Newbie question about ear pricking technique

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Missy & Jazz

Member Since 2013
Hi again everyone,

I have read the info and links on ear pricking for BG testing and they helped a lot.
Jazz has been incredibly patient with me and we have a regular spot on the sofa where we test and I can hold her fairly securely against me without really restraining her.
When she started insulin the other day, I tested every hour for the first 12 hours, and then almost every hour (tested every 2 hrs x 3 times) for the next 12 hrs and she took it all in stride amazingly.

However she is starting to get a bit fidgety now and I'm having trouble getting blood - I seem to prick and very little comes out. I warm the ears beforehand, and have tried swapping ears (the right one seems easier to do, but possibly because I'm left-handed) and 'milking' to get enough for the strip. It is pretty cold here atm, so that could add to it. She has also taken to clamping her ears down sometimes (so I either can't prick or can't get the blood) or 'pawing' at me by kind of putting her front paws up to swipe at me (no real claw action atm). I am worried that I am bruising her ears and hurting her (pricking same area; on bruised bits, etc), which I hate. If I can get it first time she seems pretty ok with it, and if I don't get it after 2-3 pricks, I 'reward' her and pop her down and let her relax a bit and then try again 5-10 min later.

At the moment (starting yesterday) we are testing:
7 am before breakfast and insulin (pre-shot = +0)
1 pm (+6)
2 pm (+7) - I skipped this one today as she was pretty fidgety and I didn't want to push it
7 pm (pre-shot = +12/+0) before dinner and insulin

Her nadir seems to be closer to +7 than +6, so I'm thinking maybe I should skip the +6 and just test 3 times a day? (the vet only wanted testing at 7 am, 7 pm, and 'between 1-2 pm').

My main question is, is the ear meant to be pricked right through? I have done this a couple of times (accidentally as I have been aiming to just prick one 'surface' of the ear) and I worry about causing extra bruising and a 'pierced ear' effect!! :shock: More blood does usually come out naturally, but I am not sure what the aim of the pricking is, in terms of how deep/right through? I haven't used one, but it sounds like the lancet pen version 'clicks' right through the ear??

I am using sterile single use medical grade (human) 26G needles (they come without a syringe) as a lancet and freehanding it. If I need to poke a couple of times for one reading, I swap to a new needle if I can. Always a new needle for each testing session.

I try to reward her (regardless of how it goes) with lots of hugs and cuddles and scratches, and occasionally a tiny food treat (her new normal meal-time wet food). I am all for positive reinforcement and would like to reward with food treats after each time, but I am really wary of the effect food treats at non-meal times might have on her BG readings. The vet feels that I should try to avoid food treats where possible, and take them out of her 'real mealtime food allowance' for the day (ie. reward with 1/2 teaspoon, and feed 1/2 teaspoon less at next meal), which I have been doing.

I and the vet also do not want to allow grazing. However the vet has recently 'agreed' that I could start feeding her more (she is underweight and super hungry before meals) at mealtimes if it is a consistent amount built up gradually. I will be starting this tonight.

For those extra encouraging members who have been helping me out with all my questions, thank you! I will be trying to set up a spreadsheet soon with all her info updated and BGs, etc. if anyone is interested in an update (may take a few days).

To all others, thank you for reading! :)
 
Hello,

It sounds like you are already doing a great job!

Regarding testing; no, the lancet shouldn't prick all the way through the ear, just deep enough to get blood. (However I've been doing this for 6 years and sometimes still accidentally do this... :roll: )

Are you applying firm pressure to the test site after getting blood? Firm pressure for a few seconds using either just your clean fingers or a piece of cotton wool or folded tissue will help to minimise any bruising. And it seems to me that the cat's ears do actually 'toughen up' a bit after just a short time of testing, and they're not so senstive.

Regarding feeding; many of us here actually free-feed our cats, because we've found that 'little and often' can help to keep blood glucose levels more stable. (But some folks do find that fixed meal times work better for their cats).

I always reward my cat with treats while testing. But if I didn't do that I'd never be able to test him at all! Some folks just give their cats a cuddle after the test and the cat is happy with that. Basically, I think it's a case of 'whatever works for you'...

Is there a reason why you're trying to limit your cat's food intake...?

Eliz
 
For treats, my cat goes nuts over the Simply Nourish freeze dried turkey treats from Petsmart. I don't even think he realizes he gets a blood draw and shot when he has those in front of him.
 
I give Chester a little bit of freeze dried chicken or a couple of freeze dried shrimps for each test. I really think the food impact from a little treat is so minimal that I just disregard it.
But I also believe that if a normal/underweight cat is hungry, feed them. Chester gets four meals a day of about half a can of Friskies each, and we have zero carb dry out for free feeding all day. He was underweight when he was diagnosed. Diabetic cats can't really utilize all the food they eat until they get regulated with the right doses of insulin. If Chester starts gaining beyond his ideal weight, we may cut his food intake back a bit, but as long as he's in a healthy range, we'll let him eat.
I also take my vet's directions as suggestions, not commands. My vet believes that all cats need to eat carbohydrates. I have been reading up on this and I disagree. So I take her suggestion, then feed Chester what I think is best for him. She's not here feeding him, she's not buying the food, she's not watching him eat.
 
Human diabetics are encouraged to spread their food out across the day so the calories don't hit in one large bolus.

The meal feeding approach is better suited to a shorter acting insulin such as Humulin N which hits almost as fast as the food does, so they match each other taking effect. Your vet may have been educated in the older insulins and not updated.

With the longer acting insulins, meal feeding results in an obvious food spike 2-3 hours after feeding, after which the longer acting insulins start to kick in. By spreading the food out in mini-meals, the food impact is spread out to work better with the insulin.
 
When you pierce the ear and go all the way through - for whatever reason, you don't get blood. The goal is not to pierce rather poke.

One technique I use when free handing is to poke at a 45 degree upward angle. Here is a pic to help

 
Hi all,

Thank you all very much for your tips and suggestions.

I will look into the freeze-dried treats more - I'm in Australia so we don't have all the brands/stores that seem to be mentioned a lot here, but I'm guessing there's something similar available somewhere. Actually, I remember I used to get her little kind of dried, crunchy anchovy things which she loved - I totally forgot about them! Maybe I can find some again - I think they were similar to what you have been describing.

I have been gradually upping her food amount at mealtimes (like MaryB said, I believe in feeding as much as she wants at the moment if she is hungry - she is underweight and has never been a cat who overeats anyway). Once she starts to level off on the gobbling (lol!) and hopefully gain back some weight, I will see about finding a feeding amount that lets her maintain condition/ideal weight without getting fat.

Hillary - thanks for the pic - much appreciated. I have been going for a 'poke' rather than aiming to pierce (have been trying to avoid that) but occasionally it happens unfortunately. I just wanted to see how others have been doing it. I will try to do that 45 degrees upwards trick more consistently now, thank you!

My vet seems pretty on the ball with most things, and is reasonably young, so I'm guessing she actually has more experience with the newer rather than older insulins. Please be aware that I am not taking the vet's word as 'the law' but I am very wary of the possible consequences of not heeding vet advice specific to her situation. I do have some background in biology (not vet science though) and I am definitely prepared to question things (and do!) in an effort to achieve the best care for Jazz. Sometimes the amount of information out there seems overwhelming, so I have been trying to come to 'agreements' (with myself) that seem logical and reasonable to me, and are more or less in line with Jazz's personality and situation, and the vet's recommendations if possible, with all the various aspects of Jazz's care. I figure that nothing is set in concrete, and I can adapt the approach if necessary.

BJM - thank you for the suggestion. I do understand your point, but have decided to go with discrete meal times currently. This is partly through veterinary recommendations (including my vet's and Dr. Elizabeth Hodgkins, whose advice I found via recommendation from this board http://www.yourdiabeticcat.com/faq.html), partly the fact that it seems to me that discrete meals naturally suit carnivores better than a grazing approach, and partly the fact that I am not (or will not be) able to provide 'mini-meals' throughout the day on a regular basis. Routine is something that is important to Jazz, and I would rather pick one method that I know I can stick to. I have considered leaving food out, but I honestly think at this point, the poor thing would scoff the lot in one go and then feel sick/have nothing left the rest of the day. Also, though it's cold here now, it does get pretty hot and I would be concerned about food left out spoiling quickly in hot weather.

Please understand I am not saying your approach is wrong at all, but just attempting to explain my personal decision. I do leave the food out for 1/2 hour or so after feeding if she does not eat it all immediately, and she comes back and finishes it in that time (would consider leaving it out a little longer if she didn't eat it within that time and circumstances permitted). I have just checked again and Dr. Lisa Pierson also seems to think it is fine to either feed discrete meals or free-feed as the owner considers more appropriate for each cat, and states that 'cats do not need access to food 24 hrs a day' (http://www.catinfo.org/#My_cats_are_now_eating).

MaryB - that's what I thought, with regard to minimal food impact from tiny treats. I think I will be looking for a suitable treat that is just for those times :) I know that the insulin is key to allowing their bodies to actually absorb the food energy, and as I mentioned above, I do take my vet's ideas as suggestions, not the 'be all and end all'! I have also been doing huge amounts of reading, with a focus on scientific evidence, and I am wanting to cut her carb intake again by switching from the Hill's m/d to another more suitable brand. However, I do want to get the insulin/testing routines sorted first and stabilize her a bit so I know what is happening before switching her food. Not to mention contacting various companies (making my own wet food is not a practical option for me at this stage) and deciding on which food!! (I know wonderful spreadsheets with nutritional analyses have been made up, but nearly all those brands/foods are not available here, so I will be doing my own research - if anyone knows of good low carb/high protein wet food brands that are available in Australia, please let me know!). I am prepared to go with what I think is best for my cat, not necessarily what the vet thinks (for example, putting her on methylcobalamin instead of vet-recommended osteoarthritis drugs - I may still go with that, but want to see what if any effect the B12 has first). I have been working closely with the vet though in monitoring and trying to manage Jazz's diabetes, and I do value her advice and support (and obviously want to maintain a positive relationship), so I do keep her up to date with any changes to her recommendations that I either want to make, or have made. I think it's important that everyone involved in Jazz's management knows 'everything that is going on' if you know what I mean :)

Mike - thank you - I am pretty sure Simply Nourish is not available here, but will try find something similar. It's great your cat is so keen on them!!

Eliz - thanks again for your support! I am trying so hard, but I think sometimes that's not so good in that she of course picks up on it when I am upset with myself for messing up... Trying to stay calm!! Thanks for your quick clarification :) I apply firm pressure for 15-20 sec with a tissue folded over the ear after getting the blood. I am so glad to hear the ears toughen up! Jazz is black (quite similar looking to Bertie and Maui, if the handsome pussies in the pics are them!) so occasionally I use a little torch too to better see the ear.

I have been rewarding her every now and then with treats... just not every time, which I may start doing. It's funny, it seemed easier when I was testing every hour somehow! I think she just resigned herself to it :P Also, I find she is getting wiggly mostly before mealtimes (when I really *have* to test pre-shot), as she knows it's food time and wants 'food, Now!' So I have been giving her a little (entree! ha) while testing so she settles long enough for me to get in there more easily. I think the 'whatever works' for each individual cat is the way to go, you're right.

I'm actually not trying to limit her food intake at all, sorry I must have mis-communicated that - I would happily feed her as much as she wants (see above in my super long reply) but just don't want to cause complications with insulin dosage amount, etc. Prior to switching diet after the diabetes diagnosis, she free-fed on dry food almost exclusively - now I know better though - just wish I realized sooner! (for maybe her first 5-6 yrs though, she ate wet canned food - switched to dry to improve her dental health on (another) vet's recommendation!! gah).

Thank you all very much for your suggestions and advice :) I do appreciate it a lot. Apologies if this reply is really long, just trying to address individually everyone who was kind enough to reply.
 
Since cats might catch small prey several times during the day; that is what a mini-meal or timed feeder approach would simulate. There are some in the Lantus forum who use this approach - Sienne & Gabby are one pair. Once you have a spreadsheet going, you'll find Lantus questions may get better answers there.

You might find it interesting to discuss the AAHA guidelines with your vet. Different county, yes, but I don't think that'll matter.

The University of Queensland should be right around the corner from you. Take a look at the Centre for Companion Animal Health and check the section on diabetes. There are several articles by Dr Rand, an international expert in feline diabetes. She worked with the Diabetes Katzen group to develop the tight regulation protocol our TR forum follows.
 
Missy & Jazz said:
Whoa, that was really Really long! :shock: Sorry about that! :oops:
Click to expand...
Ha-ha! No need for apology: You can ask/say anything you want to here. :lol:
And it's nice to meet another member of 'The Black Cat Club'! ;-) :-D

Eliz
 
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