Question regarding Likely Missed Dose

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JAAshwell

JAAshwell

Member Since 2015
Hi, I'm new and haven't even figured out what AMPS stands for, so please excuse. I'm slow sometimes. ;-)

My cat Emmy, age 12, weight 16, dx ~1 month ago, is on Lantus, 3 units 2x a day. We were using a pen and the needle tips but yesterday started using the vial and syringes.

Last night's shot at approx. 7:30 p.m. went fine; this morning after a struggle from the patient, I went to depress the plunger and noted that it didn't go anywhere. I did draw 3 units, I double-checked before I went on the hunt. So I think it is very likely that some time during the pursuit I accidentally triggered the shot. Which means Emmy didn't get a shot this morning. I am not home testing yet. I am going to call my vet to see what to do but would love your collective wisdom. Should I give the standard shot tonight?

Thanks,
Judy
 
Hi Judy

I was just reading your Introductory Post.

Welcome to FDMB. We encourage you to post on the Main Health page initially where they can teach you to home test and Create a Spreadsheet.

It's ok if you gave her what we call a "fur shot" and everyone does it at least once. The important thing is to not try and reshoot because sometimes the kitty gets in more than you realize.

Just shoot her regular dose at her regular time tonight but I would urge you to work on home testing today. She is likely to be higher tonight because of the missed dose but 2u seems high to me as a starting dose for a newly diagnosed cat and, if it is, she could be much lower than you think and it's possible even a skipped shot would not bring her up too much.

How much does she weigh and is she overweight?
 
Hi and welcome. AMPS stands for morning test before insulin and pmps is night test before insulin. We usually test 15 minutes before giving the shot, feed and then shoot the insulin. It's referred to as TFS. We all have given fur shots at times. Sometimes we think it might be a fur shot but they did get all or part of it. We don't want to overdose them so we never give a second shot. We just note it on our spreadsheet and wait for the next cycle 12 hours later to shoot again.

Did Emmy start insulin a month ago? If so that is a rather large amount to start with and I am a little concerned because you are not yet home testing. I didn't home test for the first month and then had to stop giving Max insulin for 3 weeks because he was low at the vet's office. Do you have a meter yet? Most of us use human meters because the test strips are so much cheaper. I use the Relion Micro which I bought on line from Walmart. It uses a small amount of blood. I don't live near a Walmart which is the only down side to it so I order my test strips on line often on ebay. I can also use the Arkray test strips that I buy from ADW on line too.

How long has it been since the last vet visit to check the BG?
 
Hi Marje and Gracie and tiffmaxee,

Emmy is 16 and has lost 4 lbs in the last six months so she was at 20 so yes, definitely overweight. She's actually on 3 units not 2 and everyone on the Board has said that is high but her BG has remained high. Her last test was Saturday and was 366 at 5 hours after the shot. I do have a meter, the AlphaTrak and I postively will start tonight although I may need three armed guards to hold her down.

I will just give her the regular shot this evening. And from now on ask my questions in the Main Health page. I'm learning!

Thanks
Judy
 
It's ok that you posted here, Judy, to ask your question.

So what do you think her ideal weight is? The starting dose is typically .25u/kg of ideal weight unless the kitty is underweight. That formula is for using the tight regulation protocol but I know it is the same formula often used by vets for a starting dose whether they use the TR protocol or not. If her ideal weight is 16 lbs, for example, we would have recommended s starting dose of about 1.75u.

It's not possible to know what a dose is doing from a test here and there. Cats' livers have a safety mechanism in place. If the body has gotten accustomed to higher numbers and then you start insulin and the numbers come down either fast or lower (not even necessarily low), the liver reacts by dumping counterregulatory hormones and glucagon into the blood bringing the BG way up to what it considers safe. If you test at that point, you would think she's just high and want to increase the dose. Likewise, if your vet was to do a curve in the office on that specific day, she might think Emmy (who is quite adorable) needs more insulin.

We've seen csts go from 400 to 40 and back to 400 in one 12-hour cycle. If the caregiver had not caught the 40, the impression would be that the dose needs to go up. That is why home testing is so important as well as very minor increases when needed. We typically only increase by 0.25u at a time unless the kitty is high and flat and then we would increase by 0.5u. To raise the dose by 1u at a time puts the kitty at risk for overdose ...unless the kitty is one of our rewlly high dose kitties but that is a separate issue not pertinent to Emmy at this time.

The dry food further complicates the issue of numbers but you can't just stop the dry at that high of a dose.

I think the two priorities are getting up a spreadsheet so we can see what is going on once you start testing and then getting the testing going. You can put any numbers you have...even from the vet...on the SS. Mmif you need help with creating it, please let me know. I can have one up in no time for Emmy.
 
Thank you Marje - I will give the spreadsheet a start at my lunch hour. How would I see 1.75u on a syringe? I am using U-100s, 30u max (this is new to me , so bear with my descriptions - thanks). I can barely see 2u I can't imagine being able to eyeball .25u changes? Do I have the wrong syringes too? Thanks
 
I see you're already getting a lot of great info!

One thing that will help get Emmy used to testing is treats, treats, and more treats! Give her a treat at every test, even if you don't successfully get a reading. She will quickly learn that testing = treats and are therefore a special time!

Most of us here use syringes with half-unit markings - that makes it much easier to eyeball those quarter unit doses. Some people also use calipers to help with consistently drawing the same dose. Magnifiers can also be very helpful.

Welcome aboard!!!
 
If you have U100, 0.3cc syringes then you are using the correct ones. They then vary by gauge and by needle length. Most of us use the 31g which is the smallest needle size so the kitty doesn't feel much prick from the shot. Some people prefer the longer needles, some shorter.

One thing that will help you is if you have the syringes marked in half units. What syringe brand are you using? Many of the brands such as Relion (from Walmart), BD, Monojects, and even the ones from Walgreens can be obtained in 0.5u markings.

Here's the other thing...I'm not advocating that you drop her dose. I would not change her dose at this time until we can see what she's doing. So don't worry about shooting a 1.75u dose right now. I did read that you started out with pens and the pen needles. Pen needles are designed for humans and don't typically give an accurate dose to a cat because you can only adjust by certain increments. Most of us use pens but just draw from them with a syringe as you would a vial. It's more cost efficient for most of us that way. But now that you have a vial, it's absolutely fine and most of us started out the same way.
 
Welcome Judy and Emma to L&L,

It is a lot to learn at first, but we have all been there. I find that my camping headlamp is a great help in drawing the dose. You always have good light and hands are free for the syringe and the insulin.

Ella & Rusty

p.s. Please be sure to put Alpha Trak in your subject heading and, ideally, in your signature. Readings on the AT are generally 20 to 30 points higher than what you will get on a typical human meter (such as the Walmart Relion).
 
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Hi Judy

I am really pleased that you have posted here. These kind and lovely people helped me get my cat remi regulated (and actually off insulin). You will be in no better hands.
 
Ella & Rusty & Stu(GA) said:
Welcome Judy and Emma to L&L,

It is a lot to learn at first, but we have all been there. I find that my camping headlamp is a great help in drawing the dose. You always have good light and hands are free for the syringe and the insulin.


Ella & Rusty

p.s. Please be sure to put Alpha Trak in your subject heading and, ideally, in your signature. Readings on the AT are generally 20 to 30 points higher than what you will get on a typical human meter (such as the Walmart Relion).
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Thank you Ella & Rusty - I will add the Alpha Trak
 
To let everyone know: 1) I sucked it up and did a successful BG test tonight (pre shot)! I am using an Alpha Trak. It was 423 and that is, of course, missing the morning shot. I will do another later tonight after she has her shot at 7:30 ET.

I went to the vet and had them show me again, and watched some YT videos and listened to your good advice. I definitely see why testing is so important. My vet is really supportive of this -- in fact was delighted I wanted to do it. I told her I had "specialists." ;-)

Thanks!
 
Wonderful news all-around! Home testing is probably best single thing you can do for Emmy! And testing does get easier...but you're off to great start, and it is awesome that your vet is supportive to boot!!
 
I mentioned it in your other thread but will just quickly repeat here. You would normally get a test just before you give your insulin shot and the ideally get another during the cycle. I am not sure if it is as important to get the preshot test tonight as you missed the morning shot. Maybe it will help with the overall date gathering. I don't know. Hopefully others will advise.
 
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Great job on the SS!!!! Yes...the PS is best and if you get a before bed test tonight, that would be super!!!
 
Yeah Judy!!

Welcome to the Vampire Club!!
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Just to help you out on your spreadsheet:

AMPS is the AM Pre-Shot (test you get immediately before shooting in the morning)
PMPS is the PM Pre-Shot

The "U" column is for Units....if you skip a shot you can put NS (no shot)...if you give a Furshot, NEVER repeat the shot..always assume 100% of it went in, but make a note of it in your "Remarks"

The + signs at the top relate to how many hours it's been since you shot....so if you shoot at 6pm, and 2 hours later get a test in, the test result would go in the +2 column on the PM side....Shoot at 6am and get a test at noon? That would go at +6 on the AM side since it's been 6 hours since the last shot

How else can we help you?
 
:) Well done on the testing. Purrdy hasn't been doing it long but he now goes running to his testing spot when he hears the phone alarm go - ahhh the power of treats...
 
purrdydolly said:
:) Well done on the testing. Purrdy hasn't been doing it long but he now goes running to his testing spot when he hears the phone alarm go - ahhh the power of treats...
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I'm jealous. Max has me drag him out from under the bed unless he is starving because he is dropping.
 
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Don't forget to post up the numbers on the forum. I see you are adding them to your spread sheet which is great.

With regards the syringe /plunger issue the liquid amount you are giving is small and I sometimes felt the plunger wasn't going anywhere. Just to make sure you aren't pressing it before you want to can you hold it so your thumb (or whatever finger you use) is no where near the plunger until you actually want it to be.
 
Greetings,

Last night's shot was also a failure, again, syringe depressed when I went to shoot. This morning I experimented and watched the syringe carefully. Normally I draw, corner cat, shoot. Not more than 5-10 mins (well, sometimes I have to chase her). The plunger on the syringe moved down by itself and expressed the insulin in the syringe! So I'm not crazy that the syringe was empty when I shot. I drew a new syringe with Emmy in my arms and shot that one. And I'm positive it went because I tested and her BG was down (not great, but 381 @ +2). Apparently the small dose in the syringe is not sufficient to exert pressure back on the plunger or something. I have learned that I can't draw until I am absolutely ready to shoot. (remember, I didn't go to syringes until Monday)

Working from home today (bad weather) and I will try to test every two hours until this evening. Fingers crossed. Thanks again. I will shut up and move any further discussion to the main forum.

Judy and Emmy Lou Who
 
Well done w/ the shot today!
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Interesting on the syringe, what brand are you using? I always draw the dose, put the cap back on and hold the cap in my teeth while I pick up tess and her fuds.. when I get her settled w/ fuds in front of her, I pull the syringe from the cap touching only the barrel and insert it still just holding o to the barrel. I don't go any where near the plunger until it is already inserted. Tess gets less than half a unit and i can never feel the plunger move!
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I wonder if it could be the way you draw the dose? We usually draw up more insulin than needed, and then after removing the needle from the vial "dial in" the dose, by gently twisting the plunger. It is easier to expel just a little that way. If you are pushing any excess out, it could be that there is more tension left on the plunger if you adjust the dose by pushing.

You are certainly welcome to stay on this forum! You've got a SS up and are testing. We'd like to see a few more tests though, especially the preshot. the usual format here is to put up a new post every day, w/ the date, cat's name and preshot number in the subject. Then we edit the subject during the day w/ further tests. You can add a question for quicker attention. Daily post keep things from getting too long. We put in a link to the previous post so members can go back to catch up for more info.
 
Ann & Tess said:
I wonder if it could be the way you draw the dose? We usually draw up more insulin than needed, and then after removing the needle from the vial "dial in" the dose, by gently twisting the plunger. It is easier to expel just a little that way. If you are pushing any excess out, it could be that there is more tension left on the plunger if you adjust the dose by pushing.

You are certainly welcome to stay on this forum! You've got a SS up and are testing. We'd like to see a few more tests though, especially the preshot. the usual format here is to put up a new post every day, w/ the date, cat's name and preshot number in the subject. Then we edit the subject during the day w/ further tests. You can add a question for quicker attention. Daily post keep things from getting too long. We put in a link to the previous post so members can go back to catch up for more info.
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Thank you Ann & Tess - I needed that instruction for the daily post. You are exactly right about how I draw the dose. I usually pull up 5 and then expel back down to 3. I am using SureComfort Insulin Syringes, 31 gauge, 3/10cc. I'll try drawing to 3 and see if that effects it. Your description of holding the cap in your teeth describes mine to a T. There will be two pre-shots on the SS today. I hope the Halo Liv-A-Littles get here soon. Thank you!
 
If you have a PetsMart near you, got to the dog treat aisle. They have freeze dried treats in larger packages for a lot less $$$. You will need to cut or break them up, just be sure to get the ones that are a single protein.
 
I used the BD micro 0.3 Demi U100 syringes and found them to be good. They didn't expel themselves on their own.

http://www.vetuk.co.uk/veterinary-s...l-insulin-syringes-u100-demi-box-of-100-p-296

With regards doing the curve every two hours. If you think that the last two injections have been duds then the lantus depot that builds up in a cat over a few days of injections will have been drained and therefore the results you see today may not be the true reflection of what that dose would normally do to her blood glucose levels if the lantus was fully built up in her system. Does that make sense?
 
phlika29 said:
I used the BD micro 0.3 Demi U100 syringes and found them to be good. They didn't expel themselves on their own.

http://www.vetuk.co.uk/veterinary-s...l-insulin-syringes-u100-demi-box-of-100-p-296

With regards doing the curve every two hours. If you think that the last two injections have been duds then the lantus depot that builds up in a cat over a few days of injections will have been drained and therefore the results you see today may not be the true reflection of what that dose would normally do to her blood glucose levels if the lantus was fully built up in her system. Does that make sense?
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Perfect sense. I was looking at the tests as "training" for both of us. Now I can get a good week going and I will test sporadically so I don't lose my nerve. I've already decided not to poke her again until PMPS. Thanks for the link!
 
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