1/26 Sami PMPS 327

[Tina & Sammy]

Yesterday's Condo

Sami surfed the blues very nicely last night. As you can see from the spreadsheet I checked her just about every hour until 4:30 am. When I started to see her rising I decided I should get some decent sleep so I didn't check again until AMPS.

Question of the day: Is there a trick to pulling the insulin out of the cartridge. For the past few days I have been struggling with this, until Saturday I was using a vial. I put the syringe in and start to draw the insulin, but I get huge bubbles. I try to draw enough insulin so I can expel the bubble and still have enough insulin for the dose. Sometimes this doesn't work and I have to start over, which sometimes means getting another syringe. What am I doing wrong? I think I read somewhere that you are suppose to start with the plunger at the dose mark, then insert it into the vial/cartridge and push the air into the vial or cartridge and then pull the insulin, but I have also hear not to inject air into the vial/cartridge. HELP! I feel like I am wasting both needles and insulin and it is getting rather frustrating. Plus, I now have several air bubble in my cartridge, is this going to cause a problem?

So far today, Sami has shown less interest in food, although she has eaten a little bit at AMPS and also at +2, but not very much. Is this normal, I know she can't be use to those low numbers so does this typically happen. I did give her a famotidine last night, but didn't give one this morning. Should I give her that for a few days to keep her stomach acid down.

Other than the lack of appetite she seems to be doing just fine this morning.

 

[Ronnie & Luna]

Re: 1/26 Sami AMPS 237; +2 208

Glad to hear Sami is doing well.

Have a good day!

 

[Pat+Raja+Shadow (GA)]

Re: 1/26 Sami AMPS 237; +2 208

Morning Tina...
Guess you have tried lots of techniques for the bubble dilemma....are you up for trying one more approach?

Take the syringe and push plunger back and forth a few times to spread the lubrication inside the syringe....
push the plunger IN as far as you can and hold (this expresses a lot of air out of the empty syringe before you insert it into the cart)

While holding the plunger in, insert the syringe into the cartridge or vial

Release the pressure on the plunger and slowly, slowly draw insulin into the syringe.
At this point I stop and check for any air bubbles...flick the syringe getting the tiny bubbles, if any, to the top and flick
I then turn the plunger slowly to the right until I express the air bubble onto tissue
Then, there should be no air in the syringe anymore and I reinsert and fill syringe to the correct dose.

It sounds harder than it is.
You can try it with water if you want at first. This has worked for me and I had been completely unnerved by the bubbles
in the past...twice a day...every day!!! Hope it works for you....let me know if my explanation is lacking something., k? :mrgreen:

 

[Tina & Sammy]

Re: 1/26 Sami AMPS 237; +2 208

Morning Tina...
Take the syringe and push plunger back and forth a few times to spread the lubrication inside the syringe....
push the plunger IN as far as you can and hold (this expresses a lot of air out of the empty syringe before you insert it into the cart)

While holding the plunger in, insert the syringe into the cartridge or vial

Release the pressure on the plunger and slowly, slowly draw insulin into the syringe.
At this point I stop and check for any air bubbles...flick the syringe getting the tiny bubbles, if any, to the top and flick
I then turn the plunger slowly to the right until I express the air bubble onto tissue
Then, there should be no air in the syringe anymore and I reinsert and fill syringe to the correct dose.

Thanks Pat. I did try pressing the plunger to expel as much air as possible before inserting it into the cartridge, but I didn't push the plunger back and forth a few times before inserting. I think another reason I might be getting some air bubbles is because I might be trying to draw the insulin too quickly. I have also tried to flick the syringe to get the bubbles to go to the top, but sometimes that doesn't always work either.

I will try your technique tonight. I was concerned about using the same needle to re-insert into the cartridge, but I can't keep throwing away needles and insulin.

Thanks for your help.

 

[Nicole & Baby]

Re: 1/26 Sami AMPS 237; +2 208

:RAHCAT :RAHCAT :RAHCAT

Cheering Sami on! & of course you too Tina!!
I use the Pens…have never had any bubbles. I just put my needle in the pen & pull back the dose amount & give Baby her shot.
I don't push air in because I read not to & I don’t shake or roll or warm it up.

 

[Tina & Sammy]

Re: 1/26 Sami AMPS 237; +2 208; +4 182; +5 171

:RAHCAT :RAHCAT :RAHCAT

Cheering Sami on! & of course you too Tina!!
I use the Pens…have never had any bubbles. I just put my needle in the pen & pull back the dose amount & give Baby her shot.
I don't push air in because I read not to & I don’t shake or roll or warm it up.

Thanks for the cheerleading cats, Nicole. They are so cute.

Looks like Sami is surfing the blues again today. Last night went great, but if if things play out like they did yesterday we could be looking at an even lower PMPS reading tonight. Only time will tell.

Recap:
AMPS = 237
+2 = 208
+4 = 182
+5 = 171

 

[CD and BigMac]

Re: 1/26 Sami AMPS 237; +2 208; +4 182; +5 171

Tina, very nice even set of numbers. This is just what you want to see; you have brought Sami's numbers down to a new lower plateau. Today looks like you will see a similar set as you did last night. (Whew! You must be tired today!)

Good work!

As for the Pepcid (famotidine) I have read that you can usually give 1/4 tablet every other day if needed. Sometimes they will dose it everyday if kitty really needs it. But I'd stay conservative unless your vet suggests otherwise.

 

[Tina & Sammy]

Re: 1/26 Sami AMPS 237; +2 208; +4 182; +5 171

Tina, very nice even set of numbers. This is just what you want to see; you have brought Sami's numbers down to a new lower plateau. Today looks like you will see a similar set as you did last night. (Whew! You must be tired today!)

Good work!

As for the Pepcid (famotidine) I have read that you can usually give 1/4 tablet every other day if needed. Sometimes they will dose it everyday if kitty really needs it. But I'd stay conservative unless your vet suggests otherwise.

Thanks for the advice on the Pepcid. When Sami first got diagnosed and she had elevated liver and kidney values she was on ¼ tablet of pepcid every 12 hours. I have noticed today that she seems to be burping or something after she eats, so I am wondering if I should give it to her for the next day or so while she gets use to these lower numbers. Does anyone know if lower numbers affects appetite and stomach acid?

 

[Randi & Max (GA)]

Re: 1/26 Sami AMPS 237; +2 208; +4 182; +5 171

Hi Tina
What a nice day Sami is having and I can feel a smile on your face.
You got great advice on the syringe/bubble issue.
BTW which one are you using? I posted in health back in December as to what syringes to buy.
Several people said the BD had bubble issues, which I was using and expensive, and some people love them.I bought the relion ones from walmart and they are so, so. I find them a little flimsy.
I also ordered from Hocks, the monoject ones, I can check the name more carefully if you want, or look through the old health threads on the old board.
So far I seem to like those the best. The numbers are dark, the feel is sturdy and bubbles are almost non-existent. Plus the price was nice.
I also slide the plunger up and down to lubricate the inside.

 

[Tina & Sammy]

Re: 1/26 Sami AMPS 237; +2 208; +4 182; +5 171

Hi Tina
What a nice day Sami is having and I can feel a smile on your face.
You got great advice on the syringe/bubble issue.
BTW which one are you using? I posted in health back in December as to what syringes to buy.
Several people said the BD had bubble issues, which I was using and expensive, and some people love them.I bought the relion ones from walmart and they are so, so. I find them a little flimsy.
I also ordered from Hocks, the monoject ones, I can check the name more carefully if you want, or look through the old health threads on the old board.
So far I seem to like those the best. The numbers are dark, the feel is sturdy and bubbles are almost non-existent. Plus the price was nice.
I also slide the plunger up and down to lubricate the inside.

I was using the BD before I started looking for the syringes with ½ unit marks. Then I ordered the Monojectsyringes from HOCKS, but before they arrived I picked up some Relion needles from Walmart. So far I like the Monoject syringes best too. The one thing I don't like about the Relion is that the lines are thicker and it would be difficult to alternate from one needle to the other and get the same dose. I will use the Relion syringes, but only after I finish off the box of Monoject syringes. Then I will be ordering more Monoject syringes.

 

[Tina & Sammy]

Re: 1/26 Sami AMPS 237; +2 208; +4 182; +5 171; +10 317

Looks like Sami is on the climb, hopefully just a rebound that won't last long. I will be checking her for her PMPS in another 40 minutes or so. Maybe she will surprise me with a lower number than 317.

 

[Sienne and Gabby (GA)]

Re: 1/26 Sami AMPS 237; +2 208; +4 182; +5 171; +10 317

On the backup board

We use the BD Demi+ syringes, and hold them with the needle pointing at the ceiling for most of this process.

For each shot, we do these things:

1. Throw away the plunger cap and move the plunger a couple of times. (Jojo told us that spreads the plunger lubricant)
2. Make sure the plunger is all the way to the needle end, uncap the needle, and insert the needle into the insulin cartridge.
3. Pull the plunger back pretty far, maybe the 4 or 5 IU mark. The vacuum inside the cartridge "fights" this; it goes slowly.
4. The insulin will start moving into the cylinder very slowly, watch to see how much is in the syringe.
5. When there is about .5 IU more insulin than needed, withdraw the needle from the cartridge without moving the plunger.
6. This causes the insulin to move down to the plunger (away from the needle), and the air goes up to the needle end.
7. Put the cartridge back in the fridge; do the rest of this over the sink.
8. Press the plunger to expel the excess air at the top. (don't skip this step, even if there are bubbles! The less air is in the syringe when you flick on it, the easier it is to form a single bubble that can be pressed out.)
9. If there are any bubbles at this point (often there are not), flick the syringe to bring them to the needle end.
10. Twist the syringe while pressing the plunger slowly to expel any remaining air, and to "dial in" the desired dose. This way, you can see if the bubble is sticking to the side, because you're rotating the syringe and looking at it from all sides.
11. If there's a bubble stuck to the side of the needle collar, draw a tiny bit more air in to join it, and then rotate the syringe the opposite direction to last time, while pressing the plunger. This spins the bubble together and hopefully centers it on the needle hole so you can squeeze it out.
12. Because we do micro-dose, when dialing in doses, we try to hold the syringe so the angle on the needle is facing up. This way, the little drop of insulin that forms there can be pulled back into the needle without bringing air, if we accidentally dial the plunger in a drop too far.

That's it, ready to shoot. Now... find the cat.

This method gets easier with practice, and seems to make it snap to get rid of bubbles, without introducing air into the cartridge. The trick is, unless you can make a cartridge that works like Lantus, there's no way to practice this with water or whatever. It won't work drawing liquid from a drinking glass. Maybe this is what old Lantus cartridges are for.

You do not want to push air into a cartridge. This is probably less of an issue with a vial but it is a big problem with the cartridges. The cartridges work off of a negative pressure gradient which is why the black stopper at the end moves down as you use up the insulin. If you inject air into a cartridge, there is the possibility that it will crack or explode.

The other issue is that some syringes are better than others. There is a link to a discussion in the Lantus use sticky on syringe quality. Other members, Andrew & Mim most recently, noted some problems with syringes in terms of accuracy. I'm not sure how that was eventually resolved although I do know he was in touch with the manufacturer. Some syringes are more bubble-prone and this is noted in the sticky.

 

[Tina & Sammy]

Re: 1/26 Sami AMPS 237; +2 208; +4 182; +5 171; +10 317

Sienne,

Thanks for that information. I will definitely keep it on file.

 

[Tina & Sammy]

Sami was surfing from +10 to PMPS, only a slight rise in numbers. I will be testing her again shortly just to see where she is at +1 although I can't see her having dropped that much if any after she ate.

I would have really like to see Sami back in the blue tonight for PMPS, but at least this way I get to sleep in my bed tonight. I will probably still get up to do a spot check at +6, that is after I do a +1 and +2 before going to bed.

I think I am finally getting the hang of this.

Hope everyone has a great evening.