NEEDLE SIZE/LENGTH IMPORTANT?

[KUMA CAT]

My cat, Kuma, recently was diagnosed with diabetes. I was given 29 gauge x 1/2" needles (U-40) by my vet, along with Prozinc insulin. Kuma screamed and tried to bite when I was using the thick 29 gauge x 1/2" syringe needles, so I changed to a smaller, shorter, needle (BD 31 gauge x 5/16" long) and U-100 syringes (I stayed on the same U-40 insulin, however, so had to convert the units on the new fine needle U-100 syringes). The finer, shorter, needles made a big difference in the struggle with the shots (I don't think he feels it now!), but after being on U-40 Prozinc insulin for 1 1/2 months (5 lines morning, 2 1/2 lines evening, using the fine needle, U-100 syringes, Prozinc insulin), Kuma's blood sugar was still at 480 (Kuma is still in the process of getting his blood sugar regulated, however, as vet is slowly raising his insulin after his diagnosis 1 1/2 months ago). I began to wonder, however, if the short needle syringes (31 Gauge, 5/16" long needle) that I started using, may not be getting the insulin in properly, even though I do always inject the needle in all the way? Is using a fine, short needle a bad idea, or should it make no difference? It was such a relief to get these finer needles, as there is no more struggle with the pain, so I hope I can continue to use them.

I considered the possibility of the insulin not injecting far enough in using the shorter needles, after reading the following article I found on this website:
http://www.felinediabetes.com/AAHADiabetesGuidelines.pdf
On page 9 of 10 of the article, it says you must use 29 gauge, 1/2" needles. I am now a little worried that I perhaps should not be using the finer, shorter needles? Does anyone know?

Also, is 480 a terrible blood sugar level, and how many units of insulin does the average cat require to get a level that high, down to normal? Again, he was on 5 lines morning, 2 1/2 lines evening (using U-100 syringes and U-40 insulin), when his sugar level was still at 480.

 

[BJM]

It is fine to use the U-100 syringes with a conversion chart for a U-40 insulin.
The dose needed is the one that works for your cat; we typically start low and work up in very small increments so as not to miss an optimal dose.

 

[BJM]

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)
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.

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

 

[Chris & China (GA)]

The vast majority of us use the 3o or 31 gauge 5/16" needles, so I doubt if that's the problem.

Are you home testing? If you are it'd really help if you'd start keeping track of your test numbers on our spreadsheet. We have lots of people here who are great at "reading" spreadsheets who should be able to help you understand your kitty better as well as getting Kuma under better control

 

[KUMA CAT]

The vast majority of us use the 3o or 31 gauge 5/16" needles, so I doubt if that's the problem.

Are you home testing? If you are it'd really help if you'd start keeping track of your test numbers on our spreadsheet. We have lots of people here who are great at "reading" spreadsheets who should be able to help you understand your kitty better as well as getting Kuma under better control

I purchased a home blood sugar tester with the lancets and test strips, and tried multiple times on the outer edge of Kuma's ear, for a blood sample. No blood would come. I set the lancets to go deeper, but still no blood drop came. I brought the tester in to show my vet, but he dismissed it as something I didn't need, and he did not seem to want to help me figure it out. I feel I do need to know what is going on, but I cannot get a drop of blood, so simply have had to give up with testing. I bring Kuma in for a blood sugar test about once a month - it tested at 480 about a week ago! I do not see him drinking a great deal of water, but there seems to be a great deal of pee in the cat pan. The only time I do see him drinking water, is in the morning right before I give him his morning shot, so I am wondering if his evening shot has worn off too long before he gets his morning shot. He is on Prozinc insulin, but would Lantus be better? I asked the vet about possibly trying Lantus, but he said he can only order Prozinc, so I seem to meet up with road blocks.

 

[Chris & China (GA)]

ProZinc is a good insulin for cats, as is Lantus and Levemir but without getting some testing in, it's almost impossible for us to help you decide if one might be better than the other. (Lantus and Levemir are human insulins....all your vet would have to do is write a prescription that you can fill at any pharmacy)

We can help you learn to test too! Have you ever tried just freehanding instead of using the lancet device? A lot of us do...it just depends on how comfortable you are. I like freehanding because it lets me have better control of where I'm poking, but it's totally up to you which works best for you.

Also, the more you poke, the more capillaries will grow along the edges of his ears and it'll be easier and easier to get blood.

It can be really helpful to establish a routine with testing. Pick one spot that you want your "testing spot" to be (I like the kitchen counter because it's got good light and it's at a good height....it also already blocked 2 escape routes due to the wall and the backsplash) It can be anywhere though...a rug on the floor, a table, a particular spot on the couch...wherever is good for you. Take him there as many times a day as you can and just give his ears a quick rub and then he gets a yummy (low carb) treat. Most cats aren't objecting so much with the poking..it's the fooling with their ears they don't like, but once they're desensitized to it and learn to associate a certain place with the treats, they usually start to come when they're called! Or even when they hear us opening the test kit!

You also have to remember...you're not poking him to hurt him...you're testing him to keep him safe and understand what's going on inside his body. There's just nothing better than truly understanding what's going on inside your kitty's body and with this disease, the more knowledge you have, the more power you have against it. The edges of the ears have very few pain receptors, so it really doesn't hurt them. Also, if you're nervous and tense, it's going to make your kitty nervous and tense too. As silly as it might seem, try singing! It forces you to use a different part of your brain!

It's also important to make sure his ear is warm. A small sock filled with a little rice and microwaved or a small pill bottle filled with warm water (check temp against your wrist like you would a baby bottle) works well

Finding the right "treat" will be a great help too! Freeze dried chicken, bonito flakes, little pieces of baked chicken...whatever low carb treat you can find that he really enjoys will help him to associate the testing with the treat! China's Achilles heel was baked chicken, so I'd bake a piece, chop it into bite sized pieces, put some in the refrigerator and freeze the rest to use as needed. It didn't take long for her to come any time I picked up the meter!

 

[BJM]

Get the lancets identified for alternate site testing (25-28 gauge); they are thicker and more likely to get a blood drop.

 

[granadilla]

You can also try putting a dab of Vaseline or neosporin (the clear ointment not the white cream) on the ear. That helps the blood bead up. Otherwise the blood spreads out into the ear fur. That helped me a lot.

I microwave a dry washcloth and hold it on her ear for a minute (test it on yourself to make sure it's not too hot). I think some people put a wet warm washcloth in a plastic Baggie and use that. Also be sure to have a tissue or cotton ball to protect your fingers on the other side of the ear. The first few times, I stabbed through the ear into my finger.

It will get easier. I have a drama kitty and she has gotten used to being tested so I'm sure your furball will get used to it too!

 

[Mitzelplik's Mom]

You can also massage the edge of the ear for several seconds to help warm it. The larger lancets BJ mentioned will help when you're just starting to test. Once Mitz's ears got used to testing, I was able to switch to 30 gauge lancets, but initially, I needed the 28 gauge ones to get any blood. I use a folded piece of paper towel behind her ear while poking and then fold it over the ear to blot afterwards. I try to blot long enough that I'm sure it's stopped bleeding to prevent bruises.

 

[KUMA CAT]

ProZinc is a good insulin for cats, as is Lantus and Levemir but without getting some testing in, it's almost impossible for us to help you decide if one might be better than the other. (Lantus and Levemir are human insulins....all your vet would have to do is write a prescription that you can fill at any pharmacy)

We can help you learn to test too! Have you ever tried just freehanding instead of using the lancet device? A lot of us do...it just depends on how comfortable you are. I like freehanding because it lets me have better control of where I'm poking, but it's totally up to you which works best for you.

Also, the more you poke, the more capillaries will grow along the edges of his ears and it'll be easier and easier to get blood.

It can be really helpful to establish a routine with testing. Pick one spot that you want your "testing spot" to be (I like the kitchen counter because it's got good light and it's at a good height....it also already blocked 2 escape routes due to the wall and the backsplash) It can be anywhere though...a rug on the floor, a table, a particular spot on the couch...wherever is good for you. Take him there as many times a day as you can and just give his ears a quick rub and then he gets a yummy (low carb) treat. Most cats aren't objecting so much with the poking..it's the fooling with their ears they don't like, but once they're desensitized to it and learn to associate a certain place with the treats, they usually start to come when they're called! Or even when they hear us opening the test kit!

You also have to remember...you're not poking him to hurt him...you're testing him to keep him safe and understand what's going on inside his body. There's just nothing better than truly understanding what's going on inside your kitty's body and with this disease, the more knowledge you have, the more power you have against it. The edges of the ears have very few pain receptors, so it really doesn't hurt them. Also, if you're nervous and tense, it's going to make your kitty nervous and tense too. As silly as it might seem, try singing! It forces you to use a different part of your brain!

It's also important to make sure his ear is warm. A small sock filled with a little rice and microwaved or a small pill bottle filled with warm water (check temp against your wrist like you would a baby bottle) works well

Finding the right "treat" will be a great help too! Freeze dried chicken, bonito flakes, little pieces of baked chicken...whatever low carb treat you can find that he really enjoys will help him to associate the testing with the treat! China's Achilles heel was baked chicken, so I'd bake a piece, chop it into bite sized pieces, put some in the refrigerator and freeze the rest to use as needed. It didn't take long for her to come any time I picked up the meter!

 

[KUMA CAT]

Thank you everyone for your helpful information on blood sugar testing with lancets on the rim of the ear, etc. I am now going to purchase some bigger needle lancets (28 gauge) and I will then hopefully get a blood drop from Kuma's ear. Kuma's blood sugar at 480 is terrible, and I need to figure out what is going on. At that last check, he was taking 5 lines morning, 2 1/2 lines evening (when I say "lines", I believe I should be saying "units" - each line on the syringe is considered a "unit", correct?), am using the fine needle, U-100 syringes, but with the U-40 insulin (I am using the conversion chart, however, so Kuma gets the proper dose due to using the U-40 insulin with the U-100 syringes). After seeing the high 480 blood sugar level, my vet now raised Kuma's insulin dose to 5 lines morning and 5 lines evening. I don't know if this will be enough of a jump to bring such a high blood sugar level under control, but he goes in next week again for a blood sugar test. Has anyone ever seen a blood sugar of 480 with the dose of insulin he is getting? This worries me, and I keep wondering why it is this high with the dose he is on. Do some cats need more than Kuma is getting to get their blood sugar under control?

 

[Sue and Oliver (GA)]

It is possible that he is being overdosed. I would not want to jump from 2 units to 5 units; we usually suggest increasing by .25 units. What could be happening is that he drops from the shot to a low 5-7 hours later. Then his body (sensing a number he is either not used to or is too low) releases extra glucose and he bounces up to a high number for the next shot. Or he may be a high dose cat (there are some conditions that require high doses) or he might do better with another insulin. But none of possibilities can be explored until you get some blood glucose levels.

I hope the larger lancets and warming the ear will help you get started on home testing. We all have little tips that helped so if you have trouble, just ask. We put a small make up sponge behind the ear to poke against. Mit saves your fingers and it seems easier to poke with a background. Other people use the rice sack or folded kleenix.

We put together a protocol for ProZinc that is in my signature in blue. It's the best approach we have come up with for using the insulin.