Maybe human error caused Bronx's 2 hypos???

Hi all,

Bronx hypo-ed twice this last month, both times after an Adequan shot which he gets every 2 weeks. He has never hypo-ed before this. I just gave him a shot of Adequan right now for the 1st time since the last hypo . The shot is .4ml which would equal 40u in an insulin syringe. Since he was doing so well for the 3 months before that, I stopped using his R insulin and kinda forgot it was even in the fridge next to the Adequan which is also in an exact shape vial, but inside a prescription container. The 1st hypo was after I shot Adequan after being up all night on a flight home. 2nd time there is no reason to think I used the R accidentally over the Adequan but since I only use Adequan every 2 weeks and kinda forgot about the R vial, there is the crazy chance I actually shot him 40u of R both times???? This is the only explanation I have for what happened. I now made sure to wrap orange tape around the R vial. I really forgot I even had that R vial since he has been doing so well until recently and when I reached for it the 1st time after all of this, I had an oh sh*t moment. What did I do? Is it possible? Yes, it is.

However, if he hypos again today I will know for sure that the Adequan causing something (which it never did before this month), but the more I think about it, the more I think I really screwed up and shot R instead of Adequan.

He hasn't been the same since with his BG#s since I lowered the dose a big amount and did some No Shots too. Also, he is little more wobbly on his feet probably from the hypos . He could've went blind and even died. Thank God he is still here, imagine the thought that a screw up on my part killed him after all we have been through.

 

Paul, you can kick yourself black and blue and not be able to go back and change anything. If, and I say, IF this is what happened, it won't happen again. You are a devoted cat dad, and there isn't anything you would consciously do to Bronx that would hurt him.
Going forward, take care of Bronx, and yourself. If you made an error, admit that you are human (and Bronx likes you that way!) and carry on. Hugs dear man, and hugs to handsome Bronx.

 

Oh Wow Paul!! I think you have hit the nail on the head!!! So glad that you have marked the R vial differently! Such an easy thing to do on no sleep so please don't beat yourself up for this! It could happen to anyone!

 

Don't beat yourself up. If that is what happened, it could have happened to any of us. Bronx is still with you because of the great care you give him.

 

Stop feeling guilty! You probably found the reason of his hypos and it won't happen again. Don't blame yourself, it could have happened to anyone of us! I was taught that the only ones that don't make mistakes are the ones that do nothing.
The most important thing is that the two of you are together and Bronx will get over all this with you!

 

Wow, wow, wow.

When did (or will) you give the Adequan today?

 

At +3 (I always put on the SS in the box when I shoot it but may have to change last 2 times to 40u of R . Amazing he's still here if in fact I did shoot that much, probably enough to send a human into Hypo. I should probably fast track back up to 7.5u where he was doing so well?

 

Oh my gosh Paul! Looking at Bronx's spreadsheet, the two could certainly have been mixed. I am so thankful you got to the bottom of it AND took precautions to ensure it doesn't happen again. I can only imagine how you're feeling right now, but remember that you love that handsome boy of yours and he's still with you. You are an amazing cat-dad and you take such good care of Bronx. Making a couple of mistakes like that absolutely does not negate that. Now that you're aware and took those precautions, you both can work to get Bronx into better numbers. I'm still kind of on pins and needles waiting to see how he does after the Adequan shot today. So far so good though!

Unfortunately, I'm not sure how quickly you would want to raise the dose to get him into better numbers. Regardless, I'm sending you lots of hugs and scritches for Bronx.

 

Paul you are not the first person this has happened to, if this is what happened.
I hear the helpers who guide CGs with R saying make sure the R is somewhere in the frig away from the normal insulin and marked well, because it can inadvertently be used by mistake. And I have seen it happen here on FDMB.
I worked in health and was trained to check every medication three times. ......When first selected, when dispensing into syringe or container and when giving to patient. And it is a habit I use always.
Don’t beat yourself up about this. It can happen to anyone.

 

I agree 100%. IMHO, I would do 6 cycles and raise. I wouldn't fast track. Keep the depot as stable as possible and keep a close eye on him. I am a wimp and would be extremely gun (syringe) shy after what you both have been through.

Let's see what @Wendy&Neko says though, she is much better at these things

 

Hi Paul,
I, too, await how Bronx does with the Adequan shot this evening. I think your explanation of what might have happened with the R is very plausible. All of us have done something similar. One thing is clear: Bronx rallied because he loves you and wants to be with you. You are always there for him. You are a terrific Papabean.
Lots of vines for your boy to get back on track with an appropriate dose.
And tons of s for you!

 

Mostly 300s all day, so any Adequan theory is ruled out.

 

It took a lot to figure this out. It took even more to share it with this group. By sharing what may have happened you are helping many others to avoid the possibility of a similar problem helping many cats and many people.

One question - Why is Adequan in the fridge? Refrigeration is not required.

Always wishing only the very best for you and Bronx.

 

BTW, adequan doesn't need to be kept in the fridge

 

Mistakes happen and we do our darnedest not to let them happen again, but Carol's absolutely correct... 'By sharing what may have happened you are helping many others to avoid the possibility of a similar problem helping many cats and many people.'

I thank you for that, Paul. And I'm especially thankful you arrived home when you did.

You pulled Bronx to safety... now take good care of yourself, too. You've gone through a lot.

 

So glad you figured it out and more so you were home when it happened and got him through it. He loves his papa and knows you love him.

 

So scary, but as others have said it could happen to anyone. And by sharing you have helped others to be more aware that it could happen to them. Just thankful you were home when Bronx needed you.

 

Oh Paul, I'm sorry you are struggling with this. I don't know anything about R to comment, but it breaks my heart that you are in pain about this. You must know you are such a shining light for Bronx, try not to dwell too much on the past. You have taken action to make sure, if it happened, it won't happen again. Excellent. Bronx most surely knows how much you love and care for him, let's just look forward now, and see if we can get Bronx back to a good normal routine. Sending lots of belly rubs for sweet Bronx, and a few for you, laced with a nice house brew as well

 

Looking at the timing of when you gave “Adequan” and when you saw low numbers, you theory is possible. But like Bron has said, not the first to mistakenly shoot R and the wrong dose. So sorry it happened to you.

As for dose, the dose looked a just a bit low when you actually stuck to 2.5 units for several doses in a row before the last hypo. Not sure what dosing methodology you are using now, so I can’t comment on where you should go next.

 

I'm another voice in the chorus and very glad you caught the drop in numbers and took care of Bronx.

I'd make a suggestion. If you plan to keep the Adequan in the refrigerator, move it to a spot that's different than the R. I'd also do something like put a rubber band around one of the vials, wrap one in bubble wrap -- something that will help you to differentiate between the two vials even if you're hugely jet lagged.

 

Not to make light of this at all, but recently I read of a lady preparing a new recipe - she put 3 tablespoons of salt into the glaze mixture - the recipe called for 3 tablespoons of sugar - needless to say the end product was inedible. She has since changed the clear glass jars she kept both items in. And she wasn't jet lagged, etc. Better labeling, a change of the container were a couple of steps she took to avoid this kind of end result. It can happen to anyone...but when it comes to medication the adverse result isn't as easily remedied as tossing out a bad batch of food...It takes a big person to admit that kind of mistake and I'm sure you'll have already taken additional steps to avoid another one of those in the future...we've all done it. My biggest thing is in my foggy head in the morning I want to put the insulin back into Luci's test kit - not back into the fridge! ...forgive yourself and move on...and hopefully those who read this will take that extra step TODAY to add a label, rubber band, or move items to a different location...no one is perfect. Thankfully Bronx is a tough guy and will be on the mend soon

 

{{{Paul}}} I'm sorry this happened (if it did), but glad that you were alert enough to keep Bronx safe. These kinds of lessons are the toughest, but they stick with us. I have seen similar mistakes here, too, so don't feel you are alone. Be kind to yourself and keep loving your dear Bronx and all will work out.

 

Wow, I am so worried about doing this same thing when I am tired in the mornings or after long work days. We have Adequan and insulin, and I actually almost (out of habit, I suppose) gave Darwin insulin instead of Ben. It could happen to anyone, and everyone. As a vet tech, I have seen things happen. We have implemented a "3-check" rule to avoid it. We're only human.

One good thing is that you may have an answer for why Bronx dropped as he did. I hope, though, that you don't blame yourself too harshly. Bronx is very lucky to have someone who was able to take care of him during the rough patches, and just daily, as you do! Sending hugs!