Please advise. Dose decrease for Merlin?

He has had several low nadirs. Might have very briefly (15 min?) gone hypo? Some trembling while low BG in 60s. He drinks and eats excessively, is lethargic. I reduced dose slightly. Does he need a further decrease?

Previous threads: ? - Question: Micro Dosing Lantus? Switching from micro dose ProZinc | Feline Diabetes Message Board - FDMB
Merlin-Should I increase dose? | Feline Diabetes Message Board - FDMB

STOOL: Why undigested food, pale yellow color, very stinky, voluminous + numerous [6/d])?
From the way the stool looks, I expected EPI.

TLI test of 11-18-2020: normal: 67.30 ug/L (ref 12.0-82.0).
Since 11-20-20, he is on Zeniquin for high WBC (infection or inflammation, pancreatic abscess/cyst). Spec fPLI 17.0 Hi (ref 0-3.5). Started S. Boulardii on 11-23-20.
Creatinine 2.6 (prev. 1.7 [ref 0.9-2.3]), SDMA 9 (ref 0-14). BUN 45 (ref 16-37)

@Critter Mom @Veronica & Babu-chiri @Deb & Wink @Panic

 

For him to have such drastic dips on such a low dose is very unusual.

I know you've thought about switching to Lantus. I wonder if it might be a better fit?

 

When you put 0.1, you are literally giving a drop, right? I mean the 0.1 doesn't mean you are giving it to the line that says 1, right? And you are using regular u40 syringes? I just ask because I've never seen such a drop with literally a drop of insulin.

 

Merlin's SS says: "With the small quantities of less than 1.0 unit PZI, it is impossible to be accurate in measurement. Using a U-40 syringe (30-unit, 0.3 ml), I am guessing the amount as best as possible as fractions of 1 unit."

I wouod try using U100
syringes. With 1/2 unit marked syringes, each 1/2 unit marking equals 0.1 units of as U40 insulin. Also, note where the zero mark is in relation to the syringe plunger being fully depressed. Frequently the zero mark does not correspond to the syringe plunger being fully depressed. You should adjust how far you pull the plunger out to get a consistant dose .

 

I was going to suggest she switch to u100's too.

 

I use U100 syringes along with the conversion chart and digital calipers for micro dosing Jess U40 insulin - huge stress savers!

Typo? Each 1/2 unit marking on a U100 syringe equals 0.2 units of U40 insulin
Conversion Chart

 

Thank you all. Interesting to know that Merlin's drastic drop to a nadir and the following rapid increase back to pre-shot levels is unusual. What does it mean? Why does it happen?

I have not been successful so far to get a prescription for Lantus. I am ready to buy it as soon as I can get a script.

Yes, I am using a drop-like amount of PZI. For 0.1 unit, the plunger on the U-40 syringe is almost at zero (a fraction of a mm away), some distance away from the 0.5 unit line, even further from the 1.0 unit line. I found that I can fine-tune the 0.1 unit by using the 2nd and third ring on the plunger. I can line them up with varying distances from the 0.5 and 1.0 line, thus making readings more consistent. I also found @Marje and Gracie great write-up, video, and purchase info on calipers (Info - Dosing with calipers updated w/videos | Feline Diabetes Message Board - FDMB) and the caliper to buy [ 4 in. Digital Caliper (harborfreight.com)]. I bought the calipers yesterday but need to exchange them for a non-defective set. On mine, one of the arms is nicely sharp and pointed, the other arm is shorter and blunted. That makes a correct reading impossible.

 

Great on the calipers but remember the measurements listed for specific syringes are U100. I don’t have any measurements at all for U40 syringes so you’ll have to start from scratch.

 

I will calculate the caliper measurements for U-40 syringes or use U-100 ones.

Re Merlin's EPI result of 67.3 falling in the reference range despite having stools typical of EPI:
Per TAMU, for cats, fTLI results in the refence range are equivocal. Another ref states that (with pancreatitis) EPI can be present. I asked my vet to let me try Epizyme.