New here, question regarding syringes and dosage

Hi everyone, my name is Michelle. My cat (Nao, 10 years old) got diagnosed with diabetes approximately 2 weeks ago.

We started insulin right away. He's on Novolin N but I'm thinking of switching to Lantus since I found this site.

My question is in regard to syringes. Novolin N is U-100 and the syringes I'm using are U-100 as well.
According to my vet's calculations, I think he is receiving 1.25 units of insulin, but everywhere I read online the conversions seem to be very different, and I'm really confused.

Here are some pictures of the syringe


This is what my vet says 1 unit looks like

 

Hello and welcome.

That looks like 6 units, best not to start with that! Actually, you do want different syringes. You want u-100 3/10cc syringes with half unit markings if you can find them. I see you are in Venezuela. Try human pharmacies, maybe the ones that they use for infants. It might be the BD Microfine or Ultrafine brand you can find there. The BD's are fairly common world wide. Here is a picture of what the scales look like on a couple different styles:

 

Can you upload a photo of the box?
Tagging @Veronica & Babu-chiri who may know where you can purchase syringes.

 

Hi I just did a search and found a member comes from Mexico ,she didn't say where she bought them but did say she used these , maybe call some pharmacy's and ask them if they have these in case @Veronica & Babu-chiri doesn't see the tag.
BD Ultrafine II syringes (purple and yellow box). Those are U100 syringes.

 

Hi everyone. So after a long discussion with my vet and after she got more information about feline diabetes and consulted with other vets outside latam, particularly in USA; we found that we were giving my cat 7 units of insulin. Horrible, I know. No wonder he is bouncing so much.

I'll switch to Lantus on wednesday, hopefully. In the meantime, an endocrinologist specialized in cats and dogs there in the USA, recommended that I don't shoot him any insulin until wednesday when I start Lantus. This is because Nao is being dropping to really low numbers in Nadir, all below 60, but he hasn't shown any symptoms of hypoglycemia save hunger. His numbers before I normally shoot are always high, because of the bouncing.

Should I follow that advise? It scares me to not give him any insulin, I was thinking I could give him at least 1 unit.
I don't have those syringes you guys are posting, and unfortunately you can't find them here in Venezuela. I plan to order them on Amazon, however, but that will take a while to arrive. So I only have these syringes with whole units.

Can someone advise, please?

 

Oh my goodness. Thank goodness you reached out to find out if you were giving the right dose.!!

When the Lantus arrives, what syringes are you going to use?
Are you hometesting the BGs?
Are you able to buy Ketostix or dia-Ketostix where you live to test for ketones?

 

Hello! When Lantus arrives I'm still going to use the same syringes until the right ones arrive. Vet advised to start with 2 IU.
I am testing BGs every preshot and also on nadirs that are around +4 on Novolin. When Lantus arrives, I plan to test every 2 hours.
We don't have Ketostix here but I have other types of urine reagent strips that tests for a lot of things, among those are ketones. Every morning I test his urine with the strips, and today he got a urinalysis at the vet; consistently negative for ketones.

 

Excellent no ketones in urine…well done for testing.
As long as you are testing daily for ketones, and the tests are negative, it will be ok to not give any insulin u til Wednesday..
I would recommend you start with 1/2 unit or 1 unit Lantus ….no more. It takes at least 5 days for the depot to fill and the full effect of the dose to be felt.
Have you ordered the U100, 3/10, 30 or 31 gauge, 6 or 8 mm 1/2 unit insulin syringes yet?

 

Thanks for the advise! 1 unit of Lantus sounds good, I did think that 2 units was a little bit too high.
And yes, I've ordered them but shipping here is very troublesome and they will arrive in a month or so, unfortunately

 

It should be OK to measure 1 unit on the syringes you have but very difficult to measure less.
Before you give the 1 unit of lantus, please draw it up in the syringe and show us so we can see it is the correct amount.
Looking at the photos of the syringe you have posted above, one side looks as if it is 10, 20 30 etc and the other side is 0.1. 0.2 etc
Are they the same syringe?

 

Yes, they are the same syringes. One side is in Units, the other in ml. Every small line is 1 unit.

When I get on desktop I'll post how 1 unit looks in these syringes!

 

This is how 1 unit looks like

Is this correct?

 

Can you post a picture of the bag or box the syringes come in? I'd like to see how they are labelled. How many units does the syringe hold in total?

 

The syringe holds 100 units in total. This is what the package looks like:


And this is a better picture of the whole syringe side to side. Right side is in units and left side is in ml

 

Thanks for the pics - the units are clear on that new picture. When you draw 1 unit, it will be important to be consistent where you draw the plunger in relation to the units line. It's much easier to do with the smaller syringes (30 units instead of 100) and 1/2 unit markings. Until you get them, keep track of whether the bottom of the plunger is on the bottom, top, or middle of the 1 unit line. We find Lantus does best when the doses are consistent, as much as you can. You might want to have a sample syringe with coloured liquid in it, to show you exactly where to put the plunger. Then you could keep that or take a picture of it for reference when loading the syringe.

I am surprised you can't get smaller unit insulin syringes. Human insulin doses can be a lot smaller than 100 units. Did you ask at local pharmacies?

 

The sample syringe with coloured liquid in it sounds very helpful, I'll try that!
Plunger should be at the bottom of the 1 unit line, correct? My mom helps me with this, actually, since she has more experience given the fact she is a retired nurse, and also my grandma's caretaker who was also diabetic.

I did ask at local pharmacies but they only have the ones I'm already using. Finding anything here is very difficult, definitely not a first world country.

 

Hi everyone! I'm very new here and I don't know if everytime I have a doubt I should make a different post or if it's fine to do it here?
I have some doubts regarding BG curves. Like, should I take into consideration the times I feed my cat? For example, I give a snack at +4, can I test immediately after? Or should I wait 2 hours so it's not flood influenced? Cause that's what I did today when performing a curve. I think Nao's nadir is around +4 or +5, will try a mini curve again tomorrow!

Also, my vet told me that she wanted Nao's BG values of today to determine if I should give insulin in the PM cycle. I have never heard of Lantus given just once a day. It's that a thing?
He was previously receiving 2 shots of Novolin N in a 12/12 schedule before, so it surprised me that she said that...

 

It is your choice if you want to continue on this thread or start a new one. We just ask that before you get to 50 posts, you start a new one so it's not so intimidating to read through it all. One suggestion for you, it'll help us if you put a blank line in the spreadsheet after yesterday, and label it "start Lantus" so we can easily see where you made the change.

OK, to answer your questions.

Once a day Lantus is what humans do. Cats have faster metabolisms so twice a day dosing for them. What the vet might be concerned about is if the blood sugar value is too low to consider giving insulin. For new people, on this forum, we suggest not shooting if under 200 (11.1). With data and experience, that number can be lowered.

Yes, you can test right after giving snacks in the middle of the cycle. When people are new, we suggest not feeding for two hours before the preshot test, so the number is not influenced by the carbs in food, and you know the number is higher enough on it's own (without carb influence) and safe to give insuiln. Feed and test as you normally would between the shots. A snack around +3 or +4 is fine. It'll take 5-7 days for the Lantus depot to build, and numbers should get better over than time period. And nadir times may change as a result.

I like what I see so far on Lantus. One suggestion, you should try getting a test after the PM shot if you can. If you can get a before bed test if it's a least 2-3 hours after the shot, that'll be very helpful. Many cats go lower at night. We decide how to change the dose on Lantus based on how that dose takes the cat, hence the interest in possible lower numbers at night. That +2 or +3 at night will tell us a lot about what the Lantus is doing in the overnight hours.

 

You can continue to use this thread until it gets to about 50 posts, then start a new one. You may want to change the subject line to reflect the issue though.
When you do a curve you don't need to worry about when you feed Nao. The only time to withhold food is when you are getting the preshot BG and then you don't feed for the 2 previous hours so the preshot is not food influenced. So you can feed and test anytime during the curve

Lantus dosing in cats is twice a day. Unless the BG falls under 90 you need to stay with the 1 unit for 7 days so the depot can fill.
Missing doses, or chopping and changing the dose will mess with the depot and you will get wonky numbers. Maybe the vet is unfamiliar with Lantus dosing
LANTUS DEPOT

 

Thank you so much, this has been really helpful! I will add the label in the spreadsheet, and I'll do a test after the PM shot tonight. I think I can manage a +2

 

Thanks for the clarification!
And yes, my vet is very unfamiliar with Lantus dosing. I don't think she knows much about feline diabetes either. I've been thinking of switching vets, actually, but she has been Nao's vet since I adopted him, so it's a tough decision

 

Hi sorry for the delay, I hope you can get the proper syringes for Lantus soon it will be much easier to dose, I'm not sure where to buy them in Venezuela here in Mexico they are easily avaible in pharmacies and even in supermarkets here's a photo of the ones I usually buy hope it helps

 

Hi guys! I found the BD Ultra-fine syringes in Colombia, which is really close to my city. A friend will send the syringes over and they should arrive faster than the ones from Amazon.
I wanted to check with you guys first, though. Are these the right ones?

 

Looks like the right ones to me.

 

Yes they look like the right ones, glad you could find them

 

Hi everyone!
It's been 7 days with 1 unit of Lantus. I'm guessing I need to adjust the dose, probably 1.25.
The BD syringes hasn't arrived yet, I'll have them in 2 weeks, approximately. I feel more comfortable adjusting the dose using those syringes than the ones I currently have. Would it be a problem if I stay with the same dose (1 unit) until the BD syringes arrive?

 

Looking at his SS yes I do think he needs a raise in his dose and yes raising it in 0.25 units to 1.25 units is the way to go, it is not ideal to wait too much for the adjustment but I do understand that with the syringes you have could be a bit tricky so maybe you could wait but you will have to monitor him closely and monitor him for ketones since he's a bit on the high side.

You could wait till you have the good ones or maybe i think you could measure the right dose once in a syringe you won't be using and mark it or fill it with colored water so that you can use it as a pattern and you can compare against it when you are measuring insulin that could help getting the right dose

 

The problem is that the space between the marks is too small I could try to draw a 1.25 in these syringes but I wouldn't have a way of knowing if it's the right dose, too little or even too much.

If someone that has drawn 0.25 in syringes with whole units could show me how it looks like, I could do it. But I suppose everyone here uses the half unit syringes because that's much easier

 

most everyone, yes -- but some don't have them and have had to just eyeball it. It is challenging, but I would suggest maybe a pair of magnifying glasses like reading glasses and maybe a hand-held magnifying glass and just do your best.

 

Okay I do have a magnifying glass, I could try!
When I draw the dose (maybe with some colored liquid first in a syringe I won't use), could I show you guys a picture to see if it looks right?

 

great idea and other people have done that in the past, go for it!

 

This photo uses a half unit syringe.

 

Okay after several attempts, I think this is what 1.25 look like:


I drew a little bit more at first but then that looked like 1.5 when I took a picture and zoomed it, so I'm guessing this is the correct dose.
It's just a teeny tiny bit more after the 1 unit mark.
Does this make sense to anyone?

 

It looks close enough. Is this your syringe to compare against?

 

Yes, I put some colored liquid in it

 

It really makes no difference if it is 1.2 or 1.25, What you want is a consistent dose day after dayIf yoy are really drawing uo 1.2 and it works great. If you need to increase then increase.

 

I see, that makes total sense. Thank you!

 

nice job! Looks fairly close.

 

Looks good probably close enough and with it as a guide you can be consistent every day, which as they mentioned before is what matters a more o less close enough dose to what you need and to give it the same every time

 

Hi everyone. I've held the 1.25 dose for 7 days and today I'm doing some more tests just in case but I'm sure Nao gets an increase.
I'll receive the BD syringes today (finally!) some hopefully that will make it a little bit easier with the half unit markings.

I've noticed that his numbers doesn't seem to improve with the 1.25 increase, though. I've been as consistent as I can with the dose, but perhaps I'm doing something wrong? I don't know.
I'm not gonna lie, I feel like such a failure of a mom right now

 

I'm not the right person to weigh on in dosage as I'm very new to this, you're not a failure. You're doing the best that you can to manage a very complicated situation. Don't beat yourself up; it doesn't help.

 

Sorry, I know it doesn't help, I just needed to vent ): And thank you for your kind words, it means a lot!

 

You are good to increase to 1.5 units now.

It's not you, it's the cat. Nao's body has gotten used to higher numbers and wants to stay there. You just have to keep increasing the insulin, testing as you are to make sure it's safe to do so, and you will get to that dose that gets him into better numbers.

 

That makes sense. I thought about it as well but I also got plagued with doubts about me being inconsistent or something. Ugh, it's so frustrating.
But yeah, I'll increase, and I'll keep trying. Thank you for answering!

 

I'm just popping in without advice to say: managing a pet with diabetes is stressful. My cat was just recently diagnosed as well and the process can be overwhelming and make you feel uncertain or like you are not doing enough. But you are doing the absolute best you can, you aren't failing. Over time we'll know more, we'll be more comfortable with all the processes involved and we'll feel more settled, I'm sure. And for now, we can treat ourselves with a little extra care and kindness.

 

You are right, it is stressful and can be so overwhelming. But it helps, at least to me, coming here and reading about other people dealing with the same things I deal with, and overall reading everyone's encouraging words.
So thank you for that, really. I appreciate it a lot!