? Tested 8,5 - To skip or not to skip?

(Our post from yesterday here)

This morning, Kitty's test showed 8,5. It has been going down so fast since friday (see spreadsheet), that I got scared, and gave no insulin. However I did give her some food, so can't test again yet. I am unsure if skipping the insulin was the right choice, and how to proceed from here.

Our vet prescribed to start at 3 units, but after reading and asking, we decided to start her on 1 unit. However, now I think we should not have started untill diet changes were done. We started both at the same time.

I will get syringes for giving .25 and .5 units when the pharmacy opens tomorrow (I didn't know that was an option untill I came here)

 

I found your new post.

As I said on FB Levemir can have a late nadir, but since you are just starting with insulin and testing you don't have enough data to know whether this is the case with Kitty. In this case skipping the shot is the best option. You can not feed anymore and retest in 2 hours to see if the numbers are rising on their own. However if they are and you decide to shoot, you are restricted to 1 unit because of the pen needle you are using and it would put your next shot time off by 2 hours as well which may not work for your schedule. It is better to err on the safe side. Since you did not give a shot this would be a good time to do some more testing to see how Kitty responds without insulin. A test at 2 hours after eating and then another one a few hours later will show how Kitty responds without insulin.

Getting the syringes with 1/2 unit markings will definitely be the best approach since you will be able to give reduced doses as the numbers show.

 

That is a good point! I'll take the day to see how she is without insuline, and then see if I feel safer giving the evening dose.
My schedule pretty much revolves around Kitty these days, so pushing the schedule a couple of hours would not be a problem. However, I have to go out to my office for a short trip at some point today. If I feel uncomfortable giving the shot, I'd definitely feel uncomfortable giving it, then having to leave her alone. If I don't do too muh damage skipping the morning shot, I think that's what I willl do today.

She was on 22 this friday, so I am scared it will continue to drop that fast.

Thank you so much for your input. I hope you all know how much it means to us newbies <3

 

Higher glucose readings can be caused by various effects . Many kitties will have a higher reading at the vet's office because of stress....very similar to some people who get 'white coat syndrome' and have high blood pressure readings at the doctors. This is why home testing is more reliable since it reduces most/all the stress effect. Also a higher carb food can raise glucose levels. As well an infection of any sort can raise glucose levels. Insulin absorption rates are not always the same every day. Insulin is a hormone which works much differently than something like an antibiotic and can vary for different reasons.

With a good low carb food and home testing you will get a clearer picture on where Kitty's glucose levels are and how much insulin is needed. Regular testing will allow you to keep Kitty safe and help determine when insulin adjustments are necessary. Because Levemir can have a much later nadir charting the numbers is important. As I said on my other post I used Levemir with 2 FD kitties and could have nadirs anywhere from 8-12 hours after the shot. This information makes it easier to determine whether it is safe to give a shot. With more testing information you will be able to determine how Kitty reacts to Levemir and when his nadirs usually occur.

 

It was 11 right now. And will probably rise throughout the day, but I still feel safer skipping the dose today, see what the numbers are tonight and if I feel comfortable giving a shot then, and get half unit syringes tomorrow

 

That is still not a big increase from the last test. It was best to skip without having the syringes available. If you can get a couple more tests before the next shot is due to see how the cycle goes with no insulin. Any data is useful. Also make sure not to feed Kitty at least 2 hours before the preshot testing. If you are unsure about what to do, do not give any food and and post on here for some input. Any time the preshot is lower than you are comfortable with you can stall...with NO food...and retest 20 minutes later to make sure it is rising without food influence.

 

14,4 now. I gave her some food, but the next shot is not until 6 hours from now. If the numbers are above this at preshot testing, I think I feel comfortable giving her the 1 unit for nighttime. Any thoughts?

 

With the numbers slowly climbing back up you should be able to give the 1 unit at shot time. It might be a good idea to test about 1/2 hour before shot time and post the number so that you can get some feedback.

If you give the 1 unit at shot time it would be useful to get a +3 +6 and +9 reading during the next cycle. This would give a better indication on whether the onset and nadir are coming later with Kitty. Not all Levemir kitties have later onset and nadir but many do.

 

I will try to set my alam throughout the night (can't stay up as I got work tomorrow). Thank you so much for your input. I will test half an hour prior, and ask if I am unsure

 

You don't have to worry about testing on this cycle since there was no insulin given. When you have time, do a few tests during a cycle when insulin has been given. At this point you are trying to see when the onset and nadir are happening.

 

She was back up to 18,6 So she got her evening unit. Going shopping for suringes tomorrow. Will these do?

 

You would want the U 100 3/10 ml ( or .3ml ) syringes with 1/2 unit markings. This will measure a maximum of 30 units with 1/2 unit increments. The .5 ml syringes measure a maximum of 50 units so the lines are closer together and harder to see for small doses.

https://www.adwdiabetes.com/product/6941/bd-ultra-fine-insulin-syringes

The needle lengths come in 6mm, 8mm and 1/2 inch. I personally use the 6mm or 8 mm length since I find the 1/2 inch a bit too long for my kitty.

 

We are having the same issue today. But now I got the syringes. Should I give half or .25? Yesterday when I gave nothing yesterday, we ended up at around 20 on the test.

 

I'm just playing with a test needle. This is half a unit?

 

I see another pre shot BG of 8.7 on your spreadsheet. You say you have the proper syringes now so I suggest you try 0.5 u to see how she is with that. There is a lot of trial and error at the start and Kitty's responses will probably be erratic for a while. Keep posting here for advice.
Regarding your syringes: do they say U100, o.3 mL on them? Usually insulin syringes with half unit marks have a right side scale for whole units and a left side scale for half unit marks. All of your marks are within the same scale.

 

Here's a diagram of the syringe scales I'm referring to:

 

It is, I think. At the pharmacy they said it was the only ones they had with half unit marks. Is it the wrong ones ?

 

I think the long lines are one and the small ones are half. And the really long ones are every five units.

 

Yes, those seem to be correct, just different from the more typical syringes we see here (I'm in Canada - I use the same BG units as you do). That means half a unit is the short mark between the longer unnumbered marks as you are asking about in your post #14 above.

 

What would I ever do without you guys <3 I tried a skinny .5. I will test at +3, and leave the emergency vet number with my boyfriend wen I go work (I will only be gone 2-3 hours and he will kitty-sit)

 

Please keep posting here for advice. We can help!

 

Kris has given you some good information. The main goal right now would be to find out when the Levemir is starting to work and when the nadir ( lowest number) happens since many Levemir kitties have later onset and nadir than with other insulins. If you find a later onset is occurring then it is possible to give a shot on a bit of a lower number. For instance...if you find that the Levemir is not starting to take effect until around +5 hours, then shooting a somewhat lower preshot number is not as risky since there would be 5 hours of numbers rising before the next shot takes effect. But you need to see what Kitty's pattern is. When you have the time available doing a test at +3, +6 and +9 will give a good overall of the cycle. The more data the better!!

ETA Good job on getting the syringes!!

 

I will definitely do that! Today I only gave a "skinny" 0.5 but I can do +3, +6 and + 9 testing today

 

Perfect. With insulins such as Levemir and Lantus it can take several days to see the full effect of a dose. Both insulins form an insulin 'depot' which is slowly absorbed by the body through the cycle so it can take a day or so to for a dose change to reach "full effect". By doing a few extended tests through the cycle you will get a good overall picture on how Kitty is responding and then dose increases or decreases can be made as needed.

Obviously it was a good thing you chose NOT to follow the vet's suggestion of a starting dose of 3 units!!

 

I will probably be just as confused, for a while, until I learn in interpret the results I get. It is such a comfort knowing that I can turn to this forum for help, and it will be easier to help us, once I get some data.

I am not looking forward to talking to my vet saying "Thank you for all your help, but I did pretty much nothing you told me to" (of course not in those words).

 

Best to just "nod and grin" when talking with the vet. Once you have good data and good results then you can let the vet know what you are doing. Many vets are not pleased when caregivers do their own research and many tend to discredit information on the internet even when based on scientific papers.

 

Just another comment. Since you are now using a syringe for your Levemir rather than the pen needle it can be stored in the fridge to allow for longer time usage. When using the pen needles it is advised to store at room temperature since the cold affects the measuring mechanism but when using syringes this is not the case. Also any unopened pen fills should also be stored in the fridge.

 

This is my fear, that she will get grumpy. It sort of feels safe having her support

Oh, I didnt know this! I have been keeping it all in the fridge (it said behind the package to store in fridge). Good thing you said! I figured I could still use the pen for whole units when I give that. I am more comfortable with that. MAybe I should just learn to just use syringes?

Kitty was down to 6,6 earlier. I didn't have the calm about me to wait 3 new hours, so I tested an hour later I found it to be 9,5. My Kitty's poor poor ears!

I know she is still high. I want her further down, of course, but not too fast, concidering its only a few days since we started both insuline and diet change. i don't know if this is the right mindset, but it freaks me out a little thinking how low she will go before I know how she and the insulin work together. The thought of what could have happened i I gave her 3 units like prescribed, is really scary! Thank God for you people <3

 

Yes, I think this is best. There's less measurement error if you use the same technique with each dose. I'm a science person so I think about these things ... Consistency in dosing is more important than absolute accuracy.

Yes, this is the right mind set. We always say here that this is a marathon and not a sprint!

 

Using syringes for all dosing amounts is better. That way you are using the same delivery method for all doses just as Kris has said.

Those are nice numbers for this cycle. Did you feed Kitty after the +6 test? Food will generally give bit of a spike for an hour or two after eating so getting a +9 test (if possible) would still be some good data. The 1/2 unit dose seems to be fitting well as a starting point and you are doing a great job!!

BTW I have poked my Maxie's ears well over 4000 times since she was diagnosed and her ears are fine.

 

She did NOT get food after the +6. So that was a pretty big increase considering. Sure druid get some food after her +7 though, so I'll do a +9 then it's the preshot next after that.

Do you think I should keep to .5 as "default" or is it back to 1 unit if numbers are up?

 

The increase at +7 is not a large jump. Also any glucose meter is allowed up to a 20% variance in readings so the numbers are actually pretty close. A +9 reading will show how Kitty is carrying through the cycle and whether the numbers are continuing to rise or just 'surfing' along.

With Levemir or Lantus it can take a few days for the dose to'stabilize' so the 0.5 unit dosing looks like a good starting point to stick with for now. You always have to look to see how low a dose goes rather than be overly concerned with the preshot number. If the preshot number is lower than you are comfortable with then you can always post for suggestions. Just remember not to give any food for at least 2 hours before the preshot test.

 

14,7 now.
She has not gotten any food for the last two hours. I expect it to rise more the next couple of hours. Does that mean half unit won't last all day, where a whole unit might be too much ?

 

It takes time for a FD kitty's body to adjust to insulin. It is possible that Kitty has had higher glucose readings for a while so her body is 'used' to higher numbers as 'normal' Overall this cycle has been very nice for a newly diagnosed kitty. Also it takes time for the Levemir 'depot' ( stored insulin) to be filled. Even if the numbers seem higher at preshot I would stay with the 0.5 unit for the next few days at least.

Information on the insulin depot is described here:

http://www.felinediabetes.com/FDMB/threads/what-is-the-insulin-depot.150/

There are different approaches to doing dosing changes

The start low and go slow method is described here:

http://www.felinediabetes.com/FDMB/threads/start-low-go-slow-method-slgs.129446/

The TR protocol is described here:

http://www.felinediabetes.com/FDMB/threads/tight-regulation-protocol-tr.1581/

Members will select an approach that works for them and use the guidelines to make dose changes. Of course there will always be people available to assist with that.

 

I have had a look at both guides a few times, and I am still not completely getting it (That is NOT the guide's fault, it's me just trying to learn it all at once). Now that I got the food, testing and syringes down, I'll get to that. Well, I'm not too good with syringes yet. I still find it hard to dose with the syringe, and tonight's dose came out as a fat .5 (third syringe I tried, after being too heavy handed and squizing past the .5 lines with the two first ones - Oh the frustration!)

Thank you for the encouragement. I really appreciate it

 

When you draw up insulin in the syringe, pull in a little more than the dose you want and then get rid of the excess by turning the plunger like a screw instead of pushing on it. Pushing makes it very hard to release tiny amounts slowly.

 

The difference between the SLGS and TR is in a nutshell how long a dose is held for and at what reading a reduction is taken. The TR protocol is more aggressive than the SLGS. It takes some time to absorb the information...I am sure it took me weeks to understand when I first started. Just with having a proper diet, testing and giving insulin you are well on your way.

If you have just a small amount of extra insulin in the syringe you can twist out the excess into the sink rather than using a new syringe. The only thing you don't want to do is inject insulin back into the pen vial. You can take a used syringe and practise with water to get the feel.

 

The twisting/turning is a real good tip! I will have a few pretend-goes at that before the next shot!

It is not all about learning the "theory", the practical tips like this is just as useful! All tiny frustrations (which this really is - tiny - when you look at the whole picture) adds to the emotional stress.

On a good note, I thought Kitty would hate me with all this fuss, but the last 24 hours she has stopped sleeping under the table, and are now more social in picking her sleeping spots

 

When I started testing with my Tuxie 4 years ago I was in tears and he was howling. Within a short period of time (once he figured out that he got treats after testing) I would merely tell him it was 'pokey time' and he would come right over to the testing area. Sometimes he would sit on the test mat and meow at me even when I didn't need to test him. Food was a powerful motivator for him. His sister Maxie is not quite so co-operative...she always has a comment or two to make at test time...but she takes it all in stride. I truly believe that kitties come to understand that we are doing what we do to make them feel better. Looks like Kitty is a fast learner..just like his Mom.