New to Caninsulin...struggling with home glucose testing

Hi
I’ve just joined the forum as my 14 year old cat has just been diagnosed with diabetes. He is on caninsulin. We have managed to do a glucose curve with a nadir of 12.9 so his insulin has been increased from 1unit twice a day to 2 units twice a day. So I have a couple of questions that I would be grateful of some help with.

The first thing is some understanding of how insulin affects blood glucose. So if 1 unit of insulin reduces glucose by 10mmol (which seemed to be the case on my cats glucose curve), does 2 units reduce it by 20mmol? I’m just trying to understand how the dose affects glucose levels.

The second thing is that we are struggling to get blood every time we do the home testing. We are putting a warm sock with rice on his ear first but it seems to be hit and miss if we can get enough blood. I’d say we have a 40% success rate and we hate putting him through more than two attempts but we also feel as though we are giving him the insulin a bit blindly too. I’d be so grateful of any other tips to try to help with home glucose testing.

Thank you!

 

Hi Victoria, waving to you from Surrey!

I wish it was that straightforward, but diabetes doesn't like to make our lives easy, haha! ...Higher doses have the potential to drop blood glucose more than lower doses, and vice versa, but there is not usually a precise mathematical equation. And there are a lot other factors that can affect how a dose of insulin works in the cats body. These include things like, diet, concurrent illness or infection, insulin resistance, 'bouncing' (rebound), whether the pancreas is producing any insulin of its own... Lots of things...
But, once we've been testing a while and have gathered some data, it is usually possible to more easily see the 'trends and patterns' of how our cat responds to insulin.

You do have a great attitude toward hometesting, so I absolutely believe you 'will' soon find this much easier.

With my current girl I use a mix of gently massaging the ear and using the rice sock. Her ears do not bleed easily at all. So they take a bit more work than many kitties' ears do...

Before I even get the test kit ready I give her a little stroke, scratch her under the chin, and give her ear a quick little rub. That means the blood has a bit of a chance to get moving in the ear before I actually test her.
Then I put the rice sock in the micro to warm up and get the test kit ready.
My girl hates being held or restrained, and she hates her ears being touched (!), but I've found that I can incorporate a test into a little brushing/grooming session.
She usually goes to her favourite armchair when the she hears me setting up the kit because she's learned that she gets brushed.
I sit next to her chair and give her a little cuddle and start to brush her, scratch her under the chin, etc. And I stroke her with the warmed rice sock because she likes the warmth. I've made my rice sock soft and squishy so that it fits comfortably in the palm of my hand. I stroke it over her head and down over her ear too, holding it there for a couple of seconds each time.
I feel her ear, and if it feels warm to my hand then I try a test. If it feels cool, I give her a bit more brushing, scratching under the chin, and sneak in a few gentle ear rubs.
I also sing to her. This probably sounds bonkers. But it is surprising how many people do this, and how it helps! It seems to calm both human and cat...


A while ago I put together some tips for someone else that I subsequently wrote up into a short document and I'm going to copy some of that here just in case some of this is useful. But please do shout out if you need more help:
- - - - -

HOMETESTING TIPS & TRICKS

1. WARM EARS. Probably THE most important thing. Warm ears bleed very much more easily than cold ones. You can warm an ear by massaging it, or by holding something warm against it; ie a pill bottle filled with warm water, or a ‘rice sock’ briefly warmed in the microwave.

2. MASSAGING immediately below the ear prick, with finger and thumb, can ‘milk’ more blood out. I almost always do this, if only for a second or two.

3. VASELINE. A teensy weensy smear of Vaseline on the outer edge of the ear will enable the blood to ‘bead up’ and stops it disappearing into the fur. This also makes it easier to see the blood droplet if the kitty has dark ears.

4. RESISTANCE. The lancet needs something to ‘resist’ otherwise it can push the ear away rather than pricking it effectively. Some folks use a piece of cotton wool or folded tissue. I use one of my fingers, but sometimes do accidentally take a blood sample from myself that way.

5. TWO EAR PRICKS close together can often produce enough blood for a test when one ear prick might not.

6. SCOOPING THE BLOOD DROP ONTO YOUR FINGERNAIL. Doing this is a game-changer for some people. If you can get that drop of blood on your finger or thumb nail you can then let the kitty go and finish the test without her/him.

7. TREATS. It is important to reward the kitty for each attempted test, whether the test was ‘successful’ or not. Cats very soon learn to associate tests with treats. And some will soon come running for their tests. A ‘treat’ is usually a food reward of some kind, but some folks reward their kitties with a cuddle or a grooming session. I actually crumble a few treats for my cat and test him while he’s hoovering up the crumbs.

Remember to reward yourself too. Chocolate is good…

8. GET COMFORTABLE. If you are physically comfortable you’ll be more relaxed, and also less likely to try to rush the process. Some people like to test their cats on a counter top or a desk, maybe next to a desk lamp. Some people prefer to hold their cats on their laps when they test. Some folks incorporate testing into a grooming session. You’ll find what works best for you. And once you get used to home testing you’ll quite possibly be able to do it anywhere, and maybe even while the kitty is asleep.

9. RELAX. Cats pick up on our moods. The more relaxed and ‘matter of fact’ we are, the more relaxed and confident the kitty is likely to be. Some people chat or sing to their cats while they test him. Try it. It might help you too.

10. PATIENCE. Be kind to yourself. You’re learning something new. (And you’re learning something wonderful!)

- - - - -

I also wrote a few notes on 'desensitisation' that I'm copying here (again, just in case it's useful):

GETTING KITTY USED TO BEING TESTED - ‘DESENSITISATION’

Some kitties take to being tested like proverbial ‘ducks to water’, they are just not bothered by it at all. Other kitties take a bit more work, and with a minority of kitties it can take a quite a bit of dedicated effort to get them used to the process.
Please be reassured that ‘most’ kitties can be tested, and ‘most’ people can learn to do it.

One really useful way to get kitties used to testing is to ‘desensitise’ them to the sensations and sounds involved in the test process. And a really good thing to do at first is to get them more used to having their ears touched. So, whenever you are stroking or cuddling the kitty, or the kitty is trying to wake you at 4am by sitting on your chest and patting your face, use that opportunity to include very gentle ‘ear touching’ when you stroke them, just for a second at first. Make ear touching ‘ordinary’ and nothing to fear...
You can also go to wherever the cat is chilling out, then stroke them, hold or massage an ear for a second or two, and then immediately reward with a cat treat and some praise. This starts to condition them to associate ear touching with rewards.

You can also get them used to the test kit itself. For example, you can rattle the test strip container, or click the lancing device a few times (it can be used a bit like a training clicker), and immediately give the kitty a treat. Then just walk away, leaving them with their reward. They can soon come to associate those sounds with rewards just like when they hear the sound of the can opener...
I did these kinds of desensitisation techniques with my kitties about 6 or 7 times a day at first during the first couple of weeks. It only takes a minute or two each time, maybe only seconds. But that repetition is key to success. Repetition, repetition, repetition...

It can be often be helpful at first to test in the same place so as to establish a routine. I tested my first diabetic on a table top. I test my current girl in her favourite armchair.
You can get the kitty used to the test spot by taking or calling them there and just rewarding them with strokes or brushing, or treats. Make the test spot a place where nice things happen.
If you can get the kitty to the test spot and hold or massage an ear for a second or two, and then reward with a treat and praise, you really are most of the way to being able to test on a routine basis.

[The above is copied from hometesting info on the UK Feline Diabetes Support group on Facebook].

Eliz

 

My success rate for BG testing was probably 30% at first, now after 10 days it's probably around 70%.
I am using the lancet that comes with the glucose meter (the human one). At first, I'd set that to 4 or 5, because I did not want to hurt my cat's ear too much, but then the blood drop would be sooo tiny that I had to squeeze his ear quite a bit. He didn't like the squeezing (I don't think he even noticed the pricking part though!). He'd start moving a lot and then it's getting only harder, and restraining him stresses him.
Now I'm setting it to 6 or 7, and the blood drop is a bit larger, which is just enough to do the test with no squeezing. Luckily, it stops bleeding immediately.

Ah, I am also giving him a little treat after all the suffering, so he sees it as something good eventually.

Good luck with that! I'm sure you'll learn how to do it soon.

 

What size is the lancet you are using? If it's a number on the 30's, try using a 26-28 size which are bigger. Warm the ear first by rubbing or by with a warm rice sock. I have a video in my signature showing how I test my cat CC at home.


Going right from 1 to 2 units is a big jump. Esp until you get the hang of testing I would not do more than 1.25.

 

Welcome to the club, er a club none of us want to join but this is definitely the right place to be for our situation.

Every cat is different how they respond to insulin, there's no chart to follow. For example, my guy is very sensitive to insulin, even when he's high (300 on the Relion) I only shoot 1 unit and it's plenty. For most cats that wouldn't be enough. And if dosed him based on "most" cats he'd go hypo. The spreadsheet is so incredibly useful in determining your cat's particular insulin curve.

I really got adept at doing ear prick testing after watching some YouTube videos. I also just freehand the lancet, so easy. I pricked my finger with the lancet freehand, it doesn't hurt at all and cat's ears have very few nerve endings. I was so nervous but after some videos it really improved that for us.

 

Hi Victoria,

More home testing tips and vids:

Home testing links and tips

Testing and injection tips


Mogs
.

 

And there's more!

Here is the testing method I used. Perhaps it might give you some ideas to add to your own testing technique.

1. For most meters you can insert a test strip part way without switching it on. Once you've done the poke you can then push the strip the rest of the way into the meter to activate it. (Reduces the likelihood that the meter will time out before you can get the blood sample onto the strip.)
   
   
2. Fold a sheet of kitchen paper in four lengthwise and cut it up into 1" strips. You will use these to cushion and support the ear during the test.
   
   
3. Apply a thin film of Vaseline or Neosporin ointment (not the cream!) onto the edge of the ear to help the blood sample bead up instead of wicking into the fur. (Wipe off any excess.)
   
   
4. To get a blood sample you need to increase the blood flow to the ear, so make sure the ear is really, really, really warm (but not hot) - especially in the early days of testing. (Note: With repeated 'poking', more capillaries form in the test area, so it becomes easier to get samples reliably.)
   
   
5. Once you have the testing area of the ear well warmed, wrap a strip of folded kitchen paper round your index finger then place finger under the sweet spot area of the ear you're testing to support it during the poke.
   
   
6. Use your thumb and middle finger to lightly but firmly grip the ear and paper strip in place so that the edge of the ear is taut but not overstretched; the little bit of tension will make it easier for the lancet to break the skin surface (and it helps to keep kitty's head from moving around too much).
   
   
7. When using a lancet 'freehand', make sure the bevelled side of the lancet is facing upwards. Hold the lancet at a slight angle to the ear similar to the way you hold a pen when writing, not perpendicular (easier to see where you're aiming and also makes skin prick easier).
   
   
8. When it comes to the actual poke, prick the sweet spot on the edge of the ear in a similar way to how you might quickly prick a balloon with the tip of a needle to make it pop. If you aim as close to the edge of the ear as possible you are less likely to hit the marginal ear vein.
   
   
9. Keep hold of the ear while you're pushing the test strip into the meter to activate it. (Kitties are prone to shake their heads after a poke, sending your precious blood sample flying across the room. Holding the ear reduces likelihood of this happening.)
   
   Note: As you become more practised in testing, you'll be able to activate the meter just before doing the poke and still have plenty of time to collect the sample on the strip before it times out.
   
   
10. When using the glucometer, bring the test strip to where it j-u-s-t comes into contact with the blood droplet and hold it there. The strip should then 'sip up' the amount it needs to run a valid test. Most meters beep or give a visual cue to let you know that enough blood has been collected on the strip.
    
    If your cat is a wriggler, try collecting the blood sample on the back of your (clean) fingernail and test it from there.
    
    If a test fails and you still have a lot of blood on the strip from the failed test, don't throw it away. Instead, you could pop another strip into the meter and test using the blood on the strip from the first test. (Saves an additional poke so also helpful for wriggly kitties!)
    
    
11. After the test, fold the paper strip over the edge of the ear and apply gentle pressure to the test area for about 20-30 seconds to minimise bruising.
    
    
12. Keep giving lots of praise throughout the process and reward with a favourite diabetic-friendly treat or favourite activity (e.g. brushing).
    

With a bit of time and practice you'll be able to work out a technique and a routine that works best for yourself and Ralphy.







See member @FarmKitty's excellent pictorial tutorial for visuals of some of the techniques described above:

https://www.felinediabetes.com/FDMB/threads/hello-food-and-insulin-questions.240117/#post-2709047

In particular, have a look at the pictures of the backlit ear before and after adequate warming. The difference in blood flow is really striking!


Mogs
.