Help w/ blood draw

Cleocatra

Cleocatra

Member
Cleo is now getting a short little temper and does not like me messing w/ her ears to get a blood sample. Does anyone have any tricks? It's usually when she's hungry. I can clip her front claws by wrapping a towel around her head, but obviously that won't work w/ the ears. I think the hunger drive has increased and is fueling her short temper. It's pretty much impossible to get mid-day tests now.
 
Feed her a tiny bit of food before you do those mid-day tests. Should not impact the BG levels enough that quickly, to throw off the BG readings. Food usually takes 15-20 minutes or more to have an impact on the blood glucose.

Remember, our diabetic cats get fed normally except for the pre-shot test, when food is withheld for 2 hours before. So you don't shoot into a low BG level that is inflated by the food influence.

There is even one member here, Susan and Claudio, where we have suggested she feed her cat a little bit of food, maybe a teaspoon, right before the pre-shot test, to get him to cooperate a bit more. She has been very badly clawed by her cat, and her cat Claudio got very close to Susan's eye with a claw.
 
Deb & Wink said:
Feed her a tiny bit of food before you do those mid-day tests. Should not impact the BG levels enough that quickly, to throw off the BG readings. Food usually takes 15-20 minutes or more to have an impact on the blood glucose.

Remember, our diabetic cats get fed normally except for the pre-shot test, when food is withheld for 2 hours before. So you don't shoot into a low BG level that is inflated by the food influence.

There is even one member here, Susan and Claudio, where we have suggested she feed her cat a little bit of food, maybe a teaspoon, right before the pre-shot test, to get him to cooperate a bit more. She has been very badly clawed by her cat, and her cat Claudio got very close to Susan's eye with a claw.
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We've always thought Cleo started life as a feral or stray because of her strong will. She insisted on living in a house instead of the garage. And then she would terrorize the other 3 cats living indoors at our friends house in Lubbock. So that's why I think her snappy little temper is not easily controlled. Lately, I have to wait until she's full, and then she's calm and I can attempt to test. But it's still been dicey. I'm thinking about giving her a gabapentin pill I got from the vet to prep for her test 3 weeks ago. My wife doesn't like the idea of drugging her but the dose was prescribed by the vet and it didn't really make her very drowsy. at least it will calm her down for a day--maybe!
 
Gabapentin can help with nerve pain also. I thought I remember you saying in a previous thread, that you were giving Cleocatra Zobaliine. Did a search and you did say that.
Litter box help for neuropathic rear end

Diabetic neuropathy is very painful. Trust me on that score. Personal experience with nerve pain. Cleo may be cranky and has a temper from the pain. Think of the worst headache you have ever had. Then double or quadruple that pain. That is how bad nerve pain can be.

Please help your wife understand that the gabapentin is not just to "calm Cleo down" but it's to help with chronic pain. Chronic pain can be debilitating for pets as well as people. But pets can't tell you when they are hurting except with their body language and behavior. Cleo is telling you loud and clear that she is in pain.

Arthritis is also painful. Does Cleocatra have arthritis?
 
Deb & Wink said:
Gabapentin can help with nerve pain also. I thought I remember you saying in a previous thread, that you were giving Cleocatra Zobaliine. Did a search and you did say that.
Litter box help for neuropathic rear end


Please help your wife understand that the gabapentin is not just to "calm Cleo down" but it's to help with chronic pain. Chronic pain can be debilitating for pets as well as people. But pets can't tell you when they are hurting except with their body language and behavior. Cleo is telling you loud and clear that she is in pain.

Arthritis is also painful. Does Cleocatra have arthritis?
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No arthritis that we know of. We both have forms of arthritis so we know what that feels like. I want to give her some gab to calm her down so I can run a full day of tests. The vet said 1 pill in the morning and that's it. I don't think she's in much pain because she gets around fairly well, but lays around most of the day- not very active, but very alrert. 1 pill should make her feel good for a day and hopefully let me get good tests without biting me.
 
Human acros can get headaches, so there is some speculation our kitties do too. Many of them end up on either gabapentin or buprenorphine. My girl had severe arthritis so we added bupe. It made a world of difference for her. She became a lot more interactive and playful. Before that she was just lying around.
 
I have some gabapentin- should I just give it to her tomorrow a.m.?? Not sure she should be getting it on a regular basis...but not sure. I still feel like we're wandering around in the dark somewhat. I have to call the vet Monday w/ latest curve. The cabergoline is on it's way. I think she needs higher lantus dosage, but I guess I need to hear from dr. first.
 
I rather suspect she needs more insulin. At one point I stopped waiting for my vet to get back to me about dosing. People here had more on hands experience than my vet, and it allowed me to increase faster. Lingering in high numbers is not good.

You should discuss gabapentin with your vet. For many acros, at some point pain relief becomes a daily med. Not sure if Cleo is there yet.
 
Running a full curve today. AMPS=477. I have to let her eat before she'll cooperate for a test. Gave her a gabapentin to hopefully calm her throughout the day. I went ahead and increased Lantus to 9U. It seems like throughout the increase in dosing, the numbers are not even BUDGING. I am getting pissed. How much insulin do I have to pump in her to make those #'s come down?? Poor cat has had high #'s for so long and we've just been going at this so slowwwww. I'm getting impatient and I want to increase the dose more to see if the #'s will come down.
 
It's usually better to do a curve after the depot has had time to establish. Good luck with the curve.
Cleocatra said:
How much insulin do I have to pump in her to make those #'s come down??
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We've seen acros with much higher doses, north of 50 units. Not saying Cleo needs that, we just don't know. My girl maxed out at 8.75 units. So it can be all over the place. Rather than increase the dose by larger amounts, at this point, it would be better to increase faster, if you had the data to do so safely.
 
Wendy&Neko said:
It's usually better to do a curve after the depot has had time to establish. Good luck with the curve.

We've seen acros with much higher doses, north of 50 units. Not saying Cleo needs that, we just don't know. My girl maxed out at 8.75 units. So it can be all over the place. Rather than increase the dose by larger amounts, at this point, it would be better to increase faster, if you had the data to do so safely.
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So are you saying to bump it up 1U at a time every day or so (based on test) rather than bump up 2, 3 or 4U's at a time? No I do not think big bumps are safe, rather 1U at a time every day or so at this point until I can see the #'s coming down. I do best on the weekends when I can be with her all day. Got a day job and the Mrs. can't do the tests.
 
If you were following TR (Tight Regulation) you would be getting those pre-shot tests before every shot (yes, I know she fights you on that). And you would be holding the dose for 6 12 hour cycles and then increasing the dose.

The depot needs that time to establish. Bumping up the dose every day would not give the depot time to establish.

I'll let Wendy address the bumping up more often. It's the lack of data that limits your ability to increase faster. Catch-22 situation.

Ok, you have a day job, wife refuses to test. How about adjusting your shot schedule? Would that be possible?
 
[/quote] Ok, you have a day job, wife refuses to test. How about adjusting your shot schedule? Would that be possible?[/QUOTE]
She has arthritis in her hands and can't control Cleo to draw ear blood. She's good w/ shots tho. I'm good w/ the 7am & 7pm shot schedule. I can at least do a AMPS test, then do a PMPS test when I get home, then 1 or 2 night tests before midnight bedtime.
 
Cleocatra said:
* I wonder if the hi #'s are because she's eating so much?
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No, it's not the food, it's the cat.

If you were able to get a preshot test every shot and one other test each cycle, the absolute fastest we would increase is every 4 cycles or two days, and occasionally would stretch it out to 3 days. Any increases must be done with safety in mind. When I look at Cleo's spreadsheet, I can see one possibility is she's way overdose and her body is fighting hard to keep her numbers up. I just can't tell because there's not enough data. If you can't get daytime tests except your days off, then could slow down the increases until you get six cycles with two tests in them (plus all preshots). That would still be faster than what you are doing now. One night time test before bed would probably be enough at night, for now. Could your wife do paw pad testing?
Cleocatra said:
So are you saying to bump it up 1U at a time every day or so (based on test) rather than bump up 2, 3 or 4U's at a time?
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Absolutely not, the depot needs to form first so you can see what the dose can do. That takes around 6 cycles at the same dose. Going to four or five cycles is accelerated and we'd slow down once you got below 300.

How is Cleo reacting to the shots? She's starting to get up there in dose on Lantus. Due to the acid base of Lantus, many cats start reacting to the shot, at which point we suggest people switch to Levemir.
 
Wendy&Neko said:
How is Cleo reacting to the shots? She's starting to get up there in dose on Lantus. Due to the acid base of Lantus, many cats start reacting to the shot, at which point we suggest people switch to Levemir.
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She's not reacting to the shots as far as I can tell. We shoot her while she eats and most times she doesn't flinch. She's not sensitive when I rub her in the injection site areas (side, low rib loose skin area). Ok I understand the depot needing more time to build up before it goes into bloodstream. I have to talk to the vet tomorrow so I won't increase dose. I've only hit her w/ 9U the last 2 shots. Maybe I should go back to 8U until dr. talk. I tend to be one of those "more is better" type of guys.
Time to test but she's not cooperating.
 
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I would stay with 9 units. You've already started to build the depot. Going backwards isn't usually the best way to go.

Have you ever asked your vet how many acromegalic cats they have treated?
 
Wendy&Neko said:
I would stay with 9 units. You've already started to build the depot. Going backwards isn't usually the best way to go.

Have you ever asked your vet how many acromegalic cats they have treated?
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From what I can tell by her age & demeanor, not many. Cabergoline was a new idea to her.
 
Neko was my vet's first, to her knowledge. Then once we learned more together, she realized she had another in the practice. Not surprising cabergoline is a new concept, it's only a couple years old.
 
As I said, a curve is usually better once the depot is built. There is a phenomenon we call New Dose Wonkiness, or NDW, where the numbers can go higher the first 2-3 cycles after an increase. Maybe due to the depot rebalancing? We don't know for sure, but it happens.

Poor little Cleo.
 
Rubbing the area where you shoot lantus is not good. That is because of that lantus depot. Lantus forms a microcrystalline structure beneath the skin in the injection site area. If you are rubbing or massaging the injection site, you are disrupting that microcrystalline structure and you may be causing the insulin to release faster.

You want those crystals to dissolve on their own, slowly releasing the insulin. It's what gives lantus it's nice long duration and gentle curve.

Yes, please stop rubbing the injection site to "diffuse the shot."

Lightly running your hand through the fur to check for wetness is ok. But please don't rub or massage the area.

"insulin glargine has an isoelectric point of pH 7, which renders the insulin molecule soluble in acidic solution (pH 4) [84]. Upon SC injection, the acidic solution is neutralised leading to formation of microprecipitates from which small amounts of insulin glargine are continuously released to the circulation"
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6079517/

"Soluble insulin that does not precipitate in the SC tissue will diffuse and increase in volume upon SC injection, resulting in depot dilution. The relative increase in depot volume and consequently depot dilution occurs faster for small- compared to large-volume depots [34]. Smaller depots will also have a relatively larger surface-to-volume ratio that increases the diffusion area of the injection depot [101]. The result is a relatively faster absorption with smaller injection volumes"

Relevant to the large dose of insulin you are using, that larger depot will have a slower absorption rate.

Proper injection technique with large doses of insulin are also important. So that the insulin dose does not leak back out after injection. Just as you would hold an insulin pen for 10 seconds before withdrawing it, you may want to consider using that same technique with large insulin doses. See table 4 in this document from 2018
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6079517/
 
Deb & Wink said:
Rubbing the area where you shoot lantus is not good. That is because of that lantus depot. Lantus forms a microcrystalline structure beneath the skin in the injection site area. If you are rubbing or massaging the injection site, you are disrupting that microcrystalline structure and you may be causing the insulin to release faster.

You want those crystals to dissolve on their own, slowly releasing the insulin. It's what gives lantus it's nice long duration and gentle curve.

Yes, please stop rubbing the injection site to "diffuse the shot."

Lightly running your hand through the fur to check for wetness is ok. But please don't rub or massage the area.

"insulin glargine has an isoelectric point of pH 7, which renders the insulin molecule soluble in acidic solution (pH 4) [84]. Upon SC injection, the acidic solution is neutralised leading to formation of microprecipitates from which small amounts of insulin glargine are continuously released to the circulation"
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6079517/

"Soluble insulin that does not precipitate in the SC tissue will diffuse and increase in volume upon SC injection, resulting in depot dilution. The relative increase in depot volume and consequently depot dilution occurs faster for small- compared to large-volume depots [34]. Smaller depots will also have a relatively larger surface-to-volume ratio that increases the diffusion area of the injection depot [101]. The result is a relatively faster absorption with smaller injection volumes"

Relevant to the large dose of insulin you are using, that larger depot will have a slower absorption rate.

Proper injection technique with large doses of insulin are also important. So that the insulin dose does not leak back out after injection. Just as you would hold an insulin pen for 10 seconds before withdrawing it, you may want to consider using that same technique with large insulin doses. See table 4 in this document from 2018
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6079517/
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Very good info. We will modify our technique. Thanks Deb!!!
 
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