17 year-old tortie, so hard to get blood from her ears

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Twyla17

Twyla17

Member Since 2015
hello,
we have a 17 year-old tortise-shell cat, recently diagnosed. the main reason i am posting here is that it is so hard to get blood from her ears. we've watched multiple videos, but it is just so hard. also, Twyla has been free-fed her whole life, so switching to feeding times is hard for us. her weight had always been fine until diabetes, which caused her to lose weight which led to us calling the vet. we're trying to do a curve and the idea of blood tests every hour or even 2 hours is totally nerve-wracking. we often try 2 or 3 times and give up without getting a reading because she is getting tired of us failing. i can't believe there aren't easier places to get a blood sample. we're so stressed out that i'm sure this makes us less likely to do a good job because we are so distrusting of our ability to do it properly. the range in her readings has been from 32 while fasting for 4 hours to 385 , 25 minutes after a big meal. also, we're trying to find out what is the best thing to treat her sample sites with. we're currently using Neosporin (sp?) ointment, but that is making her ears sticky. we've read that alcohol, hydrogen peroxide, and iodine aren't good to use. my wife is stressing out so much.
thanks for reading this. we are new to this community and reading as much as we can. our vet currently has her taking .5u of Prozinc every 12 hours. and we feed her 20-25 minutes before a shot.
best wishes,
joe
 
I use a black sock filled with uncooked rice, tie the end off, microwave for 30 seconds. I put Luna on the table and kind of hold her tight, scratching her neck while I hold the warm sock against the ear. Get it pretty warm, rest the needle on top of the skin (without pressure), and just kind of 'jab' it. Instant blood and the cat probably won't even notice. Have you tried the warm sock method yet? It makes it 100% easier. I hold the warm sock against the INSIDE of her her to warm up, place the needle on the outside, and use the sock to 'push' the needle into, a slight 'jab' is all it takes when it's warm. Also helps if you try and involve the cat, let them sniff the tools you're using. When I started I let Luna sniff the meter, the test strips, the lancet, etc. She yells at me now when it's testing time to let me know it's time for a test! Also helps if you massage the ear after the poke, if you don't see blood you can often massage it out.

Little webcam video I took last night showing this process (quality sucks):

Seriously once you do it 2-3 days in a row blood testing becomes 2nd nature. When I started I forced myself to do it, and it took about 20 minutes each time. Now I can do a blood test in about 15-20 seconds. You HAVE to practice, and you really need to do this if you have a diabetic cat. We've only had Luna being home tested for a month and I've already nearly got her regulated. This never would have happened if I didn't test at home.

After I get blood, I use a piece of tissue paper, and squeeze the ear for about 10-15 seconds. This prevents bruising and stops the bleeding. I dab a tiny bit of neosporin on the poke site every single time, and rub it into the whole ear not just the poke spot to thin it out. This works quite well. You don't need to use anything else.

What are you guys feeding Twyla? Wet or dry food? What kind of insulin, if any, is she on?
 
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Dear Joe, first let me welcome you to FDMB. We are glad you found us. We have all been in your shoes and understand how overwhelming all this can be. So now take a deep breath and get ready for a crash course on taking care of the feline you love who needs your help to feel better. Here's a few tips to start:
1. It will help you to know that there are few pain receptors in the ear of a cat. You are not hurting the cat when you poke. You already know that this is necessary otherwise you wouldn't have tried so hard to do it. Right?
2. There is a "sweet spot" on the ear where you are more likely to get results. Someone will know where to find the picture and will send it to you. :). This picture really helped us when we were starting out.
3. Warming the ear is also really really helpful. We use an old sock with about 1/4 cup of uncooked rice. We heat it in the microwave for about 16 seconds. Then we massage the ear with the sock. When you warm the ear you increase the blood flow making it much easier to get that necessary drop of blood.
4. When we started out and were unsuccessful with getting enough blood for the test, yes that happens to all of us, we gave the cat a low carb treat and let him go. We wanted the cat to see the test as a prelude to yummy treats and as positive an experience as possible.

Rest assured it took very little time for the cat to come to our testing site when he heard the microwave beep after the heating of the sock. He even purrs when we poke his ear. It really does get better. :)
Please let us know what else we can help you with. You have found a wonderful community of people who are always ready to help.
 
A couple other ideas: 1) use a larger gauge lancet at first (to make a bigger hole) Most kits come with 30-31 gauge for humans. 25-27 gauge may work better in the beginning 2) take a flashlight and hold it behind her ear so you can see where you are aiming. The vein runs up the side of the ear. You're aiming for the little capillaries that run off it to the edge of her ear 3) have something behind her ear to poke against. (We used a makeup sponge, other people use the rice sack or a piece of folded kleenix
 
Hi and welcome. You are right, alcohol, hydrogen peroxide, and iodine aren't good for the cat's ears. As Jan pointed out, you are not hurting Twyla's ears by poking because cats have few nerve/pain receptors in their ears. The more you poke, the easier it will be because new capillaries will form.

You want to aim for the area between the vein and the edge of the ear. See the picture in the first post here: http://www.felinediabetes.com/FDMB/threads/testing-and-shooting-tips.85113/

To warm up the ears, I use a cotton headband or small wash cloth, dampen it, microwave it for about 30 seconds, put it in a ziplock bag and test it on my arm before gently applying it to CJ's ear. Be sure the bag is warm, not hot. Some people have luck just warming up their cat's ear by massaging it. I personally don't but you may find that works for you.

Lancet/gauage size is important. Starting out, we suggest using a 26 or 28 gauge. I personally like the 26 gauage because I can get blood out faster. The lower the number, the thicker the gauge.

It is very helpful is to use neosporin or polysporin to bead up the blood. The trick is using a very very tiny amount. A tiny dab with a q-tip is all you need. Too much will result in an error message on your meter. After you poke, gently blot off the ointment with a cosmetic pad, kleenex or paper towel.

I use a flat cosmetic pad and fold it over the ear (see Step #3 in Sue's post above). After I poke, I blot up any blood gently with the pad. A paper towel will do fine, too. Some people use kleenex or cotton balls.

I never thought in a million years that I could ever poke CJ. I worried she'd grow to hate me. But now she waits to be poked and our bond is stronger.

Practice and don't be discouraged. We all started out like you did. It will get easier!
 
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joe: thank you so much for the thoughtful replies.

suloni: i misunderstood where the sweet spot is -i see it clearly in the diagram now. thank you
http://www.felinediabetes.com/FDMB/threads/testing-and-shooting-tips.85113/

joe: we've tried heating, massaging her ear. just started using rice bag.
for the past few years she's been eating Purina One Vibrant Maturity,
but we've switched her to canned Natural Balance Indoor Formula and Chicken & Liver Pate Formula,
supplemented with Evo grain-free dry food. she's currently on .5u Prozinc every 12 hours.

Q: should we feed Twyla only twice a day. she is currently underweight, only 5lbs 3oz.
and not let her feed freely any more
if the care sequence is :
7am and 7pm 1st step lancet blood test
7am and 7pm 2nd step feed Twyla - let her digest for 20 min
7am and 7pm 3rd step give her insulin shot
7am and 7pm 4th step lancet blood test? after 20 min elapses /after she eats.
remaining blood tests every 2 hrs after 7pm dinner to get the curve points for that day?

thanks again,
joe & suloni
 
Wet food is good. Keep at the home testing as best as you can, once you 'get it' a few times it usually becomes a lot easier.

5lb 3oz is pretty low. Does she eat fine? How much are you feeding? Do you know what kind of #'s she's getting? What BG level's did the vet say Twyla has? How are Twyla's teeth, does the breath stink at all? Does it smell fruity whatsoever or just plain stink, or is it ok?

If she's not eating, I think it's well advised to let her graze on low carb canned food all day to get her weight up. Let her eat whenever he wants. You need food that is UNDER 10% carbs, this list is very useful :

http://www.catinfo.org/docs/SortableCatFoodChartCatinfo.org2-22-13.htm

(this is for lantus - not so sure about prozinc):
You don't need to test immediately after eating. You test, feed, shoot - in that order. That test is called your PRE-SHOT test. You'd typically test again at +2 hours later. If you can't get that test during the day it's best to get it at night after work. During the day you want to find her 'nadir', aka the lowest point in the cycle. This is where curves are useful because you can try and find WHEN she goes the LOWEST, which is the info you use to adjust dosage.
 
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ALWAYS READY TO EAT WET FOOD
she loves the wet food
she eats fine
she wants to eat the wet food all the time.

i give her 1/2 a teaspoon of wet food every 1 to 2 hrs
between the 2 larger feedings taking place at 7:30 am & 7:30 pm
larger feeding = 21/2 teaspoons of wet food.

she prefers patte' to dry evo.kibble.

BREATH
her breath does not seem to smell bad does not smell fruity

BG LEVELS
when vet checked bg= 210
she was not on her high protein diet yet

when we checked:
8/5: 244 after feed & before ins. shot
8/6: 278 after feed & before ins. shot
8/7 : 230 after feed & before ins. shot
8/7: 0nly 32 after fasting 4hrs/after dinner/after ins. shot
8/7: 385 after 7pm bigger 3 teaspoon feed & before her evening ins. shot

 
It's good she's eating and breath smells fine. I would stop the dry personally and feed only the wet.

Is she pretty small? Or just very skinny?

Either way, 2.5 tsp's + another 4-5 tsp is no where near enough I don't think. You did mean tsp not TBSP right (which would still be pretty low).

Luna gets 4.125 oz per feeding, which is about 25 tsp per meal, and 50 a day. She eats twice a day with maybe a 1tsp in between. The can says feed 3/4 to 1 oz of body weight daily, at 5lb she should be getting at least 5 oz a day which is ~30tsp, and probably more for weight gain.

Check out the instructions on the can. I would feed THAT amount twice a day (to equal the total recommended amount), maybe a bit less with a few tiny tsp's inb etween like you're doing now.
 
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That 32 is a serious and immediate concern. You need to immediately cut back on the dose and get advice from here before shooting insulin again. With #'s like that you're giving too much insulin. I don't know much about Prozinc. I'd head over to the FELINE HEALTH main forum on here and post for Prozinc dose advice with those same #'s.

Under 40 is considered hypoglycemia and can be fatal.
 
What would be important to know is her level 5-7 hours after the shot. It's called the nadir, or lowest point of the cycle. It's possible that she is dropping low at that point and bouncing back up for the preshot test. (A bounce is when her body perceives a lower level that it has become used to and releases extra glucose. Thus her levels bounce up). If she was 32 at some point in her cycle, that is possibly what is happening.

We generally consider that a regulated cat is in the mid to lower 200s at preshot and in double digits at nadir - but not below 50 which is approaching hypo territory.
 
we've always free-fed our 2 cats (our 11 year-old boy cat is fine and perfect weight). we're trying to figure out how to properly do a curve which would seem to mean not free-feeding but give big feedings twice a day and make sure there is no food for the two hours prior to the pre-shot glucose test.

the 8/7 etc. were my wife listing the dates of the blood tests (ie. August 7th = 8/7)

Twyla is a little small, but used to weigh 8.5lbs. she is thin and underweight now with the diabetes. i think my wife underestimated the size of her feedings. basically we often feed her every hour or whenever we go to the fridge ourselves. but nadir means lowest glucose while fasting, right?
 
The nadir is just the lowest point of the cycle; it is not a fasting level. Especially in the beginning, when you are gathering data, we are not concerned about the food given during the 12 hour cycle. We do suggest that you do not feed 2 hours before the pre shot test; we do want that test not to be influenced by food because you are going to base the dose of your shot on it
 
No. Nadir has nothing to do with fasting - it's just lowest point altogether. It's a critical # while giving insulin because that's how you tell how low the insulin is making her go. If insulin IS making the cat go to 32 that is a serious problem.

We were confused what you meant on the day of the "32". Can you elaborate on where the 32 came from, was it 4 hours after the shot?

I think you have it right with the curve. Essentially all a curve is is testing every 2 hours. Doing a curve will really earn you some skills (and finger pokes) with home testing. I've done a few if you click "Luna SS" in my signature.

@ 8.5 lbs I would be giving about 4 oz a meal of my Friskies Pate food, so 8 oz a day. That's about 3/4 a can of 5.5 oz food, twice a day. I'd go off the can instructions for whatever you're feeding. I think either way you guys need to feed more food - especially if Twyla is semi-ravenous when it's time to eat, means she's hungry (typically)! (Luna is always ravenous no matter how much she eats).
 
the reading of 32 was at about 12:30am after a 8:30pm feeding/test/shot, with 4 hours of fasting in that interim.
 
we just tested her at 5:40pm and got 386. her highest reading yet. her last shot was at 8:20am this morning and her next anticipated shot is at 8:20pm tonight. she's been free-feeding through the day, but we hadn't given her much food prior to this last test because i thought she was supposed to be fasting for her blood test except when she was getting her shot. i thought that we were supposed to feed her, do the test, and then shot. but now i understand it is test, then feed, then shot if test is over, say 200. sorry we seem so dumb. i know we must seem like idiots....
 
Twyla17 said:
the reading of 32 was at about 12:30am after a 8:30pm feeding/test/shot, with 4 hours of fasting in that interim.
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I would NOT give insulin again until you talk to someone (like Sue) about dosing. You might want to make a thread in Feline Health, the main forum, in regards to DOSING specifically. That # is far too low and extremely dangerous and is indicative of too much insulin being administered.

You're definitely not idiots. An idiot is someone who knows their cat is diabetic and feeds them high-carb dry food and doesn't take them to the vet and doesn't give insulin. You're doing a good job and it's absolutely a learning process. I've only been doing this barely a month and had the same questions you're having. Exactly the same actually. Weight issues, how to take blood, when to shoot, etc. Hang around this forum for a week or two and you'll learn more then you ever wanted to know about diabetes, and then some!

Essentially you want to test, decide on a dose, feed, and then shoot. Don't worry about fasting during any of this. Also don't ever give insulin without the cat eating a full meal before hand.

You need to:

1) Talk to someone about dosing. Do not give insulin again at the same dose without talking to someone experienced with PZI. Your cat could go hypoglycemic and potentially die. If you gave insulin today already please continue testing because we need to know if he drops under 50 again.
2) Read about hypoglycemia - I linked a post in here somewhere.
3) I would feed more food in regards to the weight loss. Follow the instructions on the can for starters, and I'd give 2 big meals a day with maybe a 1tsp in the middle of that day and that's it.
 
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No, you seem to be very caring kitty parents who are trying to learn as much as you can, as fast as you can. This sugar dance has a very steep learning curve in the beginning and unfortunately most vets tell people to give insulin twice daily and come back in a few weeks. That discounts the possibility that the cat may not need as much insulin as prescribed.

So, your 386 is nine hours after her shot, right? (We don't deal in time; I am very unlikely to be in your time zone. So that number would be +9) Unfortunately, it doesn't tell us much. It may be that she is fairly high and flat and the 32 was just a bad test. Or it may be that she dropped low early in the cycle and this is a bounce back up.

What dose are you giving?
 
@Twyla17

There's a lot to learn here and it can be overwhelming. We have been in your shoes. You are already doing the right thing being here at FDMB.

It will be helpful if you update your signature line (in your profile) with Twyla's date of diagnosis, the insulin you use, food you feed, and other medical conditions if any. That way others will readily see the info and be able to assist you better.

Also very helpful will be to download the spreadsheet members use here to keep track of glucose numbers to help other members assist you with ProZinc dosing.
Spreadsheet: http://www.felinediabetes.com/FDMB/...te-a-ss-and-link-it-in-your-signature.130337/

If you need help creating the spreadsheet, there are lots of people here who will be glad to assist.
 
sorry, yes, 386 was 9 hours after shot. we are giving .5u Prozinc twice a day (every 12 hours). 32 was 4 hours post shot (night time shot), fasting.
the prior value the night she was 32 was 230. those are actually the two lowest readings we have gotten from her. all other readings have been between 244-386.
we've only been able to get one reading today as we had two previous failed attempts to get blood.
 
Twyla17 said:
sorry, yes, 386 was 9 hours after shot. we are giving .5u Prozinc twice a day (every 12 hours). 32 was 4 hours post shot (night time shot), fasting.
the prior value the night she was 32 was 230. those are actually the two lowest readings we have gotten from her. all other readings have been between 244-386.
we've only been able to get one reading today as we had two previous failed attempts to get blood.
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With these #'s the "32' could have been a fluke. If you get a # that's kind of crazy low or high like that do a 2nd test to make sure. If you get a 32 again or anything under 50 for that matter you need to immediately feed some HIGH CARB food with about a TSP of honey and start testing every 10-15 minutes, and also post here for help. That's a seriously low # that needs correction.

So you'd call that 4 hours post shot "+4", and feel free to drop fasting from your vocab for now :) (It's a little confusing).

Wish I knew more about ProZinc but I don't - I would keep trying to test as much as you can until we figure out exactly how low this dose is putting Twyla, though you're past the 'window' for the AM cycle for today (first 12 hours after morning shot). Lowest point is typically between +4 and +9 hours. I would personally be skeptical of .5 u being given tonight until I find out if that 32 was a fluke or not.
 
Hmmm. It is hard to advise because we are operating in the dark with too little data. Not your fault - you are "pedaling" as fast as you can...

.5 is a small dose. It should be completely safe in 300+ levels UNLESS she did drop into the 30s on that dose.

Do you have any idea what her levels were initially when she was diagnosed.

You should be about +10 - 2 hours before her pre shot test - so it's time to cut off the food.
 
Sue and Oliver (GA) said:
Hmmm. It is hard to advise because we are operating in the dark with too little data. Not your fault - you are "pedaling" as fast as you can...

.5 is a small dose. It should be completely safe in 300+ levels UNLESS she did drop into the 30s on that dose.

Do you have any idea what her levels were initially when she was diagnosed.

You should be about +10 - 2 hours before her pre shot test - so it's time to cut off the food.
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So not terribly high carb. Levels when diagnosed?
 
Hi I think you changed a setting in your spreadsheet because it makes us ask for permission now. At the top right hit SHARE and get the link for 'Anyone with a link can view' and post that into your signature.
 
210 when diagnosed via complete blood panel test with vet. at the time she was on normal carb kibble, Purina One Vibrant Maturity.
 
Twyla17 said:
210 when diagnosed via complete blood panel test with vet. at the time she was on normal carb kibble, Purina One Vibrant Maturity.
Click to expand...

Spreadsheet is up and running and viewable.

Head over to the Pro-zinc forum on the main page or Feline Health and make a post called something like "Prozinc dose advice". You'll get more eyes on what to do dose-wise.
 
we got her blood results 2 days later. it was a complete blood panel test. the vet drew 2 vials of blood i believe. he had us follow up with the Purina Glucotest urine squares in her litter box. then he prescribed the Prozinc and we bought the glucose meter.
 
So probably a fructosamine test. Here are the levels I found

CatsFructosamine values (µmol/L)Normal non-diabetic cats190–365Newly diagnosed diabetic cats 350–730Regulated diabetic cats:Excellent control350–400Good control400–450Fair control450–500Poor control>500Prolonged hypoglycemia<300

It doesn't look like she was in diabetic numbers, unless I am missing something. A 210 ear test at the vet would be considered low because of the possibility of vet stress, which can raise the numbers 100+points.
 
the blood was removed via vial from a syringe in her leg. it was a home visit as she can't tolerate a trip to the vet. the vet didn't have a glucose meter at the visit. we didn't know why she had lost weight at this point, which was the only reason we had called the vet (because she had gone from 8.5 pounds to 5.5 pounds over the past 6 months or so. at first we thought the weight loss was just due to old age.
 
The other consideration is that she was on high carb food then. Now she is eating lower carb. Our Oliver dropped 100 points overnight when we switched from high dry carb to low wet carb.

I am really conflicted. We don't want her terribly high if we skip the shot tonight. But it would be really nice to get a clean, non food influenced test in the morning and determine the dose based on that number.

My advice tends to be conservative and is based on the premise that it is always best for the cat to be too high for a cycle than too low for a minute. (You can always raise the dose if she is too high, but once you shoot, there is no way to get the insulin out of the cat....) And the possibility of that 32 being a valid test is scary.

You hold the syringe. What are you thinking?
 
I think it matters how much they are capable of testing tonight. If you guys can get a PM curve it be useful if you give the same dose. Otherwise I -might- consider skipping tonight and doing a full CURVE tomorrow on the same dose to see what's happening around +3, +4, +5, and +6 specifically. Please spend some time reading about HYPOGLYCEMIA as well.
 
That might be wise. Being too high is not nearly as bad as being too low. If you guys can shoot in the AM and get a test every hour or two tomorrow after the insulin is given it would be very useful. Please familiarize yourself with hypoglycemia incase he DOES go low (under 50 is low, under 40 is an emergency).
 
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