? Help with dosing

Mimis mom

Mimis mom

Member Since 2019
Hi! My cat Mimi has been home from the hospital for a week now after being inpatient for 6 days for DKA.
They have her on Lantus pen 2 units.
2 days ago her number was 34 right before her next dose and they told me to bring her back in so they can check her vitals and test my Freestyle lite against their Alphatrak 2.
Turns out the Freestyle was reading in the 30s while the Alphatrak in the 70s
Still low and advised to skip tonight’s dose, and go down to one unit until I can follow up with my regular vet.
I was advised on here that a whole unit is too much of A decrease so I went to the pharmacy to get syringes - 100 u 3/10 cc
And tried my best to measure 1.5 units.
Have also tried feeding her some smaller meals instead of twice a day large ones.
The best I can do with that so far is feed her once at 8 am then again before I leave for work- 11am, and then repeat that at night time.. there is a full 8 hours she won’t get food, but I have to figure out automatic feeders and which one to get.

this morning her reading was 115 (I bought an alphatrak2) and I’m due to give her the next dose in an hour..
The 115 was before I fed her. I haven’t tested since and it’s been almost an hour.
what do I do!???
 
It's hard to give you advice without being able to see your previous tests. If you can get a SS set up it will help us to be able to give you dose advice.

Have you ever shot a number this low?
Are you able to stay home and monitor?
What dose are you giving right now?
Do you have any test numbers fro yesterday?
 
Rosa Camaj said:
this morning her reading was 115 (I bought an alphatrak2) and I’m due to give her the next dose in an hour..
The 115 was before I fed her. I haven’t tested since and it’s been almost an hour.
what do I do!???
Click to expand...

Please re-test now. Let's see if she's come up any!

As you know, you don't want to skip shots with a recent DKA, so we'll have to figure out the best course with the info on hand.
 
If you can’t be home should she drop it might not be safe to shoot. With the DKA getting enough food and insulin is important. I never had to deal with that. I think you need an auto feeder for while you are at work. Most cats get very hungry when their numbers get to low.

Please set up a spreadsheet. If you need help someone can help you. In the meantime can you post all her tests from the past few days?

Also add a signature with type of food, meter, age, date when dx, any other medical issues or medications and when you decide which protocol SLGS or TR.
 
tiffmaxee said:
If you can’t be home should she drop it might not be safe to shoot. With the DKA getting enough food and insulin is important. I never had to deal with that. I think you need an auto feeder for while you are at work. Most cats get very hungry when their numbers get to low.

Please set up a spreadsheet. If you need help someone can help you. In the meantime can you post all her tests from the past few days?

Also add a signature with type of food, meter, age, date when dx, any other medical issues or medications and when you decide which protocol SLGS or TR.
Click to expand...

ok where do I do this signature!? I made an entire profile explaining everything in great detail.
 
On the top of the page there is a darker blue bar - on the far right of that bar you will see your name and inbox and alerts - hover or click on your name and a drop down menu will appear. The second category down in that drop down menu is called signature. click on that and write in your info and then save.
 
Sorry I can't help with your dosing question. I am too new to give good advice.
 
Hi there-

I don't have first-hand experience with DKA, but I have put the word out to some folks who do, so I'm sure they will be along as soon as possible to help guide you. I do know that with a history of DKA, you really want to find a dose that you can consistently give twice a day...insulin is very important for keeping DKA at bay.

I'm assuming the syringes you have are in 1 unit increments as well. There are syringes that come with half-unit markings; those will make it much easier for you to draw those "in-between unit" doses.

As Elise mentioned, having a spreadsheet set up is imperative for us being able to see trends and patterns and therefore help guide you. If you need help setting the SS up, there are members here that can help you with that.

When you have time, start reading the stickies at the top of the forum...they are chock full of very good information. We know it is all very overwhelming, as we have all been new to this at some point, too, so please ask as many questions as you need. We are here to help!
 
carfurby said:
It's hard to give you advice without being able to see your previous tests. If you can get a SS set up it will help us to be able to give you dose advice.

Have you ever shot a number this low?
Are you able to stay home and monitor?
What dose are you giving right now?
Do you have any test numbers fro yesterday?
Click to expand...


last night I tested she was the first test I did with the Alphatrak2- 9 pm (an hour before her usual insulin dose) she was 156.
10 pm when the dose was scheduled it was 317. dosed out 1.5 units (i hope I did it correctly. the u100 needle is very short, it makes me nervous Im not getting into her since her fur is long.. injecting it as been a challenge for me because when she went into the hospital for DKA last week the vet said she had developed a granuloma in the injection site. (between her shoulder blades, they shaved an area to help me know where to inject.)

Back to the question- I waited an hour longer than I would normally dose. so the 9:26 am was 113, and then at 11:30 it was 248.
I gave her food at 9:30 am, and then more at 11:35. gave her 1.5 lantus at 11:30am

she's also on meds for gallbladder and still has the rest of her clindamycin antibiotic (I believe for the pancreatitis?)

Im going to try and do a curve today, so Im due to test at 2 pm (well that will be 2 and a half hours- does it have to be exactly every 2 hours?)
 
Nan & Amber said:
Please re-test now. Let's see if she's come up any!

As you know, you don't want to skip shots with a recent DKA, so we'll have to figure out the best course with the info on hand.
Click to expand...
she went up to 317, so I dosed her the 1.5 units of lantus.. which needles do you use for Lantus??? I hope I got the right ones. the first one the pharmacist gave me, the smallest dose was 2 units, then she found the 3/10 CC
 
Hi there

First a few things that are important to know about DKA The way DKA works is that when there is not enough energy from food making it into the cells, the body will breakdown fat and protein to try and fulfill the need for more metabolic energy. The excessive breakdown of these stored reserves creates a toxic by-product - ketones. As ketones build up in the blood stream, the resulting pH and electrolyte imbalances can very quickly develop to life threatening levels , a state of DKA.

You must monitor for the presence of ketones either in the blood or in the urine. please get some Ketostix at the pharmacy as soon as possible so that you can check your cats urine. This is your first line of defense.

Your kitty needs calories and hydration along with enough insulin. What food are you feeding?
 
Setting up your signature (light grey text under a post). Here's how:
click on your name in the upper right corner of this page
click on "signature" in the menu that drops down
type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using and dosage amount /glucose meter you're using/what (s)he eats/any other meds or health issues (s)he has. You can
add a geographic location (sometimes the country/time zone matters) Be sure to SAVE when you are finished.

When you set up the signature and then the spreadsheet, it's very helpful to put the spreadsheet link (eg. Mimi's SS) at the very end of the info. The instructions tell you how to create a text link (the URL spreadsheet links can be very long and take up a lot of room and signature space is limited).
It's much easier to find, just in case you have an urgent event or question and the spreadsheet data needs to be consulted.

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
http://www.felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/

@Chris & China (GA)
@Wendy&Neko
@Marje and Gracie
@Bron and Sheba (GA)
 
Hi there,

Please set up a spreadsheet, as it is difficult to follow without visualizing the numbers: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

Regarding syringes, you need the U-100 with 1/2 marks. I buy these because they are very good at avoiding bubbles: https://www.adwdiabetes.com/product/1289/monoject-ultra-comfort-u100-syringes-29g-3-10cc-1-2in-100ct They are longer, which makes it easier for me to shoot past the fur :)

Do you have a hypo kit with you? = higher carb food, like Fancy Feast gravy lovers, and some honey or karo, in case she goes too low? You need to have one at hand at all times. If you find out she is going low (like yesterday), or lower too fast, give her 1_2 spoons of higher carb food and test again after 20 minutes. Here you have a good resource: http://www.felinediabetes.com/FDMB/threads/dont-panic-or-how-to-handle-low-numbers.210109/
 
Penelope and Mačka said:
Hi there,

Please set up a spreadsheet, as it is difficult to follow without visualizing the numbers: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

Regarding syringes, you need the U-100 with 1/2 marks. I buy these because they are very good at avoiding bubbles: https://www.adwdiabetes.com/product/1289/monoject-ultra-comfort-u100-syringes-29g-3-10cc-1-2in-100ct They are longer, which makes it easier for me to shoot past the fur :)

Do you have a hypo kit with you? = higher carb food, like Fancy Feast gravy lovers, and some honey or karo, in case she goes too low? You need to have one at hand at all times. If you find out she is going low (like yesterday), or lower too fast, give her 1_2 spoons of higher carb food and test again after 20 minutes. Here you have a good resource: http://www.felinediabetes.com/FDMB/threads/dont-panic-or-how-to-handle-low-numbers.210109/
Click to expand...


Are you sure they have half marks?? I have the 3/10 cc but with a different gauge and length and i don't see half marks.
 
Rosa, if you have a Walmart close by, you can get these:

You can get them at WalMart (although if you ask, they'll probably tell you there's no such thing....don't listen to them) These are the syringes you want to get. 3/10ml, 31 gauge insulin syringes.
relion-syringes-jpg.47669
 
I’m sorry I was out most of the day but looks like you’ve had help.

Can you please remove the 911? There is no emergency at this time but if members see it, they will take the time to look and see if you need help.

Thank you.
 
Rosa Camaj said:
Back to the question- I waited an hour longer than I would normally dose. so the 9:26 am was 113, and then at 11:30 it was 248.
I gave her food at 9:30 am, and then more at 11:35. gave her 1.5 lantus at 11:30am
Click to expand...
Was your kitty diagnosed during the recent hospitalization? Are you new to feline diabetes? There is so much to learn and adapt to. As if that’s not enough, the addition of DKA recovery throws you into an intensive care situation. It’s unfortunately an initiation by fire, however we are here to help you get your kitty safely past the crisis.

In answer to your question. Stalling when faced with a PS number lower than you have ever seen, particularly when you have not yet had the opportunity to learn how lantus works for your kitty is prudent.

Lantus likes consistency. Shooting late can act as a reduction and shooting early can act as an increase. Ultimately it is important to find a dose you can safely shoot every 12 hours.

As I mentioned in my earlier post, testing for the presence of ketones is key and your first line of defense. Any reading higher than “trace” warrants a call to the vet. Test at least 2x per day. ketones can quickly build up- my kitty once went from “trace “ to “large” in exactly 24 hours Hydration is also very important. Mix as much water as kitty will tolerate with her food.

Keep in mind the recipe for ketone development is:

Not enough calories + Not enough insulin + infection/inflammation or some systemic stress.

Update us when you can and keep the questions coming. :cool:
 
Rosa Camaj said:
Are you sure they have half marks?? I have the 3/10 cc but with a different gauge and length and i don't see half marks.
Click to expand...

Hi Rosa,

I know that your higher priority here is a dosing question, but once that has calmed down, I don't want to pass up the opportunity to make sure that you are confident that you have the correct syringes and know how to read and use them. We have had parents who swore that they were giving 1 unit but were actually giving 10, so I am never going to pass it up if a parent seems uncertain.

From this page: http://www.felinediabetes.com/FDMB/...info-proper-handling-drawing-fine-dosing.151/ is the attached picture. It will show you that when there are horizontal tick marks on the left side of the vertical scale, those are half unit marks, whereas the horizontal ticks on the right side are whole unit marks. And it shows you how to read them by labeling the total number of units at each of those tick marks.

GAUGE: A different gauge is fine, the dosing is no different, the gauge refers only to the thickness of the needle. It's weird, but if the number is bigger, the needle is thinner. So a 28 gauge needle is much thicker than a 31 gauge needle. I've used a variety of gauges on our two diabetics, and honestly, mine haven't really noticed much of a difference, but other kitties might. I found that if the needle was too thin, it was more likely to bend when he was squirmy.

LENGTH: The length (1/2" vs. 15/64") is just the length of the needle. This is really your preference. Some parents swear by shorter lengths because they feel more confident, but I prefer longer because my boy has longer hair, but again the dosing is no different based on the length of the needle that you choose.

VOLUME: 3/10cc is simply the total volume of the syringe. A 3/10cc syringe will have 30 units in it. Almost none of us (except the parents that have "high dose kitties") ever give more than 30 units per dose, so there is no need for a needle with a larger total volume. Humans can use a 1/2cc syringe that holds up to 50 units, or even a 1cc syringe that holds up to 100 units, but then I think that the companies do change how the syringes are marked like one "tick" for each 2 units...I've only seen one of those once or twice, but that is probably what you got originally when you said the smallest dose was 2. And anything larger than 3/10cc is probably more expensive than you need anyway.

MOST IMPORTANT is that you do make sure you have a U-100 syringe -- that part is non-negotiable, unlike the other stuff. If you got it at a human pharmacy, that is probably what you got. A U-40 syringe I believe is only used for animals, and it is for a "U-40 insulin" which has a different strength, and without doing mathematical conversion, you should not use a U-40 syringe with a U-100 strength insulin. Lantus is a U-100 insulin, so do make sure that you have "U-100" labeled insulin syringes.

Does that help clear up any questions that you have about the syringes? I want you to be able to be confident about it, but let us know if you still have questions or concerns. There are many things that may seem overwhelming at this point, but the syringe issue should be easy to clear up.

Mimi is a very pretty girl!

My best to you,
Sandi (and of course, Whispy sends his best to Mimi too!)
 

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Aww thank you for all of the information! I’ve figured out the dosing however, my confidence in where I give the injection still makes me uneasy and I wonder if it “went in”
The needles I have are 8mm in length- pretty short- which my friend who’s a pharmacist said is better because you can go straight in as opposed to off the side, might make it easier.
The vet tech told me to insert it into the “tent” of the skin where the shoulder blades are, which I had no problem doing however - the vet at the ER told me she had a granuloma at the injection site so now I have no idea where to inject her, even with all of the pictures etc, I still have anxiety doing it and wonder if it “went in”
I don’t know...
 
I used to shoot Max on his side or abdomen.

Please remove the 911 as there isn't an emergency right now thanks.
 
10 years ago with our first diabetic, on the day when he was diagnosed our vet shaved about a 4" square on his scruff. It made it easier because you could see exactly where to go (he was also a longer haired orange boy), and you could see that it all got in.

I could be wrong, but a granuloma usually refers to a pretty small area of inflammation. I would be surprised if you are hitting the same exact spot every day. We just made sure to rotate around that square with each shot to mix it up. There are other places on the body you can give the shot, but neither of our boys have liked getting it in their side or on their flank, which is what is recommended as an alternate location.

For this issue, the biggest takeaway for you is to NEVER give a second shot just because you aren't sure if it all got it. Just record what you think you gave in the spreadsheet, and maybe make a note on the right of that row to say that it "might have been a fur-shot", and wait until the next shot time and try again :)
 
Idjit's mom said:
Rosa, if you have a Walmart close by, you can get these:

You can get them at WalMart (although if you ask, they'll probably tell you there's no such thing....don't listen to them) These are the syringes you want to get. 3/10ml, 31 gauge insulin syringes.
relion-syringes-jpg.47669
Click to expand...


So the length of the needle is pretty short from what I am reading, and the needle is very thin?
 
A 31gauge, 15/64" needle is fairly thin and short, yes.

What I use from Walgreens is slightly thicker and longer. It does have half unit markings. 29 gauge 1/2" needle.

IMG_3232.JPG


If you are on a phone, the steps to remove the 911 prefix from your post is to go to the top, click on the down arrow next to "Thread Tools" under the title, and click "Edit title". Click the down arrow next to 911 and change it to "No prefix" and then click "Save changes". It should be similar if on a PC. Thanks.
 
What is the benefit or not having a short needle vs. long or thin vs thick? Aside from comfort there have to be “pros and cons”
 
That's pretty much it...the 31 gauge needles are "thinner" so most cats don't even notice them. The 29 gauge are "thicker" so if the cat is sensitive, it might hurt a little more.

Length of needles is usually just personal preference. I liked the WalMart ones because I used a little different method giving shots than the "tent" that most vets show you. I never had any trouble with fur shots because I could see where I was shooting and didn't have to worry about going "through the tent" and shooting out the other side (longer needles can do that)

What I did was a "wrist roll"....you grab some fur between your thumb and forefinger and "roll" your wrist to gently pull the fur. Where the fur "breaks", you insert the syringe at about a 45 degree angle. It's hard to explain but maybe this picture will help
China skin roll method with circle.jpg
 
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