ultra micro dose help needed urgently

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laur+danny+horde

laur+danny+horde

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Need help with ultra micro dosing for Danny! The thickness of the zero line is a huge dose difference for him. A levemir dose that is even with top of the zero line (closest to needle end) is not enough but going the tiny amount more to the middle of the zero line bounces him from 400s to 120s (fed him low carb) to 500's.

Desperate because he just keeps losing weight. Am providing subq fluids to keep him hydrated. He's still eating well -- very hungry, but I have cypro if that changes. Senior bloodwork panel including T4/free T4 was normal except for BG. He's been to vet 3 times and they can't find anything else wrong. Had dental just a few months ago. No spreadsheet, unfortunately.

Is dilution of insulin impossible? Any other ideas???

Thanks,
laur
 
Laur - do a search on micro-dosing. When I first thought we were headed in that direction, I found some posts w/ graphics and instructions on how to do basically just a drop. There was a suggestion about how to practise getting the right size bubble - and suck it up into the needle w/o filling the barrel. Worth a good look!

Also, if you're on a U40 insulin, like ProZinc, you can change to a U100 needle that has half-unit markings. WIth the conversion chart, you can calculate down to .2 units, and even eyeball .1. This is considered "mini-dosing".

Lu-Ann
 
laur+danny+horde said:
Need help with ultra micro dosing for Danny! The thickness of the zero line is a huge dose difference for him. A levemir dose that is even with top of the zero line (closest to needle end) is not enough but going the tiny amount more to the middle of the zero line bounces him from 400s to 120s (fed him low carb) to 500's.

Desperate because he just keeps losing weight. Am providing subq fluids to keep him hydrated. He's still eating well -- very hungry, but I have cypro if that changes. Senior bloodwork panel including T4/free T4 was normal except for BG. He's been to vet 3 times and they can't find anything else wrong. Had dental just a few months ago. No spreadsheet, unfortunately.

Is dilution of insulin impossible? Any other ideas???

Thanks,
laur
Click to expand...

Hi Laur. Nice to see you again, but sorry you are having these problems with your Danny. :(

Lu Ann is right. There is a great write up on the Lev forum and pictures that Sheila (Beau) has posted here:

http://www.felinediabetes.com/FDMB/viewtopic.php?f=10&t=34424

Those huge swings though are troublesome. I don't always think that this is rebound (usually it is), but sometimes there is something else that may be going on. But you have already done the bloodwork and dental and thyroid tests. I can just imagine your frustration, because I know you know what your are doing here with Danny in trying to figure everything out.

What are you feeding him?

If you withhold insulin for a little bit, does he bring himself down somewhat after he eats (at shot time)?

As far as dilution, no it hasn't been done so far with Lev here on this board as far as I know (and of course not with Lantus at all). Dr. Bernstein in his book claims it can be done with Levimer, but then he kind of backs away from it in another interview that I read. We do discuss it briefly in this thread on FDMB a while back:

http://felinediabetes.com/FDMB/view...p=381668&sid=946e76e03b206eed27ccdcbc679fdc5d

Please keep us posted and please do post on the Lev forum too for further input. I am sorry. I know this is frustrating for you.
 
thanks so much for answering. Sheila's thread is very interesting, and those are some awesome photos! But I'm having a hard time seeing how to apply that to my situation where the dose is an order of magnitude smaller. I need to measure like .01 increments. :sad: Tonight I will try using the measuring against a known point on the syringe such as the barrel, rather than using the thickness of the zero line. Maybe that thickness varies and is the problem. Maybe I could try putting a drop on a clean plate, emptying the syringe, then using the emptied syringe to try to get a fraction of a drop. ANyway I'm going to re-read it a few more times and see what I can do.

Danny eats Fancy Feast pates, FF chicken chunky, some Weruva paw lickin chicken, and when he is crazy high (like last night's HI), I give him low sodium tuna in water for the zero carb. Or some cooked chicken. Mainly I feed raw to the horde, with occasional Dave's canned chicken & turkey varieties, but Danny mostly doesn't eat that. He has always been super fussy. I am having to put fortiflora on his food lately to get him to eat well. I do have cypro that I break out immediately if he seems to not want to eat. But mostly he is hungry, yet fussy.

pamela and tigger said:
If you withhold insulin for a little bit, does he bring himself down somewhat after he eats (at shot time)?
Click to expand...

How long do you mean about witholding the insulin? Today he went from 399 before eating to 440 after eating (shot time) to 530 a couple hours later. I think there were days the last two weeks where he didn't get any insulin because I was drawing only to the half-way on zero then pushing out to align to the top of zero. Then one night I was trying to visually check the remaining drop size (push it out onto the needle tip, then suck a tiny bit back in) and that's when I realized if I don't pull a lot more than that, sometimes there is only air. So I'm being much more careful to ensure there is some insulin in the syringe. But it's not helping.

Thanks for the bit of info on dilution. I am looking on the internet to see if I can find more. Jill said in that thread that some have done it (it's not recommended) but I really need to know about that experience. So of anyone is doing the dilution, I beg you to contact me via PM.

I am really desperate. Danny has been rapidly withering away. The vet doesn't know what to tell me. Danny has very little time left for me to figure this out and fix it.

laur
 
Laur -

You're probably already using U100 syringes. For Prozinc users giving small doses, we can convert the U40 insulin into U100 syringes and get the .2 or .4 unit increments. .1 would be halfway to the first line. Not sure how it works with U100 insulin, if that's what you're using. Other than eyeballing, or drawing lines on the barrel of the needle, the only thing I"ve seen is the description of how to suck in little balls of insulin so just the needle fills. If that's what you're trying to do, the line is a moving target. Maybe someone who does it can assist?

Lu-Ann
 
Lu,

we are using U100 Levemir insulin. Yes, I am trying to measure teeny tiny doses and perhaps I just need to fill the needle and not fill the barrel at all. He rebounded from +12 350 last night to this morning's +10 290 (ate 1 can FF pate) to +12 510 on a top-of-zero-line dose, which is effectively one small drop. This morning I tried to go a tiny bit less than the zero line but that is so very close to the end of the barrel. He was dehydrated again so I gave him subq's.

I would really love to hear more about diluting levemir, or measuring doses in the .01 range... anything that may help is welcome.

laur
 
Hi Laur. I think it depends on the syringe, but in my experience the printed lines are between .15u and .2u thick, so halfway could be as much as .1u. Where there seems to be a lot of variation is in the placement of the zero line. I sometimes have .25u of space above it, so having .1 or .05 is not uncommon. I always check it before drawing a dose and take that space, if any, into consideration because I found that on the ultra micro doses a difference of .05 did make a big difference in Beau's numbers.

What are the usual nadirs for Danny? Is he on any other medication that might be effecting the insulin or BG? It seems odd that he is spiking and swinging so much on such a low dose and with a low carb diet. 500s are typical rebound numbers, so maybe he is just really sensitive to insulin.

What has his weight loss been? Beau lost weight before diagnosis and gained some of it back. Then he lost more weight about two years ago, going from about 10.25 to less than 9 and we could not figure out why. His blood work was normal, his T4 was in range on medication. He was OTJ and seemed to be eating OK. Well, two years later, he has not gained any weight back but he is happy and seems healthy. His coat is soft, he plays with the other cats. His weight has been stable so I try not to worry.

My aunt's 14 y.o. kitties have also lost weight and their blood work also doesn't show anything. The vet said that older cats sometime can't absorb nutrients as well and recommended adding enzymes to their diet. She has been doing that, but its too soon to see a difference. Her cats are always hungry, although she feeds enough. Mine free feed and hardly ever act hungry. I have been adding enzymes to their food too in the hopes that it helps Beau gain some weight back.
 
Thanks Sheila. I didn't realize the line thickness itself could be as much as .15 or .2. So I guess I've tried doing .05 and .1 increments, but not considering the relative placement of the zero line as carefully as I need to, based on the feedback I've gotten. Now I should be able to be more consistent on the dose.

Danny is not on any other meds. He was looking good at his usual 11.5 lbs and has lost about four pounds recently. I took him to the vet as soon as I saw he was losing weight for full bloodwork and he's been back several times more. According to the vet scale, he lost half a pound in the last week alone. He is scary thin now which is why I have so little time to figure out & fix this problem. The BG low points have generally been in the 300s, although the recent middle-of-zero-line dose increase (was worrying that maybe I was wrong and he wasn't getting enough lev) took him down to 127 with a follow on rebound over 500. He is very insulin sensitive now; he didn't used to be but became that way when he briefly went OTJ like a year ago.

I am leaving extra food out but the problem is that he is so fussy. Sometimes I have to sprinkle every layer of food with fortiflora. He will ignore the extra raw or Dave's left out, but if I put extra FF out, the others devour it the instant he leaves the dish. (He is eating on top of a cabinet so they can't plague him while he eats.) With all the fosters, I don't really have any place to regularly put him in by himself, but I guess I'd better shift cats around to give him his own room. Maybe that will help.
 
Laur, did the vet rule out Irritable Bowel Syndrome for Danny? I know you said he has had bloodwork done and hasn't been able to find anything, but I am just wondering if he has ruled this out since weight loss is one of the symptom, and it also could be contributing to his erratic bg cycles.

I know you said he is a picky eater, but a lot of people have said that a raw diet helped their kitties who were showing signs of IBS.

Also, regarding the dilution of Levemir. I am still not sure if anyone on this board has ever done that. I know that Mami from Japan said they did it routinely over there, but I am not sure she pursued it after posting here. You could ask on the Lantus board since I am sure they would remember her. Here is her first post on the Lantus board after asking for help there and her SS record:

http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=11036&p=109244#p109244

I am sorry. I hope you can find some answers for your boy. :(
 
Hi Laur,

I'm sorry to see you on the board with this problem for Danny.

Has he had an ultrasound or been seen by a veterinary teaching hospital? It seems to me that more diagnostic tests should be done, ultrasound being the first thing. Hyper-T has been ruled out. Most vets don't have ultrasound available, they either have to send you elsewhere or have a radiologist come on a rotating basis. It does not sound like Danny can wait for that, which is why I suggest a veterinary teaching hospital.

You may also consider syringe feeding him. Gandalf never really liked raw food either and that was how I got it in to him. I can point you to good 60cc syringes.

((((((Laur))))))
 
unfortunately finances don't allow for the ultrasounding at this time. Last week the vet did spend a really,really long time feeling him to see if there was anything palpable to indicate his cancer might have returned, or any bowel thickening etc. She didn't find anything. He didn't show any discomfort at being squeezed and prodded.

Hm on the IBD. It's possible although he is eating what he's eaten all along. He's been vomiting a lot less the last couple months although I attributed that to being much more careful to only let him eat so much at a time, then having him wait 10-15 minutes before getting more. He has had some soft poo on and off, but I attributed that to how much more he's been eating. This weekend, I will move him into his own room so I can definitively know what's his in the litterbox. I had had a fecal done recently because of the soft poo, and nothing came up there. I do have some frozen rabbit left, so I can make up some special raw for him -- he likes rabbit a lot more than chicken. Between that and fortiflora, I bet I can get him eating more raw.

I would like to lay in some syringe feeders, so yes please advise what ones are best.

Also what enzymes are recommended?

Thank you all so much.
 
Oscar is going through the same thing right now too. His numbers can be in decent ranges, but can bounce up (for him). We finally broke down and got him tested for pancreatitis anyway. Turns out that he has been going through acute pancreatitis even with halfway decent numbers. If you are also considering IBD, you need to get the GI panel blood test done where they test fPLI, fTLI, coalbumin (vitamin b levels), and folate. Oscar is not gaining weight and is loosing muscle mass, fur looks bad, needs to stay on tramadol, etc. One other thing we are trying to help his situation are herbal supplements that support pancreatic health and stabilizing blood sugar levels. We have on order this herbal supplement: http://www.nativeremedies.com/petalive/ ... ysmtac=PPC Hopefully it will come in the mail soon because I am running out of ideas too.
 
just thought I'd give an update. Danny was getting so thin that in desperation I decided I would give him some dry Evo, which he totally loves. I quit giving to him years ago because it raises his BG. But with feeding the Evo, I can give him more insulin because the Evo keeps him from dropping too low. Kind of crazy, I know, but a .5 plus Evo seems to be working. His BG's are a little better, and he is gaining some weight on the high-calorie grain free dry. That buys me time to figure out what to do.

laur
 
I used to do curves on Fred to see how he'd drop every hour or two if he ate after his shot, or not. What I discovered was that ESPECIALLY if he was high at preshot--400s or above---then he would drop very slowly and it might take 4-5 hours to see anythingmuch...and then at peak he might only have come down to 300 or 350 and start rising again. But then I realized that if he was high, I could give hiim a shot and wait about 4 hours to feed hiim...At that point it would be starting to drop, so the food would be going in on the downhill turn, as oppopsed to going in and jacking him up even further before he was anywhere close to dropping. Unfortunately Fred was fed at shot time for 4 years before I figured this out, but in his last year it really was a great finding to realize that I could totally control thing just by if I fed at shot time or not. ALSO, if he was low at shot time, I would drop his dose because if he was say, 200s, and I gave him his same dose, he would drop very quickly and too low...so I would just take off a "-" smidgen of his 1 unit or 0.75 unit at the time. It made a huge difference. If he was super high--like 500s-600s or above, I'd add a "+" smidgen extra to his usual dose--and wait to feed him. This really really worked great. So perhaps worth a try, but you need to do curves right after shot time--say +2 or +3 +4 +6, etc.

Normally lantus would make him drop around 10 or 15 pts per hour. So you can see that if he was high, no way he's dropping very far anytime soon, and especially if I fed him.
If he was low already the dose, if it was not lowered, would make him drop 25-40pts an hour, and that's why it was really important to lower the dose a bit to counteract that, and feed him of course, but I didn't find that the food had a raising effect much if he was dropping, and dropping fast, mostly it just slowed down or minimized the drop, rather than jacked him up.

It's a tough thing to figure out and find a pattern. But that was Fred's pattern. Maybe it will work for you. I did find also, that gradually he was needing less insulin, even though he was 20 and had been diabetic for 5 years, not sure why.

good luck
 
laur+danny+horde said:
...Danny eats Fancy Feast pates, FF chicken chunky, some Weruva paw lickin chicken, and when he is crazy high (like last night's HI), I give him low sodium tuna in water for the zero carb. Or some cooked chicken. Mainly I feed raw to the horde, with occasional Dave's canned chicken & turkey varieties, but Danny mostly doesn't eat that. He has always been super fussy. I am having to put fortiflora on his food lately to get him to eat well. I do have cypro that I break out immediately if he seems to not want to eat. But mostly he is hungry, yet fussy. ...
Click to expand...

I haven't checked Janet & Binky's list lately (I buy FF Classic Chicken & Classic Turkey & Giblets almost exclusively). The FF Chicken chunky might be somewhat higher in carbs.

The other day I gave Grayson a treat, and we had Ocean Whitefish (classic). He had ABSOLUTELY NO food spike! I know they don't recommend too much seafood, but it was good for testing purposes, as I feed throughout the cycle, so it appears Graysons numbers are flat as pancakes. But I can't stand to see him scavenging for food either!

Although you're having some "selective" eating, you may want to try to stick with one type food for a couple of cycles. I buy the case of Chicken and one of Turkey, and usually go about 3 cycles each before switching them up. I also feed Grayson alone in the dining room, as he's not above going and stealing others' food! You may want to close him in a room w/ his food. Maybe a guest bathroom or something if you have one. Once the food is up elsewhere, then he can be back with the hordes!
 
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