New Member - Missed Injection?

[Michele A & Christy]

Hi all - My 14.5 year-old cat, Christy, was dx'd on Saturday. This morning was her 3rd shot (1U) and I think I poked through the other side of the skin tent. The injection site smells faintly of insulin (Semglee glargine) but not as strong as the smell on the syringe (I sniffed the needle).

She was 262 at AMPS. From reading, I see that glargine sometimes takes a while to show activity, so I'm not sure how to manage a 2nd try for the AM shot.

1. Test at +1 and +2, and if both are higher than 262 (and especially if +2 is higher than +1), shoot again?
2. Test at +1 and +2, and if both are right around 262, do nothing and test again at +3?
3. Test at +1 and +2, and if both are lower than 262, then I know the first shot went in?

FWIW, testing her is really difficult. She has *always* hated having her ears touched, so she shakes her head, folds her ears, "flicks" her ears, etc. I've cleaned up so much blood spatter over the past 18 hours and had to soak blood spots out of three different shirts. I honestly don't know how I'm going to do this 6-12 times a day for the rest of Christy's life.

Michele A

 

[Teetee (UK)]

Hi all - My 14.5 year-old cat, Christy, was dx'd on Saturday. This morning was her 3rd shot (1U) and I think I poked through the other side of the skin tent. The injection site smells faintly of insulin (Semglee glargine) but not as strong as the smell on the syringe (I sniffed the needle).

She was 262 at AMPS. From reading, I see that glargine sometimes takes a while to show activity, so I'm not sure how to manage a 2nd try for the AM shot.

1. Test at +1 and +2, and if both are higher than 262 (and especially if +2 is higher than +1), shoot again?
2. Test at +1 and +2, and if both are right around 262, do nothing and test again at +3?
3. Test at +1 and +2, and if both are lower than 262, then I know the first shot went in?

FWIW, testing her is really difficult. She has *always* hated having her ears touched, so she shakes her head, folds her ears, "flicks" her ears, etc. I've cleaned up so much blood spatter over the past 18 hours and had to soak blood spots out of three different shirts. I honestly don't know how I'm going to do this 6-12 times a day for the rest of Christy's life.

Michele A

Hi Michele,
No you can't shoot again until her PM shot.
There is nothing you can do other than monitor her, you will have to wait now until her PM shot.

 

[Michele A & Christy]

Hi Michele,
No you can't shoot again until her PM shot.
There is nothing can do other than monitor her, you will have to wait now until her PM shot.

Thank you so much, Tee!

+1 was 254. I'm going to wait until +3 to test again because she's snuggled up on a heated bed in the dining room window right now (we're at +2 right now). She ate a normal amount, chowed down a small piece of FF salmon, and seems to be OK, so I don't want to stress her more than necessary.

Michele

 

[Teetee (UK)]

No problem Michele

This is taken from this Lantus sticky.

• In the case of a furshot, NEVER give another shot. There's no way of knowing how much of the first shot "got into" the cat.

https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

I don't know if you have had the chance yet but here is quite a lot of information on the Lantus forum sticky's that's really helpful.
https://www.felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/

As for ear testing it will become more easier for you both as you go along. My cat was the same, blood all over the walls etc until we both got into a routine.
Try just rubbing her ears when you walk past her and then give her a little treat so she can get used to you touching them.
Some home testing tips.
https://felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

 

[Teetee (UK)]

There is also this method that you can use to test Christy's ears, i've borrowed one of your posts @Diane Tyler's Mom i hope you don't mind.

Always aim for the sweet spot warm the ears up first, you can put rice in a sock and put it in the microwave, test it on the inside of your wrist to be sure it's not to hot, like you would test a babies bottle. You can fill a pill bottle with warm water and roll it on the ears also.Just keep rubbing the ears with your fingers to warm them up

6. As the ears get used to bleeding and grow more capilares, it gets easier to get the amount of blood you need on the first try. If he won’t stand still, you can get the blood onto a clean finger nail and test from there.
When you do get some blood you can try milking the ear.
Get you finger and gently push up toward the blood , more will appear
You will put the cotton round behind his ear in case you poke your finger, after you are done testing you will fold the cotton round over his ear to stop the bleeding , press gently for about 20 seconds until it stops
Get 26 or 28 gauge lancets
Take a look at the lancets ,you will see one side points up, that's the side you want to poke with
A lot of us use the lancets to test freehand
I find it better to see where I'm aiming
You can also put a thin layer of vaseline on the ear ,to help the blood bead up
A video one of our members posted
VIDEO: How to test your cat's blood sugar

 

[Michele A & Christy]

Dumb newbie question: Is the sweet spot on the side of the ear above the forehead or the outer side?

 

[Teetee (UK)]

Dumb newbie question: Is the sweet spot on the side of the ear above the forehead or the outer side?

View attachment 64887

Personally i use the one above the forehead but i know others use the other side, it doesn't really matter as the ear will grow more capilares as you go along

Here's a video from Janet one of our members on here showing what she used to do with her cat C.C

 

[Diane Tyler's Mom GA]

There is also this method that you can use to test Christy's ears, i've borrowed one of your posts @Diane Tyler's Mom i hope you don't mind.

Always aim for the sweet spot warm the ears up first, you can put rice in a sock and put it in the microwave, test it on the inside of your wrist to be sure it's not to hot, like you would test a babies bottle. You can fill a pill bottle with warm water and roll it on the ears also.Just keep rubbing the ears with your fingers to warm them up

6. As the ears get used to bleeding and grow more capilares, it gets easier to get the amount of blood you need on the first try. If he won’t stand still, you can get the blood onto a clean finger nail and test from there.
When you do get some blood you can try milking the ear.
Get you finger and gently push up toward the blood , more will appear
You will put the cotton round behind his ear in case you poke your finger, after you are done testing you will fold the cotton round over his ear to stop the bleeding , press gently for about 20 seconds until it stops
Get 26 or 28 gauge lancets
Take a look at the lancets ,you will see one side points up, that's the side you want to poke with
A lot of us use the lancets to test freehand
I find it better to see where I'm aiming
You can also put a thin layer of vaseline on the ear ,to help the blood bead up
A video one of our members posted
VIDEO: How to test your cat's blood sugar

I don't mind at all Tee @Teetee (UK)

 

[Noah & me (GA)]

Dumb newbie question

There's no such thing as a dumb question here. No matter how sure you are you've missed, what we call a fur shot, never ever inject again. Just ride it out until the next shot time. You're not the first, I've seen a vet do it and in the right light you could see that little stream go shooting right across the exam room.

 

[Michele A & Christy]

Thank you, Tee.

This is all so nerve-wracking. I'm lucky enough to work from home most of the time but I haven't gotten much of anything done today.

I have a rice bag that's a wrist rest for use with a mouse. It's got a soft, fuzzy side and I've been petting her ear (and forehead and cheeks, so as not to give the game away) with part of the soft side after microwaving it for 15-20 seconds.

I did the massage-the-ear thing to get a bit more blood 2 or 3 of the times I tested, but she shook her head and the blood smeared on my fingers.

After the first couple of tests, I started using the lancet free hand. I can see where I'm aiming, but I'm not as fast as the pen and have made tiny slices in her ear when she jerks her head the microsecond after the lancet pierces her skin.

I don't understand about "look at the lancets, you will see one side points up, that's the side you want to poke with". I know that some needles have a "scoop" at the sharp tip where a bit of the metal has been cut away to form the point. I don't see that on my lancets, but I haven't gotten out my magnifying glass yet, either. Other than that, my lancets have a plastic handle with the sharp metal sticking out of one end.

And, again, thank you. I appreciate you taking time out of your day to help me.

 

[Teetee (UK)]

Thank you, Tee.

This is all so nerve-wracking. I'm lucky enough to work from home most of the time but I haven't gotten much of anything done today.

I have a rice bag that's a wrist rest for use with a mouse. It's got a soft, fuzzy side and I've been petting her ear (and forehead and cheeks, so as not to give the game away) with part of the soft side after microwaving it for 15-20 seconds.

I did the massage-the-ear thing to get a bit more blood 2 or 3 of the times I tested, but she shook her head and the blood smeared on my fingers.

After the first couple of tests, I started using the lancet free hand. I can see where I'm aiming, but I'm not as fast as the pen and have made tiny slices in her ear when she jerks her head the microsecond after the lancet pierces her skin.

I don't understand about "look at the lancets, you will see one side points up, that's the side you want to poke with". I know that some needles have a "scoop" at the sharp tip where a bit of the metal has been cut away to form the point. I don't see that on my lancets, but I haven't gotten out my magnifying glass yet, either. Other than that, my lancets have a plastic handle with the sharp metal sticking out of one end.

And, again, thank you. I appreciate you taking time out of your day to help me.

Hi Michele,
If you look at this pic you will see the angle on the end, this is what you want to poke with, i'm sure you will see it if you get it under a good light and then if you rotate it it will become visible.
Also when poking try to avoid the big vein but not to worry if you hit it as it will just bleed more, also try to prick at a 45 degree angle so's that you don't poke straight through the ear, again no big issue but best try not to do that, i've gone through a few times myself as will most people on here.
If she's really naughty then what you can do is when you have poked her and got some blood put some on your clean fingernail and test from there, then she's free to go after you've cleaned her ear without you having to hold her to test.

 

[Michele A & Christy]

Hi Michelle,
If you look at this pic you will see the angle on the end, this is what you want to poke with, i'm sure you will see it if you get it under a good light and then if you rotate it it will become visible.
Also when poking try to avoid the big vein but not to worry if you hit it as it will just bleed more, also try to prick at a 45 degree angle so's that you don't poke straight through the ear, again no big issue but best try not to do that, i've gone through a few times myself as will most people on here.
If she's really naughty then what you can do is when you have poked her and got some blood put some on your clean fingernail and test from there, then she's free to go after you've cleaned her ear without you having to hold her to test.

I'm still confused. Wouldn't that pointy tip of the slant reach the ear first, no matter how I am holding the lancet?

Or are you saying to hold it so the slant is facing upward, like this?

 

[Manuel]

I had the same question, Michele, about which side of the ear to poke. Thanks for making the diagram. I just read on one of the stickies here that it helps to wait a few seconds for the blood to bead before trying to massage some more out. Maybe that will help. I also started testing just in the last week and it's good to know that we're not alone in this!

 

[Noah & me (GA)]

pointy tip of the slant reaches the ear first

That slanted end is also what most people call the bevel but pointy tip gets the point across just fine. Yes you got that right, whether it's a syringe or a lancet the tip goes in first. Most people go home from the vet thinking the syringe is the scary thing but the real test is the lancet. Our first sugar cat was a perfect patient but Noah was nervous and only had one good ear, years of practice still meant a shredded ear and too much blood some days. This will all get better, we promise.

 

[Sugar’s Mama]

Welcome! Hopefully everyone else’s advice was helpful. I’m just commenting to say how much I appreciate your illustrations! So cute. Keep ‘em coming!

 

[Michele A & Christy]

Welcome! Hopefully everyone else’s advice was helpful. I’m just commenting to say how much I appreciate your illustrations! So cute. Keep ‘em coming!

Thanks, Jen.

And, yes, everyone else's advice was helpful, especially Tee's.

I didn't check Christy BG again after +4 (300) because there wasn't anything I could / can do as it rises throughout the day. It's been hard watching her get ever more thirsty and counting down until I can give her the PM shot. Only one more hour to go!

 

[Sugar’s Mama]

They make you feel like you are torturing them without food! Mine paces and gives me the Puss in Boots eyes!

 

[Diane Tyler's Mom GA]

@Michele A & Christy
Hi Michele the side of the lancet you want to poke with is facing upwards ,that's the side you want to poke with. Curved up toward the ceiling .
It's hard to see , get a magnifying glass to take a look at it ,or put it by a good light.
On my lancets where there are those little cutouts , ( that's the best way I could explain it) well on mine one side those cutouts are bigger on one side and smaller on the other side, so one I saw where the point was facing upwards it was on the small cutouts on the plastic , so I don't have to look for the part of the lancet that's facing up. I just turn my lancets to that side and poke

@Manuel I saw you were asking about this also

 

[Michele A & Christy]

They make you feel like you are torturing them without food! Mine paces and gives me the Puss in Boots eyes!
View attachment 64903

Ha! Ain't that the truth! I always think of Little Shop of Horrors: "Feeeeed me, Seymour!"

I gave Christy small amounts of 0% carb food and treats throughout the day, hoping I could keep her nourished without completely blowing up her BG.

She came in at 347 PMPS, so, not good. But I hope that the 47 point difference between AM+4 and PMPS is a moderate (?) increase, aided by the low carb food and the long-acting nature of glargine. But maybe 47 points is a huge jump?

Anyway, I'm 90% sure I got the PM shot under her skin and not in her fur. Time will tell.

P.S. I had a CRF kitty back in the late 1990's/early 2000's and giving sub-Q fluids was soooooo much easier! I knew within a second if I hadn't seated the needle correctly, and the dose didn't need to be hyper-precise. This insulin stuff is a whole 'nother ballgame.

 

[Teetee (UK)]

Ha! Ain't that the truth! I always think of Little Shop of Horrors: "Feeeeed me, Seymour!"

I gave Christy small amounts of 0% carb food and treats throughout the day, hoping I could keep her nourished without completely blowing up her BG.

She came in at 347 PMPS, so, not good. But I hope that the 47 point difference between AM+4 and PMPS is a moderate (?) increase, aided by the low carb food and the long-acting nature of glargine. But maybe 47 points is a huge jump?

Anyway, I'm 90% sure I got the PM shot under her skin and not in her fur. Time will tell.

P.S. I had a CRF kitty back in the late 1990's/early 2000's and giving sub-Q fluids was soooooo much easier! I knew within a second if I hadn't seated the needle correctly, and the dose didn't need to be hyper-precise. This insulin stuff is a whole 'nother ballgame.

It will become second nature soon Michele, i promise.
We all found it strange and daunting at first.
As for the 47 points jump i cannot say because i'm not a Lantus user.
Sorry about spelling your name wrong (twice) i've changed it now.

 

[Michele A & Christy]

It will become second nature soon Michele, i promise.
We all found it strange and daunting at first.
As for the 47 points jump i cannot say because i'm not a Lantus user.
Sorry about spelling your name wrong (twice) i've changed it now.

Tee - Don't worry about spelling my name the "right" way! My mom is the one who got it wrong. ;-)

My manger *still* spells it with two L's, no matter how many times I reply to his emails and IM's with double consonants in his name (Jared). "Thanks for the info, Jarred!" "I'll pull that data from SAP, Jaredd, and send it over."

 

[Teetee (UK)]

Tee - Don't worry about spelling my name the "right" way! My mom is the one who got it wrong. ;-)

My manger *still* spells it with two L's, no matter how many times I reply to his emails and IM's with double consonants in his name (Jared). "Thanks for the info, Jarred!" "I'll pull that data from SAP, Jaredd, and send it over."

Lol, love it.