Discussion in 'Welcome to the Group - Post an Introduction Here' started by Luanne Cigic, Nov 8, 2015.
Hello, I'm Luanne and my girl kitty Smokey is on pro zinc insulin.
I was wondering why her sugar count went up after her shot this morning from 250 to 344. I got scared, she is getting 2 units of pro zinc. I just bought my reliOn meter last night. She is ranging around 98 to 100 about seven hours after her morning dose.
Welcome Luanne to FDMB! When was Smokey dx? Great job in wanting to start home testing. When did you start testing and do you have any other data that you can share with us? Hard to tell what could have caused the upsurge. Could be food, could be a bounce (from possibly going too low last night), could be stress, could be of an illness, etc. What kind of food do you give? How often do you shoot? Enough of questions from me, you have come to the right place for support. There are a lot of caring and experience folks here. You will be given a whole lot of information and at first, it will seem very overwhelming however in a couple of weeks, things will start falling into place.
Good Reading: This is a must read. It is an excellent 18 page informative document that covers feline health and nutrition. Don't take short cuts and read it all. www.catinfo.org Also read other postings and their spreadsheets. You will learn a lot more from others.
Home Testing: Here, we all home test. It is mandatory to understand how your kitty is reacting to the insulin and the dose. You will want to test before each shot and some additional test in between the 12 hour cycle. Another reason to home test is to keep your kitty safe. Find a place in your home where you will always perform the test and give lots of hugs before and after testing. There are many videos showing you how to test. Hometesting Links and TipsHere is a picture of where you test on your kitty. http://s106.photobucket.com/user/chupie_2006/media/testingear/sweetspot.jpg.html
Here is another good link on Home Testing:http://www.felinediabetes.com/bg-home-test.htm
Meters: There are many meters. There is a pet meter called the Alpha Trak2 and human meters. Some use the pet meter because it is what the vets use so the numbers will match up. The meter and strips are expensive though. Most use human meters that can be purchased at any pharmacy. It typically reads a little lower than the pet meter but we have ways of compensating those lower numbers. Many use Walmart's brand, Relion Micro or Relion Confirm, because it only needs a tiny drop of blood. They cost around $15 and the strips are around 35 cents each.
Lancets: These are used to poke the ear to get blood. There are many different sizes (gauges). It is recommended when you are first starting out to use a 26-28 gauge. Also, it would be a good idea to pick up Neosporin WITH pain reliever to apply on the edge of the ears and don't forget to alternate ears.
Spreadsheets: Our spreadsheet instructions are here. If you look at the signatures of the members here, you will see a link to their kitty’s spreadsheets. We keep track of all our tests. This is basically a place to collect data and help you to determine patterns, doses, etc. It also aids those that may be helping you to better understand your kitty.
Food: There are many reasons why we are here but one is due to feeding dry cat food which is high in carbs. You will want to consider changing your food to wet, low carb food. It is recommended to feed food that is under 10% carbs. Here is a list of cat food to choose from food chartyou will note that the food with fish are lower in carbs however it is recommended that you only give fish once a week due to its mercury content. Many use Fancy Feast, 9 Lives, Friskies, etc. This list can also be found in www.catinfo.org If you are already giving insulin and you have not transitioned to wet, low carb cat food, be sure to test while you are transitioning. This is because by changing to low carb food, it could decrease your kitty’s number by 100 points or more. One last thing, many of us add water to the wet food so your kitty is getting plenty of water to flush out the toxins and to keep them hydrated.
Hypo Kit: Always good to be prepared for possible hypo events which means that your cat has reached dangerously low numbers. It can be fatal, hence, the importance of home testing and collecting data in a spreadsheet. In each of the Insulin Forums are stickie’s labeled Hypo Links. Here is one: How to Handle a Hypo. Please print and post on your refrigerator so everyone in your household is aware of hypo symptoms. You will want to create your hypo kit that would include and not limited to; extra testing strips, honey/karo/maple syrup, high carb food, medium carb food, vet information, etc.
Ketones: Diabetic cats are susceptible to diabetic ketoacidosis (DKA). It is best to buy testing strips that will measure (if any) ketones in the urine. One brand is Ketostix which can be found at Walmart or any pharmacy. You will want to test periodically unless you continue to get high numbers, then it is suggested to test more frequently. Ketostix typically costs around $10.
Treats: It is always nice to have treats available for your kitty especially when testing or when they decide not to eat. I like using Pure Bites. I have found it at Petsmart and other pet stores. It is freeze dried and the only ingredient is the meat i.e. chicken, duck, etc. If your cat likes it, then I would go to the dog section where it is cheaper than the cat package. It is bigger chunks but no problem in breaking it up. Another option is to use Bonita Flakes. There is a link here somewhere that has a list of low carb treats but I don't have it right now.
Injections: Most folks here use one of these main insulins; Lantus, Levemir and Prozinc. Two hours prior to your insulin shot, you will not want your kitty to eat. Then you will test and then feed. It is best for your kitty to eat a little before your shoot. I shoot while he is eating. The reason why you do not want your kitty to eat two hours prior to your test is because food elevates BG numbers. So you do not want to dose based on a food influenced number. Here is a link on how to give injections.http://www.felinediabetes.com/injections.htm
Note: Please check your insulins as there are some (the harsher ones like Humulin, Novolin, Vetsulin, etc.) that would be best to allow some time i.e. 20 minutes, after your kitty has eaten before you shoot.
She is ten years old very fat and I had her on dry food free feeding. She was diagnosed Two weeks ago when she started vomiting. I had them do blood work on her because she was drinking so much water. Her sugar was 395 . she was at the vets for two days. They started me on pro zinc 4 units twice a day. A week later I took her for a BG and it was 98. So the vet lowers her to 3 units. I got my reliOn last night, she was 100. This morning she was 250 I gave her only 2 units because she seems out of it after her shot and I was worried. I also took her off all dry food also. A half hour after her shot I checked her because yesterday after her shot she vomited frothy stuff. Her test read today 344 which really scared me. I'm so confused!
Hi Luanne, it is confusing at first, but it'll get easier. Glad your home testing. If your 344 test was after Smokey ate, it could be high because of the food. It takes a bit for the insulin to kick in. Why don't you post on the ProZinc forum where there are wonderful people that can help you figure your dosing out.
Glad you made it over! Looks like someone has posted a general information for newbies above for you. Since you are already home testing (GREAT!)
and you've already stated you are using Prozinc for insulin.
What may help most is to share a little more background information on Smokey.
How did she get diagnosed? How did they determine the starting dose? (2U is a bit higher than average for most kitties to start- BUT there may be a reason)
What are you feeding? ...low-carb canned? Have you eliminated all kibble? How often and what amounts?
How old is Smokey and does she have any other health issues?
Can you share more BG numbers? Any and all testing you have done recently will help for determining dose as patterns begin to emerge.
Do you see the link in the above comment for the Spreadsheet? That is an invaluable tool around here. We are able to share a link to our SS with each other so we can see the numbers and what's going on with a given dose. Try to get that set up and add any numbers you already have into it. If you have any problems with it let us know and someone can help...many members are tech-y (i am not one) and happy to help you get it setup if you need it.
I am also going to tag @Sue and Oliver (GA) who is an experienced member who knows Prozinc. As I mentioned we used Lantus which is totally different in how it works, so it would be better to have someone familiar with your same insulin to give you feedback on dose, etc..
Sue Luanne posted on FB and I encouraged her to get over here to get some better and more thorough advice.
Luanne you are in the best place you never wanted to be. I hope you will post regularly so folks can keep up with her details each day and progress.
And i think it's also a good idea for you to post in the PZI forum as well.
Luanne, it is scary. But your in the right place for help. I can't not help with Prozinc. More experienced people will pop in shortly. You will see numbers go up and down until Smokey adjusts (and she will). Love the name Smokey!! My boy has been all over the place and only very recently has become somewhat settled. He does throw me curves but he is now staying in healthier zones longer. And that's a big milestone for us.
Hang in, you'll do just fine.
Ok I have now just re-read this. 4U is HIGH and way above average for a starting dose. Your instincts to get your own meter and test were RIGHT ON. Congratulations! In office curves really are not reliable. the cats BG just due to stress being at the vet can spike 100-150 points or more. If dose is established based on artificially inflated numbers, then often it is skewed and turns out to be too much insulin. Your kitty in their own environment, even on same day may have entirely different and much lower numbers. In addition BG's move up and down within a day and are not going to be the same day to day. You cannot just set a dose and keep giving it without knowing what that given dose is doing and how kitty is reacting to it. That is why home testing is critical. A human diabetic dose not give the same dose blindly every day...they test and adjust as needed.
Also VERY IMPORTANT. If you have suddenly yanked all the dry food from Smokey, the amount of insulin she needs may have changed DRASTICALLY. It can happen that fast. Please read this http://www.catinfo.org/?link=felinediabetes
The whole site is great and a bible for many of us here. (plus has the invaluable food charts we all use) Read it all. But for now most importantly read this page i linked above and the part around the stop sign.
Testing is your best friend. Monitoring the BG is what allows you to know what is going on inside her at any time and gives you the control. Please read from the catinfo.org site above we linked you to...you will see on the right a Protein/Fat/Carb chart. These were done a couple years ago so not 100% up to date with every single food out there today on it, but it is a wonderful resource. You want to look on the left hand side columns and pick food with less then 10% calories from carbs. These are considered low carb and are the foods you want to feed on a daily basis. And it is best to spread the feedings into multiple mini meals spread throughout the day. (easier on their pancreas) Add some extra water to each serving which helps with hydration and to keep them more satisfied plus tons of other health benefits. BUT you also want to buy a few cans of MEDIUM carb (MC) and HIGH CARB (HC) foods to have on hand. Pick some off the food charts. MC ranges 11-18% or so and HC ranges 19%+. Keep these on hand for a time her numbers may be running low. You can steer her numbers up higher using food with more carbs to bump them up. Same as a human would do. Of course keep Karo on hand, but typically this is saved for when kitty is really, really low...and while it can raise low numbers quickly, it also tends to wear off faster. With food you can give a little as needed to manage a cycle until the kitty is past nadir and is heading back up on her own. If you have a meter and high carb food on hand, you are in control.
You want to try and get an idea of when your kitty nadirs (peaks). For many (but not all) kitties that is around 5-7 hours past shot time. So you can start doing test randomly in those time frames over several days to see if you are seeing her likely low point and a pattern starting to show. As far as other tests go, you ALWAYS want to test before giving a shot. (we refer to the morning pre-shot test as AMPS. and the evening pre-shot test as PMPS) This test is important to be sure kitty is safe to shoot your usual dose into. Beyond that one and the nadir test, it helps to spot check at various times during the cycle....even if it's just one or two here and there at different times on different days. As you enter these numbers onto your spreadsheet, you start to SEE what the insulin is doing, and an idea of how your kitty is responding, what if any adjustments need to be made, etc.. This is SO much more reliable than an in-office vet curve. Once you are home testing there is really never a need to get curves done at vets again, You have all the data on a daily basis in front of you. Plus you save all that money.
When were these BG"S taken in relationship to the to the shot times? We tend to list this as follows. +1, +2, +3 etc.... so +1 means you tested at 1 hour after you gave the shot. +2 means 2 hours after you gave the shot. If you are testing to try and figure out when her nadir is you would test at +5, +6, +7 or in those rough windows. You always want to know how LOW is the insulin taking them. With prozinc however, I know dose is also adjusted based on preshot numbers. SO I want to leave that part to someone using your same insulin.
But bottom line, while you are figuring things out...if you have taken the dry food suddenly away, then YES it is very important to realize she may need a much lower dose. So please closely monitor her cycles until you course correct for that. It is super critical to know her numbers right now throughout her cycles. Please cross post in the Prozinc forum if you are not getting enough Prozinc user responses here so they can help you with dosing advice.
PS: 98 or 100 is still a safe number. If she starts getting below 50's you will need to intervene. And for the time being you may want to keep her a little higher than that. I would focus on being sure she is being fed multiple mini meals of low carb canned spread out through the day. You want to avoid feeding a couple hours prior to the pre-shot tests so the numbers are clean and not influenced by food so you can be sure its safe to shoot or not. If you are not sure, then test, and come back and post the number and ask for advice. For now if her number are less than 150 at shot time, I would be sure you get some feedback and guidance before you shoot anything.
the 250 and 340 test numbers should not scare you. They are a bit on the high side but not through the roof...but the vomiting frothy stuff is scary. I am not sure if there is a relationship or not. Some kitties will get acidy tummies and some folks will give 1/4 of a 10MG pepcid (original strength) to help with that. But this may or may not be what she has going on. You want to make sure she is eating enough...and if it's low carb and mini meals it can really help even things out. Most kitties are ravenous when they are unregulated as they cannot properly process their food to get the nutrients they need. My kitty who had been overweight prior to diagnosis actually lost weight eating LC canned and I fed him pretty much anytime he wanted. Also switching his diet helped him get into remission in a matter of weeks. Please keep posting and asking lots of questions.
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.
Hi Luanne! Welcome to FDMB! Can I ask when Smokey was diagnosed (sorry if you answered this earlier...I didn't see it, but I miss things sometimes).
Yes, that is a pretty high starting dose. Glad you've been testing! Remember that you're going to see higher numbers in the first hour or 2 after a shot usually since you feed at the same time. The food brings numbers up, so it's really not at all unusual to see a higher number than the preshot then. It's around +3 that they usually start to go down.
For ProZinc, we dose based on preshot and nadir (mid cycle numbers). We basically want to see how low the insulin takes her at the mid point of her cycle...which is usually around +5 to +7, though it can vary. Then we see where she is at preshot. That helps us figure out what a good dose would be.
Here's our protocol for ProZinc: http://www.felinediabetes.com/FDMB/threads/protocol-for-prozinc-pzi.109077/ . It might help to read it and let us know what questions you have.
We're here to help! Let us know what you need.
Hey Luanne and Smokey, so glad you found us and that you are home testing. As Bettyandhank said, 4 u is a lot to start with and since you have taken the dry food away, Smokey's number are going to drop. Also, they are going to be lower that the vet because of stress the BG's are elevated at the vets. You will not want to shot anything under 200 as a new diabetic cat. So, good job testing and when you need advice, ask away, as that is how we learn! And Welcome!!
I just saw luanne post again on FB but cannot hang around plus since she's on Prozinc would rather leave dose advising to those on same insulin. But please read through her thread, she just dropped dose for 2nd time...today I think shot 2U. Only started home testing last night. Not sure when dry food got eliminated, or what all kitty has eaten today. But she just posted that she just got a 46!...not sure what point in cycle. She may need to intervene and need help with that. Will need advice on future dose and when. She is too new to sort this out on her own. I commented for her to please come to PZI and post for help now. Not sure if she knows how to cross post so part of her thread may be here....I suggested she go to PZI for this. Her SS may have to wait! Kitty has her own ideas!!!!! Clearly vet had her WAY over dose. Her instincts had her lower another full unit today thank goodness....still obviously too high. Heads up and can someone watch for her here and in PZI
ETA! I think it's 146 not 46... Whole other thing but already sent her for advice!!!! Still right on cusp for newbie shooting so won't hurt to help her figure out dose going forward
Thanks for the heads up!
Looking for her post, which forum?
It was 146
7 hours after shot
Oh, okay, you are good! whew, that's a big difference from 47. How much did you shoot 7 hours ago?
Please see my edit above:
I think PZI. Can link the threads if need to
I see her post now. yes, she is 146 @+7. She should be good.
How many units did you shoot?
Your post are just sending back mine, try again and how many units did you shoot 7 hours ago?
Thanks so much!
I gave her 2 units at 10;30 this morning
I tested her around 6pm so it would be 71/2 to 8 hours
Posts keep crossing ...I saw 46 on FB ( or thought I did) and realized she should not go that alone...too new. Saw mention of karo by someone. I quicky sent her here. Then saw again it was 146. Guess this is a better mistake to make than the reverse.
Luanne this is a very safe number..slightly above normal, not to worry. Even the 46 is OK but would need to give some food to steer her up at that point. A semi false alarm....but you could use some help figuring out dose anyway. Your vet clearly had her on too much.
So she hasn't had any insulin since 10:30 AM?
Maybe some of the prozinc folks can help you get going in that forum.
I'm really upset with my vet right now. Her numbers were 394 when first diagnosed. They wanted her back the next day to regulate her with insulin due to her vomiting. I had no idea a wonderful group like this existed till I started stressing out about the shots and looked online for some support. I wish I could have just waited on the insulin and worked on her diet for a week to see where her numbers would be at then.
When it is time for you to test, feed and shoot again, unless she is at 200 you will not want to dose her. I am going to tag a few peeps and she about whether you should reduce the dose again @Sue and Oliver (GA) ,or @Rachel , @BJM could some one help with dosing for Luanne and Smokey? She is at 146 @+7.5-8. She shot 2 units at 10:30 Am. Vet had Smokey on 4 units to start and she has reduced. If she gets to 200 at shot time, should she reduce again?
No shot since this morning and this is what happened yesterday too. I think after I gave her her shot, she vomited about a half hour later, she didn't vomit today though, shes been good
I hear you. You are here now and that is all that matters.
She was probably vomiting yesterday because the dose was too high. Let's see what happens at the 12 hour mark and where she is. Post again with a new thread, Preface it as Dosing Advice Needed ASAP. If she is not up to 200, do not shoot insulin. I tagged a few peeps to weigh in about the dose for the PM tonight. I do not give dose advice as I am learning myself. Someone will be able to help. What time zone are you in?
She is safe right now and that is all that matters. The next step is to see if and what you dose at the 12 hour mark your time.
So she was at 246 at pre shot this morning and 146 at +8. So we want her to be moving up, not down. That's the first thing to figure out with your +12 number. If she is over 200, then your 2 units looked pretty good today. The only thing I wonder is whether she was quite a bit lower before the +8.
Let's see how your pm number looks and decide. Just for reference: Generally we consider a cat regulated if they are in the lower 200s and preshot and in double digits at nadir (5-7 hours after the shot) but not below 45 which is nearing hypo territory.
The protocol we put together for ProZinc is in blue in my signature.
I am not sure what her preshot number was as she doesn't have her SS up yet and I didn't see it in the previous threads. Just know that she was 146 at +8ish.
I'm in eastern time zone.
Okay, so a little before 10:30 EST, you will be testing again?
Luanne, can I make a spreadsheet for you? If you want me to, send me a private message. Just click on my picture and start a private conversation. If you want to try it, here are the directions:
Luanne, can I make a spreadsheet for you? If you want me to, send me a private message. Just click on my picture and start a private conversation. If you want to try it, here are the directions:
And let's start posting on the thread you started in the PZI forum so we don't lose you at shot time.
Ok you have @Sue and Oliver here now. She's queen of the prozinc forum with lots of experience so you are in good hands. I can't type it all out again.....one fingered here on my tablet. Please folks...read this thread from top. I saw Luanne 's posts on the FB page last night and this morning, she just did her 1st home test last night, looked likely vet had her in too high a dose. Sent her here for help with dose advice and interpreting numbers. She inadvertently PM'd her questions instead of posting a thread. By then I figured out she was Prozinc, had dropped dose twice, kitty was throwing up (may/ may not be related)...linked her here and to PZI/prozinc forum. Then later she posted again in FB what many must have read as a 46, .... in fact was a 146. I'd already sent her back here for help. No SS yet.....she only posted here first time today and we hadn't gotten that far. We have discussed the SS though and linked her to the template. In this case kitty gas her own ideas and doesn't want to wait. We touched on diet but still not clear what she is feeding, amounts, etc. Luanne hopefully you can read back through the thread and answer some of these questions you missed above. And also impirtantly please read the www.catinfo.org also linked above. Diet is a critical component of managing FD and no one explains it better than Dr. Lisa /catinfo.org.
Don't beat yourself up over the vet. Most vets are just not that knowledgeable or up to date with FD. They get like 5 hours of diabetes training over all species, and learn nutrition from the RX pet food company reps. The most experience you will find with FD is right on this message board. You don't need curves when you are home testing. And cats can't get ' regulated' in 2 days, and certainly not in a vets office. That is the worst place to be if you want to truly know what their real numbers are. Just being at the vet can spike their numbers 100-200 pts. So accuracy is skewed and not possible. Postponing insulin to see if diet change alone works is OK for a short time, but not something you'd want to do for long. It really is the combination of diet and insulin that make the difference. Plus kitties who get early treatment stand the best chance of remission. You just want to monitor the numbers closely as the diet is changed as they can drop drastically as dry food is removed and they are switched to all low carb.
Normal non diabetic numbers are 40/50-120. So she is not in 'normal' numbers as of yet. But certainly she is responding to the changes you have made. Hopefully you will start posting daily in the prozinc forum, read catinfo, and get your SS up. It won't be long before things start clicking and make more sense. Just keep asking tons of questions, and more questions. We want to help!
So glad you found us. You are in great hands now
PS. So much for my short comment
You must be related to @Robin&BB , HA!
I took her off all dry food and switched her to fancy feast classic chicken, she was familiar with canned food too so shes good with it. She was diagnosed two weeks ago, she started throwing up and I took her to vet thinking she ate something she shouldn't have, shes a strictly an inside cat. Shes' ten years old. I've had her since she was four weeks old. She started getting really fat just in a matter of six months. I had the vet take blood because of her being so thirsty and peeing a lot, was worried about her kidneys. Vet called and said her sugar was 394 or 398 I cant remember, he wanted her in the next day to keep for two days to get her insulin dose right. She was put on 4 units of pro zinc twice daily. I took her off the dry food then not realizing that and her insulin dose would clash. She weighing in at ten to twelve pounds and is a small cat.I feel so bad sticking her all the time, she fusses a little but she's a very good girl. I'm hoping to get her regulated and the this insulin as soon as I can. I feel so bad for her.
Do you sure give her a favorite treat every time you poke her? That's the secret to this. They start to associate the treat with the poke, and put up with the poke to get the snack. PureBites and Bonito flakes are popular at my house.
You can also use Neosporin with pain relief after you poke. And holding the ear for a few seconds after the poke helps with bruising.
When you have a moment, could you add a few tidbits to your signature? It will help us give you feedback.
Editing your Signature
In the upper right corner of the screen, within the dark blue bar, you will see ID, Inbox, and Alerts
Click on your ID.
On the left, under Settings, Click on Signature.
This is where you will put information that helps us give you feedback. You are limited to 2hard returns, so separate pieces by | or -.
This is where you paste the link for your spreadsheet, once it is set up.
Add any other text, such as your name | cat's name | date of Dx (diagnosis) | insulin | meter general location (city and state/province) any other pertinent issues like if there are any food issues, history of DKA, hepatic lipidosis, pancreatitis, allergies, IBD, etc.
Click the Save Changes button at the bottom.
Always click the Save Changes button at the bottom when you have changed anything.
Try spreading her feedings out to several small meals spread out over the day. Add some water to each serving (also good for urinary health). FF classics are good option and low carb. Here is a food chart we all use from the catinfo.org site. Looking at columns on left hand side You want to stay under 10% calories from carbs. You will see there are many, many to choose from. She may like some variety. Also grab a few cans of medium and high carb in case you ever need to steer up lower numbers. Ff gravy lovers is a good one, because you can just squeeze out the gravy which is where all the carbs are. Be sure to mark them as HC and keep separate from your LC foods so you don't accidentally feed it for regular daily food.
If you are feeding 2 cans per day now, you could split that into 4-6 meals over the day. I always fed a before bed meal to tide mine over. And like Sue said you need to reward every test with treats. Most cats go ga-ga over freeze dried chicken or shrimp.... Cheaper to buy these in the dog food section...same treat in bigger bags. This is pure meat and virtually no carbs. Mine also love boiled chicken breast. I cube these up and also use for snacks. Even my totally finicky civvie loves em.
Are you warming up the ear before poking? I also like to rub it between my thumb and forefinger for a minute to get it circulating. And be sure to hold something behind the ear to keep it firm and to poke against. I used a folded tissue which I then used to fold over the ear and pinch it to apply pressure for a minute after the poke. This also helps fend off bruising
I go in at the edge, I get blood every time and use the neosporin with a tissue and pressure afterwards
The treat is key! My cat fussed some, but she was mostly like "Mom where is my treat already!". I always used the same place to test her too....we had a towel on the floor by the fridge. All her testing supplies were right there and I think she felt better knowing she could escape since she was on the floor if necessary...though she never tried.
Separate names with a comma.