New to FDMB but not to diabetes

Hello!!!

My name is Kim. I have a 9 year old cat who was diagnosed with diabetes in Aug 2010. It has been a wild ride since then. He is on Novolin N insulin (which I have read is not the best) and he has ranged from .5-3.5 units twice a day during this 5 year period. It seems that he is sick with something else every six months and usually the vet doesn't know what is wrong with him. This time I had full blood work and a urine test done. They said he has a UTI which the vet says was caused by having too much glucose in his urine for too long. While looking to find a new home for Pete through DCIN I was informed of a few things. First, the insulin I am using is not the best. Second, he will do much better if he is a on a high protein low carb wet food diet. Third, it is easy to test his blood sugar at home and will help him get regulated. The vet insisted that I needed to put him on a prescription diet but I told her that I have read that it is not necessary and that I cannot afford it. I asked her what the benefit was and she said high protein and low slow releasing carbs. So I told her that I would find a food with high protein and low carbs. She also had me move his shot from 3 to 3.5 on the same day as changing his diet which from everything I read sounded like a bad idea but I did it anyway. So here I am, 4 days after switching him to Friskies canned pates with 7-8% calories from carbs (hopefully I said that correctly). I just did his first glucose test today which was as easy (actually even easier) than everyone said it would be (the hardest part was sliding my card to purchase the equipment at the pharmacy). Since last night he seems a little more lethargic then usual. Today I fed him at 730 and gave him 3.5 units at 750. I tested him at 1:45 and he was at 54. When I brought him to the vet on Monday at the same time he was at 344. Now I am wondering.... what do I do next? I started a spreadsheet which should be in my signature.

 

Hi Kim,

I am so glad that you posted here!

This board is pretty active so you should get some replies soon.

I still think Pete has a chance at OTJ.

You are correct that switching to low carb is the right thing to do and increasing the dose was the wrong thing to do. -Jenna

 

Welcome to FDMB.

Here is our primer on Humulin/Novolin NPH, to help you use it most optimally. The most important thing is to test, feed, wait 30 minutes, then shoot. This helps buffer the steep drop NPH often gives.

Testing:
1) Always test before giving insulin to make sure it is safe.
For now, your no shot level is 200 mg/dL on a human glucometer (230 for pet-specific); this will lower as you collect data around the middle of the cycle to know how low he is going.

2) Mid-cycle tests between shots - whenever possible, test around the nadir (lowest glucose level between shots) for your insulin, to see how low he's going. For Novolin NPH, this often falls between +4 to +6 hours after the shot. Some folks do this on weekends or set a clock for the middle of the night to get this test done as it helps determine dose adjustments. This number should be at or above 50 mg/dL on a human glucometer (68 mg/dL for pet-specific).

3) A before bed test is helpful in determining if you need to break out some higher carb food and steer the glucose level or go to bed with some peace of mind. Steering means giving 1-2 teaspoons of high carb gravy, waiting 30 minutes, and re-testing (repeating as needed) to make sure the glucose stays above 50 mg/dL.

 

Thank you. So I should be waiting 30 minutes after he eats to give him his shot? That's what I have been doing for years but the vet just said to give it to him right away so I started doing that. So tonight before I feed him I should check his levels and if he is under 200 I should not give him his shot?

 

54 is fairly low. We start intervening, to avoid a hypo, in the 40s. I am assuming he is fine as you posted quite a while ago. The next time you get a number in that range, feed hima little snack of regular food and retest in 20 minutes. You want to be sure he is headed up, not down.

Keeping a spreadsheet will be a great tool for you. Seeing when he drops lowest on N will help keep him safe. Yes, we suggest that new diabetics not shoot under 200, but stall. Wait 20 minutes without feeding and retest. You want him rising, not falling and over 200.

He might be low tonight or he might have bounced from the low numbers. When their body senses a number lower than they are used to, it releases extra glucose. So the preshot after a low cycle can be higher than usual.

But if he is lower than 200, do the stall and definitely reduce the dose.

Glad you are home testing!

 

Yes to the 30 minutes wait. NPH hits hard and fast, resulting in a steep drop in glucose levels that often triggers bouncing (a response that yanks the glucose right back up for up to 3 days). By buffering the impact with food, the drop may be less harsh and less likely to trigger bouncing, plus it won't feel so much like being on a roller coaster.

 

Ok I will go back to waiting 30 mins after feeding for shot. I know it is a long shot but I would obviously like him to be OTJ. Is that possible using this insulin?

 

Difficult, but not impossible. Each cat is different.

 

It is time for his dinner so I just checked and he is at 290. I feel like I should reduce his insulin from 3.5 to 3 since it is almost shot time and he is not that high. However, he was just moved from 3 to 3.5 on Monday. Should I lower it?

 

Cats tend to go lower overnight; I might back off to 3 units.
Dose adjustments are made based on how low the glucose goes, with some consideration of pre-shot.

 

I think I would. The 54 was pretty low; it could have gone lower before or after. Not a bad idea to reduce before a night cycle.

 

Thank you so much! I have a feeling he was much lower than that last night because an hour and a half after his shot he was lethargic and acting different than usual. I am going to give him 3 tonight and then check him right before he eats again in the a.m.

 

Kim, how is Pete doing this morning? Did you get any other tests besides his preshot test last night?

 

Hi, thanks for checkin in on us! Last night I gave him 3 units and he seemed fine. His preshot this morning was 357. Is that high for a preshot? I gave him 3 units 30 mins after he ate. I just tested him now, 6 hours after the shot, and it is 254. 200 points higher than yesterday. Is that normal? Is it too high?

 

With N, his nadir (lowest point) could be anywhere from 3-6 hours after the shot. It tends to run 4-6, but especially with N varies widely. Your +6 is possibly past the low point. If so, he could have rapidly jumped from that point. Some cats get a longer cycle with N, but the average for most seems to be 8 hours.

It would probably help to do a curve and get a test every 2-3 hours during a cycle. Then you might have a better idea of his nadir and how long it lasts for him.

 

Ok. I will probably be able to do one on Monday. Is there a post on here that tells how to do it?

 

Just give the shot in the am, record the test number. Then test every 2-3 hours from then until the pm shot and record. Feed as usual although recording when and what you fed during the cycle can sometimes be helpful.

You are looking to see when he starts down from the morning number, when he reaches the lowest point, when he starts back up and when he is once again in high numbers and climbing (that's likely when the insulin is done)

 

Last night Pete's preshot was 307 so I gave him 3 units. This morning his preshot is 234. Should I still give him 3 units?

 

I would lower the dose - maybe 2.5? He seems to be rapidly coming down in levels; I'd lower the dose as he does.

This is good news!

 

Thank you for the advice. I ended up talking to Jenna from DCIN and she said the same thing. So I gave him 2.5 and I am going to try to do a curve today. So in the future if he is near the 200 range preshot I should lower him half a unit?

 

Today will give you that answer. If 2.5 gives you a nice, safe curve, then it's a good dose for a number in the low 200s. If he is high and flat, then maybe a little bit more. If he dips low, a little less. The way you work with the in and out insulins vs the depot ones is to look at past data to make future doses.

 

+2 was 164, +4 is coming up in 45 minutes. Which of the more effective types of insulin is the cheapest?

 

First, look in the Supply closet. There was some Lantus - not sure if it's all gone.

Someone else will give you the Lantus info. BCP PZI is a compounded form of insulin similar to Pro
Zinc. It is about $50. Your vet must order it for you. ProZinc should be about $125 a vial. It is only available either through your vet or, if your vet will give you a prescription, you can get it on line. Sometimes it is cheaper but watch for postage costs. Overnight refrigerated shipping can be $25 or so.

 

What is the Supply Closet?

 

Sorry. On the main forum page, go down until you see the forum Supply Closet. It's under the orange bar More Topics right under Grief Support.

Here it is:

http://www.felinediabetes.com/FDMB/forums/supply-closet-for-sale-or-free.15/

 

Cool thanks! Is Lantus generally the least expensive?

 

Uh oh... +4 is 37!? But he is up and about he isn't lethargic or acting weird at all.

 

Wow! Can you feed him some gravy off higher carb food and retest in 20 minutes. We don't want him below 40.

 

Maybe an immediate retest is a good idea to be sure the first one was right. And if so, I think I'd smear a little drop of honey on his gums.

 

I just retested and it is now 31!!!!

 

I dont have any food with high carb gravy but I do have honey.... how much should I give him?

 

Did you do another test to be sure? If so, smear on maybe a teaspoon.

 

I tested him at 12 and 1 it went down 6 points. I did not test 31 and then immediately retest

 

This is a rinse and repeat deal. Try the honey and retest in 20 minutes. If you see any behavior that is unusual, get him to the vet, rubbing honey on his gums. Or if you are worried, just go to the vet now.

He will probably come up fast with the honey. He might stay there or might drop again. You want 3 rising numbers before you relax.

 

Ok I just gave him the honey. Hopefully I gave him enough. He is acting normal, nothing out of the ordinary. I will recheck in 20 minutes.

 

It went back up to 37.

 

I'd give him something to eat (not a while lot - a tablespoon full - and do more honey. He is still acting okay?

What do you think about going to the vet? He has been in very low numbers for about an hour, right? They can bring him back up quickly.

 

I can't afford to take him to the vet. I will give some more honey and a lil food. He is acting totally normal, cleaning himself, walking around, purring, etc..

 

Ok. Get another test in 20 minutes. You can mix some of the honey into the food if you want. We need him above climbing 40 and rising.

 

I gave him 1/5 of 1/2 a can if that makes any sense. I put about 1/2-1 teaspoon of honey on it. I will check again in 20. His ears are red though here is a pic. Am I doing something wrong?

 

Maybe just a lot of poking? Hold the spot for a few seconds after you poke to help with bruising.

 

I do hold it for about 20 seconds while I love him with the other hand. Poor boy! 52 this time.

 

You can put a tiny smear of Neosporin with pain relief on it. 52 is better. Your choice - a little more honey to be sure it continues to rise, or a little food to see if that will work.

You will need to buy some hypo food. Fancy feast with gravy works well. Then you can just give a tablespoon of the gravy, not fill him up but give him lots of carbs. It's better than honey because it lasts longer.

Hopefully he will continue to rise.

 

Ok. I will give him a little more honey and next time I am at the store I will by some cans with gravy for just in case situations. Should I continue to do the curve? Also, what does all of this mean for his shot tonight?

 

You want three rising numbers before you relax. The honey can be a temporary fix. So three more tests 20 minutes apart.

My guess is that he will be very high tonight. Not only will the honey impact his numbers but he will probably bounce from the low numbers. BUT, I would lower the dose. I wouldn't continue with a dose that gave you the 31. You could try 2 if you can monitor carefully overnight. Or 1.5 if you want a calmer night.

I am guessing the low carb food is starting to impact his levels. It may mean a lowering over the next few days so you will need to be careful, getting each pre shot and deciding what to dose based on what the dose did before.

 

It is 74 now, so that is 3 rising numbers since the original fall. So the curve is basically nil now right?

 

The numbers you got definitely told you the dose was too high. I am glad you are home doing it; it could have been bad if he dropped any lower without any intervention.

I'd think you can quit the curve. Maybe a number in an hour to be sure he is sure still rising.

Great job. You were very calm and did all the right things. Congrats - you've survived your first hypo. Hopefully it's your last.

 

Welcome Kim,
Just reading this now. Great job handling scary numbers! And yay! Pete gets a dose reduction.

Joan

 

Sue, I feel like I've learned so much just reading your responses to other members.
Thanks for being here!

Joan

 

Luckily, I'm a teacher so I am off right now. Hopefully he is regulated before school begins again otherwise I will have a problem. Thank you so much for your help!!! I don't know what I would have done without you @Sue and Oliver (GA) !!!

 

All I know about Novalin N is that it is very harsh and brings down BG numbers fast. I agree on the dose reduction tonight. I'm so glad you were testing today. Because of it, you could have just saved his life.

 

Preshot is 311. (Even after all that food and honey!! I thought it would be like 500!) What would you suggest for tonight's shot?

 

I'm surprised too - not only the honey but also the possible bounce. To be super safe, maybe 1.5. If you want to be sure he stays in good ranges, maybe 2. But if you decide on 2, i'd get a before bed test. Like today it is a good warning if the cycle is going south early.

Depends on whether you want to be more aggressive or not. You hold the syringe; you decide.

 

What do you mean by more aggressive? I cant stay up all night testing him but my ultimate goal is to do whatever it takes to get him regulated and even better would be OTJ.

 

Some people push a little harder than others. I am thinking 1.5 is a very safe dose and it's more likely he would stay flatter, maybe in the 200s Two units might be more likely to result in a cycle with lower numbers. No crystal ball here. Just my thoughts. And he's a cat, so all bets could be off.

There is no way to predict, especially when a diet change is in the picture. 1.5 could mean a calmer night. 2 might be fine but could mean you'd have to watch more carefully.

It is really hard to decide how much to reduce. That's why we like to start low and raise as your hometesting suggests. Once he is at higher doses and then starts to fall, it is more of a guessing game.

Not sure if I explained that well.....

 

I think I understand a little better. I am giving him 2 we will see what happens. Thank you!

 

I gave him 2 units at 8 pm I just checked and he is at 77. Is that ok for now or should I give him a little food? Seems like he could be on the same path as this morning.

 

Yes I would give him food. How many hours from the shot?

 

I think I'd give him a couple teaspoons of regular food.

 

Ok. I gave him a little bit of food. Thank you

 

So the 77 was at +3? As long as he stays above 50, he should be good. If he drops that low, try the honey mixed with a little food again.

Hope he stays up for you

 

Hope he didn't drop too low for you last night, Kim. Were you able to get some sleep?

 

He was alright. I checked again at +4 and it was 72 so I gave him a little more food. This morning was 331 and I didn't want him to dip down again so I gave him 1.5. Now at +4 he is at 159.

 

Hi Kim,

I snuck a peek at Pet's spreadsheet. It looks like he is doing good at 1.5. Those Greens are nice. It isn't lasting long enough but it would be rare to see N last the full 12 hours. I'd say you are getting the best possible result you can from it.

Are you checking the Supply closet to watch for any free insulin?

 

Hi Sue,

Is the green range the goal? Yes I am looking at the supply closet and I am communicating with someone about their insulin. Can I just switch insulin like one for one ? So if I am giving him 1.5 N and I switched to a different insulin I would still give him 1.5?

 

To be regulated, we generally want a cat in lower 200s at preshot and double digits at nadir, but not below 50.

I would err on the side of caution and maybe try one unit with a new insulin. N works so differently than the other longer lasting ones. 1.75 is getting him into nice ranges so you might end up higher than one unit with another insulin, but it would be nice to move up slowly and carefully It is always easier to raise slowly based on your testing rather than guess how much to reduce. (My two cents)

 

This morning he is at 219 which is less than he has been for preshot yet. Should I lower his insulin from 1.5 to 1?

 

I would. Did you see my private message?

 

Yes, I just messaged you back. I ended up giving him 1. I am talking to 2 other people about Lantus too.

 

Lantus is a great insulin and there is a very active forum here to help you may the switchover. If you go with it, get advice from them about the first starting dose. And read all the stickies on their forum. It is dosed very differently than N.

http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/


He is responding well to N- much better than most cats. It is lasting 12 hours overnight, but seems to peter out before pmps. What is the difference between food am/pm. Maybe you can play with those variables.

 

I give him the same amount of food in the am and the pm. Do you have any estimate about how much it costs to ship insulin?

 

I have never done it. Here is some info on how:

https://docs.google.com/document/d/1i_Pw0Kd4GAI1GqKvbxnArD6hABpWOMooswZi_7xnJX0/mobilebasic

 

Oh thank you! There was a link on there with a great calculator.

 

Hi Kim,

Gosh but you've had an eventful time!

You asked earlier in the thread about the redness on Pete's ears from the home testing. I think that a bit of redness is common at first, and poor little Pete had a bit of a baptism of fire (but thank goodness you were testing him - you kept him safe! ).

After you start testing, more capillaries develop at the test site fairly quickly so it becomes easier and faster to get blood droplets for testing. The redness should subside quickly, too.

BTW, when you get a chance it would help members reading your posts if you could add details of your insulin type and meter type in your signature line.

Wishing Pete continued improvements with his food transition.

 

When you have a moment, could you add a few tidbits to your signature? It will help us give you feedback.

Editing your Signature

In the upper right corner of the screen, within the dark blue bar, you will see ID, Inbox, and Alerts

Click on your ID.

On the left, under Settings, Click on Signature.
This is where you will put information that helps us give you feedback.
This is where you paste the link for your spreadsheet, once it is set up.
Add any other text, such as
your name,
cat's name,
date of Dx (diagnosis)
insulin
meter
general location (city and state/province)
any other pertinent issues like if there are any food issues, history of DKA, hepatic lipidosis, pancreatitis, allergies, IBD, etc.
Click the Save Changes button at the bottom.

Always click the Save Changes button at the bottom when you have changed anything.

 

Yesterday Pete was 405 in the am so I increased his insulin to 1.5. Then last night he was looking good at 260 so I reduced it back down to 1. Now he is at 145... I do not know what do with that... do I give him .5? Do I not give the shot at all?

 

Can you help me with his shot? I don't know what to do

 

Let me look at his spreadsheet. OK. I've looked.

Stall 30 minutes without feeding and re-test.
- If rising, and below 150 mg/dL, you might give 0.5 units.
- If rising fast and above 150 mg/dL, you might give shoot 1 unit.

If you do not feel comfortable shooting, don't.

If you'll be home to monitor and have Karo syrup or high carb gravied cat food, you can shoot and test about every 2 hours to see how he handles the insulin.

 

Ok. There are a few days missing because I was out of town and he was being cared for at the vet but they didn't give me his numbers.

 

How I analyzed your data:
On 7/24 with a pre-shot of 219, a dose of 1 unit dropped to 81 by +4. That is a drop of 138 mg/dL.

Today, his pre-shot was 145. Usually, we suggest not shooting below 150 mg/dL when using ProZinc NPH. If he dropped by half of the 138, that could get him down around 76 if that same amount of drop happened, hence the 0.5 unit dose option. The amount of drop can vary with the same dose due to other factors such as stress, activity, food changes, illness, etc.

 

BJ, she is using N.

 

So you think I should give him .5?

 

I do not use prozinc tho.

 

My two cents. I would stall longer, if he hasn't eaten. If he rises to near 200 (maybe 190 +) then yes, .5 If one unit on a yellow gave you an unshootable preshot, then I would lower the dose.

BTW, Julia Rae has posted looking for you on the Health forum.

 

NPH is similar in that respect to ProZinc - do not shoot below 150 mg, 200 if you've little data.
A dose of 0.5 units could be safe, but being home to monitor around +3 to +4 would be helpful so you can see how low the glucose goes.

 

I checked him at 8:45 and it was already up to 305 (how that is possible I do not know) so I gave him 1 and I will be monitoring all day. Since his shot is usually at 8 and he didn't get it til 850 this morning. I do all the +2s and +4s off of the actual time right? (Thank Sue, I am quite offended that she did that but I am addressing the situation)

 

Yes, do the +2/4 from the time of the actual shot.

The fast jump is pretty characteristic of N - when it's gone, it's gone. Just surprised that you got such a long cycle with it (12+ hours). That is unusual.

 

Now his preshot is 584!!!! I don't understand how that could be??? What should I do? I have been giving him 1 unit. Should I give him 1.5.?

 

I would guess he dropped mid cycle and his pmps is a bounce. Or the N just wore off and didn't last

The 1.5 could work but I'd plan to do a before bed and nadir test. If you can't monitor, then I'd play it safe with one

 

Ok, he got sick from being high for too long so I think I will do the 1.5 and then check him tonight. Seems like nadir is 4-5 hours so I guess Ill check at midnight. Thanks again Sue!

 

your other choice would be to eyeball 1.25

 

Ok. And just in case something comes up tonight and you are asleep... I need to be worried if it is below 50 right?

 

If he drops below 50, feed a little bit of his regular food. Retest in 20 minutes. Still dropping -a little of the gravy off higher carb, retest. Still dropping, either mix honey with the gravy or put honey on his gums. You want 3 rising tests before you can relax

Now that you're prepared, he should be fine

 

Thank you!

 

Kim, did you give 1.5 this morning as well?

 

I gave 1 this morning

 

Good looking cycle today, Kim!