Where do you inject the insulin?

So I have read on here a couple of times about the scruff not being the best place to shoot. This is where I've been injecting because it's how the Vet showed me. I know you can also do it in their side but haven't tried that.

Should I change the location of the injections? Would it change the absorption at all?

Where do you inject and why?

Thanks!

 

I inject in the scruff, have since Mousie was diagnosed. That's where my vet taught me to and it just makes sense to me. In other words, it's a nice broad area, lots of skin to work with, and I have yet to meet a cat who can get their fangs right behind their head.

And we've never had an absorption issue. Mousie responds very well to her insulin. That and if I was stupid enough to try shooting her anywhere else she'd probably hang me on the ceiling fan and use me as a pinata. :lol:

 

I began injecting in the scruff but we slowly transitioned to the sides. It's harder for us to do (lots more fur shots) because it's awkward but it gives a lot more opportunities if Willy is being difficult. We keep with the sides because we're worried about granuloma type things forming, supposedly they are less likely in the sides (probably due to area to shoot?). I have noticed (purely anecdotal) that shooting in the sides seems a lot more "reliable" and stable for BG. The scruff is a lot easier so if someone was watching Willy I would probably have them shoot in his scruff.

 

I was showed by my vet to inject in the flank. This is the 'side' area on the back half of the body,
a few inches in front of the hip.

I always injected Smokey about 1/2 hour after eating. He was a some-times barfer, and I
wanted to be sure the food stayed in him before I gave insulin.

After his breakfast was settled, I would sit on the couch and invite him for
a petting and brushing session. Have all supplies ready (filled syringe, grooming equipment, etc.)

He'd get on my lap, and I could just manipulate him onto his side. Then brush, pet, call him
pretty names and make a big fuss. While brushing/petting, move one hand to the target area,
put down the brush, pick up the syringe, pull cap off syringe with teeth, quickly tent the skin, jab, push
plunger, withdraw syringe and set it safely down. Pick up brush and keep on as if nothing happened.

The whole injection process takes 3-5 seconds.

 

I inject in the loose skin behind Tiggy's left front leg / shoulder. (gently pull up a tent to shoot into)

 

Saddle – locations for Squids/injections
Injection site locations

Some say that absorption is slower in scruff than in flank area.

 

After checking out that link, I feel so dumb! I've been injecting in the "side of the chest" area, although I have done the scruff because I watched some YouTube videos about injections and they did it there.

I may try injecting in the flank for a few days and see if that makes a difference in the numbers. Should be interesting!

LOL about the human pinata....nice visual haha

 

I should add that some cats HATE having shots near the back side .... I cannot give any side/flank shot to Shadoe as her skin is taut and there is no slack; she is like a football. And she hates shots in any place other than scruff. She will bite me if I stray from scruff.
Oliver does not much like the flank but tolerates them.
I do make sure to put a good 2inches between shots if shooting R and also lev.

 

I was initially shown by the vet how to do the sub-q in the scruff shots, and never had any problem from Bob. After a few days, due to other problems Bob was having, I had to learn how to give him sub-q lactated ringers every other day. At that time, the vet showed me how to inject the insulin IM into either of his back legs. The muscle would be the equivalent of what we call our hamstring muscle. They even shaved a small portion of hair from the back of each leg so I'd have no problem finding the right spot. I was instructed to alternate legs each shot, and to find a different spot each time so that Bob wouldn't have trouble absorbing or bruising. Been doing it that way for about 4 weeks, and have never had any problems from Bob reacting to the stick. He barely notices it. He's more upset that I have the audacity to grab his leg and hold onto it than he is with the actual shot.

Carl in SC

 

My vet said anywhere on the cat's sides or in the scruff, but that on the sides was preferrable. She didn't specify legs...just the sides since it is a subcutaneous injection that we give.

 

Injecting into muscle.

From every thing I can find on it, humans and cats, injecting into muscle is not recommended. It not only hurts but the insulin is absorbed too fast. I'm surprised a vet said to do this.

 

Re: Injecting into muscle.

The decision to change from sub-q scruff to IM leg muscle was made due to a couple reasons. Bob was critically dehydrated and his potassium level was also critically low. In order to fix that problem, I had to learn how to inject 100cc's of potassium laced lactated ringers into the scruff/shoulder areas, and that was done every other day for about 3 weeks until his potassium got back into the "low/average" safe zone.
I haven't read anything either way on whether it was a good decision or not, but if you've got links, I'm willing to read. I had only been treating Bob for a few days before this took place, and I was willing to do whatever the vet said I needed to do. Since then I have read a lot and changed his diet, and I have also dosed him twice a day, sometimes at lower levels than the vet recommended based on things I've seen on this board and other forums online.
However, what I can't argue with are the results so far. When treatments started almost 7 weeks ago, Bob's BG was 500+. The starting dose was 1 unit 2x daily. Over the course of 5 weeks, that escalated to 7 units daily (3 in the morning, 4 in the evening). In the past week to ten days, the highest BG reading I've gotten is 235, and that has been the only reading above 190 in the last 8 days. His daily dosage has dropped to 3 or 4 units a day for the past 4 days. His potassium is just under the normal range, so I have to continue "watering" him twice a week. I'm not a doctor but I'm guessing that the reasoning for changing to muscle shots is because he's trying to absorb so much in the way of fluids sub-q, that the insulin would maybe get "lost in the mix"? I dunno. As far as absorbtion rate, would the rate be slower because he's on PZI? I don't know. And maybe the shots to the muscle do hurt, but Bob shows no more reaction to that jab than he did to the sub-q ones the first few days. He's not a big fan of the lactated ringers stick, but that's understandable because the needle looks like it came off a sewing machine compared to the 29 guage hypo the insulin comes out of.
Like I said, I have been getting results using the instructions the vet has given me. She's also been very willing to listen to everything I've said, questioned, etc. She was familiar with "binky's page" and the canned food lists when I first brought those up, and she's been willing to take my calls 24 hours a day since Bob and I started this dance. I've been afraid, given the fact that Bob has made a good bit of progress, of going back to the sub-q shots and seeing any adverse reaction to his test numbers, and taking a step backwards. But I'm far from an expert at this. I'm just a first-timer trying my best not to kill myself saving my little guy's life. A big part of that effort has been reading and posting and trying to absorb everything I can so I'm open to whatever you can point me to. I also have to keep in mind, as I've been reminded dozens of times in the past 7 weeks, that ECID.

Carl in SC

 

Carl, I just googled it...injecting insulin IM in a cat........you are the first person I've ever seen on this board that injects IM. If you could give the fluids at a different time than the insulin, then you wouldn't have to worry about anything or......shoot insulin in the side and fluids in the scruff. I shoot in the side as many of us do. I guess an insulin syringe IM isn't really painful but I still worry about too fast an absorption. I use 18 gauge for fluids and an insulin syringe is so tiny in comparison.

 

Hope,
Thanks for the feedback. Like I said, I'm a first-timer. I can see in your sig that you've had at least 5 kitties you've had to dance with. Can you explain (or link me to another thread) about absorbtion rate, what's fast or slow, what effect fast or slow has, and how that relates to PZI vs. the other insulin types? I mean, does PZI absorb or act more slowly than others? Could that be why IM was deemed to be "ok" in Bob's case? I mean, IM might be absorbing faster, but I'm still getting the desired decreases in BG to this point. Bob is nearly OTJ.
Where exactly in the side do you inject when you say "side"? I understand and have been shown the scruff. Getting the "tent" there is easy. I'm assuming since you're doing sub-q, wherever it is on the body, you're still having to tent the skin and hit the right spot within that area, right? (I'd watch a video but that's not an option unfortunately - I'm tethered to my cell phone, and can't even get a 3g signal or wifi speed. I'm effectively at "dial-up" speed and YouTube vids take 20 minutes to buffer and play.)
Carl

 

Carl, no chart available for absorption rate and I don't think it matters what insulin but are you getting basically a12hr curve on the PZI? Do you know at what time his nadir is before insulin starts wearing out and he starts to climb back up? You could just try shooting under the skin for a day or two and see what happens.

I always give sub-Q's in the scruff vacinity and those who have to give both insulin and fluids usually wait a few hours between giving fluids and insulin.

As for shooting in the side, the best I can do is picture a bullseye marking right on a cats side. I shoot anywhere on the side, down some from the spine, and there really is a lot there to choose from to vary the shooting spot.

Picture of two of my civies with bullseye marking. Click on the picture to bring it up full size.

 

I've specifically read NOT to inject IM. It has to be subcu, into the fat layer. I'll try to find a link so you won't have to take my word for it!! I just looked for a link. I typed "insulin injections in cats" into google and every article said not to inject IM, but subcu into the fat layer. They also gave old info about injecting insulin back into the bottle if you draw too much into the syringe (NEVER DO THIS!!).

For the original poster, I shoot Champ when he's eating. He's never reacted to the shot because he's so into his food!! I usually just kneel down next to him, pet him down his back, pick up some skin from between the "shoulder blades" and shoot. I still don't think he knows he's getting shots every day, twice a day. :lol: I don't think it matters too much where you inject as long as you don't do it in the same place all the time which can cause granulomas to form. Just mix it up from day to day!!

 

Patty,(and Hope)
I've "googled it" too. The top three hits link you to this board. I looked at half a dozen others on the first page. All said "injections are given sub-q". But none of them had anything to say one way or the other regarding IM injections.

Regardless, it doesn't matter. I was given instructions by my vet, who I trust, to give the injections IM until Bob is no longer getting sub-q lactated ringers treatment. So I plan on following her instructions for another 10 days or so. At that time, I plan on going back to sub-q because that is what she told me I should do.

I know you and others are just trying to be helpful. But actually it is unsolicited advice. I didn't post a thread saying "hey, are IM injections an option?" If I had, I'd be doing so because I had doubts, and I would be welcoming everyone's advice. But I didn't. Again, I know people here are zealous in giving advice, and I can appreciate that. Most of you have been dealing with this with varying degrees of success (most very successful) for months or years. I, for instance, am pretty sure that I have more knowledge and experience in dealing with rehab/hand-raising/releasing Virginia Opossums than 99.9% of the people here, and most people in the country. That's because I have many years of experience in doing that. But I wouldn't dream of telling you how to rehab a possum, or go to some opossum message board and post advice unless someone directly asked for it. (If you do have questions about wildlife rehab of possums, I'd be happy to help )

I'll give you a perfect example of "google" and how unsolicited advice can be useless or harmful. Just now, when googling "insulin injections in cats", I ended up linked to this article on Yourdiabeticcat.com :

I use PZI. I know that here, that seems to be in the minority, and that most people seem to use Lantus or Levemir. But suppose on several posts where newbies posted for the first time and said "my vet says I'm going to be using Lantus." , I were to post that quote and say "No, use PZI because I read that it is far better!" She didn't ask for advice, just said she was told to use lantus.

One, I'd piss off dozens or more lantus or levemir users here,
two, I make the newbie doubt what her vet (who she may have been using for years) is telling her,
and three, I might be causing harm to the most important thing involved - her beloved kitty.

If that makes me sound like a jerk, I'm sorry. I'm not trying to be one. I have asked for advice on a couple things in other threads, and I'm truly greatful for all of the responses I've gotten. And I hope I can continue to ask questions and get a lot of positive feedback.

For whatever reasons, whether it's recommended or not, the IM injections for the past weeks have had a great deal of success in treating Bob's disease. His numbers for the past week have ranged from 69 to 160. Today they were 91 and 150 at meal and shot time. At +4 tonight it was 86. I'm not going to fix what seems to be working without asking the vet and having her tell me I might want to do that.



Carl in SC