Dialing in a Dose: .25ml Syringes or Shoot Under 150?

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Danny MacDonald

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I've been working with my cat Imogen since November of last year. In the last month, we have finally been making some really significant progress and I could not be happier. I've gone from struggling to get her under 300 to this new problem - keeping her below 300 all day. I'm using a Relion Micro which seems to be about 50-75 points "low" compared to an Alphatrak 2.

The issue is that I'm giving her .5ml in the morning. By the time for the evening shot, she's still been well under 200 and I've been too scared to give her another .5ml. Ideally, I'd try .25ml in the morning and hope she hit that 200 threshold and not too much higher. If I don't shoot her at all in the evening, by 8pm (+2) she's back well into the 350-400s and it breaks my heart. She's gone from being constantly in hyperglycemia to getting used to being back into "normal" and it really hits her hard to be back in hyper ranges.

I've seen some other threads here about going ahead and shooting even under 200. I'm just so scared that something will happen during the night if I do that. I stay up with her from 6pm - 10pm (sometimes 11pm) but I'm just so scared that during nadir she will tank and I won't be awake to catch it.

So, what are some opinions here? Shoot under 150 (again, read on a Relion Micro)? Buy some 1/2ml marking u40 syringes and try for .25/.25 shots? Something else?

Her spreadsheet is here: https://drive.google.com/open?id=1YjpPkfISxqtj0ZwFEtCPTd4uDqvRo3qEqI4LpOtSh0M (the All Data tab)

Thank you!
 
First of all, I LOVE her name! Imogen! However did you come up with that?

Second, your SS is very impressive but I am having a hard time reading it. The graph format makes it tough for me to see what she does throughout the day...where she normally is at AMPS, what she does throughout the day, and PMPS. I may just be missing it, but I'm not sure how to get all that info from your graph.

From what you've said, my thought is that you want to give less insulin...I'd go down to 0.25 for both shots per day to see if that brings her to a more regular cycle that doesn't make her preshot low for the next cycle. That way, you could give insulin both times. Make sense? I do think that might really help with things and keep her from being so low. I'd also make sure to stick with it for several cycles before you decide on anything...if she runs a bit higher than normal that's fine. You want to give her time to settle in to that dose and see what it can do for her.
 
Thank you Rachel. That was my thought too! The spreadsheet defaults to the first tab which is the graphs - the data is in the "All Data" tab. Sorry that was confusing! I should move that tab to the front but I'm usually the one looking at it!

I've looked for U40 syringes with .25ml markings but am coming up empty. Do they exist or am I stuck with U40 .5ml marking syringes? That's what I have now and they are too small to really dial down to .25ml.

Thank you for your response!

And I unfortunately didn't come up with her name. I kinda inherited her from an old roommate and she came to me already named. I believe he got the name from a movie but I'm not sure. I do love her name too though!
 
As far as I know, there are no u40's with quarter marks. You can get u100's and then use them with the conversion chart, or you can pull up a sample syringe with colored water for the amount that you think is 0.25u and then when you draw the insulin, you can compare it with the sample syringe. Being consistent is more important than being precisely accurate.
 
Hi there. Re: being consistent when the syringe isn’t marked, we’ve found it helpful to draw the dose based on a *different* part of the plunger. For ex, Josie gets 1.5, but our syringes only have full marks. So first I draw 2u, and then I push up until the very *bottom* of the black plunger is at the 3 line. We pretty sure that’s 1.5, but by using the bottom to reduce from where we know is 2, we’re certain our estimate is always the *same* estimate.
 
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