Fuzzy is a new diagnosis. He had/has DKA and just recently got out of the hospital.
I checked his urine this morning and no ketones present. Last night there was a tiny amount. I am including ketones findings in his spreadsheet.
I am having issues giving injections. This is the second time I don't know if he got it all. When I withdraw the pen and stroke his fur, my gloved hand gets damp. Not a lot, just a little. This morning it was the thumb pad was damp. I shaved his fur to ensure I wasn't having a fur stick and the needle was entering. I am tenting the skin - I thought plenty of skin, but maybe not? I don't know, does the pen dribble on the way out?
I know the vet told me there would always be a droplet at the tip at the end- which there is. But this seems larger than a small tiny droplet.
Yes, I am aware his levels are reading high. I am working on getting them normal. Today is the first day I did a pre-shot test. I was told by someone else that I need to invest in some syringes that have .25 units so I can draw straight from the pen and be able to adjust his dosing as needed.
My thing is though, if I'm not getting it all in and I attempt to adjust it and then get it all in and it really messes him up- then what. I need to make sure I am doing this right. So I'm asking, does the pen leave dampness on the fur afterwards, or does it leak out of the skin after injection?
I see your talking about a spreadsheet. That's good. Keep detailed logs if EVERYTHING. Any changes. Anything you think is "different". Any time he vomits, even if it seems "normal", like it's a big hairball. If he pees outside the box. If he just seems more tired or more active than normal. Its hard to see patterns in individual ponts but several times we figured out problems with Elmer by plotting the detailed data we kept and spotting patterns. For example, he was throwing up a lot. We tried taking him off medications for a week at a time and adding them back and we couldn't really see a difference. But then I plotted it and I could see one of the medications he was on made the instances of vomiting jump up two to three times. When we had taken him off it, it dropped, when put him back on it, it jumped up again. When we took him off it again, it dropped again. There was no doubt.
I suggest getting an infant scale. Make sure it reads to at least 0.01lb or about 1/6 of an ounce. Many only read to 0.1lb which is 1.6 oz (and probably reads on the scale more like +/-2 or 3 when you take into account the accuracy of the scale) which is not quite enough.(I guess it would be ok if it was what you had). I had one that would only read to a tenth of a lb, but it would also read in an XlbsYoz mode that went to a 10th of an oz (0.1oz) so that was ok. It was slightly annoying though because the vet always measured in hundredths of a lb. It's hard to get a good weight reading on a cat by for example holding it on the adult scale and subtracting your weight so I always felt the baby scale was one of my most important tools for monitoring his health Weigh him frequently and record it in your log. Sudden weight loss or gain is usually the first sign things are going sideways and you can intervene before he's at deaths door. We found that it was virtually impossible to detect a weight gain of less than a lb just by looking at him or picking him up. (Or having him jump on your face when your asleep). Unless he lost a pound or a pound and a half we couldn't tell without weighing him. He was 12lbs, so for a 6lb cat, those numbers would be less,as would the acceptable range. The doctor told us to keep him between a 12 and 13 lbs, and we constantly monitored and adjusted his diet. His calories were strictly controlled and we monitored bot what he was given and what he failed to eat so we knew exactly how much he consumed. What I did figure out exactly how much food he needed to maintain weight. That was in his log book. (We used an actual book) When he had food put down, if he ate it all, that's great. If he didn't and done had to be thrown away, we put it in a container and weighed it and put that in the log book. If we could we'd try to get him to eat that much fresh food that day so he got what he was supposed to. That not only helped him keep his weight in the optimal range, which important for diabetics, but gave us detailed information when something went wrong to help the doctor figure it out. For example, if he's losing weight, or gaining weight, is it because he's not eating all his food, or eating more food, or is he eating the same amount and losing or gaining which can point to specific issues.
I dont know much about the pen, I always used a syringe. What insulin is he on? I used 30u syringes with half unit markings. If you use syringes be careful to READ the packaging and create a habit where you don't just take a syringe out and use it, but every time take the syringe out and LOOK at it and READ the markings and do a mental check list to make sure it's 30u with half unit markings.
Also be aware that sone syringes have slightly screwed up markings. The ones I got at Walmart had an extra half unit at the bottom. So for example, if you drew it up to the one unit mark and dispense it all, you really have dispensed a unit and a half. Its not a problem if you always use those syringes, except you might start the initial dosage a bit higher than you expected but since your carefully monitoring blood sugar when you start or change doses you shouldn't have any issues. The problem is if you get a different syringe. Either it could have that extra half when you don't expect it or not face it when your used to dispensing it on top of what you're reading. In fact I didn't have a microgram balance available so I can't even really say it's an actual half. I found this out when I bought syringes at Sam's club because they were a few dollars cheaper instead of Walmart where I normally bought them. The Walmart ones had the half extra and I never noticed it or thought about it because it was what I always used, but the Sam's club ones did not. (Another advantage of ALL WAYS going through that mental check list of reading the size and looking to make sure it has the correct and expected half unit markings.)
Also, one time the pharmacist gave me the WRONG syringes and I didn't notice until after his shot. Fortunately he was really high that morning and it was ok and he just came down to 78. But we monitored him closely all morning.
In case he goes hypo keep a 2ml plastic syringe around (I'll send you some) filled with high fructose corn syrup (like karo syrup). Presumably you've curved him, so you know how long it takes to hit the minimum ("nadir"). Check an hour before that. If hes in the 80s to 90s check again in half hour. Then another half. You'll learn how things look after a while and it will be less stressful. If he starts going into the low 70s give him a mL of corn syrup orally (oddly, I've red cars can't taste sweet) and then check again in 15 minutes. If he's still going down give him another ml and check again in 15 minutes. If he's STILL going down give him 2ml and get him to the hospital immediately. (My plan was that I'd bring the meter and check him again the parking lot then, if it's coming back up check every 15 minutes for an hour or so sitting in the parking lot. But I never had to do it. In the rare case that the first didn't fix him right up, he second dose of corn syrup always worked for me.
Also be aware that your situation might be a bit different than mine, depending on what insulin your giving. I was using Relion NPH insulin from Walmart. The gold standard now is Lantis or it's bio similar equivalents like Semglee. Back when I started treating el er, Vetsulin was off the story temporarily and Lantis was so hideously expensive that I simply was not an option. The situation is much better now. But NPH was working for him so we just stayed with it. But it has a rather short time of action. Id give him his shot at 7am and he'd nadir about 11:30am. So if you have a longer acting insulin I suspect all of this is stretched out. Also be aware that smaller doses will affect the time to nadir of sone insulins. But I only have direct experience with the NPH.
One problem I occasionally had with the injections is poking right through and losing the insulin shot out the other side. That is expecially likely to happen if you have the longer needle. (Which may be relevant to pens as well as syringes) I'd just pull up some skin on his neck into a little tent. Make a dent with my finger, the poke the needle all the way in until the syringe body was against him, and depress the plunger down and hold it for a half second. To load the insulin in the needle, id first prep the bottle by rolling it like you have to do with nph. Then pull the plunger back to a the mark I was going to inject, put the plunger into the bottle and invert it so the bottle is upside down. Then depress the plunger fully and finally draw out the insulin into the syringe a half a mil or so past the line indicating the desired dose. If there were air bubbles, Id depress the plunger and draw it out again. Then approach the line from the plunger side of the syringe. I could gave chose the other direction, but that could draw a bubble or cavitate so I always adjusted to the final dose by expelling insulin not drawing it in. In general I never like the idea of dispensing back into a container, but it's a sterile syringe, and the product has a fairly short shelf life and I never had an issue. Then if there was a drop on the end of the needle I would flick the plastic with my finger to knock it off. I followed the procedure religiously and taught others who had to give him the insulin the exact same technique. The technique isn't actually as important as the consistency. They would often feel it was frustrating and like I was over reacting to ti y variations in how they did it. But I used to work in an analytical lab where we used precision 5,10,25,50 and 109uL syringes to dispense analytical standards. We would have to check the calibration of our syringes every six months out accuracy dispensing was tested during training and our results were constantly evaluated with blind samples tests by a QC chemist. So I have a lot of experience with using and evaluating precision syringes and my takeaway was, 1)the accuracy of a syringe goes down the smaller amount you dispense because the error is mostly related to the distance yot off the mark, and 2) even if you getting poor precision (the amount might range 20% high or 20% low for example) consistent technique will still typically get you a high precision (a highly repeatable result, for example your could have poor accuracy, at 20% high, but good precision because it's always 20% high.) In the case of insulin the precision is more important than the accuracy, because you end up dialing in the dose. To a large extent you don't really care HOW MUCH your giving so long as it's the same amount that works each time. Presumably drawing it out of a pen cartridge with a syringe would be similar to a bottle.
