2/6 Sid holding steady today - anyone shooting IM?

I didn't post yesterday because I was too busy giving Sid an injection of R every 4-6 hours and testing his bg every 30 mins to every hour. Plus giving him SQ fluids twice/day. As I mentioned, he had moderate to high ketones on saturday. On Sunday he was at trace and again today he is at trace. So that is a little bit of a relief. I thought on sunday we were at the end but he has been hanging in here! He has had such a good appetite and ate 1.5 cans (6.6 oz) of Friskie's classic pate on Sunday and about the same amount today - that is really good for him. No feeding tube either - he is eating on his own. I am using the tube for his medicine and that is very helpful.

The vet wants me to shoot IM "for consistency" do any of you do that? Tonight so far Sid has been running in the 500s and has not come down at all from the small dose of R I gave him in addition to the Prozinc. Maybe it is me and my shooting technique? I know that I shoot straight down to avoid going through the tent - and I feel the needle go through the skin before I push the plunger. I shot Jake twice/day for 8 years. Sure I had a couple of fur shots but it is very alarming when I shoot Sid twice and see no response. He did not go too low at the vet today either - they checked him every hour. The lowest was 60 but then he got food and went back up.

Last condo http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=62880

 

What kind of food did they give Sid at the vet?

 

I never shoot IM; not sure why the vet would suggest such a thing for insulin.
Shots IM are painful as far as I know, so it's not something I would consider.

 

Beth,

They fed him Friskies Chicken & Tuna classic pate and at home he ate Friskies pate mixed grill.
The vet feeds him whatever I bring him.

 

Gayle, they want me to shoot IM because the insulin gets active faster and my vet thinks it would be more consistent dosing - which I don't agree with. It would be painful and that would make him more likely to jump away thereby leading to a higher risk of a fur shot. Sid already jumps away and I have to hold him pretty well to shoot.
The specialist mentioned that a port could be installed and I kind of wish I had had that done. That would ensure consistency of dosing - not shooting IM (IMO).

 

No answer on shots from me, but a hug to you and Sid. Eating on his own is very good news. :YMHUG:

 

when i was starting with the shots at one point punkin sorta screamed at me and pulled away. someone here suggested that i'd hit muscle. when i got the tenting down he never did that again.

i'll look at the protocol for you and see if there is anything that suggests IM - i think everything says get it into the fat layer, but i don't know it that's just lantus or if that would include prozinc. we started on prozinc and the vet demo'd it the same as the lantus.

 

Hi Lydia,
I can't help with IM shooting. I always thought you were supposed to try to avoid shooting into the muscle. In any event, I'm very glad to see that Sid is holding his own and I hope that you can get his insulin to work. Is it possible that you have a bad batch of Prozinc?

Here's to a good night for both Sid and you. Thinking of you and sending lots of hugs and healing vines,

Ella & Rusty

 

here's the Prozinc page - http://www.prozinc.us/understanding_insulin.aspx

here's the video from the quote above on how to inject the prozinc: [youtube]_ha0_yz2_Pw[/youtube]

i'm just skeptical enough that i would ask the vet what he's basing the IM suggestion on. like if there is a study or ? without that, because i think it's more painful, i'd stick to the injection in the tent. part of my thought is that the ProZinc people are basing the results upon the delivery method that they suggest. if it's injected differently, it probably WILL change its action within Sid's body. perhaps it also is metabolized faster and out of his system faster. i don't know. but if he wants faster, the R delivers that.

 

Lydia...I always understood insulin is shot subq and not IM but I don't know if it's ok to do so. Sending Sid many healing vines and prayers.

 

Can't help with the IM question, but still pulling for Sid!

 

hi lydia. i'm happy to hear sid is eating and his ketone level has gone down considerably.

vets are famous for shooting insulin IM especially when BG numbers are high or when a kitty is in DKA. when shooting IM onset is fast, the insulin peaks sooner, and duration is shorter. shooting IM allows them to simultaneously administer insulin via IV or subcutaneously (as one method of delivery peters out, the other one kicks in). every once in awhile a caregiver arrives on the fdmb who has been taught to shoot IM, but this is a rare occurrence.

i guess i can see the reasoning behind your vet's request. depending on how much duration sid has with an IM shot you might be able to shoot more frequently than every 12 hours which would provide better "coverage". although, i don't know if i could shoot alex IM. shots given IM would have to hurt more than a sub-q injection.

you should probably talk to your vet about the pros and cons of shooting IM. given sid's history maybe it is a good idea. i really don't know.


sending healing vines...

 

I think I remember reading somewhere that Carl used to shoot IM and it didn't sound too horrible. I have PM'd him with this link.

So glad to hear that Sid's ketones are reducing and that he's eating well - go Sid and go Lydia you're both just amazing!

 

Sending hugs to you, Lydia, and keep fighting and doing well vines to Sid.

I hope you get some answers from your vet regarding the IM shot method. I would think the R is fast acting enough.

:YMHUG:

 

Sorry - I can't help with the insulin. I came looking for Sid's condo. Glad to hear he's perked up. What a great update. His appetite is awesome!!!

 

There's a study in the British medical journal (Lancet) comparing sub-q, IM, and IV insulin dosing in humans. There was minimal difference with sub-q and IM administration. I didn't pull up the entire article and I don't recall what insulin they were using.

 

Sending tons of positive thoughts, and healing vines for Sid! This is great news!

 

Hi Lydia,
I am not familiar with you or Sid, but Serryn sent me a PM and asked me to drop by. I hope Sid is doing better today.

Yes, my cat Bob was injected IM for all but the first few days he got insulin. It was roughly 10 weeks. He was not on Prozinc, but on PZI. PZI has a shorter duration, so what I can tell you about the timing of his cycles would have to take that into account. My understanding is that PZI normally lasts 8-10 hours while Prozinc's site says 10-14 hours duration.

When I first got here, I mentioned that Bob got IM shots, but nobody told me that it had been done by anyone else. I was told it shouldn't be done, but by that point, I had already been doing it for a month or more, so I just kept doing what I was doing and didn't ask for any dosing advice. I just read a lot and tried to figure out what to do.

My vet had never had anyone shoot IM before, so it was new ground for her. Her reasoning, as I discussed with her after Bob was OTJ, was that due to his condition, and because I would be hometesting and administering sub-q fluids daily, that it was the best option for Bob. She was concerned about the insulin absorption rate if I were to shoot the scruff while flooding the area with sub-q fluids twice a day. She never discussed shooting sub-q in any alternate location, and at this point, I had never given any animal any shot, so I had no idea what I was doing anyway. This was weeks before I found FDMB. So I just nodded my head a lot and tried to pay attention. You may have seen a thread I started in Think Tank about dehydration and if it affects insulin absorption? Nobody really replied much to it, but the whole reasoning behind the question was based on how I treated Bob, and if my vet may have been right or not. After the fact, I was sort of "gee I wonder if it realy mattered?"
What I do know is that after 10 weeks on PZI IM shots, Bob went OTJ. Would he have if I'd done things differently? I have no idea, and I'll never know. I kind of think it was a real ECID thing, which is why I have never suggested to anyone that they do what I did.

After Bob's first few days on PZI, administered sub-q, he got worse. He was diagnosed DKA and required emergency care. The vet told me that in the ER he would have gotten IV and IM insulin treatments, so she felt that if I could do the IM shots at home, it would be best for Bob. The ER costs would have been about $1000 per day, for 2-3 days. I didn't have the money, but told her I would do whatever I could do myself to save my cat. So she kept him for 3 days, at her clinic. I don't know exactly what Bob got or how he got it for those 3 days. On the third day, I went to get him, and she showed me how to shoot IM, and she sent us home with a bag of fluids. He got 200 cc's a day of lactated ringers w/ potassium, and two IM shots of PZI, 12 hours apart, 1u. Oh, the vet apparently felt bad for me due to my lack of money, so she did most of the work "gratis". The invoice was for about $250 for three days of 24/7 care. I love my vet.

What they did at the clinic to make it easier for me was they shaved a "bulls-eye" on Bob's rear legs so that I could see the injection site and see how the needle went in. The shot location was on the big muscle on his rear leg, not the rump, but the next section down. I would equate it to what we call our hamstring muscle. I would lay Bob on his side, grasp the fat part of his leg so that he couldn't move or bend his leg (to avoid him moving while the syringes was still in my hand and in his leg). I was using 1/2 needles, u40 syringes, 29 guage. I pinch the muscle so it was fattest where I'd be sticking in it, stuck it in halfway. The hardest part was drawing the plunger back a little bit to make sure I didn't get any blood. In 10 weeks, I only saw blood one time and had to jab again. It was hard to do that with one hand, but I got good at it. After that, it was just push the plunger and pull it out. The shot process itself was just as easy and quick as an IM sub-q shot. I never had a fur shot using IM. I had his leg held imobile so he couldn't jerk away. (edited)

As far as pain? I didn't see any bad reaction from Bob. Once in a while, he'd chirp or meow softly, but he never acted as if he was in pain. After the shot, I would massage the site a bit, not much, just to distract him more than for any other reason. As long as he got a treat or got fed right after, he was happy. I would alternate legs AM and PM so he never got shot in the same general location twice in a row.

His typical duration was 9 or 10 hours, and his nadir was between 4-5 hours. However, since I only shot sub-q for the first three days of his treatment, I can't compare to tell you if it was absorbed more quickly or peaked sooner with Bob. The largest dose I ever gave him was 4u BID, and he didn't act any differently when I shot 4u than he did when I shot .25u as far as how if felt getting the shot.

I hope this helps, and if you have any questions, I'd be happy to answer them.

Carl

 

Hi guys .. no advice from me, but it sure is nice hearing that sid is eating on his own with a healthy appetite! keeping you guys in our thoughts and prayers!

 

First - BIG HUG Lydia and sweet SidBaby...

When I first started insulin with KT (Humulin N), my vet told me I could shoot anywhere - scruff was preferred but I could do it anywhere, just be sure I tried to keep it shallow. After trying several places, I started using his hind leg lower muscle like Carl - he never flinched nor even seemed to notice. At that time, my other computer had a worm, I couldn't get online and read. When I got this little one (gift from friends), I immediately began looking up FD, found Dr. Lisa's site and ended up here. While reading, I found the references that says not to shoot the muscle so I quit. His spreadsheet says his numbers WERE better than - hummm....

Now you all have me REALLY thinking about this...I've now changed to Lantus so don't know if the acidity of that would cause a different reaction...

Another hug!

 

Wow...The things we learn here!

Stopping in to check on you and Sweet Siddie...
and sending all good thoughts, hugs and chin scritchies your way
(the scritchies are mostly for Sid, unless he wants to share them :lol: )