Resolved: morning overdose, management plan, skipped evening; thanks!!!

I have really screwed up badly this morning and don't know what to do! I'm having an exhausting week and getting very little sleep, and as I was stumbling around this morning, I think I gave my cat much more insulin than usual. I loaded up the syringe--usually I end up pulling the plunger out to about 2 units to avoid a big bubble--and then got interrupted before squiring out the excess. I then picked it up off the counter, injected it, and realized a split second later that I hadn't measured the dose.

I have no idea what to do. I absolutely can't stay home--normally I would cancel all meetings, etc. and do so, but I'm leading several hours' worth of training for 30 people, and it's stuff none of my colleagues know or can do on such short notice. I'm going to have to leave in an hour--only about an hour and 15 minutes after the shot. I can maybe come back to do a quick check during my lunch hour (12-1), which would be about +5. I can't stay, and I can't come home again after that until 2:30 (+7.5), and that is really, really not ideal.

What should I do?!? My husband also absolutely has to go to work, though I'm going to try to get him to leave at the absolute last possible minute and come home as quickly as he can. We have a neighbor who works from home; she couldn't test Misha, but she could come look in on him.

The dose he has been getting the last couple of days is .75, and his nadir has generally been in the blue. I think I gave him about 2 units this morning. HELP!!! What on earth do I do???????

 

OK, my husband has seen me freaking out and sobbing and decided that he can tell people he has an emergency and only be gone for a few hours. I'm going to ask someone else to do the first half-hour of my thing, so I can leave around 9:00 (and get a +2). Husband should be back by 11:00 (+4), maybe even 10:00 (+3). Possibly neighbor could check around 10; I can ask.

What do you think I should do? And what would be the right thing to do if nobody could be here at all? (Not that this will ever happen again--I am completely horrified.)

 

Any chance you can take him to work with you? Even if he has to stay in a bathroom or someplace?

Can you drop him off at your vet's office for monitoring?

About the only other thing I can think of would be to carb him up and leave a lot more high carb food down and get home as soon as possible

 

If you believe you have given 2 units rather than 0.75 units you can start carbing Misha up with HC food and syrup to stop as much of the effects of the insulin. However it would be best if someone was available to test until at least +6


ETA Chris's suggestion of taking him to work or the vet for the day would be best

 

That's a good thought, about the vet--that never would have occurred to me, and they're actually very close by, on my way to work--thank you! Husband has just witnessed the continued panic and decided he can make it to his non-missable thing and be back by 9:30. So if I can leave at 9:15, he shouldn't be alone more than half an hour even if husband is late and gets here at 10.

That's a good idea about bringing him to work. He could stay in my office; he would be very upset by the car ride and by being kept there, but I could do it.

Thank you so much for helping me think of options!!!!!!!!!!!!!

 

OK--I will give carbs right now, test until the last possible minute, set everything up for husband to test when he gets home, blockade possible hiding places so he's easy to get to. Oh wow, this is truly never going to happen again; if I'm a zombie I'll skip rather than risk this.

 

It happens to the best of us...but usually, only once!!!

Please take down the 911 now that the crisis is over so people don't worry all day when they see it

 

I will see if the neighbor can come over to cover the gap between me and husband. Thank you!

 

Thank you! I'll edit the title as well. I'm sorry for being slow on that.

 

I did that once and only once when I had 2 FD kitties and gave 2 units to one instead of 1 unit. Luckily I was home and with carbing her up and giving syrup I was able to abort the cycle. Good luck with your furbaby!!

 

No problem!! We just tend to have our hearts skip a beat when we see the 911!....but that's how they work though too!!

Hope everything turns out fine for you today...it sounds like you have a good plan

 

Thank you all so much--I literally do not know what I would have done if I hadn't known I could come and ask for help. I'd probably be the one needing medical supervision.

 

He of course is like "this is awesome! I get the yummy kind of food you won't ever let me eat!"

 

One more question...how frequently does my husband need to test today? Every hour? More often? Depends on how the kitty is acting?

 

With an accidental higher than usual dose I would test at +1 and +2 to begin with, more often if the +1 shows a big drop. Lantus "usually" has an onset around +2 with a nadir around +6 or +7 so being able to keep a good check during the whole cycle would be best.

 

OK! I will do the first couple of hours and ask my husband to test at least every hour thereafter.

 

If the numbers drop too much in that time period then more monitoring would be needed. Did you give HC food and/or syrup already?


Here is information on dealing with a hypo...hopefully it won't come to that with trying to abort the cycle:

http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/

 

Oh, I so, so know the stumbling around in a daze in the morning and questioning everything. I have shot without testing (and realized it right after so tested right away). I am glad that you have options and figured out how to keep Misha safe. I hope the rest of your week calms down and you can get some rest.

Not to make light of the situation - but watch, she will probably have an excellent cycle. - Cats

 

Just a precaution. Since Lantus is a depot insulin it is always possible that the effects of a higher dose may not show in this cycle but may show in the next cycle so you should plan on extra testing tonight. ECID and by aborting the cycle it may be fine tonight, but just something to keep in mind.

 

OK, thank you! I should be able to test very frequently tonight. If his numbers seem normal, should I plan to go ahead with his evening injection? Usual dose? Less?

 

Mostly that will depend on what the readings are. Probably the best thing to do would be to get as many tests as you can today and try to get a +11 test before the PM shot and post for advice at that point.


ETA If the numbers are good try to allow at least 2 hours with no food before the +11 test.

 

I gave high-carb food but not syrup...I'm going to test and feed a little more/give syrup/follow hypo instructions if necessary! (Let this be a lesson to everybody--thankfully, I had set up my "toolkit" and printed the instructions already, during a non-panicked moment, and I always keep lots of extra strips on hand...)

 

Good for you to be prepared. Have you done any more tests since the shot?

 

OK!

 

Yes--he was at 235 at about +1.5. Couldn't test before that because during my freakout, I set the meter down in an unusual place and it took forever to find it. Now on shopping list: backup meter.

 

(I actually have an AlphaTrak and strips as a back up of sorts, but I'm going to get a second Relion). He's acting very cheerful--really quite pleased at having gotten medium-carb food.

 

235 would be a normal morning pre-shot number for him. It's weird--he seems to be hitting his nadirs really late these days. So I'll be extra watchful/paranoid tonight.

 

So far looking good. It looks like usually there is only a small drop at +2 so at this point the higher dose is not showing any signs. Another test at +2.5 or +3 should give an indication if the dose is going to cause any problems.

 

Thank you!

 

I will be out for a number of hours shortly. So far things are looking fine, but if you have any major concerns about the readings and need help you can add the "911" to your title again to get more eyes on your posting.

 

Thank you VERY, VERY, VERY much!!!!! I think things will be ok, but I'll definitely come back to ask for more help if necessary, and to update later...

 

be safe Misha for mommy bean

 

I do exactly the same thing--load up 2U to get air bubbles out and then express to .75U. I try not to lay it down on the counter until I have it to the correct dose, but sometimes it happens. I haven't done it yet, but this is one of my fears.

What's so good is that you realized what you had done while you were still at home. Yay for DH stepping up to help and for all the good ideas. It's hard to think of things when you 're in a panic, and it's so nice to have help like this when you're desperate. Hope your teaching goes well in spite of a crazy morning. Hugs to you!

 

I hope it turns out non event!

 

@Squeakycats @Glennie you really don't need to draw back 2 units. Pull back to 1 unit is more than sufficient and you won't be wasting so much.

 

I try. I hate wasting insulin, but I get those annoying bubbles. Thanks though.

 

I noticed that I get less bubbles/smaller size ones if I run plunger up and down several times before I draw insulin and also if I press the plunger down firmly to get the air out, insert the needle in to the pen whilst still pressing on the plunger, turn it upside down to submerge the needle and only after that I let the plunger go and draw the insulin in. It seems to help with minimizing bubbles.

 

Sending hugs for you as we can all relate to being too tired and making insulin mistakes.

 

Vicki...please do give an update on Misha when you get a chance. Thanks!

 

You flick the syringe barrel ?

 

I do. I flick big time, and I can get most of them out, but I need that extra bit to work with. But thank you Woodsywife. I need any and all tips.

Oh, dear, Vicki, I made this about me again. I have got to stop doing that. So did not mean to. Just saying I do the same thing so I get it.

 

I may not be pressing the plunger down enough to get all of the air out. Thanks, I will try that.

Vickie, just checking to see how the day with Misha went. Hope it was a good one.

 

@Glennie it's truly super-helpful to hear about your experiences!!! I have had the same issue--I can flick the syringe forever and not get rid of the bubbles...I have to draw it out really slowly so the one giant bubble doesn't form (sorry, that description probably makes no sense...). I always move the plunger up and down a lot before putting the syringe in the pen, in order to make it move smoothly--but I have NOT tried pushing down on it while inserting the needle! (I do turn the pen upside down to be sure the syringe is totally submerged.) That is a great tip, @Tanya and Ducia ! I'm going to try that next time I give a shot...

Speaking of which...I finally got home and got a non-food-influenced test in, and he's at 134. It is about an hour later than I'd normally do the injection (husband had fed and I didn't want to make the "shoot or no shoot" decision with food-influenced data). This is not normally a number I'd be afraid to shoot. What do you all think???? Go for it with the usual dose, but watch closely tonight? Reduce the dose? Skip and start fresh tomorrow?

I need to get all the test data in his spreadsheet--but the lowest he went today was 63, at about +8. Husband fed him and he was back up at 184 two hours later.

I hate it that this is all happening right before we go out of town for a few days (starting Saturday)--I was hoping to get him staying in the blues/dark greens over the course of the week and be able to give the petsitter confident instructions about the dose--I want to know what would be conservative but not pointless...Oh well. One thing at a time.

 

Thank you all so much for your incredibly kind and supportive (and practical) responses. FDMB rules!

Edited to add: Misha appears totally fine--he got medium-carb snacks 3 times today, and lots of attention! And my teaching extravaganza went surprisingly well, considering how tired and distracted I was. Tomorrow I'm not on stage *at all*! So I won't really need my brain at 100% at work again until Thursday

 

I vote for skip and start fresh tomorrow. Sometimes the real action in an overdose situation is the next cycle. This will help drain the depot.

 

That would certainly be the least terrifying option...and I've missed the usual time anyway, and he's not at a *high* number...

 

Glad to see Misha made it through the cycle with no major problems. I agree with Wendy about skipping. As was mentioned sometimes the next cycle is where the larger dose show the effects. With a skip you can get a good sleep, with no worries and get back on schedule tomorrow morning.

 

Wonderful news, Vicki! Thanks for posting the update!

 

Thank you all! Sleep...sleep sounds so very very good!

 

I also push

No, your description makes perfect sense. I know just what you mean. I move the plunger up and down a lot also. Tonight I followed Tanya's advice about pushing down harder on the plunger to get more of the air out, and lo and behold, I only had a tiny bubble that was easy to get out. So thanks, Tanya!

Vicki, it was sweet of you to say that. I am so glad that your day went well both with your training and there at home with Misha and your DH. Hope you get some rest after an eventful day.

 

Wow, Vicki! That was some day! I'm so glad it turned out to be a non-event and I hope you are sound asleep right now.

Misha, don't expect that yummy food every day, but, pssst! If you want it every once in awhile, throw out a few green numbers! But not when Mama and Daddy are gone, 'cause that won't do it.