Somogyi/bouncing - when to give insulin?

Hi

Lily has been having 0.2 units (eyeballed) but was still getting big drops. She then started getting high reads even after insulin, since Saturday, and thanks to some great advice here we figured out it is likely a response to those low reads. Of course it's tricky to give her a lower dose and I have asked to move onto Lantus. The vet told me to take Lily off the Caninsulin for a few days and see what happened. I didn't give her insulin last night but am monitoring quite closely today. Her BG is around 17 (306) today before and after breakfast and I appreciate it might take a while for the high to wear off if it's her system compensating.

Question is, how high do I let her blood sugar go? At what point do I give her a dose? Is it 22 (396)?

She's asleep behind the Christmas tree again now, having eaten a lot this morning. She's gained back 200g of her lost weight in less than 2 weeks but is still skinny at 2.7kg.

 

Hi Elizabeth, I am not familiar with Caninsulin, but I am going to tag a few folks to help you.

@Chris & China (GA)
@Critter Mom
@Deb & Wink
@JanetNJ
@Red & Rover (GA)

Here's the link to your previous post for continuity - https://www.felinediabetes.com/FDMB/threads/did-i-miss-pmps-10-8-194-2-14-252.239266

 

Thanks Bhooma.

 

Are you using u40 or u 100 syringes to eyeball the 0.2 dose? It might be easier with u 100's and just using A conversion chart. Then you can use the u100s when you nice to lantus anyway. I would give insulin today.

 

Hi Janet

Thank you.

I have been using U40 syringes and even with the half unit increment ones I got last week it is still difficult. I have ordered some U100s but don't expect them before Thursday. She's gone down to 13.5 and 14.2 now which is reassuring - brought herself out of the pinks without insulin. I will keep measuring every hour and consider going to the vet and begging a couple of U100 needles from them and grab this Lantus from my friend. I'd really rather not give her the Caninsulin given the problem it's caused but I will if she is in danger.

 

Are you in the US? Most pharmacies /Walmart carry u 100

 

I'm in the UK. Having a bit of trouble finding whether they are available over the counter. I will try ringing the local pharmacy.

 

I think they are. @Tom & Monty used to buy them online. Tagging a couple of more people in the UK @Elizabeth and Bertie @Critter Mom

 

Hi Elizabeth, I am also micro-dosing (less than 0.2 units). After estimating the intended volume of 0.1 unit, I use the middle and/or other black ring of the plunger to line it up with lines that are nearby for consistency. For example, the middle ring could sit immediately above or below the nearest unit line. I just purchased a caliper and will start using that.
We just discussed details on how to measure in the 2 following links:
? - Please advise. Dose decrease for Merlin? | Feline Diabetes Message Board - FDMB
? - Question: Micro Dosing Lantus? Switching from micro dose ProZinc | Feline Diabetes Message Board - FDMB

 

Thank you Wendy, that's very helpful. I'll have a look now.

Two strips taken at 4 hours after breakfast both reading 13.9 (250). I haven't given her any insulin yet. Very interested to see if she continues dropping. She happily comes out for testing in exchange for a nibble of dried tuna and isn't begging for more food, though she did check her bowl and finish the teaspooon or two of food that was still in there.

Now that it appears to be going down I'd like to know what her actual BG would be without the compensatory response she's had/having, before I give her any insulin. Conscious that even if I start her on a tiny dose of Lantus that might be enough to keep the response going and I won't be able to tell how she's really reacting to Lantus. Is that a terrible plan?

 

On syringes, I don't know whether a local pharmacy would carry the 0.3ml ones with the ½-unit markings. I always bought my BD U-100 demis on eBay.

Here's a link to the UK supplies info that Eliz compiled (has info on where to source syringes):

https://www.felinediabetes.com/FDMB...-vit-b12-and-other-need-to-know-stuff.137376/


Mogs
.

 

Thanks Mogs, I did get mine from the online place suggested in there. Still learning my way around so it was by chance rather than having managed to find that post despite having been given the link before, so much appreciated!

I've got calipers and a magnifying glass in my Amazon basket now, Wendy, having read the stickied thing. I'll need a new storage unit for all the kit I'll have soon!

Is there a pinned post about bouncing?

 

Afternoon, Liz.

Some helpful threads...

Bouncing Tutorial (h/t member Deb & Wink)

The following discussions are more relevant to Lantus but touch on bouncing:

Bouncing and Dosing

Bouncing and Feeding / Steering

Should the time come, you can post here for help with any techniques outlined in the above threads (really needs some coaching from experienced members on this stuff because they are more advanced techniques and a lot of data is needed first).

To give you an idea of what is possible (not guaranteed), here's Blue's spreadsheet. Historically he has been a bit of a trampoline junky. After a lot of experiment and testing, @Patty and Blue is now steering him like a boss: just look at the difference in Blue's numbers over the last number of days (all down to Patty's hard work!). Blue's bouncing has reduced drastically and he's now spending much more time in the healthier blue and green range.

Blue's Spreadsheet


Mogs
.

 

(((Mogs)))

Wow, I'm just having a look at Blue's spreadsheet - that's a lot of work @Patty and Blue has put in and some exciting colours both ways! I'm going to have a good look at how she's managed to get it under control. Apart from staying up all night several times by the look of things - that's love! I am going to have to have a look at the tight regulation protocol I think, and get some different foods so I can manage her lows better, with no doubt a lot of help. Very grateful, again, for everyone. Apologies if I appear not to be listening ever, I'm just all over the place. I feel quite emotional because I know how much time you are taking to help me! What I've taken from it so far is that the dream is to keep her as flat as possible and gradually reduce that flat level, is that right?

I'm still not sure whether to dose her today. She is basically been flat at 15/16 ish for two days but I don't know whether that is because that's what her body is used to or because she's still having this response.

I think I will need to put her onto 0.1/0.2 again (Ben my boyfriend says he has some proper engineering calipers so I can measure the doses properly) and (if she actually responds which she didn't yesterday morning after her last dose) just stick a load of higher carb food in her so she doesn't drop anywhere near what she was which I now see was a massive amount as a proportion and not actually a good result. The more I read the less able my brain seems to be able to come to a conclusion I'm comfortable with. I also think I would need to stay up with her to monitor if I dosed her tonight. She's done two cycles with no insulin and it looks like that's not enough to assume she's at a level she's used to but now I think I'm just as likely to find that out if I do dose her. I'd assumed that removing a variable would give a clearer picture.

Also I don't think I'm tagging right but I had a go - another thing to learn!

 

Hi Liz @Elizabeth20 ...Waving to you from Surrey!
I see you've had some great advice.
Just a quick question, what does "change food to medicated" mean on your SS entry of 30th Nov? Was/is Lily on some special diet? What is she eating now, and what changes have there been recently?

Eliz

Edited to add: It looks like you are tagging just fine.

 

Hi Eliz! The vet wanted me to change her food to a diabetes specific food. After some advice here I decided not to mess around with her. She's eating Bozita (tetra) and Carny quite happily and has been for a couple of weeks. I think her tummy prefers the Carny but not sure.

 

The litter box is your friend!

On the bounces, it can take up to 6 12-hour cycles for levels to calm down, but they can clear much faster; depends on where the cat is at the time. Number-wise, a bounce can be thought of like an ocean swell: numbers rise to a peak level (looks like Lily's current bounce has been into the stinky pinks). Numbers might sit around that level for a while (the peak of the swell) and then start dropping down (the swell subsiding). With no insulin in the picture at the moment, it should be fairly evident when Lily clears the bounce because numbers shout flatten out at a sort of 'current baseline' level, apart from possible bumps after she's eaten. How BG levels change after food can sometimes throw light on what the pancreas is doing (hence my suggesting that you do fasting and postprandial BG tests while insulin treatment has been suspended).


Mogs
.

 

Is it though?! [puke]

 

I'm very squeamish and cleaning the litter box used to be a really unpleasant chore to me. However, I learned to love the litter box because it helped me to help Saoirse with the pancreatitis side of things, and it's now helping me to help the Noodle (Lúnasa, my civvie).

Now I regard the litter box as a best friend and a well-formed, healthy stool as a thing of real beauty. It's a way for our little ones to 'speak' to us, to tell us when they need something, and when treatments/supplements are/aren't working for them.

If you'd told me years ago that I'd ever say stuff like the above I'd have said you were 'avin' a larf.


Mogs
.

 

Haha! I have got up to find a perfect poo in there two or three times over the last week and must admit to having shouted 'What a beautiful poo!' The alternative is so flat-stinkingly disgusting that it really is a joy to get the good kind. It's the one chore Ben won't help with!

 

Thanks Mogs. I'll be sure to take and label measurements accordingly tomorrow so the data's a bit more useful.

 

Poop dances are a thing.




Mogs
.

 

She's was up in the pinks again first this morning even before eating but two hours after breakfast has gone back down to yellow (18 to 15). She doesn't seem to have a response to food so have I got it right that she hasn't stopped bouncing yet? Hopefully the measurements from the rest of the day will give a better idea. When she was at 18 this morning I wanted to give her a shot but I'm glad I waited to see her response to breakfast. She was absolutely starving and quite cross with me so I don't think it's that she'd foraged anything.

 

Hi Liz,

She certainly does, and a good one! That drop from 18 down to 15 is indicative of the pancreas producing some insulin after a meal (a bolus pulse), just not enough at the moment.

Two possible things (not certain things) that can sometimes give rise to a higher AMPS:

1. Dawn phenomenon.

2. Impaired fasting BG (pancreas doesn't produce enough of a basal trickle of insulin between meals to keep BG levels in a good range - usually manifests as a rise in BG after a longer time fasting).

One thing that's becoming clear is that Lily needs insulin support. While there's not too much data collected yet, it's starting to look like her 'baseline' level is in the teens.

Hope her nibs is in a better mood with you now that she's had her brekkie. The higher numbers could also have been influencing how hungry she felt. (((Lily)))

Great job with the testing, Liz.


Mogs
.

 

Hiya Mogs

I was expecting a rise after breakfast but that's really interesting that the response can go the other way.

My mum has steroids and was telling me today when I was talking about this that she has to time them right to avoid the endocrine spike first thing. Or something. I was definitely listening.

Lily was in a much better mood after breakfast. She even sat on the sofa with me for a bit. Back behind her tree now.

OK I'll complete today with the no insulin to get better data. Is it safe to do another day or so till I have the Lantus or should I get some Caninsulin into her? 18 made me feel a bit uncomfortable and worry about her.

 

I'd suggest giving the vet a ring ASAP to go through the BG numbers. If it was my cat I wouldn't want to wait longer to reinstate insulin treatment with numbers in that range. They're definitely over the renal threshold (approx. 14-16mmol/L on a pet meter, so range is lower as measured on a human meter). That puts the kidneys under additional strain, the glucose in the urine increases risk of UTIs, and it doesn't do the rest of the body any good either (including the nervous system and the poor little pancreatic beta cells that produce insulin).


Mogs
.

 

OK thanks Mogs. I have sent in my sheet to them by email and rung to ask someone to look at it. The vet she's been seeing is away but reception will ask someone to review it. If I don't hear from them by 7 I think I will give her a tiny dose and then I assume I need to manage the drop by giving her a higher carb food because she isn't having higher reads after food? I'm concerned about how high she'll be by tomorrow otherwise. I've asked again about Lantus which I can get this evening but I will need them to let me have the needles.

 

The vets are saying still don't give her any insulin tonight or tomorrow, that the levels aren't dangerous, and to bring her in tomorrow afternoon to go through the chart and discuss options. Feel quite tearful now that they aren't really listening to me or looking at the chart properly and that I've not got the best advice from them and won't be doing the best for Lil. I suspect they haven't registered that it's a human glucometer I'm using. Poor Lily, another trip to the vet - I have to walk for 15 minutes each way with her in the carrier and it's quite stressful for her. I'm also worried that I will be talking absolute crap to the vet and will have trouble getting them to give her something gentler for Lil.

 

Been there. It's awful, and I feel for you.

One of the most valuable things I've learned since joining FDMB is how to be a better advocate for my little ones - not just for the diabetes. I found it very difficult standing my ground when discussing/negotiating treatment plans with vets at first, but it got easier - and we ended up with better outcomes (most of the time). Members here helped me by telling me about treatment options that I'd probably never have known about otherwise and which worked much better for my babies than the options initially offered by the vets involved in their care. It does help if one finds a vet whose approach is collaborative, not dictatorial!

Question: With the covid restrictions, most vets are now doing consults either in the car park or via phone. Have your vets said why it's necessary to drag Lily in to the surgery tomorrow? (((Lily)))


Mogs
.

 

Useful info:

Alphatrak Meter

Normal feline BG reference range: 3.9 - 8.3mmol/L (range provided to me by my vet for use with a cat blood-calibrated meter).

Feline renal threshold: Approx. 14-16mmol/L (from online Merck Veterinary Manual, varies somewhat from cat to cat).

Human Meter

Normal feline BG reference range: 2.8 - 6.7mmol/L (per FDMB guidelines, based on published studies of feline diabetics).

Feline renal threshold: >11.1mmol/L (rough estimate, human meters read lower than cat blood-calibrated meters).


Mogs
.

 

Basically its a different vet giving advice and they want to see her before they give any advice. My annoyed suspicion is that they don't want to give free advice over the phone, so bringing her in is a way to get to charge for it. Goodness knows what else they'll charge for. Also tempted to just stop taking her there for a while because I feel like there's a lot more cat-specific knowledge on here than at the practice. She still has bruises in her ears where they tried to take blood the same way they would with a dog in the middle of the ear and blamed me walking with her and her being cold for not being able to get anything out of her.

Hopefully I won't get in too much of a flap and they'll take me seriously.

Thanks for being here for me Mogs.

Liz

 

This is brilliant, thank you. No wonder they think she's not in any danger if they think it's an Alphatrak.

Apart from first thing in the morning she's not polishing off every scrap of food in one go any more. She comes back to it an hour or so later and still leaves a little bit. Given that she produces some insulin after eating is it worth putting a decent amount of food down when I go to bed in the hope she won't be as high by the morning? I could set an alarm to feed her again in the night. Or do you think it's worth giving her a droplet of the hard stuff?

 

I've just measured her at 16.5 which I'm really not happy to leave her at till the morning given that she's likely to have a spike in the early hours. I've drawn the tiniest amount of caninsulin possible into the barrel, estimating at 0.1 and she's had a bit of food to go with it. I'll monitor hourly for 3 hours and give her honey and food if she drops fast and then keep monitoring till +5 if I can.

 

Hi Liz,

Sorry I've not been able to get back to you until now. I think your plan for tonight is OK with the monitoring. Do you have any higher carb food in the house, the thinking being that you could leave some out for her to graze on if necessary when you - eventually - hit the hay (and you could set an alarm to test/feed later if required, and also one 2 hours before the AMPS is due to lift any remaining food).

In the UK at the moment there are two insulins licensed for use in cats: Caninsulin and Prozinc. Legally the first two have to be tried before a vet can prescribe Lantus under drug cascade rules, so the next step would be Prozinc. When Saoirse was being treated, Prozinc hadn't yet been licensed so she was able to move to Lantus straight after the Caninsulin. The BG readings and observations I recorded in Saoirse's spreadsheet provided our vet with the evidence needed to justify the the Rx. Prozinc typically has greater duration in cats. If you look at the stickies at the top of the Prozinc support group's board you can find out more about it.

I read here a while back that more vets in the UK are open to prescribing Lantus nowadays but I'm not sure of how quickly they might be inclined to do so, given that the first two insulins need to be tried first. I'm tagging @Diana&Tom and @Elizabeth and Bertie, two other UK members who might be able to give you some more info in this regard when next they're online.

On syringes, you can buy both U-40 and U-100 syringes online without a prescription.

Our vets have always been quite good with telephone support, for which I am very grateful because I'm severely agoraphobic. When managing Saoirse's diabetes, I provided them with a link to Saoirse's spreadsheet and our main vet and myself reviewed the dosing protocol I wanted to follow (the Roomp-Rand tight regulation dosing protocol) when she switched to Lantus. I'd been treating her with Caninsulin for a few months by that stage so had some bit of experience under my belt. He followed what I was doing on the spreadsheet and thereafter he was happy for me to manage dose adjustments myself. I had more dealings with the practice for Saoirse's chronic pancreatitis, dentals and so forth than her diabetes. A full telephone consult is, quite rightly, chargeable but given we were frequent flyers, they'd usually answer quick queries about med doses, etc., buck shee. It's a similar story now with managing CKD for my civvie, Lúnasa. Again, I keep a spreadsheet for her (blood pressure, labs, clinical signs, etc.) and the vets have a link to it. I'm lucky because our main vet at the practice is highly collaborative and approachable. We don't always agree about things but if I can make a case for a particular treatment option he's usually willing to consider it. I feel heard and that makes such a difference. I felt dismissed at our previous practice.

Overall, I think the covid restrictions are making things difficult for client, patient and practice at the moment.

I hope you're feeling a bit better this evening.


Mogs
.

 

Hiya Mogs

Looks like Prozinc could be worth a go if it's a longer cycle. And it's u40 so I can stick with my current syringes till the u100 ones I've ordered arrive later this week.

Sorry to hear you're agoraphobic (((Mogs))). I've had a lot of anxiety which isn't helped by actually having something to worry about. It makes me come across as a bit of a nightmare I think, and I will try to be calm with the vet and not come across as if I'm trying to tell them my job, even if I a bit am... Sorry also that you've had such a long time looking after poorly cats - they've been very lucky to have such a dedicated mum.

Lily's alternating between rubbing against my foot and giving me a hard stare which is excellent because it means she's hungry. I'll test her in 10 mins, feed her if she needs it and nap for an hour then test again.

Sleep tight

Liz

 

Wow, she's at 20.4 this morning

 

Just responding to Mogs’s tag - sorry, I don’t know the situation about vets prescribing Lantus. There may or may not be a certain minimum time that you have to try your first insulin - Eliz knows much more about this than I do, having had diabetic cats for more than ten years. It may though depend a lot on an individual vet and if you can show them that Caninsulin is simply far from ideal, they may be more receptive to a switch.

Sorry, not much help! Reading through the last few posts though, I can sympathise with your feeling that you’re not getting the support you need from your vet. It’s a very common scenario here. When I was treating my Tom, I found a new vet because the first one didn't seem to have much of a clue, and I stayed with that vet until I lost first Tom and then his sister Sophie. When I adopted my little civvie Sapphire, she was registered with the first vet so I stuck with them as all she needed was annual check-ups/vaccinations. However, she recently needed a dental including two extractions, and - long story which I won’t bore you with here - I decided to use an excellent cat-only mobile vet in my area (which Eliz also uses). The vet and nurse come to your home, examine cat, carry out any minor treatment, and if surgery is needed they have a fully equipped Catmobile which is basically a vet surgery on wheels. Sapphire had her dental last Thursday and although I was a nervous wreck, the process itself was very smooth and the vets and nurses are just lovely and real “cat people”. They answer questions fully and you can take out a wellness plan that includes all sorts of things including phone/email access. You may not have something similar in your area but there would be no harm emailing them and asking if they know a feline friendly vet near you - the vets have worked elsewhere so might be able to suggest something. Have a look at www.thecatdoctor.co.uk to see what they do.

Best of luck.

 

Hi Diana

Sorry to hear about your cats. I've had an initial look and can't find a mobile cat vet for Nottingham. There seem to be a couple of vets who have cat specific vets at the practice. I don't drive (I had my first lesson just before the latest lockdown!) which is why I switched to this vet when I moved house but really Lily had only ever been to the vet once since getting her jabs, spayed and chipped, so I don't know if they would have been any better. Hopefully the appointment today will convince them I'm not just a lunatic and they will listen to me. Failing that I'll have to look at getting taxis to a more specialist vet.

 

Ok you’re in Nottingham... I’ll post on the Facebook UK owners group (which you could usefully join if you don’t mind FB) and ask if there are any members in your area who could recommend a vet. If so I’ll get back to you.

 

That's very kind Diana. I'm quite happy to join the group.

 

https://www.facebook.com/groups/196780940826285

 

just a thought about making a vet visit less stressful... a 15 minute walk isn’t much fun for either of you. What I’ve done in the past to carry heavy “loads” is to use a shopping trolley... if you take the bag/basket off you’re left with the trolley itself onto which boxes etc can be strapped. You may be able to get a cat basket on that way, well secured of course - then you’re not having to carry anything. If so, spray the inside of the basket with Pet Remedy and cover the basket with a towel or small blanket so kitty is enclosed... it may sound a bit odd but that’s what I’d do. My new vets do the Pet Remedy / blanket method and say it works fine, even for ferals.

Cats who really freak out at the vet’s can also be given gabapentin two hours beforehand to calm them down. My Sapphire is pretty skittish with strangers and I’ve been giving her this - works well, just makes them slightly drowsy.

 

Here’s one answer from the UK group:

 

Bulwell will be the one closest when we move house I think. The one we're going to here is a Vets4Pets but that means nothing as I think they have just incorporated a lot of existing practices.

Thank you so much for getting that for me Diana. I had wondered about covering the carrier - I will give it a go this time. I'm pretty sure I could pick up one of the discarded trolleys from the Morrisons on the way along the canal too!

 

No problem! Do join the group tho, it’s very supportive.

 

I already clicked the button. Never know, might be able to set up a swap for the 36 cartons of food she can't tolerate!

 

The vet told me she should still be on 0.5 units twice a day with a view to increasing to 1 unit a day, and I should start giving her that, not change it for at least a week and then do a full curve at the end of 7 days. She says the issues are because of me reducing Lily's dose and that 3.3 at nadir is fine. She said I'd know if she goes into hypo and it was easily fixed so not to head it off until she starts walking into things. She didn't agree that Lily's had any kind of bounce, or even that such a thing exists. She also said cats are very easy to treat for diabetes which I found rather surprising.

She was insistent on a change to Royal Canin dry, and on only giving a measured amount twice a day. I said she's very hungry in the mornings and I assumed that was because her BG was high. She said that would have the opposite effect because she's full of sugar. I said about the calories being 25% from carbs but she said that didn't matter because of the fibre content. I was running out of fight by then. The vet took her in and then said her BG was 22. She softened on the food realising I was rather resistant.

I'm getting a strong urge to go rogue. Ive picked up the Lantus from Ben's mum so it's there as an option. I want to take the legitimate professional's advice but it sounds like madness to give her a dose that's going to take her that low or cause a bounce reaction. I suppose a sure fire way to know if it is a bounce is to force it to perpetuate and then when she runs out of resources she'll plummet. Having done damage to her insides.

Telling me it was my fault has really done a number on me. I'm paralysed with indecision again and upset. Sorry for the long post.

 

I can't get to the end of your post right now, Liz, because it's making me angry. I think your vet only has a cookie cutter approach to FD, gleaned from some textbook or other.

I need to go away for a little bit, spit more feathers and calm down before replying further.

I'm so sorry she upset you.

(((Liz)))




Mogs
.

 

Sorry to stress you out as well Mogs, it was a lot! I'm just totally flummoxed. I've given Lil a drip of Caninsulin to get her down from the 20s because that at least was a no-brainer. I'll leave her behind the Christmas tree for a little while now.

She said Prozinc was too irregularly available, so I guess at least I can say we've ruled that out.

 

There was an uncharacteristic disruption to Prozinc supply earlier in the year (apparently down to some shenanigans where it now has to be sourced in the US rather than Europe) but I believe normal supply levels were restored a couple of months back. If you ask in the Prozinc group they might have more up-to-date info on this. Note that you can buy Prozinc from online veterinary pharmacies with a written Rx from your vet (and it would probably be cheaper).

It sounds like your vet has very much a 'my way or the highway' approach to FD. There are so many things she said to you that are just plain wrong at best, and downright dangerous at worst.

I'm absolutely smothered with a stinking cold today, but I'll try to go through it point by point for you tomorrow. In the meantime, here's one of my old posts which touches on the approach a lot of vets use (and it sounds like your current vet may be among them):

https://www.felinediabetes.com/FDMB/threads/results-of-first-at-home-curve.233843/#post-2616680

The approach discussed in the linked thread is likely to reduce the chance of a cat achieving remission.


Mogs
.

 

Oh my dear Mogs, get yourself better. I think a cold is the most miserable illness. It makes life so tiring and difficult and you swear the whole time you'll never take breathing for granted again. Under the duvet with you.

That's a beautifully written post on that thread. I'm entirely happy with Lil's food and have no intention of upping her carbs just to keep her within the vet's desired curve range of 5 to 15. I would hope with a bit of care and the excellent advice here we can get her a bit flatter than that.

Sleep well.

 

There was a temporary supply issue for a few months. But that was resolved back in August. Since then there have been no problems with supply of Prozinc. It's widely available.
The issue seems to have been that it was not possible to get supplies from Europe. And it became necessary to establish new suppliers in the US. (I'm 'guessing' this may be because of our coming out of the EU, but I don't know....)

Elizabeth, I think I read somewhere in your thread that you are switching to U100 syringes? If so (and if these are the BD ones - which they usually are) do just be aware that the markings on the syringe barrels can be a bit wonky.
The issue is mainly about exactly where on the syringe barrel the 'zero line' begins. It can vary quite a bit, and can be out by as much as half a unit or even more. For humans who are having much larger doses of insulin this small anomaly probably makes little difference. But with cats on small doses it can make a very significant difference...
The lines can also sometimes be at a bit of a wonky angle which makes it hard to see exactly where the true measurement is...
When you get your syringes pull some of them out of the pack and compare them, and you may see what I mean (unless you are lucky enough to get a really good batch!)

There are a couple of ways to deal with BD syringes.
I have a syringe I use as a 'template' to compare the others to (with the end painted neon green so I don't lose it!). It was selected for having good, clear, average markings. ...I draw the plunger in my template syringe to the dose that I want. Then I draw insulin into a fresh syringe, and compare that to the template syringe, adjusting as necessary so that they are both the same. I have a magnifying glass on a stand that I use to compare the syringes (my close vision isn't great...).
Another way of dealing with the BD syringes is to use a digital calipers to measure the dose, rather than relying solely on the markings on the syringe barrel.

Are you intending to use the U100's with your current U40 insulin? And if so has anyone given you the link to the 'conversion chart'? They probably have... But my vision isn't great today and I'm having a bit of a problem scanning back through all the posts. Here's the link again just in case you don't have it:
http://www.felinediabetes.com/insulin-conversions.htm

Eliz

 

Hi Eliz

Thanks for the Prozinc info.

Yes to both in the interests of accurate dosing and if necessary in readiness for a possible switch to Lantus. Thank you for the chart, I would have had trouble finding it no doubt when I needed it!

Ben is an engineer and has some excellent calipers so I will have some fun with those. I might mark up a couple of template syringes that way I think.

And I don't think I'm going back to that vet surgery. I've created a second spreadsheet and amended the link in my signature, so that vet can't see what I'm doing any more. That's probably overkill but I feel quite mutinous! That said the biddable part of my brain accidentally gave her 0.5iu this morning. I am very tired from staying up late with her - more in awe than ever of people who do that. Or have children. No thank you.

 

@Elizabeth and Bertie - Thanks for the additional info on Prozinc supply.

@Elizabeth20 -

Liz, I can second everything Eliz advises about how 'off' the markings can be on the BD U100 syringes.

In addition to the tips Eliz has given you, another one is to go through the entire box of syringes and sort them into groups based on how far off the markings are. Hopefully with the digital caliper in play you won't need to resort to such desperate measures.

Another couple of tips for measuring doses:

1. It's easier to see where the plunger is if the syringe is lit from both front and rear.

2. Use two pairs of cheap 'n' cheerful reading specs doubled up.

3. Use a cheap 'n' cheerful jeweller's loupe to check the position of the plunger, e.g:



https://www.ebay.co.uk/itm/LED-Illu...sh=item23886c1b1c:g:NLoAAOSwDrpb6i1x#payCntId


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Yesss I was wondering about a loupe! Couldn't work out how else I'd hold everything. Thanks both x

 

Another idea: I've seen some members mention using those magnifying specs + headlamp thingummywossnames.


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