Smiffy Autumn progress

- Link removed by Moderator - Please see the "recap" Lucille has posted below.

Lucille, the thread you linked was closed for a reason. You were warned not to drag anything from that thread into a new thread or the new thread would be closed. However, I've opted to leave this thread open (for Smiffy's sake) for the time being... barring any further problems. Please be advised this and other problems surrounding your threads have not gone unnoticed. All these types of incidents have been taken straight to our Board Administrator.
Action pending.

Edited to add - Here's the correct link to your last thread: Smiffy Caninsulin beg Autumn progress

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@MrWorfMen's Mom @JanetNJ @Alexi @manxcat419 @Woodsywife @donnalea @Louise1989 @Squalliesmom @HWright @purpleallie @scoobydoox @Kako & Tux


This is Smiffy's Autumn thread, so to recap:

Smiffy and I are in the UK. She is on Caninsulin and was diagnosed in April 2016.

As you will see from her spreadsheet she has very recently enjoyed some very nice blue numbers and for four or five days required no insulin:

This is what her Vet Roberta had to say about her spreadsheet and dosing at that point:

"Hi Mrs Smith,
That's all really positive isn't it! Fantastic work, you've both done brilliantly. I would agree with you that I would be nervous of giving insulin below 8, especially in the morning. My view would be that Smiffy is in remission if she manages to keep her BG below 12 (so below the renal threshold) without insulin. I would also prefer her blood glucose to remain above 4 ideally, I have seen cats hypo on 2.5-3. I think also that we have to take into account a little degree of sampling related hyperglycaemia (stress related) and differences between glucometers. I think the 'tight regulation' numbers are a little too tight for practical use if that makes sense? I would only give her insulin if her numbers are above 12, and keep a very close eye on her.
Absolutely brilliant news"

However for the last few days Smiffy's numbers have risen again (coinciding with a thunderstorm breaking the hot weather to damp weather and DH - her Daddy - going abroad for a couple of weeks).

The sliding scale that I have devised for her from experience and looking back at her spreadsheet is still in place but for the past couple of days her numbers have still stayed high which is out of character.

So it feels a bit as if I am starting all over again.

However in the last 24 hours her numbers have gone down again

Smiffy's AMPS was 10.6 so as I am not around to test her at her Nadir I didn't give her her shot - this is until I know a bit more about what is going on with her numbers now that they are falling lower again .....

I am really pleased for her but I am not going to risk her going into dangerous numbers during the day ......
She was 9.7 (175) at +4 so she is still holding that number from her PMPS last night which was 10.6 (190).

More data later.

Thank you to Smiffy's regular friends for popping in to see her and for your continued support and friendship

 

Smiffy was 9.5 PMPS after being around 10 (180) since last night's PMPS (when I gave her half a unit but no shot this morning after her AMBG).

She is eating so I am going to give her a half unit to keep things going and test her at +2 and +3 to make sure she doesn't drop too low.

She is completely on the lower carb dry food now (no Hill's m/d) but wouldn't eat the wet tonight just now ....

Well the end of the story tonight is that at +2 she is 11.2 (202) so not sure what to make of that ... could be a bounce or the 0.5 units has no effect on her?

OK so I have now done a +3 and she is 10.6 (190) so she may have gone up after eating and now her shot is kicking in and she has gone down.

Thinking aloud here ... now leave her alone until tomorrow.

Well she was 13.4 (241) AMPS this morning so I think she has bounced from last night so I gave her one unit and at +4 today she was 8.2 (148) so it will be interesting to see if she can hold that number today.

Having trouble with my computer and today the FDMB is really slow for me and not functioning as it should so hope this new thread works.

 

The update sounds good. Dr Roberta sound like a nice Dr. Smiffy is looking good.

 

Hello!

Yes getting better numbers again I think after a bit of a blip!

How is Smokey?

 

Smokey is Smokey, going back up in doses again. Otherwise he is fine. He needs a good poop but being on homemade they do go less often so I'm told.

 

@Owen & Ceci

Hello!

Lovely to hear from you on Facebook and this will give you the update on Smiffy you enquired about

 

Nice to see Smiffy's numbers are slowly transitioning from most yellow to most blue Let's hope she keeps going that way or even better

We know that normal range is even lower, but definitely there's progress here, and that's what's important.

Giving my short experience with feline diabetes, I can't say much more than that, but one more thing: Don't give up on the wet food, it's amazing how the diet change can improve everything, it was hard for me to believe it until I saw it in my own kitty.

Of course I really understand you when you say Smiffy won't eat it, Owen didn't wanted it that much either but since there was the only thing I offered him (which was a very risky decision given he was already on insulin), he had no other choice in the end if he was hungry.

But Owen was on Lantus, you can't do that to Smiffy because she's on Caninsulin and if she doesn't eat you can't give her a shot. That's a big impediment it seems

Anyway, I think you're doing a good job, like I said, there's progress and that's valuable

 

Oh I sorry to hear that Smokey's numbers are going up again. Do you think it is because he is uncomfortable being constipated?!

He is doing really well for his age though

 

Hi!

Yes it is looking at the moment as if I could give her a higher dose on her numbers but I am just waiting to see if she comes down a bit further on her own like she did before.

I am still persisting with the wet food but I am not going to go down the route of only leaving out wet food for her if she is not going to eat it partly because I would have to hold of giving her shots for maybe too many times. I have offered her wet food in the morning and the evening but she is not interested at all so far. But she DOES still have a little bit as a snack during the day. It helps if Pasha is about as she always has to have what Pasha has which also makes it difficult for me to work out how much she has eaten as they switch bowls etc,

As long as I can keep her under the renal threshold for the moment I am happy. I think that the 'healing' range is not the same for all cats and Smiffy has definitely shown signs of some activity by her pancreas but not for the past few days.

Lovely to hear from you and good luck with your studies

 

Smiffy was only 9.2 (166) tonight but she ate reasonably well so I have given her one unit tonight and will test her again at +2 and/or +3 to see how she goes.

Want to get her AMPS down a bit if I can.

 

Looby, that 1u may be a bit much for Smiffy so I would definitely get a +3 reading and probably at least a +4 and maybe even a +5 to be on the safe side. I'd also make sure she has some food available through the night. I understand you want to get Smiffy's AMPS down but you can't force it and if she drops lower on that 1u tonight you may find she has a higher AMPS because of bouncing from dropping into numbers she is not accustomed to or even too low. I don't want to sound like a broken record but again, the key here would be to get used to the syringes so you can try a dose of 0.75u instead of trying to force her down. The goal is to get a gentle curve and that can be difficult with Caninsulin because of the sharp drops it can cause in BG.

 

I will take the syringes to the Vet when we go in October.

I did give her a one unit and she is 10.3 (186) at +3.

I know what you mean about her bouncing .... I wonder if she is already.

I am getting mixed messages - on the one hand I am being advised that I am not dosing enough and on the other to be cautious.

I appreciate everybody's input - tonight I went with my instinct because she has been getting higher readings in the evening and 0.5 has not been enough.

So difficult to tell if she has already bounced? I will check again in another hour.

Thanks Linda

 

Looby, I don't want to be a panic monger by any means but with any insulin, you need to take small steps to make sure you don't miss that "sweet" dose that does the trick. To my knowledge you've never given Smiffy 1u at a reading under 10 before so I just wanted to be sure she stayed safe. These furballs don't always do what we expect them to do as you well know. If only we could get them to read the manual and follow it, this would be so much easier!

 

I appreciate what you are saying ... I will test her again at +4.

I recently gave her a whole unit at 10.4 (187) and she was 11.6 (209) by +6

I will keep testing tonight.

I have been told recently that my Accuchek meter is about 20-30% reading lower than a pet meter and that I am dosing too conservatively? But I would not take a big risk with her of course ..... I would be too scared to dose as aggressively as some of the members here would have me do!

 

9.4 (167) at +4 so dropping a bit.

Will test again at +5 @MrWorfMen's Mom

Food is still out

This is unusual for her to go lower at night ...

 

Looby, you cannot rely on a 20%-30% difference in readings between a human and pet meter and whoever said that is wrong. And pet meter readings have nothing to do with how you determine your dosing. You dose according to the meter you are using. I have been and continue to dual test with both types of meters and can unequivocally tell you that there is NOT a firm 20-30% difference. It depends on the reading. Generally the higher the reading the greater the difference between the meters but there is no "set" percentage. I've had readings 50% apart and some almost identical. Under 10, the readings are much closer to one another than at a reading of 20.

You may well be dosing too conservatively generally but 0.5u changes for our little ones is a lot of insulin which is why all of us, no matter what insulin we use, suggest making dose changes of 0.25u when the dose just needs a little adjustment.

Just saw your latest note. The readings of 10.3 and 9.4 are not that far apart but it does demonstrate that the cycle won't necessarily be the same when you give her 1u at PMPS of 9.2 and the nadir isn't always at exactly the same point in time every cycle. Another reason to adjust doses in small amounts.

I have a cat who can be sitting in the mid teens for days and then suddenly without any dose change, like tonight, is now down to 5.9 on a pet meter which I would guess to be in the neighbourhood of high 3's or low 4's on a human meter (she's antsy for food and I couldn't get the human meter reading), two hours before her shot is due. I need to watch her tonight because she is not playing by the expected rules of this game. Cautious and conservative dose changes are the safest.

 

Oh OK that's really interesting and I am glad you have clarified that for me.

I have always dosed based on Smiffy's Accuchek meter readings alone and I did know that the lower the reading (around 4(70) or lower the closer the human and pet meters are?).

I am glad you have told me that the two people that have mentioned the difference recently are wrong because it might have made persuaded me slightly to be a bit braver with dosing!

Oh under 10 (180) the readings are closer! Sorry reading and commenting as I go along .... OK thanks.

Forgive me but I don't understand exactly what you mean in your next sentence apart from the fact that Nadirs occur at different times (I have noticed that of course) "The readings of 10.3 and 9.4 are not that far apart but it does demonstrate that the cycle won't necessarily be the same when you give her 1u at PMPS of 9.2"?

Sorry it is 3.30 am so maybe I am tired!

Goodness down to 5.9!

Smiffy is still about the same 9.7 (175) at +5 so I think safe for tonight.

Good luck with your puss.

Will let you know what happens to Smiffy tomorrow am ..... of course she might bounce up again but not on numbers like 9.7 (175) I wouldn't imagine?

 

I've read what you said again and I DO understand what you are saying and yes I agree that x number of units does not mean y amount of points drop in BG

It seems there are sometimes some conflicting points of view on a number of things even here on the Board at times!

Smiffy is around the same number at +5 so I think she is OK but I take all your points

Thanks again Linda

 

All meters are allowed some variance in their readings. I do not know what that allowance is in the UK but here in Canada it's 15% and in the US it's 20%. I think it's a pretty safe bet, your variance is in the same range. That means that the reading of 10.3 could really be anywhere from 8.8 to 11.8 using the 15% variance allowed in my location. Likewise the reading of 9.4 could really be 8 to 10.8. If you use the 20% US variance allowance, the spread of acceptable readings widens further. We never know if a reading is a bit low, pretty accurate or a little tad high so unless the readings are farther apart than allowed by the variance, they can basically be considered the same.

I wholeheartedly suggest you forget about pet meters altogether. They are NOT relevant to your situation. There are a lot of erroneous notions on the board and elsewhere about the differences between human and pet meters. When you factor in the allowed meter variance which also applies to the pet meters, it further complicates any attempt to determine a percentage difference between the readings on the two meters when the difference already widens as readings get higher. The reference numbers on this site are for use with a human meter and that's what you are using so pet meter numbers have no bearing on what you should do for Smiffy. There are always going to be differing opinions so you have to filter the opinions you get based on what your experience is with Smiffy and what you can and cannot do from your own comfort perspective.

My only goal is to ensure that Smiffy stays safe so I'm glad to hear you checked her till +5 and she is still sitting at 9.7.

I will be scarce for a few days as I have a house guest arriving tomorrow so I may not get the opportunity to check in much until the weekend.

 

Thank you Linda,

Yes I wasn't thinking about human meters at all until somebody mentioned it recently with such conviction so you've got me back on track to where I was - thank you

Smiffy is 11.3 (203) this morning so I am going to dose her conservatively with just 0.5 units as she falls quite a lot during the day and then tends to hold her number more or less until her PMPS.

Thank you for being the voice of reason

Have a lovely time with your houseguests and speak to you soon

 

8.4 (151) at +4 during the day so I might have given her a whole shot instead of just half but see if she holds this number. I have a feeling we are on the cusp of those lower numbers again

So Smiffy was 10.5 (189) at +8 but now she is PMBG 8.1 (146) so no shot for her tonight

Once again I think she is showing those little signs that maybe just maybe her pancreas is having a little splutter

However she is now 13.6 (245) at +5 so can't win them all. I think that might be a bounce!

 

Smiffy 8.8 (158) at +3 today and also at her PMPS so not giving her a shot.

 

Looby, was Smiffy not eating today? The other night you gave her 1u at a reading of 9.2 but you are not giving her anything at 8.8 which again, given meter variance, would be considered the same reading so I don't understand why you decided to skip rather than give Smiffy some insulin even 0.5u?? You need to keep Smiffy's numbers as low as possible to get her used to lower numbers if you want her numbers to come down and stay down.

 

She didn't eat at all tonight for some reason so I felt I couldn't risk it and also since she had held that number since +3 this morning. She has not come to eat since her PMBG either. I know I was really hoping she would eat tonight.

I also had major dental work today and have taken painkillers and my mouth is hurting and all I really want to do is sleep tonight and I doubt I will be up to do her +3 and +4 tests ....ouch!

 

Fortunately after no shot last night, Smiffy is only 11.3 this morning so not too bad ..... Mummy's tooth is still hurting though!

I think she is happy that her Daddy is home again

 

Wishing I was a bit more with it this morning and given Smiffy a whole unit as she has gone up to 14 (252) at +7 today and she won't eat any of the wet food I have put down three times now ... better day tomorrow I hope!

Well there's a surprise! I was thinking that Smiffy's PMPS was going to be really high but it has gone down to 9.7 (175)

Giving her half a unit .... pleasant surprise

 

Smiffy is only 10 (180) this morning after being +3 after her PMPS last night 11.9 so she keeps coming down in her cycle when not expected now so that is good sign

 

good, but why no shot this morning? should have done at least half a unit. You've been doing good with dosing lately... don't stop now.

 

I hope your tooth stops hurting very soon! Hopefully Smiffy will keep giving you those blue pre-shots numbers. It's really important to try to keep her in those better numbers as much as possible. I agree with Janet.....half a unit this morning would have been ideal. Was Smiffy being a fussy eater again? If you skip shots instead of trying to keep/push her numbers down you could lose ground you have gained.

 

Yes in retrospect now I could have given her a half a unit but I am not around for her morning Nadir so I am extra cautious for her morning shot as she tends to drop a lot in the day.

Hind sight is a wonderful thing!

I am hoping she will drop again on her own as she did yesterday.

 

As I said to Janet in hindsight I would have liked to have given her half a shot but I am extra cautious with her morning shot as I am not around for her morning Nadir and she usually drops quite a lot during the day.

She didn't eat a lot this morning which is always a bit of a worry.

As I said to Janet, I am hoping she is going to drop gain by herself by this evenings PMPS as she did yesterday .

I will certainly give her a shot tonight even if she is around 10 and as long as she eats.

Tooth is still playing up but better than the other night thank you

 

@JanetNJ @MrWorfMen's Mom looking at Smiffy's spreadsheet, I have never given Smiffy a shot on 10 (180) in the morning ... and in the past she has come down again before her PMPS .....not sure if I would give her a half unit on that number unless she had a good breakfast.

Just did a urine test and she is negative for keytones and glucose

 

@JanetNJ @MrWorfMen's Mom

Smiffy went up to 11.6 (209) at +4 after I didn't give her a shot this morning but she has come down by herself as I suspected to a PMBG of 8.5 (153) so I am reluctant to give her a half unit on that number.

I have never given her a shot in the evening on that number.

She seems to be bringing her numbers down by herself yesterday and today.

 

Looby, from the data you have for Smiffy, I think you could have given her the 0.5u provided she ate and you could get your post shot tests at +3 and +4. It might have got her down to a good green number but I don't think she would have gone too low and if you are testing, you'd be able to steer her with food to keep her from going too low. Each of us learns to shoot at lower and lower numbers over time and Smiffy is definitely getting more used to being in nice blue numbers so it would be in her best interests to try to keep her there and to get those numbers down a bit more. Being able to adjust doses by 0.25u instead halves would also be very helpful. When is your appt. with Roberta?

 

The appointment is around October 13th

 

I don't know that I would have given a shot - not with Caninsulin at that number. 153 is about on the no-shot limit for Caninsulin even with experience on what usually happens...even with experience I've never seen a recommendation to shoot a number under 150 with one of the harsher insulins apart from on the Hodgkins protocol which personally I don't believe is safe. Maybe a 0.25u would be an option numbers-wise, but until your vet appointment there's really not a lot you can do about that. Maybe you can get a before bed test to see what happens with her numbers tonight.

 

OK I will try to test her later

 

Ohhhh +3 and she is 5.8 (105) in the morning

 

Looby, that 5.8 is indeed a great number but is that a +3 or a +5 reading? It's on your spreadsheet at +3 but your note suggests it's the +5.

 

It was a +3 ..... have edited my post ...... was a bit stressed and anxious at the time I posted

She is +5 11.8 (212) but I am hoping that she will bring herself down by her evening preshot reading.

{By the way I have been told at all times to put both UK and in brackets the US equivalent BG readings in all my posts.)

 

Looby, I'm in Canada so I use the same measurement as you. I see Smiffy is climbing again now.

 

Yes she is rising but recently she has had a tendancy to come down again so that's what I am hoping will happen today.

I didnt realise you were in Canada - how lovely

However, I still have to post both measurements for the benefit of anybody from the US looking in - I have been told quite specifically that I must quote both measurements at all times.

 

Smiffy has, as I thought, brought her numbers down again by herself for her PMPS - she is 8.8 (158).

Now I need to see if I can get her to eat enough to take half a unit.

She has eaten enough I think so gave her half a unit but only because she seems to have higher numbers at night.

I will test her at +3 to make sure she is OK.

+3 11.7 so I think that is a bit of a bounce as I know I didn't give her a fur shot.

There seems to be a bit of pancreas activity bringing her numbers down again before the PMPS and then some bouncing ...... or it could be because she has eaten quite a lot after all tonight whilst I feel asleep on the sofa!

 

@donnalea do you go on Facebook? What is your name?

 

Very rarly. I usually don't have time. I was on last night for a while. My name is Donna Olson Laymon.

 

I have sent you a short PM as a friend request but if you don't go there much then no worries - I can see you here

PS there is nothing else in the PM other than requesting to be a friend on Facebook main page.

 

Smiffy giving me some nice blue numbers recently again but I am still giving her half unit shots to keep her numbers in the blue if I can.

 

Hello @Tigger and cheryl

@MrWorfMen's Mom I hope you are well? I have not posted for some time now.

Smiffy is a little up and down recently but at least her numbers are still beneath the renal threshold of 13 (123)

 

Hi Looby. All is good here other an pile of road construction which is driving me and my fur kids nuts!

Yes it looks like Smiffy has been holding her numbers fairly well. Hopefully once you've had a chance to talk to Roberta you'll be able to finesse her doses a little more using the syringes and get her down a little more. She may be below renal threshold some of the time but ideally you want her down there all the time. And I don't think anyone really knows exactly where that renal threshold is for all cats especially using a human meter as every cat is different. Anything I have seen quoted has been based on animal lab values of 250-275 (13.9 - 15.3 mmol on our measure scale). Because these are animal lab values and you use a human meter, your goal should be to keep Smiffy well below those numbers. Have you ever checked her urine for sugar?

BTW 13 in our readings would be 234 in US measure which means she may or may not be below renal threshold.

 

Yes there seems to be a lot of difference of opinion as to what is the renal threshold for cats! Roberta told me 13 (234).

Hello Oh road construction is terribly annoying but there is never a good time for it to happen. I hope you weren't caught in the storm at all?

I am not seeing Roberta now until December when both Smiffy and Pasha are due for their annual check up and possible booster shots.

I test Smiffy's urine fairly regularly and the last time was on the 2nd October when the result was negative for both ketones and glucose.

I am being a bit more brave with her evening shot now to try to get her AMPS down ... she seems to run high at night after her shot for some reason .... don't know if it is a bounce or a food spike.

xxx

 

Do you leave food out all night for Smiffy to graze? Many cats tend to run lower at night but all cats are different. Certainly eating at will all night could have some influence on BG levels. And the only way to determine if Smiffy might be bouncing a bit would be to get more night time tests. If she is dropping down lower at some point at night that could cause the higher AMPS.
Again though, this is where finessing doses comes in really handy and gives you much better control. I thought you had an appt. with Roberta on the 13th of this month? Did you cancel that appt.?

Even if you did cancel, you could just discuss using the syringes with Roberta by phone and we can help you learn how to use them. Have you tried the syringes on some fruit yet? I think once you try that, you will see it's no big deal and a lot easier than you think it will be.

 

No I don't leave food out for Smiffy at night beyond about +4.

She is a nibbler so she nibbles a bit of food for her supper, then I give her a shot and then I have to take the bowl upstairs so that she eats a bit more especially as I am giving her shots now on numbers below 10 (180).

I will try to test her at +2 tonight and she is she goes down quickly before she goes up again. I test her most nights at +3 and/or +4.

I didn't have an appointment booked but she was due a follow up but having discussed it with DH, I have had to agree that her she can wait until December. Having said that I am going to discusss it with Roberta in an e-mail which I will do tomorrow .....

We are getting a new cartridge for the pen this week as the 28 days are up.

I will of course mention the syringes with Robera. No I have not got practiced on fruit yet. I think I will try to find a video on Youtube just to have a look to see if I think it is not as daunting as I think!

 

Do you know of a good video on Youtube that I could watch?

I have found this one:



or this one:

 

Looby, I don't think either of those videos are ideal because drawing insulin out of a pen cartridge is a little different from drawing it from a vial.
THIS video shows how to draw it from a pen and a vial. She does the pen draw first so you don't need to watch all the way through. She is using a Lantus pen but yours should be similar.

If you are switching cartridges soon, you could keep the old cartridge and refill it with coloured water so you can practice drawing from it directly without the pen. Do you have new cartridges at home or do you have to go see Roberta for them? I know you were getting Roberta to help change them in the past. This would be the perfect opportunity to discuss the syringes if you do have to make a trip over there anyway.

 

The second video shows how I draw the insulin, I don't roll the vial for as long. Injecting air is a bit old fashioned and we don't advise that any more. As Linda says - drawing from a pen is different as it is designed to administer a set dose each time and not to have air in it. If you end up with Caninsulin in vials they come in 2 sizes and you need the small one.

 

@ Alexi Good points. I never thought about changing over to a vial because I didn't know there were 2 sizes so I assumed Looby would have to use the pen cartridge as if it were a vial. Now you have me wondering if the smaller vial is available in Canada. My pet pharmacy only carries the 10ml. vial and the pen cartridges.

 

It appears to be available as the 2.5ml in Canada, http://druginfos.com/caninsulin-vial-canada-2/

 

Oh! I assumed those 2.5ml vials were the pen cartridges but it looks like they're not. Appears my pet pharmacy doesn't carry the 2.7 ml pen cartridges. Interesting but good to know for future reference. Thanks for the link and info.

 

OK I will bookmark YOUR video

I can switch cartridges easily by myself now so DH is just going to collect one from the surgery for me.

That is a good idea - I will keep the old cartridge (actually it is still more than half full with Caninsulin/Vetsulin but I will empty it and put food colouring on the shopping list so that I can colour some water.

I am housebound unless escorted by my husband and don't drive at the moment. I have only been out of the house for appointments for five years now - such is the level of my agoraphobia and anxiety (I am currently being helped to rehabilitate finally by a private team).

I don't know if our surgery supplies Caninsulin/Vetsulin in vials so that is another question for Roberta. I have made a note
@Alexi that I need the small size of vial - thank you.

In the meantime I will bookmark and watch your video Linda.

Thank you

 

Just realised that the u40 syringes already come with the unit markings on them appropriate for use with Caninsulin - one step closer to being happier about maybe using them at some point!

Now to watch the video.

I can't get the flipping syringe out of the packet - good start!

So I got it out of the packet

Changed Smiffy's cartridge this morning so kept the old one for practice (before I get some food dye to practise with coloured water).

I withdrew some insulin but made first mistake and put some air in the cartridge. Nevermind lesson learned.

I found it very difficult to measure one unit never mind half or less! This really worries me but hey I tried so that is one foot in the right direction.

And I will try again with coloured water

Still won't use syringes until I have seen Roberta in December though as I want her to be on board with what I am doing.

Will be writing to her with Smiffy's spreadsheet this weekend.

 

Looby, if you are writing to Roberta this weekend, no harm in mentioning the syringes and why we think they might help you get Smiffy's numbers down a tad more. She may not want you to wait for December which is still quite a ways off.

 

I will of course mention the syringes and discuss it with her on line.

I am sorry I thought I made it clear that I would discuss them with her

I am pleased that I have handled one now but I found it very difficult to see the less than one unit measurements on the u40 syringe because the black plunger appears to get in the way and the needle is soooo long compare to the Vetpen!

I was expecting to see 0.25 increments on the syringe. They are the ones that were recommended for me to buy on another thread - I followed the link to VetUK to buy them.

 

Hi Looby, if you bought the ones I linked to each little mark is 0.5 units - can you check? It will have a 5 unit mark written on the syringe so if you count down from 5 you should find each mark, once you get to 10 marks you can stop as the mark closest to the needle marks the end of the syringe. so if you count back up from that mark you should have 10 marks to reach the number 5. 0.25 units is half way between each of the little marks and it is possible to eyeball with some practice.

 

@Alexi can you post a picture of the syringe with the markings clearly visible? If so, I'll try to alter it to show where the 0.25u, 0.75u or 1.25u doses would be so Looby has a reference to look at.

 

Will this do? I have pulled the syringe to the 10 unit mark and loosened the cap.

 

Hello Alexi and @MrWorfMen's Mom

Yes I have the syringes you linked me to and bought them from VetUK.

I can see the 10 marks so I can see that an increment of 0.25 units is between each of the marks. It is just that the black plunger makes the black marks difficult to see so I suppose it is something that I need to get used to. I think the idea of practicing with coloured water to begin with will help me get used to it.

I have to say my eyesight is not great even with my reading glasses on .... maybe I will have to order some +4 reading glasses!

At least getting used to the syringe is one step in the right direction and I have kept the old cartridge of left-over Caninsulin cartridge as well to practise with to (not to shoot Smiffy with though of course - don't worry!).

But I will start with coloured water.

Thank you both

PS Just ordered some stronger reading glasses!

 

Looby, what some folks do when they are going on vacation is fill syringes with coloured water to be used as a comparison for the sitter. If you are having any difficulty seeing, this might be something to consider when you do start using the syringes. You could keep syringes with the different quarter doses of coloured water handy and marked so all you have to do is a comparison of the plunger position when drawing up the real thing. We're just full of little tricks around here!

I'll work on the picture ASAP.

 

Clever

Oh the picture is fine as it is thank you

 

Awwwww Smiffy just sicked up clear fluid and the tiniest amount of sick on my bed and her stools this morning were ever so slightly soggier than usual. Maybe she has a little tummy bug? Or maybe an imminent fur ball?

I have put some Fortiflora on her food.

She is fine otherwise - quite herself - just a bit embarrassed ... poor thing .....

 

Smiffy is all better today and started off the day with lovely 10.4 (188) so all is well

 

Smiffy's numbers all over the place at the moment ..... I suppose that just happens sometimes!

She is over her little bug so I see no logical reason for her to be so inconsistent. Oh she coughed up some grass this morning so maybe she DOES have a fur ball lurking after all - we shall see.

 

I seem to have lost some posts her for some reason.

I was saying that Smiffy's numbers are higher for some reason and I have for the past two mornings had to give her 1.5 units which I have not done for weeks!

She seems to be healthy and bright.

Do you think it is the change of season?

@MrWorfMen's Mom

How are you doing?

 

Well Smiffy has come down from her +3 of 13.8 (249) to a PMPS of 8.5 (153)! Her numbers are not as consistent as they have been.

Gave her one unit - which would have been quite an aggressive shot not so long ago but she is now +3 12.2 (220) - just don't understand it!

Today is Tuesday 25th October.

 

Smiffy's numbers today are a bit baffling but really good in the end

@MrWorfMen's Mom @Alexi

 

Lucille, did you have a chance to speak with Roberta about using syringes instead of the pen for Smiffy's insulin? Have you done any practice with the fruit yet? I think the key to get Smiffy leveled out a bit more is to have the ability to finesse doses by 0.25u instead of 0.5u so if I were you, I'd really try to get used to the syringes. I am working on the pictures for you for quarter doses but in the meantime for practice, you can just draw up to any line on the syringe so you get a feel for using them.

 

I haven't spoken to Roberta nor sent her an e-mail yet.

I was hoping that Smiffy's numbers would have settled a bit before I send Roberta a message. Smiffy seems to have responded to the more cold weather - up and down - but she is realy well so that is the main thing.

I have been doing a lot of work with my CPN recently and made a great deal of progress.

I am going to write to Roberta with an update soon and mentions syringes but as I have said to you before, I am still very reluctant to use them for the reasons I have already given and those reasons have Smiffy's best interest at heart of course.

She is not easy to treat .... she has now decided to sit under the very big chair when it is PM time to have her test and eat and get her shot. For the last couple of nights I have had to drag her out to have her test and then as soon as she has finished eaten she has gone back under the seat. She continues to surprise me. I suppose it is cosy under the chair on the thick pile rug where Malcolm sits.

There seems to be some pancreas activity which is great.

I will be writing to Roberta next week for sure.

I did have a go at drawing insulin from Smiffy's old cartridge and the first thing I did was to put air bubbles into it .... I am really not happy handling syringes.

 

If you are using cartridges like a vial it doesn't matter if air gets in, it does obviously if you use the cartridge in the pen. Often with syringes you do get a tiny air bubble, if I can't get rid of it then I depress the plunger fully into the vial, pull up slightly more than the dose and then keeping the needle in the vial depress just enough to get the dose. Keep having little practices until you gain your confidence.

 

Lucille, I realize that anything new can be a source of anxiety for you. New things generally cause all of us anxiety to some degree but if you take baby steps at it, I'm sure you can get comfortable with the syringes and that's why using the fruit for practicing can be very useful. As for the bubbles, don't get discouraged. We all get bubbles into the syringe and the trick is to hold the syringe with the needle pointed up and give the syringe a good flick with your finger to dislodge the bubble and send it to the top of the syringe barrel (right below the needle) where it can then be pushed out. Drawing back on the plunger to add more air sometimes helps to consolidate air bubbles that can then be pushed out by depressing the plunger back to the right dose marking. If you need more tips on how to do this, we can help. Many of us give the shot while kitty has their head stuck in their food dish and they barely notice if they notice at all so I don't think Smiffy's behaviour should be a barrier to using syringes vs. the pen.

Again, I think you need to decide what your goal is for Smiffy. If you choose not to use the syringes, then getting Smiffy's numbers more consistently into the blues/occasional greens or even better with luck, getting her into remission, is going to be that much tougher, if possible at all, because a quarter of a unit of insulin can make a lot of difference in a cat.

 

I really appreciate what you are saying - please be sure of that.

Tonight is an example of how tricky Smiffy can be to treat.

I decide on her Caninsulin (Vetsulin) dose not only on her preshot number but also on the amount that she eats.

She is a nibbler. Just now she came downstairs for her supper. I tested her and she is 9 (162) so my judgement is to give her one unit on that number provided that she eats a decent amount of food.

She nibbled at her food (not enough to give her a shot on) and went back upstairs so I have had to follow her upstairs with her bowl of food and pen and if she hadn't have eaten any more I would have changed my judgement and given her only half a unit. I don't set the Vetpen to its dose until I am sure what dose I am going to give her.

As it turns out, she happily (of course I didn't force her) ate a good amount and I was able to turn the pen to one unit and administer her dose.

I would not be able to do this with a syringe.

Thanks for the tips about the bubbles. I did already know how to get bubbles out of the syringe but in my post was actually referring to the video that Linda recommended where they said when taking insulin from a cartridge to be careful not to inject bubbles into the cartridge - unless I am mistaken. At the time I thought this was a bit odd as it is bubbles in the syringe that would be a problem and they are easily expelled. Of course when I prime the Vetpen I have to get rid of the bubbles.

It is not so much my anxiety that is making me reluctant to using syringes as the logistics of doing it for Smiffy not only the way she is but circumstances in the household and other reasons. I am sure I have listed them before and they include me not being completely 'with it' in the morning because of my medication that I take at night. I have to really concentrate on what I am doing and sometimes there are distractions that are unavoidable that I don't really want to discuss here.

For the time being at least, I appreciate your concerns and thankfully have not found the need to think in terms of 0.25 increments on Smiffy's numbers since that five-day period when I gave her no insulin at all as she was maintaining a comfortably below 10 (180) number all day for five days.

I have the syringes and I have already said that I will talk to Roberta about them and take them along with me to Smiffy's next trip to the Vet and if and when I use them, I am really pleased that I can rely on you and Linda to help me out with them so thank you very much for that

 

Lucillle, I am in somewhat of the same boat as you with my Menace. She has a condition where she may be running at higher numbers for no physically apparent reason but I assume it's her unruly antibodies doing their thing. So for example, last night I gave Menace insulin on a reading of 16. This morning around 10 hours post shot her reading was 4.7. Quite the difference, it's almost time for her next shot and I have to figure out if she is dropping or rising before I can determine what dose I should give her. Menace has her nadir VERY late in the cycle quite often (different insulin than yours but still much later than expected)which makes it more difficult to predict where she's going to be at shot time. So while I use to draw up her insulin, then test, feed and shoot, I now test, and make Menace wait till I make a decision about her dose and then I feed her and shoot.

Now with Caninsulin, you have to feed Smiffy first, wait, then shoot, so you could feed Smiffy most of her meal, then while waiting, go draw up the insulin dose you deem appropriate, then give her the last tsp. or so of her food while you shoot. I know sometimes they can be little rascals when it comes to timing and sticking to the plan but we have to look at it as a game of sorts and outsmart the little critters.

 

16.4 (289) this morning!!! Had to give her 2 units and leave a bit of food out just in case that is too much but I think she should be fine. Don't understand why she needs more insulin past few days to get her BG down .... more than my previous data indicates to me so I am having to readjust.
Oh here she comes .... took me four goes to get her to eat this morning but she is having a bit more now so I am not so worried about not being around for her Nadir.

Having said that - it will probably be at about +4 as I gave her 2 units and I will be back down for that.

At +4 she is 10.4 (180) so the same as she was this time yesterday. Wondering why she threw up that high number for me this morning. There was nothing stressful going on and she is behaving perfectly normally - purring and going out as usual.

I have posted a separate thread about her numbers on the main Forum and tagged you Linda

 

@MrWorfMen's Mom @manxcat419

I am going to continue the thread that I started over on this Caninsulin/Vetsulin Forum called Smiffy change in numbers

 

Sounds good to me Looby. As you know, I don't have any real advice on Caninsulin as I haven't used it, but I am very interested in Smiffy's progress and how the different doses work for her.

 

Thank you April