Canine insulin injection -- what am I doing wrong?
My dog was recently diagnosed with diabetes, so I have been giving her twice-daily insulin injections for the past 10 days. I've watched my vet do it, I've watched dozens of YouTube videos, and I've read everything I can find about the proper technique, but somehow, I can't seem to get it right.
Every time I inject my dog, she fidgets when I insert the needle, but not overly much, but as soon as I begin to inject the insulin itself, she yelps and either jerks away, or tries to bite me. More than once I've ended up with bent syringes and insulin on her fur because of it.
I'm following the procedure as shown, for example, in this video: https://www.youtube.com/watch?v=6jOEKUTU-Ac
- Take the insulin out of the fridge and roll it around to mix it up.
- Draw out slightly more than the needed dose into a new fresh syringe, tap out the air bubbles, then return the excess.
- Allow the syringe to warm up in my hand for several minutes as I prepare and put out the dogs' food.
- After my dog is finished her meal, I pull her onto my lap and find a place where the skin is loose. I have been rotating between left and right shoulder and left and right rump so far.
- Pull up a fold of skin ("tent" it) between my fingers.
- Push the needle into the middle of the folder at ~45 degree angle
- Slowly inject the contents of the syringe.
From everything I've read, this is supposed to be so painless that the dog may not even acknowledge that anything happened, but my dog is getting progressively more anxious each time I do it. I thought I would have gotten the hang of it by now, but I seem to be getting worse.
My main concern is that I'm doing something wrong and injecting the insulin incorrectly; my vet said something about making sure I was doing a subdural and not an intradermal injection, but how would I know? As far as I can tell I'm getting the needle beneath the skin correctly: it's hard to tell with my dog's long hair, but I'm not feeling any resistance to either the needle or the fluid, and the needle's not coming back out of the skin.
(I've done the practicing on the orange bit, and I think I have it right, but oranges don't yelp when you mess up :( )
Is there something else I can do to make sure I do this injection properly, or at least reassure myself that I'm not hurting my dog and that her insulin is going where it should?
I have never done this, so I'm reluctant to answer, but have you taken her to the vet and had them *watch you* do it?
I've considered doing that, if I can't figure it out by her next appointment I likely will. I'm just concerned that the high-stress environment of the vet's office will just make things worse, and I'd have to adjust her dose schedule, so I'd prefer to figure it out at home.
Every thing you write here seems correct. My guess is that is not your technique, but that you are transmitting your anxiety to your pet.
@JamesJenkins that's also what I thought but she acts as if she's really in pain, not when the needle goes into the skin but only once the medicine starts going in.
It's possible that the first time you did it, it was a little uncomfortable and she yelped and got some sort of attention from you because you were concerned that you had hurt her and she's replicating the circumstances to get that attention again. My Basenji mix is a master manipulator though, so I'm always on the lookout for that type of thing. I have to be very matter of fact with her or she guilt trips me relentlessly. You don't want to know what it takes to clip her nails after I accidentally nipped her quick once.
Are you rotating sites? Right shoulder one time, left the next? The next other thing is penetration, if you are doing more than a couple units, and not getting deep enough you may be delivering in the skin rather than Subcutaneous, the Subcutaneous area can take a lot of fluid, but if your needle is to short, or your angle of penetration is off, you could be putting the fluid in between the layers of skin instead of between the skin and the muscle.
@JamesJenkins this sounds like what my vet was trying to tell me; how can I tell if that's what I'm doing? It's only 3 units but I'm using the smallest syringe they had (ReliOn 31 gauge 8mm) so that sounds like a real possibility.
8mm is about a 1/3 of inch long (needle length) when you grasp the dogs skin and pinch to lift the hide, you should be able to tell that the hide is less thick than the needle is long. The reason you are lifting the skin is to create a space between the hide and the muscle, in your mind target the end of the needle entering the space. You don't want the tip of the needle in the muscle or in the skin. With people they will often plunge the needle straight in to the skin in an area that has fat underneath, so the insulin is delivered in the fat between the skin and the muscle.
FYI - As time allows I will work to convert these comments into an answer with references.
Your question does a great job of addressing many key points about giving insulin to your dog.
Nothing in the following answer is intended to replace direction by your veterinarian. These are just considerations not addressed in your question.
One of the first things that comes to mind, is your comfort level. Consider if you are transmitting your anxiety to your pet.
Rotating sites is important your Vet should have given you direction Try not hit the same spot regularly, but try to hit the same area regularly. Maybe alternate shoulders morning and night, but get slightly different spots. See related question How important is the insulin injection spot on a dog?
If you are using an 8mm needle it is about a 1/3 of inch long when you grasp the dogs skin and pinch to lift the hide, you should be able to tell that the hide is less thick than the needle is long. The reason you are lifting the skin is to create a space between the hide and the muscle, in your mind target the end of the needle entering the Subcutaneous space. You don't want the tip of the needle in the muscle or in the skin. With people they will often plunge the needle straight in to the skin in an area that has fat underneath, so the insulin is delivered in the fat between the skin and the muscle.
Be alert for bruising, If you can see a bruise under the fur don't use that area until the bruise has healed.
You may or may not have been taught to check for flash back, once the needle is inserted if you pull up on the plunger and blood enters the syringe you are in a blood vessel, this is called flash back. There are differing lines of thought on this, if you have questions/concerns discuss them with your vet. RE:Aspiration in injections: should we continue or abandon the practice?