Info Preventing over doses

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Jill & Alex (GA), Jun 10, 2016.

  1. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Yesterday, we saw 3 kitties mistakenly over dosed in a single day. I've never seen that happen in the 10 years I've been a member of the FDMB. Mistakes happen and always will, but it got me thinking. The intention of this thread is not to blame, single out, or point fingers but rather a means to gather ideas to help prevent over doses from happening in the first place.

    I wonder if there are methods we can share that have safeguards built into the routine... safeguards for the whole test, feed, shoot system we use everyday. After all, there are so many distractions on a daily basis. On a good day most of us are multi-tasking. I also remember instances of being so over-tired that my eyes could hardly focus when drawing insulin into a syringe... especially in the morning. I am so not a morning person and my eyesight isn't the best any more!

    This was my routine with Alex:

    1. After giving the PM shot, every night I would place 2 syringes for the next day into a little red cup.
    2. In the morning, I drew the appropriate dose into one of the syringes and checked the amount of insulin drawn.
    3. I carefully recapped the syringe and placed the filled syringe (needle side up so the needle won't clog) back into the cup.
    4. I prepared her meal, meds, etc.
    5. I tested her blood glucose.
    6. I fed.
    7. I checked the amount of insulin in the syringe (for the second time). Gave her shot.
    8. I disposed of the used syringe. The remaining syringe in the cup was left for the PM shot.
    Using the cup system was good for me because it was a visual reminder. It gave me an opportunity to double check the amount of insulin I was giving, the insulin had about 5 minutes to come to room temperature, and I knew immediately if I forgot to give a shot.

    Let's keep this positive. What's your system? What works for you?
    Please share if you think it might help prevent over doses from happening. You never know. Your routine or even parts of your routine may resonate with others.



     
  2. Madrona and Leda

    Madrona and Leda Well-Known Member

    Joined:
    May 4, 2016
    Like Jill I check my syringe volume at least twice: when I fill it, and again just before I shoot. To be sure it is right I count the bars (markings) down from the top--it I used calipers my routine would probably be different, but the counting makes me feel secure that I've measured correctly.
     
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  3. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

    Joined:
    May 18, 2016
    If there is more than one person in the household who gives shots. Designation means making sure everything is clear, and always ask each AM and PM if the shot was given, how much, and when. And tell if the shot was late or was a possible fur shot. Communication is key. Until recently, my DH did the AM shot and I did the PM shot (I'm not a morning person).
     
  4. Amy&TrixieCat

    Amy&TrixieCat Well-Known Member

    Joined:
    Feb 14, 2011
    Now that you mention it, Jill's "two syringes in a cup" method sounds like a a great way to reduce the risk of double-dosing a cat when there are two people in the house who are doing shots.
     
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  5. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    I wonder if color coding the cups (and labeling with the cat's name and current dose) if there are multiple diabetic cats in the house would be a workable idea.
     
  6. Doodles & Karen

    Doodles & Karen Well-Known Member

    Joined:
    Jun 2, 2015
    Double check and recheck. Before T/F/S I get the syringe and place it on the paper towel in the designated spot. Test, feed the beast, draw the dose...check, double check and shoot. My designated spot is right next to the sink so after he's done eating I wash the bowl and the syringe is there. When finished I clean up and reorganize the dedicated spot.

    Yesterday was pretty scary but luckily everyone caught the mistake and there were no tragedies.
     
  7. mucacopatarica

    mucacopatarica Well-Known Member

    Joined:
    Apr 22, 2016
    I usually fill the syringe (and i have a lot of work with that because i try to deport every sigle buble, even micro ones) Than I close the syringe and postpone it on a shelf. Than I gave her food (which I prepare earlier in 20min gap) and than check syringe again and than I shoot (this is all in 5 minutes) I am very sleepy sometimes in the morning but because i test her at least 20min earlier (these 20min i have if result of testing would be too low and if i should consider about the shot) my head is cleared enough (i hope so) when I shoot her.
     
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  8. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    Having a reference syringe for a substitute shooter may be helpful (so you can't confuse 1 unit with 10 units as my friend did .. to the tune of over $2,000 in emergency vet bills.)
    An administration log (your spreadsheet, perhaps or a paper log posted if multiple shooters) where you enter or initial it after shooting could help.
     
  9. Jan Radar

    Jan Radar Well-Known Member

    Joined:
    Jun 27, 2015
    The use of calipers at our house is our biggest safety net. When the dose changes we both check and double check to make sure the measurement is correct and the calipers are set correctly. We also use a magnifying glass to be triple sure. We also have a household policy that at shot time we don't have other discussions or projects going on that might distract us. Everything is all about the kitty for those few minutes. :cat:
     
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  10. Sandy and Black Kitty

    Sandy and Black Kitty Well-Known Member

    Joined:
    Dec 31, 2009
    I used both Lantus and R for quite some time and needed to be sure I didn't mix them up. Additionally, to reduce the number and frequency of fur shots I was experiencing due to serious tremor of Parkinson's (undiagnosed at the time), once the Lantus dose got larger than about 7u I had to split it into 2 syringes So 2 insulins and 3 syringes every 12 hours with ever changing doses.

    I would first place one sticky note for each syringe on the counter. Written on each was the insulin and dose. I would pull the Lantus doses, return the vial to the fridge and then pull the R dose and return the vial to the fridge. As each syringe was filled it was placed on the corresponding sticky note. A quick cross check and then I'd shoot.

    It was a bit tedious however it worked. The panic of " did I shoot 13u R and 5u Lantus instead of the other way around" never entered my mind.
     
  11. Marje and Gracie

    Marje and Gracie Well-Known Member

    Joined:
    May 30, 2010
    Although Mike could easily give shots, if I was home, I was always the designated shooter. I agree with Jan that using calipers really helped us to avoid not giving the correct dose. After I drew the dose, I’d look at the syringe and note where the insulin came to for “eyeballing” purposes. Even with calipers, I would double check the dose and then right before I shot, I’d look at the syringe again to ensure the dose was correct and was where I had eyeballed it after pulling it up.

    We also used “R” and would only pull one insulin out of the frig at a time and always levemir first. I had two sets of calipers; one was for the levemir, one was for the R. So I would get my levemir caliper and my levemir insulin out and draw that dose first, double check it and note where the insulin level was in the syringe, put that all away, and then pull out the R insulin and R calipers and draw that dose and do the same thing. Then before I shot, I double checked both syringes and would give the lev dose first followed by the R.

    Great idea to do this @Jill & Alex (GA). Thank you.
     
  12. Melanie and Smokey

    Melanie and Smokey Well-Known Member

    Joined:
    Feb 24, 2010
    We do this too. The only time he shoots when I am home is when I am asleep and neither of us shoot if we get up after shot time until we confirm the other hasn't.

    Before taking preshot tests, I lay 2 syringes on the counter. That way if I get distracted with testing, feeding, etc, I know if those syringes are still laying there unused I've forgotten shots. I draw insulin for both boys at the same time and double check the syringes after its been drawn since their dose differ significantly. I lay them back on the counter together. Once I have Lincoln food ready to go in his feeder tray, I put his syringe into an empty slot of his tray. I always check the amount of insulin in the barrel again before I shoot. Not only could we be tired, but the syringe could be bumped between the time we draw and shooting and we've lost some of the insulin we needed.

    With Percy coming and going to 2 different insulin in the house, it worries me more about mix ups. The cup system sounds like it might help keeping syringes straight. I been thinking the last day about ways we could make those U40 and U100 clearly marked even to a tired, half asleep person.
     
  13. Olive & Paula

    Olive & Paula Well-Known Member

    Joined:
    Sep 6, 2015
    I have a washed out container, like the one potato salad from the deli. It's a tall one. The current pen or vial in use is in. I get up, pull the container out and any food in the fridge out and sit it on counter. Then I set up the test spot, which is a throw rug on my table, meter stuff next to it. Insert strip part way, Put Smokey on rug, push strip in to turn meter on. Poke, get reading. Put Smokey on floor. Immediately write reading on hard copy ss (or I would forget it) which sits on top of my toaster. Nuke my water for tea, put tea bag in to steep.

    I use calipers that lock. I have a piece of paper in case that has the current number on it that the calipers should be set at. I check to make sure calipers are set at proper measurement. Start drinking my tea. Then weigh out Smokey food, add the zobaline, put food in civvies bowls. Smokey gets his bowl first or he would steal others. Put other two bowls in their spots. While they are eating I pull up the insulin just past to what I need. Then use calipers to get my dose. Then give injection while he is still eating. By now my tea is cold and gets reheated. My hubby only gives injection when I'm not home, and he usually gives less than I tell him.

    If I had multiple cats, each cat would have their own container and own pen or vial in it. Their name would be on container. A card with their name on it, amount of insulin, caliper setting (each cat would probably have own calipers, to make it easy) with their name on calipers in the container. Once cat gets its insulin their container would go back in fridge. Then next one would be done and their container back in fridge, the next cat. Since monoject syringes are individually wrapped you can mark each one AM and PM and after the PM shot put new ones still in their wrapper in container for the next day.

    Great idea Jill. I was wondering what was going on yesterday (full moon, Friday the 13th, Murphy's Law etc.).
     
    Last edited: Jun 10, 2016
  14. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014
    I keep a written chart of daily doses and nadirs. The first thing I do after testing in the morning is record the two tests and look at the numbers from the day before. Then I fill the two syringes one for each kitty, double checking each measurement. Since Tuxie is on the higher dose, his shot is done first. If I were to give the wrong syringe by accident it would be a much smaller dose than he is supposed to get. After the shot I mark on the records the position of the shot..abdomen or flank...the the next kitty gets hers.
     
  15. Melanie and Smokey

    Melanie and Smokey Well-Known Member

    Joined:
    Feb 24, 2010
    Oh, I also put a log on the fridge showing the date of dose changes so that its easily seen when opening the fridge for the insulin what the current dose it. We'd been missing communication on the dose changes. Having it on the fridge means no one can get to the insulin without seeing the correct current dose. Its also there for petsitters and if something came up suddenly and we had to have someone else come in without being able to leave instructions, the dose information is there.
     
  16. Vyktors Mum

    Vyktors Mum Well-Known Member

    Joined:
    Nov 15, 2011
    I have a sample syringe filled with coloured water of the current dose that I use to measure against the dose I am drawing so I can't go wrong on dose. I also keep a paper diary for Vyktor that I enter the BG levels and shots into straight after they're done (as well as every other whisker movement throughout the day lol). I think a paper diary or whiteboard or some other similar method would be especially useful if there are more than one caregivers.
     
  17. Tricia Cinco(GA) & Harvey

    Tricia Cinco(GA) & Harvey Well-Known Member

    Joined:
    Jul 18, 2011
    When Cinco was diagnosed and we started giving him insulin and testing at home, I bought a pack of small spiral notebooks (the kind that flip at the top). When we test we put the date, time, + or - from shot time, and BG on the next available line. When we shoot, we put PMPS/AMPS and the dose amount instead of the + or -. DH does 90% of the shooting and I do 90 percent of the testing and all of the SS entering. This way we always have a record at hand of what was shot when and how much, plus his BGs.

    When Harvey was diagnosed, he got his own notebook and we continued the practice. We had to write their names at the top of each page to be sure we kept them straight.

    Regarding the syringes, DH would draw up one dose, put both the top and bottom cap on it, and set it in front of him on the counter. Then he'd draw up the other dose, put the caps on, and set it in a different location on the counter. He'd bring in Cinco, put the food in front of him, test, and if he was eating, check the dose and shoot (he was always eating). He'd then clip the needle off the syringe and throw it away. Then he'd repeat the process with Harvey. When he was done, he'd check to be sure there were no syringes on the counter. That last step saved him a few times when he forgot to give the dose!

    Great idea to do this, Jill! :)
     
    Last edited: Nov 19, 2016
  18. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

    Joined:
    Feb 17, 2011
    One more thought for those who are using a second insulin (R) along with Lantus or Levemir. It can help to put something different on the R vial. Wind rubber bands around it so it has a tactile feel that reinforces that this is not your Lantus or Levemir insulin.

    We kept the Lantus vial or pen in a cup in the fridge on the back of a shelf and kept the R insulin in its box in the butter compartment.

    It's also important to take reductions if the cat earns them by dropping below the reduction point for the glucometer/dosing guide you are using. Choosing to not take earned reductions increases the risk of a cat becoming overdose and bringing on a crisis.
     
  19. Tara & Ivana

    Tara & Ivana Well-Known Member

    Joined:
    Aug 20, 2015
    Our TFS routine was almost always done by both hubby and I together. I would test Ivana, then feed her and draw up her dose using the insulin ruler. While I was feeding/drawing hubby would enter her number into her spreadsheet, and then ask me what dose she was getting so he could enter that too. This worked as a sort of confirmation of dose I guess, because if I said a weird dose then he could immediately see it was wrong. Then I'd hand him the syringe and he'd do the shooting and I'd do the posting here. It worked really well for us, and we never once (that we know of) either missed a shot or gave an extra shot.
     
  20. Voula

    Voula Well-Known Member

    Joined:
    Sep 15, 2014
    I draw the insulin into the syringe and place the syringe on a plate with the needle over the edge so it does not touch anything and remains clean or you can put the needle cap back on. I take a photo with my iphone zooming in onto the syringe and this helps me also to see that I have the correct dose as we don't have half unit syringes here. The iphone records the time and date of the dose and I can clearly see the dose on the syringe in the photo. I check the dose again before giving my Lucy her insulin to be absolutely sure and safe. I also put the syringe and lancet and test strip into a small container as a reminder that I gave my Lucy her insulin dose. This discussion is a great idea. Thank you.
     
  21. Squalliesmom

    Squalliesmom Well-Known Member

    Joined:
    Jun 26, 2015
    I use a cup method similar to Jill's. Then I count the bars on the syringe prior to drawing up the dose, so I already have a visual established in my head. Then I draw the dose, adjust for bubbles, then check it again to make sure I have the correct dose. I take the syringe with Squallie's food to his designated eating spot, then check the syringe one last time, again counting bars. If all is good, I shoot while he is eating.

    On occasions when I have been distracted or overly tired I have asked another person in the house to double check the dose for me, as well. I figure another pair of eyes never hurts!
     
  22. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

    Joined:
    Jun 15, 2015
    This is a great idea to brain storm safeguards. Mistakes do happen especially while we are all in drowsy stupors. My system is to fill the syringe first before testing and feeding. I use 3.0 magnifying glasses to fill and then I use a magnifying glass with those 3.0 to check again. Then I use my calipers and always check to see if they are set at the correct dose. I test and feed and while Bubba is eating, I recheck the amount again with the 3.0 glasses and magnifying glass. I use a paper log to record everything each day along with the SS. That way if my tablet has issues, I have all the data in a notebook. After I shoot the insulin, I record the time I shot. Then if I were to have any doubt "did I shoot?" I look back in my log and see the exact times gave him the insulin . The notebook log has helped me a lot because distractions happen and sometimes I have a brain fart.
     
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  23. Ella & Rusty & Stu(GA)

    Ella & Rusty & Stu(GA) Well-Known Member

    Joined:
    Jan 11, 2010
    When using the type of digital caliper that you can leave locked into your dose, it is very important to turn the caliper on each time you use it and check the screen to make sure that it is still set for your dose. Don't assume that it is OK: they can get knocked around. Also, when you change a dose, be sure to move the caliper arms back to zero and to push the "zero" button. Then you can reset them to the new dose accurately.

    Like many others here, I write down everything in a paper logbook to guard against computer failures.

    This is a great thread!
     
  24. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

    Joined:
    Feb 17, 2011
    One more thought - if you have any doubt about whether or not you have shot, it's better to skip the shot than it is to possibly shoot twice.
     
  25. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Dec 28, 2009
    Bump for newer members! :)
     
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  26. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Dec 28, 2009
  27. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Dec 28, 2009
    There are some good ideas here...
    might be a good time to bump this thread up again.
     
  28. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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    Jun 15, 2015
  29. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Dec 28, 2009
  30. Rebecca.garfie

    Rebecca.garfie Member

    Joined:
    Jun 25, 2018
    I think cup idea is a great idea if more th3n 1 person is shooting. I know myself it was only me doing it my husband forget it he couldn't even watch me poke garfie ear. Still I would lay everything out. Do what I had to wrote it right into his book right away . Garfie has his own little garfie corner on counter. Nothing gets touched unless asked and answered by me. I don't like things out of place.
     

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