1st test, 1st insulin..freaked out.

Hello!

My husband and I are going to start testing and insulin on Friday for our 18-year-old dude, James.

It seems all so complicated. I wish I could have someone come over and help, but I think we are on our own (we are in Philly if anyone wants to visit and save us!)

Could someone lead us through day 1, step by step? We plan to feed him breakfast at 7am. I may not be able to test a lot, we are new to this. 10x a day will not be realistic.

Vet is recommending 1u of Lantus 2x a day. We should be getting a vial in the mail tomorrow.

I have a sock with rice for ear warming, a relion Prime meter and strips, and syringes. The only thing I don't have are lancets.

Thanks for any and all help!

 

It seems so hard at first, and I know it's hard to picture, but it really gets a whole lot easier once it's no longer new stuff.

Ok, so Bandit was also on a 7am/7pm schedule, so let me share with you my step by step process! You don't have to test 10x a day with Lantus...I work a lot so Bandit and I got by just fine with testing 3-4 times a day and a curve once week. However, you may want to get a few more tests in the beginning when you are able as you're finding the right dose to get him regulated.

If you haven't already, set yourself up with a spreadsheet, like the one in my signature. You can do that here: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/. The spreadsheet is a great tool to help you visualize his numbers when making dose adjustments. You can also use it to get dosing advice here, and to share with your vet.

So, the first thing we do at 7am is get a test. this is called the AM Pre Shot, or AMPS. Here's how I hometested Bandit in the beginning, which is different than now because in the beginning he didn't like it and fought me a lot. Now, he runs to me and sits patiently through the test when he hears the meter beep on, so time and routine will definitely be your friend when testing! But I want to give you instructions for a difficult cat, just in case you have any problems. Cats sometimes resist in the beginning because you're doing something new to them and they can sense your nervousness. Once you and your cat gets used to it, it's never as hard to test as it is the first few weeks. And despite what you may think, it doesn't hurt them at all--cats have less nerve endings in their ears than people do in their fingertips, so pain is not an issue.

If your cat struggles at first, I would recommend getting a fuzzy, comfortable blanket, wrapping him in it and putting him in a box, container, or basket (anything that he fits inside comfortably that encloses him on the sides). Do this for every test, and do the test in the same spot. Make sure you're either feeding or giving him a treat after every test.

1. Warm the ear with the rice sock.
2. Back the ear with a piece of tissue or a cotton ball. This will help you poke without stabbing your fingers, and you can use it to put pressure on the poke spot after you're done testing.
3. Find the "sweet spot" where you'll be poking. This is the area between the vein and the outer edge of the ear. Here's a picture: http://s106.photobucket.com/user/chupie_2006/media/testingear/sweetspot.jpg.html. You can use a flashlight behind the ear if you're having trouble finding the vein.
4. Load the strip into the meter. It should turn on and give you a beep. Usually, there's an indication that it's ready for blood that varies with each meter. Mine has a flashing blood drop icon.
5. Poke the spot with the lancet. You can either freehand the lancet or use a lancet device. I use the Relion Lancet device--and I position it so the circle in the middle is aligned to where I want to poke. When you're starting out, make sure you're using a larger size gauge lancet--26-28g. The ultra thin ones are really hard to get a big enough drop of blood with, especially at first.
6. If you get a good sized drop of blood with poke, great! put the end of the test strip to the drop of blood. The strip will "sip" up the blood on its own when the tip comes in contact with it.
7. If the drop of blood isn't big enough for the test, you can "milk" the spot to make the drop bigger. You do this by gently squeezing near the outside of the poke spot with your fingers.
8. If you still can't get a drop, try poking again. Make sure that your poke spot is being firmly backed with your tissue/cottonball so that the lancet isn't just glancing off the spot. Try poking with a little more force if you're freehanding, or using a deeper poke setting on your lancet device.
9. After every test, successful or not, give him a treat! This is a VERY important step!

After you get your test and the number indicates it's safe for you to shoot his insulin, then it's time to do breakfast and the shot. My routine with Bandit is this:

1. Prepare the cats' breakfast. Food goes into bowls with a little water mixed in.
2. Prepare the insulin shot.Take the caps off the syringe, and then pull the plunger back and forth a few times to get the syringe lubricated. Insert the needle into the vial. Pull the syringe back just a little further than his dose. Remove the syringe from the vial. Holding the syringe upright with the needle facing to the ceiling, flick the syringe with your finger to get any bubbles up to the top. Slowly (this may take you several tries at first) push the plunger forward until you reach your desired dose. If you accidentally remove too much insulin from the syringe, reinsert the syringe in the vial and try again. Don't worry about wasting insulin; you'll never get through the whole vial before the insulin goes bad, even if it lasts you several months. Check out the Lantus forum for storage and handling tips.
3. Give the cats their food.
4. While he's eating, give Bandit his shot. You do this by tenting the fur on his back or flank, inserting the syringe needle into the skin (not the muscle), and pressing down on the syringe plunger.
5. Dispose of the syringe in a sharps container (you can buy them or use a heavy plastic container like an empty laundry soap bottle. Just make sure you mark it!)

At 7pm, you repeat the same thing. The test then would be the PMPS.

About halfway through either cycle, try and get another test. With Bandit, this was usually at his 1am feeding. But it could be at 1pm, or before bed, or whenever you're home and able to test him. Lantus is dosed based off the mid-cycle tests, not the AMPS or the PMPS, so that's why that third test is really important.

Good luck, and ask lots of questions if you have them! There's also a lot of experienced folks in the Lantus forum that can help you out.

 

Julia, that is a fantastic description of the steps! The only thing I do different is scoop the drop of blood onto my thumbnail. That way if Ben wants to wander off, I still have the blood.

 

Nice to see you here.
You will be surprised how easy it really does get, Blitzen's ear always needs to be nice and warm as the other I can get blood with just slightly warming it. I always give them their shot while they were eating...they never even noticed. you will want to test him right before 7:00 then before you feed. I hope James reacts to treatment as well as my boys . Sending positive vibes out to you and James.

 

What a fantastic description!

Dtmfa I'm also new to this, just two weeks into lantus tr, it gets easier and the nerves subside especially with the help and support of the guys here, they do a fab job of virtual hand holding.

I started practising testing before starting the insulin regime, so that both George and I got used to it, I felt that way I reduced our stress levels because I felt confident I could get a BG reading once he was on the juice, and therefore I wasn't panicing about whether I'd be able to get a reading or not.

Take a look at the videos, I found them very helpful, different people/cats different techniques find which one suits you and James best

Good luck

It gets easier

 

THANK YOU all, especially @Julia & Bandit for that great step-by-step which will definitely get me through the first day and more! Although my nerves are shot with this, I'll do my best. Thanks for the encouragement! I will let you know how it goes.

One question: what is the AMPS or PMPS range where his bg would be considered too low to give a shot? 200?

 

As a newbie can't answer your question, but perhaps I can point you in the right direction for info.

Take a look at the lantus and levimir support group forum, there are stickies there which describe the different types of protocols pros and cons, and how to handle low numbers.
I've opted to try the Tight Regulation protocol, and barring some rookie mistakes it's going well, with the help of the guys in the support group, we're back on the straight and narrow. For us its been invaluable as our vet, though lovely and supportive, has very little experience with sugarcats, so this forum has been invaluable.
It's also a good place to post for advice that's lantus specific.
As I understand with lantus we have to look at our kitties mid cycle numbers for an indication of what to do with the dosing, but up till now I haven't had to worry about that as George is still in the 300s

I'm sure more experienced users will pitch in with more specific advice.

Gill

 

Right now, if you get a Pre-shot under 200, we suggest stalling, don't feed and post for help. Keep testing about every 20 minutes and if the numbers keep going up (or go over 200) that's usually a good sign that the insulin is wearing off and it's safe to shoot (but of course your ability to monitor/test later in the cycle also matters)...ALSO you have to remember that as long as you stall, you have to be able to push back your shot times so you're not shooting 2 hours late one morning and not able to shoot 2 hours late that night

I really encourage you to get your spreadsheet up as soon as possible....what's going to let us know how to help you is to look at the data in your spreadsheet....without that data, the best we can do is guess and that's not something we like to do.

There's lots of information on Shooting and Handling Low Numbers here....since you don't have you signature filled out, I don't know which protocol you're going to use (Tight Regulation or Start Low Go Slow) ......The linked information is for TR but there's a link included in that sticky on handling low numbers on Start Low, Go Slow too

 

Can we get you started using our grid to record your glucose tests? It will help us give you better feedback. Instructions are here.

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning, pre-shot, test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening, pre-shot, test)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

The nadir is the lowest glucose between shots. There is a general period when it will happen which is specific to the insulin being used and testing then helps make sure your cat doesn't go too low.

It is merely a grid for storing the info; no math required.

 

Hey, just check in on you and James. Hope your all doing well.

 

Hi all -

We did a test on James tonight, just to try it before tomorrow, when we plan to start insulin at 7am. It went really well, I am so relieved! I have the spreadsheet all up and ready and in my signature, thank you!

1) We are doing the Start Low, Go Slow protocol, starting at 1u 2x a day, 12 hours apart, per the vet. As I read it, this is starting at 1u, hold for a week, do a bg curve, and then adjust the dose as necessary. Is that correct?

2) Tonight's test (his first home test ever!), right after he had a little snack after not eating all day, was 274 on the ReliOn Prime. So, if that is his AMPS tomorrow, he would be safe to receive a 1u insulin shot after breakfast, correct?

Thanks all!

 

Hello mi mane is Julia and welcome to the sugar dance, your doing wonderful so far everything your doing looks correct. The big thing you might want to remember is to BREATH this is not rocket science.

 

That's great !!
I'm feeling hopeful that James will fall into remission quickly.

 

If you've decided on 7am/7pm shooting schedule, in the morning you'd want to make sure there's no food available to James after 5am then at 7 you'd Test/Feed/Shoot...all within about 5-10 minutes

Test to make sure he's high enough for insulin...at this point, if he's under 200, you'd want to stall, DON'T feed and post for help. If over 200, you'd go ahead and Feed (to make sure he's eating fairly normally) and Shoot

If at all possible, try to get a mid-cycle...somewhere between +5 and +7...finding James' nadir will help determine how he's doing and if he needs an increase in dose

Repeat on the PM cycle...no food after 5pm...Test/Feed/Shoot at 7pm and make sure to get a "before bed" test to make sure it's safe to sleep the rest of the night (or knowing you need to set an alarm to make sure you wake up to get more tests in if necessary)

 

Ok thanks! Will let you know how tomorrow goes!

 

Good luck with your first shots, hope all goes well.

 

@Julia & Bandit @Chris & China

James' AMPS this morning was 232. We decided to go with .5u for the first week, instead of the 1u recommended by the vet. First shot went...OK, pretty sure I got it in. He definitely felt it, but we will get better with time!

 

Good luck on your new adventure!!!

 

I am so happy that you decided to treat James!!! Sounds like you are off to a good start, too, that's wonderful! You already have a very good understanding of the situation, so you'll be an old pro at this in no time at all!

 

Well, we just got his first +6 test - came in at 156. I don't know enough to know what this means, but sounds like a good thing? He's supposed to get dinner and his next shot at 7pm...

 

yes...that's a good thing!!

Normal numbers for a human meter are 50-120, so that 156 is a nice nadir...as James's depot fills (it takes 5-7 days) you'll really start to see how well he's going to do on the .5 unit dose

 

Julia, just read that blow-by-blow and it's terrific! My cat Lamont was diagnosed today with diabetes and I'm fleshing it all out, figuring out what to do and it's a great blueprint. Question: Do you feed Bandit 3x a day? At 7am (with shot), 7pm (with shot) and 1am? I'm trying to figure out good feeding times for Lamont. Thanks!