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-   -   Gretel is now our angel (http://k9diabetes.com/forum/showthread.php?t=5547)

CarolW 03-07-2010 09:03 PM

Re: Mini Schnauzer Gretel - Injection problems brewing!
 
Hehe, Carolyn - don't think you're ALONE in arriving home and discovering you have the "wrong stuff!" One time, when a locum vet was on, she prescribed an antibiotic for Kumbi that I really, really didn't want to give him - Cephalexin. Nothing wrong with it, EXCEPT - it does tend to nauseate some dogs, and I didn't want to risk Kumbi being nauseated, and maybe vomiting his dinner - then what would I do about his insulin injection?

Of course, I didn't discover this till some time after I got home, but luckily, the clinic was still open, and the vet was in, so she agreed to change the antibiotic to what Kumbi had had before. This meant, for me, about 1.5 hours' drive. ARGH! And I could ill-afford the gas!

Then there was the time (here, I was luckier) the pharmacist handed me Humulin-NPH instead of Novolin-NPH. Some say there's little difference, but they ARE a bit different, and I surely wasn't going to change Kumbi from one to the other. Something about the box looked unfamiliar, and I realized it just in time, on my way out of the store, so I turned around, went back to the pharmacy, and exchanged it for the Novolin-NPH. Whew!

Who has the brain, when overloaded and overwhelmed, always to notice these excruciating details? HAHA!

I try to teach myself habits of checking things. It takes time. To learn, that is.

If you haven't yet tried the 3/10 cc BD UltraFine II insulin syringes, with the 8 mm (5/16-inch) needles, 31 gauge, and the half-unit markings, you might like to try them. They are SO comfortable for the dog! I think they're also easier to manage when you can't pinch up much skin, just a tiny fold.

Since we started our conversation, I've been experimenting - dear Kumbi - he doesn't mind! - with pinching up a much smaller fold of skin than I was doing (as shown in the picture on Coherent Dog). and then, tucking that needle very carefully against the bottom of the tiny fold, just under my thumb - and checking the angle before I slide the needle in. It's been working really well - no fur shots yet that way! If it's easy to pull up a big hunk, fine, but I think I like the little tiny ones, too!

I think you've identified the MOST crucial elements of making injections painless for the dog. Usually, warming the insulin - IN the syringe - thoroughly, so it really feels warm to the fingers - is the very most common way to prevent pain. And that marking the bevel, and having it face UP - is the other!

I only learned that last one about a year ago, and it clearly made a big difference to Kumbi!

So now I can add this third tip for you - the very fine-gauge, short needles; that also aids a lot, I think maybe especially for small dogs like ours. But it looks as though big dogs appreciate it equally!

And you're spot on about the Village! This is a truly fine one!

Sun, 7 Mar 2010 20:00:33 (PST)

CoolGram 03-09-2010 05:24 AM

Re: Mini Schnauzer Gretel - Injection problems brewing!
 
Carol, your response made me chuckle, and Iíll tell you why. As you know, I wasnít happy because the pharmacist gave me the wrong syringes on Saturday. I didnít like them, but decided since I had already opened a pack that Iíd make do with them. But yesterday I changed my mind and decided to try to take them back, hoping the pharmacy would have the correct size in and make the exchange for me. When I called to ask about it, he said yes they did have a new shipment in, and he mentioned he also had the 31gauge needles which he explained were even thinner and I indicated that either 30 or 31 would be fine.

As I had a choir rehearsal last evening, I asked my husband if he would go to the pharmacy and make the swap for me. So, when I got home at about 9:30 last night, the first thing I did was look in the pharmacy bag to check the syringes, and the size was right (3/10 ml), and the gauge was 31G, which was fine, but they were the short needle!

Again I fumed and grumbled and was determined to march right back to the pharmacy this morning with them. After I was done venting, I came in to my computer and thought I would check this web site to see if there was anything new that I hadnít read yet, and what do I find but your message, encouraging me to use the short needle! It did make me laugh. :D

My only reservation about the short needle is the fact that Gretel has so much hair right now around her neck because I had cancelled her last grooming appointment as it was right in the middle of her not feeling well, having surgery, needing to go to the vet for curves, etc. Iím afraid I wonít get the needle in far enough because it has to go through all the hair fist. However, I do have clippers, and my husband (who is a barber) volunteered to trim her neck so I can at least see what Iím doing when I inject. She finally gets groomed next Thursday, so that will be a blessing. Until then sheíll look a little funny, but at this point itís the least of my worries!

Iíll let you know how it goes with the shorter needle, and thanks!

Carolyn

CarolW 03-09-2010 07:08 AM

Re: Mini Schnauzer Gretel - Injection problems brewing!
 
Hi again Carolyn,

Yeah, I did chuckle, reading your post! Hey! no need to shave! If it makes things easier for you, though, go ahead!

The hair will compress by your thumb, if you pinch up a fold of skin, and when you inject with the needle close to your thumb - it's the moment you slide the needle in - you just slide that needle till it stops - at that time, the needle has penetrated the skin, and it can't go further in. But it's likely in practically perfect position!

Remember to SLIDE the needle, without pressing hard at all. You can put moderate pressure on it when it stops, having reached the skin. It only takes a tiny bit of pressure (very light, really), and you can feel the needle is in as far as it will go. It very kindly stops when it's all the way in. (haha!)

Is there a reason you're shooting into the neck? Has nobody written into your thread about the best site for injecting? Maybe not!

People here generally follow the advice of Dr. Greco (from the bd.com site), and avoid the neck (scruff) because absorption tends to be rather poor there.

There's a thread on injections here:

http://www.k9diabetes.com/forum/showthread.php?t=973

It has a lot of pictures - you could try those approaches - some are quite different from what my vet showed me, in the sense of where you place the needle just before sliding it under the skin.

A couple of the pictures come very close to what my vet showed me, where the needle is placed fairly close to the human's thumb. Other pictures (apparently of Dr. Greco) show GORGEOUS pinch-ups of skin - you can see the pinch-up are small. But instead of injecting "under her thumb," she injects from the opposite side! However, the angle of the syringe looks perfect to me. I don't know why she calls that "45 degrees." Maybe that's about what it is! Seems to me a lesser angle than that, though I am so often wrong! I notice the dog, a Standard Poodle, has a puppy-clip - so the curly-fur is short.

I'm very conservative about where I shoot Kumbi. I tend to stick to what's very specifically recommended on the Vetsulin web site (doesn't matter that Kumbi is getting Novolin-N, not Vetsulin). Here's an illustration I made to show how I interpret the instructions by the makers of Vetsulin:

http://www.coherentdog.org/vek/backscruffinj.php

But it's not necessary to be so limited, as other pictures in the forum thread show.

And - HAIRY? you want HAIRY? I REALLY should have used Kumbi, instead of Kwali, as a model for these pictures, but I thought the needle would show up better, in the picture, against Kwali's darker hair. But Kwali's hair lay quite close and flat, so you can't tell all that well. Kumbi's, though, is very-hairy. Have a look at this picture:

http://www.coherentdog.org/arc2006/rgal02phot09.htm

When I pinch up that fold, I do it in line with how the hair lies, rather than cross-wise.

Is Gretel's hair very curly? is THAT perhaps a problem? I'd think even if it is, your thumb compressing the hair a bit should allow room to insert the needle as in the diagram here (third picture on the page)

http://www.coherentdog.org/vek/bevelup.php

I found what I did (with these short needles; but, then, I never ever had longer ones!) was to pretend to myself the hairiness didn't exist! Well, there WAS a time in the early days when I'd try to brush some of the hair aside a bit, but I found that wasn't necessary - just a waste of time, and a kind of bother. It worked a lot better for me when I pretended it wasn't there!

And so it goes with these excruciatingly-detailed injection-studies! Here I am, well over three years into this, and STILL experimenting at times! - largely, in conversations with my buddies here (for instance, I'm now making REALLY tiny folds in Kumbi's skin - and THAT is going just beautifully, too)!

It's close to Kumbi's injection-time - about 15 minutes (I'm sneaking up on the change to Daylight Saving Time), and I'm wildly tempted to try what I was first trying - with a single change. That is, I was grabbing as much skin as i could get hold of, from Kumbi's back (that was before he lost a LOT of weight), hiking it up as far as I could - and then shooting into the very top of that hiked-up fold! Nowhere near my thumb!

It's quite possible that with the insulin warmed properly, and the BEVEL UP on the needle, Kumbi will be fine with it, and the insulin will arrive properly at its destination - the layer of fat (however small) under the skin. It's the angle at which you hold the syringe, once the skin is pinched up (or even if you don't pinch up skin at all) that determines - along with the length of the needle (yeah!) - where the insulin arrives.

I'll let you know later whether I DID this experiment or not, and if I did do it, how it went.

If I had some ham, I could have ham and eggs, if I had some eggs.

Tue, 9 Mar 2010 06:04:42 (PST)

CarolW 03-09-2010 07:31 AM

Re: Mini Schnauzer Gretel - Injection problems brewing!
 
Poor Kumbi! He's SUCH a good sport! I DID do that little experiment, a few minutes ago. I hiked up a big fold of skin (as much as would come up) a bit down from his spine, along his left side, where I inject mornings (right side, evenings), and I placed the needle, bevel-up, along the very top of that fold, parallel to it. Slid the needle in - no problem - but then, as I injected, Kumbi shuddered. Oops! He was feeling the insulin going in.

That used to happen a LOT, till I asked my vet to show me specifically, which she then did, resulting in the way I do it now, holding up a fold of skin, with my thumb on one side, and injecting close to my thumb, at the BASE of the fold. Not into the top of it!

Okay, Kumbi, you've made your generous contribution to Gretel, now that's done; no more of THOSE!

Tue, 9 Mar 2010 06:30:33 (PST)

CoolGram 03-09-2010 12:29 PM

Re: Mini Schnauzer Gretel - Injection problems brewing!
 
Gretel and I would like to thank Kumbi for being such a willing "test dog". It's "folks" like you that make it possible for Gretel and I to get through these trying times without feeling like we're the only ones in the world going through it. I appreciate you and everyone else here who have helped and encouraged me more than you'll ever know.

Carolyn & Gretel

k9diabetes 03-09-2010 03:51 PM

Re: Mini Schnauzer Gretel - Injection problems brewing!
 
The really fine 31 gauge syringes I think only come in the short needle version at the moment. We used them and loved them... I am a bit needle phobic - the worst is with needles stuck in me - but I liked being able to put the needle in through Chris' fur cuz then I didn't have to really see it!

Natalie

CarolW 03-09-2010 04:11 PM

Re: Mini Schnauzer Gretel - Injection problems brewing!
 
Hey, Carolyn - all of us are somehow faced with this INJECTION PROBLEM! It's easier for those who have done it before - I had, but it was so long ago - it was myself - allergy shots. But that was back in the old days of re-useable needles, boiling to sterilize - what a bore! And I was shooting myself in the thigh. Myself, not a dog - another creature, a moving, movable creature - with lots of HAIR! Haha!

Not only that; *I* couldn't feel what Kumbi was feeling, so I had to depend on Kumbi to tell me how I was doing! And - good ol' Kumbi - he did! Very reliably, too!

In order, he'd:

yelp - OUCH - bad shot!
flinch - pretty bad; think about it, and try to improve
shudder - as he did this morning - not too bad, but let's improve!

It wasn't till I combined the bevel-up, and shooting into the base of a FOLD of skin (not actually a tent), AND with the insulin at body temperature - extra-warmed by holding in armpit - that Kumbi and I achieved truly painless injections. Shooting into the base of the fold, below my thumb, was what I last got from my vet, when I made a specific request for her to show me, which she did.

Anyhow, we're all in this together, and I think you have a fabulous tolerance for taking in a heck of a lot of stuff in a short time!

And - Natalie - I think you're right about those syringes. You go to the 31-gauge, and you get the SHORT needles. Glad to know they were fine for Chris. I think they're likely fine for most dogs; a very few might have too much thickness of skin; the HAIR doesn't count!

And I laughed and laughed about not having to see the needle go in! Oh, Natalie; your sense of humor - and reality - complements your knowledge so very well! Thanks!

Tue, 9 Mar 2010 15:08:57 (PST)

ozzi 03-09-2010 06:43 PM

Re: Mini Schnauzer Gretel - Injection problems brewing!
 
LOL. My first needles were 29 gauge 1/2" length, which I got used to using. When it was time for a refill, I asked the pharmacist about a smaller gauge and she gave me a box of 31-gauge. I got home, all jazzed up, and realized that they were the short ones. I believe they are 5/16" which is just 3/16" inch shorter, BUT that made a huge difference on Ozzi. He has a lot of fur, and I found them too difficult to use, so I donated them to the local shelter and got the 29's again. On the plus side, the 29 gauge needles inject faster because the lumen is larger which I think makes it easier for those folks giving larger quantities of insulin. With readjusting Ozzi now, I changed his dosage from 23u to 17u and it felt like nothing having been used to giving him the 23 u 2x/d for the past 6 months! I guess like everything else with diabetes, it's all about what works best for you and your kid!
Kevin

CoolGram 03-10-2010 05:17 AM

Re: Mini Schnauzer Gretel - Injection problems brewing!
 
Good Morning everyone - (at least it's morning where I am :))

Had to report that I used the short needle for the first time this morning and absolutely loved it! I was really worried about all that hair but it was really not a problem at all. And the best thing was that Gretel didn't even seem to notice the needle going in - no reaction from her whatsoever. Yea!!!

And Natalie, you had a good point (no pun intended!) about not seeing the needle going in. That was the best part for ME! I very careully felt all around the injection site afterward, just thought surely I'd feel wetness, but no, all dry.

I just have to say again how much I appreciate this forum and all of you. Even though we all (hopefully) get good advice from your vet, it's almost like ok, that's your starting point. But being able to compare notes with others who are going through it too shows you that it's possible to fine-tune those basic instructions for the benefit of our dogs (and us too).

Thanks to all and have a great day!

Carolyn

Patty 03-10-2010 10:16 AM

Re: Mini Schnauzer Gretel - Injection problems brewing!
 
Carolyn,
That's great news! Glad the short needles worked for you :)
Patty


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