12/29 Ozy AMPS-357,PMPS-256,+2-305,+11-98

[donaleen and Ozy]

previous http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=110787&start=50

I know I said I wouldn't post today, I needed a day off. But things have gotten worse. First, Ozy is very thirsty and lies hugging the water bowl, something he did before being treated but has not done again until yesterday and today. He is also not eating so well. I'd say he ate only about half an ounce of his food this morning, which is about a third of his food.

Second, we are having serious problems with his insulin injections. He is fighting like crazy. I normally inject him in his sides. He never used to give me any trouble about that. Then, we got up to 6 units of insulin, he started acting like the injection hurt. It became a struggle to inject and that is why we moved to Levemir, to avoid the sting of Lantus, especially in high doses. That part of Levemir seemed to be working. Until yesterday. Both last night and this morning, he fought his injection pretty hard. It is heart breaking to have him like that. It is also hard to get the insulin in.

I have spoken before about his skin developing areas where the needle doesn't go in so easily. And problems with insulin leakage. I think/fear that his skin is somehow allergic to the insulin.

Thanks to all who are are trying to help.

 

[mariko]

Re: 12/29 Ozy AMPS-357

(((Donaleen)))
I don't have any advice to give, but just wanted to show support.
I know how frustrating and worrying when things go worse.
Hang in there, Donaleen, lots of experienced people are keeping their eyes on Ozy's condos, and they'll be here soon.

 

[Sandy and Black Kitty]

Re: 12/29 Ozy AMPS-357

Hi Donaleen,

Please try and get a ketone test.
Do you think all the insulin from this mornings shot made it into Ozy?

 

[donaleen and Ozy]

Re: 12/29 Ozy AMPS-357

There was a little bit of a smell when I sniffed him, but no wetness. But then I found he had been licking the injection site so I don't know if he got some of it out that way.

And we are locked in together with the cat box ready for ketone test.

 

[julie & punkin (ga)]

Re: 12/29 Ozy AMPS-357

I think there are a couple of things you can do to help.

First, yes, it's possible he could have something else going on. Let's try the ordinary things first.

It's common for cats to get a thickening of the skin where they are injected. Punkin had some spots that when we hit them, we knew there was a little bit of scar tissue we were getting. Could've been from previous shots, could also have been from previous skin owies from scratches or other ordinary things.

The technique you showed me on Friday that the you're using for shots has the needle extremely close to the surface. I haven't ever used that method and I can see that it's very possible you could have difficulties with it. I'd like to see you try a different technique. I'm not surprised it's leaking through because of how close the tip is to the skin. Here are 2 videos that show a technique that many people use. It worked for us, although we directed the needle away from the head rather than toward the head.

[youtube]JrC7VHd-uro[/youtube]
[youtube]drMDxAez4sM[/youtube]

I also think once you've started in a spot, using this technique, just go through the skin and inject the insulin. Don't remove the needle and find a new spot. Just stick with it. I get allergy shots and sometimes the needle goes in easily, and sometimes it's like going through leather. Just do it.

I also think it would help if he were distracted by food while you are shooting, instead of doing it while he's got nothing to pay attention to except the needle going into him. Put down plenty of food, then shoot him while he's eating.

Give these couple of tricks a try tonight and see how they go. Hopefully they'll be helpful and he'll take it more easily.

 

[donaleen and Ozy]

Re: 12/29 Ozy AMPS-357

Thanks, Julie. Boy, I'd sure be happy if it can be fixed by changing my technique.

One good thing, he couldn't lick it, like he can with his side. That would be good. But he could scratch it like crazy with his back feet. He was really scratching his neck with his back feet when his eosinophilic granuloma was kicking up on his neck.

 

[julie & punkin (ga)]

Re: 12/29 Ozy AMPS-357

oh - in one of those videos the tech pulls back the plunger before injecting. I HATE THAT. when the nurse does that with my allergy shot it hurts - we never did that with punkin. i think the point of it is to make sure you aren't injecting into the blood stream, but if you've tented and injected accurately, i don't think you're going to hit a vein. there shouldn't be any there.

 

[julie & punkin (ga)]

Re: 12/29 Ozy AMPS-357

Have you tried enticing him to eat? try one of those other new foods you got, perhaps, or sprinkle fortiflora, parmesan cheese, oregano, catnip, etc on the food?

is he meatloafing?

did you see Sandy asked about a ketone test?

also, if you can get him to play with anything, activity helps the cells be more receptive to insulin. will he go for a feather wand? i could see he likes to lay about (hahaha me too!) but if there's anything you can do to get him to move off his favorite chair or out of the favorite box that would be good.

 

[donaleen and Ozy]

Re: 12/29 Ozy AMPS-357

I offered him more chicken, which he gobbled. I sprinkled fortiflora on his food, he licked it a little. He acts like he did before diagnosis, when he would sit in front of the food bowl and ask for food when there was some in it. I will try the other food.

Yes, saw the ketone request. We are locked in together with the cat box. He is sitting by the door asking to go out. I think the bupe has taken effect so he is up.

No meatloafing.

Will try to play with him. Harpo put Ozy's stuffed mouse in the water bowl. He likes to put things in the water bowl. But we have more mice. And there is always the tape measure, which he loves.

He is QUITE playful... oh, love that bupe.

 

[julie & punkin (ga)]

Re: 12/29 Ozy AMPS-357

wonderful! that all sounds good. so he has eaten some and it sounds like with the bupe kicking in, he's acting like he feels better.

could be a little bit of pancreatitis speaking this morning.

 

[Sandy and Black Kitty]

Re: 12/29 Ozy AMPS-357

I think that if he has been letting you shoot him in his side while lounging he won't have a problem with a shot in the scruff while eating.

Bk came to us as a 5 yr old stray tom - an intact male that had been living on the streets of Baltimore all his life. As good natured as he was he was a bit scarey in the beginning. He learned that the treats were kept in the fridge real quick and as soon as the door opened he would put his front paws on the bottom shelf to peer inside. In the early days I would take that opportunity to shoot him at times. He had to be distracted with food or treats.

When BK got into high doses I had to split the lantus dose into 2 syringes due to my hand shaking (I'm a Parkie but was undiagnosed at the time), I was queen of the fur shots for a while. I also shot R with both AM and PM shots and mid cycle for quite some time. So 8 injections every 24 hours , all in the scruff, while he had his head in the food bowl. He would get a thickening at the injections site, however there is a good bit of wiggle room in the scruff area so if I detected thickening I could move the site slightly to the right or left for a while.

 

[julie & punkin (ga)]

Re: 12/29 Ozy AMPS-357

Did you buy a blood ketone meter or order on online? I was thinking you bought one, but maybe you're waiting for an order to come.

glad to hear he's very playful now. great sign.

 

[donaleen and Ozy]

Re: 12/29 Ozy AMPS-357

Ozy finished his food with mucho Fortiflora and the bupe helped, too. I really didn't want to give him high carb when his numbers are so high or are carbs good if ketones are a fear?

I watched the videos. It seems much like I inject fluids, except the needle is thankfully much smaller. I know that is the technique that was taught at the vet when he was diagnosed; the vet tech demonstrated and I practiced ... we were using saline solution. But then I read that the sides were a much preferred site with better absorption; pretty sure I read that here. Also, the side is nice because I think the skin is easier to see there than the scruff, making fur shots less likely. In both locations I "feel" the needle pierce through a layer (scruff has thicker layer)... isn't that what under the skin means?

I guess it shows how being freaked out like I am keeps me from thinking. It makes absolute sense to move to his scruff and makes me laugh at myself, ruefully, for having my mind frozen by fear.

So, where should I inject his B12? and what about subQ fluids?

In any case, we will definitely be moving to the scruff. And I hope I don't get a fur shot. It's nice to have a plan. Thank you.

 

[donaleen and Ozy]

Re: 12/29 Ozy AMPS-357

I think that if he has been letting you shoot him in his side while lounging he won't have a problem with a shot in the scruff while eating.

Bk came to us as a 5 yr old stray tom - an intact male that had been living on the streets of Baltimore all his life. As good natured as he was he was a bit scarey in the beginning. He learned that the treats were kept in the fridge real quick and as soon as the door opened he would put his front paws on the bottom shelf to peer inside. In the early days I would take that opportunity to shoot him at times. He had to be distracted with food or treats.

That is similar to Ozy, who wasn't really acclimated to being handled by humans when we we got him. And, when he really objects to something, can still be that way.

When BK got into high doses I had to split the lantus dose into 2 syringes due to my hand shaking (I'm a Parkie but was undiagnosed at the time), I was queen of the fur shots for a while. I also shot R with both AM and PM shots and mid cycle for quite some time. So 8 injections every 24 hours , all in the scruff, while he had his head in the food bowl. He would get a thickening at the injections site, however there is a good bit of wiggle room in the scruff area so if I detected thickening I could move the site slightly to the right or left for a while.

We tried splitting the Lantus dose when it was high. That helped some. But I don't understand what you are saying about wiggle room. and what you did when you detected thickening.. Did you pull the needle out and shoot in another spot? Or what?

 

[julie & punkin (ga)]

Re: 12/29 Ozy AMPS-357

i shot everything in the scruff - and when i say scruff, i would say we had an area about 6" long that we considered scruff, from the back of his head back towards his spine, and a couple of inches to either side of his spine. so it wasn't all in the same place, but relatively so.

when we did the subq's, we did it at pm+3 or in the afternoon. and we didn't shoot in the same side as the insulin. so if we gave the insulin slightly to the right side of his spine near his shoulder, we would wait 3 hrs and give the fluids more to the left side of his spine.

subcutaneous means under the skin, yes. but consider the skin has several layers and then fat attached under it. i think you're still in the skin when you are injecting, based upon what you're describing as being able to feel the needle. my allergy shots are considered subq and they have the needle going in at right angles to my arm.

in any case, let's see if changing how you're doing things will help.

 

[donaleen and Ozy]

Re: 12/29 Ozy AMPS-357

Thanks Julie. I do have a ketone meter on order, but not here yet.

Ozy feels good this afternoon. Best he has felt in days. Happy about that. I tested him at 7.5 just because he felt so good that I wanted to know his glucose.... it was 320, which is lowest reading in more than 48 hours. He is coming down some. Now I guess we'll see how the antibodies are doing.

 

[julie & punkin (ga)]

Re: 12/29 Ozy AMPS-357

wonderful! i'm thrilled he's feeling better.

i assume no urine ketone test success yet? it'll be easier when the blood meter arrives. when you described him this morning he sounded like a sick puppy, and of course we worry about ketones when a cat is described like that. but since he's feeling better after the bupe, that likely says his feeling crappy was from other reasons. which is better than ketones, of course.

 

[donaleen and Ozy]

Re: 12/29 Ozy AMPS-357

No ketones!. I tested him and I put it in the SS. I tested at AM+5. I didn't know you expected the result here.

I will be very happy if a change to my technique makes a difference. I am quite hopeful but still concerned about fur shots.

I hate it when I lose insulin in any way so that I don't know what is in him.... that is a bad, bad thing. And the last two shots have been problematic.

 

[julie & punkin (ga)]

Re: 12/29 Ozy AMPS-357

it's fine. i looked at his ss when i posted last but just didn't notice your note.

glad to hear that they were negative. way to go, Ozy! cat_pet_icon good job!

 

[Sandy and Black Kitty]

Re: 12/29 Ozy AMPS-357

But I don't understand what you are saying about wiggle room. and what you did when you detected thickening.. Did you pull the needle out and shoot in another spot? Or what?

by 'wiggle room' I mean what Julie describes:

an area about 6" long that we considered scruff, from the back of his head back towards his spine, and a couple of inches to either side of his spine. so it wasn't all in the same place, but relatively so.

One stick per syringe - I had to be quick like a bunny. It took some practice. There were times when my angle was off and I was shooting through the 'tent'; in one side and out the other! ohmygod_smile If I messed up (which I did plenty and sometimes 2 cycles in a row ) I chalked it up as a fur shot and tried my best the next time. When I detected thickening I made note of it so that I would remember to shift the 'target area' slightly in one direction or the other, always staying somewhere within the scruff region.

Very happy for negative ketones
\M/

 

[donaleen and Ozy]

Re: 12/29 Ozy AMPS-357

Thanks Julie and Sandy.... earlier in this condo I asked about what subcutaneous really means. When I give Ozy an injection that I believe is subcutaneous, I pull up on his skin and push the needle parallel to his body until I feel it pierce through a layer into a space below. I pull his skin away from his body and shoot beneath the layer. Isn't that right? Isn't the fat layer attached to the skin? And I think I am going under the skin and fat layer. Is that not correct? I have always been confused by directions that talk about shooting into the fat layer. I think it is pretty difficult to distinguish the layer of skin from the layer of fat.

 

[Carl & Polly & Bob (GA)]

Re: 12/29 Ozy AMPS-357

I think the fat layer is further under the skin that you might be thinking? I couldn't find a really good picture but did find this one.

If you have the skin tented well, you don't have to try to keep the needle flat against his body when you stick it in. I used to go in at about a 45 degree angle, push the needle all the way in (my needles were 1/2" long) and it never hit muscle or "meat". The only needles I ever had to worry about were the long sub-Q fluid ones.

 

[donaleen and Ozy]

Re: 12/29 Ozy AMPS-357

Thanks, Carl. Still confused. This seems pretty important to get right so please help me.

And my needles are a half inch long, too.

 

[donaleen and Ozy]

Re: 12/29 Ozy AMPS-357,PMPS-256

He is yellow and I shot him in the scruff. He didn't care at all. No smell of insulin. Yayyy!

 

[Marje and Gracie]

Re: 12/29 Ozy AMPS-357,PMPS-256

Yay!!!! Great news on two fronts today....no ketones and a successful scruff shot.

I found this on the felinediabetes.com FAQs


I just wanted to show you this to be sure you are shooting with the bevel up because that will make a difference in his comfort.

 

[Sandy and Black Kitty]

Re: 12/29 Ozy AMPS-357,PMPS-256

:RAHCAT

so happy to see that PMPS
Below is another graphic cross section that illustrates were the various layers are:


(I could not figure out how to make it bigger - apologies)

 

[donaleen and Ozy]

Re: 12/29 Ozy AMPS-357,PMPS-256

I must be in the right place. It feels like "space" but I looked at lots of cat anatomy photos and I guess it is connective tissue (fascia/fat).

Between the ease of the injection and the yellow number and especially Ozy feeling so very good, I am feeling pretty darn happy. Ozy is a different cat than he was this morning. And I'm a different person. John says he feels safe sending my straight jacket to the dry cleaners.

Well thanks for your support. Really.

 

[Sandy and Black Kitty]

Re: 12/29 Ozy AMPS-357,PMPS-256

BTW, In the short time I've been following Ozy, it's seems that when you give him bupe he is transformed into one happy cat (who whouldn't be???). I get the feeling chronic pain is an issue for Ozy. Having had more than my fair share of pain, I know first hand the importance of staying ahead of it.

Have you considered making it part of his daily routine? I don't believe there is a down side. . .

 

[donaleen and Ozy]

Re: 12/29 Ozy AMPS-357,PMPS-256

Thanks, Sandy. Yes, bupe is important to Ozy. I do give it to him mostly twice a day. Every now and then the vet tsks tsks at me about tolerance and addiction and such things and I back off. But, I am always sorry I backed off. I am convinced he needs his bupe.

Sienne said this not so long ago and I agree with her.

Several years ago, a colleague of mine who works in the area of pain management, noted that MDs are very good at prescribing for acute pain (like post-surgical pain) but are often much less good at prescribing for people who are experiencing chronic pain. I wonder if it's the same with vets. Vets have the additional complication of their patients not being good at describing what hurts, how much it hurts, and exactly where it hurts. To make matter even more difficult, cats are the champions of compartmentalizing their discomfort. If a small dose of a narcotic like bupe makes Ozy more comfortable, it sounds like it's a good option.

I think I should adjust the timing of when I give it. It should be an hour or so before his big pre-shot meals, I think.

And sometimes I give it to him three times a day, but not often.

In fact, I should give it to him now. He feels good now but if I don't give it to him, he will be miserable in the middle of the night. I wish I knew what hurts him but the best guess is smoldering pancreatitis.

 

[Wendy&Neko]

Re: 12/29 Ozy AMPS-357,PMPS-256

Yipee!!!! So glad to see that yellow tonight. And very happy to hear he's feeling better tonight. And you too Donaleen. :YMHUG:

I shoot in the scruff/shoulder area too, alternating left and right sides. Neko has a white "collar", which makes it easier to move the shot around. In the middle of the collar, at the edge, out of the collar. Does Ozy have any stripes that would serve the same purpose? That way you can still have quite a variety of shot locations, even in a smaller space.

 

[donaleen and Ozy]

Re: 12/29 Ozy AMPS-357,PMPS-256

Thanks, Wendy. ANd good tip. Ozy does have two stripes that go up the back of his neck. I don't think I would have thought of that.

 

[Sandy and Black Kitty]

Re: 12/29 Ozy AMPS-357,PMPS-256

Every now and then the vet tsks tsks at me about tolerance and addiction and such things

hmmmm.....kitty addicts, an interesting concept. I wonder if it actually can happen. . . .
I can see it now - kitties stealing money from their beans, sneaking out during the wee hours, heading to the "other side of the tracks" to score a bupe fix. . . ;-)

Seriously, the only experience I have with bupe is for acute pain, for BK following dental surgeries. Also with one of our other cats, Samantha who came home one night with a broken femur. . .

I'm sure there are folks around here who use it regularly who can chime in on whether or not consistent use is bad for kitties. Seems like a great palliative therapy to me (as long as Ozy will not be driving a motor vehicle or operating heavy machinery ;-) )

Like all things pharmaceutical, it boils down to weighing the benefits against the risks.

You gonna grab a before bed test?

 

[donaleen and Ozy]

Re: 12/29 Ozy AMPS-357,PMPS-256

Yes, I will get a before bed test. And a few others, too. I think anything is possible tonight, and I can't predict what he will do. So, I will test. I will go get a +2 now. I think it is close enough.

 

[julie & punkin (ga)]

Re: 12/29 Ozy AMPS-357,PMPS-256,+2-305

i take a nap and Ozy puts his toe in the yellow waters. mighty nice. even though he's up a tiny bit now, it's a mostly flat cycle today, which probably feels good to him.

punkin got 2ml or 2u of bupe BID for months. given how Ozy perks up whenever you bupe him and blahs out without it, i'd just do it.

glad you've sent the straight jacket to the cleaners. ;-) :lol: we all have our days and it's hard to see ones we love having a hard time. :YMHUG:

 

[donaleen and Ozy]

98 @+11 hmmmmmm. probably his nadir

 

[Marje and Gracie]

Wow! :mrgreen:

 

[Wendy&Neko]

Fantastic work Ozy and Donaleen! I love seeing :mrgreen: beside Ozy's name. Neko's done this to me too, go to bed on a pink and wake up to a green.

It is a little unnerving the first time shooting green, but he'll get a boost from his breakfast and then his onset from this morning's shot is not for several hours after that.

 

[donaleen and Ozy]

Thanks, Wendy. Very nice to see a hint of green. Oh, yes.

 

[Tina and Boozle]

I never really thought of animals in that capacity... as being addicts. I guess it would be hard for your kitty to find a supplier though.