? Roxy 6/24 Increasing dose

[Roxy & Deb]

Hi guys. So been talking to my vet about the syringe issue and he said to just increase Roxy’s morning dose to two, and keep her at 1 at night as that will be the same as 1.5 twice a day which was his recommended starting dose (which I couldn’t do due to the pens the pharmacy gave me.) I did this yesterday and her number was 16 AMPS then no change +5 but 18 at PMPS, is that a bounce? Is this OK to do, am a bit anxious but he says he has cats on 3 or more units twice a day who are doing well; and that after a week we would probably need to go to 2 twice a day., I’m just a bit worried about a hypo event..?

 

[Katherine&Ruby]

Hi Deb,

Here is your last post for continuity: https://www.felinediabetes.com/FDMB...ed-by-australian-customs.248861/#post-2807149

Just so I understand, you're using a pen that can only administer 1 unit doses? Is there any way for you to get syringes, even 1 unit ones, so that you can try to eyeball smaller increments? Lots of vets suggest one unit increases and decreases, but that's often too much and I'd worry about hypoglycemia, so I would definitely test a lot more than you have been, like at +2, +4 and +6, especially during the AM cycle while you are giving 2 units and only 1 at night.

It's also not recommended on the FDMB to give two different doses of Lantus as it is a depot insulin and needs consistency in dosing. I'm going to tag @Sienne and Gabby (GA) and @Wendy&Neko on this because they can explain better why two different doses is not a good idea.

Bounces are when a cat goes from low numbers to high ones. I don't see bouncing on your SS, mostly flat numbers. Here is an explanation of bouncing.

 

[Roxy & Deb]

Thank you. It’s so hard and very stressful not knowing what to do. I can’t get the smaller increment syringes here and it’s such a minute amount I can’t see how I can possibly break down that tiny 1 unit dose?! Talking with my vet - who is very nice and helpful - he couldn’t see how that was possible either….my pens hold 300 doses - is that normal? I’ve only used like 40 something so far, the plunger is still only showing up to the 260 mark. Sorry feel so stupid as everyone is seemingly able to just do the syringe thing but I don’t understand how the amount is measurable when I look at the volume in the pen - is it more concentrated as it’s for humans? Should I go back to one unit until I can get syringes? Also re the “bounce” - I assumed as her BG went up not down with a higher dose of insulin so that meant her liver was dropping glucose?

 

[Roxy & Deb]

Also re the bounce - she’s been on one unit for almost a month so her depot is already full ?

 

[Katherine&Ruby]

Thank you. It’s so hard and very stressful not knowing what to do. I can’t get the smaller increment syringes here and it’s such a minute amount I can’t see how I can possibly break down that tiny 1 unit dose?! Talking with my vet - who is very nice and helpful - he couldn’t see how that was possible either….my pens hold 300 doses - is that normal? I’ve only used like 40 something so far, the plunger is still only showing up to the 260 mark. Sorry feel so stupid as everyone is seemingly able to just do the syringe thing but I don’t understand how the amount is measurable when I look at the volume in the pen - is it more concentrated as it’s for humans? Should I go back to one unit until I can get syringes? Also re the “bounce” - I assumed as her BG went up not down with a higher dose of insulin so that meant her liver was dropping glucose?

Also re the bounce - she’s been on one unit for almost a month so her depot is already full ?

It's clear that Roxy needs more insulin and that's why her BGs are high, but I'm concerned that adding a whole unit on top of that would be too much. My cat was on a drop of insulin for a while and it was keeping her regulated.

Here are photos to show you how smaller increments are measured on half unit syringes, just to give you an idea:

 

[Roxy & Deb]

How can you even tell the difference between those?! It seems so inaccurate. Is there such a thing as cat insulin that is more dilute that we can measure more accurately?

 

[Katherine&Ruby]

How can you even tell the difference between those?! It seems so inaccurate. Is there such a thing as cat insulin that is more dilute that we can measure more accurately?

I haven’t heard of a pet specific insulin outside of Vetsulin, and I’m not sure it’s more dilute. Lantus is best for controlling glucose levels in cats. Consistency in dosing rather than accuracy is what we are going for, and calipers as suggested to you before can help you with that. I also use magnifying glasses to help my old eyes see the syringe.

 

[Roxy & Deb]

Ok so I only gave her 1 unit this morning. I will talk to vet about sourcing some syringes that he uses - you’d think they’d have the best ones. Failing that I’ll get smallest I can from pharmacy. So if I’m understanding it correctly the pens are not accurate anyway in such tiny doses (I turned the dial and it goes up to 80!). Also I tried to click on a link in a post about the Solostar pen but got the 404 page not found error. I read something about priming the pen? But can’t find the details?

 

[Wendy&Neko]

We find that consistent dosing makes it easier to figure out how to change doses with our dosing methods. With the in and out insulins, it is common for vets to suggest a lower dose at night when kitty isn’t monitored as much. But doing that messes the depot, so it’s not something we do here.

Ask the chemist what syringes they’d recommend for children, the6 have smaller doses. Still not small enough or marked for use with cats though.

 

[Roxy & Deb]

Thanks Wendy can you explain why 2 different doses are not recommended, I need to talk to my vet and would like to be able explain

 

[Wendy&Neko]

Have you read this Sticky Note: What is the Insulin Depot? If you are changing doses all the time, the depot doesn't have time to stabilize. It's the nice stable depot that helps bring consistency cycle to cycle. For the dosing methods that we use here, we need a consistent depot, so we can see how low a particular dose takes the cat. It's those lows or nadirs, that tell us whether the dose needs increasing, decreasing, or to stay the same.

 

[Roxy & Deb]

Thanks Wendy yes I did read that but thought once the cat had been on insulin for a few weeks the depot would be full, and didn't realise it could get unstable again. Thank you.

 

[Nate2021]

Thanks Wendy yes I did read that but thought once the cat had been on insulin for a few weeks the depot would be full, and didn't realise it could get unstable again. Thank you.

If it's any help my cat took 6 cycles /3 full days to see what a dose change will do. If you check my SS you'll see pm on the 3rd of May I reduced, and then 6th May pm we could see it wasn't enough insulin. BUT it only seemed to take half the time (almost less than 3 cycles) the for the depot to fill again

 

[Roxy & Deb]

Thank you.
I have ordered an LED magnifying glass and have printed out the measurement sheet which Laura kindly shared. I am going to try and find the syringes today /tomorrow as my hubby and I will then try and start new method asap. I am also tempted by the counting drops method - isn't that something that can be standardised? i.e. if some people count the drops in 1 unit can't we all use that average as a starting point? So I could then draw up 2 units and expell the right no of drops from the syringe?
Thanks so much to all you wonderful helpful people, so grateful.

 

[Nate2021]

I think counting drops could be good, but could be hard to get consistent too. If you think you'll find once you've got roxy stabilised things will be much easier and you'll know if your doses are consistent. Someone might be able to tell me otherwise, but I find with my cat now he is mostly regulated that his pancreas kicks in enough to keep him in the same range as long as there isn't a big change in dose. Ie 0.1iu difference in dose he'll be fine with and stay stable, but 0.25 will have him go high. My guess with your numbers rn is that you'll go a bit higher before finding your right dose, so if you start now "close enough" to 1 will do and then go from there. Roxy is quite flat even though high numbers, hopefully that will be the trend in the blues and greens too. My cat required 3.5iu (I was more aggressive with dosing) to break the insulin resistance, and then 10 days of reductions to go back down to 1iu, and steady around that number in the months following.

 

[Wendy&Neko]

I am also tempted by the counting drops method - isn't that something that can be standardised? i.e. if some people count the drops in 1 unit can't we all use that average as a starting point?

People get different size drops out - so unfortunately cannot be standardized. And it does require some practise. Make sure you move the syringe up and down a few times so that the lubricant in the syringe is spread evenly and the plunger moves easier. Otherwise it could stick and make it hard to squeeze those drops out.

If hubby likes making things and knows of a wood working or metal working tool store, you should be able to pick up a pair of calipers quite easily. That's what i found to be the easiest and most consistent method - also helped when either one of us was drawing the dose to make it consistent.

And remember, ECID, each cat is different is very true. What worked for one cat may not work for you. My girl, even though she ended up on higher doses, was quite sensitive to small changes in dose. However, at this point in Roxy's diabetic journey, you don't need smaller changes than 0.25 units at a time.

 

[Roxy & Deb]

Thanks Wendy and Nate
So do you think I should start with 1.25 twice a day as the new dose once I get my syringes?

 

[Roxy & Deb]

Also just occurred to me that yo achieve consistency I could measure up the first dose and then before delivering it, mark up another syringe with a fine permanent marker to show the amount and do that each time so that the next dose is always same as one before?

 

[Wendy&Neko]

You can mark a syringe or load one with colour liquid to the new dose and compare to that. Either option works. I've also heard of people taking a picture with their phone camera.

So do you think I should start with 1.25 twice a day as the new dose once I get my syringes?

Can you do a curve before then?

 

[Roxy & Deb]

You can mark a syringe or load one with colour liquid to the new dose and compare to that. Either option works. I've also heard of people taking a picture with their phone camera.

Can you do a curve before then?

I’ll try however when I’ve done lots of tests there has been little variation, no curve discernible

 

[Wendy&Neko]

Don't worry about it then, you've been on 1.0 long enough to have some data to show Roxy needs an increase.