? HELP? Jade amps 421/+3 297 pmps 118/!! first day back OTJ

Jill & Jade

Jill & Jade

Member Since 2018
Started Jade on 1 unit again today after a delightful 3 1/2 year OTJ honeymoon. I will keep my SS up to date but may not be poking every two hours for awhile. This is a big adjustment ( in many ways) for both of us and I don’t want to over poke because of my extreme fear of hypo. My Vet ( like many) has quite a different recommended regime and I have to find a spot that’s comfortable for me. I have the Lantus pen and although I am more comfortable drawing from a syringe, she wants me to use the needle that comes with the pen. I will try that at her PM shot.
Happy Tuesday!
 
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Did your vet say why she wanted you to use the pen? If you use the pen needles, you can't keep the pen in the fridge or the pen mechanism might jam. Meaning a pen open and used out of the fridge will have to be replaced every 28 days. Seems a waste of insulin.

A pen needle will be more accurate under 5 units, but if you are careful, you shouldn't be far off with a syringe. Other notes from the Sticky Note on Insulin Care & Syringe Info: Proper Handling, Drawing, Fine Dosing

  • When dosing cats, there can be more negatives to using pen needles with an insulin pen than positives:
    • Inability to administer doses in increments of 0.25 - 0.50 units with pens.
    • Forgetting to "prime" the pen prior to each use will result in a smaller dose than intended. Priming the pen involves wasting 2 units of insulin for every shot.
    • One must keep the pen needle in for 5 - 10 seconds after the shot or you'll run the risk of not administering a full dose (can be tough with some cats).
    • Manufacturers do not recommend refrigerating an in-use pen. Therefore, shelf life may be shortened to 28 days (Lantus & Basaglar) and 42 days (Levemir).
    • Some FDMB members have reported shots administered from insulin pens are more uncomfortable than from a syringe

Good luck with the insulin and getting back into the swing of things.
 
Wendy&Neko said:
Did your vet say why she wanted you to use the pen? If you use the pen needles, you can't keep the pen in the fridge or the pen mechanism might jam. Meaning a pen open and used out of the fridge will have to be replaced every 28 days. Seems a waste of insulin.

A pen needle will be more accurate under 5 units, but if you are careful, you shouldn't be far off with a syringe. Other notes from the Sticky Note on Insulin Care & Syringe Info: Proper Handling, Drawing, Fine Dosing


Good luck with the insulin and getting back into the swing of things.
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Yea, she said the risk of compromising the pen would be higher. I will make sure to calibrate the pen each dose to make sure it doesn’t jam.
 
Wendy&Neko said:
Did your vet say why she wanted you to use the pen? If you use the pen needles, you can't keep the pen in the fridge or the pen mechanism might jam. Meaning a pen open and used out of the fridge will have to be replaced every 28 days. Seems a waste of insulin.

A pen needle will be more accurate under 5 units, but if you are careful, you shouldn't be far off with a syringe. Other notes from the Sticky Note on Insulin Care & Syringe Info: Proper Handling, Drawing, Fine Dosing


Good luck with the insulin and getting back into the swing of things.
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I meant “priming” the pen. Also, we are only using full units for a bit. She wasn’t happy when I told her I used a syringe. So, I will try the pen to see how it goes. I have enough anxiety as it is with this relapse, I don’t want to lose my in home veterinarian on top of it. There is bound to be conflicting advice at times and I have to decide what is best for Jade AND me. Slippery slope, for sure. I hope that didn’t sound salty towards you, it wasn’t meant to be at all. I am frustrated with so many different advice/ instructions. Puts a lot of extra weight on my heart. I did just call the pharmacist and she recommends refrigeration either way.
 
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Jill & Jade said:
Yea, she said the risk of compromising the pen would be higher.
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We've had hundreds and hundreds of members use syringes to withdraw insulin from the pen, without it being an issue. I think the odds of contamination are practically nill. Just remember, your vet is not there when you give insulin. You shoot the cat. If you were to tell the vet you successfully used syringes before, I think any good vet would listen to that.

Definitely store unopened or unused pens in the fridge. From the manufacturer: https://www.lantus.com/-/media/EMS/...F/lantus-quick-reference-patient-brochure.pdf A quote from that brochure "Never refrigerate the pen after opening it".
 
Jill & Jade said:
I have enough anxiety as it is with this relapse, I don’t want to lose my in home veterinarian on top of it. There is bound to be conflicting advice at times and I have to decide what is best for Jade AND me.
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I found that the less I said to my vet(s) the better. They tell me what to do, and I smile and nod and acknowledge that I heard them...and then I go home and do exactly what I've been told to do by the fine folks here on the FDMB.

After multiple times of minimal engagement regarding Luci's diabetes it seems they lose interest quickly. If they ask I will share my Spreadsheet, often they want to recommend aka sell me some DM food - I decline politely...pay my bill and leave. They usually ask me to call them regarding modifying her dose - yeah, right...not gonna happen. Not one of them has ever called me and said, I think you need to change Luci's dose - although one vet asked me why I kept moving it up and down (well based on the numbers, was my response) and that seemed to be enough for him...

I'm sure you know already that with thousands of people here who've done it all, seen it all and been there done that -- with schedules and families and the whole nine yards - they have better outcomes that 99% of the vets who attempt to manage FD...

Well, that's my opinion...you may of course keep a good relationship with your vet, just dial it down as far as your expectations of the best advice for managing Jade's FD - starting with recommendations about using the pen needles vs syringes - you're comfortable using the sryinge, the advantages of using the syringes are many (as Wendy pointed out above)...go right ahead and use those sryinges - no point in arguing that point with your vet - she feel one way and you feel another - your cat, your judgement...do what's best for Jade.

Have a great evening!
 
I remember feeling this exact same way the first time around with Jade. I appreciate all that you’ve said. I definitely want to do what I’m comfortable doing and the people here have been much more of a help than the Vet I was with when Jade was first diagnosed, that’s for sure! They left me hanging like FD was really no big deal. It a very big deal to us. My new vet is better but I still feel like I need to stick with what I’ve learned here and what feels comfortable for me ,as it gives me confidence when taking care of Jade. Thank you for the pep talk.
:bighug:
 
Sue and Luci said:
I found that the less I said to my vet(s) the better. They tell me what to do, and I smile and nod and acknowledge that I heard them...and then I go home and do exactly what I've been told to do by the fine folks here on the FDMB.

After multiple times of minimal engagement regarding Luci's diabetes it seems they lose interest quickly. If they ask I will share my Spreadsheet, often they want to recommend aka sell me some DM food - I decline politely...pay my bill and leave. They usually ask me to call them regarding modifying her dose - yeah, right...not gonna happen. Not one of them has ever called me and said, I think you need to change Luci's dose - although one vet asked me why I kept moving it up and down (well based on the numbers, was my response) and that seemed to be enough for him...

I'm sure you know already that with thousands of people here who've done it all, seen it all and been there done that -- with schedules and families and the whole nine yards - they have better outcomes that 99% of the vets who attempt to manage FD...

Well, that's my opinion...you may of course keep a good relationship with your vet, just dial it down as far as your expectations of the best advice for managing Jade's FD - starting with recommendations about using the pen needles vs syringes - you're comfortable using the sryinge, the advantages of using the syringes are many (as Wendy pointed out above)...go right ahead and use those sryinges - no point in arguing that point with your vet - she feel one way and you feel another - your cat, your judgement...do what's best for Jade.

Have a great evening!
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I will say that Dawn ( my vet) is pretty hands on. She’s my vet that makes the house calls because Jade is sooooo insane about going in the carrier and to the office. So I don’t have to call a clinic and go through all of that. I just send her a text and she responds pretty quickly. I’m definitely grateful for that part. It’s not easy to find a reasonable house call vet in Chicago.
 
Sue and Luci said:
I found that the less I said to my vet(s) the better. They tell me what to do, and I smile and nod and acknowledge that I heard them...and then I go home and do exactly what I've been told to do by the fine folks here on the FDMB.

After multiple times of minimal engagement regarding Luci's diabetes it seems they lose interest quickly. If they ask I will share my Spreadsheet, often they want to recommend aka sell me some DM food - I decline politely...pay my bill and leave. They usually ask me to call them regarding modifying her dose - yeah, right...not gonna happen. Not one of them has ever called me and said, I think you need to change Luci's dose - although one vet asked me why I kept moving it up and down (well based on the numbers, was my response) and that seemed to be enough for him...

I'm sure you know already that with thousands of people here who've done it all, seen it all and been there done that -- with schedules and families and the whole nine yards - they have better outcomes that 99% of the vets who attempt to manage FD...

Well, that's my opinion...you may of course keep a good relationship with your vet, just dial it down as far as your expectations of the best advice for managing Jade's FD - starting with recommendations about using the pen needles vs syringes - you're comfortable using the sryinge, the advantages of using the syringes are many (as Wendy pointed out above)...go right ahead and use those sryinges - no point in arguing that point with your vet - she feel one way and you feel another - your cat, your judgement...do what's best for Jade.

Have a great evening!
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Also...had it not been for you,@Wendy&Neko and many others here, I would never have known about feeding her FF, testing,keeping a SS,earning a reduction, helping her when her numbers fell too low etc..... I don't think Jade would have made it without the FDMB.
This is the first place I came when her numbers went back up, I absolutely trust the guidance I get here. :)
 
Wendy&Neko said:
We've had hundreds and hundreds of members use syringes to withdraw insulin from the pen, without it being an issue. I think the odds of contamination are practically nill. Just remember, your vet is not there when you give insulin. You shoot the cat. If you were to tell the vet you successfully used syringes before, I think any good vet would listen to that.

Definitely store unopened or unused pens in the fridge. From the manufacturer: https://www.lantus.com/-/media/EMS/...F/lantus-quick-reference-patient-brochure.pdf A quote from that brochure "Never refrigerate the pen after opening it".
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Hi Wendy,
Can you remind me how much of a window of time is safe for her injections? I know that every 12 hours is ideal, but I work in the evenings at a restaurant. I'm aiming for 10:30 a.m./p.m. knowing that there's a chance that at times I may not make it home until 11:00-11:30.
If I shoot at 10:30a.m. and cannot shoot until 11:30p.m. , what time is ok for the following morning?
Much appreciated!!
 
Without impacting things, you can shoot 1/2 hour early once per day, or 15 minutes per cycle. Shooting 1 hour later is OK, so at 11:30PM, but I wouldn't move it more than 1/2 hour, to 11:00AM in the following morning. One caveat, if she's really high in pinks or reds, you can probably get away with shooting at 10:30 AM. Do you work every day the same shift time? Just wondering if we can figure out something to work for you.
 
Wendy&Neko said:
Without impacting things, you can shoot 1/2 hour early once per day, or 15 minutes per cycle. Shooting 1 hour later is OK, so at 11:30PM, but I wouldn't move it more than 1/2 hour, to 11:00AM in the following morning. One caveat, if she's really high in pinks or reds, you can probably get away with shooting at 10:30 AM. Do you work every day the same shift time? Just wondering if we can figure out something to work for you.
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Thank you. Unfortunately, even though the restaurant closes at 10:00 pm every evening there’s no guarantee that I’ll be home soon after that. I can probably change her shot time to 11:00a.m./p.m. though. I’m off tomorrow so I can keep an eye on her. I’ll shoot at 11:00a.m./p.m. tomorrow. I would think that the latest I would get home from a shift is 11:30.
 
First day back on insulin and something seems wrong with these #'s. I am NOT going to give her a pm shot but how can her number have dropped SO dramatically and is there a chance that after 12 hours from her first dose that she can go hypo?? I don't want to keep poking her if I know that she can't. I already poked several times just now to get that 118 reading....
 
Do you have any idea what might have changed recently? Any diet changes? Curious why you started at 1U, dosing guidelines recommend 0.5U.

It helps if you link other posts for continuity...I know I saw another post from you will have to dig.
 
If you've skipped the shot, please put NS in the U column for the PM cycle.

You could go down to 0.5U tomorrow morning and see how that work out. Please do get a before bed test just to see how she is doing after the skip?
 
FrostD said:
Link to other thread

https://www.felinediabetes.com/FDMB...1-and-so-it-begins-again.254707/#post-2869738

We do ask only one thread per day per cat - you could have edited the title of your other one asking for help. I'm guessing one of the moderators may condense them.

Edit - you're getting replies in your other thread so anyone checking here please go to the thread linked above

@Wendy&Neko @Sienne and Gabby (GA) @Marje and Gracie
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Thank you, I'm sorry! It's my first day back and I forgot so many things....:banghead:
 
Bandit's Mom said:
If you've skipped the shot, please put NS in the U column for the PM cycle.

You could go down to 0.5U tomorrow morning and see how that work out. Please do get a before bed test just to see how she is doing after the skip?
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I just edited my post as you were posting - Suzanne was also over in her other thread. Just trying to make sure nothing gets confused
 
Jill & Jade said:
Can you go hypo after only one dose of one unit after 12 hours in her system?
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I am pretty sure that I read that it is possible to hypo as long as there’s insulin on board. There’s only no chance of hypo if the cat hasn’t received insulin - under normal circumstances that is. If it were my cat I would be closely monitoring and setting alarms for myself in the night to make sure she was stable or rising.
 
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Can anyone confirm that if I didn't shoot her this evening, that she's safe? I swear my head feels like it's going to explode.
She has been fine for 3 1/2 years of remission. She had a slight cough a couple months ago so she went in for X-rays. She has to be drugged for any car ride so I gave her half of a gabapentin. That drug (any drug) really throws her off for days. The x-rays showed some asthma/bronchitis so my vet put her on 3 weeks of amoxicillin to see if that would help before any steroid was given because she really wanted to avoid any relapse for her. Last Tuesday, I drugged her again and we got a follow up x-ray which didn't show much improvement but she told me that Jades BG was 290. It had only been 109 just 9 days earlier. I have been checking her ever since(see SS) and yesterday Dawn (Vet) made the call to try the 1 unit of Lantus. That's how we got to this moment. She has been constipated and I usually give her lactulose but Dawn wanted me to stop everything except her thyroid meds just to make sure nothing was contributing to the drastic # changes.
 
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Do you have a spreadsheet? Get a test 3 hours after she eats. If her pancreas is sputtering it will be lower than the pmps so don’t get worried.
 
She’s back up to 209
one hour after eating her FF mixed with Lactulose and her thyroid meds. Whew. But still….. why? How?
 
Wendy&Neko said:
And now that you are going to be shooting a smaller dose, you will need to use syringes.
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She was at 183, 2 hours after eating. I was going to stay with the syringes. I don’t even want to give her .5 to be honest. Now I’m a wreck about giving her any at all. And who knows what Dawn will say? What if she recommends giving 1 unit again, assuming Jades number goes back up? I did ask her today what # she considered too low to shoot at and she said 200 but was pretty certain that wasn’t a possibility. Go figure.
 
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Jill & Jade said:
She was at 183, 2 hours after eating. I was going to stay with the syringes. I don’t even want to give her .5 to be honest. Now I’m a wreck about giving her any at all. And who knows what Dawn will say? What if she recommends giving 1 unit again, assuming Jades number goes back up? I did ask her today what # she considered too low to shoot at and she said 200 but was pretty certain that wasn’t a possibility. Go figure.
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I haven't commented because you seem very overwhelmed but I think maybe you need to hear some other voices chime in.

I agree with everything the others have said. So many of us (myself included) have used syringes with the pens successfully, never any problems. It's the only way to fine tune a dose. Pens and their needles are intended for humans weighing at least 10x more than a cat does, needing much more insulin. If you had to give your cat any other medication would you use full size human syringes and dose in human increments? No, it's just not safe.

As for the vet...I understand wanting to keep the vet happy, but in my experience no vet gets it right every time. In fact, I've seen 4+ vets that have come highly recommended and NONE have known enough about FD. It's a miracle my cat hasn't died due to bum advice. I stick with my current one because he's happy to ride along while I do my thing, do spot checks, and write scripts. So, who cares what the vet says. You're the one doing all the work, you're the one paying her, do what you're comfortable with and what you think is right/safe
 
Lantus takes about a week for the depot to fill. Some cats see a strong reaction to the first or second shot but I would not say it happens often. I wonder if the lower pmps was just her.
Fwiw after Max was regulated I used digital calipers and took increases and decreases in 1/8 units. Making dosing changes by 1.0 can miss a good dose and also be risky in my opinion.
 
tiffmaxee said:
Lantus takes about a week for the depot to fill. Some cats see a strong reaction to the first or second shot but I would not say it happens often. I wonder if the lower pmps was just her.
Fwiw after Max was regulated I used digital calipers and took increases and decreases in 1/8 units. Making dosing changes by 1.0 can miss a good dose and also be risky in my opinion.
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I would be very relieved if she stays in the blue. Greens are the best, but if she stays low maybe she hasn't had a relapse? When we were here last time, she micro dosed right into remission (quickly). Back then, I believe it was food related but she's been eating FF Pate since June 2018. I wonder if the gabapentin/stress/constipation led her to the elevated #'s?
 
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