19/09/21 Fergus PMPS 489 +2 273 +3 331

I've realized that I've been drawing up the syringe incorrectly and the insulin is contaminated and compromised. I've been getting totally random numbers and I didn't know why. I feel so stupid.

I'm worried right now because at +3 his number is already going back up. He's had some high numbers in the past, but still continues to eat and drink and though he seems to be getting weaker, he can still jump on the couch. He seems ok right now, eating and drinking and he just used the litter box. I just have to make it to his next dose. I will start with a new vile of Lantus.

I really really can't afford a trip to the emergency vet, and i'm not sure what they could do at this point anyway... Is there anything i can do in the meantime to mitigate this? I will give him lactulose and subq shortly for his constipation. I guess just monitor him till then? I appreciate any advice. Thanks.

 

What makes you think the insulin is contaminated? What have you done wrong? Is it cloudy or do you see particles? Is it because you shot some back into the vial? If clear and no particles I would not worry. The worst that might happen is it might lose potency a little sooner than it should.

 

I think it lost potency because the numbers are erratic. I have def been drawing the insulin in before expelling the lubricant in the syringe. I have literally been doing it all wrong. I am starting a new vial tonight, and i will do it properly.

He seems ok, and i'm about to dose him properly now. Hopefully everything evens out. Will keep you posted.

 

You don't have to expel any lubricant. Before you draw out the insulin, "prime" the empty syringe by moving the plunger up and down in the empty syringe a few times. This spreads the lubricant around and makes it easier to move the plunger in smaller increments to measure the dose.

The only thing you should not be doing is squirt any excess insulin from the syringe back into the pen/vial.

It looks like he needs more insulin. Are you following TR? You need at least one more test per cycle in addition to the preshot ones. And depending on his numbers, you can increase as often as every 3 days. Keeping a cat in higher numbers for too long makes it harder to break through to lower numbers.

 

I did squirt the insulin back into the vial, along with the lubricant. I have been doing it all wrong.

I was trying TR, but then my cat got constipated and needed to go in to have an emergency enema. The vet was upset with me for not using his dosing recommendation for the insulin. I got scared and dosed him with 3 units that night, which then made his numbers erratic... and didn't solve anything. Ugh.

I'll start doing TR again. I wonder if I should increase his dose right away or see if the new vile of insulin starts working better?
I'm worried about his number being so high, but I'm also worried about my vet getting upset with me for not using his recommendation.

Thanks so much for your help with this.

 

Just don't discuss dosing with your vet or let him think you are following his dosing recommendations.

I don't think the insulin is off. You can increase to 3.50 with TR but you would need to get at least one more test per cycle in addition to the preshot. It's possible for newly diagnosed cats to start high, go much lower in the cycle and bounce back to highs by the end of the cycle. Preshots are not an indication of how low the dose is taking the BG.

 

I was thinking I would do a curve today, on his next cycle starting at 1 pm. I'm not working so it's the only day this week i could do it.
Then from here on in I will resume TR and get more tests in. Ideally +3 +6 +9

Do you think I should increase the dose to 3.5 for this curve today or start tomorrow once I get the data?

 

I'm a little confused. Your SS has a +5 reading for today. Is that yesterday's reading entered in today's row?
Unless your PMPS is at 1pm?

You don't need 3 tests in every cycle. Though more data is always welcome. The idea is to figure out how low the dose is taking the BG. So more tests in active cycles and a pokie break im bounce cycles.

 

Yes. My PMPS is at 1pm... my work schedule is 4-12pm. Sorry for the confusion.

So his next dose is in an hour and a half.

I have been trying to dose 3.25, but i'm not sure how accurate it is. Going up to 3.5 would be easier for sure.
But a will do a curve today because the Lantus tends to peak fast for him then drops off quickly.

 

Take him up to 3.5U so you can monitor him. Some cats react in the very first cycle after an increase.

 

Ok. Thank you so much for this.
I'll keep a close eye on him today.

I hope this works. I've been worried he's just insulin resistant or something (is that even a thing?). Everything I've been trying to do hasn't been working. I've been so scared and stressed out about it.

 

You did get a blue nadir on 9/14. It's possible that he may have gone lower in cycles where there were no tests - maybe not - hard to say.

Yes, insulin resistance is very much a thing. Glucose toxicity is a form of temporary insulin resistance. When a cat stays in high numbers for too long, it's body gets used to higher numbers and treats them as normal. It then requires much more insulin to break through to lower numbers.

There are secondary conditions called Acromegaly and Insulin Auto Antibodies (IAA) which cause insulin resistance but I don't think Fergus falls into that category.

It's probably just a matter of getting him to his good dose and TR is the fastesy way to do that.

 

This is helping calm my anxiety a lot. I really can't thank you enough.

I really hope something starts working soon. Fingers crossed.