Drawing Blood Issues

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PBMM

Member Since 2016
Hi - (first of all thanks for this site/board...its been VERY helpful)

MM (8.5) was diagnosed about 2 weeks ago. Blood test had her at 486 and she was drinking and urinating excessively. I immediately switched food from dry to wet and the following week retested with a monitor at the vet and it went down to 382, so yay! So being all other tests clear (including pancreas-just above normal levels) vet wanted to start at 3/4 unit of Lantus (pen with syringe), 2x a day with testing before shot. No problem. She doesn't miss the box and her urine amount is back down to her pre-diabetes level. Of course I would need to at some point check her urine but it doesn't appear to be an issue at the moment.

Have the AlphaTrak2 pet monitor works fine...but now I cant get the lancer that came with it to prick either MM's ear or paw. My husband tried it as well after I was in tears for 30 minutes trying to get the darn thing to prick her. He couldn't get it to work either. It shoots, sometimes makes contact with the ear but never pricks it enough to draw blood (and I can see the vein on her ears so I know where to go).

Lancer has this plastic cover on it that is the problem so when you trigger it the needle rarely goes past the plastic cover area. I have taken that plastic cover off, used it and eventually drew blood but the darn thing will go right through her ear. Now her ears look like they have been in a fight I have ruined my trust with her because initially she hardly noticed it and now I'm starting to see her stressing out and fighting me. That obviously does no good to test when she is at that state.

I have since read I am not the only one to find this out (cheap, defective lancer) Her numbers when I can get the sample fluctuate from 377 to 435 because MM is getting stressed and doesn't like that clicking sound...especially when I dont get a draw and have to try multiple times. Is there a alternative lancer that someone can recommend? I want to do the right thing, but I feel horrible that I cant take care of her as she deserves. So frustrated...

Thanks.
 
I like the lancing pen that comes with the ReliOn From Walmart. I don't know if they also sell it separately.

However, with my first diabetic cat we didn't use the lancing pen at all. He liked it better if I just freehanded it. You can use either a cotton ball or a cotton make up pad to hold behind his year, and then just poke the sweet spot with the lancet in your hand.

You might end up going all the way through at times, but that isn't really a problem. Just put good pressure on it after you get the sample and it will heal up fine. Use Neosporin ointment plus pain relief after too if you want.

Good luck!

Sandi.
 
You might want to try just freehanding the lancet...You don't HAVE to use the device at all. You might want to try using a different lancet size too. I think the one that comes with the meter is usually a 33 gauge and that's too small for "new" ears. Getting a lancet that's 25-28 gauge will make a bigger "hole" and is better for newer ears

I freehand and think I have better control over where I'm poking and how deep (but when we first started, I was like you!!...I seriously considered buying China a pair of diamond stud earrings because I was piercing her ears so often!!)

As you poke more and more, new capillaries will grow into the area and make it easier to get blood.

This is the "sweet spot"....if you're aiming for the vein that's going to hurt more (as well as possibly make your house seem like a crime scene)
sweet spot diagram.PNG


Here's something I wrote up for others that needed help with testing...maybe it'll help you too! (substitute "her" for "him"...LOL)

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.

When you're first starting, it's also important to use a lower gauge lancet, like 25-28 gauge. Most of the "lancet devices" come with 33 gauge lancets and they are just too tiny to start with. The bigger lancets (that are lower numbers) make a bigger "hole". As you poke more and more, the ears will grow new capillaries and will be easier and easier to get blood from...we call it "learning to bleed"

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!
 
The lancets that come with the Alphatrak 2 are 29 gauge.

I never used the plastic cap. I put the lancet into the device and freehanded the actual poke (i.e. no clicking noise). My hands shake quite badly and putting the lancet into the pricking device gave me better control over where I needed to poke. I assume that you're already warming kitty's ear before poking.

When you insert the lancet into the device twist it in a bright light to make sure that the bevelled side of the lancet is facing toward you. That helps make a smooth prick of the skin. Place a 1" strip of folded kitchen paper under the ear then wrap the paper and the edge of the ear round your index finger. Hold both in place with thumb and middle finger to create a little tension in the skin. Should make it easier for the lancet point device to easily break the skin surface to produce a droplet.

FYI if you do get on better with some of the suggestions offered and want to continue using the Alphatrak lancing device, come the time you need to buy more lancets look for Freestyle 29 gauge lancets. They're exactly the same as the Alphatrak-branded lancets but much, much cheaper.


Mogs
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I also use the AlphaTrak lancer freehanded. As you get more experienced you'll be able to gauge how much pressure to use to get blood but not go through the ear - although that's not a huge problem. Teasel is a very cooperative cat though! I have significant issues with muscle weakness/atrophy in my hands and this method still works for me. If you can stay calm that's a big bonus! :)

BTW - I can get 3 pokes out of one lancet before it loses its sharpness. I clean it off with alcohol between uses.
 
I use the Accu-Chek Softclix lancing device, and I highly recommend it.

It's well-reviewed among human diabetics. I personally think it's the least painful. Other people agree.

Accu-Chek has a page with suggestions on making testing less painful. I'll describe what I do below.

1. Use a fresh lancet each time. To reduce pain at first, using a fresh lancet each time will make a big difference. I somewhat quickly moved on to reusing them, but while establishing the routine I strongly suggest using a fresh one each time.

2. Warm the ear. This makes drawing blood easier so you can start using shallow pokes sooner. Shallow pokes means less pain. I had to use the "3" setting when I first started, but I was able to move down the settings fairly quickly. I use the most shallow setting nearly every time now. Taking the time to carefully and thoroughly warm the ear may be the most important step to successfully getting enough blood. Make sure you don't burn your kitty.

3. Make the skin taught. This makes a huge difference! (Imagine trying to cut a plastic wrap with a knife: when you hold it loosely the plastic wrap tends to tear, but stretching it taught makes for clean cuts.) I fold a piece of toilet paper into thirds and place it behind the cat's ear. I ensure my finger is directly behind the spot I want to poke. I firmly press the lancing device to his skin and then press the button to poke. After I get the sample, I fold the toilet paper around his ear and hold it firmly--be careful you aren't folding or pinching the edge of her ear. I believe doing this minimizes pain, quickly stops blood flow, and helps prevent bruising. You may consider applying a small amount of petroleum jelly to the ear to promote healing.

4. Do not intentionally poke the same freshly-poked spot. Try to rotate your poking spot higher and lower on the ear, and switch ears.

Good luck! It can be a little tricky to figure out where to place the lancing device at first, but you'll get it. And the cat's ears truly bleed more easily with time.

Be sure to follow the advice here about training your cat to accept testing. Rewards, rewards, rewards! Even if you didn't get the sample you wanted, you reward the kitty for cooperation. They need a reason to sit there for you. :P
 
Lancet pens work by launching the lancet towards the member (finger/ear) and the lanced bounces back. Thus, the lanced goes in further than if you just check how much the end of the lancet protrudes from the plastic cap.

Are you using the deepest setting on the pen?
Are you firmly backing up the ear where you poke? If not the ear will deflect instead of being pierced.
What gauge (diameter) lancet are you using?n You want larger diameter than the typical 29-31 gauge ones used by human for fingers. One marketed for human for alternate (other than finger) site testing are larger diameter with gauge of 26/27.
Each cat's ear is different. Some bleed easier than others.
Some lancet pens work better than others too.
 
I can totally relate, I went for not using the lancet because the clicking noise is not a good idea, Babu jumps at it and it only gets worse, I'm trying free handed, but got to admit with not much luck. Just can't find the sweet spot, well not even the vein, I've tried with a lamp to try and see through the ear but he really has a LOT of hair so it didn't helped, on the inner side he has almos as much hair as on the outside, he even has a very thin line of very very short darker hair near de end of his ear just where the sweet spot is I guess.

So up to now I either get nothing or really a lot (also thinking of getting him a nice earing to wear in the hole ) since I totally went through and I got blood from both sides of his ear ( used Neosporin to control the disaster a little )

Not much help here but just to let you know you are not the only one, so far I'm feeling awful since I know I should be testing more but I've limited the testing to only when I see him acting a little strange and the vet is taking a sample (from his neck ) once a week.

I'm taking note of all your suggestions thanks I know I have to keep trying
 
You can also try to get them conditioned to the clicking.

Think of it literally like Clicker Training that they use with dogs. When you are just hanging around with your kitty, just click the pen (no lancet, just to get the sound) and then give them scritches and a treat. It might help either decondition them to the sound or even to positively associate it with treats (low carb, of course!)

I also strongly recommend the rice sock. Their ears are so thin that even just the cool air from the A/C in the summertime can make it more difficult for them to bleed.

Best,
Sandi&Whisper.
 
Hi - Thanks for all your encouraging words and suggestions. I was able to do it by removing that plastic cover and turning the dial up to 3 (was at 2). Its also quieter without that cover too. I also am putting a cotton ball on the inside of the ear - Thanks for that suggestion. That allows me to have her ear firmly so I can place the needle in the right area and quickly shoot it. She is the color of Sandi &Whisper's profile picture but short haired (light orange tabby). Her ears are light in color so I am very lucky I can see her blood vessels and the area of where to poke. I do switch ears so not to have her hurt in the same place every day. I also do her shots in different parts as well and I never have issue with the shots.

It seems evenings she is more tolerant than in the mornings. This morning she kept folding her ear and twisting her head so it took me a few minutes to get her settled so her numbers came in higher at 424. Last night she was totally chilled and her number was at 314. She doesnt really move her body (I have her on the counter) but that head and her ears go all over the place (sometimes with biting). Hope she will settle down in the mornings with time.

The other bit of good news was her eyes initially appeared to be stuck dilated and not going down. Vet was slightly concerned it may be some vision loss. Yesterday when MM greeted me at the door her eyes were significantly smaller, looking like normal kitty. So something is working in the right direction. :cat:
 
Good news on the testing front. Do experiment with the 1" strips of folded kitchen paper, too, to see whether MM might find it less objectionable (provides enough of a cushion without the bulk of a cotton ball).

PBMM said:
The other bit of good news was her eyes initially appeared to be stuck dilated and not going down. Vet was slightly concerned it may be some vision loss. Yesterday when MM greeted me at the door her eyes were significantly smaller, looking like normal kitty.
Click to expand...
Be alert to anything odd to do with the eyes (a vulnerable area for diabetics). It might be worth getting a referral to an opthalmologist - if only to get a baseline of eye condition. My little one lost an eye (most likely due to secondary issues caused by chronic pancreatitis). If I had the time again, I would have made sure to get regular eye health checks.

Is your little one getting any other meds? Or did she by any chance have a parasite spot-on treatment just prior to your observation of the dilated/non-reactive pupils (can be a side effect of Advocate spot-on if some of it is accidentally ingested).

Another thing to watch for with dilated pupils is low BG. If it happens again, I suggest doing a BG test to be on the safe side.


Mogs
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