What dose is a Drop? How to do it?

Status
Not open for further replies.
StarburstMom

StarburstMom

Member Since 2021
Tomorrow morning I have to be out for about 4-5 hours. Later in the afternoon Starburst has her vet appointment where we will get new labs (yay!). I've been trying to give her 0.6U dose as it gets her into the upper double digits. This morning I dosed her 0.4U due to a lower than normal preshot as I really don't want her getting under 80 (she is wearing a Libre, which reads interstitial fluid and is 10-15 minutes behind blood glucose values). The reduced dose still brought her down to the same nadir but didn't have the duration. I won't be able to monitor her tomorrow morning. So, I have three options....do these sound reasonable? Am I missing something?
1-If PS is 120 or less = no shot. Depending on reading when I return (+5-+6) give following dose early and have new shot time or wait until evening to resume dosing
2-If PS is 120-150 reduce dose to 0.2U.
3-If PS is 150+ give 0.4U.
Or should I just NS regardless and pick up when I return? She is trying to maintain her BG as it seems to be slightly curving down or holding towards the end of her cycles the last few days. I would really appreciate any suggestions.
 
I wish I could advise on the dosing. Hmm. Keep in mind she will likely have elevated blood sugar due to vet stress. Maybe @PerfumedCatMom has some insight as she has experience with Libre.
Good luck at the vet today.
 
smorgasbord said:
I wish I could advise on the dosing. Hmm. Keep in mind she will likely have elevated blood sugar due to vet stress. Maybe @PerfumedCatMom has some insight as she has experience with Libre.
Good luck at the vet today.
Click to expand...
I went ahead and made the decision to skip the shot since she was 120 at PS. So far she's holding her BG today, but vet trip will be soon so I will likely need to give her insulin tonight. I think she's close to remission (Crossing fingers). Hoping her labs, specifically kidney values are good today
 
StarburstMom said:
I went ahead and made the decision to skip the shot since she was 120 at PS. So far she's holding her BG today, but vet trip will be soon so I will likely need to give her insulin tonight. I think she's close to remission (Crossing fingers). Hoping her labs, specifically kidney values are good today
Click to expand...
I think I'd be nervous as well about getting a 120 and then not being able to monitor after. Better safe than sorry.
Do they do the labs in-house and you'll get the results today?
 
smorgasbord said:
I think I'd be nervous as well about getting a 120 and then not being able to monitor after. Better safe than sorry.
Do they do the labs in-house and you'll get the results today?
Click to expand...
The vet wanted to send them out...he said they will get more results for the same price (called it a number 1). They should email me the results tomorrow.
 
So what you're seeing is that her pancreas is still working! Just not quite where it needs to be to keep her under 120 most of the time (ideally we like to see mostly under 100 before calling it remission, but can be hard to do on ProZinc depending on the cat).

Couple questions:
  • What time(s) do you feed her (in the + X format)? It's possible some slight tweaks to that can get some better duration/more even numbers
  • Is there a reason your color coding doesn't follow the forum standard? I'm guessing green to you is the range you want her in. It's a little hard to look at when it doesn't match the forum standard...perhaps you could duplicate the sheet, set up some formulas to automatically copy data, and have a version for you and a forum standard version.
 
StarburstMom said:
Tomorrow morning I have to be out for about 4-5 hours. Later in the afternoon Starburst has her vet appointment where we will get new labs (yay!). I've been trying to give her 0.6U dose as it gets her into the upper double digits. This morning I dosed her 0.4U due to a lower than normal preshot as I really don't want her getting under 80 (she is wearing a Libre, which reads interstitial fluid and is 10-15 minutes behind blood glucose values). The reduced dose still brought her down to the same nadir but didn't have the duration. I won't be able to monitor her tomorrow morning. So, I have three options....do these sound reasonable? Am I missing something?
1-If PS is 120 or less = no shot. Depending on reading when I return (+5-+6) give following dose early and have new shot time or wait until evening to resume dosing
2-If PS is 120-150 reduce dose to 0.2U.
3-If PS is 150+ give 0.4U.
Or should I just NS regardless and pick up when I return? She is trying to maintain her BG as it seems to be slightly curving down or holding towards the end of her cycles the last few days. I would really appreciate any suggestions.
Click to expand...
you could do a bit
of a sliding scale at this point.

How come the numbers in the 100's are green on your spreadsheet?
 
FrostD said:
So what you're seeing is that her pancreas is still working! Just not quite where it needs to be to keep her under 120 most of the time (ideally we like to see mostly under 100 before calling it remission, but can be hard to do on ProZinc depending on the cat).

Couple questions:
  • What time(s) do you feed her (in the + X format)? It's possible some slight tweaks to that can get some better duration/more even numbers
  • Is there a reason your color coding doesn't follow the forum standard? I'm guessing green to you is the range you want her in. It's a little hard to look at when it doesn't match the forum standard...perhaps you could duplicate the sheet, set up some formulas to automatically copy data, and have a version for you and a forum standard version.
Click to expand...
I feed her every 3-4 hours or so, it is kinda based on her cues and how much she ate previously. Today I did feed very low carb (0-4%) food before going to the vet, but she had 7ish% carb after the vet. The main thing I am doing is withholding food 2 hours prior to shot time. I'm debating trying to focus on <5% carb food to help a bit. The problem is that I have to add Friskies classic pate sometimes (like an ounce or so) to get her interested in eating and the phosphorus level is too high in that, so I'm trying to deal with low phosphorus needs as well as low carb, and her preferences.
The color coding I did to see how much time she was actually spending in "good" numbers. I made a copy and reverted back the one attached in my spreadsheet now. Thanks.
 
JanetNJ said:
you could do a bit
of a sliding scale at this point.

How come the numbers in the 100's are green on your spreadsheet?
Click to expand...
OK, thanks. I reverted the spreadsheet back....I have a copy that way so I can see how much she is in "good" range overall. But I realize that is confusing when everyone else is using different color ranges.
 
StarburstMom said:
I feed her every 3-4 hours or so, it is kinda based on her cues and how much she ate previously. Today I did feed very low carb (0-4%) food before going to the vet, but she had 7ish% carb after the vet. The main thing I am doing is withholding food 2 hours prior to shot time. I'm debating trying to focus on <5% carb food to help a bit. The problem is that I have to add Friskies classic pate sometimes (like an ounce or so) to get her interested in eating and the phosphorus level is too high in that, so I'm trying to deal with low phosphorus needs as well as low carb, and her preferences.
The color coding I did to see how much time she was actually spending in "good" numbers. I made a copy and reverted back the one attached in my spreadsheet now. Thanks.
Click to expand...
No problem! The CKD does complicate things a little bit, but plenty of cats here have CKD and FD and do just fine.

So, I would not feed after nadir. Or if you do, make it very small snacks (tsp or so at a time). You don't want to boost numbers that are going back up as insulin wears off.

As an example - my cat was free fed and "fed his own curve", I very rarely had to intervene with food. He ate about 1/3 his food by +1/+2, nibbled on another 1/3 til nadir, and very rarely touched the last 1/3. If he did, it was usually 1-2 tsp total (or he was having other health issues).

You might try that for a week or so and see if that helps get some longer duration and more consistent numbers. Starburst is doing great though!
 
FrostD said:
No problem! The CKD does complicate things a little bit, but plenty of cats here have CKD and FD and do just fine.

So, I would not feed after nadir. Or if you do, make it very small snacks (tsp or so at a time). You don't want to boost numbers that are going back up as insulin wears off.

As an example - my cat was free fed and "fed his own curve", I very rarely had to intervene with food. He ate about 1/3 his food by +1/+2, nibbled on another 1/3 til nadir, and very rarely touched the last 1/3. If he did, it was usually 1-2 tsp total (or he was having other health issues).

You might try that for a week or so and see if that helps get some longer duration and more consistent numbers. Starburst is doing great though!
Click to expand...
Great idea, thank you! Will start that tomorrow
 
@JanetNJ she seems to be getting consistently down to the upper 80s during the AM cycle but not for a long duration. Is that good enough or should I up the dose a touch to try and get the duration at those double digits longer? The dosage guidelines refer to the nadir, but not sure if duration near nadir comes into play too. Do you think it matters at this point?
 
StarburstMom said:
@JanetNJ she seems to be getting consistently down to the upper 80s during the AM cycle but not for a long duration. Is that good enough or should I up the dose a touch to try and get the duration at those double digits longer? The dosage guidelines refer to the nadir, but not sure if duration near nadir comes into play too. Do you think it matters at this point?
Click to expand...
If you give more it might go too low. Just hold the dose, the numbers are wonderful.
 
I just received the email with lab results. Her creatinine is up to 3.2. A month ago it was 2.0. Her phosphorous is up to 6.4 (I've been using phosphorous binders and weruva food). Her HCT is slightly better (25.1 vs 22.3). However her RBC is lower, from 5.13 to 4.92. Her SDMA is lower (22 to 14). From the quick google I did, this combo (decreasing SDMA with lower RBC) means that her red blood cells are getting destroyed (hemolysis). Basically, I am pretty sure she has cancer. These results don't make sense to me if it was anything else.

He said I need to watch YouTube videos on how to administer subQ at home and we need to have a discussion.
How can her creatinine gone up that much in a month? Should I just put her on a renal diet and adjust her insulin from the higher carb it will have?
 
Last edited:
My last tortie died of cancer. I love torties, but I can't get one to live into their teens apparently . I'm heartbroken.
 
StarburstMom said:
My last tortie died of cancer. I love torties, but I can't get one to live into their teens apparently . I'm heartbroken.
Click to expand...
Don't give up on her just yet. Last month the creatnine was 2.8. 2.8 to 3.2 is a jump, but beginning stage 3 is not the end. This is my favorite how to give sub q's video.

I've done them now with 3 different cats. Did he recommend an ultrasound to look for tumors?
 
I am sorry you got these results to lead you to believe what you believe. You are doing an awesome job though. Her numbers (BG) look so good.
 
JanetNJ said:
Don't give up on her just yet. Last month the creatnine was 2.8. 2.8 to 3.2 is a jump, but beginning stage 3 is not the end. This is my favorite how to give sub q's video.

I've done them now with 3 different cats. Did he recommend an ultrasound to look for tumors?
Click to expand...
July 6th it was 2.0, July 14th it was 2.8 and yesterday(August 9th) it was 3.2. So in 33ish days it went from 2.0 to 3.2. that's breaking my mind.

He didn't recommend anything other than subQ fluids. I called back and asked to talk with him about the results and got a callback from the office lady saying she spoke to him and he left a long voicemail message and for me to listen to it. I told her I did listen to it, she then asked what additional questions I had for him. That triggered me and I started sobbing....geez.
We will see if he calls me back. I think he just wants to focus on subQs and CKD without questioning how it has gone from early stage 2 to 3 within a month. I have alist of things but he will probably tell me "keep it simple".

Thanks for the video, just watched. Still need to process.
 
Last edited:
StarburstMom said:
July 6th it was 2.0, July 14th it was 2.8 and yesterday(August 9th) it was 3.2. So in 33ish days it went from 2.0 to 3.2. that's breaking my mind.

He didn't recommend anything other than subQ fluids. I called back and asked to talk with him about the results and got a callback from the office lady saying she spoke to him and he left a long voicemail message and for me to listen to it. I told her I did listen to it, she then asked what additional questions I had for him. That triggered me and I started sobbing....geez.
We will see if he calls me back. I think he just wants to focus on subQs and CKD without questioning how it has gone from early stage 2 to 3 within a month. I have alist of things but he will probably tell me "keep it simple".

Thanks for the video, just watched. Still need to process.
Click to expand...
I'm not very familiar with CKD or much else, just chiming in to say he doesn't sound very supportive.

Bright side, subQs are pretty easy to give! A lot of us give them for various reasons. They really should show you in the office too, a little tutorial. Due to COVID my vet isnt letting most people in the office, but they let me in to teach me.

Ive heard IM vets may be better to handle multiple diseases?
 
FrostD said:
I'm not very familiar with CKD or much else, just chiming in to say he doesn't sound very supportive.

Bright side, subQs are pretty easy to give! A lot of us give them for various reasons. They really should show you in the office too, a little tutorial. Due to COVID my vet isnt letting most people in the office, but they let me in to teach me.

Ive heard IM vets may be better to handle multiple diseases?
Click to expand...
I talked with him since and he wants to start with basically a "flush" with subQs for a week to see if her kidneys improve after that. If so, great, if not try and find out why. It makes sense I just am freaking out because of how fast the creatinine is changing. I'm supposed to go in Friday and they will show me how to do it. I need to learn of a different place to shoot insulin as the scruff has been the spot so far (I know we should move it around but at one month in I thought I had more time to figure that out.
 
StarburstMom said:
I talked with him since and he wants to start with basically a "flush" with subQs for a week to see if her kidneys improve after that. If so, great, if not try and find out why. It makes sense I just am freaking out because of how fast the creatinine is changing. I'm supposed to go in Friday and they will show me how to do it. I need to learn of a different place to shoot insulin as the scruff has been the spot so far (I know we should move it around but at one month in I thought I had more time to figure that out.
Click to expand...
I see. Take your time to have a freak out, we all need it sometimes. Then you can regroup fresh, and ready to march on!

I actually give subQs in the flank, and shoot insulin in the scruff. I never moved my shots around, always in the scruff, but following the "clock face" strategy of moving it around in the scruff itself.
 
StarburstMom said:
July 6th it was 2.0, July 14th it was 2.8 and yesterday(August 9th) it was 3.2. So in 33ish days it went from 2.0 to 3.2. that's breaking my mind.

He didn't recommend anything other than subQ fluids. I called back and asked to talk with him about the results and got a callback from the office lady saying she spoke to him and he left a long voicemail message and for me to listen to it. I told her I did listen to it, she then asked what additional questions I had for him. That triggered me and I started sobbing....geez.
We will see if he calls me back. I think he just wants to focus on subQs and CKD without questioning how it has gone from early stage 2 to 3 within a month. I have alist of things but he will probably tell me "keep it simple".

Thanks for the video, just watched. Still need to process.
Click to expand...
Sub q's are the way to go. They will make him feel more comfortable. :)
 
I know this could be a one-off but in the last 24 hours Starbursts reaction to dosage has changed a bit and I'm wondering if this is typical. Her PS had been ~150 with nadir ~90. Starting last night she is getting just over 200 within 1 hour of insulin and her nadir last night was low 70s. I did drop her dosage a touch this morning based on that nadir (previously dropped it if PS was lower than normal). I know it's been less than 24 hours that it's been this way (and I've been stressed/emotional myself so maybe I'm stressing her out) but is this typical? @JanetNJ
 
Remember insulin is a hormone, it doesn't act the same way every time. What you're seeing is fairly normal. Especially when there's potential underlying issues. With MPM you wouldn't reduce til under 50, but do what you're comfortable with for now.
 
StarburstMom said:
@JanetNJ how much subQ did you give, my vet wants 300 mls/day
Click to expand...
. Nooo. 300 is way too much. You give 10 ml per pound. So if he's 10 lbs it would be 100 ml per day. If he was very dehydrated you could probably do 75 twice a day... But don't too much all at once can cause him to get water on the heart.
 
JanetNJ said:
. Nooo. 300 is way too much. You give 10 ml per pound. So if he's 10 lbs it would be 100 ml per day. If he was very dehydrated you could probably do 75 twice a day... But don't too much all at once can cause him to get water on the heart.
Click to expand...
That's what I thought and I even mentioned to him that last time she had subQs at the vet she was acting out of it for a while that night. Not sure how I will address that with him or if I just do 100/day and not tell him. I know I'm annoying him.
 
StarburstMom said:
That's what I thought and I even mentioned to him that last time she had subQs at the vet she was acting out of it for a while that night. Not sure how I will address that with him or if I just do 100/day and not tell him. I know I'm annoying him.
Click to expand...
You can confirm what I think on the ckd forum.

When my 17 lb cat Zimmy had pancratitis we did 200 ml for I think 2 days, but then went back to 100 ml. 300 is way too much unless your cat is like a 25 lbs Maine Coone
 
JanetNJ said:
You can confirm what I think on the ckd forum.

When my 17 lb cat Zimmy had pancratitis we did 200 ml for I think 2 days, but then went back to 100 ml. 300 is way too much unless your cat is like a 25 lbs Maine Coone
Click to expand...
Everything I am reading says 150 mL max...she's 11 lbs right now. I'm tempted to wait and do antibiotics first and try to get in with a different vet but they all have such long delays until available appointments and this vet has been my vet for 15 years now and so good previously.
He just texted me that I can give her the 300 ml split up over several sessions a day and as creatinine goes down we can lower fluids. He's agreed to antibiotics just in case and looks like I will try and get an ultrasound tomorrow (they only do them Thursdays).
 
Last edited:
StarburstMom said:
Everything I am reading says 150 mL max...she's 11 lbs right now. I'm tempted to wait and do antibiotics first and try to get in with a different vet but they all have such long delays until available appointments and this vet has been my vet for 15 years now and so good previously.
He just texted me that I can give her the 300 ml split up over several sessions a day and as creatinine goes down we can lower fluids. He's agreed to antibiotics just in case and looks like I will try and get an ultrasound tomorrow (they only do them Thursdays).
Click to expand...
I personally wouldn't do more than 150 in a 24 hour period. With an 11 lb cat. If she was extremly dehydrated MAYBE I could see doing 2 sessions of 100 each time making sure all of the previous fluids had been absorbed. 300 on a small cat sounds risky to me.


Oh good she'll have the ultrasound.
 
@JanetNJ Starburst has only been in good numbers for a bit over a week but at what point should I try a trial OTJ run? Should I try whittling down her dose more or just keep it as it for a certain amount of time before trying? Her PMs aren't going green at all at 0.4, should I bump that back to 0.6 or just leave it?
She will be starting subQs soon (likely) so not sure if that will impact BG significantly (I'm assuming not, unless the stress of it does).
 
Remission seems to stick better if you take it down gradually. Starburst isn't quite there yet.


Is leave it as is for now. It's only been two days and with sub q's starting is just wait and see what happens.
 
JanetNJ said:
Remission seems to stick better if you take it down gradually. Starburst isn't quite there yet.


Is leave it as is for now. It's only been two days and with sub q's starting is just wait and see what happens.
Click to expand...
Based on her still going down this morning (I'm trying to steer with LC and MC food 3tsp when at 50) I think if she is at 125 or less for PS I either reduce dose to 0.2 or NS. @JanetNJ what would you do?
 
Last edited:
Even at the lowest dose Starburst needed steering with food late last night. With U100 syringes (and U40 insulin) I can get down to 0.2U dose, but I have seen some people write "Drop" for the dose on their spreadsheets....how do you do that? 0.2U seems like a drop to me. @JanetNJ
 
Last edited:
The next step down some caregivers try if needed is 0.1U then 1 drop.

Here's a write up @Deb & Wink did for drop dosing:

"Here is what I wrote up on drop dosing, for a few other folks.
Practice, practice, practice is the key.

Drop Dosing

How many drops do you get from your insulin syringes if you draw the liquid up to the first line? Not the first line with a number next to it, or the shorter line that shows half unit markings. The very first line on the syringe. What we think of as the zero mark.
Practice, practice, practice to see how many drops you can get out of the syringe.
Use some sort of colored clear juice like apple juice or colored water.
Mark the syringe well. Painter's tape, duct tape, masking tape at the top of your “practice syringe”. So you don't forget and use that syringe to draw up insulin.
Draw the "test liquid" up to the first line on the syringe.
After you have drawn up a tiny bit of “test liquid”, point the needle up towards the ceiling and give the syringe a "finger flick. To move/push the air bubbles to the top of the syringe. Push out the air bubbles.
Slowly “twist” the syringe plunger to push out all the “test liquid.”
Then when one small drop of “test liquid” is all that is left on the beveled tip end of the needle, draw the syringe plunger back to "suck" that 1 drop back into the syringe.
You are looking for consistency.
Try to get evenly sized drops.
Practice, practice, practice until you get a consistent number of drops.
Do you think you have the technique down for the drop dose?
Then let me know.

When it’s for real. You’ve practiced and are ready to give a tiny “1 drop” dose.

Draw up a tiny bit of insulin, needle pointed up to the ceiling and give the syringe a "finger flick”. To move/push the air bubbles to the top of the syringe.
Push out the air bubbles that have floated to the top.
Slowly “twist” the syringe plunger to push out all the insulin.
Then when one small drop is all that is left on the beveled tip end of the needle, draw the syringe plunger back to "suck" that 1 drop back into the syringe."Finger flick” technique - make a circle with thumb and first 2 fingers tucked into first thumb joint. Quickly “snap” those first 2 fingers against the syringe barrel held in your other hand. That will force any air bubbles up to the top of the syringe. Then you can push the air bubble out.

Syringes have a lubricant inside. Before you draw up insulin, moving the syringe plunger up and down a couple of times helps the plunger move more easily.

Give the shot. Monitor.

Later, if you need to, you could increase the number of drops.
Be aware that some syringes can vary on where the lines are on the barrel."
 
Status
Not open for further replies.
Back
Top