Learning to inject insulin and it's not going well

Hi everyone. I hope I am doing this right. I found out on Thursday my cat Tubba has diabetes. He is seven years old. He was an overweight cat and I put him on a diet. After the diet seemed to be out of control this last month I took him to the vet. He is down to 11 lbs. (this is how i got the news) his level was 404. well they gave me a bunch of paperwork and food and insulin (lantis) & 1/2" 29 gauge u-100 needles. Now my first BIG problem. My cat does feel the shot. He jerks and yells. I'm sure I'm just horrible at it but I really am trying. He is very thin and I am having a hard time have enough skin to tent. He is long hair and it's hard to see the skin. And my kitty was clawing me this morning. I have been practicing not shaking on a banana. (I have always been terrified of blood needles etc but when it's your child I'm shocked at what I can do) any advice would be great. I've been looking up videos... Pictures etc but those cats are just sitting there almost sedated which I'm hoping tubba will eventually be that cat.

Thanks in advance I'm freaking out a bit.

~holli & tubba~

 

hi and welcome.

Where on the body are you trying to inject him?

Here is a link to show you how to tent the skin: http://petdiabetes.wikia.com/wiki/Injecting_insulin

Many people inject in the flank area which is located near the rear hip area. However, you may find it easier to inject in the scruff of the neck.

Also, how deeply are you inserting the syringe? It doesn't need to go all the way in, in order to be effective. You only need to insert it just past the opening, so the insulin goes in and doesn't end up on the fur.

You may also want to get a higher gauged needle - such as 31 gauge - and if you get ones with the 1/2 unit marking, you will see just how tiny they are and that your cat may not feel it as much as a 29 gauge needle.

did anyone talk with you about home testing? This is a vital part of diabetes care and helps to ensure that you are giving the right amount of insulin.

viewtopic.php?f=14&t=287


Also, what kind of food are you using. Diet plays another vital role in the management of diabetes and it is important to not feed dry food, and to feed low carb wet food only. viewtopic.php?f=14&t=115

viewtopic.php?f=14&t=956

Where are you located? There may be another member close by who can help you in person.

 

Thank you for your reply. I have been trying to get his sides. Not sure of the proper term it's just were the vet showed me. BUT I had much more success this evening closer to his neck. I am inserting it all the way by of the way the vet showed me.... I have been so worried that I'm hitting muscle. I actually bought a cat trimmer and trimmed him tonight so I could see better and when I thought I was pushing hard enough to go in I was just poking the poor baby. After seeing I poked with a little firmer and tuba didn't even squeal but that could just be a coincidence. I go back to the vet Tuesday and will ask about the needle size. Actually I've been reading forums and have a whole bunch of questions. He hasn't mentioned home testing to me but I was a hot mess after he told me and after he brought out the needle and I almost passed out he may have known I couldn't handle it all at once. The vet did say he may have to stay to get leveled out BUT due to the weekend he let him come home. Currently tuba is getting 2cc twice a day (12hrs apart) the vet gave me purina dm wet and dry for now he said bc tubba was used to it and has lost too much weight. Although today I made a run to Walmart with my list off of here bc he doesn't like the wet food. I got the fancy feast classics. I'm really not sure how many he should get a day??? Or how important timing of the insulin shots are with food. I live in Arkansas I haven't figured out how to edit my profile or add a picture of tubba or anything. I'm REALLY trying to take this all in. Wow it's a lot. I'll do anything for my baby don't get me wrong im just panicking.

Thanks for any help

 

I'm new to this too. It's definitely a learning process! I would definitely ask about the needle width. Mine is so small that I literally can't feel it going in the skin. So I have to look really closely to make sure it goes in! Tonight we shaved a little patch off Lily's shoulder area so I can see things better. Also, I'm trying to focus on only putting it in a little bit, not all the way, b/c when I push it in all the way I have the tendency to keep pushing and then she yelps But when I do it right, she doesn't notice at all.

All this to say, hang in there. It does get easier, and you will figure this out.

 

You might try using a comb to part the fur and give you a better view of the skin.

Lantus, Levemir, and Humulin N come as U-100 formulations, which means 100 units in 1 mL. Perhaps you mean 2 units of insulin ??

1 CC = 1 cubic centimeter = 1 milliliter = 1 mL ... and generally is a completely full syringe, which would be an unlikely dose for the average diabetic cat. (There are certain exceptions to this.)

The needle points into the tented skin with the angle of the needle roughly in the middle of the widest edge of the skin fold. (At least, thats how I think of it.)

 

PurinaDm wet food is ok, but dry will only cause higher bg levels!

Don't worry about hurting your cat. 90% cat reactions are caused by either the "surprise effect" or the cat owner being stressed out and passing the stress over to the cat!

My cat does not have long hair but still I would find the spot I want to use, pull the hair back with my fingers and pinch the skin to clearly see the area that I am about to use. If you have a nervous cat you can try to make her comfortable, pet her, and pinch different areas then a little scratch on the head , then pinch other areas on her back and then pinch and inject insulin... It's one way I found to avoid the surprise effect. My cat wouldn't make the difference between one of these pinches and the "real one"

And one last trick ... Cold insulin can be a little painful. To avoid that, hold the seringe between your thumb and index (with the cap on to avoid hurting yourself!) to warm up the insulin couple of seconds before the injection.

 

Let me try to address each of your concerns:

Again, the idea isn't to insert the needle all the way into the cat. By doing that, yes you could hit muscle. I believe you will be better with the short needles, as there isn't as much to insert into the cat. You just want to insert it enough so that the opening of the needle is under the skin, so that all the insulin goes into the cat.

.

Look at this picture, this is where you are trying to get if you do the sides (also known as the flank):

http://www.bd.com/us/diabetes/page.aspx ... 01&id=7374

It is where the rear leg meets the body.

However, if you find that injecting into the scruff (back of neck) is easier for you, it's fine to inject there.

With many cats, it isn't so much that you poked the cat or injected him, it's more that he has been confined or detained or held in one place that upsets them. With practice you will get the technique and feel more confident.

Yes it is a lot of information to take in at one time. However, it is vital that you learn to home test. Think about it this way. If Tubba were a human child, the doctor would tell you that you must test before giving insulin, otherwise, how do you know the amount and if it is safe to give insulin at all? You don't want to go into this blindly. And I can't stress enough the importance of learning to home test.

I promise it is not difficult, again, you will need to learn the technique and come up with a process for you and Tubba. And no, you aren't hurting the cat by home testing. Actually, you could be hurting the cat by NOT home testing.

I believe you mean units and not cc. So the question I have are you giving 2 units twice a day or 1 unit twice a day for a total of 2 units given in a day?

This is an important distinction as we have a motto here - start low and go slow -

what that means, is you want to start at a low dose of insulin - 1 unit or less and make adjustments, based on home testing in small increments, such as 1/2 or 1/4 unit amounts. Hence another reason why you want syringes that have 1/2 unit markings, it will make it easier to make these adjustments.

What kind of insulin are you using?

the vet gave me purina dm wet and dry for now he said bc tubba was used to it and has lost too much weight.

Dry food of any kind is not ideal for any cat. As dry food can cause the BG's to increase and in some cases has been the reason why a cat became diabetic to begin with.

Fancy feast classics are perfectly fine to feed. As to the amount, well it really depends on the cat. Before Maui got regulated with insulin, she could eat 2 1/2 cans at one time and I fed her 2-3 times a day. And yes, I allowed her to eat all that. As she got regulated and her need for food lessened, she dropped down to 1 can at each feeding.

Today, she may eat an entire can at one feeding, or she may graze it on all day long. I do leave the food out all day, for her and my other cat to eat at their leisure. I also add about 1/2-3/4 can of water to each can of food. This does a few things:

1) it keeps the food moist longer
2) it ensures she gets plenty of water in her system without having to drink separately
3) it keeps the kidneys working well as water is important for kidney function

It is important that when giving insulin, your cat is eating at the same time. Again, think about a human diabetic, when they inject themselves, they typically will eat within 30 minutes of injection, otherwise they could have a hypo episode. Again, it's the same with cats, you want them to eat when injecting insulin, to help keep the BG balanced. This is another reason why it's important to home test, as you will know where the BG currently is and if it is at a level that is safe to inject insulin.

I'll see if there is another member in Arkansas and direct them over here to help you. And don't worry about the pic or profile. What's more important is that you don't panic, you understand that you found a great group, who will help you and that you ask questions so that we can better assist you.

 

You can fully insert a 5/16 inch needle into the tented skin. Holli is using 1/2 inch nedles so maybe only up to half the needle can be inserted without hitting muscle.

Holli, buy some 30 or 31 guage insulin syringes instead. 29 gauge is a bit thick and some cats do feel it. The most ideal insulin syringes to use with Lantu sis U100 3/10 cc with half unit markings. Needle guage and lenght is mostly preference but do try a higher gauge needle. The only needle lenght available is 5/16 inch.

Also it helps to insert the needle bevel side up.

 

Wow you guys are fabulous. I'm so glad I found this website while I'm trying to take it all in its nice to talk to people who know how hard what I'm going thru is and also those of you who give me hope. I'm happy to report that tubba and I have started to get a routine going and the last 3 injections (last night. This morning. And this evening) went soon much better. It's strange though while it breaks my heart to do it and he has definitely proved that I sucked at it. He has been overly clingy. that really has helped my confidence I think. I just hope he knows it's bc I love him. I'm going to the vet tomorrow and first thing on my list is to tell him about home testing if he doesn't say anything. I am also going to ask about the shorter smaller needles. Is there somewhere else I can order them. ?? I paid $25 for this box of 100. Yes I meant 2 units twice a day of lantus (the box says 100 units/mL u-100) it cost me $125 is this a normal price?

Ok so I am doing ok to give insulin then a can of wet food?? ...... He's still very hungry and is scarfing the food.

How should I go about looking up on here about home testing. I did see a few forms or spreadsheets but it was like looking at Spanish.

Also can anyone give me info on missing doses or safe timing to give doses. I know 12 hours apart is best but not always doable......

Also can I load my insulin in the syringe and put out the night before so it's not as cold or any tips besides using my fingers to warm...... Or is that the best way.

Sorry I'm all over the place.

THANK YOU ALL SO MUCH

 

Some vets are all for home testing, others try to discourage clients from doing it. There's a list of abstracts for published veterinary aritcles that promote hometesting here: http://felinediabetes.com/FDMB/viewtopic.php?f=28&t=2509

You don't need the vet's permission to test anyways. There are people here who started testing and eventually convinced their vet that it could be done and that the numbers were valuable to understand how the cat's diabetes was being managed.

Many people order insulin syringes from AmericanDiabetesWholesale.com Here are some popular ones:
Monoject 31 gauge 5/16 inch with half unit markings Also available as a case of 3
Monoject 30 gauge 5/16 inch with half unit markings Also available as a case of 3
UltiCare 31 guage 5/16 inch with half unit markings Also available as acase of 5 (Note: Ony 60 insulin syringes per box)

There are a couple other ones that are either 30 or 31 gauge and 5/16 inch but do not have half unit markings.

The bottle isn't really cost effective. It can last as little as a month, sometimes a few months, even with proper handling. Most of the time you are throwing away a barely used bottle ony to spend another $100 for another one.

Lantus users here use the Lantus SoloStar pens instead. Each pen contains 3 ml of Lantus and comes in a box of five. That's essentially at least a 5 month supply you will have on hand. The price is more than a bottle ($225 or so?) but per pen the cost is a lot less.

There's info on the Lantus ISG about how pens work: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=151

Tips on how to save money on Lantus: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=67852

Use the bottle for now but when you need to buy more insulin, ask the vet to write the prescription for the SoloStar pens instead. You use the pen like the bottle: insert insulin syringe into rubber stopper and draw up a dose.

You can feed right before or after the insuiln. Some people give insulin while their cat is eating. You don't want to feed your cat more than 2 hours before the insulin shot because the food can inflate blood glucose levels.

New diabetics are always hungry so it's best to free feed them. Many people here use a timed feeder to allow their cats to have several small meals throughout the day.

Hometesting tips and info: http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=287

The spreadsheet is a great tool to track your cat's blood glucose levels. The template is here: http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=50130

You read the spreadsheet by row.

Date is self explanatory.

AMPS is the morning pre-insulin blood glucose level

U is how many units of insulin was given.

The + numbers indicate hours after the insulin shot. If you test 3 hours after the insulin and get a reading of, say, 300, then you would put a 300 in the +3 box for that date.

PMPS is the evening pre-insulin blood glucose level.

Comments is for any notes on your cat, like if he threw up or if insulin was given late or whatever.

You do have some leeway with insulin shots. 12 hours is ideal but not always practical. If you can give insulin +/- 30 minutes or so, your cat will be ok. If it's like 3 hours late, then I would skip insulin and resume again at the next scheduled time. Of course, every cat is different so if you do need to give insulin earlier or later than usual you should try to post here on FDMB for advice.

If you give a fur shot (you didn't inject correctly and some insulin endsup on the fur instead of in the cat), DO NOT give any more insulin. You don't want to risk an overdose by giving more insulin.

No, Lantus cannot be pre-filled into insulin syringes. The inside of the syringes have a lubricant that can affect the potency of the insulin. Just draw up each dose when you need to give your cat the shot. You can briefly warm up the syringe in your hand for a few seconds before injecting. Most cats aren't bothered by cold insulin.

 

Many of us develop a very special bond when going through this process with our cats. Glad you are getting a routine going and feeling better about the injections.

You can get these needles at Walmart, it's about $13 for a box of 100. Depending on your state, you may need a prescription from the vet. Just ask the vet to write it out with this information:

100 U100 syringes, 31 gauge, short needle

Walmart sells the Relion brand and they are the cheapest around and will do the job you need done.

It sounds like you purchased a vial. And that's about the going price for a vial. Next time, ask the vet to write a prescription for the Lantus pens. You get 5 pens in a box and while you get less insulin overall, as long as the pens are unopened and you keep all Lantus in the fridge, they will be good through the expiration date.

If you have a Costco nearby, they typically sell the insulin at a less expensive price than the other pharmacies, including Walmart. And no, you don't have to be a member in order to use the pharmacy. If you are a Costco member, you may get a little better price than the non-member price.

Just ask for pens with a long expiration date.

And NO you don't need to buy the needles that go with the pens. Pretend the pen is a small vial and insert your insulin the same way as you do with the vial.

Also, 2 units to start out with is what we consider a higher than normal starting dose. As I mentioned before, no matter what insulin you use, we recommend a starting dose of 1 unit. Once you are home testing and start collecting data, the dose amount can be changed, again in small increments such as 1/4 or 1/2 units at a time.

Read this too: http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=61800

Yes, that's fine. You may find that giving him two cans of food will help. Also, add water to the food, it will help fill him up and slow down his eating some.

http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=287[/url] Home Testing Instructions

Here are some links to help you understand how better to use lantus. Please read the information on the lantus forum, so you can get a better idea of how lantus works in the body and what the different terms mean, etc.

http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=18139 Getting to Know Lantus

http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=151 Proper Handling of Lantus

http://felinediabetes.com/FDMB/viewforum.php?f=9Lantus Forum

No you don't want to preload the lantus. Nor do you want to leave it out. It's best to warm the lantus with your fingers.

 

Any tips on a good meter.... Also he's been on the 2 units since Thursday..... Well pm dose Thursday. 2 doses Friday. 2 doses Saturday. 2 doses Sunday. And 2 today. I go to the vet tomorrow after work you think it's safe to give him the 2 units in the morning???? And then discuss my concern with the vet. ???

 

The shot box says 3/10 cc low dose.... But my vet label says 2 units maybe I'm not giving as much as what a normal 2 units is bc of my syringe type??.... It's a very small amount of liquid. I was trying to post a picture of the box for you but couldn't figure out how.....

 

2 units is 2 units regardless of the insulin syringe capacity. It is a very small amount of insulin. Here is a picture of the markings on a 3/10 cc insulin syringe that is labeled up to the 5 unit line:

Wal Mart's Relion meters are good and not expensive. I like the AccuChek Aviva but test strips are pricey. Don't use the FreeStyle meters. They read numbers too high so you won't get an accurate reading.

 

Holli - I responded to your PM, but I will post it here as well:

Holli, without home testing, nobody knows what a safe dose is for the cat. That's the problem, you are shooting blindly and it's not something you would ever do or be told to do to a human who needs insulin. Just because the patient is a cat, it doesn't change the fact that you are giving insulin without knowing if it's safe.

If you have a walmart - you can pick up a relion meter - they are inexpensive and easy to use and most of them require a small blood sample. Just remember you need to get the strips that match the meter.

As for name brand meters - Bayer Contour is another good one that requires a small blood sample and is also easy to use.

I hope this helps.

Just to add to this, my former vet actually forbade me from home testing. She told me that she would not treat Maui if I home tested. Rather, she wanted me to leave Maui with her for a week to "get regulated". The place was not a 24 hour place, there was no overnight supervision and she wasn't going to shoot insulin at 12 hour increments - why - because the place had to close and there wasn't time in her day to do that.

I found this board immediately and was told that all that information was just bogus and that no cat gets regulated at the vet and why can't I test my cat myself? After all, did I really want to shoot blindly into the cat. The example that was given to me was: Would I put a paper bag over my head and then drive my car?

Needless to say, I fired the vet, got help from this board, secured a new vet and managed Maui's diabetes with home testing.

I hope this helps give you the courage that if you need to go against the vet's advice to do so.

Oh and the best part of Maui's story - when I asked the vet why can't I home test, her answer - she didn't want the liability that if I did something wrong that I would sue her! So, it was all about the vet and had nothing to do with the best interests and taking care of the cat.

 

Well made it back from the vet. He did NOT promote home testing and said he should come off the wet food and use dry purina dm if he starts to gain too much weight. Ahhhhhhh which is complete opposite of everything on here. His glucose reading was 404 on Thursday at the vet and it was 275 today. (it had been almost 11 hours since his shot) doesnt stress affect these numbers too ? He has been on 2 units twice a day. The vet said up him 1 unit more twice a day and come back in a month. so I begin the search for a new vet tomorrow without this one knowing yet bc he is my supplier of insulin and my in case of emergency. I plan on picking up a meter tomorrow. So any links to explain peaks adjusting etc would be great. I have found plenty on how to get the blood now I just need you all to walk me thru the readings bc I'm clearly not going to get help from my vet. Also was I correct to change my post icon to a ? Mark bc I'm new to this or should i start anew thread. But clearly you all are all I have bc my vet was against everything!!!!!!!

 

Holli,

I am very sorry to read that your vet is not supportive of home testing. I am honestly not surprised as there are many vets who don't promote it and I just don't understand why not.

I am glad to see that you are going to take matters into your own hands and Tubba's paws to help him.

Vet stress is a big factor in the bg's numbers. It can change the numbers 100-200 points in either direction. So, getting a reading at the vet, really doesn't give you accurate information. Nor is changing the dose based on one reading alone.

The fact that this vet believes wet food is not good for the cat, clearly doesn't have a clue about nutrition. And again, sadly many vets don't understand that either.

Vets are like general practitioners, where they know a little about a lot of different things, but don't know enough detail about things.

I too had to shop for a new vet. I called at least 10 places nearby, before I found one that would follow the philosophy and protocol of this board when it came to diabetes care. Here are some questions to ask when shopping for a new vet:

http://gorbzilla.com/decisions_decisions.htm

There's a list of published veterinary articles/studies that promote hometesting here:

viewtopic.php?f=28&t=2509

Your vet can probably get full access to the journals to read the entire articles/studies. There is also VIN.com, a veterinary only web site, where your vet can read up on the latest diabetes treatments and get advice from other vets and those in the veterinary field.

Here is the Rand study on using Lantus for cats: http://www.uq.edu.au/ccah/docs/diabetesinfo/link4.pdf


Also, you currently have plenty of insulin on hand, so you don't need to feel dependent on this vet. With some research, you will have a new vet lined up quickly and you can collect your cat's records from the old vet, keep a copy for yourself and make a copy for the new vet.

Have you visited the lantus forum yet? In my previous post, I provided links to things you need to know about lantus and the forum. Please take a look at that and it will give you the information you are seeking.

 

Happy to report I have found a new vet. After asking how he treates diabetic cats I found he didn't disagree with one thing on here. He agreed about home monitoring. Food. SMALL increases based of readings. He even said he likes to go over home monitoring together. It is so nice to have some good news.

 

that is wonderful news indeed!

so tell me, do you now feel like a huge weight was just lifted off your shoulders. It so great to find a knowledgeable and supportive vet

it's exactly how I felt when I was in the same situation. and know what a relief I felt.

 

Holli and Tubba: that is great news about the new, supportive vet!

I can't believe some of the horror stories I've read on here about vets. I am so lucky that mine respected the research I did, didn't fuss about my home testing, didn't fuss about my wanting to switch Pumbaa to low carbs before starting insulin, didn't fuss that I didn't want her recommended canned cat food, didn't fuss that I preferred Lantus over the Prozinc that they carry, and was actually appreciative that I called in my numbers so that she could go over them before calling me back. And...I am going to send them the link to my spreadsheet so that they will have an updated chart on Pumbaa, regularly. I am lucky to actually have a vet that cares about the animals, instead of just about the profits.

 

Hi there, I just read through the thread and I'm so glad you found a new vet! Did the new one talk to you about dosing? I ask because the advice you got from the last guy to increase the dose to 3 units is rather suspect. That's a huge dose increase to make with so little data. You only have two numbers at this point, right? That's not enough information to make dosing decisions. It's not a good idea to up the dose until you are hometesting and have more info. Most of us recommend holding a dose for several days to a week before deciding whether to increase. In general, cats that are otherwise healthy can handle high numbers a lot better than getting too low.

Please read the sticky on hypoglycemia, if you haven't already:
viewtopic.php?f=28&t=15887

You've come to the right place!

 

I'm in Tucson, Arizona. Do you know of anyone who lives here?

 

This thread is from 2012

If you're looking for suggestions in your area, probably best to just start a new thread with a subject line saying something like "recommendations for the Tucson, Arizona area"?

 

I am in Tucson, unfortunately at the moment my husband is in ICU. @Chris & China is @Marje and Gracie around? I could not tell if she had been on lately from her profile. what is it that you need help with @srk4cats

 

not sure. somebody recommended it, but I think I'm doing okay. I hope your husband gets better soon.

 

It's definitely a learning process. I thought I was always giving fur shots. Especially that once or twice I smelled the Lantus on him. When we went for a follow-up test. I had the vet tech confirm I was doing it right. Fur shots happen occasionally. You learn the process and at least for me I know he gets used to it. For my Buddy, I think he's less annoyed by the shot as he is that sometimes I pull him away from his food before he's done to give the shot

 

I sent her a PM. Prayers for your hubby, Cathie.

 

I had the same problem with

my

 

heres an awesome idea which I do not understand why vets dont suggest....shave the area so you can SEE exactly where the needle is going...ive done this to several of my rescue kitties who needed ringers...took all the anxiety away...i also went to the thinnest highest gauge needle i could ...worked like a charm...no more anxiety or mispokes!