Help needed - not 911 but New Wenchie issue and question

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Diane Engoron

Diane Engoron

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This morning Wenchie was at 393, gave her .10 unit of Lantus. I retested her at +3 - 196. She just threw up so I retested to see if there's a correlation in her BG dropping and vomiting. She tested at +5 at 91 - still within the normal range but I decided to give her a tablespoon of HC wet.

She "appeared" to be feeling good, jumped up on my lap and then took over my chair when I walked out of the room - all Wenchie pre-diabetes behavior.

So, I need advice on what to do next. Obviously retesting but what time frame does anyone suggest?

Thanks so much in advance!
 
If Wenchie has kept her food down since you tested her at +5, you should be ok to test again at +6. The HC wet will keep her BG's higher than a simple sugar alone (like honey, corn syrup).

The 91 BG reading is not too low, but I would get another test at +6. Make sure she isn't dropping <50 mg/dL.
Not sure when her nadir is yet, so a test at +7 may be in order too. Depends on the +6.

Vomiting in a cat is not normal. This is something to ask/tell your vet about.
 
OK. I'm planning to retest at +6. I didn't want to spike her BG so I thought just a tablespoon of HC Beef Feast would help. What I'm thinking is she tends to vomit (early morning usually) when her BG goes down. I don't know what the correlation is. She's a slow eater and doesn't gobble (like my Bengal).
 
Regular low carb Fancy Feast probably would have been fine.

Vomiting only in the mornings?
Any food left out at night for her?
No YAZM dry food?
Which Purina and Pro Plan?
Any particular flavor of food?
Maybe one of the foods does not agree with her stomach.

That is why I'm asking all the questions.
Doing a little detective work. Or asking questions so you can be the detective. ;)
 
Deb & Wink said:
Regular low carb Fancy Feast probably would have been fine.

Vomiting only in the mornings? - Yes - usually around 5 am-ish
Any food left out at night for her? - Yes - and taken away by 4am for her AMPS
No YAZM dry food? - No - took all dry away
Which Purina and Pro Plan? - Today Beef with giblets - only the Pro Plans and Purina Ones that are pates and low carb
Any particular flavor of food? - she gets different foods each day. I will start to keep a log of what she’s eating to try to correlate her vomiting.
Maybe one of the foods does not agree with her stomach. - yes!

That is why I'm asking all the questions.
Doing a little detective work. Or asking questions so you can be the detective. ;)
Click to expand...


Vomiting only in the mornings? - Yes - usually around 5 am-ish
Any food left out at night for her? - Yes - and taken away by 4am for her AMPS
No YAZM dry food? - No - took all dry away
Which Purina and Pro Plan? - Today Beef with giblets - only the Pro Plans and Purina Ones that are pates and low carb
Any particular flavor of food? - she gets different foods each day. I will start to keep a log of what she’s eating to try to correlate her vomiting.
Maybe one of the foods does not agree with her stomach. - yes!

Retesting in a minute but will keep a log of her foods to try and see if there’s any correlation.
 
You could note the foods for each cycle and day on the spreadsheet. There is a Remarks column over on the right hand side of the SS. Perfect for notes such as the foods, how much, fed a bit of HC at +5, etc.
 
Deb & Wink said:
You could note the foods for each cycle and day on the spreadsheet. There is a Remarks column over on the right hand side of the SS. Perfect for notes such as the foods, how much, fed a bit of HC at +5, etc.
Click to expand...

I will do that as well as keeping my own notes. So, we just retested her at +6 and she's dropped to 66. Karo syrup on her gums and now she's eating HC Beef Feast. Could she possibly be so sensitive to Lantus - even .10 unit?
 
Diane Engoron said:
Could she possibly be so sensitive to Lantus - even .10 unit?
Click to expand...
Yes,

Karo syrup can wear off quickly. You want to retest in 20 minutes or so from the last test.
Until you get rising numbers for at least an hour past nadir. Maybe longer.

Good that she ate the HC food. No more karo for now. Let's see what the next BG test is.

(Daytime pajama party. NOT going anywhere for a while. I'll stay with you until the BG's get back up. )
 
Deb & Wink said:
Yes,

Karo syrup can wear off quickly. You want to retest in 20 minutes or so from the last test.
Until you get rising numbers for at least an hour past nadir. Maybe longer.

Good that she ate the HC food. No more karo for now. Let's see what the next BG test is.

(Daytime pajama party. NOT going anywhere for a while. I'll stay with you until the BG's get back up. )
Click to expand...

I guess I’m joining you in the daytime pj party. Still in mine! She’s sitting on my lap right now. I will retest in a half hour as she just finished eating.
 
Deb & Wink said:
Yes,

Karo syrup can wear off quickly. You want to retest in 20 minutes or so from the last test.
Until you get rising numbers for at least an hour past nadir. Maybe longer.

Good that she ate the HC food. No more karo for now. Let's see what the next BG test is.

(Daytime pajama party. NOT going anywhere for a while. I'll stay with you until the BG's get back up. )
Click to expand...


OK. So +7 she is at 72. She's acting fine but I know that doesn't mean anything. She's eating FF Chopped Grill Feast (she loves that one). Will retest at +8 - we're keeping track of which ear. Poor baby - she probably feels like a pin cushion.

My question is - should I stop the insulin to see where she is? To me - and tell me if I'm wrong - even this tiny amount is too much. Is it possible the change of diet has been enough and I need to let her "settle"?
 
72 is better.
I think you should test for at least 1 more hour Diane

Diane Engoron said:
Is it possible the change of diet has been enough and I need to let her "settle"?
Click to expand...
Yes, it is possible the diet change made a big difference.
There is also the insulin "depot" when you are using lantus, and that may still be providing some insulin and that "depot" has not drained completely yet.

It's also possible that Wenchies own pancreas is starting to produce some insulin.

p.s. How is the disabled kitty doing by the way? Jealous of all the attention Wenchie is getting?
 
Deb & Wink said:
72 is better.
I think you should test for at least 1 more hour Diane


Yes, it is possible the diet change made a big difference.
There is also the insulin "depot" when you are using lantus, and that may still be providing some insulin and that "depot" has not drained completely yet.

It's also possible that Wenchies own pancreas is starting to produce some insulin.

p.s. How is the disabled kitty doing by the way? Jealous of all the attention Wenchie is getting?
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We will retest at +8.

OK - I kept thinking about the insulin depot - perhaps she should be on it once a day? This is so trial and error until you find exactly what works. But I promised Wenchie today that we will not let diabetes kill her. We will get her feeling better. I can't break my promise to my first born. Also, my husband and I have talked about her making her own insulin. Sheesh - how I wish her body parts could talk to me!

Our disabled kitty, Christopher, is a spoiled boy - he will not be ignored!! He still gets a lot of attention because we have to - he cannot walk - he's a severe Cerebellar Hypoplasia cat. We adopted him almost 3 years ago at 12 years old. His first mom, who had him since he was a kitten, passed away suddenly. Her son found her gone in the bathroom while taking care of Christopher. Very sudden and very unexpected. It took her son 2 years to find the right person to adopt Chris and I give him credit for not dumping him in a shelter or putting him down. He is my second CH kitty (my first passed away in 2017). I have him trained to go on cloth wee-wee pads in a soft-sided playpen - and he picked up on it quickly. The trick is to bring him in at set intervals or, when he goes off schedule, he lets us know by yelling out. He has his own room overnight where he can roll into his "tent" to do his business and roll on out to eat, drink or crawl into his little house to sleep.
 
Did you ever get the ketone test strips? For testing the urine for ketones. Dangerous if the ketone levels are above a trace.

Right now, if you told me Wenchie had no signs of ketones, I'd suggest skipping the dose for several cycles and see if the BG levels settle down.

CH kitties do have some special needs. But Christopher is your second, so you have some experience with helping a CH kitty. Special needs kitties are easy to love. Do you belong to one of the CH cat groups?
 
Diane Engoron said:
My question is - should I stop the insulin to see where she is? To me - and tell me if I'm wrong - even this tiny amount is too much.
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With the depot, the tiny amount of insulin, the food change, all together are taking Wenchie too low at the middle of the cycle.

With the high carb food today, she is likely to bounce tonight.

How do you feel about stopping the insulin for now?
No ketones, no history of DKA?
You'd still want to monitor.
 
Deb & Wink said:
Did you ever get the ketone test strips? For testing the urine for ketones. Dangerous if the ketone levels are above a trace.

Right now, if you told me Wenchie had no signs of ketones, I'd suggest skipping the dose for several cycles and see if the BG levels settle down.

CH kitties do have some special needs. But Christopher is your second, so you have some experience with helping a CH kitty. Special needs kitties are easy to love. Do you belong to one of the CH cat groups?
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I did get the ketone test strips but I have absolutely no idea how to use them nor how to catch her peeing. Any suggestions welcome! She has no history of DKA.

Christopher is a doll. We just adore him and he adores my husband. Me, not so much because I'm the one bathing, cleaning him, medicating him (he's asthmatic) so I'm the bad guy! And yes, I belong to several CH groups and I'm considered one of the experts on there LOL! How I wish I was an expert on Feline Diabetes!

My "gut" is telling me to either only administer .10 units in the morning (once a day). Or, I could totally stop it. Would it be more prudent to just dose her once a day?
 
Deb & Wink said:
With the depot, the tiny amount of insulin, the food change, all together are taking Wenchie too low at the middle of the cycle.

With the high carb food today, she is likely to bounce tonight.

How do you feel about stopping the insulin for now?
No ketones, no history of DKA?
You'd still want to monitor.
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119 at +8. I'm reading the Ketone package now. I just have to catch her peeing!
 
In the last 6 days, Wenchie has had 3 incidents of very low numbers. Those low BG readings are even scarier since you are using an Alphatrak pet meter to monitor her blood glucose levels.

You've had so many skipped doses, dose changes, kept lowering the dose, more skips, pre-shot BG's too low to give Wenchie her insulin, propping her up with HC food and karo syrup. All that in the last 3 weeks. Looks like your vet was having you change the dose based on the pre-shot tests. Bad idea as you have found out.

My recommendation would be to stop the insulin completely for now.
Let the depot drain.
Test her at the usual pre-shot times. If green, no more testing for that 12 hour cycle.
If the pre-shot BG is in the blue color range or higher, test Wenchie again at around +3 or +4.
If her body is producing some insulin on it's own, that +3 +4 should be lower than the pre-shot test.
Food raises BG levels, and if there is still insulin being provided, then the pancreas is working or there is still some insulin left in the "depot.
I'm guessing that Wenchie is dropping really low during the night time cycle also.
You simply are not catching those lows, since you can't stay up that late to test.

Keep us posted here on the message board in regards to how things are progressing for Wenchie.
 
Deb & Wink said:
In the last 6 days, Wenchie has had 3 incidents of very low numbers. Those low BG readings are even scarier since you are using an Alphatrak pet meter to monitor her blood glucose levels.

You've had so many skipped doses, dose changes, kept lowering the dose, more skips, pre-shot BG's too low to give Wenchie her insulin, propping her up with HC food and karo syrup. All that in the last 3 weeks. Looks like your vet was having you change the dose based on the pre-shot tests. Bad idea as you have found out.

My recommendation would be to stop the insulin completely for now.
Let the depot drain.
Test her at the usual pre-shot times. If green, no more testing for that 12 hour cycle.
If the pre-shot BG is in the blue color range or higher, test Wenchie again at around +3 or +4.
If her body is producing some insulin on it's own, that +3 +4 should be lower than the pre-shot test.
Food raises BG levels, and if there is still insulin being provided, then the pancreas is working or there is still some insulin left in the "depot.
I'm guessing that Wenchie is dropping really low during the night time cycle also.
You simply are not catching those lows, since you can't stay up that late to test.

Keep us posted here on the message board in regards to how things are progressing for Wenchie.
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All great recommendations and exactly what I was thinking. No more insulin, especially tonight because of the bounce. I'm disappointed that my Vet is not more clued in on this. Just like with human doctors, we need to be our own advocates.

I will absolutely keep you posted and thank you so much for all your help today! I finally took a shower LOL!
 
Diane Engoron said:
I finally took a shower LOL!
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Thursday I made the mistake of coming downstairs to feed my cat, before my shower. Still in bathrobe and jammies. Thought I'd check the message board for a couple of minutes. At 2 pm, I gave up on trying for a shower that morning, got dressed and came back to the message board. Shower was very late. What can I say. Life happens.
 
Deb & Wink said:
Urine catching tips.
https://docs.google.com/document/d/1quta5WLEjdO0Y_t2dAYSwN84h-LNZWxOdtVsJDKZ16A/pub

Your Christopher would be much easier to get a urine sample.

I think you are ok to stop BG testing for this AM dosing cycle.
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Believe it or not, she was EASY to catch her urine! I was shocked - even my husband said - are you kidding? Wow!

Did the ketone test and she negative so we're good to go. I will follow your recommendations to a T! I honestly cannot thank you enough. I can rest a little easier. It's almost a reset to the beginning in a way. We'll see what's going on with her body without me messing with it and then can make a good decision on the next steps!

You have no idea what your help has meant to me. If you were here, I'd hug you! Thank you from the bottom of my (and Wenchie's) heart. If I had only listened to my vet, she'd be dead by now. I don't even want to think about that.
 
Deb & Wink said:
Thursday I made the mistake of coming downstairs to feed my cat, before my shower. Still in bathrobe and jammies. Thought I'd check the message board for a couple of minutes. At 2 pm, I gave up on trying for a shower that morning, got dressed and came back to the message board. Shower was very late. What can I say. Life happens.
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LOL! It sure does!
 
Diane Engoron said:
You have no idea what your help has meant to me. If you were here, I'd hug you! Thank you from the bottom of my (and Wenchie's) heart. If I had only listened to my vet, she'd be dead by now. I don't even want to think about that.
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You're welcome.

Ketones negative. Please test for ketones every day for now, since you are stopping the insulin.
Add to this same thread if you would please. That way, I'll get an alert with each of your new posts.

Attach a picture of your Christopher CH kitty. Love to see pictures of other cats too, not simply the extra-sweet kitties. Please. That is my "fee."
Virtual hugs accepted. :bighug::bighug::bighug:

Diane, you probably don't know how much you have done and helped your kitty Wenchie in only the last 6 days. You did an absolutely stellar job, getting the SS set up, learning to home test more, learning what to do for low BG readings, learning why tests in the middle of the cycle were important. It was our pleasure to help you. Everyone here is part of our FDMB family. We may never meet in person. but we know and care for and look out for each other.

Keeping all paws crossed here for continued good BG readings for Wenchie.

p.s. Grew up in a small town in western NY state myself. Kept moving east ever since. Can't go too much farther or I'll end up with wet feet, standing in the ocean. ;)
 
Ahhh... an Upstate girl - so you know how miserable the winters are up here!!! I miss the west coast so in two years we're heading back out there. I so wanted to love it up here but, as I get older, I just cannot deal with these winters. We're horsey-people as well and the Saratoga Springs is perfect for that. I always loved winter and I'm shocked that I've taken a complete turnaround. When we were in San Diego, there was massive blizzards in NY (winter 1996 I think?) and we were jealous and wanted to come home. Be careful what you wish for I guess!

This group is just amazing. Every single person, even if they didn't have any advice, just giving me words of encouragement. In this messed up world of ours, this just gives me hope!

I've attached pictures of Christopher (with my husband and his all-time favorite person), Cooper (tripod), Riley, and Monkey. Monkey is our youngest and the most insanely hilarious cat on the planet. Hence, her name.

I'll stay with this thread and keep you posted - thank you so, so much!

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Deb & Wink said:
My Dancer and your Monkey could be kitty cousins.
View attachment 51463

Lake effect snow anyone?
Now, I just live where there is ocean effect snow. Same thing, but heavier. Nor'easters.
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Dancer is beautiful! What a gorgeous face!

Nor'easters - we used to live in Mass and CT so we've had our share of Nor'easters! I just want warm and dry - no humidity! My husband went to school in Brockport and he keeps reminding me that I haven't experienced winter until I experience lake effect snow. I went to school in Southern California so I've dealt with plenty of earthquakes - so every place has something!
 
I just read the full thread and you’re doing great.

I too had a cat who was super sensitive to insulin. It was surprising even to my university vets to see the BG swings that such a tiny amount of Lantus would cause (and he even proved it to them when he was hospitalized). If the BG doesn’t stay low enough with no insulin, but 0.1u is too much, you can try using just a “drop” of insulin.

As for the vomiting in the early morning ... is this new since the diabetes diagnosis (or since starting insulin, which I assume are both around the same time)? Or perhaps since you started pulling up food for two hours prior to shot time? Have you ever gotten a BG test when she vomits?

Some cats just do not do well with an empty tummy. Since it’s once a day, or once every few days, it’s hard to know. My guy would vomit like clockwork at 4 am every day, and it got to where I kept a towel on the floor next to the bed and simply grabbed him at the first retch, rolled over, lowered him down to the floor and held him while he puked, then pulled him back up into bed with me and we went back to sleep. His issue turned out to be chronic pancreatitis (CP), which isn’t uncommon in diabetics, but his issue evolved from vomiting once a day to ten times a day until we found a treatment that worked for him. Doesn’t quite sound like what you’re dealing with, though. But I did always joke that the most effective alarm clock is the sound of retching cat. :)

Is it possible Wenchie is grooming more, perhaps overnight, and that’s causing a mild bout of vomiting?
 
JL and Chip said:
I just read the full thread and you’re doing great.

I too had a cat who was super sensitive to insulin. It was surprising even to my university vets to see the BG swings that such a tiny amount of Lantus would cause (and he even proved it to them when he was hospitalized). If the BG doesn’t stay low enough with no insulin, but 0.1u is too much, you can try using just a “drop” of insulin.

As for the vomiting in the early morning ... is this new since the diabetes diagnosis (or since starting insulin, which I assume are both around the same time)? Or perhaps since you started pulling up food for two hours prior to shot time? Have you ever gotten a BG test when she vomits?

Some cats just do not do well with an empty tummy. Since it’s once a day, or once every few days, it’s hard to know. My guy would vomit like clockwork at 4 am every day, and it got to where I kept a towel on the floor next to the bed and simply grabbed him at the first retch, rolled over, lowered him down to the floor and held him while he puked, then pulled him back up into bed with me and we went back to sleep. His issue turned out to be chronic pancreatitis (CP), which isn’t uncommon in diabetics, but his issue evolved from vomiting once a day to ten times a day until we found a treatment that worked for him. Doesn’t quite sound like what you’re dealing with, though. But I did always joke that the most effective alarm clock is the sound of retching cat. :)

Is it possible Wenchie is grooming more, perhaps overnight, and that’s causing a mild bout of vomiting?
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Thank you so much - it's been really hard, as I'm sure it has been for everyone else. I feel like I finally have gotten over the "hump" so to speak.

I like the idea of using just a drop of insulin but how do you get just one drop? I'm using a Lantus pen but drawing with a syringe. Believe me, and I'm sure you know, getting .10 unit is difficult enough! I always would draw it and then have my husband double check it.

The early morning vomiting is a new thing and now I'm wondering if it has something to do with taking her food away. We have to at 4am so we can test her at 6am. Today we got a BG test because she vomited between the +5 and +6 time frame and her BG was falling fast. At +3 we checked her and she was 196, then she vomited and at +5 her BG fell over 100 points. At +6 another 30 or so points. Still, I haven't been able to firmly say it's because of one thing or another. I'm going to have to talk to the vet about this. She's a Maine Coon and, though never overweight, she was about 14 pounds healthy. She's now 6 pounds and it breaks my heart. And I haven't caught her grooming more when I'm awake but I wonder what she does when we're sleeping. Hmmmmm.....

Oh, I hear you about a vomiting cat. We have 5 and when one of them starts in the middle of the night, we bolt up out of bed like the house is on fire! It's funny thinking about it but not so much when it's happening LOL!

I will continue posting on this thread as I try to figure out what we can do to get her into remission. Honestly, I don't fully trust my vet because I feel like, in this short time, I know more than she does! I asked her about the Lantus Insulin Depot and she didn't know what that was. Sheesh.....

I really, really appreciate your message! Thank you so much for your kind and caring words. Wenchie and I will get through this. I promised her this morning that I would let this get her!
 
JL and Chip said:
Haven’t read the entire thread in detail so this might have already been mentioned ... but I think since it’s an AlphaTrak meter, we want her to stay above 65-70, no?
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Yes, with an Alphatrak meter, any BG number below 68 is a cause for concern and the BG levels should be brought up more quickly with food.

Wrote the drop dosing procedure down in a Word document. Been talking to a few other members that are getting those low blues, not quite in remission, need tinier amounts than the 0.1U, using Prozinc or Vetsulin. So I've told them about the drop dosing. Those insulins can also use U100 syringes for measuring smaller doses with the U40 concentration insulin.

Lantus and levimir users don't have that option, of the different syringes.

Diane, I can teach you how to draw up a single drop. But could this wait until tomorrow? Full day for me today, getting late and I go to bed really early.

If I forget, give me a nudge and I'll copy and paste the information on drop dosing for you.

Kerri & Tigger, HelloKrystie and _Bobbie. Mentioned it to one more person who's name escapes me at the moment.
 
How is Wenchie’s appetite? Voracious? Normal? Reduced?

I ask because sometimes we see compound problems. A six-pound Maine Coon is heartbreaking, and sometimes there are other issues that cause weight loss in addition to diabetes. If she has a good or voracious appetite, her BG values improve, and she’s still not gaining weight, I’d probably want to consider checking for hyperthyroidism. If her appetite is poor, I’d probably want to know what the kidney values were doing and run an SDMA.

My Charlie had lots of issues ... he was diabetic and had hyperT as well as IBD, CP, and kidney disease so it was a little tricky to figure out what was causing what. Hopefully Wenchie is “simply” diabetic and all will resolve with a little time and insulin and good food.
 
Deb & Wink said:
Yes, with an Alphatrak meter, any BG number below 68 is a cause for concern and the BG levels should be brought up more quickly with food.

Wrote the drop dosing procedure down in a Word document. Been talking to a few other members that are getting those low blues, not quite in remission, need tinier amounts than the 0.1U, using Prozinc or Vetsulin. So I've told them about the drop dosing. Those insulins can also use U100 syringes for measuring smaller doses with the U40 concentration insulin.

Lantus and levimir users don't have that option, of the different syringes.

Diane, I can teach you how to draw up a single drop. But could this wait until tomorrow? Full day for me today, getting late and I go to bed really early.

If I forget, give me a nudge and I'll copy and paste the information on drop dosing for you.

Kerri & Tigger, HelloKrystie and _Bobbie. Mentioned it to one more person who's name escapes me at the moment.
Click to expand...

That's fine, Deb - when you get a chance today, tomorrow, early next week - the info on drop dosing can wait. I appreciate your help!
 
JL and Chip said:
How is Wenchie’s appetite? Voracious? Normal? Reduced?

I ask because sometimes we see compound problems. A six-pound Maine Coon is heartbreaking, and sometimes there are other issues that cause weight loss in addition to diabetes. If she has a good or voracious appetite, her BG values improve, and she’s still not gaining weight, I’d probably want to consider checking for hyperthyroidism. If her appetite is poor, I’d probably want to know what the kidney values were doing and run an SDMA.

My Charlie had lots of issues ... he was diabetic and had hyperT as well as IBD, CP, and kidney disease so it was a little tricky to figure out what was causing what. Hopefully Wenchie is “simply” diabetic and all will resolve with a little time and insulin and good food.
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She has a voracious appetite! We pretty much free feed her pate whenever she asks because she is so painfully thin. She had a full bloodwork panel and, other than the diabetes, her numbers are perfect - kidneys, thyroid, everything is well within the normal range.

I'm just wondering - and this may be my next question - should I continue feeding her whenever she wants - basically all the time except for the 2 hour fast before AMPS and PMPS? It breaks my heart to see her so thin. I can feel every rib, every bone in her spinal column.
 
My Charlie was a walking skeleton for awhile too. I fed him whenever he was willing to eat — he definitely needed all the calories he could get. Smaller, more frequent meals can be easier on the pancreas.

I’m glad the vet ran the thyroid test. It’s not always included in “standard” bloodwork (my local vets can’t do thyroid in-house so have to send it out, and even the university vet only does a T4, not a full thyroid panel).

I had to do the “drop” of insulin routine with Charlie. It’s not an exact science. I’d draw up a tiny amount of insulin, pull the needle out of the vial, pull back the plunger a bit and flick the syringe gently to remove air bubbles, then hold the syringe up to a light, needle up, and gently push (more like twist/wiggle) the plunger ever so slightly to push out a drop of insulin at a time, until the black rubber stopper nearly touched the end of the syringe barrel. The final firm push of the plunger into the end of the syringe would yield one last drop of insulin. If you’re careful and have steady hands, once you push that last drop out to the tip of the needle, carefully pull back slightly on the plunger to suck that drop back into the needle. Then go inject that drop into Wenchie.

Practicing with colored water is a great way to get the hang of it. You can experiment and feel how many drops you can get out even when you think the syringe is empty, and how to wiggle/twist the plunger “just right” so you don’t end up wasting insulin or muttering four-letter words. :)
 
Is this another way of doing a drop dose. I was given this by another member a while ago Drop dose which is done by depressing the plunger as hard as you can before inserting the needle into the vial or pen. When inserted, just let go and let the suction draw up a drop of insulin. It won't look like there is anything in the syringe barrel. When injecting, depress the plunger as hard as you can and hold it for a second or 2 before withdrawing the needle
@JL and Chip

@Deb & Wink
 
JL and Chip said:
My Charlie was a walking skeleton for awhile too. I fed him whenever he was willing to eat — he definitely needed all the calories he could get. Smaller, more frequent meals can be easier on the pancreas.

I’m glad the vet ran the thyroid test. It’s not always included in “standard” bloodwork (my local vets can’t do thyroid in-house so have to send it out, and even the university vet only does a T4, not a full thyroid panel).

I had to do the “drop” of insulin routine with Charlie. It’s not an exact science. I’d draw up a tiny amount of insulin, pull the needle out of the vial, pull back the plunger a bit and flick the syringe gently to remove air bubbles, then hold the syringe up to a light, needle up, and gently push (more like twist/wiggle) the plunger ever so slightly to push out a drop of insulin at a time, until the black rubber stopper nearly touched the end of the syringe barrel. The final firm push of the plunger into the end of the syringe would yield one last drop of insulin. If you’re careful and have steady hands, once you push that last drop out to the tip of the needle, carefully pull back slightly on the plunger to suck that drop back into the needle. Then go inject that drop into Wenchie.

Practicing with colored water is a great way to get the hang of it. You can experiment and feel how many drops you can get out even when you think the syringe is empty, and how to wiggle/twist the plunger “just right” so you don’t end up wasting insulin or muttering four-letter words. :)
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Poor baby - that's exactly the perfect description, a walking skeleton. She literally eats like a horse. I give her a couple of tablespoons at a time of food. She's a slow eater, which is a good thing. I have one that wolfs food down then vomits it back up whole. We keep trying to slow her down - different types of plates, tiny portions - for 11 years she has and continues to wolf her food down. I don't get it!

Thank you for the "tutorial" on the one drop method. I have a vial of saline to practice on but I'm buying some food coloring today to practice first on some colored water. If I can see it first, I'll be able to get a feel for it. Then I'll try with the saline before I work on Wenchie.

Just tested her at +3 and she was high - 355 - but we've taken her off the insulin and kind of allowing her body to reset and see where we are. She's been on only wet pates and, at Deb's direction, have taken her off the Young Again Zero Mature in case that is raising her BG. I also managed to test her ketones yesterday - first shot! I just followed her into the litter box room, put the cup under her bum and it was easy - I was happily surprised! And she was negative for ketones. Will be retesting her today.

So, I'm feeling a bit more at ease because I know she's not going to crash on me. Now I have to make sure she's not going the other way. Retesting at +6.

Thank you so, so much!!!!!
 
Diane Tyler's Mom said:
Is this another way of doing a drop dose. Drop dose which is done by depressing the plunger as hard as you can before inserting the needle into the vial or pen. When inserted, just let go and let the suction draw up a drop of insulin. It won't look like there is anything in the syringe barrel. When injecting, depress the plunger as hard as you can and hold it for a second or 2 before withdrawing the needle
@JL and Chip

@Deb & Wink
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Interesting! I'm going to be practicing today with colored water to get the hang of it. Thank you!!!!
 
@JL and Chip gave a good description of the drop dosing method.

Here is what I wrote up on drop dosing:
Drop Dosing

How many drops do you get from your insulin syringes if you draw the liquid up to the first line? Not the first line with a number next to it, or the shorter line that shows half unit markings. The very first line on the syringe. What we think of as the zero mark.
  • Practice, practice, practice to see how many drops you can get out of the syringe.
  • Use some sort of colored clear juice like apple juice or colored water.
  • Mark the syringe well. Painter's tape, duct tape, masking tape at the top of your “practice syringe”. So you don't forget and use that syringe to draw up insulin.
  • Draw the "test liquid" up to the first line on the syringe.
  • After you have drawn up a tiny bit of “test liquid”, point the needle up towards the ceiling and give the syringe a "finger flick. Push out the air bubbles.
  • Slowly “twist” the syringe plunger to push out all the “test liquid.”
  • Then when one small drop of “test liquid” is all that is left on the beveled tip end of the needle, draw the syringe plunger back to "suck" that 1 drop back into the syringe.
  • You are looking for consistency.
  • Try to get evenly sized drops.
  • Practice, practice, practice until you get a consistent number of drops.
Do you think you have the technique down for the drop dose?

Then let me know.

When it’s for real. You’ve practiced and are ready to give a tiny “1 drop” dose.
  • Draw up a tiny bit of insulin, needle pointed up to the ceiling and give the syringe a "finger flick. Push out the air bubbles.
  • Slowly “twist” the syringe plunger to push out all the insulin.
  • Then when one small drop is all that is left on the beveled tip end of the needle, draw the syringe plunger back to "suck" that 1 drop back into the syringe.
"Finger flick” technique - make a circle with thumb and first 2 fingers tucked into first thumb joint. Quickly “snap” those first 2 fingers against the syringe barrel held in your other hand. That will force any air bubbles up to the top of the syringe. Then you can push the air bubble out.

Syringes have a lubricant inside. Before you draw up insulin, moving the syringe plunger up and down a couple of times helps the plunger move more easily.

Give the shot. Monitor.

Later, if you need to, you could increase the number of drops."

@Diane Tyler's Mom

There was an article I read years ago, on how it's almost impossible to measure 2U or less of insulin, accurately and consistently from shot to shot. Don't know where that article is. But we certainly give our cats tiny doses of insulin.

Here are links to a couple of articles on measuring small doses in human infants and children. In case anyone is interested.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939443/
https://www.ncbi.nlm.nih.gov/pubmed/14968895
https://www.researchgate.net/public...ministration_using_pen-injectors_and_syringes
https://journals.sagepub.com/doi/full/10.1177/1932296817736316# <<<<< Now, if they would develop a 1/4U pen, that would be perfect for our cats.
 
Deb & Wink said:
@JL and Chip gave a good description of the drop dosing method.

Here is what I wrote up on drop dosing:
Drop Dosing

How many drops do you get from your insulin syringes if you draw the liquid up to the first line? Not the first line with a number next to it, or the shorter line that shows half unit markings. The very first line on the syringe. What we think of as the zero mark.
  • Practice, practice, practice to see how many drops you can get out of the syringe.
  • Use some sort of colored clear juice like apple juice or colored water.
  • Mark the syringe well. Painter's tape, duct tape, masking tape at the top of your “practice syringe”. So you don't forget and use that syringe to draw up insulin.
  • Draw the "test liquid" up to the first line on the syringe.
  • After you have drawn up a tiny bit of “test liquid”, point the needle up towards the ceiling and give the syringe a "finger flick. Push out the air bubbles.
  • Slowly “twist” the syringe plunger to push out all the “test liquid.”
  • Then when one small drop of “test liquid” is all that is left on the beveled tip end of the needle, draw the syringe plunger back to "suck" that 1 drop back into the syringe.
  • You are looking for consistency.
  • Try to get evenly sized drops.
  • Practice, practice, practice until you get a consistent number of drops.
Do you think you have the technique down for the drop dose?

Then let me know.

When it’s for real. You’ve practiced and are ready to give a tiny “1 drop” dose.
  • Draw up a tiny bit of insulin, needle pointed up to the ceiling and give the syringe a "finger flick. Push out the air bubbles.
  • Slowly “twist” the syringe plunger to push out all the insulin.
  • Then when one small drop is all that is left on the beveled tip end of the needle, draw the syringe plunger back to "suck" that 1 drop back into the syringe.
"Finger flick” technique - make a circle with thumb and first 2 fingers tucked into first thumb joint. Quickly “snap” those first 2 fingers against the syringe barrel held in your other hand. That will force any air bubbles up to the top of the syringe. Then you can push the air bubble out.

Syringes have a lubricant inside. Before you draw up insulin, moving the syringe plunger up and down a couple of times helps the plunger move more easily.

Give the shot. Monitor.

Later, if you need to, you could increase the number of drops."

@Diane Tyler's Mom

There was an article I read years ago, on how it's almost impossible to measure 2U or less of insulin, accurately and consistently from shot to shot. Don't know where that article is. But we certainly give our cats tiny doses of insulin.

Here are links to a couple of articles on measuring small doses in human infants and children. In case anyone is interested.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939443/
https://www.ncbi.nlm.nih.gov/pubmed/14968895
https://www.researchgate.net/public...ministration_using_pen-injectors_and_syringes
https://journals.sagepub.com/doi/full/10.1177/1932296817736316# <<<<< Now, if they would develop a 1/4U pen, that would be perfect for our cats.
Click to expand...
I will definitely practice this technique for a dropo dose. Thank you
 
@Deb & Wink @JL and Chip @Diane Tyler's Mom
Just an FYI - I bought some red juice to test out doing one drop dosing and I got it!!!! I practiced, practiced, practiced and now I'm sure I'll be able to do this for my girl. Her numbers are on the high side today and she seems very tired but affectionate. Still, I'm more comfortable not giving her insulin until I know that her depot is drained and seeing what her own body is making. I'll know more by tomorrow and may start the once drop dosing on Tuesday morning.

Question, though, how do I indicate that on the SS?
 
Deb & Wink said:
Put 1 drop. 2 drops, etc in the Units column on the spreadsheet (SS).

p.s. 2/22/20 PMPS if no insulin, please remember to put 0 in the units column. Plus any BG testing you may have done for last nights cycle.
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We started the one drop tonight because her numbers were high (355, 341, & 372). I was nervous but am sure she only got one drop. Will retest at +2 (fingers and paws crossed)
 
I’m glad you didn’t wait too long to start the insulin back up.

Remember that there’s a cumulative or “depot” effect from Lantus and that you’ve skipped shots, thus drawing down the depot. This first shot might not be fully reflective of what a drop of Lantus will do for Wenchie. Also, it’s not abnormal for the BG to bump up the first hour or two after the food and shot, especially in the early days before things level out.

It might be that Wenchie needs more than a drop of Lantus, but be patient as you collect data for a few cycles. Mostly, try not to be discouraged. This is a marathon, not a sprint, and you’ve come a tremendous way already in a short time.

Out of curiosity, I’d draw up the old 0.1u dose in a syringe and then hold it needle up and see how many “drops” I could squeeze out. Yes, it’ll waste a smidgen of insulin, but it’ll give you a clue as to how many “drops” you might have been giving in your 0.1u dose (for comparison). And yes, I’d use actual insulin rather than water in case there’s any difference in viscosity, etc. that would affect the result.
 
JL and Chip said:
I’m glad you didn’t wait too long to start the insulin back up.

Remember that there’s a cumulative or “depot” effect from Lantus and that you’ve skipped shots, thus drawing down the depot. This first shot might not be fully reflective of what a drop of Lantus will do for Wenchie. Also, it’s not abnormal for the BG to bump up the first hour or two after the food and shot, especially in the early days before things level out.

It might be that Wenchie needs more than a drop of Lantus, but be patient as you collect data for a few cycles. Mostly, try not to be discouraged. This is a marathon, not a sprint, and you’ve come a tremendous way already in a short time.

Out of curiosity, I’d draw up the old 0.1u dose in a syringe and then hold it needle up and see how many “drops” I could squeeze out. Yes, it’ll waste a smidgen of insulin, but it’ll give you a clue as to how many “drops” you might have been giving in your 0.1u dose (for comparison). And yes, I’d use actual insulin rather than water in case there’s any difference in viscosity, etc. that would affect the result.
Click to expand...

We wanted the depot to drain and her BG was high. This morning she missed the litter boxes and peed over the sides. Luckily I had wee wee pads underneath to catch them but that's not a good sign to me. It seems she's losing strength to be able to hold herself in the litter box.

I will do that this morning with the .1u dose! Great idea - it gives me an idea of the difference between the 1 drop and the .1u. Thank you!
 
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