Start our first glucose rundown monday

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Patty & Teal'c

Patty & Teal'c

Member Since 2019
I posted in the introductory area first and was told to come here.
Teal'c was diagnosed yesterday 11/07 with diabetes. His blood test revealed his blood sugar lvl was at 532. I have been instructed by vet that through the weekend I'm to only feed him twice a day 1/2 cup of the current food. Nutro essentials indoor adult. I'm also to only allow 20 mins for the cats and dogs to eat and then to remove the food. Monday I'm to feed him 1/2 cup at 6:30 am and have him in their office by 7:30.
At that time they will do his glucose rundown. I've not been told anything else and to go from free feeding to 1/2 cup twice a day I'm sure my animals think I'm trying to starve them.
I hope I'm doing the right thing I'm so scared when I think about it I want to cry.
 
Welcome to FDMB!!

Everyone is terrified at first. I think it's part of the initiation. You'll find a great deal of knowledge and support here.

I suspect I won't be the first to tell you this but I don't agree with your vet about feeding Teal'c. First, we are big advocates of a species appropriate diet for cats. In other words, no dry food if you can avoid it and there are only a handful of dry food that aren't a problem for a diabetic. Lisa Pierson, DVM has a wonderful website on feline nutrition. There is also a link both on her website and at the top of this forum to her food chart. A diabetic cat needs to be on a low carbohydrate diet -- carbs = sugar and sugar is the last thing you want to be feeding a diabetic. The dry food you're using is approximately 36% carb. That is very high carb food. Most of us use a low carb food (i.e., below 10% carbs and usually about half that amount of carbs).

There is no need to restrict your cat to twice a day meals. In fact, feeding several small meals a day puts less stress on a healing pancreas as well as allows you to use food to buffer the effects of insulin. You generally don't want to feed past the active phase (nadir) of the insulin you're using. (Nadir varies depending on which insulin your vet is recommending.) You also don't want to feed your cat in the window of 2 hours prior to shot time. If your kitty is used to free feeding, that's fine. Just pick up the food bowl 2 hours prior to what you plans to shoot.

Currently, the insulins that are recommended for feline diabetes by the American Animal Hospital Association are either Lantus (glargine/the generic is Basaglar) or Prozinc. If your vet recommends a different insulin, I would push for one of the two I mentioned. Lantus is dreadfully expensive but we can direct you to resources in Canada where it is a fraction of the cost in the US. (You can check around your area to see if. you can buy a single pen and then order from Canada. You'll need a separate Rx to order from two places, though.)

Since you won't be starting insulin for a few days, I'd encourage you to read the sticky notes on the forums. If you do happen to know which insulin your vet is going to prescribe, there is even more information in the sticky notes at the top of the various insulin support groups. These informational posts will help you get oriented. We also have posts and videos about home testing, etc. The front end of the learning curve is overwhelming but the members here are very generous with their time and knowledge and will help you get up to speed.
 
When you say glucose 'rundown', I assume you mean a glucose curve? (Testing every two hours.) I find it interesting that your vet just did a blood glucose test on your visit and wants you to come back for more blood glucose testing on Monday. I think that most vets normally do a urine test to see if there is sugar in it and then a fructosamine test to confirm the diabetes diagnosis (those give an average over previous 2 to 3 weeks so are not impacted by vet visit stress). They normally don't ask to do a curve until a cat is on insulin. Hmm...

You could tell your vet that you have been doing research and have found that a low-carb wet food diet is recommended, and that you want to try that first. Then, switch your cat's food and give that a few days to impact his glucose. It can make a huge difference when a cat goes from high carb food to low carb. For some cats, that switch is all that is needed to bring their glucose back to normal. If you are willing to home test your cat, you could go ahead and get a meter and strips (there are a lot of great tips on this site for home testing; it seems scary to begin with but usually becomes much easier pretty quickly). Glucose curves done in a vet's office are usually impacted by stress which makes the numbers appear higher than they are. So, if you can get the hang of testing, you will be able to do curves at home where your cat is more comfortable (and won't have to pay the vet for it).

I have a link in my signature to the food list created by Dr. Pierson (who created catinfo.org). You can enter parameters and filter the list down to foods that meet those. Dr. Pierson says, "I usually like to start with protein minimum of 40, fat maximum of 50, carb max of 10, and for cats with kidney issues....phos less than 300". Most of us find that we need to feed foods with even less than 10% carbs... I like to stay 3% or less. It is fine to feed multiple meals per day and leave the leftovers out for grazing. You can determine how many calories your cat should be eating (a common formula is 20 calories per pound of healthy body weight) and break it up into multiple meals. Until your cat's glucose is better regulated, he may need additional food since his body is not able to correctly use the food he is eating. With multiple cats, it is a little harder, but if no one is a bully eater, you should able to calculate the calories for them all and feed the group based on that. If your cat ends up on insulin, two of the meals need to correspond with the times of your insulin shots since a cat should eat when they are going to be given insulin. The normal routine is to test the cat's glucose, then feed, then give the shot. When someone is starting out, it is recommended that food be withheld for two hours before the pre-shot test so the test will not be food-influenced, and you will know it is safe to give the planned insulin. Once you have been at it awhile and are more familiar with your cat's insulin responses, that two-hour 'rule' does not have to apply (unless you just want to keep doing that).

This is always overwhelming and scary in the beginning, but it will get better. It is great that you found this place so soon after the diagnosis. Unfortunately, most vets know very little about feline diabetes, so we cat parents end up having to educate ourselves so we can determine what is best for our cats and not just blindly cooperate with everything the vet says. Hopefully, your vet is reasonable and will be willing to work with you. While the vet might not respond so well to you saying a bunch of people on the internet told you XYZ, maybe he/she will be more apt to take you seriously if you mention sources such as the AAHA guidelines or vet-created catinfo.org. I think this one statement from the AAHA guidelines sums up the most important points (homes monitoring, low-carb diet.. and it mentions two really good insulin options): "Predictors of diabetic remission in cats include achieving excellent glycemic control within 6 mo of diagnosis, using intensive home monitoring, discontinuation of insulin-antagonizing medications, and use of insulin glargine (Lantus) or detemir (Levemir) along with a low-carbohydrate diet."

Post any questions you have, and let us know how things go!
 
Ok thank you. For what ever reason he didn't want to change Teal'c's diet at this time. I asked about changing his food. Teal'c also is not a lover of moist food but I have decided there has got to be a flavor out there he will eat I'll try different combinations till I find it. Right now with the removal of food except for the twice a day he is spending all his time by the empty food bowl.
I have been doing a lot of reading up on feline diabetes on this site so that maybe I can go in knowing. Think things will fall into place once the vet does what ever he is doing on Monday and I know what his treatment will be.
 
A lot of us have cats who had previously eaten only dry food, and the transition is sometimes hard, but it is possible. If you need a dry food to use during the conversion, maybe consider Dr. Elsey's Clean Protein Chicken. At least the carbs will not be so horrible. It has between 4 and 5 % carbs. (There are other reasons for getting away from dry food besides the carbs, but I totally understand needing some dry food during the conversion. I had to use it.)

Keep in mind that if you don't change to low-carb food before staring insulin, you will definitely need to be testing glucose at home before doing it. The change can dramatically reduce a cat's glucose, so it can be dangerous if all the sudden his glucose is lower and you give insulin without realizing it.
 
That's what bothers me. After learning in the last couple days what I've found I'm questioning the vets instructions. Thinking I need to do the food swap before we start injecting him. Off sunday going to get a meter printing list of moist cat foods. I do know he really likes cheese so maybe one with some kind of cheese in the description not sure what's out there. I'm just worried about not changing his food first. Do you think it might be in his best interest to cancel the test for Monday?
 
Want to add I have never giving him cheese but have seen him go nuts over cheese wrappers to mo indicates a like of cheese.
 
Given that Teal'C was just diagnosed a few days ago, I think it would fine to try a switch of diet before starting insulin but I wouldn't hold off insulin for too long as the faster you get these kitties BG down, the better the chances of getting them regulated and in some cases into remission.

Good luck with the transition to wet food. I have a girl who was stubborn and absolutely refused to touch anything that didn't crunch for the longest time. She continually tried to bury her brother's food like it was waste. She eventually gave in and ate soft food I think simply because her slave..me....didn't get off her butt quick enough to get her highness dinner one night. She decided to pilfer some of her brother's left over wet food and I just stopped her dry food cold turkey.

You may have to hold a few stand offs but hopefully Teal'C will be more co-operative than my girl and decide that wet food is pretty darn good! Good Luck!

BTW....Love Teal'C's name. I take it you are a Stargate fan! Me too!
 
Teal'c is at the vets. They are doing a glucose curve, they explained today would be his start of insulin and they are doing this to see how much to give and how his system reacts. It is only a 91/2 hour test which confuses me cause I thought insulin was a 12 hour cycle. They said they will train me how to give his shots when I pick him up. I asked about testing him at home and as I suspected they do not think it is a good idea. They claimed that you have to hit a vein and it's just to hard to do at home. They said they would instead give me a sheet of signs to watch for. I'm still planning to start home testing. I have spent the past few day messing with his ears. At first when I would touch them he would flick them yesterday he let me rub his ear with out flicking and I could even feel it warming up. I believe getting him comfortable with this will be the key to success.
 
It makes me furious when a vet says it is not a good idea to test. They automatically get 500 idiot points in my book. :mad: And, you do not want to hit a vein (which would actually be pretty easy, not hard). The goal is to hit between the vein and the edge of the ear. As far as what to watch for, by the time you see visible symptoms of hypoglycemia it is late in the game and dangerous. If you are testing, you can catch it much quicker if the cat's glucose is going too low. You have time to intervene BEFORE it gets to the point of symptoms. I am so glad you have already figured out to ignore them on this!!!

They are probably going to tell you to come back in X amount of time for them to do another curve. If you are home testing, you can do your own curves! Curves done at home are more accurate because the cat does not have the stress they do at a vet (and you don't have to give your vet money). This is even found in the AAHA guidelines: "Obtaining BGCs at home is preferred to doing so in the clinic." (BGC = Blood glucose curves). https://www.aaha.org/aaha-guidelines/diabetes-management/monitoring/ (Is your cat 'senior'? They also say "Senior cats and dogs of advanced age need to be closely monitored.")

I know I quoted this part above, but it is worth mentioning again: "Predictors of diabetic remission in cats include achieving excellent glycemic control within 6 mo of diagnosis, using intensive home monitoring, discontinuation of insulin-antagonizing medications, and use of insulin glargine (Lantus) or detemir (Levemir) along with a low-carbohydrate diet." https://www.aaha.org/aaha-guidelines/diabetes-management/treatment/cats/

Hopefully, you will be given a long lasting insulin like those mentioned in the above quote or ProZinc. And, hopefully, the starting dose will be no higher than 1 unit twice a day. Let us know!
 
I'm not the least surprised by what you were told but I don't agree with any of it.

For starters, there are guidelines for how much insulin to start a cat on and a curve in the vet's office, given that one day on a dose tells you nothing and that most kitties are so stressed at the vet that the BG testing they do is elevated (sometimes by 100 points or more) and not reality when kitty is at home. Hate to say it but that to me is a money grab and nothing more.

Secondly, if the vet's office is using the vein for testing, it's no small wonder they don't recommend their clients home test. If they are drawing a venous sample from the leg etc. for their purposes, of course we aren't going to do that at home. I hope they are not planning to use ears for their testing. When we test the ears, we poke along the edge of the ear, outside where the vein runs through the pinnae. Kitty hardly feels it if you test the way we do because they don't have a lot of nerve endings in that area but hitting the vein is going to cause kitty discomfort. Paw pad testing is also possible but far fewer folks use paw for testing because most kitties aren't keen are having their paws manipulated.

I'm glad to hear you are still going to home test. Your glucometer serves to give you accurate BG data in kitty's normal comfortable environment so that dosing can be based on reality and not inflated numbers, keeps kitty safe and gives you, the CG, a sense of control knowing what is going on. And as FurBabiesMama says, you can do your own curves at home with no need to repeatedly take Teal'c to the scary vets office.

What insulin did the vet prescribe for Teal'c?
 
Earprick.jpg
Diabetic Cat Care Home Testing Your Cat’s BG
 
So we are back from the vets office. They said he was at 432 when they first tested him. They gave him 1.5 units of Prozinc. And tested again around 9 (which I believe was 2 hours later). They said he was up to 477 ( wonder stress induce rise) so they decided he needed a full 2 units so gave him more which brought it down to 293. They said they would like to keep it around 300.

I am feeling really bad at the moment he is 13 years old and was over weight. March 30 of this year I took him to be shaved he had some matting. At that time he weighed 20.2 pounds. When I picked him up today he now weighs 13.4 pounds why did it take me 7 pounds to realize there was a problem.

He said to feed him then do the shot but I think I would prefer using the reward of food after the shot. Does it matter if food is offered before or after?

He was not totally against me testing at home but he said they do a fructose test they can do that would be easier according to them. I don't need easier. He said look for him to start yowling this is an indication that he is in trouble. I told him I don't want to wait for him to start yowling to indicate a problem. He was also pleased that I had done some research.

They let me do a empty poke to make sure I understood how to do it. Omg Teal'c was so calm about it.

I was wondering if someone can point me to the spreadsheet so I can set one up for Teal'c. Thank you in advance.
 
Patricia Chambers said:
So we are back from the vets office. They said he was at 432 when they first tested him. They gave him 1.5 units of Prozinc. And tested again around 9 (which I believe was 2 hours later). They said he was up to 477 ( wonder stress induce rise) so they decided he needed a full 2 units so gave him more which brought it down to 293. They said they would like to keep it around 300.

I am feeling really bad at the moment he is 13 years old and was over weight. March 30 of this year I took him to be shaved he had some matting. At that time he weighed 20.2 pounds. When I picked him up today he now weighs 13.4 pounds why did it take me 7 pounds to realize there was a problem.

He said to feed him then do the shot but I think I would prefer using the reward of food after the shot. Does it matter if food is offered before or after?

He was not totally against me testing at home but he said they do a fructose test they can do that would be easier according to them. I don't need easier. He said look for him to start yowling this is an indication that he is in trouble. I told him I don't want to wait for him to start yowling to indicate a problem. He was also pleased that I had done some research.

They let me do a empty poke to make sure I understood how to do it. Omg Teal'c was so calm about it.

I was wondering if someone can point me to the spreadsheet so I can set one up for Teal'c. Thank you in advance.
Click to expand...
Hi when it comes to giving insulin
First you test her
Then you feed her
Then you give the insulin
Please read all the sticky's in the prozinc forum
What dose did they say to start her on?
 
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Here's the link to the spreadsheet instructions.

Not to throw a brick at your vet but one reason a vet will discourage home testing is so you can either have a curve done at the vet's office ($$) or so you can have a fructosamine test run ($$). If you test at home, you don't need any of this. A fructosamine test is an average across about 3 weeks of blood glucose levels. You're spreadsheet will give you more data, depending on how much you test. (Fructosamine is similar to a hemoglobin A1c in humans.)

Do you know what time your vet gave Teal'C his shot? With kitties and insulin, you want to give shots 12 hours apart. I have no clue what to do if he gave a second shot. I'm a veteran Lantus user so I'm not sure what happens with Prozinc and a 2nd injection.

Don't beat up on yourself. Whatever you may have been oblivious to, and frankly, you see your cat every day. It can be hard to see small changes until they are really big changes. The important thing is you are doing what you need to do now.

With an insulin like Prozinc, the order is test, feed, shoot, all within a few minutes. Gabby got her shot when her head was in her bowl. She was a very food motivated kitty and didn't notice the shot.
 
Oh, my goodness. Where to start.... Normally 1 unit is the starting dose, so 1.5 was already too high. Then, if they tested just 2 hours later and were concerned that he had risen a tiny amount since the pre-shot test, they obviously do not realize that ProZinc often does not even have it's onset that early. If they gave him another 1/2 unit at that point, they are.. sorry.. crazy! They were no where near the lowest point in the cycle (nadir), so why in the world would they pile on extra insulin? And, when did they get the 293? I bet they did not even test long enough to see the full curve (meaning until his glucose rose back up again).

You do want to feed him some food before giving the shot. You may want to let him start eating and give the shot while he is eating (he may not even notice). You just want at least a little food in him before you give him insulin. The correct order of things is 1) take a glucose test, 2) give some food, and 3) give insulin.

I'm glad he was not "totally against" you testing. A fructosamine test gives the average over the last 2 to 3 weeks. They are great at diagnosis and in cases where the pet owner is not willing to test at home. But nothing is as good as at home testing. If you are doing that, you should not need a fructosamine test (which you, of course, would have to pay for). I am glad he thought it was good that you were researching, too. Maybe he will listen when you give him references to explain why you don't do what he says. :D It makes me cringe that he told you to look for your cat to start "yowling" to know he is in trouble. Good lord. How ridiculous.

Here is info on the spreadsheet:
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
http://www.felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/

Don't beat yourself up about not noticing the weight loss sooner. What matters is you got him to the vet and found out what is wrong, and you are prepared to do what you need to do. Also, you get bonus points for researching and being willing to do what you learn is needed even if it is against what the vet says. It is a rude awakening when you realize you cannot just blindly trust your vet.
 
Oh, and if it was my cat, I would not start at 2 units. I would start at 1 unit and home test from the get-go. It takes a few days on a dose to really see the impact of the dose. It is crazy to me that they thought they could do one partial in-clinic curve and figure out what dose to give. He would need to be on the 1 unit dose for at least 3 or 4 days to decide if a larger dose is needed.

It is, of course, up to you how comfortable you are with following or not following your vet's exact advice. But that is what I would do. I would also start transitioning to low-carb wet food.
 
I'm happy to hear they started Teal'c on ProZinc however 2u is a bit high for a starting dose. And yes that increase in BG could very well have been stress induced unless they fed Teal'c which also could have elevated BG but in any event, that didn't necessarily mean he needed more insulin. And keeping kitty around 300 is not going to improve his health. Something is wrong with this picture. They are giving more insulin than we would have recommended but their goal is to keep BG higher than we would consider optimal. Staying below renal threshold (when excess glucose is being excreted through kidneys) would require keeping BG at least 200 or lower.

Frustosamine tests are fine for diagnostic purposes but of little value if you are testing at home because all it will tell you is what you already know. And frankly my experience with the fructosamine other than at diagnosis was dismal. My girl's BG's BG was hardly moving and I had data to prove she was not in good BG range yet her first and only fructosamine supposedly showed she was under good control. Wouldn't waste my money on it again.

The suggestion that you can just watch a cat for physical symptoms or yowling to know if their BG is low is crazy. Some cats like some humans, have no sense of being low at the time. Waiting for obvious physical symptoms and you stand a higher chance of having kitty throw a seizure. Home testing allows you to dose appropriately, limiting the possibility of a hypo event considerably and enabling you to test to detect the possibility of a hypo event before it starts.

I agree with Sienne. Giving the second shot means you are in effect dealing with 2 overlapping cycles now. Do you know for sure when the 2 shots were given? It sounds like the 2nd shot was 2 hours after the first which means the first had not yet reached peak action. ((Your vet needs to go back to school for a refresher on diabetes and insulin!!!!)). :mad::rolleyes:

ProZinc can last as long as 14 hours, and given that you have no data to guess what might happen, I would be inclined to recommend that you don't give any shot until 14 hours past the last shot the vet gave which appears to mean roughly 11pm tonight. I'm betting you have no intention of normally giving shots at that hour. When do you think your ideal shot time would be? If need be, as long as there are no ketones or DKA in the picture, it might be better to hold of until tomorrow to give your first shot.
 
Unbelievable with what her vet was telling her and giving a second shot.You are so right Linda when you said the vet needs to go back to school for a refresher course
 
Patricia Chambers said:
2 units twice a day
Click to expand...
Please read what the other members have suggested about the dose and setting up a spreadsheet also your

Signature so people can quickly see which insulin you're using and get a little background. You'll see our signatures under each of our comments. Things we like to see are:

Your name/Cat's name, age, sex, date of diagnosis, type of insulin, type of meter, type of food, any other health issues or medications? and a general location
 
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He did tell me not to give him a shot tonight, but his reason was so we could get him onto our schedule tomorrow. Plan is 5:30 a.m. when I get home from work(took a sick day today) and then by my husband at 5:30 p.m. (I will show him how to do the shot in the morning) I work 5 p.m. to 5 a.m. he works 4:30 a.m. to 4:30 p.m. so one of us will almost always be around. The vet talked like it would be ok for me to do one shot in the morning after I get home and 1 before I leave but this is less then 12 hours between the a.m. shot and the p.m. shot. That scares me.

I have the Relion premier classic. Our walmart only had 30 gauge lancets so I got them. Relion lancing device as well as test strips. Reading the instructions for the meter I need some control solution? Also it said something about setting the hypoglycemic lvl do I do that as well.

The vet also did not want me to change his diet which is Nutro essentials indoor adult he said as long as he will eat it he will be fine, but from all I've read low carb is best. I have picked up a box of Fancy Feast Chicken Feast Classic Pate. Will try him on it on my day off. Want to be home off work in case of what ever. I want to be able to check him through out the day. Also get him some Fancy Feast chicken treats only ingredient is chicken.

I trust all of your knowledge and wisdom in dealing with this. Also realize your not interested in the cash in my pocket. Will start tomorrow with 1u and see how we do before I go to work.

Thank you all for your support and suggestions. I'd be alone in this and would have just done as instructed without question.

The Lancet device has 5 settings what setting is best? Thinking to start at 3.
 
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I agree it is better to share the duties with DH and keep shots 12 hours apart. You can give shots up to an hour early periodically if needed once you have more data but best to keep as close to 12 hours as possible as much as possible.

While manufacturers will tell you that you need control solution, they rarely include it with the meter which has always seemed strange to me, if it were really that important. Human diabetics are often told to test the meter when starting a new vial of strips however in my experience, likely because the control solution is not that easy to obtain for many meters, most don't use it. Using control solution tells you the meter is working and reading in range but it won't tell you the accuracy of the meter readings. I don't personally think you need to worry about it. If you are questioning the meter, you can always test yourself. Others may have a different opinion.

You can set the hypoglycemic level on your meter but you don't have to. It's an option. HERE are some videos for your meter including set up. If you choose to set the hypoglycemic level for Teal'c, you'd set the level at 50. Just be aware that while the meter suggests that is hypoglycemic, we consider 50 to be your warning point that BG is dropping and you need to take action to avoid a hypoglycemic event. Not quite sure why you'd need that feature on a meter but perhaps they added it so an absent minded human wouldn't misread the display!

On the food front, I'd suggest you get a bit of testing under your belt before switching over to the low carb diet as that can in some cases have a dramatic lowering effect on BG. It's Ok to start giving Teal'c some FF to get him used to it and figure out what flavours he likes but I'd keep his regular food in the mix for the moment. It's also a good idea to change diet slowly so as to avoid any GI upset.

Lots of helpful information about testing at http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/
You may find the 30 gauge lancets are a bit too small when first testing. You should be able to get 28 gauge lancets at a pharmacy. Kind of surprised Walmart didn't have them. If you have any other questions, let us know.

And if you have any problems setting up the spreadsheet, just holler.
 
So testing did not go as intended. Several tries to get some blood then I couldn't see it and accidentally wiped it off his ear. He was pretty calm. Did 1u instead of the 2. He didnt eat much will try again with testing later. Will get some vaseline his dark fur on his ear hides blood well.
 
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Oh those dark ears. :rolleyes: I know only too well how difficult dark fur on the ears can make testing. Using a very thin skim of Vaseline on the intended poke spot does help the blood to bead up making it easier to see. If you see a drop of blood, scoop it up on a clean finger nail and test from there. This helps immensely if kitty decides to flip his ear or his head while you are testing. Don't forget to hold pressure on the pokey spot for a few seconds after testing to prevent bruising. And make sure Teal'c ear is warm. Some folks make little rice socks and heat them in the microwave to warm the ear. Just be sure to check the temp before applying.

Not sure if you are testing from the outside or inside of the pinna but I found the inside worked better because the hair was sparser than on the back. It does however require manipulating the ear a little more.
 
You asked about what setting to use on the lancet device. I don't use one. I find it better to hold the lancet in my hand and poke. The device is just another bulky item to mess with and may make a scary clicking sound. There are mixed opinions on that here, but you could try both ways and determine your preference.

Warming up the ear really does help. I get the corner of a washcloth wet with very hot water, wring it out well and hold it on Mia's ear for a few seconds before testing. Then, after the test, I use it to wipe the area and apply light pressure a few seconds.
 
One other thing about the lancing device. If you choose to use it, take the cap off. Those devices are made for fleshy fingers and ears are too flimsy to go into the opening on the cap without some pressure and even then sometimes the lancet doesn't penetrate enough. Without the cap, I don't think the depth setting makes a lot of difference.
 
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