Turtle's numbers -discouraged

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Avery

Avery

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Hi,

I'm a bit discouraged by Turtle's numbers the last few days...I had her on .25u twice a day for about 8 days, and seeing numbers mostly in the 200s with a few 100s thrown in, I decided to up the dose. I've been doing .4u twice a day for 4 days now and I'm seeing higher numbers, in the upper 200s and 300s, creeping higher by the day.

Turtle's on the PZI insulin from VPA, and it was opened 11/3. So it's almost exactly a month old. Could it have gone bad already? From searching this board it seems like peoples' experience is that the PZI really should last quite a bit longer than a month.

Or, could the .4 be too high of a dose and she is having rebound? I had originally weaned her down to the .25 because she kept getting pre-shot numbers which were too low.

I am thinking of putting her back down to .25u twice a day. If she responds favorably, I'll know the insulin isn't bad. I have to admit, though, I frankly don't see that my .4 is much different than my .25! Some days I think I know what I'm doing when I'm measuring the dose, some days I think, "who are you kidding? There's no way to differentiate between .25 and .4 with such small doses!" I've even done the drop-measuring trick but honestly it seems like I get a different number of drops every time I try.

Another thing...I know not to jostle, shake, drop, or otherwise abuse the insulin. Yet when you're flicking the syringe to get air bubbles to the top (like I've recently started doing) does that not hurt the insulin? Probably a dumb question, but I gotta ask...!!!

Any thoughts? Does the .4 look like too much, or could the insulin have expired?

Thanks!
Avery & Turtle
 
Not sure, Avery. I wonder about trying a fat .25 That would be your putting more than .25 into the syringe and then squirting out until it is just a little more than the .25

I know the mini doses are very hard. Some people have found this info helpful: http://felinediabetes.com/FDMB/viewtopic.php?f=10&t=34424#p360982

Have we talked to you about changing where you shoot? Sometimes that makes a difference: http://www.bd.com/us/diabetes/page.aspx?cat=7001&id=7434

I wouldn't make both changes at once.
 
I suspect the .4u is too high; she was getting pretty good results on .25u.

Is your PZI U-40 or U-100? If it's U-40, what syringes are you using? You can use U-100 syringes with half-unit marks and the conversion chart here to make smaller doses easier.
 
Thanks Sue, you're absolutely right...I need to see the positive side of this! :)

I've just ordered the U-40 insulin from VPA since that's all they have in stock right now. They may not even get the U-100 back in stock and if they do they said they're going to have to double the price. I'm hoping that will make the dosing a little easier with the U-100 syringes. If I am reading the conversion chart correctly, to continue giving Turtle .4 units of insulin I would draw to the 1 unit mark on the U-100 syringe. If I want to give her .2 units, I would draw up to the .5 unit mark on the U-100 syringe.

Is this correct?

I've been injecting Turtle in all of the places shown in that slideshow except the scruff, so I think I'm OK with the injection location.

Thanks!
Avery
 
Yes, you are reading the chart correctly. I will be watching to see the responses to the PZI shortage. Haven't heard of that. Seems like the manufacturer would not want to lose the market. Lots of vets don't like prescribing human insulin; they like the profit of selling the ProZinc themselves and having it marketed as a pet insulin. And they seem to be more comfortable prescribing/dosing it. We have sure had a lot of new diabetics on it in the past month.....
 
Your numbers are correct for U-40 using U-100 needles. I don't think that .4u of U-40 is equivalent to .4u of U-100.
 
But when you post your numbers, Avery, post the amount of U40 insulin you are giving - not the converted number. So you are giving .4 units, not one unit. Makes a big difference in dosing advice. :mrgreen:
 
The math is this:

U-100 syringe mark * 0.40 = U-40 dose

if you have U-100 syringes with half units, you can measure 0.2 units at a time
ex U-100 mark of 0.5 * 0.4 = 0.2

if you have a U-100 syringe with whole units, you can measure 0.4 units at a time
ex U-100 mark of 1 * 0.4 = 0.4

A lookup table is going to be helpful in the ranges you think you'll be shooting; you don't have to trust your math to be sure you are dosing correctly.
 
wow, I go to work one day and miss all the fun!
Hey wait a minute, I'm supposed to be Mr. Bright-Side. But nice job, Sue for accentuating the positive!

On the PZI shortage. Don't know the specifics as to why it is running short. I do know that the original PZI, think it was called PZI Vet maybe? That was discontinued to the company using all of it's stockpile of cow pancreases.....
That's what they used to make it. I read that, and thought, "how can you run out of cow parts?" They still have beef in the supermarket, what happened to all the pancreas supply? Maybe someone decided they couldn't be used anymore? Made no sense to me. But VPA or BCP PZI, I think they are both compounded. I don't understand why you can get u40 and not u100, unless they decided it was more economical for them to make only one, and u40 was the easiest and cheapest to produce. It makes sense the u100 would cost more, it's 2.5 times as "strong".
It is easier when using u40 with u100 syringes to make all the adjustments in .2 increments though. Just because the math lines you up better with the hash marks on the syringe.
You are using the ones with half-unit hash marks, right?

Carl
 
Yes, fortunately I have half-unit markings on my syringes. I have been using the Relion syringes from Walmart, but ordered Monojects which just came in yesterday. I was surprised at the difference....the unit markings are much thinner on the Monojects, and the plunger head is thinner too. I find that it makes measuring the smaller doses much easier, plus the plunger moves more easily which is conducive to "twisting" it up to the correct dose. I am quite encouraged just by the change in syringes.

I bumped her back down to .25 last night, still waiting to see if there will be any effect. If nothing changes then I think I can assume that the insulin has expired. The new U-40 insulin should be arriving today.

The Pharmacist at VPA told me that the shortage applies to the U-40 as well...they're selling what they have at the old price, but after that they will run up against the same problem, which is they just can't find it. He kept mentioning "the government" being responsible, i.e. "the government has been trying to get it off the market." Some regulation which is keeping the PZI from being made?

Sigh...like the sugar dance wasn't already complicated enough without the *government* getting involved....!!!
:smile:
-Avery
 
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