Dosing Advice Needed for Novolin

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JanetNJ said:
I'd try 0.5 for a few days to see if the bouncing will settle and let the preshots come down. Once the preshots come down the dose can be adjusted again.
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Are there syringes that have .5 on them? I currently have ones that go up by one unit each time.
 
JanetNJ said:
Yep sure are. My fave place to buy them is Adwdiabetes.com
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Thank you!
T.C. is used to 6mm and I found some available in store at Walmart called "BD Ultra-Fine Half-Unit 31G 0.3cc 6mm Syringes". Would these be okay? I'm not sure what the .3cc means however.
 
Yes those syringes will do the trick! The .3cc just means the volume of liquid the syringe holds and you won't be injecting anywhere near that much!
 
JanetNJ said:
I'd try 0.5 for a few days to see if the bouncing will settle and let the preshots come down. Once the preshots come down the dose can be adjusted again.
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Ok, his PMPS was 252 on One Touch Ultra. Fed him, then gave him 0.5 units. Gonna check in again at +2. What should it ideally be?
 
tcmeowmixtc said:
Ok, his PMPS was 252 on One Touch Ultra. Fed him, then gave him 0.5 units. Gonna check in again at +2. What should it ideally be?
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Hi,
You're getting some extremely steep drops in BG; which looks to me like the effect of the insulin itself and the fact of TC dropping out of a bounce.
I wonder if it's possible to level that out a bit with food...

Novolin N can drop the BG fast in the first few hours of the cycle. For that reason it is helpful to feed the cat and then wait for a while before giving the shot.

The general recommendation here for Novolin N is to feed the cat an hour before giving insulin. This is to ensure there is food in the cat’s system for when the insulin starts to work, and to help ensure that the BG doesn’t drop too fast or too low.
Ideally, the sequence would be: 1. test BG. 2. feed. 3. wait for an hour. 4. give the shot.
(If you're not able to wait for an hour then even waiting for 30 minutes would be helpful).

If you do a BG test an hour or two after the shot, and find the BG is dropping too fast, it's often possible to slow down the rate of BG drop by feeding a small snack of ordinary food.
(If the cat’s BG is actually in danger of dropping too low, DO post on the forum for advice immediately.)

When the BG drops too fast this may be sensed as ‘dangerous’ by the body whether the cat is actually in danger or not. (‘Too fast’ could mean faster than 100 mg/dL [5.5 mmol/L] per hour - although the ‘trigger’ number varies from cat to cat.) When this happens the body may seek to protect itself by releasing stored glucose, thereby 'bouncing' the BG to a much higher level. This is why giving a snack can be helpful to slow down the rate at which the BG is dropping.

We generally suggest that caregivers using Novolin N aim to not let the BG drop lower than 100 - 120 mg/dL [5.6 - 6.7 mmol], as measured on a human meter, at the peak of the cycle.
But since you're using Alphatrak2 you may want to aim to keep the BG even higher, maybe at least above 125 - 145 mg/dL [7 - 8 mmol], or higher (since there is no reliable way to convert human meter values to Alphatrak values).
Aiming to not let the BG drop below these levels helps to give a further buffer of safety.

This is the lowest preshot number you've given insulin at, so you'll need to monitor closely.
If you're seeing a low number - and there is still some time to go until the peak of the cycle - you may need to take action to ensure that the BG doesn’t drop much lower, and monitor until past the peak of the cycle.
It may be that all that is needed is to feed a little snack of ordinary food if the BG is dropping too fast or too far. But let's see how things are after the next BG test.

Eliz
 
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Elizabeth and Bertie said:
Hi,
You're getting some extremely steep drops in BG; which looks to me like the effect of the insulin itself and the fact of TC dropping out of a bounce.
I wonder if it's possible to level that out a bit with food...

Novolin N can drop the BG fast in the first few hours of the cycle. For that reason it is helpful to feed the cat and then wait for a while before giving the shot.

The general recommendation here for Novolin N is to feed the cat an hour before giving insulin. This is to ensure there is food in the cat’s system for when the insulin starts to work, and to help ensure that the BG doesn’t drop too fast or too low.
Ideally, the sequence would be: 1. test BG. 2. feed. 3. wait for an hour. 4. give the shot.
(If you're not able to wait for an hour then even waiting for 30 minutes would be helpful).

If you do a BG test an hour or two after the shot, and find the BG is dropping too fast, it's often possible to slow down the rate of BG drop by feeding a small snack of ordinary food.
(If the cat’s BG is actually in danger of dropping too low, DO post on the forum for advice immediately.)

When the BG drops too fast this may be sensed as ‘dangerous’ by the body whether the cat is actually in danger or not. (‘Too fast’ could mean faster than 100 mg/dL [5.5 mmol/L] per hour - although the ‘trigger’ number varies from cat to cat.) When this happens the body may seek to protect itself by releasing stored glucose, thereby 'bouncing' the BG to a much higher level. This is why giving a snack can be helpful to slow down the rate at which the BG is dropping.

We suggest that caregivers using Novolin N aim to not let the BG drop lower than 100 - 120 mg/dL [5.6 - 6.7 mmol], as measured on a human meter, at the peak of the cycle.
But since you're using Alphatrak2 you may want to aim to keep the BG above 125 - 145 mg/dL [7 - 8 mmol].
These BG numbers are quite safe, but aiming to not let the BG drop below this level helps to give a further buffer of safety.

This is the lowest preshot number you've given insulin at, so you'll need to monitor closely.
If you get a BG of 125 - 145 mg/dL [7- 8 mmol] on your Alphatrak2 - and there is still some time to go until the peak of the cycle - you may need to take action to ensure that the BG doesn’t drop much lower, and monitor until past the peak of the cycle.
It may be that all that is needed is to feed a little snack of ordinary food if the BG is dropping too fast or too far. But let's see how things are after the next BG test.

Eliz
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Wow, this is great information to have!
I did not know about waiting after he eats. I will be sure to do that! His +2 was 226 on the One Touch Ultra (still waiting on my delivery for more alphatrak strips). I usually give him a snack of canned low-carb food at +2 and +6. By ordinary, do you mean dry food?
Thank you for all this information!
 
Also, I was thinking of cooking some chicken in the oven, letting it chill, and then cutting it up into bite-sized pieces to use as treats. Is this an okay thing for cats with diabetes?
 
tcmeowmixtc said:
I usually give him a snack of canned low-carb food at +2 and +6. By ordinary, do you mean dry food?
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If ordinary low carb canned does the trick, that's great. Testing about 20 mins after the snack should let you know if it's slowing down the BG fast enough..

tcmeowmixtc said:
I was thinking of cooking some chicken in the oven, letting it chill, and then cutting it up into bite-sized pieces to use as treats. Is this an okay thing for cats with diabetes?
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Plain cooked chicken is a great treat for cats. :cat:
.
 
Just checked his +3 and it was 114 on human meter. Gave him a snack to see if I can bring it up. It seemed to be going well, I'm not sure what I'm doing wrong. :banghead:
 
@tcmeowmixtc , that BG is dropping fast and looks like it could drop too low.
I'd suggest you feed a little bit of something higher carb. Do you have any high carb wet that you could feed a little gravy from?
If not, I'd suggest you add a tiny bit of honey or syrup to a small amount of low carb, and feed that now.
.
 
@tcmeowmixtc , if his blood glucose is continuing to drop after that, then, depending on the number, you may need give a little honey or syrup to quickly bring the numbers up. Or that can be mixed into a tiny amount of gravy if that's easier. Then test after 10 - 15 minutes.
And, if necessary, you may need to repeat that action until you are past the peak (lowest number) of the cycle.
You need to try to keep the numbers above 68 on your AT meter for safety's sake.

Take deep breaths. I know it's stressful. But you're doing just fine. :bighug:
.
 
tcmeowmixtc said:
The higher carb was what stopped it I'm pretty sure.
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It'll be interesting to see what TC's blood glucose does now. It may rise, or there is the possibility that it will drop again.
This is quite a learning curve, isn't it, this FD malarky?!

How many hours into the cycle is TC now?

Oh, and would you like to tell us your name?
.
 
Elizabeth and Bertie said:
It'll be interesting to see what TC's blood glucose does now. It may rise, or there is the possibility that it will drop again.
This is quite a learning curve, isn't it, this FD malarky?!

How many hours into the cycle is TC now?

Oh, and would you like to tell us your name?
.
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It definitely is a learning curve!
He is 4 and a half hours in, so I'm looking to test again at 5 hours in and hopefully 6. Then 5 hours of sleep to start all over again. :coffee:
And I'm Shannon! :D
 
Shannon, are you planning to use the One Touch meter from now on? Is that what the asterisks beside readings on the spreadsheet designate?
If that's the case, then you need to insert another row into your spreadsheet that indicates you are now using a human meter. If you need help to do that, let us know. Perhaps a note in the top bar indicating the meter change as of 'DATE' would be good too just so anyone helping doesn't get confused. This is not critical right now because as Eliz says, being too conservative isn't a problem but as you get closer to regulation it will become more important.
 
MrWorfMen's Mom said:
Shannon, are you planning to use the One Touch meter from now on? Is that what the asterisks beside readings on the spreadsheet designate?
If that's the case, then you need to insert another row into your spreadsheet that indicates you are now using a human meter. If you need help to do that, let us know. Perhaps a note in the top bar indicating the meter change as of 'DATE' would be good too just so anyone helping doesn't get confused. This is not critical right now because as Eliz says, being too conservative isn't a problem but as you get closer to regulation it will become more important.
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I ran out of alphatrak strips and Amazon couldn't get them to me until today (even with one day shipping.) Then, if it wasn't long enough, our mailbox will not open. So the strips are in there, but I can't get to them!
So, I plan on using the alphatrak as soon as I can get into the mailbox! (hopefully tomorrow.) Should I add a row in for the past few days?
 
tcmeowmixtc said:
Should I add a row in for the past few days?
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No I don't think that's necessary but perhaps a note in the comments just to say the readings with * were with One Touch meter for future reference.

Hope you manage to get your mailbox fixed soon. I have a different problem with mine. We've been having torrential rains every afternoon all week and the mailperson has not been closing the door all the way so my mail has been a tad soggy! :banghead:
 
MrWorfMen's Mom said:
No I don't think that's necessary but perhaps a note in the comments just to say the readings with * were with One Touch meter for future reference.

Hope you manage to get your mailbox fixed soon. I have a different problem with mine. We've been having torrential rains every afternoon all week and the mailperson has not been closing the door all the way so my mail has been a tad soggy! :banghead:
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Okay. I've updated the comments section and signature, so hopefully I can avoid confusing people in the future. :oops:
Oh no! Sorry about your mail! Sounds like some intense weather! At least from a Californians perspective haha. ;)
 
MrWorfMen's Mom said:
Shannon, are you planning to use the One Touch meter from now on? Is that what the asterisks beside readings on the spreadsheet designate?
If that's the case, then you need to insert another row into your spreadsheet that indicates you are now using a human meter. If you need help to do that, let us know. Perhaps a note in the top bar indicating the meter change as of 'DATE' would be good too just so anyone helping doesn't get confused. This is not critical right now because as Eliz says, being too conservative isn't a problem but as you get closer to regulation it will become more important.
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I made that suggestion a few days ago when the two meters were being used interchangeably in the same cycle. I had also suggested that an explanation for the asterisks be added to the notes section of the SS. :)
 
Shannon, it looks like the amount and type of food you gave was sufficient to stop a BG drop of 112 points per hour in its tracks, and to effectively abort the cycle (since the BG continued to rise.)
This is useful information, and it's well worth remembering this response for the future.

Food can be an extremely useful tool for 'steering the curve'; and it's good to know how certain foods affect our own cats. ...You may not get exactly the same response from the same food in a future situation, but this is very valuable experience.
You may find that in a similar situation in the future - if you feel confident to do so - you could try to give a little less food and manage to slow or stop the BG dropping without causing it to rise. But with cats there are no guarantees, haha!

It's possible, of course, that the BG rise was also a bit of bounce from the steep BG drop this morning.

It also seems that doing the +2 and +3 tests has given you some very good information today. And it might be that these would be good times to test in the future to clue you to how the insulin cycle is likely to go.

Oh, that 252 preshot was very nice to see this morning. Let's hope for more preshots like that. :cat:

Well done, Shannon. You're doing great! :bighug:
 
Kris & Teasel said:
I made that suggestion a few days ago when the two meters were being used interchangeably in the same cycle. I had also suggested that an explanation for the asterisks be added to the notes section of the SS. :)
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Indeed! I had changed to asterisks and added it in the notes section, but didn't update my signature. :oops:
JanetNJ said:
Looks like a little over correction.
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It seems so based on the high preshot today. :banghead:
 
tcmeowmixtc said:
It seems so based on the high preshot today. :banghead:
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Don't worry, Shannon. It's just one day. And it's all useful experience. :bighug::bighug::bighug:

Janet's dosing suggestion above looks like a good idea. And hopefully you will soon see the numbers level out a bit with the reduced dose.

Has your vet suggested a threshold number below which you shouldn't give insulin? (What we call a 'no shoot' number?).
.
 
Elizabeth and Bertie said:
Shannon, @tcmeowmixtc , how is TC doing today?
.
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Hi, I haven't updated my spreadsheet yet. He's doing okay. We had another really low reading after just 0.5 units of insulin. We are contacting the vet to see what we can do. They said it's better to miss a dose than give too much, so I'm just monitoring as best I can. Hopefully we will get some answers from them soon.
 
tcmeowmixtc said:
Hi, I haven't updated my spreadsheet yet. He's doing okay. We had another really low reading after just 0.5 units of insulin. We are contacting the vet to see what we can do. They said it's better to miss a dose than give too much, so I'm just monitoring as best I can. Hopefully we will get some answers from them soon.
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How low did it go today? If too low do 0.25
 
It went 56. I did the Karo syrup and some high carb food. And that was with a high preshot and only 0.5 units. I will lower it and ask the vet as well. Thank you.
 
tcmeowmixtc said:
It went 56. I did the Karo syrup and some high carb food. And that was with a high preshot and only 0.5 units. I will lower it and ask the vet as well. Thank you.
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What hour did it go to 56? Can you write it into the spreadsheet? While it is low it's not quite a hypo on a human meter. If it was early you did the right thing. If it was at nadir you'd want to steer with just a bit of low or medium carb food so you don't over correct. It's crazy how sensitive he is to the insulin... He really crashes on just a few drops. Maybe levemir would be a more gentle insulin.
 
It was at 6 hours. Sorry I can't update my spreadsheet! My meter is at home with all the numbers on them. Let me update my signature because I am using the alphatrak now.
Yeah, it's very worrisome that he drops so low. I will ask the vet about the different insulin.
 
tcmeowmixtc said:
It was at 6 hours. Sorry I can't update my spreadsheet! My meter is at home with all the numbers on them. Let me update my signature because I am using the alphatrak now.
Yeah, it's very worrisome that he drops so low. I will ask the vet about the different insulin.
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Ok well that was probably the lowest it went....still to close for comfort. You only went half way to the first line, right? Like as in a few drops, right? (Just checking because we've had people that were confused and thought the 5 was a half.
 
JanetNJ said:
Ok well that was probably the lowest it went....still to close for comfort. You only went half way to the first line, right? Like as in a few drops, right? (Just checking because we've had people that were confused and thought the 5 was a half.
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Yeah, I was a bit panicked when I saw 56 on the alphatrak. He didn't show any symptoms of hypo either. His ears were warm though. Not sure if that's something?
Yes halfway to one. Used a magnifying glass to make sure. Going to pick up some half-unit syringes too.
 
tcmeowmixtc said:
We had another really low reading after just 0.5 units of insulin.
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Sorry to hear that, Shannon. ...It must be very stressful...

However, it looks like TC's insulin requirements are dropping quite dramatically... ...If he's very sensitive to insulin then it may well be, as Janet says above, that a switch to a different insulin would be appropriate.

I'm wondering what TC's BG would be if you stopped insulin for a couple of days. It's something I seldom suggest, but in TC's case it would enable the bouncing to settle out, and it would give you a baseline for his BG levels. ...With all the bouncing that's going on at the moment it's hard to know what is caused by the bounce and what is TC's 'actual' BG....

It has happened, on rare occasions here, that a cat has ceased to need insulin but that wasn't apparent because the insulin shots were actually raising the BG levels, and the cat had been caught in a kind of chronic rebound.

If drastically reducing or stopping insulin we'd always advise that you check your kitty's pee for ketones. That's not difficult. It only involves dipping a ketone test strip in a little drop of pee. Crumpling plastic food wrap loosely over the litter tray is a good way to catch a sample - it collects in the creases. And some folks here hold a spoon under the kitty's butt while they're peeing (!)

It's good that you're getting half unit syringes. That will make measuring small doses a lot easier. And it's also possible to measure insulin in 'drops' if need be. There are quite a few techniques here for measuring teensy tiny doses.

Sending you reassuring (((hugs))), Shannon.
 
Elizabeth and Bertie said:
Sorry to hear that, Shannon. ...It must be very stressful...

However, it looks like TC's insulin requirements are dropping quite dramatically... ...If he's very sensitive to insulin then it may well be, as Janet says above, that a switch to a different insulin would be appropriate.

I'm wondering what TC's BG would be if you stopped insulin for a couple of days. It's something I seldom suggest, but in TC's case it would enable the bouncing to settle out, and it would give you a baseline for his BG levels. ...With all the bouncing that's going on at the moment it's hard to know what is caused by the bounce and what is TC's 'actual' BG....

It has happened, on rare occasions here, that a cat has ceased to need insulin but that wasn't apparent because the insulin shots were actually raising the BG levels, and the cat had been caught in a kind of chronic rebound.

If drastically reducing or stopping insulin we'd always advise that you check your kitty's pee for ketones. That's not difficult. It only involves dipping a ketone test strip in a little drop of pee. Crumpling plastic food wrap loosely over the litter tray is a good way to catch a sample - it collects in the creases. And some folks here hold a spoon under the kitty's butt while they're peeing (!)

It's good that you're getting half unit syringes. That will make measuring small doses a lot easier. And it's also possible to measure insulin in 'drops' if need be. There are quite a few techniques here for measuring teensy tiny doses.

Sending you reassuring (((hugs))), Shannon.
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Hi.

Thanks for all the help. I was gone a couple nights and did not feel comfortable with T.C. being unmonitored when he's been dropping so low. On my spreadsheet I did take a couple of blood tests during this time. So, my preshot was 466. I gave him 0.25 units of insulin and his +4 is 110. :banghead: We have a vet appointment on Monday. They told me to bring in a record of his numbers from now until then. I'm definitely thinking he needs to be switched to a different insulin. What is the technique for measuring in drops? Should going lower than 0.25 be my next step.

Thanks again. This is really tough and your support is really appreciated. :bighug:
 
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