? Does anyone have experience treating Cats with NPH Insulin?

I was welcomed by the lovely cat people on the Introduction page and did not want to wear out the "welcome". I have written sooo much already. Now, I really need to know if others have treated their cat with NPH. Things are not going well for Elliott, in my opinion. I joined on January 1,2016 and wrote: "Hello, I have 8 Bichons and agreed to adopt 2 cats 6 years ago. They are beautiful unfriendly cats and now one is sick. We are"dog" people but my priority in life is to strive for the rights of all animals.However, I don't understand cats, their purpose in life and what they expect from a relationship with humans...but they are family now and we love them. Elliott was diagnosed with DM 4 days ago. Apparently differentiation of type 1 vs type 2 is not possible in cats. Frightened out of my mind, the DVM said, "You worked with serious DM patients in ER and L&D for how many years? Your diabetic cat will be fine." I am exhausted, worried and hope not to endanger Elliott during my attempts to stabilize his condition. And so, I thought that joining up with "cat" people would be of great value with regard to caring for cats in sickness and in health. Thanks for letting me join!!!"
So many nice people have offered the greatest suggestions and have really helped me to hopefully help Elliott. He is NOT getting physiologically better. His behavior is fine but after draining every brain cell and medical article, my suspicion is that NPH is not helping this situation. However, I have no experience with animal diabetes and can find no literature or BG curves of cats (or dogs) treated with NPH Insulin. Any pros or cons or any information of your experience would be greatly appreciated.

 

I thought everything would be okay until last night when I almost went over the edge worrying and scribbling...I AM EXHAUSTED AND VERY DISCOURAGED..Maybe it's just ME!!! But I am at the "Nobody can/will help me " stage..I started manually inserting information in "a diary" type log and nothing is in order..no graph pops up.. I saw your spread sheets believing you are using AlphaTrak or similar. Mainly, I wanted it to show you all Elliott's BG pattern on NPH..because it's awful but after 2 hours of everything not in order, I stopped and started reading about NPH, resistance to insulin, diet, stress, PZI, Lantus, etc. ARE ANY OF YOUR CATS ON NPH insulin? Are there any charts showing the BG curve of cats or a cat receiving NPH 2 u q 12 hours? After 7 days, should there be no normal BG in am or pm? I read that the longer a cat's BG remains above the "norm", the more damage occurs that prevents the pancreas (I of L) from ever producing insulin again. Of course, I realize that insulin might never be produced again anyway, but still...Poor Elliott is receiving only 2- 3 oz cans of FF classic/day=180 cal and he is 14.8 lbs. And so, I tested controls that allow variance of 100-185...and his twin brother whose BG= 60..I snuck him 1/4 c. dry kibble.They have always eaten together out of the same plate, but since dx, I sit and watch them both eat a 3 0z can. I think they are receiving 1/2 the food needed for a 14 + 20 lb cat. And so, thinking I am doing everything correctly and following orders to increase his NPH q 12 h. from 1.5 to 2.0 u (4 days ago)..I get the following: 538, 174, 490, 379, 89, 449, 545, 195, 104 or 195 (using alphatrak strips from 2 new bottles)549, 123, 409. Relion are all 30-50 pts lower. All low BG are at 1-2 pm. Insulin is administered approx at 7am and 7 pm. That is why I am wondering if the NPH cannot work long enough to keep BG down for 12 hours. I am sorry for burdening you all. I do so appreciate all of your calm and suggestions. Can anyone tell me that this is all normal and that cats are hard to regulate but in a month or two, his BG will be WNL or sort of WNL using his present Insulin protocol? I am going to take a picture of him since the avatar was when he was his usual fat self that I do so wish I hadn't let happen. I just do not/ did not know anything about cats and what to expect. My good friend who is a cat lover has bragged for year that her cats weigh about 30 lbs.for years...and..they look it. I am going to try to find some info on BG in cats on NPH..You are really great people!!! P.S. I even watched the basic video by Alphatrak and learned that the BG concentration in cats whole blood so different from humans and then I read THIS:http://animaldiabetes.com/faq.......It has your pawprint? I think. One contradicts the other and i had no idea that the "strip " has membranes that separate the plasma. It should say on the bottle if it has been "Plasma corrected " as most are, acc to another article listing Bayer, etc as most accurate. On the other hand last article does not mention the plasma difference in humans, cats, dogs...I am in way over my head..Maybe DVM was right, "Stop reading" Good night nicest (cat) people!!!

If someone will take a look at Poor Elliott's Diabetes Spread sheet, I would be grateful:?https://docs.google.com/spreadsheets/d/1l08kgX9WSiJEenVlq2rAeC4FxEqoeAUlnBPqganucis/edit?usp=sharing

 

What you are seeing is typical of N/NPH insulin. I typically only last 8-10 hours. Better insulins are the human Lantus and Levemir and the pet insulins ProZinc and BCP PZI. For those two human insulin it is best to get the 5 pack of 3 ml disposable pens via a 10 ml vial. Although per ml the vial is less expensive most cats will not use up a 10 ml vial before the insulin goes bad/becomes ineffective.

I have successfully used only N/NPH insulin for my Twiggy. She is one of the few where it work goo. I could keep her GB below 150 all day.

 

Hi, Fran and Elliott. I haven't read your other posts so I may be repeating things you already know. NPH is the same thing as Humulin N. If you haven't read it yet here is some info on Humulin N:

http://www.felinediabetes.com/FDMB/forums/vetsulin-caninsulin-humulin-n.19/

I use a similar insulin, Vetsulin, and I have had periods of great luck with it but also periods of frustration and no luck with it! I looked at Elliot's SS; what was his BG when the vet first diagnosed him? A cat's BG is typically higher at the vet's due to stress. Has he had a curve done? It would be very helpful if you could get some additional tests in from time to time during the day. How did you discover that his nadir is at 1-2 PM? It's possible that Elliott is receiving too much insulin and "bouncing" as a result; I'm not saying this is necessarily the case but it may be something to consider. Here is a link to another post that will help to explain bouncing:

http://www.felinediabetes.com/FDMB/...-ndw-and-failed-reductions.46012/#post-642819

Read the second section titled BOUNCING. Bouncing can occur with any insulin if the dose is too high.

There really is no "normal" BG for a cat on insulin. We all strive for regulation and remission but it takes time and patience, and sometimes we never achieve our ultimate goal. If you find your kitty's insulin isn't very effective you always have the option of switching to a different one.

Don't get discouraged! I know it's difficult because we all want our pets to be well and healthy asap, but you have to remember that treating this disease is a marathon, not a sprint. We will try to be here to help you as much as possible!

Lucy

 

I should start doing q 4h BG round the clock to assess what the NPH "is" doingand "when", I guess. Elliott is supposed to go the the DVM next week for a BG testing curve and Fructosamine test. I am speculating that NPH insulin coverage does not last long enough to meet the 12 hour span ordered. but will go read about the bounce now..Thank You!!!! I'll have to verify that the first DVM BG was 580 and that it was venous tested by his lab and not a glucometer.

 

And do know that vet curves tend to be less reliable than your numbers at home (which, if used to determine dosing can mean too much insulin once the cat gets home). Cats most often are stressed at the vet (too much noise, lots of other animals and strange people) and we know stress raises bg levels. Some people report their cat testing 100 fewer points or more when they get home and retest.

With your insulin, I'd do a test at +2 (to see if he has an early drop) and +4 (ditto) and then around 6 and or 8 to see if you can catch when he starts up. If he is dropping low early and the insulin quits around +8, maybe a different insulin would work better for both of you.

 

It helps to grab a BG test just before leaving for the vets. It's not much in the way of data, but the pre-vet test together with your other data may help you to roughly gauge how much stress influence there might be on the vet's BG data.

Some links you might find interesting:

Info about action profile of NPH in humans. NB: cats metabolise insulin MUCH faster than humans.

Graph - Insulin Action Profiles in humans (includes comparison of NPH, Levemir (insulin detemir) and Lantus (insulin glargine)).

The graph gives you a rough idea of how the action profiles vary but ignore the timings: for cats the intervals will be MUCH shorter.


Mogs
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See our posted Humulin/Novolin NPH guide.
You may need to test and shoot every 8 hours for good control.
It helps to test, feed, then wait about 30 minutes or so before giving the shot.

 

I have used novolin N on my diabetic cat miss kitty before.i usually had to give it every 8hrs.sometimes it would last 10-12 but not very often.she did pretty good on it.i think 3 units was about the right dose for her.it works fast at dropping blood sugar and when it time to wear off it wears off fast as well.i would feed her 30min or so before shot to help make the drop easier on her.

 

I just read this post from earlier tonight, from a member whose cat was on Humulin and went into remission:
http://www.felinediabetes.com/FDMB/threads/ambees-time-on-humilin-n.150706/

 

After getting into the DVM website, I read study #1- Newer glucometers have a membrane that separates the plasma from the RBC's that would adjust the results. However, #2 article does not mention this and discusses how newer meters should read "Plasma corrected" or Whole blood. Both meters list "Whole blood. I ran out of A.T and using Relion (40-80 pts lower)again until Bayer meter arrives and Alpha Trak strips can be purchased online. I am counting on his behavior as an important value. That was another symptom that worried me..He let me pick him up which he never does and is back to running from me. Elliott was 20 lbs. When diagnosed he was 14.8 lbs. I noticed that his brother was looking a lot bigger and the solid urine hunks in litter pan were "huge". I hope everything will be okay. I read that these very high BG cause damage to I of L (Pancreas) every single time it is high. A Fancy Feast expert told me that he should be getting 4-5 cans/ day if 3 oz. I am feeding him one 3 oz in am and one in pm and his blood sugar with AT is still 4-500 unless at peak insulin time or using Relion. I am drinking one diet coke after another..as usual.
THANKYOU..THANKYOU..THANKYOU. I am reading everything I can get my hands on..So far, NPH not studied too much--I really wonder if he should be on it!!

 

We suggest that folks not let the glucose go below 80-90 mg/dL on a ReliOn Confirm, Micro, Vital, or Prime meter when using an in and out insulin such as NPH. This will give you some margin for error and reduce your chances of inadvertent hypoglycemia should the insulin needs start reducing.