Think I need to increase insulin dose? Advice needed

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phlika29

phlika29

Member Since 2014
Hello everyone.

First of thankyou to all those who have helped me over the last week. I would also like to thank anyone who has ever contributed to the forum, I have found much help and support reading other threads.

Remi has been on caninsulin just over a week. Following some very sharp drops and low readings on the initial 1 unit dose on advice from forum members and the vets I reduced the dose first of to 0.6 and then increased back to 0.8. During this time remi has transitioned fully onto wet food and his steroid has reduced from 1.25 mg eod to 0.5 mg eod with a view to weaning him off completely by the middle of next week.

I have been following the start slow stay low (or is that the other way around!) but as the days have past Remi doesn't seem to have such deep drops on the dose he is on. Is this common? Does this mean if I increased him back up to one unit he wouldn't necessarily get those scary low numbers as before? My vet feels the dose should be put up 1.2 units but that feels like a big jump for me. I would love to know what others think. I was abit disappointed with the marginal + 2 drop tonight but then his preshot BG level was lower so maybe the curves get softer? Will do a +4 in half and hour.

I think I can see a pattern with his BG on the day after his steroid dose. It looks higher to me.

Also can someone link to the instructions of filling the syringe with insulin. I can't find the instructions I read before and I keep getting tiny air bubbles in the syringe. Does anyone have any tips.

Many thanks

Sarah
 
Hi Sarah,

I cannot comment on the dosage as the 2 kitties I have are on Lantus.

As far as the air bubbles, occasionally I get air in and I just squeeze it all back into the vial and start again slowly drawing it up and waiting for the syringe to fill. The .5 u that I give is so small I always get about 5 units and then push back the overfill into the vial till I am at .5. This usually expels any air. I am holding the syringe vertically at this point so the bubble will be at the top near the needle.

If I get a stubborn bubble I will draw more insulin so that I can see what I am doing and then with my finger flick the body of the syringe to get all the air to the top, then I push the plunger (again holding the needle vertically as if I was going to shoot the ceiling) and the air bubble and some insulin will shoot off. You know, like you see if the movie. Well they do it like that in real life for the same reason, to get the air out.

They take more of the solution than they need and then holding the syringe straight up, they squirt it out till it is only solution and no air.

Does that make sense?

Ask more questions if it is not clear.
 
Thankyou for advice and the link. Yes it was the sugarpet one that I had read but couldn't remember how to find it again :-D I reread it and I still can't seem to get rid of a tiny bubble that forms on the plunger. It is so annoying no matter what I seem to do the bubble remains resolutely attached to it.

I put the syringe in (by this point I have usually pressed the plunger right up to the needle end but have tried it with air in). Turned the vial over and then tapped it with my finger. I then draw up past the amount I need and then tap it. But the air bubble is right on the base of the plunger and it won't budge. So I push the insulin back in the vial and repeat but the bubble just reappears in the same place. One time I dislodged it but it just stuck to the side of the syringe and wouldn't go to the top so I pushed the insulin back into the vial and then it just reappeared when I tried it again. Argghhhhh :oops:

Next time I am going to turn the vial upside down more slowly as I wonder if there is some air trapped in the lid area.

I increased the dose to 1 unit this morning and will monitor during the day. Fingers crossed the BG goes lower but not too low.
 
Hello Again,

Persistent bubbles they are.

I might try to draw up a couple units, take the syringe out of the vial and just squirt the insulin into the sink pushing quickly on the plunger to possibly expel the air in the stream. This is the only different thing I can think of doing.

When you insert the needle into the vial, Are you holding it vertically? Needle pointing up, vial top pointing down? That is just the way I do it, was taught to do it and watched on TV the MD's doing it..

I think that way, so long as you have not touched the plunger after twisting off the plunger cover, you would be inserting the needle directly into liquid and the slowly draw up the insulin.

When you have a bubble, can you hold the syringe up and flick it with your finger. Like you were hitting the back of someone's ear. That usually does it.

When you take the insulin out of the fridge you are supposed to just gently roll it in your hand or as I do, I just gently tip it end to end 10 times very slowly.

Better luck with the bubbles next time!
 
Hi

Thanks again for your suggestions.

I think I do it as you are describing but will endeavour to get it perfectly right next time. I am a little worried as I have been pushing the caninsulin back into the vial between one and three times in order to try to expel the air bubble. I hope that's okay for this insulin as I watched the video on lantus and you obviously aren't mean to do it for that insulin. Next time I will expel into the sink.

At first I didn't insert the needle whilst vertical but definitely do it that way now. I read on the descriptions about pulling back the plunger, before inserting the syringe, to the dose you are going to draw up in order to keep the pressure even. But then later read somewhere that injecting air into the vial wasn't such a good idea. Is there a general consensus on whether to do that or not?

The 1 unit dose has managed to get remi into the blue zone at +4. The drop seems quite hard but I am goings to be pleased with this unless anyone looks at remi's spreadsheet and tells me otherwise :lol:
 
Hi Sarah,

I also read to pull back the plunger to the dose, insert squeeze out and then pull back again when in the liquid.

I do not do that any longer because of the air.

I think if you insert the syringe into the liquid while holding it upright and then pull back when its in the liquid it might do the trick.

I am not familiar with the action curve on canninsulin. It does appear that the numbers dropped in relation to the increase but then again, remi could bounce, so just be ready for it.

Otherwise, you are in the middle of where you were and where the Vet said. Not a bad place to be. Once you get more numbers with the same dosage, it should tell you how well that dose is doing. Then if it is not getting remi down low enough, then you might want to increase to what the vet recommended . I would give it a few cycles so long as it does not go too low.
 
Hi thebudster

I am cursed by a bubble. I did everything we said and still a tiny little bubble stuck to the plunger :roll: . I expelled all air from the syringe, turned the vial upside down, stuck in the syringe and then pulled slowly back and there it was again. Anyway will keep trying and thankyou for all your suggestions.

I think your advice re the dose in very sensible. I will look out for a bounce (which is higher readings for a few days isn't it) and try not to panic. I don't think I will increase again until remi is off the steroids which should hopefully be this week. At the moment I am just aiming for the middle of the blue range at the nadir. I was quite surprised that this morning he appeared to be lowest at +6. I will recheck this period again tomorrow.
 
Keep trying, You will get the hang of it.

Since the shot is given under the skin and not into a vein, the risk of bubbles are not nearly what they could be.

Try a persistent flick against the syringe cylinder. That might dislodge it.
 
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