AMPS=66: 1 drop, did I do the right thing?

Hello all;

@Bobbie And Bubba

I am taking online courses, so I don't have the time I wish I could have to be on this forum more often.

I do have a question, as the title reflects this amps, did I choose my correct option? My options, as I am aware of, would have been:
a.) wait another 20 minutes, test again (though Dante is at the end of his 12 hr cycle)
b.) shoot half of .12 = .6, which on my meter is invisible to the naked eye, (so I decided to go with the 1 drop method from the instructions offered on this site).
c.) don't shoot at all
Are there any other options and was this the right option?
I am surprised that I was even willing to shoot at 66; however, under your guidance, today's shooting occurred without hesitation, (hope I am not becoming trigger happy?), so I definitely welcome some shared wisdom, thank you!

 

Impressive green numbers - how long before he goes OTJ?

 

Waaa?? - hah, I was wondering about that, though a bit too scared to get my hopes up...

 

You've got some great looking numbers there - you may want to ask the experts about an OTJ trial. My Luci and I dream of the day! It's been a long hard road getting her anywhere near numbers like yours! I'd show Dante's SS but she'd be so jealous! She may balk - she's funny like that

 

Trust me, if you look at my earlier years on the Dante's SS tabs, you will see numbers just like yours, though since you are monitoring much closer than I was, you have a much(!!) higher chance of getting Luci OTJ quicker than me. With more history and following exact instructions from the wisdom of the 'angels' here, you will easily get there! A few months ago, I would have never shot below 100 without total fear; this is the best forum with the BEST people here; everyone here has one goal, to get cats OTJ!! This place is incredible!

 

Oh my! That's reassuring! And you're 100% correct! The folks on here are lifesavers! Luci was given a death sentence by our vet (he said, 'If it was my cat, I'd just put her down') - I thought that was the most heartless thing I'd ever heard and I cried for two days before I found this group! So yes, it's a lot of work and some expense - but this little girl is our responsibility and we're going to do whatever it takes to restore her health - and hope for many more years of antics by our crazy cat Or maybe I'm the crazy one??? Crazy cat lady - I'm sure that's what my friends and family say about me when I have to leave their gatherings because I HAVE to go home and take care of Luci...oh well - one day it might be them and I'll have many words of wisdom

Thanks for your kind words and I hope Dante gets that OTJ trail really soon!! Hoping Luci has a nice day easing down to the lagoon for a dip too...

 

Wow, clearly, your vet doesn't know you! Maybe he thought the involved healing process would not be worth the time, effort and expense - I heard this from several receptionists after Dante had heart failure. They told me many, many patients are put down because the owners don't have the time/money, unfortunately, it is so sad. I was abruptly told, without any advance warning, that Dante would be dead in less than a year, I immediately cried and later called to suggest to the head of the cardiology department that this doctor perhaps can be a bit less harsh and at least prepare the owner- then I was informed that he was the head, ugh! My follow-up with a different cardiologist had her shaking her head and apologizing repeatedly for his brute candor. It makes you wonder how these vets have become so heartless, I don’t think that is how they started. That was 3 years ago…

Hah, I concur, we are responsible, it is extremely expensive, but they are family!

Hah, I actually missed my boss’s Christmas party last year - due to the fact that I had to be home before 6 pm to shoot Dante and their house is 90 minutes away with the party starting at 4:00, so - there it is!

Luci will get there(!), I know that everyone on this forum now has a fighting chance, keep up the great monitoring you are doing, and there are some greens in there that give you great hope, so keep doing what you’re doing, it can happen! Great job!

 

Hi Carol, sorry I was off line when you tagged. I think you could have shot the .12 dose with monitoring. Remember what we say, "Shoot low to stay low" So far she is about the same as the pre shot so this could be an active cycle. If you haven't all ready, give him a little snack now to just help her to surf along.

It's hard to know exactly where his nadir time is with out a lot more mid cycle test so just monitor him today. Keep us posted.

 

Hello Bobbie;
Not a problem! Thank you for responding! Unfortunately, I knew I couldn't come home to test during the day, so therefore the 1 'drop'; I didn't read your response until I came home at 5:45pm. His pmps was still at a good level of 78, so I shot .12; if I am correct about his Lantus depot, his numbers will probably go much higher, since I only gave him the single drop, I guess we'll wait and see. Thank you for your guidance!

 

No problem. Seeing the +2 tonight, lower, be vigilant with testing tonight. Get at least one before you go to bed and I would say until at least +4 if you can. He is really close to an OTJ trial.

 

Carol, can you please tell me (I'm new at this) how you get a feel for his Lantus depot? I'm really trying to understand when Luci's depot is going to come into play - so far I just haven't been able to predict much about her numbers - except at times she takes a run at the lagoon and I have a heck of a time slowing her down - and then it's down with the sharks before I know it! I'd like to get a handle on what days/nights I need to be more diligent and what days perhaps I don't need to poke her so many times. One recommendation I've gotten is to get 1+ BG, but so often it seems that she's just languishing at 1+ - nothing happening until 2+; just another poke that wasn't helpful IMHO...others see patterns perhaps? Maybe I need a lesson in reading the tea leaves??

And congrats to you and Dante for being SO CLOSE to an OTJ trial! That's so very exciting!!

 

Hmm, I tried to post this morning, but this website was down...

Bobbie: Ugh, I was so exhausted, after being sick, that the +2.5 WAS the last test before I went to bed at 8:30! Dante, my daily alarm clock (Ugh!), woke me up at 5:30, so I managed to get 9 (!) hours of sleep, and now feeling more rested!
So, to expand my earlier conversation, I had to go in a bit earlier so I did not give him a snack before leaving at 8:30am. Additionally, before shooting him last night, I checked to see any responses (I didn't know I could have shot .12 instead of the drop...) and as per your instructions, I shot the pm of .12. Question: With an OTJ trial, wouldn't I need to test more often? Unfortunately, at work, we are handling a major project, and I cannot afford the time to come home during the day, too much happening there. During the weekend, I will get more tests during midday. Yes, Dante LOVES (!) to be tested, (huh?) in fact, he sits right on top of my textbook and stares me down, until I test him, that is because he gets fish flakes every time, and the kid LOVES his fish flakes! Every am before work, he starts staring me down when he thinks it is time for another test, so- more fish flakes for the kid it is!

@Bobbie And Bubba; @Sienne and Gabby (GA)

Whew, Sue, again, sorry for the late response, tried to answer this am, but the website was down, I couldn't post anything, then the website wouldn't even load while other websites loaded instantly. Anyway, this is too complex of a question for someone like me, I only know that Lantus is stored in the body for a 'deposit' to be used for later. Dante takes several cycles before I actually see the change in his numbers. However, I am the last person to be explaining this to you, so I am tagging Bobbie and Sienne as they have helped me so much both in my learning process and - mentally as well. They are much more qualified to answer that for you; here is the definition as offered by FDMB: Depot - One's subcutaneous "spare tank" of insulin, which has yet to be used by the body.

Hmm, for me, I have found that Dante's numbers were in the same boat as you, in that 2+ seemed to reflect more of a response to the insulin than at 1+. I feel that if I am changing a dose, yes, starting at 1+ is a good idea to see any response, otherwise, I usually start at 2+. Bobbie and Sienne may think differently, as their experience may show otherwise. I would defer to their thoughts on this as well. As much as Dante loves his fish flakes for being tested, I feel that when he starts having a response to the insulin, at 2+, if the response is more than expected, then it would warrant frequent testing, if possible. One great thing is happening though, Luci will get used to the pokes and she knows it will help her!!

I will say one major thing that helped change Dante's numbers - Consistency and timing - shoot as close as possible to the 12-hour mark if using Lantus, allowing only a 10-15-minute variance, and as you will hear many times on this forum, do NOT feed 2 hours before testing, as it will affect the BG. Since I work full time, Dante is fed 2x daily, for a total of 9-10 oz daily total for both meals. My earlier years on his SS tabs show the exact amount of each type of food. When he was first diagnosed with diabetes, I spent about 40 hours researching the best food; the best food was Hounds and Gatos, the first paleo cat food. Unfortunately, I bought 2 cases of a bad batch of chicken, and Dante got really sick, so now I am afraid to buy it. Now I make skinless chicken for him in the slow cooker using the skimmed broth for liquid every 6 weeks , certain canned Weruva, and FF classic only. so a 3-course meal 2x daily. The food is all important, and the shaved fish flakes treat doesn't raise his BG in any way.

When I first started testing him, he would run away and hide a few times. I let him hear the treat container, and when he came to me, I held him on my lap for about 30 minutes and massaged and brushed him, then took his BG. The next time he heard the treat container, he ran toward me to get tested, knowing he would get brushed and a treat, Woo Hoo! I brushed and held him for 25 minutes, then took his BG, then 20 minutes, and now, it takes less than a minute and he now waits for me in the dark bathroom to get tested! My kids see him waiting and they think it is amazing that he waits to get tested; fish flakes are a miracle! I hope this helps!

 

Sue; Have you seen the "Post for new members", I saw it posted today? It gives you complete instructions of everything you will need for your little one; you will also see the link to explain about the Lantus Depot, it will take you a long time to go through it, but very informative! Today, I am testing more often as Dante's +4 was 58, I was out of the house early this am, so I am glad I checked as soon as I came home, just to see his pattern. Anyway, I am going through it as well! Take care!

 

Yes I've read those stickies - a while back - I think it's time for a re-read. Luci sure hit me up side the head today - I was considering a dosecrease and had gotten some advice that now was probably a good time to increase - I checked her at 2+ and she was at 59!! Where did that come from? Most likely her depot had gotten replenished and was doing it's 'thang' - along with her regular dose of 1.5 u - she went to the lagoon and did some surfing...after feeding some MC to try to keep her away from the sharks (she has a history of diving and diving fast!) - now she's soaring (Ms. Trampoline Kitty) to 271...passed her nadir and she's off to the races in the other direction...tonight should be interesting to see if she'll drop again after her little visit today...she's sneaky like that... As always I'll be waiting an watching - because as I mentioned in my post this morning - Luci does whatever Luci wants to do and I'm just along for the ride... Cat in charge = Luci (at least in this household)... I think I'll watch the Kentucky Derby to see some fast horses - this fast cat could take a lesson NOT...

 

Hey Carol. I am responding here because I don't see a new post for today. As far as the OTJ trial goes, usually we go from .25 unit to. 10 and you are at .12 and he is giving you some really nice numbers. He has had a few blue starts 6 days ago. I think what I would do is after 7 days in a row on .12 dose in all greens with no blues, I would sneak him down to .10 and if after 7 days in a row with all greens again and no blues, take him to a drop dose and see if he stays in all greens. Of course if he were to drop below 40 since he is a long term diabetic, you would take the reduction to the next dose on the next cycle.

Since he is a long term diabetic, the longer he will tolerate being on insulin will give his pancreas more support and give him a better chance at a good strong remission. He is so close.............

 

Yowsers Luci!! Whatcha' doin' there, you must like carnival rides, but this is crazy! Thank goodness you are monitoring her closely! Just to be on the safe side, perhaps double checking to ensure she is getting the exact dosage for every shot is another safeguard for you - for me, I found that I cannot go by the lines on my syringes as they are never consistent. I recently found out that 1 drop(!) (reading from other postings) makes a difference, so I tried it with Dante and found it to be true. Marje was the first one who told me about calipers for correct measuring when I first joined, then Bobbie mentioned to me earlier this year, so I decided to get one and now I know the shots are accurate, even though the lines on the syringe aren't...just an FYI Well, Luci sure knows how to keep you on your toes!

 

Speaking of syringes it appears s the ones I picked up at Walmart today do not have the half line marks..
I’m on my way back to the store to see if they will exchange..
does anyone know what I should be asking for???

 

Hello Bobbie; I usually study 12-14 hours on Saturdays and Sundays, but taking a break today and catching up on reading posts again! It was good for me to reread the Post for new members again, so I have been doing that as well.

I was reading your thread about Bubba last night and with my 2 cents, I was thinking that you're right about the outdoor heat may be too much for that long-haired beauty of yours! Don't forget to check on his resting respiratory rate RRR as my vet tells me, it should be between 20-35 for a 1-minute interval. I test his heart rate on his front paw using my middle finger for 15 seconds and multiply by 4. I know, I am being overly cautious as Dante had a heart failure, so, during summer, I have to keep the AC on at all times for him. Most people lower increase their AC temp while at work, but I have to keep it cool all day for my little one! Not to trigger anxiety in you, just being cautious! When the electricity went out during a summer storm, I added extra water to his home cooked and canned food to make sure he didn't get dehydrated...he is so lucky that you know him so well!!

Got it; more notes to add to my electronic FDMB notebook, thank you! Today's BG's have been low all day so I am glad I have the chance to test him quite frequently. You are so busy, so thank you so much for responding!

I tagged both you and Sienne in a response to Sue and Luci's inquiry for clarification on "depots", and today suggested she read the Updated post for new members. Luci is on a crazy roller coaster ride, keeping Sue quite busy!

I buy mine from Walmart: Reli On 31 gauge, 8mm, 3/10 ml/cc these show the half unit marks, but again, they aren't consistent as sometimes the lines are off on them. I usually buy the whole box, it comes 10 to a pack, but also bought a caliper for exact measurements. I will do a search and look for the calipers, I think Bobbie(?) gave me a link to buy them online???

 

Definitely looks like a cat who's getting tired of the juice!

 

Harbor Freight Tools
https://www.harborfreight.com/

you want the 4 " digital calipers.

 

@Sue and Luci and @Sienne and Gabby (GA) @Marje and Gracie @Stephanie & Quintus

Aha, Marje told me about calipers the first time but I was too overwhelmed with Dante's Dx, so it was over my head. This year, it was Sienne who gave me the sticky on calipers:

, there is a link inside the post to tell you where to buy them, fortunately, there is a Harbor Freight store about 30 minutes away and I went to buy it directly from them. With too many options of light boxes, I instead use the flashlight on my phone and cover the light with a small folded and taped, square of a scott towel as it is too bright; this works perfect for me. Sienne, Marje, Bobbie, Stephanie and others have all helped Dante and me get on the right track! I can't thank them enough!

 

@Sue and Luci

yes, that is it, thank you Bobbie!

 

We have a Harbor Freight right across the street - well it's a couple of miles...but it's on the other side of 41...so DH could run over to see if they have one in the store...otherwise I'll order this! And then I'll need to learn to use it - and what exactly I'm looking for on the syringe. I did go back to Walmart and although they would not accept the return of the unused, unopened box of syringes without the 1/2 line markings - they did have the 1/2 line markings so I bought another box. I can possibly use the '1' marks when Luci is not getting a fractional dosage - or donate...they won't go to waste.

 

Yes, good to hear that! Actually, with the caliper, I find that the markings are a nuisance, as sometimes they are crooked, unevenly spaced...so when I measure with the caliper, I measure from the side that doesn't have the markings. In this way, you can measure anything, from .12 (Dante's dose) to the maximum amount. Before donating the box without the 1/2 markings, try getting used to the caliper, you may find that the markings become irrelevant. Just allow yourself the time to calculate, calibrate and measure as it took me 10 minutes just to do that the first time, so you want to have the caliper calibrated before you have to shoot. Once you have it calibrated, you can lock it in place, so you don't have to recalibrate it every time; the lock holds very tightly. Since I am shooting fractions, I keep a note inside the box for the calibrations I should be using to match the amount I need to shoot. The sticky video has great instructions, and when you try it, the video makes even more sense. I realized after using the caliper, that I had not been giving the exact dosage every time. Also, now I squeeze the plunger several times before pulling the needle out to ensure every drop gets in. Having the caliper really changed the process of my shooting, more exact and using every single drop of insulin. In pulling out used needles from the coffee tin, I found there were still droplets left in the recent ones before I started using the caliper, now, none of my needles have any droplets left...then again, I may be showing some OCD here...however, it seems to be working so far... Good stuff, Sue!

 

What is this about? 'too many options of light boxes' ?

 

Ah, I went to Amazon to look for a small light box, and there were too many to choose from with varying degrees of light, so instead, I created my own way of having a light source underneath while measuring the insulin into the syringe. Having a light under the syringe makes it much easier to see the distance of the space on the caliper. If you notice in the video, Marje uses a light box; however, as the flashlight on my phone is too broad and bright, I needed a narrower band of light and less brightness. I folded up a small square of a scott towel and used tape to cover the square completely and use that to cover the eye of the flashlight on my phone, it works perfectly.

 

@Bobbie And Bubba
DH sent me this question:
Ask this person if they have ever considered measuring the plunger position. Once you know you have determined the correct amount of medication in the syringe, it might be easier and more accurate to measure the position of the plunger from the body of the syringe.

He's very familiar with calipers as he used them on his job measuring extremely fine clearances in machinery...I know nothing about them so showed him the syringe and what the issue is (the lines aren't always correct for fine measuring)...

Could you please reply to his question and advise?

Thank you1

 

Yes, that is exactly what I do, I have never worked with calipers; however, it was my assumption that the plunger depth must be taken into consideration while measuring the insulin. I have noted that not all plunger depths are the same, some 'give' more than others - each syringe is different, so I check the plunger depth on every one before I measure the insulin.

 

I bought the Artograph light tracer $41.99 from Amazon on Marje’s recommendation and it worked well.

 

Good question. First you want to find a syringe that is accurately marked. You do this by taking the plunger and with light pressure push up to the top. The zero line should be even with the top of the plunger. When you find that good syringe use it for you calibration. Then you do not have to worry about whether any of the rest of the syringes you use are marked accurately. Just ignore the lines on the syringe and use the calipers that have been set for your dose. When the dose changes either up or down then you would have to recalibrate your calipers. My DH did all my calculations and made me a cheat sheet with all the doses in increments of .25 and I could just consult my cheat sheet when and if my dose changed.

 

Aha, I have been checking the plunger depth of every one, so I guess I don't need to do that since my caliper is set already?? Does it matter if one syringe's plunger 'gives' more than another?

 

I don't think that matters. If you set the calipers according to a syringe that was marked accurately you should just rely on the calipers.

 

ok, gotcha' less work for me then! - my thought processes were that a stiff plunger would allow less extraction than a softer plunger as the softer one can be squeezed closer to the end, hah, must be my OCD, thank you for your patience!

 

I tend to try to over analyze too. You are in good company.

 

When DH was showing me where he 'would' put the calipers he was not referring to the cylinder where the insulin actually goes - he was talking about the distance between the 'shoulder' of the syringe and the bottom of the 'plunger head' - as I read your responses, it still appears that you're referring to the actual cylinder - not to the shoulder of the syringe and the plunger head - is that correct? He thinks it would be easier and more accurate to measure that distance once the syringe plunger is pulled up to the correct dosing amount - and not the inside of the cylinder itself (once you've set it to 1 u or 1.5 units) - what is the distance at that time from the bottom of the plunger to the shoulder of the sryinge? Whatever that distance is on your calipers is then your gauge for future dosing...

Since I don't have my hands on any calipers yet (he insists he has a digital calipers back in Michigan and doesn't want to go across the street to buy another one from HF - although I thought with the receipt we could return it)...I'm really talking out of my head - trying to translate what he's showing me and what you guys are saying about measuring... I saw the video -and it is very clear that they are measuring the cylinder - the distance from the top of the cylinder 0 line and the top of the plunger (inside the cylinder)...

Why do men have to do everything different?

 

I would have DH view the video too and ask him if his calipers are 4" which is what the board recommends for measuring insulin doses.

 

Yep, he did...I sent it to him and he watched...still asking me about the distance between the bottom of shoulder and top of syringe...I suppose if once we have the calipers the measurement is the same, then it won't matter - if the distance between the shoulder and top of syringe is xx and the distance inside the syringe is also xx - then if they are the same then the dosage should be set on that reading...one can only surmise (since one is without calipers to actually demonstrate the amount of insulin that's going to be extracted from the vial and held in the syringe)...sheesh...as if I didn't have anything else to worry about today...