Lewie high at +5

[Kathy4Lewie]

I guess 0.5 units isn’t enough... I’m really surprised and worried that his +5 reading of 380 is so high.
What do you think about this?

 

[Kris & Teasel]

I wouldn't worry. It could be a bounce number. We need to keep reminding ourselves that it's the overall trends that tell the story and not individual numbers (with lime green being the exception!). It's possible that 0.75 u will be a better dose. I know you reduced to 0.5 u after those stall episodes. Maybe try a bump to 0.75 u tomorrow?

 

[Rachel]

I agree. Looks like a small increase could be in order.

 

[Kathy4Lewie]

I purchased the U-100 syringes. Here's the link if you would please confirm that I purchased the right ones:
https://www.walmart.com/ip/Relion-31g-0-3cc/132388525

At +9 he is at 421 This is before pills and breakfast (he had access to food all night but I don't know if he ate since I have other cats.)
Maybe I should try out the new syringes and give 0.6 units?
Thoughts?

 

[Kris & Teasel]

I purchased the U-100 syringes. Here's the link if you would please confirm that I purchased the right ones:
https://www.walmart.com/ip/Relion-31g-0-3cc/132388525

At +9 he is at 421 This is before pills and breakfast (he had access to food all night but I don't know if he ate since I have other cats.)
Maybe I should try out the new syringes and give 0.6 units?
Thoughts?

I think that's a good experiment to get accustomed to the new syringes. You'll learn to love them!

 

[Djamila]

Yes, those are the correct syringes. Make sure you use the conversion chart: http://www.felinediabetes.com/insulin-conversions.htm

If you're going to give 0.6u, you would draw the insulin to the 1.5u line

 

[Kathy4Lewie]

Great! Thank you. I'll give 0.6 u at his next scheduled shot time.
I just put the u-40 syringes in a zip lock bag and put them on the top shelf of the cabinet. Thank you so much for telling me to hide them away to prevent an accidental overdose.
I also printed out the conversion chart so I'm ready to go!

 

[Kathy4Lewie]

I really had to study the lines on the syringe and afterwards I freaked out thinking that I gave too much... but I think I did it right. Nerve racking
Question 1: Is the top of the black stopper supposed to be in the middle of the line?
Question 2: See the bubble on the top of the stopper? I can never get those out.
Question 3: At +9 he was 421, but at +11.45 AFTER his pills and eating breakfast, he was 347. Do you find that interesting?

 

[Jenna Josie]

Re: bubbles. I was told to draw the dose slowly, but I've actually found the opposite: the faster I draw, the less likely I get those bubbles! I think it has something to do with the viscosity of the insulin (?)

 

[Kathy4Lewie]

Re: bubbles. I was told to draw the dose slowly, but I've actually found the opposite: the faster I draw, the less likely I get those bubbles! I think it has something to do with the viscosity of the insulin (?)

Interesting, I'll keep experimenting! Thanks!

 

[Djamila]

As far as the plunger location, I'm not sure of the scientifically correct answer to that, but in a practical sense, it doesn't matter as long as you're consistent. So whether you put the plunger just at the top of the line, straddling the line, or below the line isn't as important as just doing it the same way each time. So wherever you can be most consistent is the "right" way to do it.

Hmmm....I think I just said the same thing three times I'm guessing you've got the point by now.

 

[Kathy4Lewie]

As far as the plunger location, I'm not sure of the scientifically correct answer to that, but in a practical sense, it doesn't matter as long as you're consistent. So whether you put the plunger just at the top of the line, straddling the line, or below the line isn't as important as just doing it the same way each time. So wherever you can be most consistent is the "right" way to do it.

Hmmm....I think I just said the same thing three times I'm guessing you've got the point by now.

LOL Redundancy is good!
And thank you for pointing out the "practical sense"... sometimes I'm just so literal!

 

[Kris & Teasel]

I agree with Djamila. Just decide where you want to place the plunger top relative to the line thickness and stick with that.

 

[Crista & Ming]

Hi @Kathy4Lewie ! I did a little digging because this was a question I've had for the last week but failed to ask any of the professionals at work (vet clinic) and hadn't needed to draw up any medicine all week (surprisingly).

http://www.diabeticcatinternational.com/knowledge/dosing-fat-increments/

Question 2: See the bubble on the top of the stopper? I can never get those out.

Now... please don't take my advice as 100% correct (or sterile practices) but this is what I personally do and what I've observed the technicians do at my clinic: Before I even take off the cap of any needle syringe, I pull back the plunger and push the air out. Sometimes it works... sometimes it doesn't. Most if the time, I draw up an amount and push it all back into the vial and usually the bubble disappears. If there's small bubbles in the syringe, then I draw a bit more than usual again and while having the needle still in the vial, I hold the syringe down with my pinky and flick the syringe with my other hand. It's a weird way to hold it though.

My mom is a nurse and she said she usually tries to avoid injecting things back into vials for sterility reasons. So lots of dilemmas, I have lol

 

[Kathy4Lewie]

Hi @Kathy4Lewie ! I did a little digging because this was a question I've had for the last week but failed to ask any of the professionals at work (vet clinic) and hadn't needed to draw up any medicine all week (surprisingly).

http://www.diabeticcatinternational.com/knowledge/dosing-fat-increments/

Now... please don't take my advice as 100% correct (or sterile practices) but this is what I personally do and what I've observed the technicians do at my clinic: Before I even take off the cap of any needle syringe, I pull back the plunger and push the air out. Sometimes it works... sometimes it doesn't. Most if the time, I draw up an amount and push it all back into the vial and usually the bubble disappears. If there's small bubbles in the syringe, then I draw a bit more than usual again and while having the needle still in the vial, I hold the syringe down with my pinky and flick the syringe with my other hand. It's a weird way to hold it though.

My mom is a nurse and she said she usually tries to avoid injecting things back into vials for sterility reasons. So lots of dilemmas, I have lol

Sorry for the delay... for some reason I didn't see this until now! Thank you for your techniques... I'll give them a try. I've wondered about pushing the insulin back in the vial. Some of these syringes have silicon to make the slippery and the silicon goes into the vial I'm sure!

 

[Kathy4Lewie]

I tested Lewie at +11.45 and his value is at 97.
I tested at +5 and he was 199 so I thought we were on track. So... I guess I'm going to skip tonight! It's 11:30pm Central and it will probably take hours to get within shooting range. I think I'm going to feed him his midnight dinner and call it a night.
Any thoughts about today's numbers? I gave 0.6 units for the morning cycle. Yesterday 0.5 wasn't enough and today's 0.6 is too much. Assuming I gave the right amount with the new syringe but I've looked a million times and it seems correct... 1.5 with the new syringe. Picture is above in post #8.

 

[Kris & Teasel]

I tested Lewie at +11.45 and his value is at 97.
I tested at +5 and he was 199 so I thought we were on track. So... I guess I'm going to skip tonight! It's 11:30pm Central and it will probably take hours to get within shooting range. I think I'm going to feed him his midnight dinner and call it a night.
Any thoughts about today's numbers? I gave 0.6 units for the morning cycle. Yesterday 0.5 wasn't enough and today's 0.6 is too much. Assuming I gave the right amount with the new syringe but I've looked a million times and it seems correct... 1.5 with the new syringe. Picture is above in post #8.

Don't rule out 0.6 u just yet. Let's see what his AMPS is today. It's not unusual for a dose increase (even a tiny one) to cause an overreaction the first time it's given and then kitty settles out into less drama. They don't always overreact though - just another kitty trick to keep us guessing ...

 

[Kathy4Lewie]

Don't rule out 0.6 u just yet. Let's see what his AMPS is today. It's not unusual for a dose increase (even a tiny one) to cause an overreaction the first time it's given and then kitty settles out into less drama. They don't always overreact though - just another kitty trick to keep us guessing ...

This morning he is at 361... basically the same as yesterday morning (when he was at 347).
In regards to the overreaction, are you thinking the low of 97 at +12 last night was the overreaction, and now he is back to normal requiring 0.6u and he probably won't go as low today because he is settling out with the dose increase?

 

[Kris & Teasel]

This morning he is at 361... basically the same as yesterday morning (when he was at 347).
In regards to the overreaction, are you thinking the low of 97 at +12 last night was the overreaction, and now he is back to normal requiring 0.6u and he probably won't go as low today because he is settling out with the dose increase?

Yes, I was referring to that 97. It's impossible to predict what he'll do today but I would try 0.6 u again if you can monitor. Get a +2 test to see if he's dropped significantly and be prepared to steer with food if he's 100+ points lower at +2. These experiments are stressful but the data they generate is invaluable for future dosing decisions in similar circumstances. They'll teach you whether Lewie is prone to these one-off overreactions or not, among other things.

 

[Kathy4Lewie]

Looking at the link that Crista & Ming provided, it looks like I gave too much yesterday. I thought I was giving 06.u, when in fact I really gave 0.8u.
Will someone please confirm that I messed up? UPDATE: Maybe I did it right... see next post.
There isn't a black line on my u-100 syringe to indicate 0.

 

[Kathy4Lewie]

Sorry for being confused about the markings. I have trouble with dyslexia sometimes and this kinda thing is difficult for me.

 

[Kathy4Lewie]

Yes, I was referring to that 97. It's impossible to predict what he'll do today but I would try 0.6 u again if you can monitor. Get a +2 test to see if he's dropped significantly and be prepared to steer with food if he's 100+ points lower at +2. These experiments are stressful but the data they generate is invaluable for future dosing decisions in similar circumstances. They'll teach you whether Lewie is prone to these one-off overreactions or not, among other things.

Thank you for the details for this experiment. I'll give his shot now since it's 9am Central and this is a respectable time to get back on schedule.

 

[Kris & Teasel]

There isn't a black line on my u-100 syringe to indicate 0.

All syringes should have a first line closest to the needle when holding the syringe vertical, needle pointing up. That line won't have a number on it but it's the zero line.

Every increment of 0.5 on the U100 syringe stands for 0.2 u of actual ProZinc. So it works as follows:
0 on U100 - 0 u
0.5 on U100 = 0.2 u
1.0 on U100 = 0.4 u
1.5 on U100 = 0.6 u
2.0 on U1200 = 0.8 u
2.5 on U100 = 1.0 u
and so on.
No need to apologize for dyslexia or any other issue reading scales. I was a physics/chemistry teacher for 30 years and I know that this is an issue for many people. I had to devote whole lessons to reading scales on voltmeters, ammeters, burettes, even meter sticks.

 

[Kathy4Lewie]

No need to apologize for dyslexia or any other issue reading scales. I was a physics/chemistry teacher for 30 years and I know that this is an issue for many people. I had to devote whole lessons to reading scales on voltmeters, ammeters, burettes, even meter sticks.

I didn't realize reading scales could be so difficult. It seems so straight forward and then my eyes fool me and see something different. Thank you for sharing your teaching experience and that you devoted whole lessons to help people like me.

 

[Djamila]

Kris has helped a lot of us through this. Once you get it, it's easy, but the first few times can be a bit confusing! And it's much better to check, double check, and ask for confirmation than to mess it up. That's one of the reasons why this community is so valuable!

 

[Kris & Teasel]

I'm pleased that I can help.

 

[Kathy4Lewie]

0.6 seems to have been a little too much today because I'm having to stall. AM+12=198. He was low at AM+9=66.
Maybe I should try 0.55 units... I'm trying to figure out how to do that if they are any suggestions? Maybe I need to pull out a u40 syringe and give a "fat" 0.5?
UPDATE: I used the u100 syringe and just a smidge less than 0.6u.

 

[JL and Chip]

What did you end up deciding to do? Have you tested again?

I would NOT pull out the U-40 syringes again. You'll be able to be much more accurate using the u-100s (it's just too hard to eyeball partial units on the u-40s). Maybe go a couple of cycles with the u-100s and see where things land. It's possible you weren't giving the dose you thought you were giving with the old syringes.

 

[Kris & Teasel]

I'd say stick with the U100s. You have the options of a skinny 0.6 u, an eyeballed 0.5 u, a fat 0.4 u or a regular 0.4 u dose to try in the days ahead. You could try an eyeballed 0.5 u (easy to do on these syringes) on the U100s today.

 

[Kathy4Lewie]

What did you end up deciding to do? Have you tested again?
I would NOT pull out the U-40 syringes again. You'll be able to be much more accurate using the u-100s (it's just too hard to eyeball partial units on the u-40s). Maybe go a couple of cycles with the u-100s and see where things land. It's possible you weren't giving the dose you thought you were giving with the old syringes.

Apologies for the late reply. When I post from my phone I guess I don't tap "Post Reply" or something. Here's what I thought I posted last night:
I waited 1.5 hours until he was at 250, then I gave a hair under 0.6u. I’m sure he will be low again tomorrow so I will need to watch him closely. Tomorrow I will try to figure out where 5.5u would be using the u100 syringes.

 

[Kathy4Lewie]

I'd say stick with the U100s. You have the options of a skinny 0.6 u, an eyeballed 0.5 u, a fat 0.4 u or a regular 0.4 u dose to try in the days ahead. You could try an eyeballed 0.5 u (easy to do on these syringes) on the U100s today.

So a fat 0.5 after conversion will be a fat 1.25 on the u100 syringe?
U-40 U-100
0.2 0.50
0.3 0.75
0.4 1.00
0.5 1.25
0.6 1.50

 

[Kris & Teasel]

So a fat 0.5 after conversion will be a fat 1.25 on the u100 syringe?
U-40 U-100
0.2 0.50
0.3 0.75
0.4 1.00
0.5 1.25
0.6 1.50
View attachment 39502

I tended to work with the divisions on the U100s only. So - I knew I could read U100 lines to get a 0.4 u or 0.6 u dose of ProZinc; I could eyeball 0.5 u on the U100 easily. I avoided dealing with fat or skinny 0.5 u fractions using U100s because I'd have to estimate slightly more or slightly less of a dose that already required me to estimate half way between two lines. I used fats and skinnies only if I was giving 0.4 or 0.6 u fractions that were drawn up using lines. Does that make sense?

If 0.6 u was too much and 0.5 u wasn't enough, instead of guessing where a fat 0.5 u was in the space between 0.4 u and 0.6 u, I'd try a skinny 0.6 u. To do that, I drew up 0.6 u using the lines on the U100 and then let out a drop so the plunger top was just a hair above the 0.6 u line if the syringe is held vertically with needle up. That's a very reasonable guesstimate of a fat 0.5 u too.

 

[Kathy4Lewie]

Oh! So forget thinking about what I gave with the u40... just look at the u100 divisions only... and start recording those values on the spreadsheet. So instead of recording 0.6, I will enter 1.5. Is that what you're saying? That would make sense. But then when I take Lewie to the vet, look at the conversion chart to see the u40 value to tell the vet.

 

[JL and Chip]

Oh! So forget thinking about what I gave with the u40... just look at the u100 divisions only... and start recording those values on the spreadsheet. So instead of recording 0.6, I will enter 1.5.

No, no, no!

We always talk in actual units. Lewie is receiving 0.6 actual units of insulin, regardless of where you draw to on the u-100 syringe. So 0.6 is what you want to put on the spreadsheet.

Think of it as a cup of sugar. Regardless of whether you're putting that cup of sugar into a one-cup measuring device or into a gallon jug, it's still one cup of sugar!

Edited to add: don't feel bad ... that's a very confusing issue and a very common question. I wasn't yelling, I promise.

 

[Kris & Teasel]

You definitely want to record your number of units, NOT the mark you draw insulin to on the U100 syringe. Think of those U100 marks as just guides for the insulin level and what they stand for in units as the actual dose. The actual unit dose is what you want to tell your vet.

 

[Kathy4Lewie]

I'm learning more as I study the syringe... I can't effortlessly figure out how much to draw into the u100 syringe, though. I created a spreadsheet to break the doses down even further and it's helping me understand the "fat" dosages.
I've been having trouble trying to figure out how to microdose even smaller than the u100 provides... On Oct 6th and 7th, I gave a fat 0.6.
When I backed it off to a normal 0.6, he goes in the pinks. Tonight at +9 he is already at 308. He does fluctuate and may be lower before +12.
Tonight I'll lean more towards the fat 0.6

 

[JL and Chip]

Tonight at +9 he is already at 308

Has anything changed today? That's a pretty big jump and a bit out of character for him. If you get a wonky or unusual result, it's a good idea to test again just in case you got a bad test strip or something.

 

[Kathy4Lewie]

Has anything changed today? That's a pretty big jump and a bit out of character for him. If you get a wonky or unusual result, it's a good idea to test again just in case you got a bad test strip or something.

I gave him his pills in the 1/3 pill pocket (duck and pea flavor) 2 hours and 10 minutes before the +9 test so those carbs may still be in his system.
Also, I was late giving his A.M. shot by 40 minutes.
Otherwise, a normal day.

 

[Kris & Teasel]

Do the best you can with the fractional doses but don't do too much manipulation. For now, try a regular 0.6 u and let him run with that unless he pops a lime green. Your goal is to find one reasonable dose that allows you to give the same dose AM and PM and that allows a decent mid cycle range. Don't agonize over every PS number and try to figure out a microdose that'll generate a particular nadir. Kitties will defeat you every time! Insulin is a hormone and its action doesn't permit that "x dose = y drop" thinking, particularly so in the early days and in a bouncy kitty with other health issues.

It can actually be counterproductive to tinker with doses every time you see the PS and think it's either too high or too low. It can increase the volatility of his responses, especially in a bouncy boy. The PS is affected by many things - whether he's bouncing or not, reacting to a dose change or not, lack of insulin duration in a particular cycle or not and on and on and on ... There's no way to predict that if you fatten or skinny a dose by a hair that it'll generate a particular drop by nadir. Insulin doesn't work that way nor does Lewie's body. The response WILL vary cycle to cycle and day to day.

Over many weeks and months on the path to better regulation you will likely find a dose range that gives decent numbers more consistently. That's when a bit of microdose tinkering *might* help you refine the dose. You're not at that point yet.

Here's what I recommend:

• select an easy to measure dose (on a U100) that seems reasonable for the low numbers it gives you and stick to it as long it's working. Right now 0.6 u *might* be that dose if you get mid cycle BGs in the low 100s.
• make no dose changes unless he drops into lime green
• ignore the high PSs and inflated mid cycle BGs associated with bouncing. Using those WILL lead to dosing mistakes.
• once you have a few days' data at that reasonable dose you can look over his pattern and decide whenther that dose needs adjustment. Ask for help here.

I see you creating a lot of extra stress for yourself in attempting these teeny tiny adjustments on the U100s and worrying whether a PS requires yet another adjustment. "Therein lies madness" as they say. So - take a deep breath and decide to give yourself a break. We're always here to help!

 

[Kathy4Lewie]

Kris & Teasel: Thank you so much for your educational/instructional post... this really helps me!

He is a bouncy boy and keeps me guessing. I'm taking a deep breath and will relax into this for the next several days to see how he does with the 0.6u dose.
With that said, I really, really need to move his shot time to 9:30am. That's the latest morning appointment time I can get with my vet... and I am tired of going to bed at midnight every night and trying to work for my job that has corporate standard hours.

Question: Should I stay at the 11:30am/11:30pm shot time for several days to get him regulated... and then after that start moving his schedule? Or can I move by 30 minutes starting today and not worry about what his numbers are unless his PS number under 200? I know with ProZinc I can technically move his time within an hour, but I've been unsuccessful moving his schedule in the past.

 

[Kris & Teasel]

Kris & Teasel: Thank you so much for your educational/instructional post... this really helps me!

He is a bouncy boy and keeps me guessing. I'm taking a deep breath and will relax into this for the next several days to see how he does with the 0.6u dose.
With that said, I really, really need to move his shot time to 9:30am. That's the latest morning appointment time I can get with my vet... and I am tired of going to bed at midnight every night and trying to work for my job that has corporate standard hours.

Question: Should I stay at the 11:30am/11:30pm shot time for several days to get him regulated... and then after that start moving his schedule? Or can I move by 30 minutes starting today and not worry about what his numbers are unless his PS number under 200? I know with ProZinc I can technically move his time within an hour, but I've been unsuccessful moving his schedule in the past.

You can begin moving his shot time now in whatever increments you prefer. I’m glad I was able to put your mind at ease a bit.

 

[Kathy4Lewie]

You can begin moving his shot time now in whatever increments you prefer. I’m glad I was able to put your mind at ease a bit.

Thank you! It will be nice not to worry for awhile. I'll start moving his schedule tonight. With his numbers being higher, fingers crossed, I will be successful!

 

[Kathy4Lewie]

First day of not worrying and I messed up. I got tied up in a meeting and then obsessively solved a work problem and forgot to give Lewie his shot. I'm 3 hours late. His BG is 363 at 2pm Central.
What do I do? Give it now at 2pm Central? or Wait till 5pm Central (3 hours) and then get up at 5am tomorrow? What are my options without hurting him and without making me get up in the middle of the night?

 

[Kris & Teasel]

First day of not worrying and I messed up. I got tied up in a meeting and then obsessively solved a work problem and forgot to give Lewie his shot. I'm 3 hours late. His BG is 363 at 2pm Central.
What do I do? Give it now at 2pm Central? or Wait till 5pm Central (3 hours) and then get up at 5am tomorrow? What are my options without hurting him and without making me get up in the middle of the night?

The easiest thing to do is skip this shot and give his dose tomorrow AM at the time you wanted to shift to. Missing one shot won’t be a big problem and you’ll have dealt with the time change you wanted to make. As we often say here, think of it as a fur shot.

 

[Djamila]

I agree with Kris. Just count it as a fur shot and you can both take the cycle off. Then you can start anew with your preferred schedule and move forward from there.

 

[Kathy4Lewie]

Excellent. We were at 11:30am/11:30pm so I'll give him his shot earlier tonight to get back to normal.
Thanks!!!

 

[JL and Chip]

I might be misunderstanding ... but I think you're only 3 hours late for today's AM shot. Rather than skipping all of today, I think I would shoot now (3 or 4 pm CT your time if I have my time zones correct), then shoot again first thing tomorrow morning (5 to 7AM CT or so, depending on when you get up). That way Lewie is getting some insulin today but you're stretching the cycles to be a little longer (13-15 hrs each). After that you can then push each cycle a little longer (12.5-13 hrs) to get to your preferred shot time of 9:30 am CT.

 

[Kathy4Lewie]

I might be misunderstanding ... but I think you're only 3 hours late for today's AM shot. Rather than skipping all of today, I think I would shoot now (3 or 4 pm CT your time if I have my time zones correct), then shoot again first thing tomorrow morning (5 to 7AM CT or so, depending on when you get up). That way Lewie is getting some insulin today but you're stretching the cycles to be a little longer (13-15 hrs each). After that you can then push each cycle a little longer (12.5-13 hrs) to get to your preferred shot time of 9:30 am CT.

Thank you! I was able to give Lewie his shot at 4:50pm Central... his BG was 470. I'll go to bed early and get up early. I'm looking forward to the going to bed early part!