Newly Diagnosed and need help with insulin shots

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jazzysmom123

Member Since 2013
Hi All-

I am brand new to this board and am very grateful that there is a community to go to for help. My cat was newly diagnosed with Diabetes and my vet had me give just one unit twice a day for the first week. I gave the insulin shots twice each day and thought I was doing well. My cat is very cooperative and I had no issues, and no wet spots on her fur afterwards.

We went back to the vet for more testing yesterday and he increased her dosage to 2 units twice each day. I gave her the shot last evening and noticed a wet spot on her fur which means I did not do it correctly. I did not give her any additional insulin and waited until this mornings shot.

When giving her the shot this morning, I measured carefully, warmed up the insulin in the syringe a bit before injecting, and there was a wet spot again.

What am I doing wrong? I thought I had this but now with injecting more insulin it appears that I don't get it all injected. Should I be leaving the needle in longer before pulling it out? Am I pushing the plunger too quickly? When you pinch or tent the skin, I think I am inserting the entire needle, am I supposed to just insert a part of the needle into the skin? I don't see it coming out the other end but maybe it is??

Any and all advice is appreciated!
 
Welcome Jazzy's mom! And your name is?

Shot technique:
Pull up the skin to tent it.
Push in the needle. Some folks put a finger on the other side to help guide the depth.
Push in the plunger.
Pull out the syringe.

If you feel wetness, you might have gone all the way through, or the needle wasn't under the skin, or the skin is dehydrated enough to leak. (See my signature link Secondary Monitoring Tools for dehydration checks.)

You were correct in not giving a 2nd shot, as you don't know how much went in.

What insulin are you using?
Regardless of insulin, we do dose increases in 0.25 units, which are eyeballed on the syringe which have half unit markings at most. Cats are so much smaller, and you can miss the optimal dose. I suggest you back off to 1.25 units.

Are you home testing yet? It will help you keep your cat safe. An inexpensive human glucometer, test strips, and 27 to 28 gauge lancets are all that are needed. Many of us use the Arkray Glucocard 01 or Glucocard Mini from ADW (link at top of page) or the branded version, the WalMart ReliOn Confirm or Confirm Micro, because it takes the smallest blood droplet.
 
Hi -

My name is Susan and the insulin my vet prescribed is ProZinc. Thank you for responding. I am not home testing yet as the vet is testing every week - he wants to see her once a week in the beginning.

I am going to get home testing supplies this weekend.

When I inject the needle, should I be pushing it all the way into the skin, or should I just insert it half way?
 
You're probably using U-40 syringes with half inch long needles. The tip is where the hole is in the needle, so only getting the tip part under the skin is fine. If you push it all the way in under the skin (not in muscle), you are OK too.

Seeing the vet weekly is a good source of income for the vet. Once you are home testing, you won't need that expense, because you will have data on how your cat is doing. Plus, you will ensure your cat is at a safe level to give insulin and doesn't go too low.

Glucose measurements done at the vet on a lab machine will differ from those done with a pet specific glucometer and will differ from a human glucometer. It is like reading temperature with different systems - Fahrenheit, Celsius, Kelvin - when you have the reference numbers, you will be able to interpret them appropriately and act as needed if adjustments are required. The reference numbers follow.

Here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first. Numbers in parentheses are for non-US meters. Numbers in curly braces are estimates for an AlphaTrak.

< 40 mg/dL (2.2 mmol/L) {< 70 mg/dL for an AlphaTrak}
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL (2.8 mmol/L) {< 80 mg/dL for an AlphaTrak}
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50 (2.8).
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.

= 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- no shot limit for ProZinc, PZI, or other non-depot insulins

> 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1 mmol/L) {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins (Lantus, Levemir, and ProZinc) as data collection shows it is safe

180 - 280 mg/dL (10 - 15.6 mmol/L) {may be 210 - 310 mg/dL for an AlphaTrak}- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL (15.6 mmol/L) {may be >=310 mg/dL for an AlphaTrak}, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.
 
Yes they are U40 syringes. Thank you for all of the information on home testing.

I pinched the skin at scruff of neck and it does snap back quickly so I don't think she is dehydrated. She does drink water each day. She is a very good eater so I will add a little water to her wet food to ensure that she is hydrated.

Next shot I will not insert the needle all the way in and see if that helps. Maybe I am going all the way through and not realizing it.
 
I hope the shots are going better. So glad you are planning to hometest. Be sure to get a meter that takes a tiny sample. ReliOn meters (Walmart) are popular here as not only is the meter inexpensive, but so are the strips. Stay away from meters with Tru in the name or the FreeStyle meters. People have had problems with both brands. You'll also need lancets - 25 to 27 gauge.

While you are waiting, get him ready. Pick a spot where you will test. Play with his ears and give him a treat. After a few times doing that, start warming his ear. (you can microwave a sock filled with raw rice until very warm in the microwave or fill a pill bottle with very warm water.). Then a treat and praise. By the time you poke, he should be used to the routine.

Here is a document with ProZinc info that may be helpful

http://www.felinediabetes.com/FDMB/viewtopic.php?f=24&t=109077
 
It is possible to use U-100 syringes with ProZinc. Each half unit tick mark equals 0.2 units of ProZinc because ProZinc is less concentrated (40 units per mL, instead of 100 units per mL). The advantage would be the option of shorter needle length and easier dose adjustment.
 
I just administered a successful insulin shot with no wet fur this time! Inserting the needle about half way did the trick so will do this going forward.

Thank you so much for the support.
 
What food are you feeding? Food is key in regulating diabetes...

Heres a home test shopping list if you need it?

Getting started shopping list
1. Meter ie Walmart Relion Confirm or Micro.
2. Matching strips
3. Lancets - little sticks to poke the ear to get blood . new members usually start with a larger gauge lancet such as 28g or 29g until the ear learns to bleed. Optional - lancing tool.
4. Cotton balls to stem the blood
5. Neosporin or Polysporin ointment with pain relief to heal the wound
6. Mini flashlight (optional) - useful to help see the ear veins in dark cats, and to press against
7. Ketone urine test strips ie ketodiastix - Important to check ketones when blood is high
8. Sharps container - to dispose of waste syringes and lancets.
9. Treats for the cat - like freeze dried chicken
10. Karo syrup/corn syrup or honey if you dont have it at home - for hypo emergencies to bring blood sugar up fast
11. A couple of cans of fancy feast gravy lovers or other high carb gravy food- for hypo emergencies to bring blood sugar up fast
 
My vet has Jazzy on Hill's M/D. We started with the diet change for about 3 weeks before he started her on insulin.

Thank you for the list of supplies. I have everything you mentioned except for the ketone strips and freeze dried chicken. My vet had me get Karo syrup and I read on this board to have a couple of cans of Fancy Feast with Gravy available in the event of emergency, so I bought some.

I will get the ketone strips tomorrow.
 
MD wet? It's not awful in terms of carbs but many cats tire of the taste as it is liver based. And very expensive for you, considering its ingredients are not better than OTC food and worse than premium foods. If he starts to refuse it, we'll have ideas for alternatives.

Ket us know how it goes. You could start with playing with his ears and giving him a treat. Then add the ear warming and treat. After you've tried the meter on yourself and feel confident, he may be pretty relaxed about the process when you add the poke.
 
I feed the pride Friskies pates - with 15 cats, 1 of which is diabetic, I use the 13 oz cans @ around $0.78 per can.
 
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