? Injection tips

Hi
I have had big problems before trying to do a glucose curve (as you may have seen in my other posts) but the insulin jabs have usually been ok.

We have always done his jab on the breakfast bar and given him his brekkie or tea on there at the same time then done the jab as he is eating followed by lots of fuss & praise.

However, as Mac is getting better he has got more alert and the last few injections when I got the scruff tented he moved away from me sideways a bit as I was about to insert the needle, I then left it a few seconds then lifted the scruff again and tried again successfully. He is limited as to how far he can go as there is a wall there.

That has worked ok the last 3 or 4 times with me holding fire then starting again. But this morning on the second attempt he moved again once I actually had the needle in place and was depressing the syringe causing a complete furr shot - I actually saw the liquid come out the other side and hit the wall. Luckily our vet is open 24 hours a day 365 days a year so I was able to speak to someone at 08.45 on a bank holiday about what to then do about how much to give (was told a half dose) and managed to give that.

I feel a little down as I am willing to accept that getting blood samples is a battle with Mac (and may always be) but I really cannot risk his twice daily insulin jabs being a trauma and it is slowly getting harder And of course his fur is getting less loose as he puts weight back on which makes it a little less easy anyway. A friend had a dog with diabetes a few years ago and he proved to be utterly impossible to inject so had to be put to sleep in the end. I am now dreading the thought that I may ever have to face that issue with Mac.

I have read what I have found about de-sensitivity & conditioning & had a think about what I can try which I have listed below and I would be grateful for any thoughts\comments please about if this is the right direction to go or may make things worse. Or any other suggestions to try.
i) feed Mac every one of his meals on the breakfast bar with lots of fusses and praise - he has 4 or 5 small meals a day but only the injection time ones are fed to him on the bar - perhaps if I do every one there he will not be so twitchy as he will not know if it is jab time or not ? and associate it more with nice things not just injection time ?
ii) one idea (adapted from a video I saw) - put him on the bar, tent his fur for a few seconds and press into it,, praise him then give him his food bowl. Let him have a few bites whilst still praising him. Then take it away, wait a few seconds tent his fur again etc and give him his food back. Repeat a few times.

Any input would be very gratefully received as always. Night time jab is in 3 hours so depending on how that goes I may need to implement sneaky methods from tomorrow.

Thanks

Gill

 

I know what you mean Trouble never really felt his insulin injection. But I remember reading a long time ago that one person worked for a Zoo vet.his cat was difficult to shoot. His boss told him to give the area some really good scritches before injecting. Kinda like ruffing up the area then inject. It worked for that person but dont know if anyone else used the idea. Maybe try that?

I'm sure others will chime in on this. hang in there !

 

Hi Gill,

I disagree with the advice your vet gave you here.

The standard recommendation here is that if you have a fur shot you don't give a second injection because you can never be certain how much of the fur shot insulin dose the cat may have actually received. It is safer to wait until the next dose is due and then give the normal dose as usual.


Mogs
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And there's more...

Re desensitization, definitely getting Mac to spend time there when only nice things happen (e.g. treats, fuss and praise), then if there's the occasional BG check or insulin injection thrown into the mix it should become less of a deal for him (hopefully).

Re injection technique, I'm tagging @Elizabeth and Bertie to ask her to share her technique with you because I think it might help you with Mac.


Mogs
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Thanks Mogs I'll bear that in mind for the future - I'd like to think there would never be another fur shot but I doubt it. my usual vet wasn't on today so it was a vet nurse who told me that perhaps I should have insisted on speaking to a vet. Thinking about it my vet did say at the very start of this journey that it was not the end of the world if one injection got missed as too high BG for a half day is not severely dangerous in the way that too low is. So that would make sense with what you know.

Gill

 

Agree with Mogs I should have said that! my BAD!

 

I would like to know what any one has to say on this subject. Buddy is taking SuB Q fluids at home and he is a little on the chubby side and I am having a heck of a time tenting his skin for the needles that is used for fluids, he doesn't have much loose skin. I try to have him laying down with his feet in front of him, but that does not last very long.

 

Can you do a test please?
You don't know if some of the insulin from the fur shot went in. Because of this, it is recommended never to give a second shot no matter what. I'm concerned that some insulin from your fur shot went in.

Also, a spreadsheet would really help us help you. @Chris & China (GA) or @Bandit's Mom can help you with that.

 

Hi Gill, first off, here's a huge ((((reassuring hug)))) for you...

When Bertie was first diagnosed I absolutely hated giving insulin shots at first.... Well, that's not strictly true, the first couple of shots went fine, but things quickly went downhill from there for a little while...

I hated syringes anyway, but I'd practised on an orange to get the hang of things (surprisingly effective, actually, in terms of just getting used to the feel of the syringe and the sensations involved in giving the shot).
What I 'think' happened was that I injected too deeply and pricked some sensitive flesh. And that made Bertie wary of me for a while. ...Generally speaking our cats are actually incredibly forgiving of our little mistakes, and are usually fine again with shots once we've clocked up a few 'good' ones. But while our cats can be very forgiving, we can be less forgiving of ourselves. And if we think we've given a shot wrongly, and have maybe upset or hurt our cat, that can really damage our confidence. We can become more nervous of giving shots (there were times when I honestly thought I was going to puke when a shot was due...) and that nervousness can actually make giving the shots a bit harder to do. Then, if we give subsequent shots that go a bit wonky we can quite wrongly see that as a kind of confirmation that we just aren't any good at it. And before we know it we can start catastrophising and imagining all kinds of 'worst case scenarios'...

I'm going say something that I totally believe to be the case: You absolutely will get the hang of this, and it will become routine. I totally believe in your ability to do this, even though you may not, at this moment, believe that of yourself.

There are a number of things you can do to help rebuild your confidence, and the first thing is to just be kind to yourself; give yourself time to learn this, and also permission to make mistakes...

Something I found really helpful was getting Bertie used to the sensations involved in giving a shot at times when I wasn't actually giving the shot... If that makes sense..? ...So, at other times of day, just when I was stroking him normally, I'd gently just pull up some skin on his scruff, just for a second, and then let go and go back to stroking him normally, with lots of praise, and maybe a treat too. And if he was OK with that then later on I'd try stroking him, pulling up skin, and then just pressing against that with the tip of my little finger. Then he'd be rewarded with treats and praise. Then you can do the same thing but with a capped syringe instead of your little finger. In this way the kitty starts to get used to the sensations and come to see them as non-threatening, since nothing bad happens; and what's more he gets a cuddle and a treat as well.

It is also helpful to review the way that we're giving the insulin shot, taking it step by step. I realised that I was inclined to rush insulin shots because I just wanted to get it over with, but in fact slowing down made things easier... So, with the tenting technique it's important to check that you're pulling the skin well away from the flesh underneath. Then you can press against the wall of the tent with your finger and feel that 'hollow' area. And then you give the shot 'through the imaginary door' of that tent.

However... It turned out Bertie was a complete fidget and the tenting technique didn't actually work well for us for that reason (he'd just suddenly decide to wander off sometimes). And it was hard to give the shot if he moved. So, I used different technique which worked way better for us. ...I'd grab some loose skin between fingers and thumb of my non-dominant hand and pull it up and sort of tip it up slightly. Then I gave the shot almost directly downwards into the skin that I was holding in my hand, about mid-way between fingers and thumb. This method had a couple of advantages over the tenting technique for us. Firstly, if Bertie moved I could still give the shot, as long as I was holding on to that skin. Secondly, it meant that there was significantly less chance of injecting too deeply and pricking sensitive flesh, because the depth of skin in my hand was greater than the length of the needle, so the needle couldn't go too deep... This technique was a game changer with Bertie, and made things so much simpler with him.

I am sure you will find a method that works for you...

 

@Elizabeth and Bertie - Thanks, Eliz.


Mogs
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Thanks Elizabeth there's some great tips there that I will certainly be trying out.

 

Gill, another option you have that can be helpful (and as I mentioned a few days ago to Anna) is to use U100 syringes with your U40 insulin; but this has to be done with our 'conversion chart' to ensure you're giving the right dose. U100 syringes are a bit shorter and finer than U40's. This does make giving injections easier for some folks. If you'd like me to send you some U100's to try I'm happy to do that.

 

I also find that room temperature insulin “stings less” so I leave the syringe out for about 20 minutes or so to warm up. I also rub it with my fingers. Sorry if Vetsulin is not refrigerated, disregard my comment. The angle to the needle and the length of the needle also play a part. What the needle length you’re using? Shorter ones are better like 6mm. As for angle, I try to get is as parallel to her body as I can so the needle is not digging in but going int sideways

 

When I was still giving Jack insulin, I found that the timing was extremely important. The first few times, I gave him his insulin while he was eating and that seemed to work okay. But early on he decided that he absolutely no longer wanted that shot. I found that with Jack, I had to wait until he was done eating and actually done cleaning himself before he would tolerate the insulin. And then, he seemed fine. But he made it clear he did not want it while he was eating and he wanted to give himself his bath afterward.

 

That is so kind of you Elizabeth I'll certainly keep the idea of swapping sizes in mind - I'll probably panic then about getting my dose wrong though lol.
Just done his night time injection using my stop wait fuss and try again method when he moved away but going slower so I could make sure I stayed parallel to the skin and it went better again. I also moved back a bit further from the scruff to more shoulder blade level. Want to try the idea sometime of injecting downwards between fingers but need to work that out a bit more as if he keeps of squirming I've can image ending up an angle and going out the sides or impaling my fingers on the way down- I've stabbed myself before but never yet managed to inject any insulin in - perhaps I should get a high carb food in ready for me in case !

 

Hi @Gill & Mac (UK),

I absolutely feel your pain as its been hit and miss for me. Last night was probably the worse, Douglas moved so much that the needle bent so I had to get a new one set up. By this time I was so nervous and shakey, plus Douglas trying to bite me that I eventually gave up. I just couldn't go through with it.

But today I reset, and got it done. I am finding that if I hesitate after pulling up the skin then Douglas starts to squirm. Its almost like he's telling me 'right, you've got one go then I'm moving'. Good days and bad days for me at the moment.

I even showed my mum at the weekend how I administer (thinking about when I want to perhaps go away for a day or two) and she just looked at me and said 'I dont think I can do that but you are so good at it'. I remember a couple of months ago thinking I could never do it, let alone hometesting. Yet here we are.

Quite early on I stabbed myself with the needle while injecting Douglas and it crossed my mind that apart from pure sugar, I didnt have anything too sugary (all sugar free stuff only!) But I went on a video call with a couple of my friends and told them that if I pass out that they just needed to call my mum. Haha

 

[QUOTE="Aleluia Grugru & Minnie, post: The angle to the needle and the length of the needle also play a part. What the needle length you’re using? Shorter ones are better like 6mm. As for angle, I try to get is as parallel to her body as I can so the needle is not digging in but going int sideways[/QUOTE]

Hi Aleluia
I've just done the evening injection so I measured the needle and it is a 10mm one. The vet issued me with those ones (same as the caninsulin ones but by Sol-Vet) and I've just bought some more of the same. Didn't realise you can get shorter ones so I'll have to look into that next time if I'm still having issues.
It is interesting you saying about letting the insulin get to room temp - I read about that tip somewhere on here about insulin in general so I asked my vet at the start could I do that with the whole vial or just put the dose in the syringe and leave that out for 10 mins ? but he said not to as it would start to break down straightaway. I was surprised that 10 mins could make much difference but i don't know any better so I have just tried to warm the syringe in my fingers for a few seconds. Interestingly I'm sure I've read that if you use the caninsulin vetpen that does not have to be kept in the fridge only any cartridges that have not been put in the pen have to be. So unless it is a different formula something does not seem to agree - perhaps I'll email the manufacturer and ask them.
Took my time on the jab an hour ago and seems to have gone a bit better.

Gill

 

Hi Carolyn - that was a great tip thanks. So when I did the injection an hour ago I watched Mac's reaction and left it for a minute or so with just fusses & praise whilst he got a few mouthfuls of food down then noticed that he seemed to relax slightly so then I went in for the injection whereas before I would dive in as soon as he lowered his head to his bowl in case I missed my chance. Will definitely try to factor in that lesson in future.

Gill

 

PS @Douglas_my ginger cat
to Douglas' ' parent somehow i managed to get my reply to you in the orange quote box in the reply so you'll need to expand it to see it.

That's a new one for me - going well today !

 

That’s a really good point. They certainly know what they want and what they don’t want. Minnie would stop eating when I would give her the injection during. And now I have to make sure she eats so I’m usually holding the bowl and can’t inject at the same time. She likes to walk away from the spot she’s eating at and I need to wait until she sits again to then inject her. Sometimes she will walk away because she’s just not in the mood for it. So I’ve learned to insert the needle into her skin and take a beat before pushing the insulin in. That beat allows me to see what her next move is going to be. If she walks away and the needle comes off, at least I haven’t wasted the insulin and I can try again because nothing was pushed in yet.

 

I always found it interesting to read through the Message Board. There are as many ways of testing and injecting insulin as there are diabetic cats and their human parental units. Each cat is so different, and they see to it that we accommodate them!

 

Accommodate is my middle name now. I’ve been rebaptized by Bobo and Minnie

 

Funny...mine is SLAVE

 

They teach us well. My daughter's been telling me for years that Jack has me wrapped around his little kitty paw!

 

I was actually going to refer to us as human slaves and changed my mind. I decided to just go with parental units.

 

LMAO!!!

 

Need to do another BG curve for the vet tomorrow (the second one) - had nightmare with Mac last time so am debating using lancing pen just to hold the lancet with the top off so I can see better and then pricking it manually rather than firing it. But I am worried that I might be too heavy handed when making the prick. I've just done a trail run on husband and got much more blood when I did it myself rather than using the tool's shot so I think I went too hard. Does it take much pressure to break through the the skin on a cat's ear to get a blood drop? I don't want too press the lancet in too much but neither do I want to go too light and have to do it several times.

 

Hi, I'm not as experienced as others on here but I dont use the lancet pen. I find that it doesn't take a lot to break the skin and I can hear, what can only be described as, a little 'tear' or a light pop. I never get nowhere near the amount of blood on that photo. I also use a cotton ball pad to hold against the other side of the ear.

 

My husband always has bled easily - I didn't prick him with that much force I promise. A light pop sounds a good description I'll try for that.
I can't believe what a good boy your Douglas is being so soon about being tested. I need to get him on a video call to lecture Mac on how to behave.
I have tuna ready for tomorrow for each post test attempt treat - not tried tuna before. If all else fails I am going to go the "burrito cat" route as a last resort.
Give Douglas an extra fuss well done from me & yourself a big pat on the back.
Yours filled with envy
Gill

 

If you prick through the ear you wont do anything ALL of us havent done at one time or another. After collecting the blood and reading just hold the ear with a little pressure. Having a cotton ball helps.

 

Thank you, I am waiting for the day the wind changes and it all falls apart.

The 'pop' is now followed by a little 'ouch' (I sweae it sounds like that) so I know ive broken skin. This evenings test, the first try no pop or ouch and then second go, it all came together.

I also snuggle Douglas between my side and arm and gently push him towards my leg (I do the testing on a corner sofa) if he tries to wriggle away. He's kind of learnt that he won't get away until the beep.

I know you will get there with Mac.

 

To be honest, I think I prick through the ear 75% of the time. Agree with JT, holding the cotton bud on both side for a few seconds really helps. I do this while he snacks on his treat

 

I wonder if there is a business opportunity just waiting to taken up for cat earrings to fill all those accidental full piercings we make! Hmm. "Kitty jewels" or "Ear kitty kitty" perhaps.

Gill

 

LOVE THIS! Dragon Den it!

 

A re you using a 26 or 28 gauge lancet, they are a little thicker. I just hold the lancet and prick the ear. Try to milk the ear a little, push up under where you see the blood. Good luck