Diabetes in Dogs: The k9diabetes.com Forum

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CoolGram 03-01-2010 09:43 AM

Mini Schnauzer Gretel
 
Hello Everyone,

I have an 8yr. old mini schnauzer, Gretel, who was diagnosed with diabetes one month ago. Presently she weighs 18.5 lbs., but normal for her is around 20 lbs. As of this writing, she is still not regulated, although the vet has done 4 curves plus a few spot checks, and she is up to 8 units of NPH insulin twice a day. Her lowest reading so far was 250 but most of them have been in the 3 and 400 range. Complicating things is the fact that she just had bladder stone surgery a week and a half ago. (This is her 3rd bladder surgery in less than 2 years.) Tomorrow she goes to get the stitches out and will stay for the day for another curve.

She has been on wd canned and dry dog food (I mix them), plus I add to her food Tricitrate syrup which is to keep her urine ph at an acceptable level to try to prevent stone formation. It's been a real balancing act with her, because the food/medicine that helps one condition isn't usually good for the other. She also was recently diagnosed with a disc problem in her neck that was causing her pain. She seems to have recovered from that, at least for now, but she was on meds for that as well.

Through all of this, Gretel has remained a cheerful and energetic little girl. She takes the injections quite well. I can tell she doesn't exactly want it, but she will come right to me when I call her, and as soon as I give it to her I praise her greatly and give her a small treat (which is compatible with the wd dog food.) She gets no other food or treats throughout the day.

I do have a question that may not seem all-important but I'm curious as to what feeding schedule works best for others. Since they must be 12 hours apart, at some point in time there may be a conflict with your own schedule, and I'm wondering how you handle those occasions. I've always tried to stay at exactly 12 hrs. apart (give or take 5 mins.), but is there any room for leeway - like maybe 20 mins. or even 1/2 hour? (Just on the rare occasion, obiously not all the time.) Right now I'm feed her at 6:30am and 6:30pm, with the insulin following immediately after she finished eating. I chose this schedule because I thought that if we had plans for the evening we wouldn't have to rush back at a certain time to feed her. However tonight I have a situation where I need to leave the house by 6:15, so over the last two days I have inched her feeding back by 6 or 7 mins. each so that by tonight she'll be due for her feeding and insulin by 6:15 (but I don't necessarily want to stay that early). Would love to hear how others handle this type of situation.

Again, I'm thrilled to have found this forum. I'm sure all of us wish we didn't have to be here, but it sure is nice to know you can help one another out with questions and just with support in general. Thanks to all who respond!

Carolyn

k9diabetes 03-01-2010 10:06 AM

Re: Feeding schedule question
 
Hi Carolyn,

Welcome to you and Gretel!

Life happens :) We all have had to adjust on occasion because of a scheduling conflict. A half an hour should not be a problem. We occasionally had an extreme circumstance that required us to delay longer and if that happens you can adjust things back to normal in 20 minute or 30 minute increments over a day or two to reduce how much difference there is.

So if I'm late an hour tonight, I could give it half hour later in the morning and then at the usual time that evening and be back on track.

Hope that makes sense - I'm feeling a little disjointed today!

Gretel has a lot going on! When things settle from the surgery and the neck, you may see better blood sugar. Pain and inflammation can both raise blood sugar levels.

Natalie

CoolGram 03-01-2010 10:24 AM

Re: Feeding schedule question
 
Thank you Natalie. I'm trying so hard to do everything "by the book". It's been a rough 2 yrs. with all her issues and I want so badly for her to feel well and to know that I'm doing everything I can to help her. I wouldn't want to do anything that might be detrimental to her. Again, thanks for your response, it did help.

Carolyn

Patty 03-01-2010 01:40 PM

Re: Feeding schedule question
 
Carolyn,
Just wanted to say welcome! Sorry to hear about Gretel's surgery. Glad she's on the mend. What a sweet picture :)
Take care,
Patty

CarolW 03-01-2010 02:15 PM

Re: Feeding schedule question
 
And so, we get to meet ANOTHER super-great Human Dog-Mum! Wow; Carolyn, you have REALLY had your hands full.

I just loved your question about scheduling meals. I'm so compulsive I go to the minute - pretty much, anyway. And because I use my computer an awful lot, and also, I'm wildly absent-minded, I put my computer to work to tell me what to do when. For me, this is a great blessing, because my computer won't shut up until I check off the task I'm supposed to be doing!

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

I think it DOES make a difference to the dog - our bodies - and dogs' bodies - can be quite time-sensitive, in a biological sense. I'm so compulsive about it that I start changing times, a little at a time, two weeks before we go to Daylight (or Summer) time, and two weeks before we go back to Standard time. I change 15 minutes a day, for three days at a time, and set that all up on my CalendarScope program. Today is my first day of time-change. I'll actually be on Daylight time FIVE DAYS before it arrives!

But I can do that, because I'm long-retired, and always at home. I don't recommend my method to anybody. Some ultra-compulsive people who are always home might like it.

Dogs can easily adjust, say 15 minutes, 20 minutes, even half an hour - the main concern would be whether insulin doses might overlap, or fail to cover, say 13 hours, rather than the 12 they're designed for.

About regulation, that does often take time, and with all Gretel has been through, it may still take a little more time. I think you're getting very good numbers for the situation.

Kumbi says, Hi Gretel! and he adds licks and wags.

Mon, 1 Mar 2010 13:13:37 (PST)

BestBuddy 03-01-2010 06:26 PM

Re: Feeding schedule question
 
Hi Carolyn,

I used the 6am and 6pm schedule for Buddy because like you we were up early and if we wanted or needed to go out in the evening it didn't mess anything up. There were occasions when I was an hour late or early with the injection and in the grand scheme of thing it didn't make much of a difference to BG's. If you know early enough you can make those small 10-15 minutes up in the days before.

Jenny

CoolGram 03-03-2010 07:45 AM

Re: Feeding schedule question
 
Hello again,

Iím writing with an update on Gretelís curve yesterday. Unfortunately, her numbers still havenít come down. The lowest reading was 330 at 8:30am (2 hrs. after feeding and insulin). At noon she was at 383 and by 3:00pm she was up to 441. Needless to say, I am very discouraged.

Since the very beginning, I have been very suspicious that maybe the Tricitrate solution I give her for her urine ph might be a culprit in elevating her blood sugar. I questioned the pharmacist as to whether this was a sugar based liquid because it does come in either sugar based or sugar free formulas. He assured me that what I had was sugar free although the bottle does not say sugar free. Also, the liquid forms a sort of granulation around the opening of the bottle which made me really suspicious that there was sugar in it. The pharmacist said that even if it was sugar based, thereís only a small amount of sugar added to those types of solution, and he also said that if the high readings were coming from that, he would expect to see the sugar level elevate shortly after I gave it to her, but then the levels should drop rather quickly. Since her numbers go up and stay up he doesnít think that would be causing it. So, neither he nor the vet think it could be a factor. As I told the vet, Iím just grasping at straws, trying to think of anything that might be keeping her numbers up. I am even questioning myself as to whether Iím doing something wrong when I give her the injection. I really donít think so; I tent the skin and inject at a slightly downward angle and I know itís not coming out the other side because I always feel the hair around the injection site to make sure I donít feel anything wet and I never have. I honestly do believe that everything is being done that can be done, but since Iím a novice at this, itís kind of hard not to worry that itís something Iím doing wrong.

The vet assured me that this difficulty in getting the numbers down is not uncommon and that we will eventually get there, but it needs to be done slowly because she is a small dog and we canít take a chance on taking her too low. Sheís now up to 9 units twice daily and the vet wants to do a spot check next week. On the bright side, she gained several more ounces since her surgery a week and a half ago (sheís now 18.8 lbs., up from a low of 17.5 when she was diagnosed a little more than month ago), so the vet said that shows things are going in the right direction.

On another note, thanks to all who responded to my question about feeding. Itís really nice to ďmeetĒ all of you. Itís just great to have that support and I really do appreciate it.

Carolyn

k9diabetes 03-03-2010 01:32 PM

Re: Feeding schedule question
 
Mini Schnauzers are infamous for a couple of contributors to high blood sugar, one of which is high triglycerides. So I wondered if those have ever been checked.

I am with the vet on this right now - with so much that Gretel's been through recently, I think it's just going to take some time for everything to get healed up and uninflamed.

Also, she may have built up some temporary insulin resistance that comes from having high blood sugar for a while. If that's true, then that will break after she's had these higher doses of insulin and then she will become more sensitive to the insulin and get even better levels from the same dose.

If the insulin wasn't working for her, you would not see blood sugar down into the 300s. So it's working and even seems to be providing a pretty nice, flat response, which is what you want in order to get the best regulation possible.

So I know it's really hard not to worry - I remember many sleepless nights early in Chris' diagnosis and regulation - but I agree with the vet that things are moving in the right direction.

Natalie

CoolGram 03-03-2010 02:11 PM

Re: Feeding schedule question
 
I have never heard the vet mention anything about Gretel's triglycerides, I didn't even realize that could be a factor in high blood sugar. She just had bloodwork done prior to her surgery and since she was known to be diabetic maybe her triglyceride level was included in that. I will ask the vet next time I speak to her.

Thanks for the suggestion.

Carolyn

k9diabetes 03-05-2010 09:41 PM

Re: Feeding schedule question
 
Just thought I'd copy this here for handy reference.

Quote:

Dog's Name: Gretel
Sex: Female
Breed: Miniature Schnauzer
Age: 8
Current weight: 18.8 lbs.
Weight when diagnosed: 17.5 lbs.
Average weight: 20 lbs.
Diagnosed with diabetes 1/21/10

Insulin: NPH - currently at 9 units twice a day

Food: w/d canned and dry mixed
1/2 can and 2/3 cup dry at 6:30am and 6:30pm

Treats: Hill's Veterinary Treat (compatible with w/d dog food)
She gets one small treat after her morning and evening injection

Still working on getting regulated. Not yet doing home testing.


CoolGram 03-06-2010 06:13 AM

Trouble brewing at injection time
 
Hello everyone!

It has been about 6 weeks since Gretel (my 8 yr. old mini schnauzer) was diagnosed. Up until a few days ago, she was taking the injections like a champ. The first week I gave them to her she came to me after eating without me even needing to call her to me. Then she gradually decided maybe she really didn't want to come, but when I called her she came without hesitation. This past week she has gotten more and more hesitant to come, she has jerked several times and yelped once when the needle went it. Of course this isn't helping me, because it makes me more nervous to give it, which I know isn't good. We seem to be doing things in just the reverse of everyone else. Most people start out rocky, but eventually things improve. We started out better than expected but now we're going downhill. I would really like to nip this in the bud before it gets worse. Oh, in case anyone is wondering, I do give her a treat following the injection, so she knows she has that to look forward to.

I have been injecting into the scruff of her neck because it seems that's where the most loose skin is on her. I had been instructed to inject anywhere from the scruff down to an area above the shoulder blades, sort of in a triangular area. But the lower I go, the less excess skin there is and it becomes harder to inject there.

I'm wondering if she's simply getting sore in the scruff area? I do move the site from left side, then middle, then right side. But every third injection I'm back at the same site again.

I've also read in this forum that the beveled edge of the needle should be down when the injection is given. Could this be the problem, that the needle isn't turned in the right direction? I really couldn't even tell which side was which until I got a magnifying glass out. Does anyone know whether the beveled edge is always on the same side of the syringe barrel or do you need to look at each one to see where it is?

As always, thank you to all who respond. I really appreciate your help.

Carolyn

Dakotapix 03-06-2010 06:42 AM

Re: Trouble brewing at injection time
 
My own schnauzer, Wolfie, had an excess of fatty growth around his scruff so my vet advised us to inject insulin below the scruff. I tried to vary the injection point from both sides of his back and along both flanks to avoid overly sensitizing any one area of his body. I also kept a bag of his favorite treats in his vision to distract him while giving the shot. I think Natalie and most forum members will suggest that you vary the injection point. Somewhere on the forum there's an illustration that diagrams good injection points on a dog.

catusgirl66 03-06-2010 06:43 AM

Re: Trouble brewing at injection time
 
Hi i'm new at this too lol. My dogs name is Boober we have been having a heck of a time with her... at least she is eating some now. I too have been having some problems with the shots, so you are not alone. But see I was told not to give in the neck area but to imagine a saddleback like whats on beagles and to do it only in that area and to switch sides each injections. Boober she is the same way, she yelps or jerks whats bad is one night she didn't even get all meds had to stick twice, because I put it in and she jerks on me urggggg. I hope like you this gets easier .

Kelly

CoolGram 03-06-2010 06:54 AM

Re: Trouble brewing at injection time
 
Yes, I did see the instructions on different sites to inject. I have just been doing what I was instructed to do by my vet, but I plan on mentioning this to her to see if she has any particular objection to me finding a different site. I do vary the site as much as I can, given the small area I have to work with, but she just doesn't have much loose skin anywhere but on her scruff. I think I will try to set the treat container in front of her while I inject her, so maybe that will help her refocus on that, rather than what I'm doing to her! Thanks for your suggestions!

ozzi 03-06-2010 07:00 AM

Re: Trouble brewing at injection time
 
Quote:

Originally Posted by CoolGram (Post 25683)
I've also read in this forum that the beveled edge of the needle should be down when the injection is given.
Carolyn

Hi Carolyn,

Actually, the bevel should be UP when giving the injection. This is for purposes of comfort for the dog. You do have to look for the bevel every time because the needles are not in the exact same position on the barrel of the syringe each and every time. If the bevel is down, it will still be effective, so that is not the worry...it's about comfort when injecting. Gretel might be having pain because the bevel is down. I'm not sure if you're warming the insulin prior to injection, but I take it out of the frig, draw it up, and put it under my armpit for 5 minutes. I think if you warm it and try injecting with the bevel up every time, Gretel will find it more comfortable.

Regarding locations, I have read that absorption is less effective in the scruff because of limited vascularization, and that the armpit and flank are more effective, however my vet did instruct me to inject in the UPPER half of the body and showed me how to do it in the neck, and I have been doing that as well.

Kevin

CarolW 03-06-2010 07:47 AM

Re: Trouble brewing at injection time
 
Hi Carolyn,

The bevel on the syringe needs to be UP, not down! I mark the bevels on my syringes. Have a look here:

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

Make sure to scroll down on that page and look at each of the pictures.

That page is part of the "painless injection" series, and you can use the NEXT, PREV, and UP buttons above the main picture on each of those pages, to look at the other pages in the series. On the main index page, scroll down to see the "Parts List" that takes you to the page of your choice.

Where the bevel is varies completely; there's no way to tell, but if you've marked the syringe (I use a Sharpie, Fine Point, permanent marker), it becomes easy enough to hold the syringe with the bevel up.

Another possibility that occurs to me is that maybe you're not getting the insulin warm enough for Gretel's comfort. When you test the contents of the syringe with your fingers, you want to have the impression that it's VERY distinctly WARM-feeling. It should feel as though it's at body-temperature, at least.

So, have a look here:

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

and use the NEXT button to check the next page as well.

I'd actually suggest you read the entire series with some care, because it took Kumbi and me a long time to discover each of the excruciating details that go together to assure that injections remain truly painless.

Kumbi REALLY lets me know when an injection hurts. As one did the other day. I just must have hit something wrong. But when some 99.9% of the injections really are painless, dogs do very well, and easily forgive the very rare painful one.

About injecting anywhere but into the scruff - the scruff being definitely the easiest place to pull up a lot of skin - it feels scary to me, too, to shoot into other areas, where I can only pull up just a little bit of skin - a tiny fold between my fingers. The pictures on Coherent Dog show a fold-pinch, rather than the "tent-style" I've seen on some other sites. As long as you can get a bit of a fold up, you can place the needle just below your thumb (bevel up), holding the syringe almost tangent to the body, but aimed so the needle tip will go under the skin when you slide it in.

Dr. Greco, on the BD site, says insulin is poorly absorbed from the scruff, so she recommends using the other sites available. There's a picture of some of those sites here

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

and another, which shows some other alternatives, here:

http://www.k9diabetes.com/forum/show...51&postcount=5

By the way, what syringes are you using - could you describe them in detail, please? That is, what's the capacity? I'm using 3/10 cc syringes by BD. What gauge are the needles? And what length is the needle? Mine are 8 mm (5/16-inch) - these are SHORT needles. Should suit Gretel very well. And the syringe barrels - big bonus here - have half-unit markings. Mine are called BD UltraFine II 3/10 cc, 8 mm, 31-gauge, half-unit markings. I'm in Canada, which is why the "8 mm."

If you're not using the thinnest (higher gauge numbers are thinner), these very fine needles should make injections very comfortable for Gretel.

You're now at an awkward stage with Gretel, who WILL be suspicious that the injection is going to hurt. In this situation, I'd give Gretel a treat before the injection, as well as after.

Gretel sounds like all truly great dogs - she is very cooperative!
Good for her, and good for you!

Don't miss this post by Ozzi (Kevin) that he wrote yesterday; though it's about getting blood samples for a glucometer, the same principles apply when you change where you inject, and how you're holding skin:

http://www.k9diabetes.com/forum/showthread.php?t=1701

Oh, hey, Kevin seems to have replied to you here while I've been writing this long post - I'll have to wait to read it! (not for long, though).

Yell if you want more help with this!

Sat, 6 Mar 2010 06:46:53 (PST)

ozzi 03-06-2010 07:50 AM

Re: Trouble brewing at injection time
 
LOL...I just love you to pieces Carol!!
Kevin

Margaret Boyle 03-06-2010 08:02 AM

Re: Trouble brewing at injection time
 
Hi Carolyn,

I have a mini schnauzer Lucy, all the advice you have been given is spot on.

As regards the scruff area this can build up fatty tissue, so it is best to try and find other sites. I inject Lucy down both sides of her sides away from the spine area, I alternate one side in the morning the other at night.;)

You will find what is best for you. The bevel should be facing up the bevel
glistens when you hold it under a light. Put a little straight line at the top of your barrel with a red marker pen. This will keep you right.:) I open a packet of syringes and I mark them all the ones I am going to use.

Always warm your insulin in the syringe put it under your armpit for 60 to 90 seconds it will feel warm when you take it out. Cold insulin stings.:eek:

You will be fine Carolyn, we have all been there it all takes time.

I keep Lucy's treats beside me and she can see the little tub and knows she will have her treat. I use boiled turkey cut into small bite pieces.
Everyone has there own treats.;)

You are doing well.

Marg

CarolW 03-06-2010 08:08 AM

Re: Trouble brewing at injection time
 
Gosh, Kevin!

Quote:

I'm not sure if you're warming the insulin prior to injection, but I take it out of the frig, draw it up, and put it under my armpit for 5 minutes.
FIVE MINUTES? Your armpit must be even colder - lots colder - than my scrawny little one! Oh, I KNOW WHY! You expend all your warmth here on the forum!

(Hehe - my vet suggested 15 seconds, but I find 30 seconds works better - that long seems very reliable!)

I suppose, too, it depends on just HOW you tuck the filled syringe in to your armpit! I place my finger over the filled area, needle already carefully re-capped, so as not to dull the needle. I protect the plunger end from rubbing against anything by cradling it in my palm. And then, I duck the syringe tip under my clothing, and carefully place the needle-end, using my finger as a guide, against the nearest fold of my armpit - and -

CLAMP! - arm against chest-wall. Whew!

Meantime, I'm standing at my computer, looking at pretty pictures, or reading this forum, and watching the Duality Software clock count the seconds. Very handy stuff.

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

It's better if I look at pictures instead of reading this forum, or I might be clamping on that syringe for five minutes! So absorbing!

Sat, 6 Mar 2010 07:06:56 (PST)

ozzi 03-06-2010 08:16 AM

Re: Trouble brewing at injection time
 
Wow Carol...thank you! Actually my vet never told me about warming the insulin at all and in the beginning I never did! It wasn't until I brought my cat Zakk to his vet for an annual physical exam that I found out about it. I told Zakk's vet that Ozzi seemed to be in pain when I gave him the injections...you just know when your dog is in pain vs being "a baby." LOL She suggested taking out the bottle of insulin and leaving it on the counter to warm up. I thought this seemed excessive, so developed my "own" procedure and stuck it in my armpit for 5 minutes. I am so glad that you told me I don't need to do it that long! I will make that adjustment!! Thanks again!

Margaret Boyle 03-06-2010 08:22 AM

Re: Trouble brewing at injection time
 
Quote:

Originally Posted by CoolGram (Post 25687)
Yes, I did see the instructions on different sites to inject. I have just been doing what I was instructed to do by my vet, but I plan on mentioning this to her to see if she has any particular objection to me finding a different site. I do vary the site as much as I can, given the small area I have to work with, but she just doesn't have much loose skin anywhere but on her scruff. I think I will try to set the treat container in front of her while I inject her, so maybe that will help her refocus on that, rather than what I'm doing to her! Thanks for your suggestions!

Carolyn,

Sorry I think I posted in the wrong post ,it is in the trouble brewing post,
talk about confused, my apoligies.
Scroll down here and you will get my post.

CarolW 03-06-2010 08:32 AM

Re: Trouble brewing at injection time
 
Wow, Kevin; you are very innovative! I wouldn't have thought to warm the insulin (in the syringe) in my armpit! It's great that you cooked that up on your own! (any pun intended).

It's VERY interesting, how much vets vary in their knowledge of diabetes and all the associated procedures we Human Dog-Parents face. Not only that, but some vets are much more communicative than others. I got lucky - great vet, great communicator. Well, I chose my vet with great care, too, but she's also the vet almost-nearest me, at a 40-minute drive from home.

We do discover, on this forum, that some vets appear just to go by some book they read, and since every dog is different, doing a really good job of managing diabetes in any of our dogs SOMETIMES indicates we have to change vets. Quite a few members here have changed vets; some of them, several times.

Apparently, though, you don't need to do that, Kevin!

For vet difficulties, and heart-rending tails, see this thread:

http://www.k9diabetes.com/forum/showthread.php?t=1617

People who come here for the first time are usually wildly overwhelmed, so can only ask questions, and do their best with whatever can be offered. Later on, though, as they gain control over their dogs' diabetes, and the dogs are feeling better, those who explore the forum, reading different threads, will find all kinds of useful tips and tricks.

Then after a time, some of these people become super-helpers, as well!

Carolyn - you will likely be one of those, because I can see how you concentrate well, and pay attention to detail -and I see your truly devoted concern for Gretel's comfort and well-being. Same as Ladybug (and Linda) - and most others here, too.

Sat, 6 Mar 2010 07:30:48 (PST)

Noodle 03-06-2010 10:44 AM

Re: Trouble brewing at injection time
 
Our vet originally told us to inject into the scruff as well. In the beginning, like you and Greta, he tolerated it well. But it wasn't long before he was flinching and acting like it was bothering him, despite rotating the injection site.

After reading & researching more on this board, I found information that indicated the scruff wasn't the ideal place for the best absorption and was also more prone to scar tissue formation. After that we started injecting Noodle on his side, which we actually find much easier since he is lying down. For him, we stick to an area from just past his ribcage to just before his legs, and from a few inches down from his spine and a few inches up from his stomach. That still gives us quite a bit of space (he's a medium size dog) to rotate things around to keep from hitting the same spot, and we also rotate from one side to the other - right side am, left side pm.

Making sure the insulin is warm is also a high priority. There is an old thread around her somewhere that a human diabetic posted reflecting on her own experiences with things like injections. She made the point that cold insulin hurts. We keep our vial in the refrigerator. I draw Noodle's 30 units and then leave the filled syringe on the counter while I'm getting things ready and feeding him. While he's eating, I roll the syringe in my fingers and that's generally enough to warm it. If not, I hold it in my lips crosswise and that heats it up fast.

I think many vets tell you to inject in the scruff because that's where they give vaccinations and they know it's easy and dogs tolerate it well. But dogs also aren't getting vaccinations twice a day, every day...hence the problem. Our vet also only instructed us in how to test his blood sugar by using his ear. UGH! What a disaster that was! Even they had a heck of a time doing it and Noodle hated it! :eek: If I hadn't found out about all the other options we never would have been able to successfully test Noodle's BG at home. Now I don't even let them near his ear when he goes for vet appts.

Like so many other things related to aggressively managing canine diabetes, a lot of it is left to communities of experienced diabetic pet caretakers to learn from each other. Many vets just don't have a lot of experience with managing it in a very proactive way because they learn a very limited amount about it in veterinary school. But if your fortunate, they end up learning a lot from you & your pets journey and they carry that over to future patients as well. :)

k9diabetes 03-06-2010 11:23 AM

Re: Trouble brewing at injection time
 
Here is a diagram of the many different places you can inject. We started in the scruff but Chris quickly developed thickened skin there so we moved down to the side of the chest from his front leg back about half way across his rib cage.

From BD's Dog Diabetes Learning Center (lots of good tutorials and images): http://www.bd.com/us/diabetes/page.a...t=7001&id=7395

http://www.bd.com/resource.aspx?IDX=2551

This and other information is posted on the Links Page: www.k9diabetes.com/complinks.html.

What gauge are the needles on your syringes?

You can also try different angles, ways of tenting, etc. Sometimes that makes a big difference. We have seen quite a few dogs who don't like to have their skin pulled into a tent and it's not necessary to do that to give a good subQ injection.

I will pull up the injection tips thread... have to find it. Possibly at the Answers forum: http://www.k9diabetes.com/forum/forumdisplay.php?f=14

Natalie

k9diabetes 03-06-2010 11:26 AM

Re: Trouble brewing at injection time
 
This is another extensive thread on injection problems: http://www.k9diabetes.com/forum/showthread.php?t=1002

I'm sure you will find lots of good ideas there.

I'm going to merge this thread with your other one so we can keep all of your information together in one place.

When you want to post something new, add it to your existing thread and people will respond there. We always check the threads that have new posts in them.

I know you will find a way to make it work. :)

Natalie

CoolGram 03-06-2010 12:52 PM

Re: Mini Schnauzer Gretel - Injection problems brewing!
 
Thank you so much to all of you who responded. To answer a few of your questions, I have been trying to warm the insulin, although maybe I'm not warming it enough. I get it out of the fridge while I'm getting Gretel's food ready. Then while she's eating I prepare the syringe. Usually I just hold the bottle between my hands for a couple of moments, gently rolling it back and forth. After reading all your posts though, I probably should be warming it after I draw it into the syringe - much less to have to warm!

As to the syringes I use, currently I'm using BD Ultra-Fine 1/2ml - 12.7(1/2") -30G. The first box I had, the syringes were 3/10ml, but when I went last night for a new box, the pharmacy was out of the 3/10's so she gave me the 1/2's. I don't like them as well, because they hold more and the unit markings are closer together. I will use the suggestion to start marking the beveled side of the needle, hopefully that will help with any discomfort Gretel's been feeling.

As always, thank you all for your support. It's helping me to get through this without a nervous breakdown!

PS - I'm diabetic myself (although not on insulin) and my own numbers have been a bit off lately, what a pair Gretel and I are - diabetes is all I think about lately.

Carolyn

CarolW 03-06-2010 06:33 PM

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

You remarked on the warming - yes; by all MEANS, warm the insulin IN the syringe - armpit method, or, as some do, holding it sideways in your mouth. I think my buddy Eileen does that, and also, somebody else here mentioned, today, doing it that way.

The syringe contents really should feel, right through the barrel, distinctly warm to your fingers, before you inject. This makes a big difference to the dog's comfort!

And, you also remarked:

Quote:

Originally Posted by CoolGram (Post 25725)
As to the syringes I use, currently I'm using BD Ultra-Fine 1/2ml - 12.7(1/2") -30G. The first box I had, the syringes were 3/10ml, but when I went last night for a new box, the pharmacy was out of the 3/10's so she gave me the 1/2's. I don't like them as well, because they hold more and the unit markings are closer together.

Well, I think that pharmacist did you a dirty deal - "accept no substitutes!" I guess the pharmacist isn't a dog being injected [deadpan]

You bought a whole box? I'd return all unopened packets, and ask for replacements with the syringes you were using before.

This picture (ignore the stuff about conversion) shows the differences in needle length, between 12.7 mm (half-inch) and 8 mm (5/16-inch).

The long-needle ones shown are from 1 cc (1 ml) syringes, but the half-cc, or half-ml syringes have the same needles (12.7 mm = half-inch) as the ones shown in that picture.

http://www.coherentdog.org/vek/cvt6p5udisplay.php

You can see that the difference is fairly dramatic.

The change in gauge between 30-gauge, and the even thinner 31-gauge, isn't quite as crucial, though even that difference is significant for the dog.

I buy syringes well in advance, to make sure I don't run out of my favorites.

Keep reporting in, will you? I KNOW you'll do REALLY well with Gretel - because you care!

Sat, 6 Mar 2010 17:32:03 (PST)

CoolGram 03-06-2010 07:57 PM

Re: Mini Schnauzer Gretel - Injection problems brewing!
 
Correct me if I'm wrong, but I think the only difference between the syringes I just bought and the original ones is the fact that the new ones hold more, thus the barrel is a bit larger. However the length of the needle is 1/2" on both and the gauge is the same - 30G.

I didn't look in the bag when the pharmacist handed it to me, didn't realize until I got home that there was a slight difference, so I called the pharmacy right away as it was almost their closing time. She apologized profusely to me for not explaining why she gave me the different ones.

That taught me several lessons - don't wait until you run out of them to get more, and look in the bag before you leave the pharmacy counter! I'm learning - the hard way I guess.

Oh, by the way, tonight when I gave Gretel her insulin, I made sure the beveled side was facing up AND I warmed the insulin after it was in the syringe and it went well, so maybe those two things alone will make a difference.

Thanks all, for the input. Sometimes it takes a village doesn't it? ;)

Carolyn

ozzi 03-06-2010 08:11 PM

Re: Mini Schnauzer Gretel - Injection problems brewing!
 
Carolyn,
I was sooooo happy to read your post about Gretel's injection tonight! HURRAY! I hope that was the reason for her discomfort, and that all of her injections continue to go smoothly and fairly painlessly! Good job!! You did good!
Kevin

Margaret Boyle 03-07-2010 05:41 AM

Re: Mini Schnauzer Gretel - Injection problems brewing!
 
Quote:

Originally Posted by ozzi (Post 25760)
Carolyn,
I was sooooo happy to read your post about Gretel's injection tonight! HURRAY! I hope that was the reason for her discomfort, and that all of her injections continue to go smoothly and fairly painlessly! Good job!! You did good!
Kevin


WELL DONE CAROLYN:D

Marg

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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