? Need advice whether/what to shoot

Hello, I'm moving my thread started in the main forum over here as I've had a tricky day with Ruby with her first low numbers. Have just done a +11.5 test (spreadsheet below) and would really appreciate any advice as to tonight's dosage. She's def moving in the right direction but wondering what's going to be safe. Will also add I currently don't have the means to accurately micro dose. Have BD syringes but in Australia so only 1u markings. Thanks.

 

Here is a link to your condo (thread) on the Health forum, for those that would like to see what has been discussed already. From your spreadsheet, I see that Ruby is on the rise. Are you able to monitor for at least 3-4 hours after the shot tonight? I'm guessing she is going to bounce, but there are no guarantees.

As for shooting a half unit dose with syringes that have one unit markings, we recommend you decide what looks like a half unit and draw up some colored liquid to that point. Then you compare each dose to that to be sure you are shooting the same amount each time. Pinpoint accuracy is not necessary - being consistent is more important.

 

Thanks so much Tricia for posting my thread across (still trying to navigate my way around this site). Yes I'll be able to monitor her tonight post shot. I'll do up a coloured eyeball dosage add you've suggested. I'm wondering if 1u would be appropriate tonight or do need to close the gap to closer to 2u? Just going to do pmps now (if she'll let me... starting to get pretty over it and telling me! )

 

Okay we have a pmps reading of 144. I'm thinking I'll try for a 1.5u?? What do you think? Thank you!

 

Sorry, Fiona. I got immersed in some banking stuff.

Did you shoot? I would have recommended you do 1.5 (or the closest you could get to that).

 

Here is a post we put together to help new members get comfortable with posting on our Board. Kind of like a FAQ. Ask lots of questions, and read all the stickies, Fiona. There's a ton of info here, and it will take a while to absorb it. I'm still absorbing it, after 6 years!

 

Phew, I'm glad you liked 1.5u coz that's what I went with. I'll do another test soon (+2) and see how my girl is doing.
Thanks again, I'm just blown away by the amount of amazing support and good will here. Yes it feels like information overload at times with my brain feeling like it's going to explode! Need to take it in at measured doses for myself.

 

Well I'm afraid I won't be up when you get your +2. I'm a night owl, but it's 3:15 am here and I'm about ready for bed! But if you have any questions, change your subject line to reflect the question. Some of our East Coast US members should be around.

If she's still going up at +2, you can probably grab one more test (+3 or +4, depending on how late you want to stay up) and then call it a night (assuming she doesn't pull a fast one and head down).

We're all in the same boat, pretty much, and those of us that have been here a while still remember what it felt like to be new, confused and scared. Someone helped us then, so we return the favor. It helps all of us to help each other. We're like a family, really. We all love kitties and want the best for them - ours and everyone else's.

Speaking for myself, I learned so much here that helped my other kitties, as well as my diabetics. Cinco would have died if I hadn't found this site and learned how to deal with his FD. Instead we got five more years with him until cancer took him. And I knew what to look for and caught Harvey's FD early because of what I learned here. It would take me forever to list the ways I have benefited from this Board. We call it "the nicest place you never wanted to be."

 

Wow I didn't realise it was so late for you! Thanks for tracking with me for these hours. I doubt I'll get another reading in after this one....completely buggered after today on top of the past couple of weeks. But I'm hopeful things will be okay. Sleep well!

 

Hi there and Welcome to Lantus and Levemir. Looks like Ruby is in bounce mode so momma can get some rest. Glad you found this forum, this group is so helpful and so much information. Keep posting and asking questions as that is how we all learned.

 

Looks like she's going to bounce for you tonight, which isn't a surprise

One nice thing about it though....you can safely go to bed!!! If they have to bounce, doing it at night is the best time!!

 

Thanks, happily hitting the sack and hopefully tomorrow will be really predictable and boring Thanks again for your reassuring experience.

 

Hi Fiona and Ruby!

I'm in Sydney, and I understand you want to get some 1/2 unit syringes. I get mine from Hyperdrug UK: they arrive in about a week or so. These are the ones to get: BD Microfine Insulin Syringes 0.3 ml Item Number: BDMICROFINE03ML, webcode D7118

I couldn't see the dose to get without a magnifying headset, so I got this one on ebay: http://www.ebay.com.au/itm/Headset-...e=STRK:MEBIDX:IT&_trksid=p2057872.m2749.l2649

Just extra info, most of which I'm sure you have already:
I get my cat food delivered from www.petstock.com.au ; https://www.mypetwarehouse.com.au/ ; https://www.petcircle.com.au/ and also https://www.petbarn.com.au/ I buy in bulk when they're having sales. Petstock has sales pretty regularly.

The best source of info for carbs in cat food is Dr Lisa Pierson's chart. Here's her post with good info and a link to the chart: http://www.felinediabetes.com/FDMB/threads/dr-pierson-new-food-chart.174147/

I've attached highlighted lists of the FancyFeast we can get here in Oz. Some of the names will be a little different; let me know if you have any questions.These are the Fancy Feast I use for Girlie:

• Low carb: Classic Savoury Salmon Gourmet (LC 1); Classic Ocean, Whitefish Tuna Gourmet (LC 0); Classic Cod, Sole, Shrimp Gourmet (LC 1)
  
• Medium carb: The Classic Grilled Filets: Prime Filet of Beef (MC 12); Prime Filet of Chicken (MC 12); Prime Filet of Salmon (MC 13); Prime Filet of Turkey (MC 13); Grilled Ocean Whitefish & Tuna (MC 13); Grilled Tuna (MC 14) - and see others over 11 and under 15% carbs I've highlighted in the attached.
• High carb: Use when in danger of a hypo, etc.: see ones over 15% carb on Pierson's list that I've highlighted

And welcome to this wonderful forum!

 

Hi Darrah & Girlie!
So nice to meet you both, I'm down in Ballarat, Vic. Thanks for all the info it's all really helpful and I'll source the syringes from the UK mob you've mentioned (it baffles me we can't get these in Oz). Have you ever used the insulin ruler for BD syringes? If so how did you find it?
Thanks for the food source guide too. I'm currently feeding selected Cats in the Kitchen from Petbarn, which looked to be a pretty good composition based on Dr Lisa's research. Luckily I don't have a fussy eater (at all!) She vomited it all up this morning though (unusual) so I've topped her up and done a +1.5 test and she seems okay. Feel like I'm playing a game of Russian roulette!

 

Also Darrah, do you know how we factor in daylight savings time change to our cycle? Do we just edge back /forth over a couple of days? Gosh each day and a new conundrum!

 

You edge back/forth 15 minutes per shot or 30 minutes a day.

 

Fantastic thanks for that Tricia!

 

Hi Fiona and Ruby,

Lovely to meet you. I live in Sydney and will help in any way I can.
Chris asked if I could help with the ruler but I have had no experience with that sorry but I do know someone who has. She is not here often but I will PM her and see if I can contact her.
Darrah has given you lots of good Australian information. I use the Cats in the Kitchen cans sometimes too and liked them.
The 1/2 init marking syringes are great so if you are able to order those, they are worthwhile.
And I believe the calipers are good too, but I never had to use those.

You did well yesterday managing the low numbers. Do you have some MC and HC foods as well as honey at home in case you need it. Best to keep it somewhere in the kitchen so you can get it quickly if needed.

I agree with everyone that giving the same dose night and morning is the correct way with Lantus.

Again welcome. Keep asking lots of questions. Knowledge is power and while it may seem overwhelming at the moment....it will soon be old hat.

Bron

 

Hi Bron!
Thanks for your warm welcome and lovely to meet you too. It's great to know there's so much support around and I appreciate your efforts in trying to seek out some advice on the ruler...maybe the 1/2 unit syringes will be enough but it would be good to understand the ruler application for back up.
Thanks for the tip with having some HC food available. I was about to donate a slab of Hills r/d to the rspca coz it was too HC (bad advice from previous vet) but I might just keep a few cans for low bg readings!

 

Do you mean r/d or m/d?

 

Hi Fiona! I'm on the Central Coast NSW, nice to see another Aussie here

My girl is OTJ now but I used the ruler when we were still giving shots. If you haven't already found it, you can download it here. I printed it on photo paper so it was a bit more stiff, and make sure you print it at actual size with no scaling. Cut it out very carefully to make sure it's straight (I used a craft guillotine).

(This part is a copy-and-paste of instructions I wrote to my cat-sitter): To use the ruler, insert the syringe into the insulin cartridge and hold it so that the needle is pointing upwards. Then butt the insulin ruler card up to the collar of the syringe (the bit that sticks out just above the 0 line) in the 1.0u (or whatever) measurement section of the card. Move the plunger down so that the middle of the stopper is at the line of the 1.0u line on the card (see diagram below). It’s only a tiny amount, so it’s often easier to twist the plunger down instead of pulling it, as it can go too far that way. I used velcro to stick the insulin cartridge to the fridge at eye level, that way you have one hand for the ruler and one hand for the syringe - makes it a lot easier!

Hope that helps, please do let me know if I can be of any more help - I'm not on the board that much these days but I'll get a Pm or a tag in my email

 

It's always a good idea to have multiple cans of both MC (10-16 %) and HC (17% and above) on hand in case your kitty decides to throw a pajama party (that's what we call it when they go low late at night and you can't just run out for supplies). We also use MC sometimes to steer the numbers when kitty is dropping too fast too early in the cycle. There are lots of strategies used here!

 

Oh I just had a thought, let me know if you want me to take a photo of the syringe with the ruler so you can actually see how to use it - I'm heading out for a few hours now but can do that this afternoon - I still have the ruler, I'm sure I still have some syringes hanging around, you'll just have to imagine the insulin in the pic

 

Thanks for answering my SOS @Tara & Ivana!!

 

It's r/d because initial vet advised there were signs of some ckd and we had to support the kidneys...but after some research here I decided best to get diabetes under control, which new vet also supports.

 

Hi Tara
Thanks sooo much for your posts and welcome they are so helpful and good, clear instructions given. If you can be bothered to take a pic of demo that would be great, I think I've got the concept...but to be sure, to be sure! So glad to hear your beautiful Ivana is otj. Ruby and Ivana (Russian Blue??) look like they could be sisters.

 

Here's the pic Fiona. Note that this is NOT the syringe you'd be using, these are ones I ordered by mistake and didn't actually use - so ignore the 0.5 mL/cc on it.



This is measuring a 1.0 unit dose, and you can (hopefully) see that the top of the ruler is up against the collar and the middle of the plunger is lined up with the horizontal measuring line. If ever you end up doing fat or skinny doses, then line up the top of the plunger to the measuring line for a 1.0 fat, and line up the bottom of the plunger to the measuring line for a 1.0 skinny as below (left is fat, right is skinny):

 

So you're wanting a low carb, low phosphorus diet, I assume. We have a number of people here whose kitties also have CKD, so you're in good company.

 

I woke up this morning to the same dilemma! What you have to do is move your cycle. You can either move 1/2 an hour at ONE time during the day (e.g. shoot at 6:00 am (rather than 6:30 am) and then 6:00 pm), or you can move 15 minutes: shoot 6:15 am (instead of 6:30 am) and then 6:00 pm. But you don't want to move more than a 1/2 hour in a day. Here's a link explaining this:

Getting back on schedule

 

I printed out and laminated the ruler, but I must be all thumbs compared to everyone else, because I never could manage to keep the ruler from moving while I was trying to get my dose - it was just too hard basket for me, so I eyeball the 1/2 unit syringes using my handy-dandy and ultra-chic magnifying headset. But I can see that lots of people have given you good suggestions on how to use the paper ruler already. Let me know how you go!

I like the idea of it, though, because the syringes themselves can vary even slightly. I've attached the Management of diabetic cats that has wonderful detailed info on this and the TR and SLGS protocol fyi where they talk about how much variance there can be between individual syringes. I'll have to really get my act together and try this; note to self: get more thumbs.

 

That would make you a polydactyl!

 

Ahh I get it!! This is brilliant, thank you so much because the way I had it in my head was different. I'm going to definitely give this a go. Much appreciated Tara.

 

Thank you Darrah! Yeah I've missed the boat today with adjusting her cycle (this year's DLS completely caught me by surprise) so for Ruby it starts tomorrow! I somehow don't think she'll suspect anything.

 

Yes I may well be the same! But I'll let you know how I go when I get my 'lab' set up! There's no way I'd be this far without Tara's pic to make things clear. If I learn any clever tips I'll be sure to pass them on.

 

It definitely takes practice! I'll get hubby to take a pic of my hands actually holding everything (minus the actual insulin), that might help

My Ivana also has CKD. If you have a look in my signature at the Aussie Food & Supplies List, this is info that I put together last year of food available in Australia. Most of it was by directly contacting the manufacturer, and some was already online. It lists the carbs and phosphorous levels - you already know about the carb levels of course, and for the phosphorous it's recommended to keep the levels below 200mg/100kCal for CKD kitties. There is actually quite a selection that fit low carb and low phos, although obviously kitty's tastes come into it. It's a bit crappy that BFF is still recalled though...

 

Yes my new vet is a bit suspect of just how afflicted she is with CKD at this point due to non-conclusive evidence from other vets history...we're just trying to get the FB under control (with the theory this will help the kidneys). But I've tried to choose wet food that can tick as many boxes and at the moment feeding Cats in the Kitchen: La Isla Bonita & Lamb Burgini (but will replace this with Chicken Frickazee when more arrives in Aust.)

 

Just remember re: the carbs and phosphorous levels: they can change pretty quickly if a company decides to change their formulas, which is not unusual for them to do. Wellness just did this, so the phosphorous levels listed in Dr Pierson's chart for the Wellness foods are no longer accurate: they're much, much higher now. Because Dr Pierson got the info for 2017, the other foods should be pretty accurate, but I'd double check with the company or against another list. There's a great CKD site that lists phosphorous levels, but much of it is probably out of date by now, unfortunately. You'll have to check the dates when the values were actually gotten and whether the company has changed their formulas since then.

 

Photo of the insulin ruler in action. It seems hubby is not a good photographer because it's blurry and doesn't even show both my hands haha. Basically, those two velcro dots are stuck to my fridge at eye height. I had another two velcro dots on my Lantus cartridge, and just stuck the cartridge to the fridge so that I didn't have to hold it. My left hand (that you can see) is holding the syringe up against the ruler with both of them between my thumb and fingers, and my right hand (that you can't see) is pulling the plunger down to get the correct dose.

 

Thanks for this, I'll have to go and redo the Wellness section of my spreadsheet.

 

You and hubby done good! I'm off to Officeworks to get my ruler laminated and will give it a go tonight. I think this is going to be important to fine tune Ruby's doses, already showing signs (for what little I know) of needing further tweaks. Just got 4.2 at + 6 test so keeping an eye on her today ( dropped to 2.6 on Sat so these numbers are making me a bit nervous Nelly).

 

Hey Tara! My problem is that I always get air bubbles - always. I've never managed to just draw an exact dose. I always draw more than I need and then flick and flick and flick and do what I need to do to get rid of bubbles, and then try to get the right dose. If there's a secret to this, I'm all ears!

Oddly enough, if I go over the right dose and have to draw insulin again, for some reason I don't seem to get air bubbles - no idea why. I hate using the same needle twice to draw a dose, but I often do...the mysteries of trying to draw an accurate tiny dose...sigh...

 

Hmmm, I'm afraid I have no suggestions for the air bubbles as I never had an issue with them (perhaps I was just super-lucky?!). Maybe instead of pulling the plunger down, try twisting it down - it will be slower, but it might mean less chance for air bubbles to form? Not sure, just putting it out there

 

I've tried the twist thing - no joy. I guess I'm just a bubble magnet!

 

I'm exactly the same, flick away and that bubble just stays in the neck of the syringe. I wish I had an answer. I'm working on the theory that the bubble sits above the very top line and if it's always there I'm giving a consistent dose.
Also started using the ruler and it's fantastic. I feel like I'm finally able to give some accurate and consistent dosing. I've actually blutacked my ruler to the inside of my cupboard door (fridge isn't high enough for me). I then insert syringe into cartridge and rest the collar of syringe on top of ruler. Draw a slightly higher dose, then remove cartridge so I've just got the syringe against ruler and measure exact dose. Is working a treat.

 

Are you talking about Tanya's site - felinecrf.org? She updated her list this year, too. She actually published a booklet with the list in alphabetical order. I have one, so if anyone needs me to look up a particular food, let me know.

 

Yes, thanks so much!

 

@Tara & Ivana and @Fiona & Ruby : I've been testing an old syringe with the ruler strips. Currently, Girlie's been getting 0.1, which is a tiny amount. But it looks like it's just a big drop of insulin. I just find that the ruler vs. the markings on the syringe - even up to higher numbers like 5 units - are clearly, clearly so different. Are you finding that the case, too? Tara, as you went OTJ, you must have given tiny doses like the 0.1 Does a fat drop sound like 0.1 to you? I'm just wondering whether I'm measuring correctly... if I am, then the doses that Girlie has been getting are nowhere near what I thought they were!

 

Hi Darrah, yes I was blown away with the disparity between the ruler and the syringe gauge. What I thought was 1.5u eyeballing on the syringe turns out to be 2.0u on the ruler! Oh just a whole 1/2 unit out, not that big a deal...OMG. Using the ruler I now feel like I'm giving consistent dosing each time and the 1.5u on the ruler seems to bringing in some nice blue numbers for my girl so I'm feeling so much more at ease. Also, re the bubbles in the syringe, do you shoot air (the dosage you're going to give) into the vial before drawing up the insulin? Read a sticky on LL that days not to do it, however, also read another thread (sorry didn't copy it ) that included instructions from Lantus that says to do this. I've since been doing that and drawing a bit extra insulin to get exact reading and the combination of this and expelling the excess seems to eliminate the pesky bubble...hope this helps.

 

We have always been told not to squirt back into the vial or cartridge, as you risk contamination. Better to expel the air or insulin outside the vial or cartridge.

 

Mmmm was getting excited, thought I'd found a solution. Perhaps not. Just did some further skeuthing and read that it's imperative to press the plunger firmly when inserting into vial and before drawing dose. Maybe that's the key for bubble ridding @Girlie's mom ??

 

Hi Fiona,

I had a whole drama with the Lantus cartridge before I realised I'd been doing everything wrong from the start and opened a new cartridge. You do NOT put air in if you're using a cartridge (as I'm doing: 3 ml cartridge): you only put air in if you're using a big vial. I confirmed this with experienced people after I watched the video on the sticky re: lantus and drawing doses, which is when I realised I'd been stuffing things up big time by putting air in AND squirting insulin back into the cartridge.

I had been seeing really awful numbers and saw a dramatic change when I switched to a new cartridge and started drawing doses properly. I just draw a larger dose and then get rid of bubbles and get to the right dose carefully by expelling what I don't need. I don't care about the wasted insulin at this point!

I do this now, too, but still have bubble issues. One thing I also hadn't been doing, but do now: I make sure that I have the plunger firmly depressed before I pull the syringe out of Girlie. I'd been inadvertently leaving a drop of insulin in the syringe by not doing that, and a drop is a lot for a cat not to get!

 

I just took a look at your SS and saw that you've decreased from 1.5 Units to 1.3 units even though you've only been getting AM and PM pre-shot numbers. I assume that you're at work all day (like a normal person!), and that that's why you haven't been able to get any tests in in the middle of the day. I just thought I'd mention this - I'm sure others have already - but dose changes in Lantus aren't based on AMPS or PMPS: they're based on how low the cat goes after the shot. Are you able to get any more tests in during the day this weekend or at least a +2 or +4 at night during the week? That will give a better picture of what Lantus is actually doing for Ruby.

I am guessing that on 4 Oct Ruby probably went to a low number that's unfamiliar, and that's why the bounce at the PMPS to pink and then the bounce up to yellow at the AMPS. I assume that you're doing the SLGS as you're not able to test much - is that right? It would be great to see some more numbers in there if you can manage. I'd rely on more experienced people to give you dose suggestions, but people won't be able to give much advice if they can't see more data and know what the Lantus is actually doing during the cycle. I'd like to see more experienced people chime in, but those are my two cents. What do you think?

Also, if you do decide to post again, could you create a new thread? It's generally easier to follow how a cat is doing if we post a new thread every day with a link to the previous day's thread.

 

Hi Tara - here's the post with the info re: new Wellness phosphorous levels: http://www.felinediabetes.com/FDMB/threads/wellness-complete-health-is-very-high-phosphorus.182879/

 

Thankyou! I emailed them a week ago and I still haven't heard back...

 

I can still get some of the old Wellness from my local Petbarn, so I'm trying to stock up on them while I can. It's really a challenge to find food that's okay for a diabetic cat with CKD here in Australia, isn't it? We just don't have as much choice available to us as in the U.S.

 

Yes I'm working full time, just had some holidays which is why I could do some testing during the day. But good idea with the evening tests.

 

Nighttime tests can be very valuable - many cats actually go lower at night than in the day.

 

I've been lucky so far to still be able to be at home post-ankle surgery so I can get the day tests in. I'm dreading going back to work full-time: I think I'll go a bit nuts not knowing how she's going through the day! Fortunately (or unfortunately), she tends to go low during the day. I'll figure how to work it out somehow... It's hard to have a diabetic cat when you have to work full-time: that's my verdict, at least...