Levemir user - help needed for variable shot schedule

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KSAkitties

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Unfortunately, I have to be away for a week next week. The vet who is supposed to give my sweet boy Major insulin shots while I am away just told me that he is going away as well.

My 'back up' vet can only come at 7:00 am and 09:30 pm to give Major injection. We are using Levemir. How do I dose Major with this +14/+10 shot schedule? Major is currently on 0.75u bid and tightly regulated.

Any advice is much appreciated.
 
Re: Levemir user - Can shots be given at +14 and +10?

Can you have the vet do one of the shots and find someone else to do the other shot, so you can stay on the 12/12 schedule?
 
Re: Levemir user - Can shots be given at +14 and +10?

Dyana said:
Can you have the vet do one of the shots and find someone else to do the other shot, so you can stay on the 12/12 schedule?

I am currently training someone/cat sitter (for over a week now) to do the mid-cycle BG reading but he is not really up to the task yet. I am reluctant to ask him to give Major insulin shots when he is having trouble with home testing AND do the feeding for five cats. I don't have any one whom I can trust or know anyone who likes pets/cats here. Language barrier is also a big problem.

I am so stressed now. I have to be away for medical reasons; otherewise, I will not go away.
 
Re: Levemir user - Can shots be given at +14 and +10?

Does vet office have any other tech type staff who could be trained?

Is there any kind of vet school, vet tech school, agriculture school (because farmers may give shots to animals), etc, or nursing school where you could find & train someone?

I'm just tossing those ideas out there hoping one may be useful.
 
Re: Levemir user - Can shots be given at +14 and +10?

BJM said:
Does vet office have any other tech type staff who could be trained?

Is there any kind of vet school, vet tech school, agriculture school (because farmers may give shots to animals), etc, or nursing school where you could find & train someone?

I'm just tossing those ideas out there hoping one may be useful.

Thank you for the suggestions. There is no vet school or agricultural school here. There are only two vets (they don't have vet techs at the clinics) in the entire province, and both vets are from abroad (the Philippines and Zimbawe). The vets here pretty much do everything on their own.

I will look into nursing school tomorrow. However, I doubt there is a nursing school here because all the nurses are from the Philippines or other foreign countries, and the doctors are from abroad as well.
 
Re: Levemir user - Can shots be given at +14 and +10?

How about home health/nursing services? Might find a nurse, or nurses aide that could be trained.

Also, you could try using Google Translate to take short sentences and put them into several other languages. Then try a reverse translation - put Google's version back in and ask it to translate to English to verify the meaning. Assemble step by step instructions in the language groups you choose. English, French, Spanish, and German are some popular and widely used languages which may be good options (I didn't see Phillipino listed)

If you can put together some simple instructions in a language that the other person can read, maybe with some drawings or photos, it could help in instructing someone new.
 
Re: Levemir user - Can shots be given at +14 and +10?

I can't recall the people but there have been others who work shift work and 12hr shifts so that cannot stick to the 12/12 shot times, but they adjust the dose of each shot.
Maybe try changing your subject to ask for dosing when working 12 hour shifts.
 
Re: Levemir user - Can shots be given at +14 and +10?

Two years ago I uses a 16/8 schedule on the weekends. I used Lantus for five and N for one. It was OK. I just had to remember that a high BG would be expected after the 16 hour period but not to increase the dose since the next period would only be 8 hours.
 
Re: Levemir user - Can shots be given at +14 and +10?

BJM said:
How about home health/nursing services? Might find a nurse, or nurses aide that could be trained.

I will try to find some info on health services tomorrow. Not sure how I am going to do it since I can't speak nor read Arabic.



BJM said:
If you can put together some simple instructions in a language that the other person can read, maybe with some drawings or photos, it could help in instructing someone new.

Thank you for the suggestion. I have put together some simple instructions with photos - images showing step by step how to do home testing and how to prepare the food. I also have a daily log sheet outlining every single task to be carried out by the cat sitter. He needs to check off each task after he's carried out the task.

I am beginning to think the problem I have is due to the language barrier AND lack of competency but he is my best chance. I interviewed no less than 15 candidates and had tried at least 10 of them. The one I am training now was the best of the lot.
 
Re: Levemir user - Can shots be given at +14 and +10?

Larry and Kitties said:
Two years ago I uses a 16/8 schedule on the weekends. I used Lantus for five and N for one. It was OK. I just had to remember that a high BG would be expected after the 16 hour period but not to increase the dose since the next period would only be 8 hours.

Thanks, Larry. How did you deal with the low BG at the end of the +8 cycle? Did you keep the same dose?
 
Hi Ping,
That is a predicament, but you are using the best insulin for this type of problem. It's pretty simple to work around though, especially since Major is regulated.

First off, I'd like you to try it first at least 2 or 3 days ahead of time to see if it works OK. Give him .5U at 9:30, then .75U at 7AM. Giving the lesser dose at +10 will maintain the overlap or shed a little longer so the next cycle can go to +14 but won't be so much that the next time you have a too-low preshot and even though the cycle after that will be a shot at +10 after a .75U dose, as long as the BG is fairly stable you should still have a shootable BG. I hope that makes sense.

If you can get some tests in between those times to see where the action goes, that would relieve your anxiety about it somewhat.

Just for safety's sake, you may want to lower dose even further for each shot, say a skinny .5U and a skinny .75U. You may want to make up syringes ahead of time for the vet, and put them in something labeled which times they are supposed to be given. There is no harm in drawing doses of Levemir ahead of time, several of us have done it.

I'm sorry your original plans fell through. If I can be of further help, you're welcome to PM me. He's doing so well, I doubt a week's worth of wonky scheduling will mess him up too badly. Can they maintain cellphone contact with you while you're away?

And for those who can't remember, I have extensive experience adjusting shot schedules with Levemir. Not only do I have a changing shift work schedule, but I am using it TID currently to overcome concurrent Prednisolone usage. A few hiccups here and there on that, but Levemir is much more flexible than it's given credit for, you simply have to understand how it's meant to work and use that to your advantage sometimes.
 
Thank you very much, Vicky.

I will follow your advice. I have finally moved Major's shot time from 4:00/4:00 to 7:00/7:00 as of today. I can try 0.75 u at 7:00am then 0.5 u at 9:30 this weekend. I leave Wed night so I will have at least three days to see how it works.
 
Re: Levemir user - Can shots be given at +14 and +10?

I usually gave a reduced dose after the 16 hour period.

KSAkitties said:
Larry and Kitties said:
Two years ago I uses a 16/8 schedule on the weekends. I used Lantus for five and N for one. It was OK. I just had to remember that a high BG would be expected after the 16 hour period but not to increase the dose since the next period would only be 8 hours.

Thanks, Larry. How did you deal with the low BG at the end of the +8 cycle? Did you keep the same dose?
 
I wonder if you could have a trial run with the person as well, before you leave.
Have your instructions all prepared, then have the person come over and follow the instructions while you are there and watching, then you can confirm that your instructions are clear. That way, the person will have hands on experience with your guidance.
Making sure you have the doses working like Vicky suggests, then have the person do a run-through.
 
Gayle and Shadoe said:
I wonder if you could have a trial run with the person as well, before you leave.
Have your instructions all prepared, then have the person come over and follow the instructions while you are there and watching, then you can confirm that your instructions are clear. That way, the person will have hands on experience with your guidance.
Making sure you have the doses working like Vicky suggests, then have the person do a run-through.

Thank you for your suggestion. This person/cat sitter-in-training has been comeing for 'trial runs' every day (some times he comes for trial runs twice a day) for almost two weeks now. He still has not been able to do one testing sucessfully on his own. He has his own notes and my simple instructions in front of him but still can't get it right. He is trying really, really hard but he seems to blank out or is too nervous to remember what he is supposed to do every time he comes. Last night, he put Vaseline on the back of his own hand instead of Major's ear and was ready to do the poking before he even put the lancet in the lancet pen and the testing strip in the meter. This is after almost two weeks of practice/trial runs. I really don't think I can ask him to give Major insulin injection if he is having a hard time with hometesting.

So far I have been trying to encourage him by telling him that he just needs some more time and practice but we are kind of running out of time since I am leaving next Wed. DH is suggesting that we should just cancel the trip/doctor's appointments because this is not working out.
 
Maybe have him practice testing on a moderate ripeness banana peel or apple - the resistance to the needle feels about the same and it doesn't squirm.
 
I'm sorry this is so difficult. I have to be gone for one day for an out of town meeting next week and have someone coming over to give shot/meds maybe and I'm nervous about that. I can't imagine the stress this is causing you.

Is there a way you could take Major with you? DH can do what's needed, right?
 
Hi Vicky,

Unfortunately, hubby and I are going to the UK for medical; therefore, it's not possible to take Major along given the 6 month quarantine law (it will be abolished in Jan 2012 though).

I understand how worried you will be when you are away next week. I have got more gray hair in the last few weeks than in the last few years, ever since I found out that I have to be away for a week.

DH said we still have a couple of days to make up our mind about whether we are leaving or not. In the mean time, I will pray for a miracle that the cat sitter in training will suddently get a awakening call and get the whole thing. He is still coming every day for the trial runs. The vet is coming for training on Sunday. I have to keep my hopes up.

I hope Gandalf is doing better.
 
BJM said:
Maybe have him practice testing on a moderate ripeness banana peel or apple - the resistance to the needle feels about the same and it doesn't squirm.

Thank you for the suggestion. I just so happen to have some moderate ripen bananas at home. I may ask him to practice the testing on the banana this evening. Major started hiding under the bed when the cat sitter-in-training comes. I think my 'most patient and cooperating' Major has had enough of pokings from him. I did tell this person that he can only do a maximum of two pokings each time then he has to stop it and give Major a treat. I don't want Major to get stressed and associate home testing with pain.
 
Would it be easier for the sitter to use the lancet without the pen? I cried when I first tried using the lancet pen. I just couldn't get it and I was afraid I was hurting him. Until I realized I could use a lancet without the pen, I stressed myself, stressed Gandalf horribly and it was a miserable experience 'cause I knew it was important. That may be what's causing the sitter so much trouble.

Thanks for asking about Gandalf. He's doing OK, but it's very difficult right now.
 
Ping,
I was just wondering how you are poking for the testing?
You are poking freehand or are you using the lancet device?
The device is a quick snap but the freehand is often slower and may actually hurt when done by a new person.
If using the lancet device maybe try adjusting the depth?
 
Gayle and Shadoe said:
Ping,
I was just wondering how you are poking for the testing?
You are poking freehand or are you using the lancet device?
The device is a quick snap but the freehand is often slower and may actually hurt when done by a new person.
If using the lancet device maybe try adjusting the depth?

Hi Galye,

We are using the lancet device. I may have to adjust the depth and ask the cat sitter to warm up Major ear just a bit longer so he can get the blood. I will also give him a banana/apple (have both at home) to do more practice. He still needs to work on the sequence of steps, which he still gets them in the wrong order sometimes.

I have till Sunday to cancel the trip.
 
can you write out the steps? Or have him write each step himself so that he understands what to do and when?
He can number them and tick them off with a pencil as he does each one. That way he does not have to remember the sequence. You can even have a fresh paper for each shot time.

When unfamiliar with a process and the steps, if nervous about doing something wrong and causing harm, the written steps can be calming as he can do one and then move on to the next one.

Be sure you get every little step
 
I would like to add another comment to the great suggestions above. Even if you weren't going away, I suggest reducing Major's insulin dose. When you are following the Tight Regulation Protocol with Lantus or Levemir, two ways to "earn" dose reductions are by going below 50 or by holding BGs in the normal range (generally under about 120) for a week. Major has done both of those things, so even if you were staying home I would attempt a reduction to 0.5 units BID.

About how to work around that schedule with a tightly regulated cat, it sounds like you have been given some good ideas. I'm facing a similar dilemma in a couple of weeks, and an option I am considering is just having my petsitter give Jazzy one shot a day while I'm gone. I'll only be gone for a couple of days, and usually she gets back on track quickly after a missed shot, so for me that seems like the best plan for my petsitter who can't visit on a regular 12 hour basis and with a cat who likes to surprise me with low preshots sometimes. It might not be as ideal if you're gone for a whole week, but then again it might work ok. Just throwing that out there as another option. :smile: You have to do what you have to do. And no matter what you decide, I almost always recommend reducing the dose a little when a cat will be in someone else's care because you never know if your cat will eat normally while you're gone. Better safe than sorry.
 
Gayle and Shadoe said:
can you write out the steps? Or have him write each step himself so that he understands what to do and when?
He can number them and tick them off with a pencil as he does each one. That way he does not have to remember the sequence. You can even have a fresh paper for each shot time.

When unfamiliar with a process and the steps, if nervous about doing something wrong and causing harm, the written steps can be calming as he can do one and then move on to the next one.

Be sure you get every little step

Hello Gayle,

Thank you for the suggestion. The cat sitter has written out and numbered each step himself. This is a great idea - I will ask him to tick them off as he does each one. He finally got a sucessful reading with very little help form me. He is coming back again this evening, and we will try your suggestion of ticking off each step as he does one.
 
Libby and Lucy said:
I would like to add another comment to the great suggestions above. Even if you weren't going away, I suggest reducing Major's insulin dose. When you are following the Tight Regulation Protocol with Lantus or Levemir, two ways to "earn" dose reductions are by going below 50 or by holding BGs in the normal range (generally under about 120) for a week. Major has done both of those things, so even if you were staying home I would attempt a reduction to 0.5 units BID.

Thank you for the dose suggestion. I was planning to ask the vet to give 0.5u while I am away, just to be on the safe side. I started giving Major 0.5u last night.
 
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