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Lancets - Monolet, BD Ultra-Fine II, Gentle-let

Examples of Lancets:

Sherwood Monolet (blue, not so good)

B-D Ultra-Fine II (green, our favorite)

Ulster Gentle-let Lancets (white, excellent)



Lancets

Lancets are not the same as syringe needles. They have a very short, sharp tip, made to puncture the skin and produce a blood drop. Smaller diameter lancets and sharper lancets hurt the least and penetrate most easily. They may be held in your hand or used in a spring-loaded lancet device. Lancet devices allow consistent depth of penetration but can be harder to aim exactly.

BD Ultra-Fine II lancets (green ones, middle of the picture, always successful) are easy to hand-hold and the cap stays on when re-capped after use. They didn't hurt when we stuck ourselves and they don't seem to hurt Harry either. The BD Ultra-Fine II lancets fit in the Autolet, Autolet II, Autolet Mini, Auto-Lancet, Exactech, Autoclix-p, Glucolet, Medisense, Penlet II, and Soft Touch lancet devices.

Ulster Medical Products Gentle-let Fine Point lancets (translucent white one, front of the picture, always successful) are also easy to hand-hold but the disk cap is hard to replace (the tiny hole in the cover is difficult to see) and the cap tends to fall off easily once recapped after use. The "twist to break off" tab style probably all share the problem with staying on securely after recapping, which is a safety issue until you dispose of the lancet, unless you use a lancet device that automatically retracts the sharp tip. The General Purpose style Gentle-let Fine Point lancets fit in the Autolet, Autolet II Clinisafe, Auto-Lancet, Autoclix, Checkmate, Dialet, Glucolet, Monojector, Penlet, Penlet II, Soft Touch and Ultra TLC lancet devices.

Sherwood Medical Monolet lancet (blue one, back of the picture, more difficult to prick) seemed less sharp than the BD Ultra-Fine II and Gentle-let Fine Point lancets and larger in diameter. It was harder to penetrate the skin, but the prick did bleed okay.

Liberty New Thin lancets (gray or opaque white, not pictured, NOT recommended) were even less sharp than the Monolets and we were unsuccessful in getting blood with them from ourselves or our cat.

Lancet Devices

SoftTouch pictureSoft Touch diagram, parts labelled

SoftTouch packageSoft Touch has a newer model with an adjustable depth head. Both the Soft Touch and BD lancet devices take the BD Ultra-Fine lancets. They are easy to put in and safe to take out of the device without sticking yourself.

 

 

 

Microlet from front, added tape for horizontal alignmentMicrolet from top rearThe Microlet comes with the Elite XL and Dex models. It has 2 different end caps, which penetrate to different depths-- 3 dots regular and 5 dots for deeper. It may be more difficult to aim than the other ones (more blunt-ended), but with practice, it works fine. The center dot marks the vertical line to the lancet point. Laura added blue tape to mark a horizontal line to the lancet point, sort of like the cross-hairs in a site. She lines up the horizontal line from the tape with the vein in the ear and uses the center dot to guide the prick.

 

Penlet II lancet device has a new model with seven easy-to-dial lancing-depth selections and hands-free lancet removal for safer disposal (not shown). Both versions of the Penlet II use BD Ultra-Fine II lancets, Gentle-let Fine Point lancets and others of the standard style shown. The Penlet II CE included with our FastTake (shown) doesn't have adjustable depth settings, but is easy to use. The lancet ejects without being touched again when you hold onto 2 prongs while pulling back the sliding barrel. Penlet II and lancet

 

 

Penlet II - open with lancet inserted and cap removed

 

 

 

 

Softclix package and lancet deviceSoft Clix

lancet device takes a different kind of lancet. One person had trouble locating lancets to fit it that were as thin as the BD Ultra Fine ones, she reported that the Soft Clix Fine lancets hurt when she stuck herself.

 

 

Urine Test Strips Bayer Ketostix boxBayer Keto-Diastix BoxBayer Multistix 10 SG box

Urine testing strips can tell you when blood glucose levels are too high and detect the presence of ketones in urine. For blood glucose monitoring, blood testing is definitely superior, since urine can only tell you what your blood glucose levels were a few hours ago, while blood tests report current levels. You should not make insulin therapy decisions based on a urine test strip. However, when it comes to ketones -- a byproduct of lipid fat and protein metabolism -- urine testing is best. Ketone presence in urine is a sign that your pet may be in a state of Ketoacidosis, a life-threatening condition that requires immediate medical attention (usually IV or subcutaneous fluids to re-hydrate and Regular insulin to bring BGs down quickly).

Color charts for Diastix and KetostixDiastix glucose (sugar, - light green to dark brown +)

Ketostix ketones (- pink to dark purple +),example strip is negative.Ketostix strip and color chart

Keto-Diastix measure ketones and glucose in the urine, have 2 pads on one strip (not shown).

Explanation of Urine Glucose measured with Diastix Since the Diastix measure urine glucose, not blood glucose, they really don't correspond to any numbers from the blood glucose. All they measure is how much glucose has spilled over from the kidneys into the bladder. The longer the spilling before the cat pees, the darker the strip. If BG is less than 200 or so for the entire time the urine collected in the bladder, then it will read negative. BG could be 195, or 25, you can't tell by the urine strip.

If the urine strip shows color, it also tells you almost nothing - except BG was over the spilling level. BG could be 200, 300, 600, or 900. You don't know, since the strip color only measures glucose concentration in the urine - which is a time dependent number. Darker numbers usually mean poor duration with BG over 250 - that's about it. And then there are BG spikes, which may produce any color possible on the glucose strips, depending on the time width of the spike. [posted to FDMB by Jud & Call]

Urine Ketone Test Strips Miss One of the Most Common Ketones, add Hydrogen Peroxide

Occasionally cats, and rarely dogs, in a DKA [Diabetic Ketoacidosis] crisis, may not show a positive ketone reaction on a urine dipstick. Urine test strips primarily detect acetoacetone, but not b-hydroxybutyrate, which may be the predominant ketone. Adding several drops of hydrogen peroxide to the urine sample [in a cup] will convert b-hydroxybutyrate to acetoacetone to help confirm the diagnosis. This information was obtained from a paper entitled Diabetes Mellitus in the Dog and Cat written by a vet, Dr Abrams-Ogg in 1996. The tip came from a section on treating DKA

This only applies to the urine test strips and not the Clinitest (test tubes and tablets) since they pick up all the ketones. It does not refer to adding a drop directly onto a test square sample but if one were to do so I would imagine one drop to be sufficient. I would probably do it if I suspected DKA. [Posted to FDMB by Kathy and Cashew (GA)]

Multistix 10 SG (not shown) can be used to detect possible urinary tract infection in cats. Multistix test for ten different things including blood in the urine, specific gravity, protein, pH, bilirubin, nitrite, leukocytes, urobilinogen, as well as for glucose and ketones. You can use these "human" urine test strips to check for blood & increased protein, but not leukocytes (white blood cells) in cats. Cats will read false positive for leukocytes, so that test pad must be ignored. Iddexx makes a product called Petstix 8 for vet use.

Explanation of Ketones and Ketoacidosis

Cat Treats

Treats and foods appropriate for diabetic cats are still areas of debate among nutritional researchers and vets. You must consider dietary restrictions of any concurrent medical conditions. The general dietary recommendation for diabetic cats is high in soluble fiber, low in fat, and higher in protein. But if your cat's kidneys are not in good shape, less protein is better.

Treats are always a problem for diabetics. Whatever you give has to be considered part of their daily allotment, since even tiny amounts of food can have a significant effect on BG. In all foods, it is the carbohydrates and simple sugars that are converted to glucose. Simple sugars hit the bloodstream fast, the complex carbohydrates take longer because they have to be converted first. Discuss with your vet what treats and foods are appropriate for your cat.

Try to find treats that do not contain simple carbohydrates like corn syrup, malt flavoring, or other sugars (glucose, dextrose, maltose--the "ose" means sugar. Look for products where some type of meat is listed as the main ingredient (if your cat doesn't have kidney problems).

Some treat suggestions:

Vaseline - no nutritional value, but helps to prevent hairballs and ease constipation. Too much interferes with vitamin absorption.

Low protein - Green beans (fresh, frozen, or cooked with meat flavoring), olives (high in fat)

High protein - baked chicken or other meat, tuna (juice from water-packed), cheese (often high fat)

Dry commercial treats that are higher in protein and don't have corn or sugar, like the Nature's Recipe Optimum Chicken Meal & Rice or Lamb & Rice Feline Crunchy Treats are pretty good. Kitty Kissers has a 100% chicken liver, all natural treat.

Abbreviations

BG Blood Glucose level
DC Diabetic Cat
DD Diabetic Dog
DX Diagnosed
FDMB Feline Diabetes Message Board at  www.felinediabetes.com
L, Lente an intermediate-acting insulin, may be Humulin, or Pork, or Beef based
mg/dL milligrams per deciliter, blood glucose units of measure used in the United States
mmol/L millimoles per liter, blood glucose units of measure used in Canada, England, Europe, and Australia
N, NPH an intermediate-acting insulin, may be Humulin, or Pork, or Beef based
PU/PD Polyuria (excessive urination) and Polydipsia (excessive drinking), symptoms of unregulated diabetes
PZI

A long-acting buffer, Protamine Zinc, can be added to a variety of insulin species and called PZI. It comes in a variety of dilutions, from standard u-100, to u-40 or u-50. Be careful--PZI can refer very different insulins, ask questions and know exactly what species and dilution you will be getting.

Differences between the species can be very important for individual animals. Beef is closest to a cat genetically, Pork is in the middle, and  the Humulin insulin is most different. Cats who didn't get enough duration with Humulins have done exceptionally well with all-beef PZI.

The Manufactured PZI insulins have stringent quality control standards and tend to remain stable for 3 mo after opening. Compounded PZI is mixed up in a Compounding Pharmacy, often from a Humulin Regular base. Batch to batch quality may vary, causing difficulties in BG regulation. Eli Lilly recommends that Humulin insulins be discarded one month after opening.

UK PZI is manufactured, all beef, u-100, from CP Pharmaceuticals, in Wales, United Kingdom. It can be ordered with a credit card and a simple phone call to Mr. Deech at Wellington Pharmacy in London, England. It is called Hypurin Bovine Protamine Zinc. Other durations of all-beef insulins (equivalent to Regular, or Lente), can be obtained from the same source. Order details are given at www.sugarcats.com in the Infirmary.

Blue Ridge [BR] PZI is manufactured, beef/pork, u-40, made in the United States. It can only be ordered through your vet, involves paperwork, and comes with large syringes with a large bore, long needle that many people find too large/long for use on a cat.

R, Regular A short-acting insulin with fast onset and brief duration
U,Ultra-Lente A long-acting insulin with slow onset and longer duration
UTI Urinary Tract Infection, common problem in diabetics
W/D food Diabetic prescription diet food from Hills Science Diet, formulated for cats or dogs, canned or dry. Sold only by vets, often recommended for diabetic pets.