie, at PMPS +3, she had dropped 65 points from 104 to 39 in a matter of 3 hours. Had I not tested her at that time, there's a good chance that she would've continued to drop. Now, I'm working to get her # above 50, which means staying up to do this. I do regret not having to do a midcycle test during the day, though. My DH is off on vacation, and we're normally out doing things. My intent was to do a later midcycle on her, but that didn't happen. As you can see, midcycle testing is very important to do. Cats are resilient. They'll learn that it's part of a daily routine, and will accept it as such.
Hosanna
Member Since 2012
Sienne, with all due respect, I was not asking for dosing recommendations but about the bubbles in the vial. I'm not sure how we got onto the topic of dosing.
I do understand that BGs can drop, I went through this with Martha if you recall. It dropped to 41 one night. I would not have known had I not tested her. That was the result of giving the vet's prescribed 4 units of Lantus. Believe me I have not done that since, and have learned not to follow all of the vet's advice, even though he is a specialist.
As to the nadir, it is pretty much agreed what you said:
- the nadir. This usually falls somewhere in the middle of the cycle although this varies for each cat and the nadir is not always at the same time
This is why I have trouble understanding this. I could spot check her at +4 and her nadir is not occurring until +6, or +7. Or I could check at +8 and her nadir was at +4. So do you see why this confuses me? How do we really know when the nadir actually occurs unless we are spot checking constantly?
And say the nadir might be 70. And then the PMPS might be 280....am I going to give insulin based on 70, when it is now 270?
I am trying to understand this, I am not trying to be difficult.
I do understand that BGs can drop, I went through this with Martha if you recall. It dropped to 41 one night. I would not have known had I not tested her. That was the result of giving the vet's prescribed 4 units of Lantus. Believe me I have not done that since, and have learned not to follow all of the vet's advice, even though he is a specialist.
As to the nadir, it is pretty much agreed what you said:
- the nadir. This usually falls somewhere in the middle of the cycle although this varies for each cat and the nadir is not always at the same time
This is why I have trouble understanding this. I could spot check her at +4 and her nadir is not occurring until +6, or +7. Or I could check at +8 and her nadir was at +4. So do you see why this confuses me? How do we really know when the nadir actually occurs unless we are spot checking constantly?
And say the nadir might be 70. And then the PMPS might be 280....am I going to give insulin based on 70, when it is now 270?
I am trying to understand this, I am not trying to be difficult.
Dosing came up since whenever I stop by to answer a question, I usually open the spreadsheet. I'd also commented a few days ago that you needed to get some mid-cycle tests when you asked whether to raise Martha's dose. I was following up.
If you go back to the Tight Regulation Protocol sticky, you'll note that it's recommended that you get a "mini-curve" (testing every 3 hours) the first several days that a cat is on Lantus. The purpose of getting a curve, either then or at other points, is to have a reasonable idea of when Lantus onset begins, when nadir is, and how much duration you're getting. As you continue to gather data, whether from a curve or from spot checks, you'll see trends. For example, Gabby's nadir is typically at around +3 or +4. Sometimes, it's earlier and there have been cycles when her nadir is as late as +7.
The value of the pre-shot test is to inform you whether it's safe to shoot. A pre-shot of 270 is safe to shoot. If nadir is at 70, there's no reason to change the dose. The problem is that if nadir is at 30, and you don't know that's the lowest point in the cycle, you are over dosing your cat. Let me use a different example. You see high pre-shot values. Your assumption, then, is that Martha needs more insulin so you increase the dose. The same thing is happening so you keep increasing the dose. Without getting spot checks, you have no idea that your cat has a pre-shot in the 400s, a nadir in the 40s, and bounces back to the 400s by the next shot time. The nadir would have dictated a dose reduction whereas without that information, you'd be increasing the dose. Eventually, you end up with an avoidable emergency.
The goal with Tight Regulation is to have your cat's numbers get into a healthy, normal range as quickly and safely as possible. To do so you need to be able to shoot low numbers. In order to shoot low, you need to be data ready. If you take a look at the information at the begining of the Shooting & Handling Low Numbers, being "data ready" is described.
There is no one best time to test. This varies for every cat and is a process of your getting to know Martha's patterns. Gabby has a tendency to have early dives. I test more the first few hours because I've been surprised in the past. If I see that there's a big drop between her pre-shot and her +1 or +2, I can intervene with food and steer the curve. It does mean I will be testing more that cycle but it's the best way I know of to keep her safe.
If you go back to the Tight Regulation Protocol sticky, you'll note that it's recommended that you get a "mini-curve" (testing every 3 hours) the first several days that a cat is on Lantus. The purpose of getting a curve, either then or at other points, is to have a reasonable idea of when Lantus onset begins, when nadir is, and how much duration you're getting. As you continue to gather data, whether from a curve or from spot checks, you'll see trends. For example, Gabby's nadir is typically at around +3 or +4. Sometimes, it's earlier and there have been cycles when her nadir is as late as +7.
The value of the pre-shot test is to inform you whether it's safe to shoot. A pre-shot of 270 is safe to shoot. If nadir is at 70, there's no reason to change the dose. The problem is that if nadir is at 30, and you don't know that's the lowest point in the cycle, you are over dosing your cat. Let me use a different example. You see high pre-shot values. Your assumption, then, is that Martha needs more insulin so you increase the dose. The same thing is happening so you keep increasing the dose. Without getting spot checks, you have no idea that your cat has a pre-shot in the 400s, a nadir in the 40s, and bounces back to the 400s by the next shot time. The nadir would have dictated a dose reduction whereas without that information, you'd be increasing the dose. Eventually, you end up with an avoidable emergency.
The goal with Tight Regulation is to have your cat's numbers get into a healthy, normal range as quickly and safely as possible. To do so you need to be able to shoot low numbers. In order to shoot low, you need to be data ready. If you take a look at the information at the begining of the Shooting & Handling Low Numbers, being "data ready" is described.
There is no one best time to test. This varies for every cat and is a process of your getting to know Martha's patterns. Gabby has a tendency to have early dives. I test more the first few hours because I've been surprised in the past. If I see that there's a big drop between her pre-shot and her +1 or +2, I can intervene with food and steer the curve. It does mean I will be testing more that cycle but it's the best way I know of to keep her safe.
rhiannon and shadow (GA)
Member Since 2012
I think it might help you understand a little better to go read or re-read the stickie about the insulin depot. It's really helpful in understanding
how Lantus works.
http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=150
how Lantus works.
http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=150
The "sticky" notes are the starred notes at the top of the board. They have the word "Sticky" in the subject line.
rhiannon and shadow (GA)
Member Since 2012
When you click on the lantus-tight regulation forum and it takes you to the page.
There are 6 sticky's in a row before you get to all of our names and individual posts.
If you haven't read all of those yet, It would a great time to do so.
There are 6 sticky's in a row before you get to all of our names and individual posts.
If you haven't read all of those yet, It would a great time to do so.
rhiannon and shadow (GA)
Member Since 2012
They are posts that you can't reply to at the beginning of the topics list in theTR forum.
They are a great resource for information and everyone should read them , often more than once.
Have you found where they are?
They are a great resource for information and everyone should read them , often more than once.
Have you found where they are?
Angela & Blackie & 3 Others
Member Since 2010
A sticky is a post (or posts), which have a wealth of information, and are created by at least the owner of the board (and any others that are of the administrative type) for those of us to learn how to regulate our sugarkitties, and do it safely. Even though some of us have been here for a long time, there are occasions when we still revert back to the stickies for guidance. For instance, last night when my cat, Blackie, dropped down to 39 +3, I reverted back to the Tight Regulation Protocol sticky to find information with regards to a reduction in her dose. I found it, and she got a reduction. For a long term diabetic like Blackie, if she drops below 40 (even down to 39 as was the case), she gets an automatic 0.25u decrease in her dose.
They're extremely helpful, and if you don't understand something, just ask. You'll find the stickies at the top of the forum. They'll have gold stars, and the word "STICKY". They always stay in the same place above the posts (or condos as we like to call them) that we make each day.
With regards to curves, I've done a 12 hour curve before (my choice, and I wanted a lot of information on her spreadsheet), which means that I tested every hour on the hour to see what Blackie does. You can do them every 3 hours, or every 2 hours, or do what I did. It's up to you. :smile: I'm not sure, but I think some people may have done them from say +3 to +5 or +6 to get any idea on when the nadir is, and when their kitty starts to rise again before the next shot. Regardless of what you decide, you do need to have a record of midcycle #s to acquire a history, and a pattern of how your kitty does on insulin. Without it, you don't know how your kitty is doing, and nobody can safely give you advice on dose increases. Listen, and trust them, Hosanna. They're not going to say anything to harm your kitty. I know. Blackie and I have been here since March 13, 2010, and Blackie's doing extremely well because of them.
One other thing.. I, too, used to take Blackie to the vet's for testing each week. I've stopped doing that and started hometesting because it saved us money, not to mention gas. Plus, Blackie, who has no cardiac condition at all, got stressed out at the vet's each time, which ultimately rose her BG's through the roof (you can check out her 2010-2011 spreadsheet if you'd like to see what I went through with her). She's much more calmer at home, and more willing to get a test done.
Anyway, I look forward to seeing how your spreadsheet looks with those midcycle tests. The more information that you can provide on your kitty, the better. Experienced eyes can help you with dosing correctly, and safely that way.
They're extremely helpful, and if you don't understand something, just ask. You'll find the stickies at the top of the forum. They'll have gold stars, and the word "STICKY". They always stay in the same place above the posts (or condos as we like to call them) that we make each day.
With regards to curves, I've done a 12 hour curve before (my choice, and I wanted a lot of information on her spreadsheet), which means that I tested every hour on the hour to see what Blackie does. You can do them every 3 hours, or every 2 hours, or do what I did. It's up to you. :smile: I'm not sure, but I think some people may have done them from say +3 to +5 or +6 to get any idea on when the nadir is, and when their kitty starts to rise again before the next shot. Regardless of what you decide, you do need to have a record of midcycle #s to acquire a history, and a pattern of how your kitty does on insulin. Without it, you don't know how your kitty is doing, and nobody can safely give you advice on dose increases. Listen, and trust them, Hosanna. They're not going to say anything to harm your kitty. I know. Blackie and I have been here since March 13, 2010, and Blackie's doing extremely well because of them.
One other thing.. I, too, used to take Blackie to the vet's for testing each week. I've stopped doing that and started hometesting because it saved us money, not to mention gas. Plus, Blackie, who has no cardiac condition at all, got stressed out at the vet's each time, which ultimately rose her BG's through the roof (you can check out her 2010-2011 spreadsheet if you'd like to see what I went through with her). She's much more calmer at home, and more willing to get a test done.
Anyway, I look forward to seeing how your spreadsheet looks with those midcycle tests. The more information that you can provide on your kitty, the better. Experienced eyes can help you with dosing correctly, and safely that way.
We are always happy to help with dosing advice and answering any questions you have that you find in the stickys or that you see on Martha's SS and wonder about.
When you spot check, you might not find her nadir every cycle and that is not the goal anyway. Nadirs move, as Sienne said. But you can see if she is trending down which tells us alot. When we are giving dosing advice, we look at waves of action from the last several cycles....we don't just look at one cycle. And we have some very experienced members who are very good at seeing "invisible" numbers....that is the numbers for times you didn't test but which fit a pattern or a trend.
When you spot check, you might not find her nadir every cycle and that is not the goal anyway. Nadirs move, as Sienne said. But you can see if she is trending down which tells us alot. When we are giving dosing advice, we look at waves of action from the last several cycles....we don't just look at one cycle. And we have some very experienced members who are very good at seeing "invisible" numbers....that is the numbers for times you didn't test but which fit a pattern or a trend.
Angela & Blackie & 3 Others
Member Since 2010
Some cats eat at different times than others, and will show different #s at different times. All I know is that it's best to give less food, more often than a whole bunch of food at once, and less often. The less food, more often approach may help to keep kitty surfing better (if I remember correctly).
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