Smiffy Autumn progress

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Looby & Smiffy said:
she seems to run high at night after her shot for some reason .... don't know if it is a bounce or a food spike.
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Do you leave food out all night for Smiffy to graze? Many cats tend to run lower at night but all cats are different. Certainly eating at will all night could have some influence on BG levels. And the only way to determine if Smiffy might be bouncing a bit would be to get more night time tests. If she is dropping down lower at some point at night that could cause the higher AMPS.
Again though, this is where finessing doses comes in really handy and gives you much better control. I thought you had an appt. with Roberta on the 13th of this month? Did you cancel that appt.?

Even if you did cancel, you could just discuss using the syringes with Roberta by phone and we can help you learn how to use them. Have you tried the syringes on some fruit yet? I think once you try that, you will see it's no big deal and a lot easier than you think it will be. :)
 
MrWorfMen's Mom said:
Do you leave food out all night for Smiffy to graze? Many cats tend to run lower at night but all cats are different. Certainly eating at will all night could have some influence on BG levels. And the only way to determine if Smiffy might be bouncing a bit would be to get more night time tests. If she is dropping down lower at some point at night that could cause the higher AMPS.
Again though, this is where finessing doses comes in really handy and gives you much better control. I thought you had an appt. with Roberta on the 13th of this month? Did you cancel that appt.?

Even if you did cancel, you could just discuss using the syringes with Roberta by phone and we can help you learn how to use them. Have you tried the syringes on some fruit yet? I think once you try that, you will see it's no big deal and a lot easier than you think it will be. :)
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No I don't leave food out for Smiffy at night beyond about +4.

She is a nibbler so she nibbles a bit of food for her supper, then I give her a shot and then I have to take the bowl upstairs so that she eats a bit more especially as I am giving her shots now on numbers below 10 (180).

I will try to test her at +2 tonight and she is she goes down quickly before she goes up again. I test her most nights at +3 and/or +4.

I didn't have an appointment booked but she was due a follow up but having discussed it with DH, I have had to agree that her she can wait until December. Having said that I am going to discusss it with Roberta in an e-mail which I will do tomorrow .....

We are getting a new cartridge for the pen this week as the 28 days are up.

I will of course mention the syringes with Robera. No I have not got practiced on fruit yet. I think I will try to find a video on Youtube just to have a look to see if I think it is not as daunting as I think!
 
MrWorfMen's Mom said:
Do you leave food out all night for Smiffy to graze? Many cats tend to run lower at night but all cats are different. Certainly eating at will all night could have some influence on BG levels. And the only way to determine if Smiffy might be bouncing a bit would be to get more night time tests. If she is dropping down lower at some point at night that could cause the higher AMPS.
Again though, this is where finessing doses comes in really handy and gives you much better control. I thought you had an appt. with Roberta on the 13th of this month? Did you cancel that appt.?

Even if you did cancel, you could just discuss using the syringes with Roberta by phone and we can help you learn how to use them. Have you tried the syringes on some fruit yet? I think once you try that, you will see it's no big deal and a lot easier than you think it will be. :)
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Do you know of a good video on Youtube that I could watch?

I have found this one:


or this one:
 
Looby, I don't think either of those videos are ideal because drawing insulin out of a pen cartridge is a little different from drawing it from a vial.
THIS video shows how to draw it from a pen and a vial. She does the pen draw first so you don't need to watch all the way through. She is using a Lantus pen but yours should be similar.

If you are switching cartridges soon, you could keep the old cartridge and refill it with coloured water so you can practice drawing from it directly without the pen. Do you have new cartridges at home or do you have to go see Roberta for them? I know you were getting Roberta to help change them in the past. This would be the perfect opportunity to discuss the syringes if you do have to make a trip over there anyway. :)
 
The second video shows how I draw the insulin, I don't roll the vial for as long. Injecting air is a bit old fashioned and we don't advise that any more. As Linda says - drawing from a pen is different as it is designed to administer a set dose each time and not to have air in it. If you end up with Caninsulin in vials they come in 2 sizes and you need the small one.
 
@ Alexi Good points. I never thought about changing over to a vial because I didn't know there were 2 sizes so I assumed Looby would have to use the pen cartridge as if it were a vial. Now you have me wondering if the smaller vial is available in Canada. My pet pharmacy only carries the 10ml. vial and the pen cartridges.
 
Oh! I assumed those 2.5ml vials were the pen cartridges but it looks like they're not. Appears my pet pharmacy doesn't carry the 2.7 ml pen cartridges. Interesting but good to know for future reference. Thanks for the link and info.
 
MrWorfMen's Mom said:
Looby, I don't think either of those videos are ideal because drawing insulin out of a pen cartridge is a little different from drawing it from a vial.
THIS video shows how to draw it from a pen and a vial. She does the pen draw first so you don't need to watch all the way through. She is using a Lantus pen but yours should be similar.

If you are switching cartridges soon, you could keep the old cartridge and refill it with coloured water so you can practice drawing from it directly without the pen. Do you have new cartridges at home or do you have to go see Roberta for them? I know you were getting Roberta to help change them in the past. This would be the perfect opportunity to discuss the syringes if you do have to make a trip over there anyway. :)
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OK I will bookmark YOUR video (:

I can switch cartridges easily by myself now so DH is just going to collect one from the surgery for me.

That is a good idea - I will keep the old cartridge (actually it is still more than half full with Caninsulin/Vetsulin but I will empty it and put food colouring on the shopping list so that I can colour some water.

I am housebound unless escorted by my husband and don't drive at the moment. I have only been out of the house for appointments for five years now - such is the level of my agoraphobia and anxiety (I am currently being helped to rehabilitate finally by a private team).

I don't know if our surgery supplies Caninsulin/Vetsulin in vials so that is another question for Roberta. I have made a note
@Alexi that I need the small size of vial - thank you.

In the meantime I will bookmark and watch your video Linda.

Thank you (:
 
Just realised that the u40 syringes already come with the unit markings on them appropriate for use with Caninsulin - one step closer to being happier about maybe using them at some point!

Now to watch the video.

I can't get the flipping syringe out of the packet - good start!

So I got it out of the packet :)

Changed Smiffy's cartridge this morning so kept the old one for practice (before I get some food dye to practise with coloured water).

I withdrew some insulin but made first mistake and put some air in the cartridge. Nevermind lesson learned.

I found it very difficult to measure one unit never mind half or less! This really worries me but hey I tried so that is one foot in the right direction.

And I will try again with coloured water :)

Still won't use syringes until I have seen Roberta in December though as I want her to be on board with what I am doing.

Will be writing to her with Smiffy's spreadsheet this weekend.
 
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Looby, if you are writing to Roberta this weekend, no harm in mentioning the syringes and why we think they might help you get Smiffy's numbers down a tad more. She may not want you to wait for December which is still quite a ways off. :)
 
MrWorfMen's Mom said:
Looby, if you are writing to Roberta this weekend, no harm in mentioning the syringes and why we think they might help you get Smiffy's numbers down a tad more. She may not want you to wait for December which is still quite a ways off. :)
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I will of course mention the syringes and discuss it with her on line.

I am sorry I thought I made it clear that I would discuss them with her :)

I am pleased that I have handled one now but I found it very difficult to see the less than one unit measurements on the u40 syringe because the black plunger appears to get in the way and the needle is soooo long compare to the Vetpen!

I was expecting to see 0.25 increments on the syringe. They are the ones that were recommended for me to buy on another thread - I followed the link to VetUK to buy them.
 
Hi Looby, if you bought the ones I linked to each little mark is 0.5 units - can you check? It will have a 5 unit mark written on the syringe so if you count down from 5 you should find each mark, once you get to 10 marks you can stop as the mark closest to the needle marks the end of the syringe. so if you count back up from that mark you should have 10 marks to reach the number 5. 0.25 units is half way between each of the little marks and it is possible to eyeball with some practice.
 
@Alexi can you post a picture of the syringe with the markings clearly visible? If so, I'll try to alter it to show where the 0.25u, 0.75u or 1.25u doses would be so Looby has a reference to look at.
 
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Will this do? I have pulled the syringe to the 10 unit mark and loosened the cap.
 
Alexi said:
Hi Looby, if you bought the ones I linked to each little mark is 0.5 units - can you check? It will have a 5 unit mark written on the syringe so if you count down from 5 you should find each mark, once you get to 10 marks you can stop as the mark closest to the needle marks the end of the syringe. so if you count back up from that mark you should have 10 marks to reach the number 5. 0.25 units is half way between each of the little marks and it is possible to eyeball with some practice.
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Hello Alexi and @MrWorfMen's Mom :)

Yes I have the syringes you linked me to and bought them from VetUK.

I can see the 10 marks so I can see that an increment of 0.25 units is between each of the marks. It is just that the black plunger makes the black marks difficult to see so I suppose it is something that I need to get used to. I think the idea of practicing with coloured water to begin with will help me get used to it.

I have to say my eyesight is not great even with my reading glasses on .... maybe I will have to order some +4 reading glasses!

At least getting used to the syringe is one step in the right direction and I have kept the old cartridge of left-over Caninsulin cartridge as well to practise with to (not to shoot Smiffy with though of course - don't worry!).

But I will start with coloured water.

Thank you both :)

PS Just ordered some stronger reading glasses! (:
 
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Looby, what some folks do when they are going on vacation is fill syringes with coloured water to be used as a comparison for the sitter. If you are having any difficulty seeing, this might be something to consider when you do start using the syringes. You could keep syringes with the different quarter doses of coloured water handy and marked so all you have to do is a comparison of the plunger position when drawing up the real thing. We're just full of little tricks around here!

I'll work on the picture ASAP.
 
MrWorfMen's Mom said:
Looby, what some folks do when they are going on vacation is fill syringes with coloured water to be used as a comparison for the sitter. If you are having any difficulty seeing, this might be something to consider when you do start using the syringes. You could keep syringes with the different quarter doses of coloured water handy and marked so all you have to do is a comparison of the plunger position when drawing up the real thing. We're just full of little tricks around here!

I'll work on the picture ASAP.
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Clever :)

Oh the picture is fine as it is thank you (:
 
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Awwwww Smiffy just sicked up clear fluid and the tiniest amount of sick on my bed and her stools this morning were ever so slightly soggier than usual. Maybe she has a little tummy bug?
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Or maybe an imminent fur ball?

I have put some Fortiflora on her food.

She is fine otherwise - quite herself - just a bit embarrassed ... poor thing .....
 
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Smiffy's numbers all over the place at the moment ..... I suppose that just happens sometimes!

She is over her little bug so I see no logical reason for her to be so inconsistent. Oh she coughed up some grass this morning so maybe she DOES have a fur ball lurking after all - we shall see.
 
I seem to have lost some posts her for some reason.

I was saying that Smiffy's numbers are higher for some reason and I have for the past two mornings had to give her 1.5 units which I have not done for weeks!

She seems to be healthy and bright.

Do you think it is the change of season?

@MrWorfMen's Mom

How are you doing?
 
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Well Smiffy has come down from her +3 of 13.8 (249) to a PMPS of 8.5 (153)! Her numbers are not as consistent as they have been.

Gave her one unit - which would have been quite an aggressive shot not so long ago but she is now +3 12.2 (220) - just don't understand it!

Today is Tuesday 25th October.
 
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Lucille, did you have a chance to speak with Roberta about using syringes instead of the pen for Smiffy's insulin? Have you done any practice with the fruit yet? I think the key to get Smiffy leveled out a bit more is to have the ability to finesse doses by 0.25u instead of 0.5u so if I were you, I'd really try to get used to the syringes. I am working on the pictures for you for quarter doses but in the meantime for practice, you can just draw up to any line on the syringe so you get a feel for using them. :)
 
MrWorfMen's Mom said:
Lucille, did you have a chance to speak with Roberta about using syringes instead of the pen for Smiffy's insulin? Have you done any practice with the fruit yet? I think the key to get Smiffy leveled out a bit more is to have the ability to finesse doses by 0.25u instead of 0.5u so if I were you, I'd really try to get used to the syringes. I am working on the pictures for you for quarter doses but in the meantime for practice, you can just draw up to any line on the syringe so you get a feel for using them. :)
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I haven't spoken to Roberta nor sent her an e-mail yet.

I was hoping that Smiffy's numbers would have settled a bit before I send Roberta a message. Smiffy seems to have responded to the more cold weather - up and down - but she is realy well so that is the main thing.

I have been doing a lot of work with my CPN recently and made a great deal of progress.

I am going to write to Roberta with an update soon and mentions syringes but as I have said to you before, I am still very reluctant to use them for the reasons I have already given and those reasons have Smiffy's best interest at heart of course.

She is not easy to treat .... she has now decided to sit under the very big chair when it is PM time to have her test and eat and get her shot. For the last couple of nights I have had to drag her out to have her test and then as soon as she has finished eaten she has gone back under the seat. She continues to surprise me. I suppose it is cosy under the chair on the thick pile rug where Malcolm sits.

There seems to be some pancreas activity which is great.

I will be writing to Roberta next week for sure.

I did have a go at drawing insulin from Smiffy's old cartridge and the first thing I did was to put air bubbles into it .... I am really not happy handling syringes.
 
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If you are using cartridges like a vial it doesn't matter if air gets in, it does obviously if you use the cartridge in the pen. Often with syringes you do get a tiny air bubble, if I can't get rid of it then I depress the plunger fully into the vial, pull up slightly more than the dose and then keeping the needle in the vial depress just enough to get the dose. Keep having little practices until you gain your confidence.
 
Lucille, I realize that anything new can be a source of anxiety for you. New things generally cause all of us anxiety to some degree but if you take baby steps at it, I'm sure you can get comfortable with the syringes and that's why using the fruit for practicing can be very useful. As for the bubbles, don't get discouraged. We all get bubbles into the syringe and the trick is to hold the syringe with the needle pointed up and give the syringe a good flick with your finger to dislodge the bubble and send it to the top of the syringe barrel (right below the needle) where it can then be pushed out. Drawing back on the plunger to add more air sometimes helps to consolidate air bubbles that can then be pushed out by depressing the plunger back to the right dose marking. If you need more tips on how to do this, we can help. Many of us give the shot while kitty has their head stuck in their food dish and they barely notice if they notice at all so I don't think Smiffy's behaviour should be a barrier to using syringes vs. the pen.

Again, I think you need to decide what your goal is for Smiffy. If you choose not to use the syringes, then getting Smiffy's numbers more consistently into the blues/occasional greens or even better with luck, getting her into remission, is going to be that much tougher, if possible at all, because a quarter of a unit of insulin can make a lot of difference in a cat.
 
MrWorfMen's Mom said:
Lucille, I realize that anything new can be a source of anxiety for you. New things generally cause all of us anxiety to some degree but if you take baby steps at it, I'm sure you can get comfortable with the syringes and that's why using the fruit for practicing can be very useful. As for the bubbles, don't get discouraged. We all get bubbles into the syringe and the trick is to hold the syringe with the needle pointed up and give the syringe a good flick with your finger to dislodge the bubble and send it to the top of the syringe barrel (right below the needle) where it can then be pushed out. Drawing back on the plunger to add more air sometimes helps to consolidate air bubbles that can then be pushed out by depressing the plunger back to the right dose marking. If you need more tips on how to do this, we can help. Many of us give the shot while kitty has their head stuck in their food dish and they barely notice if they notice at all so I don't think Smiffy's behaviour should be a barrier to using syringes vs. the pen.

Again, I think you need to decide what your goal is for Smiffy. If you choose not to use the syringes, then getting Smiffy's numbers more consistently into the blues/occasional greens or even better with luck, getting her into remission, is going to be that much tougher, if possible at all, because a quarter of a unit of insulin can make a lot of difference in a cat.
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I really appreciate what you are saying - please be sure of that.

Tonight is an example of how tricky Smiffy can be to treat.

I decide on her Caninsulin (Vetsulin) dose not only on her preshot number but also on the amount that she eats.

She is a nibbler. Just now she came downstairs for her supper. I tested her and she is 9 (162) so my judgement is to give her one unit on that number provided that she eats a decent amount of food.

She nibbled at her food (not enough to give her a shot on) and went back upstairs so I have had to follow her upstairs with her bowl of food and pen and if she hadn't have eaten any more I would have changed my judgement and given her only half a unit. I don't set the Vetpen to its dose until I am sure what dose I am going to give her.

As it turns out, she happily (of course I didn't force her) ate a good amount and I was able to turn the pen to one unit and administer her dose.

I would not be able to do this with a syringe.

Thanks for the tips about the bubbles. I did already know how to get bubbles out of the syringe but in my post was actually referring to the video that Linda recommended where they said when taking insulin from a cartridge to be careful not to inject bubbles into the cartridge - unless I am mistaken. At the time I thought this was a bit odd as it is bubbles in the syringe that would be a problem and they are easily expelled. Of course when I prime the Vetpen I have to get rid of the bubbles.

It is not so much my anxiety that is making me reluctant to using syringes as the logistics of doing it for Smiffy not only the way she is but circumstances in the household and other reasons. I am sure I have listed them before and they include me not being completely 'with it' in the morning because of my medication that I take at night. I have to really concentrate on what I am doing and sometimes there are distractions that are unavoidable that I don't really want to discuss here.

For the time being at least, I appreciate your concerns and thankfully have not found the need to think in terms of 0.25 increments on Smiffy's numbers since that five-day period when I gave her no insulin at all as she was maintaining a comfortably below 10 (180) number all day for five days.

I have the syringes and I have already said that I will talk to Roberta about them and take them along with me to Smiffy's next trip to the Vet and if and when I use them, I am really pleased that I can rely on you and Linda to help me out with them so thank you very much for that (:
 
Lucillle, I am in somewhat of the same boat as you with my Menace. She has a condition where she may be running at higher numbers for no physically apparent reason but I assume it's her unruly antibodies doing their thing. So for example, last night I gave Menace insulin on a reading of 16. This morning around 10 hours post shot her reading was 4.7. Quite the difference, it's almost time for her next shot and I have to figure out if she is dropping or rising before I can determine what dose I should give her. Menace has her nadir VERY late in the cycle quite often (different insulin than yours but still much later than expected)which makes it more difficult to predict where she's going to be at shot time. So while I use to draw up her insulin, then test, feed and shoot, I now test, and make Menace wait till I make a decision about her dose and then I feed her and shoot.

Now with Caninsulin, you have to feed Smiffy first, wait, then shoot, so you could feed Smiffy most of her meal, then while waiting, go draw up the insulin dose you deem appropriate, then give her the last tsp. or so of her food while you shoot. I know sometimes they can be little rascals when it comes to timing and sticking to the plan but we have to look at it as a game of sorts and outsmart the little critters. :cat::D
 
16.4 (289) this morning!!! Had to give her 2 units and leave a bit of food out just in case that is too much but I think she should be fine. Don't understand why she needs more insulin past few days to get her BG down .... more than my previous data indicates to me so I am having to readjust.
Oh here she comes .... took me four goes to get her to eat this morning but she is having a bit more now so I am not so worried about not being around for her Nadir.

Having said that - it will probably be at about +4 as I gave her 2 units and I will be back down for that.

At +4 she is 10.4 (180) so the same as she was this time yesterday. Wondering why she threw up that high number for me this morning. There was nothing stressful going on and she is behaving perfectly normally - purring and going out as usual.

I have posted a separate thread about her numbers on the main Forum and tagged you Linda (:
 
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Sounds good to me Looby. :) As you know, I don't have any real advice on Caninsulin as I haven't used it, but I am very interested in Smiffy's progress and how the different doses work for her. :)
 
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