Frustrated! Not sure if I injected or not?

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Lauren & Red, Jul 24, 2021.

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  1. Lauren & Red

    Lauren & Red Member

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    Jul 16, 2021
    So I had a weird experience just now giving insulin. I know I had 0.5 units in the syringe. I inserted the needle into the skin and then pushed down the top to inject the insulin but it was already pushed all the way down.

    Now, normally it’s a barely noticeable amount to push down.
    0.5 looks like literally a few drops at most. I don’t see any liquid or drops of anything on the floor. I don’t feel anything in his fur and I was checking thoroughly. I don’t know what happened.

    I’m second-guessing myself about being positive I had the insulin in the syringe. I filled it well passed the amount I needed. And then pushed insulin back into the vial until it was at the 0.5 line.

    Could I have been injecting the insulin as I was inserting the needle and not aware of it? I didn’t think I was touching the top part but I cannot be 100% certain.

    Is the problem because I can’t remember if I put 0.5 of air into the vial before drawing the insulin? I think I didn’t do that this time.

    Let’s say it was being injected as I was inserting the needle— does that mean it’s not going to work? Hopefully I will know more at my +2 test (although I won’t know for sure why the numbers are where they are. I can only guess)

    I know I can’t give another shot just in case I did inject him but I’m trying to understand and make sure I don’t do this again next time.

    Feeling very frustrated because this time it went much smoother than last night and it might have been for nothing. It seems like I can’t do anything right and I’m trying so hard.

    Also, I’m trying to stay on the 12 hours apart, which is important with Lantus. But the time continues to get later and later (which is more and more unmanageable).

    Last night the plan was to get back on a 10/10 injection schedule. But I had a panic attack and didn’t inject until 11:40pm. It was my first time injecting on my own and only the second injection total. So this is VERY new.

    Today was the third injection. I forgot to remove food 2 hours prior and had to delay my time again to get a reading not influenced by food. Another dumb mistake! Ugh!

    So today I injected at 12:30pm. Again, took me awhile to get myself to go through with it. I don’t know what’s wrong with me. Besides the obvious. Feeling like a total failure.

    So what’s the earliest I can inject tonight? And how can I slowly get back to a 10/10 or even 10:30/10:30 time schedule? Safely of course? Although my hesitance to inject always takes awhile to overcome.

    I thought about starting earlier than the planned time. But that will be the one time I actually do it quickly. And I know giving early is dangerous.

    I tested ketones and they are negative again. I think? The color is definitely closer to negative but kind of in between negative and trace. I think I left it in the urine stream a little long because I couldn’t tell at first if I was in the right spot. So that might be the problem. They were negative yesterday too. How often do I need to test that?

    Most importantly, what do you think happened with my insulin injection? I’m feeling very defeated :(
     
  2. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    The one thing that may give you a clue is whether there's a drop in Red's numbers. If the numbers are lower, the insulin most likely got where it was supposed to go. However, the injection may have been fine but the numbers don't really change or they even rise, so it's not a guarantee. If you didn't shoot properly, you will not be the first person who ever gave a fur shot. (If we have a name for it, it's not a unique occurrence. The pain in the neck aspect of giving a fur shot is that if you did, you could shoot at whatever time you wanted due to the missed shot but since it's unclear, we will presume that you shot accurately.

    In the case of moving shot time, you have two options. You can move your shot time by 15 minutes at every shot time until your back on schedule (i.e,, you can shift by 15 min twice a day). Alternatively, you can move the time by 30 min once a day (edited to correct the riding which was a typo -- 20 min to 30 min).

    Lauren -- take a few deep breaths (and please don't hyperventilate). You really and truly can master this. You're not dumb. You're not a failure. This is all new "stuff" and there's not a single person here who wasn't anxious starting out. The amount of information to assimilate is overwhelming. You're having to master what is likely an entirely new skill set with no time to really practice. You need to get a handle on your anxiety so it doesn't effect Red. If you're anxious, he'll sense it and make everything more difficult. So something that may seem silly -- sing to him while your testing and shooting. It will help to drown out all of the "what ifs..." that are going on in your head. I suspect that you're already finding that this is easier than what you anticipated aud it only gets easier.
     
    Last edited: Jul 24, 2021
  3. Katherine&Ruby

    Katherine&Ruby Well-Known Member

    Joined:
    Oct 8, 2020
    Hi Lauren,

    You sound panicked and overwhelmed and I totally understand the feeling! I was super emotional and so worried about screwing things up for my cat when I joined the forum, but everyone here is so helpful and kind that it got easier and easier as time went on. The learning curve for managing feline diabetes is steep. There are lots of things to remember but you get into a routine. Try not to be too hard on yourself. :bighug:

    Did you notice any odor on Red's fur? Usually Lantus smells very antiseptic like a hospital room. Furshots happen to the best of us, so please don't beat yourself up over it or try to figure it out. Just give yourself enough time before your next shot to make sure everything is good. The picking up food 2 hours before advice is something to help you in case your cat tends to run low at shot time to make sure you're not getting a food influenced number. But since Red is hovering around the 200-300s, even if he eats an hour before that is no reason to delay the shot. Does he have a history of DKA? Once a day should suffice with ketostix testing.

    Since you shot at 12:30 PM, you can safely shoot 30 mins earlier tonight, so at 12:00 AM. Here's a post for getting back on schedule. https://www.felinediabetes.com/FDMB/threads/getting-back-on-a-12-12-shot-schedule.101059/
     
  4. Lauren & Red

    Lauren & Red Member

    Joined:
    Jul 16, 2021
    Thank you both for the kind words! I wasn’t delaying the shot because he ate. I was delaying the AMPS. Which in turn, delayed the insulin. Is that not correct?

    I can say with almost certainty that I did not do a fur shot. There’s no smell, no liquid whatsoever and I had a very clear view this time of what I was doing.

    I’m thinking it was either being injected at the same time I was inserting the needle (as opposed to after the needle was in) or I somehow I didn’t have insulin in my syringe.

    It’s almost hard to see because the amount is so small. I had the line in the correct spot so I’m not sure what happened between then and giving the shot.

    Could the problem be that I didn’t inject air into the vial? The instructions say to insert the dosage amount of air prior to pulling insulin into the syringe. I didn’t do that this time.

    I don’t want to test glucose more than necessary. I know eventually I will need to test more, but it’s an adjustment and I’m trying to ease into it for my cats sake. He seems really bothered by it. It breaks my heart every time.

    I’ve only injected three times. Each time I’ve tested prior to shooting and last night I did a +2. I don’t have much data because that’s how new this is. The first night I was unable to get a test after insulin because he hid under the bed all night where I couldn’t reach. I tried everything to get him out and gave up at 5am. I shoved stuff under the bed so this can’t happen again.

    Anyway, keeping in mind that I don’t want to do multiple glucose tests unless I have worrisome numbers. Would it be better to do +2 or +3? I don’t want to do both (again, unless I see something that would indicate a problem).

    He ate a good amount after the shot and was just playing with a toy. He’s now sleeping next to me. Would it be ok to wait until +3? Or does it need to be +2? I really don’t understand how any of it works or why the times of the tests matter. I understand the pre tests but not the rest. It’s over my head. I will keep reading and trying to understand it and hopefully will get it eventually
     
  5. Katherine&Ruby

    Katherine&Ruby Well-Known Member

    Joined:
    Oct 8, 2020
    Insulin is a hormone. Lantus is a particular kind of insulin that is long acting. It gets stored in the subcutaneous fat and it gets released slowly. It begins to take effect somewhere between +2 and +6, so that is why we suggest testing during those times. When we are helping you with dosing, it is important for us to know how LOW the dose takes your kitty. If you are only getting tests before shots, that is usually when glucose levels are highest. Imagine a curve of numbers that makes a smile. We want to know what numbers appear at the lowest point in the curve so that we don't inadvertently give the cat more insulin it can handle because that invites hypoglycemia. Having 4 tests a day, once before each shot and one in between each shot is the minimum we ask of caregivers so that we can help.

    I had SO MUCH trouble with testing at the beginning. I broke out in a sweat every time, was so worried about hurting my cat, ruining my bond with her, stressing her unnecessarily. However after about two weeks into a routine of regular testing, my kitty got used to it and now she hears me break out the kit and she comes running to the couch and assumes the position. I know this sounds unfathomable now, and I certainly did not believe everyone here who told me this, but it gets easier. I almost always feed her a small meal after her test so she has positive associations with testing. Knowing how your cat does on insulin keeps him safe, and helps us advise you on the optimum amount of insulin needed so that we can try to help you get him into remission. With the few tests he's gotten, it looks like he's not doing too badly for a cat new to insulin, and the switch to low carb food should help a lot too.

    The +2 test is helpful because it can often tell us whether or not the cat will drop low. A test result that is the same or lower than the preshot number indicates that the cat may go low, so you will know if you need to get another test at +3 or +4 and how much you need to feed.
     
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  6. Lauren & Red

    Lauren & Red Member

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    Jul 16, 2021
    Does anyone have a link that explains how glucose fluctuates based on food, insulin, etc.? And what the numbers/change in numbers mean?

    I’m trying to get an idea of what’s normal so I have something to use as a comparison.
     
  7. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    I never injected air into a vial. Prior to doing anything, I would move the plunger up and down the syringe a few times. (There's some lubricant in there and it spreads the lubricant around making it easier to move the plunger.) I'd insert the syringe into the insulin and draw up a little more insulin than I needed. I'd withdraw the syringe. I'd flick the syringe while holding it with the needle pointed to the ceiling so any bubbles would go to the end and then I'd then rotate the plunger to expel the excess insulin and any bubbles.

    Testing "more than necessary" is a relative issue. I'm on the other extreme -- look at Gabby's spreadsheet. I was a testaholic. Look at Ruby's spreadsheet - Katherine tests a good amount as well. That said, Gabby's ears were just fine. They really do begin to understand that what you're doing will make them feel better. You don't have to test as much as we did but my point is that our cats didn't hate us. I know you mentioned that Red isn't a big fan of treats. Find something that's a reward -- it can be food or it can be brushing, a period of play, whatever your kitty likes and do that after you test. You want Red to associate testing with something positive. You will need to get at least one additional test each cycle beyond your pre-shot test.

    The +2 or +3 test is often a way that some cats signal that they are going to have an active cycle -- that their numbers are dropping. Theoretically, with Lantus numbers rise a bit between your pre-shot and +2. Onset -- when the insulin starts to kick in, starts around +2 or +3. The lowest point in the cycle, the nadir, should be at around +6. These are all approximate since some cats just do not follow the rules. (Gabby was one of them -- she had an early onset and nadir, except when she didn't.) These are also not fixed points for every single cycle. any number of factors can influence onset and nadir.

    This is from one of the sticky notes on the Lantus board:
     
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  8. Lauren & Red

    Lauren & Red Member

    Joined:
    Jul 16, 2021
    Thank you for explaining that!

    I would do anything for my cat to come running for the blood test. Problem is I don’t have an incentive. I don’t only feed at certain times. LC wet food is being left out (replenished/ made fresh as needed) at all times. My cat has never been one to sit down and eat all or most of his food. He goes back MANY times throughout the day and night. It’s been 10 years this away… so I don’t know how I would change that now.

    I can certainly remove food and only feed when I want him to eat, but I don’t want to do that. Plus, I thought a diabetic cat should be able to eat whenever he is hungry. Am I wrong about that? I hope not but please tell me if I’m doing something incorrect. The only thing I’ve changed besides the type of food he’s eating is I remove all food two hours prior to the pretests. The other 20 hours of the day, he always has food available.

    He’s also quite strange in the fact that he doesn’t like treats. It’s so weird. I’m sure the only ones I’ve tried were not low-carb anyway. He stopped eating his dry food for the most part even before he was diagnosed. Now there is no dry food for either of my cats. The vet said his teeth looked fine but I don’t trust a word that man says anymore.

    This week I have tried plain chicken and some pieces of deli meat. He shows no interest. I’ve tried cheese which he normally loves but apparently he only likes it on occasion. Trying to give him a few tiny pieces more than once a day has surprisingly been a no-go. My other cat goes nuts over all of these. Can you please recommend some cat treats that are low carb (preferably small and soft)? I think I should try again because I don’t know how I can possibly get my cat to come to me when he knows I’m testing.

    I’ve been brushing as an incentive because he usually loves that. But he won’t come running for it unfortunately. Not sure what else I can try… :(
     
  9. Lauren & Red

    Lauren & Red Member

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    Jul 16, 2021
    I have every intention of increasing the tests. But so far, Red hates it. He’s normally my second shadow. Literally never likes to be in a different room from me. Usually as close to me as possible or on top of me. We share a pillow at night.

    But after the ear test, he hides for awhile. He’s never hid from me since I got him 10 years ago. I’m really struggling with this.

    Despite how sad I am, I’m still doing the preshot tests and +2 after insulin at night. For now, I only want to test one other time (so 4 total). I promise to work my way up to more. But keeping in mind I only want to do one after the morning insulin (not including the PMPS) for just starting out, what would be the best time to do that? +2 or +3… or maybe +6? so I know his low number?
     
  10. Katherine&Ruby

    Katherine&Ruby Well-Known Member

    Joined:
    Oct 8, 2020
    My Ruby had dry food out all of the time before she got sick. Then I started feeding her on a strict schedule. If Red's a grazer and you're home a lot, you can feed him small meals throughout the day. By small, I mean 1-2 ounces per meal is what I feed Ruby for a total of about 6-7 ounces a day. This will replicate his pattern of grazing, and you can keep him hungry for the times when his numbers might be dropping low and you need to intercede with medium or high carb food. The thought behind feeding a diabetic cat whatever it wants is when a cat stops eating and is on insulin, it can drop dangerously low. Also, cats who are chronically hyperglycemic can lose their appetite, which can cause ketoacidosis and hepatic lipidosis, both pretty dangerous conditions. Small meals throughout the day is better for the action of the insulin and better for his pancreas. Ruby is also not a treat oriented kitty. That's why the small meal after a test works for her. Have you tried small bits of canned tuna or sardines packed in spring water (no salt) as a treat? Fish isn't great to feed long term but as treats I think it's fine. Most low carb treats for cats unfortunately are freeze dried and therefore hard, but you can rehydrate with some water before you give it to him. Purebites makes some that cats go crazy for.

    I'm sorry that Red is hiding from you. I'm sure he will come around to the testing thing once it becomes routine. You can move the test time around during the day up to +6 if you're only getting one test during each cycle for now. So if one day you're getting +2, get a +3 the next time and so on.
     
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  11. Lauren & Red

    Lauren & Red Member

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    Jul 16, 2021
    Got it. Thanks! Is it important that he eats close to the time I test or hasn’t had food in a certain amount of time prior to the test, wether that be +2, +3, etc.?
    Basically, how do I get the most accurate number or is this not relevant other than the pre-shot tests?
     
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  12. Katherine&Ruby

    Katherine&Ruby Well-Known Member

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    Oct 8, 2020
    Not terribly relevant other than with the preshot test. If you know you're not testing until +4, it's fine to feed two hours before but I wouldn't do it immediately before the test until you get to know how Red responds to carbs to get the most accurate number.
     
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  13. Amy ♡ Cozmo

    Amy ♡ Cozmo Member

    Joined:
    Mar 27, 2021
    My cat is really picky about treats as well. Try anything freeze dried with only meat as the ingredient. A lot of cats love those. Mine finally fell in love with Norhwest Naturals raw Rewards for dogs and cats chicken breasts.
    upload_2021-7-24_15-1-6.jpeg
     
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  14. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Four test is perfect!

    When you have a minute, read Gabby's Legacy in my signature. My post is #7 in the thread.
     
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  15. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    If you only want to do 4 tests a day for now, you want to take food up 2 hours before shot times so that the Pre-shot tests aren't influenced by food. Then try to get another test mid-cycle (like between +4 and +7)...and feed him as you normally would in between the shots. The take the food up 2 hours before the PMPS test and get at least 1 more "before bed" test...either +2 or +3 if that works for you.

    The only treat that my China couldn't resist was the Orijen Wild Boar freeze dried treats (I bought the dog ones because they're cheaper per ounce and the exact same ingredients...just a little bigger but they break easily). The don't make just the Wild Boar anymore, but a lot of us that didn't have any luck with other treats swear by the Orijen treats
     
    Last edited: Jul 24, 2021
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  16. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    May 30, 2010
    @Lauren & Red

    Please be sure you read closely what Sienne said about drawing from a vial. Don’t push air into the vial and if you overdraw insulin, which all of us do on purpose, do not put it back into the vial or pen because it has come in contact with the lubricant in the syringe. Just squirt it into the sink or a paper towel, etc.

    Also, I believe Sienne made a typo about moving his shot time back. It’s 15 mins every cycle or 30 mins once a day, not 20. I definitely think you need to rethink your desired shot time. I’d think about 8 or 9 depending on what time you are up in the morning and how much time you have before you have to work. There will be other times, even after you get really good at testing and shooting, when you might feel you want to stall and then you will be constantly fighting these late night hours as you always need to get at least a +2 or before bed test at night.
     
    Last edited: Jul 24, 2021
  17. Lauren & Red

    Lauren & Red Member

    Joined:
    Jul 16, 2021
    I apologize for the delayed response. I lost power and internet yesterday. I just downloaded google sheets app because I still have no internet access. I will enter the numbers after I’m done messaging on here.


    I have been intentionally drawing in more insulin than needed and pushing the rest back in the bottle. I didn’t know I wasn’t supposed to do that. Does that mean my insulin is compromised now?
    So I did the AMPS and PMPS yesterday. I even did the +2 after the PM shot. I tried doing one after the morning shot, I got blood 3 times but he fights me so much I can never get the sample. The last time I tried, I accidentally went on the wrong side of the vein and he made a loud and horrible yelp. I left him alone after that. I’m still not getting the hang of it.
    The last 3 times I have injected it feels like the plunger is already all the way down when I go to push it (after the needle is in). This last time, I was careful and made sure I didn’t touch the plunger until the needle was in and it still felt like nothing. Could it be because it’s such a small amount that it’s hard to notice?

    Each time I have felt his fur, smelled where I injected… And nothing. After being careful today, I’m thinking I’ve been doing it right. Maybe? But yesterday I thought I messed up both shots.

    I wish I knew for sure. I read somewhere about someone diluting the insulin with water for this reason but I don’t think I can try to even understand that concept for awhile. If it’s even legitimate because I know there’s a lot of incorrect info on the internet.


    Ok everyone… I have to tell you something you won’t like.

    Today, I tried getting an AMPS 3 times. Very difficult and I’m bleeding from scratches again. But I got a good sample 3 times. His poor ear! Every time I got the sample it was saying “E-3”. Which according to the manual means “used test strip or sample on top of the test strip”. It’s not possible because I let the blood get sucked up and they are all brand new strips.

    I then tried on myself and got the same “E-3” error message twice. Each time I’ve used a new strip. I’ve wasted A TON trying to get samples and failing. The only thing I can think of is last night after struggling with tests I knocked over a glass of water and it spilled onto the bottle of test strips. The bottle was closed so I didn’t think anything of it. Even now they don’t feel wet at all but none of them are working.

    I know I shouldn’t give insulin without testing first but I did anyway (about an hour and a half ago). Here’s why: I was worried that both shots last night might have been unsuccessful and he was going too long without insulin. This one may have been too. It’s frustrating that I don’t know. I gave him a little of the gravy from the higher carb food on top of his low carb food. He ate. I also gave him a couple pinches from the dry food bag that he no longer gets. He ate them like they were treats.

    I have honey out and I’m not leaving his side today. I have memorized all the symptoms for hypo. Even though I do understand sometimes there won’t be symptoms and that’s why testing before is so important.

    I also have the emergency vet closest to my house with their phone number and address on my counter.

    My mom is picking up new strips when she gets off work and dropping them off to me. That won’t be until after dinner though. I can’t get them myself sooner because I don’t want him out of my sight for even a minute.

    I made a decision in the moment. Even as I was doing it I knew you would tell me I shouldn’t but I had this nagging feeling that he wasn’t getting the insulin he needed. And just a gut feeling that I needed to inject.

    It’s such a small dose. My vet told me to do four times as much twice a day without testing. So I’m thinking such a small dose, even though I know it’s possible and does happen, is probably unlikely. Not impossible though. I don’t plan on making it a habit. I understand why testing is important and I hope I didn’t make the wrong decision.

    Forgive me? The last thing I want is to make anyone feel like they are wasting their time helping me because I broke the rules.
    So if anyone is still talking to me, can you please give me advice on the best way I can keep him safe today without being able to test until probably the PMPS?
     
    Last edited: Jul 25, 2021
  18. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Lauren --

    Indeed, you are overanalyzing everything. If you overdosed Red, he would not be active enough to bite you. Look at the symptoms of hypoglycemia. It doesn't sound like he has any of the symptoms. Read some of the threads from other new members. Most people experience the same uncertainties. It's normal. You're just overanalyzing and catastrophizing. We really do understand. You just need to take a few breaths and think about this logically (and not emotionally).
     
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  19. Lauren & Red

    Lauren & Red Member

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    Jul 16, 2021
    You’re right. Thank you
     
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  20. SashaV

    SashaV Well-Known Member

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    Apr 25, 2020
    Relax please! :bighug::bighug:

    You're doing your absolute best!
    We've all been exactly where you are, second guessing ourselves if we really did shoot, or feed.. testing it easy to find out, your meter has memory! :D:p

    It's a total cliché, but you can't help Red if you can't help yourself.

    This is all very new, and there's a lot more to it than one should think. You can't possibly take it all in, in such a short time. And no one is expecting you to do so.
    So please take it easy, think logical and push the bad thoughts out of the way. In a few months you'll be educating your vet in diabetes.

    You did great! Many people's first reaction is to give another shot, you didn't. You did awesome!:bighug:
    Please take care of yourself too. This is not a sprint, but a marathon, so don't run yourself out already :bighug::bighug:
     
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  21. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    No, it should be fine as long as it's clear with no floaties. Many of us didn't know that we shouldn't shoot insulin back into the vial or pen at first. When you know better, you do better!
     
  22. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    No but I’d just not do it anymore.

    Are you trying to get the blood immediately on your nail so you can let him go and then suck the blood up from your nail? Most members keep 200-300 strips at any given time and an extra backup meter that is the same as their primary one.

    Excellent, excellent advice. In fact, the entire post is excellent.
     
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