Dose advice needed

Hi everyone. I haven't posted much lately for various reasons but I thought I should post and ask for some feedback about increasing Lucy's insulin dose. Our dosing schedule has been a bit disrupted lately due to my medical issues and appointments and other commitments which have been a bit unpredictable and have interfered with dosing consistency. In addition, a couple of very low glucose levels made me anxious and wary about increasing the dose. I decided to increase the dose today to 1.75 units though I have not held the dose for exactly 10 cycles at a time due to unpredictable events and commitments outside the house and a couple of times I gave a reduced dose rather than miss a dose, because I could not be home to monitor Lucy's glucose levels though probably everything would have been fine. The episodes of very low glucose levels in recent months have made me anxious. In addition, I started a new batch of syringes yesterday that has a reduced distance to the first line on the syringe so I think we could well have reduced the dose by 0.25 units due to the variation in syringes. Thank you for any opinions on dose and whether I should have held the 1.5 unit dose longer given the interruptions to our dosing schedule in recent weeks. I have also been wondering whether we should change to the start low go slow protocol as I feel remission of Lucy's diabetes is probably not likely at this point. But then you never know. I am trying to find a balance between Lucy's health needs and keeping her safe when my health and commitments might interfere with careful monitoring of her glucose levels at this time. If you look at our spreadsheet please see the world version as I need to add extra rows to the U.S. version it seems. Thank you.
My previous post:
http://www.felinediabetes.com/FDMB/threads/dose-increase-definitely-not-needed.145030/#post-1505197

 

Hi Voula.

I'm not good at dosing advice, but regarding the syringes, have you tried using calipers to measure the dose? Many here find them invaluable to keep it consistent. Failing that, if you still have one of your "good" syringes, I'd fill it with colored liquid to the correct dose and use it to measure the "new" syringes against. At least that way you know you're giving the same amount each time.

It's late on Sunday so there probably won't be anyone around who can help with the dosing for at least another three hours. Hopefully someone will chime in then.

Sorry to hear about your health issues. Switching to SLGS may make sense if you feel you can't monitor enough. You can always switch back when things settle down. The most important thing is to keep Lucy safe.

 

Hi Voula,
No dosing advice from me either.
But I can completely understand where you are coming from with trying to keep Lucy safe and juggle your own health issues and commitments.
Don't give up on Lucy possibly going into remission......you just never know!
I think you have to do whatever you think is best for you and Lucy in the current circumstances...and if you think doing the SLGS is the answer, give it a try. You might be able to find something inbetween the two at a later date which suits.

 

Thank you Tricia and Bron. I might buy some calipers as I find the syringes inconsistent from batch to batch so the increase of 0.25 units will really probably only compensate for the reduced dose from using the new batch of syringes. So I went ahead with the increase as I think it is needed but I wasn't sure as we did get some green numbers a while ago on 1.5 units. I have hesitated changing to the start low go slow approach as I am okay giving Lucy insulin at a reading of about 4/72 as long as I am home to monitor. I guess we can just continue the tight regulation protocol with some adjustments as I have been doing such as reducing the dose or delaying doses when I am not home to monitor as I do feel that reducing the dose when the glucose level is 5/90 and under as is done with the start low and go slow approach and also as outlined in Table 2 of Roomp/Rand might mean we would get even less green numbers than we do now as Lucy does have a lot of bouncing numbers after green and sometimes blue numbers. Most of the time I can do enough tests to do the tight regulation protocol but I am uncomfortable at the moment with my often unpredictable commitments to give Lucy insulin and leave the house all day without monitoring. This happened this morning and so I delayed the dose. I want to do the best I can for my Lucy and I worry that I am not doing the best for her because of the other challenges I have with my health issues and my anxiety and other commitments and so I feel quite overwhelmed at times. My Lucy is my heart and my whole world too. And remission could still happen as you said Bron. Thank you so much for your replies.

 

For years I used syringes that the markings varied a lot. When we had to measure smaller doses, I found that that variance was worrisome and started using calipers to keep the dosing consistent. Keeping Lucy safe is always most important and it looks like you are doing the best you can with your circumstances. You're doing a great job. That 1.75 dose did get her into some lower number a few weeks ago, so I would be cautious and keep up the testing like you have been.

 

@Bron and Sheba Sheba's numbers are looking good in between the bounces.

 

Is Lucy's SS up to date? I can only open it as far as the 12th of the month.

 

Hi Sienne. Lucy's spreadsheet is up to date on the world version but on the U.S. version I have to add some more rows. I don't know why that happened but I will try and fix it soon.

 

Thank you so much Dyana. Yes I think I will buy some calipers soon. The 1.75 units I have increased to now is using the different batch of syringes so I think it is basically the same as 1.5 units using the previous batch of syringes which had a larger gap to the first line. The 1.75 units that produced the 1.7/31 reading was measured with the previous batch of syringes that had the large gap to the first line so really that could have been equivalent to 2 units on the current batch of syringes which have a smaller gap to the first line. But I will be cautious and test often in any case. Sometimes I have thought that some batches of syringes vary anywhere from 0.25 to 0.5 units at the same dose. It sounds like you had similar issues. I think also I am quite hard on myself and I need to be gentler with myself more often. Lucy seems happy in herself and her quality of life as far as her diabetes goes seems good. In some ways I am more worried about her arthritis than her diabetes.

 

I could only open it up to the 12 th as well on the world version

 

I can see up to the 19th on the World version.

 

I can still only see up until the 12th on world version......sorry. It just won't move past that date. I have tried several times to get it to do so. Don't know what is going on....don't think it is your fault Voula.

 

Thank you Dyana and Bron. I will try to fix the spreadsheet tomorrow. When I view it and amend it it is fine on the world version but it says to add more rows on the U.S. version. Thank you again.

 

It was fine on the world version for me, as well.

 

Hi Voula. Sorry you are having issues. Do get digital calipers. I'm using up my syringes with accurate markings first and I have three boxes with crazy ones. I still use calipers that help except for the darn bubbles which I have to adjust for. When I switched syringe brands the relions held much more than the terumo and it took some time to get the dose right so that could be part of the issue. Feel better.

 

Where do you buy the calipers?

 

I got mine from harbor freight but I'm in the U.S. They were just $15. I think you should be able to get some from a hardware store. They are on sale there for just $10. Look for some like this.
http://t.harborfreight.com/6-inch-digital-caliper-47257.html

 

In regards to syringes, please remember the length and gauge of needle and barrel size will make a difference on the markings of the barrel.

The marks on 5/16" needle on a 3/10 cc syringe will not match the marks on 1/2" needle on a 1/2 cc syringe. So 2U would show very differently and could be a costly mistake.

Have to be careful and make sure you are using the same type and brand of syringes.

 

Thank you Elise for telling me about your use of calipers and also for your good wishes for my health too.

 

Thank you. You make some good points. I am using the same brand and type of syringe with the same needle length and it is just the batches that are different. It really is very obvious with some of the batches that the dosage of insulin must be affected by the differences in the marking of the lines and I can understand that when dosing for people these small differences in the lines on the syringes are not an issue but they can make a big difference when measuring doses for cats or for small children too.

 

I have updated the spreadsheet now so any advice about dose is most welcome thank you.