Wrong syringes?

[Hine87]

My Jasper has been on PZI for a few months now but now reading that I may be using the wrong syringes. My vet told me to use the U100 but reading that I need to use the U40. His numbers have been wonky and he recently recovered from DKA and now I am overly paranoid about him falling back into that again if we don't get his numbers under control. He is getting 2.5 units twice a day and trying to be hopeful that they will even out since it has not been a full week yet but the BG keeps bouncing at +6 hours to still being in the 300's or a few times around 100 and 2-3 times when he is due for another shot to be at or under 100. =/

 

[Squeaky and KT (GA)]

http://www.felinediabetes.com/FDMB/...ase-read-newbies-and-oldies-links-info.32799/

Looks like you should be using either the U40 syringes with the RED caps OR using the conversion chart at the link above if you're going to use the U100's. I tried to copy both for you but it didn't 'save' for me...check out the info there.

Hope this helps....

 

[Sue and Oliver (GA)]

Let's try to figure out the syringes first. Here are two pictures of U40/U100 needles.

http://www.adwdiabetes.com/images/newsletters/ulticare-syringes-comparison.gif

The other thing is that sometimes PZI can come in U100 strength. Then U100 needles would be the right kind. Only BCP PZI comes in U100 strength. What does your bottle say?

I am pretty sure ProZinc only comes in U40 strength. If so, we use U40 syringes. OR we use U100 needles with this conversion chart:

http://www.felinediabetes.com/insulin-conversions.htm

Using U100 needles is popular because it is so much easier to dose in small amounts.

So if you have been using U100 needles with U40 insulin, you have been giving less insulin than you thought and that might explain the high numbers. You can continue using the U100 needles using the chart and then you'd be able to give doses like 1.2 and 1.4 instead of trying to eyeball between one and 1.5

Does that make sense?

 

[Hine87]

These are the syringes we are using now. Hm ok it says the insulin is a 100U/5ml vile. I remember my vet saying to use the U100 syringes but when I looked at the companies website it said to only use the U40, the same with another site unless you used the conversion chart. A few days after he recovered from DKA the vet OK'd him getting 3 units but after a few days he dropped below 100 when it was time for his shot and my husband felt that he was getting too much insulin so we talked to the vet again and she was ok with trying out 2 units to see how that would work and we have since been doing the 2.5 for almost a week now. 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[Sue and Oliver (GA)]

Ok. So you are most likely using BCP PZI rather than ProZinc. And 100U syringes should be fine.

It is probably better to post on this forum as you are wondering about the dose. Everyone here uses or has used your insulin. The protocol we put together for PZI is in my signature in blue.

So, looking at your spreadsheet. What I see is that he is getting some low numbers on 2.5 units. Yesterday, after 12 hours, he had dropped to 49. You shoot 2 units there, which was quite dangerous. We consider 50 as a watch number for a hypo. We suggest new diabetics not get shots under 200 until they have lots of data no know how their cat is likely to react. Then yesterday he also was in lower ranges and most likely bounced up to a high number this morning.

A bounce is when their body perceives a lower than normal number and "panics". It releases extra glucose. That makes the blood level bounce up - higher than normal. So we often say, after a low number and then a high for the next test, the kitty bounced. I would guess that is also what happened with some of the blue numbers you have gotten and then the highs after.

If he were my cat, I would reduce the dose, perhaps to 2 units on the higher ranges. I wouldn't shoot under 200 but would stall, waiting 20 minutes without feeding (which raises the levels) and retesting. You want a number that is rising, not still falling. A falling number would mean the insulin is still in his body and working and you don't want to add insulin to that. And you want a number at 200 or above. Then you could give the shot, but a smidge less than your previous dose (because you don't want a cycle similar to the last one when the pre shot tests was too low to shoot)

I know this sounds complicated, but if you post here regularly we can help. This is a small, friendly forum. It is busiest in the morning and evening, EST. if you have an emergency, post here and on Health as you will get more eyes.

And Welcome!

 

[Hine87]

Ok. So you are most likely using BCP PZI rather than ProZinc. And 100U syringes should be fine.

It is probably better to post on this forum as you are wondering about the dose. Everyone here uses or has used your insulin. The protocol we put together for PZI is in my signature in blue.

So, looking at your spreadsheet. What I see is that he is getting some low numbers on 2.5 units. Yesterday, after 12 hours, he had dropped to 49. You shoot 2 units there, which was quite dangerous. We consider 50 as a watch number for a hypo. We suggest new diabetics not get shots under 200 until they have lots of data no know how their cat is likely to react. Then yesterday he also was in lower ranges and most likely bounced up to a high number this morning.

A bounce is when their body perceives a lower than normal number and "panics". It releases extra glucose. That makes the blood level bounce up - higher than normal. So we often say, after a low number and then a high for the next test, the kitty bounced. I would guess that is also what happened with some of the blue numbers you have gotten and then the highs after.

If he were my cat, I would reduce the dose, perhaps to 2 units on the higher ranges. I wouldn't shoot under 200 but would stall, waiting 20 minutes without feeding (which raises the levels) and retesting. You want a number that is rising, not still falling. A falling number would mean the insulin is still in his body and working and you don't want to add insulin to that. And you want a number at 200 or above. Then you could give the shot, but a smidge less than your previous dose (because you don't want a cycle similar to the last one when the pre shot tests was too low to shoot)

I know this sounds complicated, but if you post here regularly we can help. This is a small, friendly forum. It is busiest in the morning and evening, EST. if you have an emergency, post here and on Health as you will get more eyes.

And Welcome!

Oh crap, no sorry I didn't give him insulin when he was at 49! I just accidentally got in the groove of putting 2.5 when I was updating it today. I will fix it asap!

 

[Hine87]

Ok. So you are most likely using BCP PZI rather than ProZinc. And 100U syringes should be fine.

It is probably better to post on this forum as you are wondering about the dose. Everyone here uses or has used your insulin. The protocol we put together for PZI is in my signature in blue.

So, looking at your spreadsheet. What I see is that he is getting some low numbers on 2.5 units. Yesterday, after 12 hours, he had dropped to 49. You shoot 2 units there, which was quite dangerous. We consider 50 as a watch number for a hypo. We suggest new diabetics not get shots under 200 until they have lots of data no know how their cat is likely to react. Then yesterday he also was in lower ranges and most likely bounced up to a high number this morning.

A bounce is when their body perceives a lower than normal number and "panics". It releases extra glucose. That makes the blood level bounce up - higher than normal. So we often say, after a low number and then a high for the next test, the kitty bounced. I would guess that is also what happened with some of the blue numbers you have gotten and then the highs after.

If he were my cat, I would reduce the dose, perhaps to 2 units on the higher ranges. I wouldn't shoot under 200 but would stall, waiting 20 minutes without feeding (which raises the levels) and retesting. You want a number that is rising, not still falling. A falling number would mean the insulin is still in his body and working and you don't want to add insulin to that. And you want a number at 200 or above. Then you could give the shot, but a smidge less than your previous dose (because you don't want a cycle similar to the last one when the pre shot tests was too low to shoot)

I know this sounds complicated, but if you post here regularly we can help. This is a small, friendly forum. It is busiest in the morning and evening, EST. if you have an emergency, post here and on Health as you will get more eyes.

And Welcome!

*now that I read your whole post =)
Thank you so much for the help-I posted in the main forum the other day and felt as if I was starting over again with Jasper even though he was diagnosed last November. I was in Japan and moved back this May but while I was there the vet didn't really know how to treat him and would always ask me how I wanted to treat his diabetes (they were also giving me an insulin meant for dogs-but thankfully knew better than to constantly up the insulin). I have never been to active in a forum before although I sure should have been here from the get go and would have learned how to treat his diabetes better and got onto a different insulin. I sure learned the hard way! Your instructions do make sense and I also have my husband here to help, he is fairly familiar with diabetes since his parents and his best friend are all diabetic. Other than Jasper I have no previous experience in all of this. I will try this out for a few days and post my results, thank you thank you so much!!

 

[Sue and Oliver (GA)]

Oh good. I didn't want to panic you, but thought you'd be lucky if he didn't die, if you gave 2 units on a 49.

It sounds like your husband can be a big help. And it is encouraging if Jasper is needing less insulin

 

[Rachel]

Hello! Sue has already given you super excellent advice, so I just wanted to stop by and say hi! I'm the "early morning crew" throughout the weekdays here on the PZI forum. I get up super early for work (and coffee!) so I tend to pop in here around 5:15 or so CT. Very little happens that early..

 

[Hine87]

Ok. So you are most likely using BCP PZI rather than ProZinc. And 100U syringes should be fine.

It is probably better to post on this forum as you are wondering about the dose. Everyone here uses or has used your insulin. The protocol we put together for PZI is in my signature in blue.

So, looking at your spreadsheet. What I see is that he is getting some low numbers on 2.5 units. Yesterday, after 12 hours, he had dropped to 49. You shoot 2 units there, which was quite dangerous. We consider 50 as a watch number for a hypo. We suggest new diabetics not get shots under 200 until they have lots of data no know how their cat is likely to react. Then yesterday he also was in lower ranges and most likely bounced up to a high number this morning.

A bounce is when their body perceives a lower than normal number and "panics". It releases extra glucose. That makes the blood level bounce up - higher than normal. So we often say, after a low number and then a high for the next test, the kitty bounced. I would guess that is also what happened with some of the blue numbers you have gotten and then the highs after.

If he were my cat, I would reduce the dose, perhaps to 2 units on the higher ranges. I wouldn't shoot under 200 but would stall, waiting 20 minutes without feeding (which raises the levels) and retesting. You want a number that is rising, not still falling. A falling number would mean the insulin is still in his body and working and you don't want to add insulin to that. And you want a number at 200 or above. Then you could give the shot, but a smidge less than your previous dose (because you don't want a cycle similar to the last one when the pre shot tests was too low to shoot)

I know this sounds complicated, but if you post here regularly we can help. This is a small, friendly forum. It is busiest in the morning and evening, EST. if you have an emergency, post here and on Health as you will get more eyes.

And Welcome!

I wanted to double check first, for the 2 unit dosing on the higher range-would this be anything that is over 300 or 400? I went and gave him 2 units last night and this morning. Last night they were pretty high but this morning it was 366 (it was nice to see under 400!) and the same where I would give him the smidge less than the previous does-would that be between 200-300? I just want to make sure I am doing this right, thank you!

 

[Hine87]

Hello! Sue has already given you super excellent advice, so I just wanted to stop by and say hi! I'm the "early morning crew" throughout the weekdays here on the PZI forum. I get up super early for work (and coffee!) so I tend to pop in here around 5:15 or so CT. Very little happens that early..

Oh yes they were definitely helpful! I started feeling lost in how to manage his insulin since moving back to the states and having a terrible vet overseas. Thank you for popping in to say hi and hi back 'atcha =) (I cannot start my morning without coffee either!).

 

[Sue and Oliver (GA)]

It looks like your syringes don't measure the small gradients. People here use syringes that measure half units. If you look at the picture I posted of the U100 syringes, they make it easer to dose smaller amounts. These pictures are used for a different insulin, so ignore everything until you get down to the pictures of the syringes and dosing.

http://www.felinediabetes.com/FDMB/threads/lantus-levemir-new-to-the-group-please-read.18139/

It isn't terribly important now but will be useful when you start giving smaller or more precise amounts.

I like 2 units for today. If you can get a number 5-7 hours after the shot, that will help us see how this amount is working. At this point, think of the process as "data gathering". You are giving a safe amount, seeing how it works for a few cycles and then adjusting if needed. This advice applies unless you get a low number for a pre shot (under 200). Then do the stalling thing.

 

[Sue and Oliver (GA)]

And I forgot to say - with a DKA kitty, you want to be vigilant with ketone testing. You use the ketone strips that humans use. Some cats will let you stick it in their stream after they start. With Oliver, he wouldn't let anyone watch him pee. So we gave him a clean box with aquarium gravel in a room with the door shut. He'd have to christen the clean box; we would swoop in and get our test because the gravel didn't absorb the urine.

 

[Hine87]

It looks like your syringes don't measure the small gradients. People here use syringes that measure half units. If you look at the picture I posted of the U100 syringes, they make it easer to dose smaller amounts. These pictures are used for a different insulin, so ignore everything until you get down to the pictures of the syringes and dosing.

http://www.felinediabetes.com/FDMB/threads/lantus-levemir-new-to-the-group-please-read.18139/

It isn't terribly important now but will be useful when you start giving smaller or more precise amounts.

I like 2 units for today. If you can get a number 5-7 hours after the shot, that will help us see how this amount is working. At this point, think of the process as "data gathering". You are giving a safe amount, seeing how it works for a few cycles and then adjusting if needed. This advice applies unless you get a low number for a pre shot (under 200). Then do the stalling thing.

I guess it is hard to see in the picture I shared (for me) but I looked at our syringes and they do have the half unit markings on it. I will also be looking at getting a ketone test today to be sure he is still all in the clear until he gets back to the vet next week. =)

 

[Sue and Oliver (GA)]

Sounds great!

 

[Hine87]

I am really wondering if his teeth having something to do with this...his numbers are not any better and with him bouncing at the 2.5 units. Not sure what to think, I take him into the vet tomorrow so I will for sure be asking but this sure is frustrating. =(

 

[Sue and Oliver (GA)]

I certainly think he is bouncing. The 2.5 seems to work on the 400s but that amount on the yellow pre shot
may be taking him too low , causing a high number for the next pre shot. I think I'd give less on the 200-300 pre shots, maybe 2 units?

Sometimes they do okay with holding the dose but because his pre shots are varying between 200 and 500, I'd try varying the dose. Does that make sense?

 

[Hine87]

Yes it does! =) Went to the vet today and she would like to take care of his teeth soon. He's teeth are pretty rough =(
She thinks that the 2.5 may be a little too much so she wanted me to try 1.5 and to see how he does on that and if it doesn't work to come back up to 2 units. Guess we will see!