Fur Shot City & Resetting Dose

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Scott & Buster

Scott & Buster

Member Since 2022
HI Everyone,

For some reason all of a sudden I am back in fur shot city. Since the end of August almost 25% of attempts have ended up on instead of in, and we're back to readings in the 500s.

Around the same time we started giving Sub Q fluids for dehydration 1-3x per week as needed. Is it a case of I learned how to shoot on a dehydrated-ish cat and need to relearn now that he's a bit more hydrated?

Is it the needle? I am using these - Ulticare U-40 Insulin Syringes 29g - Box of 100 Needle 1/2 inch | Pharmacy Medical Supplies | PetSmart - is there a better needle I should try that makes it less likely to fur shot?

Do I also need to go back to the lower .75 unit dose we were at before this started and start over on making adjustments? Looking at his spreadsheet I understand why his dose has traveled as much as it has, however I am concerned the repeated fur shots are masking that I've shot past the right dose since we can't level out. I also am concerned with shooting the same dose if he's in the 400-500s and when he's in the 200s, when we're getting a drop of 250+ points (417 to 105, 522 to 126). Maybe the fur shots are me subconsciously missing to avoid shooting 1.25 units?
 
Scott & Elmsley said:
These finally came tonight, and I just used one. I definitely felt more confident that I wasn't going to poke out the other end of the tent. Thank you for the suggestion!
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You're welcome. Ironically, we had a fur shot yesterday because Bella was determined to get away by any means. But most of the time, these syringes work great. Just be aware that thin needles are more prone to bending (especially if you're trying to use them on a cat that's running away).
 
Alicia2022 said:
You're welcome. Ironically, we had a fur shot yesterday because Bella was determined to get away by any means. But most of the time, these syringes work great. Just be aware that thin needles are more prone to bending (especially if you're trying to use them on a cat that's running away).
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WOW... just this morning I might have had a miss (not sure) - I could smell insulin on my hand after petting the area, but it wasn't wet... hoping he got most of the full unit this morning - I would think if I missed completely he would have been a lot wetter.

Should I be leaving the needle inserted after injecting for longer than a longer needle since its depositing closer to the surface of the skin?

Hoping that this was just a one time thing this morning and we are good going forward. He was at the vet this weekend, and has lost the weight we worked so hard to gain back. :oops:
 
Sorry did not get first tag

See what the 1U does for him the next few days, but I suspect you need to go back up to at least 1.25U. If he's sick, remember that not enough insulin is a factor in DKA - so be sure to check ketones.
 
Scott & Elmsley said:
WOW... just this morning I might have had a miss (not sure) - I could smell insulin on my hand after petting the area, but it wasn't wet... hoping he got most of the full unit this morning - I would think if I missed completely he would have been a lot wetter.
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Spoiler alert: Seems to have been a complete fur shot... 497@+4. :arghh:
 
Scott & Elmsley said:
Seems to have been a complete fur shot
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So sorry it didn't work this time. I don't think shorter needles require additional waiting. A good advice from this forum is to count till 10 before pulling the needle out. Our girl Bella is very skinny, she lost lots of weight before we figured out she's diabetic, so it's really hard to find a place to inject safely. But with a longer needles I'm sure we would get a lot more fur shots.
 
I think we got a no fur shot dose this evening. I recorded it, can someone please take a look and let me know if they see something obvious I am doing wrong? Am I coming in at too steep an angle? The plunger gets pressed at 17 seconds. After this I am feeling for insulin in his fur - is it possible that sometimes doing that I am forcing it right back out?

Watching the video, its a miracle this wasn't a fur shot with all the moving around he did, he's usually not this bad. :D

https://drive.google.com/file/d/1bCZfe20ZSNBScyBuMgFwYQVGH2kbeXc4/view?usp=sharing
 
Scott & Elmsley said:
Am I coming in at too steep an angle?
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Maybe a bit too steep, but this is very hard to tell because this is a very individual thing.
Scott & Elmsley said:
After this I am feeling for insulin in his fur - is it possible that sometimes doing that I am forcing it right back out?
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Yes, this is possible. It happened to me a couple of times, I was complaining about this here on this forum back in July :) so I got an advice not to touch the injection area after the shot! I actually shaved Bella's scruff area (she's longhair) to be able to see this spot better and be more confident that there is no insulin outside.
 
Scott & Elmsley said:
I think we got a no fur shot dose this evening. I recorded it, can someone please take a look and let me know if they see something obvious I am doing wrong? Am I coming in at too steep an angle? The plunger gets pressed at 17 seconds. After this I am feeling for insulin in his fur - is it possible that sometimes doing that I am forcing it right back out?

Watching the video, its a miracle this wasn't a fur shot with all the moving around he did, he's usually not this bad. :D

https://drive.google.com/file/d/1bCZfe20ZSNBScyBuMgFwYQVGH2kbeXc4/view?usp=sharing
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Interested to hear what others say. I am not an expert and can’t offer any advice, just commenting that I thought he was wonderfully still! Injecting my Herman is like shooting a piranha! So I have to be much quicker than I’d like. After depressing the plunger, if he is still, then I will sometimes wait a few seconds before pulling it out but often don’t have that luxury. My technique will need to evolve though. His winter fur his coming in thick so it’s near impossible to see a part in the fur to the skin and he’s gained wait so it feels quite different too.
 
Alicia2022 said:
I actually shaved Bella's scruff area (she's longhair) to be able to see this spot better and be more confident that there is no insulin outside.
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I ended up trimming his scruff so I could be more confident in where the needle was going after ANOTHER fur shot (luckily it was a fur shot he could afford - he was in the blue preshot - and I think I accidentally hit the plunger early rather than poking through). This also helps a lot, and it actually saved me the other day because I was able to see I had gone right on through the side of the tent before hitting the plunger. I think it also helps me see when I am going in too steep or off center so I can course correct.

FrostD said:
I suspect you need to go back up to at least 1.25U.
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We've been at 1.25U for 4 days / 8 no miss shots in a row. On one hand I think he might benefit from moving to 1.5U, on the other hand I'm concerned about increasing because of what we're reading at +4 - we're where we'd peak at +6 at a good to almost low number since we've got blues and greens if he wasn't eating second breakfast and dinner. But he's underweight and usually hungry so he eats again +4 am/pm so that is the rise we're seeing in the BGs at +6 & +7, but its an inconsistent rise - sometimes its around +60, others its +200. To complicate things sometimes he just doesn't feel good and eats slow (which I agonize over the decision to shoot at all), other times he scarfs it down as soon as he gets it. The other morning it took about 3 hours for him to eat his breakfast, this morning he gobbled it down and begged for more. We've also had to bust out the Mirataz twice this month in the morning; we're working on getting his cerenia/famotidine/zyrtec and sub q fluids cocktail right.

This is his food schedule right now (BFF Play, mixed in here he's getting a Lysine chew 2x and 1 pill pocket 2x to take his meds) - he's on a 500+ calorie diet to help put some weight back on as going down to around 350 was too little coupled with fur shots and the bunk meter caused the weight loss:
  • Breakfast/Dinner: 5.5oz can - 1/4 right after test, 1/4 after waiting 10-15 min to make sure he's not going to puke and he gets his insulin while eats that, the other 1/2 can about 30 minutes or so later. He gets Proviable in dinner and Pro-Pectalin in both.
  • Second Breakfast/Dinner: usually around +4 - one half of a 5.5 oz can
  • Afternoon snack - usually around +8 or +9 - sometimes some Tiki Cat shreds, or homemade pulled chicken breast with some chicken stock for easy hydration (poor man's broth pouch :)). This is when he gets his Orbax liquid as well.
A kidney diet is also on the horizon (I have on hand to see what he actually will eat), but I want to get him regulated before trying to swap out his food and have to play with increasing the insulin again. So my dilemma is do I increase on current diet and hope he eats good, or is there something I can do to modify the dose/frequency?

Thanks for reading and replying.
 
Truthfully I just don't think ProZinc is going to work long term, and the diabetes is going to keep wearing on his kidneys. You don't have any room to increase given his nadirs, and he just continues to bounce given how harsh the ProZinc is for him. You can try to feed higher carb food in those first few hours to help slow the drop, but my preference would be a change in insulin.

Forgive me if it's been covered before, but have you discussed Lantus/generics with your vet? It's likely he'll still continue to swing, but it should be lessened and can hopefully get him better regulated.
 
FrostD said:
Forgive me if it's been covered before, but have you discussed Lantus/generics with your vet? It's likely he'll still continue to swing, but it should be lessened and can hopefully get him better regulated.
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I've not discussed with my vet, but asked about it once here a few months back but it was right after he was first diagnosed (New Member - Elmsley | Feline Diabetes Message Board - FDMB). He hadn't been on Prozinc 3 months yet.

I was looking at the Lantus sticky (Sticky - Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR) | Feline Diabetes Message Board - FDMB) - thinking that he's really not a candidate for TR since he bounces so much and we're expecting him to continue to bounce a bit even on Lantus?

I also think Lantus might be a better fit for him because he would eat all day if you let him; am I right in interpreting that this allows for more than a snack on the back 6 as long as he fasts at least 2 hours before a PS BG reading? I would love to be able to spread his food out more instead of cramming 8oz of food into 4 hours, and am I right in thinking that if he is having an off day where he eats slow/less it won't be nearly as alarming as that happening on Prozinc for a drop?

Can someone tell me what to expect if I can get his vet to switch? It looks like somewhere between .5U and 1.25U would be his starting dose? That seems to be a pretty big spread - based on what he's on now and where his BGs are does anyone have a recommendation for a dose (a check against what he's prescribed)? I am also assuming that we're going to see a rise in BGs until we get his dose tuned, though I should not see the swings across a cycle that I see now? Does he need to be insulin dry before getting his first Lantus shot, or can he get his regular Prozinc at night and the next morning start Lantus? I know he'll also need to change from u40 to u100 needles - does that draw look/inject differently?
 
I think you've given ProZinc a fair shake and done what you can, and have seen it's not going to be a great fit for him. Since he's already Stage 2, I'd rather get him to a more gentle insulin (and hopefully better regulated) to help those kidneys out.

As for the methods, bouncing doesn't matter. Dose is always based on nadir. You can follow either, it's up to your comfort level and goals for him. You can always start with one and switch to the other, I tend to advise that when possible because it usually allows for faster increases until you get to better numbers.

You would want to post on the Lantus board for starting dose advice the day or so before you are going to switch. Given his current numbers, I suspect they will tell you to keep the 1.25U. Typically yes he will start out a little higher since it's more gentle, and then increase from there. You would give your last shot of ProZinc, then start with Lantus 12 hours after that. You would hold the first Lantus dose for a week in order for depot to build.

Eating - technically there is nothing stopping you from feeding in the back half of the cycle right now, but yes it certainly will shoot him back up as it wears off/he bounces. The effects of later food on Lantus tend to be more dampened, yes (but not always). It would take some playing with the timing since Lantus will likely have a different trend vs ProZinc for him. Some cats do still do an early dive, but usually hold fairly flat once they get settled in.

The U100s are actually a little easier to read, you would want 0.3cc with half unit markings. It's drawn the same way though, 1.25U is 1.25U regardless of syringe (the inner volume of the syringes it's what's different, the markings themselves are in units - occasionally though, usually over in Europe, we get volume-based markings so let us know if that's the case).

Most of us tend to get the generic Semglee or "insulin glargine" as they're much cheaper and do the same thing. Basaglar is not the same, but is considered a biosimilar and would also work. I am not sure the cheapest way to get it anymore - some people find they can use a GoodRx coupon at a local pharmacy, some order from Marks Marine in Canada (beware possible shipping delays/temperature issues)
 
The syringes you need for the Lantus insulin are U100 3/10 ml 30 or 31 gauge 6 or 8 mm insulin syringes with 1/2 unit markings.
There are several brands available.
Cats that are not doing well on one insulin can do often better when switched to another type.
 
@FrostD I am still waiting to hear back from my vet regarding switching to Lantus (I e-mailed the morning of the 23rd and we've had a weekend and Hurricane Ian since, plus he has an appt next week), however it might be a good thing there was a delay - can you please take a look at his spreadsheet? I have actually had to DECREASE his dose again... and had a few instances where I wasn't comfortable shooting at all with his pre-shot numbers. At first I thought I had another meter go sideways like his original One Touch did, however then I started catching the mid and end cycle food/bounces so, to me, the meter has to be right. What in the world is going on - is this an artifact of the steep drops and bounces the Prozinc has been causing?

Some other info that I am not sure if it is relevant or not... but it might/probably be, so here it is:

His hydration levels have improved during this process - he's getting between 50-75ml SQs 3x per week where before it was once or twice a week. I can't remember if hydration impacts glucose readings or not?

He's also been on Orbax throughout (I am going to call tomorrow and confirm he should stop taking it since it's been 3 weeks - at least it killed his URI), and either it, or his other underlying issues, have done a number on his appetite. Its not that he's really eating less - still around 16oz per day - its just that he is taking forever to eat to the point I've had to delay giving a shot which throws off his entire schedule because we only have an hour to play with to get back on track later. I've been waiting until he's eaten at least 3/4 of his shot meal (just over 4 of 5.5 oz), and he's not inhaling his snack later like normal... I know a "normal" cat doesn't eat as much as he does, but he's underweight and I've been trying to fatten him up. I suppose his slower eating could also be his numbers being in a much better place than they were and he's just not ravenous anymore. I would expect his numbers would be higher since he's spreading the food out over a longer period, as well as building up a bit of a glucose reserve before getting his shot, but to me his numbers look like there is no way I could have kept him at 1.25 units.

EDIT 10/1: After days of meh appetite, he vomited overnight and was almost completely back to normal eating - bright and excited for food. Ate his 5.5oz in an hour. Too low to shoot tho, what a waste of a good morning. :joyful:

We've also tried swapping out Cerenia for Ondansetron to help with the panc/morning sickness, but that doesn't seem to help much as well. He still vomits - though not as often - however it takes him longer to do it... but also extends the amount of time he's not eating well beforehand.

Thanks to everyone and anyone for reading and responding.
 
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It's a little hard to tell what's going on with the changing doses, vomiting, etc. It could be that he's finally settling down, it could be the UTI finally gone, less carbs with vomiting, combination of things...

I would try to hold the 0.5U for a week if he's over 200. I would have called this morning close enough, or tried something like 0.25U if youre around to keep an eye on him.

Were/are you giving any sort of probiotic? Sometimes the antibiotics are so rough on the tummies that also affects eating habits, vomiting, etc. They just have to be spaced out at least 2 hours apart.

If he's actually vomiting, then Cerenia is better, yes.

His drive for food - again, hard to say whether that's because numbers are better or because his stomach is off. I will say that as soon as I saw better numbers with my cat, the appetite/drive changed right with it.

Sorry for the waffling answers! Just a lot going on at once, hard.to pinpoint what exactly is affecting what. But it does look like he's doing well on the ProZinc the last few days, probably worth holding off another two weeks to see how he does. Of course, no harm in asking for a script either, nothing says you have to fill it.
 
@FrostD thanks for looking and responding. Yesterday was a good day for Elmsley, and looking at his 4 readings he was pretty glucose steady.

I wasn't in a position where I could keep a close eye on him last night, so he got .25 units instead of .5 on a 201 reading. At +4 he was 237, and I even told him at the time looks like he could have got the half unit... though I did find it interesting that the .25 was enough to cover most of the rise on 5.5oz of BFF. He also got his 2.8oz oz BFF snack at +4, so this morning I surprised he was at 164 - I stalled/no food 30 minutes and he tested 163. I even tested myself and his meter was only 5 points off my Dexcom.

No shot again this morning... though if I had a syringe that would make it easy to dose 1/8 units I probably would have given him that since I know even a 164 is outside a "normal" glucose reading. I did look at the info on here about using calipers, however it seems that even breathing on the plunger of the 0.3cc needles on such a small dose would cause a fur shot. I looked around Amazon, and unless I am missing something, there aren't u40 syringes that get that granular? I also saw a similar quandary here (How to do .25 iu doses in a u40 syringe? | Feline Diabetes Message Board - FDMB) and it seemed the answer was using u100 syringes... but then same issue of eyeballing above or below marked units.

He is on a probiotic because of the chronic diarrhea, he is getting a Proviable capsule once per day (CKD side note - the bacteria in these are suspiciously close to the bacteria strains in Azodyl :confused:) as well as Pro-Pectalin twice daily. We did stop the Orbax yesterday (now need to watch for opportune infections in his chronic herpes) so hopefully his stomach will be a bit better.

This morning his appetite seems to be a repeat of yesterday morning - even after eating his entire 5.5oz for breakfast he pointed out twice that his food dish was empty lol.
 
His SS looks so good!

As for syringes, no. It is our main gripe, because they also often don't come with even half unit markings

It probably would be worth getting some U100 syringes with 1/2 unit markings because they do make it much easier to eyeball smaller doses....and he seems to be heading that way and fast (knock on wood). Conversion table here - http://felinediabetes.com/insulin-conversions.htm

Truthfully if you want a 0.25U dose of ProZinc, I'd just draw to 0.5U on the U100 (technically the conversion is 0.6U).

If you go that route we do recommend adding columns to your SS. Your dose column stays the U40 dose amount (0.25U) then you'd add a column next to it for the equivalent U100 dose. For your sanity and ours lol you'd also add "using U100 syringes" to your signature

Truthfully giving the small doses is no different than the big doses even though it seems more delicate. It's not so much are.you accurately eyeballing 0.25U, it's more are you consistent in what you're calling 0.25U.
 
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