Giving Insulin Injections

If you are are afraid of needles you will either get over it very quickly or have a lot of trouble giving your Sugarcat his or her daily insulin injections. I feel that anyone can become comfortable with giving insulin injections, with practice. You just need to know a few pointers and understand the why of it as well as the how of it.
I have no problem grabbing a syringe and giving Simon his insulin, but before you think I'm naturally comfortable with needles, let me tell you how I used to be.
My earliest memory of getting an injection was my Small Pox vaccination. I was quite young, but I still remember that my Dad had to set down in a chair and put me on his lap and hold me in a tight bear, pinning my arms to my sides, so that the doctor could give me the vaccination.
As I grew older, I understood that the various injections for my health, but I still had trouble with them and would never watch the needle going in. Even doing my best to ignore the whole procedure I'd get a little shocky and some times have to put my head down to keep from fainting.
When I went in the Navy I overcame some of this (a very little of it) what with all of the injections they give you in boot camp - it seems like hundreds every week.
It wasn't until some years latter when a doctor wanted me to have a Glucose Tolerance Test done that I really made an progress. Over the course of some 8 hours they took more than a dozen blood samples. By the time of the last sample, I would not have cared if they had come at me with a 12 inch needle.
That was the turning point, I can now actually watch the needle going in - though I make sure that I'm ready for it before letting them do it.
As to Simon's injections, well, it's him getting stuck not me so that helps a lot (Yeah, right! It probably makes the whole difference!) Well, yes, Simon, it is easier than doing it to myself, but I still feel a little bad about having to stick you with that thing.

Some Syringe/Needle Basics (actually a tad more than just the basics):

Terminology and Syringe Anatomy

First, technically, the SYRINGE is actually only the portion that holds the medication and the plunger which draws in the medication and then expels it through the NEEDLE.
NEEDLE refers to only the needle at the end of the Syringe, you know, the sharp part.
Okay, as long as you know those distinctions, you can call the whole think a Syringe, or a Needle, or a Syringe and Needle. It doesn't matter, as long as you understand the parts.
Being a technical sort person, I always like to call a spade a spade and a shovel a shovel
(I thought you were talking about Insulin Injections. All this digging utensil talk - is there something you're not telling me?) No, Simon, I just used that as an example.
For simplicity sake I will be calling the Syringe/Needle combination a Syringe. If there is a need to talk about a specific part I'll make that clear.
There syringes specially made for injecting Insulin. They have very find needles to lessen the discomfort and the syringe portion is quite small because Insulin doses are usually much smaller than other medications.
The diameter of needles on insulin syringes are measured in Gauges. These are the same Gauge measurements used to measure wire, for what is a needle, but a wire with a hole down the middle. As an example of gauges sizes, the electrical wire which runs inside walls in buildings in the US is either 14 or 12 gauge wire. The wire in US telephone cords is usually 22 gauge. Gauge 22 wire is smaller than gauge 12 wire - the Gauge number goes up as the diameter of the wire gets smaller.
Insulin needles are available in sizes ranging from Gauge 26 to 29, 29 being smaller than a 26 gauge needle.
The needles I'm currently using for Simon are gauge 29 - it is a very narrow needle, indeed.
The capacity of the syringe itself will be either 1/2, 1/3, and sometimes, 1/4 cc. This is an indication of the amount of Insulin the syringe will hold or more properly, the amount the syringe will hold up to the highest marking on the barrel of the syringe. All syringes always have some room at the top beyond the last marking.
Correct Syringes for Insulin being used
As you learned or will learn on the Insulin Know How Page Insulin does are measured in Units, not cc, and Insulin preparations are formulated with so-many Units per ml of the preparations.
Note - it is a strange fact that insulin syringes are labeled as being some fraction of a cc, but insulin is labeled as having some many units per ml. For all intends and purposes, and certainly for our purposes here, a cc is the same as a ml, and you will see me use both cc and ml. (Please don't write me and explain that one is a measure of volume, the cc, and the ml is a measure of a volume of liquid, that is, some part of a liter or that a cc is really only .97464 of a mL.. The difference is not important in this discussion)
In case you've not read the Insulin Know How Page yet, or by way of review if you have, 100 Units per ml is the most common type of Insulin, but there are insulins which are formulated with 40 Units per ml and other number of units in specially prepared formulations. A formulation with 100 units per ml is called a U100 insulin, accordingly, an insulin formulation with 40 units per ml is called a U40 insulin.
Insulin syringes are designed for a specific Units per ml formulation of insulin. There are syringes designed for use with U100 insulin as there are syringes for U40 insulin.
It is important to understand the the "U" rating of the syringe must match the "U" rating of the insulin to be used.
Important Rule - always match the U number of the syringe to the U number of the insulin. Failure to do so will result in incorrect doses of insulin being given.
I have always been one to question rules and ask why the rule exists. As a matter of fact, I always question just about anything I come across. I always want to know the WHY behind a rule or procedure.
I feel it is important that you also learn the WHYS behind such things as this "Match U Numbers" rule, so here's the explanation.
If you look at a 1/3 cc U100 syringe, you will see that the markings on it run from zero at the needle end to 30 at the other end.. Actually the zero is not marked, the first marking line signifies 1 unit. There are narrow markings at each unit position, only the "5s" are marked -- 5, 10, 15, 20, 25, 30. There would not be enough room to mark each unit position with a number like - 1,2,3,4,5,6,7..
If you look at a 1/2 cc U100 syringe you'll see that its markings go up to 50.
Well, if there are 100 units of insulin in a ml of U100 formulated insulin, then it stands to reason that half of a ml (or half of a cc) of U100 insulin will contain 50 units.
(Okay, wise guy, one third of 100 is 33.33333. So why is a 1/3 cc syringe marked only to 30?) Because, Simon, that's just the way the are marked, they simply stopped the marking at an even 5 unit marking. If someone needs more than 30 units of insulin they will be using a 1/2 cc syringe.
By the way, insulin doses in cats run in the range of 1 to 15 units. It is rare to see anything higher and most doses are at the low end of that range. Simon is currently getting 1 3/4 units 3 times a day
(Are you going to tell them how you can measure 1 3/4 units using a syringe that is only in marked in units?) Yes, I discuss that on the Insulin Know How Page.
(Oh, I guess I wasn't reading over your shoulder when you typed that one up.)
Folks, does you cat have the same over inflated view of the feline place in the world?
Back to the explanation of the "Match the U number of the syringe to the U number of the Insulin" rule.
Let's say we fill a 1/2 cc U100 syringe to the 50 marking with U100 insulin. We have 1/2 of a cc of the insulin formulation in the syringe and that 1/2 cc contains 50 units of insulin.
If we were to fill the same 1/2 cc U100 syringe to the 50 marking with U40 insulin we would NOT have 50 units of insulin in the syringe. Remember, U40 insulin contains 40 units of insulin per ml.
We would have only 20 units of insulin in the U100 syringe filled with U40 insulin to the 50 marking.
    1 ml of a U100 insulin formulation = 100 units of insulin
    1 ml of a U40 insulin formulation   =   40 units of insulin
    1/2 ml of a U100 insulin formulation = 50 units of insulin
    1/2 ml of a U40 insulin formulation   = 20 units of insulin
So if you use U40 insulin in a U100 syringe, you will not be administering the correct dosage. For example, if you filled the U100 syringe to the 5 units mark with U40 insulin, you would not have 5 units of insulin, you'd only have 2 units.
Each unit marking on a U100 syringe would be 2/5 or a unit of U40 insulin.
Confused? Don't worry if you are confused, just take that confusion as a sign of why you need to always obey the "Match the U number of the syringe to the U number of the Insulin" rule.
If you're not confused enough already, let me tell your there is an exception to this rule - but don't worry about it now. It has to do with a way to measure out very small fractions of a unit of insulin. This is discussed in detail on the Insulin Know How Page - Diluting Insulin
(Well, why don't you just tell them about it here?)
Simon, I think I hear Rusty in the bathroom, maybe he caught another mouse and put it in the tub, why don't you go see? '(Hey, Rusty, did you catch another mouse?) (sound of elephant feet running down the hall - he who said cats are quiet never had a cat!)
To recap - always make sure the U number of the syringes match the U number of the insulin. Use U100 syringes with U100 insulin; U40 syringes with U40 insulin.
Not so much as a rule, but as a tip, always use the smallest syringe (1/3 cc or smaller) that you can find. The spacing between the unit markings will generally be wider, because the syringe's diameter is smaller hence the need to use more of the length of the syringe for a given amount of insulin, and it easier to see what you're doing.
Correct Measurement Method

The drawing on the right shows the proper way to measure an insulin dose. In this drawing the insulin is shown as yellow, though in reality it will be clear or slightly cloudy in appearance.
The important thing about measuring a dose is to use the front of the plunger not the rear. This drawing shows a dose of 7 units, as measured by the position of front of the plunger, not the rear. Always think of the end with the needle as the front of the syringe.

The Insulin Know How Page contains instructions on how to properly load a syringe with insulin. See the section Loading a Syringe with Insulin.
Syringe Safety
The needle on a insulin syringe is quite sharp. and you should keep this in mind at all times.
I always recap the needle after loading a syringe with insulin, primarily to keep it clean and to avoid bending it until I am ready to do the injection. And I recap after giving the injection, to increase the safety when I dispose of the syringe.
But the box of Reli On syringes, which we use, has this warning printed on it:
IMPORTANT SAFETY INFORMATION: Always handle needles with care. Bend, used, damaged or improperly recapped needles can result in needle breakage, damage to tissue, or transmission of infectious diseases. Do not recap except at permitted by OSHA, CDC, or local policy. Dispose of this product in a puncture resistant container, following local ordinances.
Note the warning about recapping. It refers to two dangers - 1) injury to the person (hey, cats are persons!) receiving the injection if the needle is bent or broken and 2) injury to yourself while recapping the needle.
You might bend the needle while putting the cap back on and when you did the injection it could break off - in the cat's skin. Worst case? The needle breaks off and goes all the ay in and is now under the skin. An incision would have to be made in order to remove the needle the and the incision would require stitches to close it. Definitely not something we are going to do ourselves, so a trip to the vet or emergency clinic would be called for, immediately.
The second danger is that you will stick yourself with the needle as you recap it. While we are not worried about any infections from the cat, or at least so says our vet, you are still open to the danger of damage if you stick yourself with the needle.
And, if the syringes is loaded with insulin, there's the danger of injecting yourself with insulin. This could cause you to become hypoglycemic.
Some syringes have a needle guard through the side of which you can easily push the needle and thus stick it into yourself. This is especially true of the syringes with tapered needle guards.
So, while I will continue to recap syringes, after loading them and after giving Simon his injection, I follow these precautions:

I always look at what I'm doing. Like the saying "Keep your eye on the ball" here it is "Keep your eye on the needle"

I always hold the he needle guard close to the open end

I always make sure I inset the needle straight into the guard cap, not at an angle.

As for disposing of used syringes (and lancets if you do home testing) the proper way is to place them in an approved "sharps" container and then disposing of the container as dictated by local ordinances. You can purchase sharps containers at most drug stores, I believe that Wal-Mart also carries them. Some vets and drug stores will dispose of syringes if they are in a proper sharps container. Check around and see what is required in your area.
Some people place used syringes in plastic milk containers, soda cans, or such and then dispose of them with the rest of their trash. They feel that placing them in such a container is safe.
The decision is up to you. You know the e proper way to do it.

Injections

Where to give an Insulin Injection:
Insulin is injected under the cat's skin. You do not inject it into a blood vessel or into muscle or fat.
As to where on the body to do the injection, well, there are two schools of thought on this matter.
One says to inject under the skin at the nap of the neck or a few inches back from there.
The second school of thought is to inject under the skin on the side of the body at the abdomen. This school maintains that insulin injected here will be more quickly absorbed into the cat's bloodstream.
I always inject Simon at or near the nap of the neck and have never tried it on his side at his abdomen.
I will try and dig up more information on this issue and post it here at a future date.
Regardless of the site, the idea is to simply deposit the insulin under the skin and it will be absorbed into the bloodstream and circulated around the body.
How to give an Insulin Injection:
Insulin is injected under the cat's skin,- not into anything - not into muscle, fat or any other tissue. Remember you want to inject the insulin under the skin, not into anything.
The basic procedure is:

Pull up the skin at the injection site to make what most people call a "tent" which will create a gap between the skin and the cat's tissues under the skin

Insert the needle into the skin of the "tent" and inject the insulin, sort of like injecting the insulin through the door of the tent.

That's all there is to it, well not really.
There are a number of points to which you need to pay attention.

Gripping the Syringe - hold it in the classic injection position you've seen in all those movies and doctor television shows. Grip it between your pointer finger and index finger. If you want you can put your thumb on the barrel of the syringe to allow you to hold it tighter, but stay off the plunger, I explain that below.

You want to hold the syringe so that you can exert enough pressure to put the needle through the cat's skin - a cat's have very tough - but you also want good control of where the needle goes in.

You also want to avoid having to reposition the syringe in your hand after the needle is in. This means that you want to be able to grip the syringe so that once it's through the skin, you can simply move your thumb to the plunger and push it down without having to change your grip on the syringe or juggle it around in your hand.

Why? Because once you've put that needle just where you want it, you don't want to move your hand and fingers around to get at the plunger - you may inadvertently pull the needle out or even push into the tissue under the skin.

Why spoil that great aim that put the needle right on target only to accidentally pull it out because you have to shift the syringe in your hand to get at the plunger?

Insert the needle so that the it goes into the "tent", not down in the tissue below the tent. To accomplish this, hold the needle more or less horizontally. You may need to angle it downward a bit, but don't over do it.

You want to simply deposit the insulin under the skin, not into fat or muscle tissue below the skin. If you hit the fat or muscle below the skin it will hurt and, your cat will probably let you know about it. Doing this too often may make the cat needle shy.

If you inject insulin into fat it will slow down the system's absorption of the insulin. If you inject into muscle, the absorption will probably occur more quickly. You want the dose to be rather slowly absorbed and the place for that to happen is right under the skin, not in muscle or fat.

You also want the absorption to be fairly constant from shot to shot and so you should consistently put the insulin under the skin.

You've probably had people, maybe even the vet, tell that after you have the needle in place to pull back on the plunger to see if any blood is drawn into the syringe as a check that you are not going to inject into a blood vessel.

Good advice if you were doing the injection into muscle or fatty tissue, but unneeded if your going to inject the insulin under the skin, not into something.

Don't fret about it, if you are under the skin and the end of the needle is in the empty area under the skin,, even if you went through a blood vessel to get there, you will not be injecting into any blood vessel and you can skip the "pull the plunger out and check for blood" bit.

If you've ever seen a human diabetic give themselves insulin, you know that they just jab the needled in their arm, leg, wherever they do the injections and then push the plunger in.

Under the skin will do quite nicely. As long as you put the insulin under the skin and not into something, do not worry about hitting a blood vessel.

By the way, the more quickly you insert the needled the less pain the cat will feel form the needle prick.

Take care not to go through both layers of skin, that is, don't go in the font door of the "tent" and then out through the back wall. Obviously if you do this, the insulin will wind up on the cat's fur, not under the skin.

Don't touch the plunger until you have the needle in the skin. It is easy to accidentally and without knowing, push the plunger in as you push the needle through the skin. This will result in all or part of the insulin being sprayed out on the cat's fur.

We want the insulin inside them, not on the outside. After you get the needle inserted, then gently push in the plunger. Until you get a lot of practice at this, it is wise to keep your thumb off the plunger until the needle is in place and you are ready to push in the plunger.

Because the doses that cats receive are generally rather small, the plunger will not have to move very far before it hits the end of the syringe.

You will want, at first, to really concentrate on what you're doing as you push the plunger in.

The first few times I injected Simon I wondered if I'd actually pushed the plunger in after getting the needle in place or if I had pushed it before the needle was in place thus not getting all the insulin into him.

The plunger has such a very tiny way to move with low doses that I did not feel it move unless I really concentrated on the feeling as I pushed the plunger.

As a result I worried that I hadn't got all the insulin into him and I'd make a frantic search for Wet Fur. (This is not a problem for me now as we dilute Simon's insulin in order to more accurately measure fractional unit doses and as a result I draw up more liquid than before. See the Insulin Know How page for information on Diluting Insulin.)

So, until you've done if few times, really concentrate on the plunger as you push it in so that you'll actually feel it move and won't be worrying about whether you got the insulin in or if you maybe accidentally pushed the plunger before the needle was in place.

If you are unsure of whether all the insulin went into the cat, check for wet fur spots around the area you injected. Any wetness is a sign that not all the insulin went into the cat. We call this syndrome "Wet Fur"

If you find Wet Fur, or for some other reason you did not get all the insulin injected, don't repeat the injection. You have know way of knowing how much went in and how much wound up on the fur.

It is always better for a cat to have high BG levels than low BG levels. Low BG levels can trigger hypoglycemia and that can kill.

If you blow an injection and create Wet Fur, simply chalk it up to learning and pay more attention to what you're doing the next time. The cat will be okay, his or her BG levels will simply be high a few more hours than if they'd gotten the full dose of insulin.

Some people say that if you inset the needle with the bevel side upward it will go in easier and cause less discomfort. I do not know about this - I've found it makes no difference how the bevel side of the needle is oriented when I insert it into Simon's skin. You can try this and see if if makes a diffeernce for you.

This site is dedicated to Sugarcats everywhere and, in particular, to my Best Buddy - Simon

"Simon, If I could, I would search the entire universe for a cure for this damn disease.
Why did it have to be you?"