Glucose Curve (Humulin N)

I also posted this in the Insulin Support area, but havent received a response yet.

My cat Ginger was diagnosed with Diabetes a few months ago, then they told me they misdiagnosed her and she was not diabetic after all.
She had new blood work done and ultrasounds done of her liver, pancreas and heart.
They found nothing wrong.

After she was brought home, I checked her glucose myself 3 times that week. It was normal each time.
She was still tho not acting herself and was lathargic. She then seemed a little better, tho still not herself.

Recently she started urinating on the carpet, so we took her to a new vet.
She IS diabetic.

I have had her on Humulin N 2x a day for the last 2 weeks. Her glucose readings have still been pretty high.
So I started her on the Humulin N 3x a day. Breakfast, dinner and bedtime.

The vet asked me to do a glucose curve today.
These were her readings:

7am (481) gave 3 units of insulin.
10am (110)
12pm (230)
2pm (387)
3pm (419) gave 3 units of insulin.
5pm (265)
7pm (184)
9pm (388)
10:30pm (451) gave 3 units of insulin.

She is on Humulin N, weighs about 18lbs and is 11 yrs old.
I feel these readings are pretty high.
Any suggestions are welcomed.

 

Re: Glucose Curve

The Humulin support group doesn't get a whole lot of traffic so you are better posting here. Very few people here use Humulin. It tends to hit hard (bg levels go down right away) and not last long. It is though the kitty is on a roller coaster, as your readings show. Here is a primer about its properties and use: http://www.felinediabetes.com/phorum5/r ... 241,831241

Most of us will probably urge you to try a milder, longer lasting insulin like Lantus, Levemir or PZI. They tend to last 12 hours and give a much gentler curve. It has seemed to be much easier to regulate and often get a cat into remission on one of these insulins.

It is wonderful you are hometesting. What kind of diet do you Ginger on? Wet lo carb food can make for a huge improvement in bg numbers.

I have never heard of giving Humulin 3 times a day. Hopefully someone will be along who used it and can comment.

 

Re: Glucose Curve

She won't eat wet food.
I have her on the EVO Chicken & Turkey low carb dry food. It is grain free.

 

Re: Glucose Curve

BTW the vet did not suggest me giving the insulin 3x a day. That was my choice because of how high her numbers are at bedtime.
When they are 450 at bedtime, by morning they are well over 500 when I wasnt giving the extra insulin.

I cannot afford the Lantus or Levemir. (I am not working)
I really cannot afford the PZI either, but it looks like I might have to buy that.
Right now I am only paying $24 for a bottle of Humulin N.

 

Re: Glucose Curve

I know the other insulins are more expensive. I don't know if the fact that you might be able to give less (only twice a day) would be a help. I just checked the Supply closet and there isn't any insulin in there at the moment. (Sometimes someone donates insulin.)

The board is really slow tonight. I never used Humulin so I can't comment on your dosage. You might add Humulin advice needed to your subject line and check in the morning. You may have more responses then. Wish I could help.

 

Re: Glucose Curve

I will add Humulin to the subject line thanks.

7am this morning her glucose was 372.
We gave her 2 units of Humulin N.

We usually give 3 units if her glucose is 400+
2 units if in the 300's.

She moans alot throughout the day. Is this normal?

I am going to stop giving her 3 units at bedtime and instead just give her 1 unit to tie her over til morning.
I dont want her to have to eat so late at night.

She has gained alot of weight in the last few months, eating more is not something she needs.

 

The moaning doesn't sound good. Is that when she moves or when you hold her or what?

Keep checking in this am. I sent a private message to the moderator of the Humulin Support group. She is trying to hunt up someone who has used Humulin and can give you some ideas.

 

I'm sorry, but you increased her dose AND you increased the number of times you are giving it? COrrect? You went from 2 units twice a day to 3 units 3 times a day? This is an absolutely huge increase and goes against any kind of logic. I know you want to get her numbers down but this is not the way. Humulin N is typically fairly short acting, so you may be putting her on a nasty little rollercoaster, and are more than likely setting her up for rebound. None of this will save you money...

You say that she is gaining weight...this is not normal for a diabetic...have you had her thoroughly tested for other possibilities?

Lantus sounds expensive but I've read that if you get the cartridges it is much more affordable. I'd strongly suggest either lantus or PZI, and start with a much more reasonable dosing schedule.

Sorry if this sounds harsh, its not meant to be, I just wonder if you realize that this isn't a great idea?

 

I use NPH. I do not give more than 2 times a day.
NPH is least expensive of the insulins. Lantus where I live is $120.00 . NPH $60.00.
I would start 2units 2times a day every 12 hours. It will take 1-2 weeks for the dose to settle out. Recurve . Share curve with vet work from there. Yes Lantus would be the gentler route. But using N it is a harsher insulin. Giving 3 times a day like I see on the curve could cause kitty to have a large drop.I would stop the 3rd dose of N asap.Only give amand pm. 12 hours apart. .Food and insulin together are what control bgs.
Ginger's other issues I would have her get a check up and lab to check for other things that could be causing bg swings etc.

 

I am waiting on an email from my vet concerning the dosaging.
I told her in the email I didnt plan to give her a bedtime dose of 3 units, but maybe 1 unit would tie her over until her morning dosage.
Her glucose is well over 400 at midnight each night, which concerns me.
When it is that high, she is in a state of confusion and urinates on the carpet instead of the litter box.

Her moaning is just when she is laying there. She moans whether her sugar level is 110 or 480.
She had ultrasounds and extensive blood work a few months and nothing wrong was found. I was even told at that time, she was not diabetic afterall, because her blood glucose had returned to normal. She was not eating much at the time, and that is probably why her readings were normal.

I just recently found out that she is diabetic afterall.
She has gained 5 lbs in the last few months.
She rarely moves from the water bowl and is very sedentary.

 

1. how was she diagnosed with diabetes the second time? BG test or fructosamine or ??
2. What dose did you start at, what numbers did you get, etc? ANy chance of you filling out a spread sheet?
3. Her behaviour is not normal. It could be that she's a high doser or she could be completely overdosed...
4. have you heard about rebound/somogi effect?

Jen

 

Hi Ginger's mommy,

Diabetes that comes and goes -- feeling poorly (moaning) -- weight gain --

I really think you need to request the test for Acromegaly -- it is IGF-1 test and in North America, it is only run by the Michigan State Univ laboratory. (cheapest to have your vet deal with them directly)

I have used Humulin N in the past, and also did TID dosing using PZI (every 8 hours) using a scale (adjusting the dose based on blood sugar at shot time).

Your curve looks good for dosing every 8 hours, but definitely - please visit the Acromegaly, IAA, Cushings Cats Insulin Support Group and read the information about Acromegaly.

I had a kitty with Acromegaly, and it sounds to me like Ginger has this. The diabetes is caused by a small brain tumor on the pituitary - which causes "Insulin-like Growth Factor" production to increase (or fluctuate) and interfere with the normal insulin.

I will ask some of the other Acro-moms to come here and read your post and see if they have any suggestions.

I do think you need to ask your vet about treating the pain (moaning).

I gave Norton Prednosolone every day (6mg for 14 lb cat) to reduce inflammation from his tumor.

Recently, some of the acromoms are finding good pain relief using "Gabapentin" for their acro-kitties. Ask your vet about this.

Most vets poo-poo the idea of Acromegaly because they are trained to look for cats that look freakish. Most of our acrocats here on FDMB are discovered because they need more insulin than "normal" diabetics to get blood sugar in a good range. They still look normal because we are finding the condition EARLY.

Ask your vet for this test to confirm: ($44 for the test -- your vet will charge you for drawing blood and overnight shipping to the lab)
http://www.animalhealth.msu.edu/Bin/Cat ... st&Id=1401
there is a related test for IAA at the same lab that only costs $14. Best to request it at the same time because the overnight shipping is the biggest cost.

Edited to add: Most poorly controlled diabetic cats LOSE weight. This is a BIG factor in my thinking that something more is happening here. The extra growth hormone causes them to GAIN weight.

Our acrocats can still have good lives -- some have been happy and healthy for 3+ years after diagnosis.

It is important to get control of the diabetes -- having the acromegaly diagnosis "allows" you to be more aggressive with dosing -- giving enough insulin to get your baby feeling better.

It is also important for quality of life to treat the pain. The "moaning".... Please ask your vet about Pred and gabapentin as soon as possible to help Ginger feel better.

 

To me the curve with TID dosing of N is about the best you are going to get with N and with eating dry food. I would not reduce the dose but would like to see a BG about three hours after the evening dose.

 

Larry, she went from a total of 4 units a day to 9 units a day, in one jump. How is this a good idea?

 

That's alot of insulin, and you may be better off switching to a kinder and gentler, longer lasting insulin - Lantus or maybe Levemir would be better for you.

As for cost, looking at the price of a vial without considering how long it will last sort of throws off decisions.

Sure a vial may cost $120, but if it is lasting you for 3 months, then it breaks down to much less a month, yes?
Also, if the insulin you are using is doing a very poor job, then it's not helping your kitty.
Compare the insulin to a thermostat. Crank it up to 100 degrees, and you get hot, too hot. So you turn it right off, but then you are freezing. So you crank it back up to 100 again.... That's the insulin you are using now.

Now, think of putting that thermostat at a nice comfy 78 degrees. That's your goal, and if you test and see it's a little off, you do some fine tuning. That's how you will find the longer lasting insulins will work.

A few questions:
What foods are you feeding? Often the foods you are feeding can cause a rise in BG, so you will find that low carb, wet foods will help with lower numbers. You mentioned EVO dry - change that to a cheaper and much better wet food such as Friskies or 9lives, or even fancy feast. The DRY food, any dry food is not good for the BG numbers. Once you are feedig low carb AND wet food, you will see the numbers drop.

Test results:
Get copies of ALL the test results. Keep a record of everything so that you can SEE FOR YOURSELF what are on the results. Just becsause a vet says oh everything's fine, how do you know? There are way too many vets who have no experience and very little knowledge of diabetes plus forget about your vet knowing about testing for any sort of insulin resistance! I had to get the info about the tests and provide the shipping details to my vet and they still did not want to test my cat!
Both of my cats tested positive, so now my vets listen to what I say.

Moaning and gaining weight worries me; something is very wrong. With diabetes, there is normally a weight LOSS, not a gain.

For the ultrasound, get a copy and be sure to get the written report that states what was seen. Do NOT go by just your vet's interpretation; get the actual report from the techn/expert who did the ultrasound.

Ask your vet to show you what showed your cat was NOT diabetic and then what showed that your cat was INDEED diabetic?

I need to mention - have you considered another vet? Just wondering that if you have other vets near you, maybe another one would be more knowledgeable, BUT you would be wise to get all of your test results, even pictures of any xrays and ultrasounds done by your current vet.
You did mention going to a new vet; was the old one who said your cat was not diabetic and the new one said yes?


By changing to a better insulin and changing to wet low carb foods, you may well see a very big improvement in your cat.

PLease ask about the tests for IGF-1 and IAA when you speak with your vet. The tests may well tell you why you are having such problems.

 

hello.

It is good to see you cross posting on health etc and asking for thoughts where there are more frequent eyes.
I am posting this in both places...I also agree with the idea of testing for acromegaly.
Weight gain and need for higher than most doses ( as seen by how she is using the insulin now ) are good first indicators that this is a possiblilty.

For those reading.. I giving the following thoughts based on the apparent need for higher doses ( the fact that N runs out of steam so quickly and the evidence of TID dosing in the past being successful for other kitties to create a shallower curve if needing to use this insulin along with the fact that heart issues have been indicated in the past.

That curve you posted has a couple of things that stand out to me.

1- the drop from 7am 481 shot to 10am 110 is very steep and fast.
This can cause kitty's body to feel really awful with the potential to cause the body to try and protect itself from going too low by dumping glucose into its system. This can then be seen as a higher preshot and a big drop once more following the original fast drop.

A too fast and steep drop can set up rebound the same way a blood glucose level that level that goes too low into hypo territory can.
This can be evidenced by high preshots 400s and drops to the 100s in the first 4 hours as nadirs....I believe you may be seeing this here. A big rollercoaster looking curve. This is really hard on kitty's body and one of the reaosns why we encourage switching to the longer lasting insulins. However you are not seeing a drop to hypo territory therefore I would not suggest dropping the dose back much here.

One thing you could do to try and create a slightly shallower curve would be to cut back your dose just a bit and continue with the three times a day shooting.
I would consider 2.5 units as a thought and try that.
A whole jump from 2 units to 3 units may have missed a good dose. Are you also ketone testing?

2- feeding
I am curious as to what the feeding schedule looks like and what you are currently feeding.
Would you mind adding that info along with the curve? I have added examples to the curve below.
A smal low carb snack about 1 hour after shot will help slow down the drop also, and allow for a shallower curve.
Food can really help with this insulin.

3-How is her heart these days? I know there was discussion early on here about cardio issues?
What other medications has she been given recently? These can all have an impact on the curve.

I am linking some info for you about humulin N and about rebound.
viewtopic.php?f=19&t=303
http://petdiabetes.wikia.com/wiki/Somogyi_rebound

The fact that you had normal readings and then diabetic readings over the last several months has me wondering if the diabetes could be a result of
meds given to help the heart at some point and the fatc that acromegaly could be suspect?
Just thinking outloud here.

I also support the using N more than twice a day...to get any kind of shallow curve and enough insulin coverage for 12 hours...shooting more often with this insulin will let you have a little more control.
However, I am concerned that 3 units is too much and would love to see more of you curves from previous doses if you don't mind sharing?
a snack about 1 hour after shot, a slightly lower dose and keeping an eye on where the nadir is and ensuring it has passed and Ginger is truly rising again before giving next shot, are all keys to shooting a TID schedule.

It would be remiss of me not to mention the longer lasting insulins as an option here...they really do make all this a lot easier, but I understand why you have stuck with Humulin N so far so am trying to help address those needs here.

One more thought...shooting a little earlier and thinking more " as needed" instead of a strict 3 time a day schedule....
You need to know peak/nadir has happened and you need to be sure the blood glucose levels are rising... I have put in what a possible as needed schedule may have looked like with this curve....

*********I would only change one thing at a time though..

*I would consider dropping the dose to 2.5 for a few days and seeing how that helps before trying anything more. Do a curve once more and share here.

Meanwhile ask questions and read up on as needed dosing......and come back here with any questions. I will keep my eyes open for you here.

7am (481) gave 3 units of insulin. add feeding example- ( fed 2/3 of a cup a fancy feast chicken grill )
10am (110) ------ lowest point is quite a drop from that preshot and hard on Ginger's body
12pm (230)
2pm (387)---if you had shot 2 units here instead of waiting you may be able to bring the curve down with less of a drop. A slightly lower dose on lower prehot levels on this rising lelve, but that is not too high yet would really help
3pm (419) gave 3 units of insulin.
5pm (265)
7pm (184)---lowest point is 4 hours after shot once.
9pm (388)---level is rising....a possible shot here...again a lower dose as a lower preshot

Hang in there.....I know this forum is slow, but a few of us are kicking around

Kimmee

 

Re: Glucose Curve

If you would like to try Lantus, I will send you what I have left (I think I have 3 cartridges). Just PM me your address and promise to give to someone else if you end up not using it.

My Boo has acromegaly...I really would have your girl tested. Gaining weight...going on and off insulin...high numbers & high doses...those are suspicious.

 

Because with 3 units TID she obtained a typical N curve, peek in about 3-4 hours with a step drop and rise. The peaks are about as what is desired, so I would be leery with increasing the dose because of risk of hypo. Remember, ECID. You have to look at the results for THE cat. My Twigie is on N and I can keep her under 125. Tonight I gave her 0.5 units of N with a PS of 105. It works for her and it is not at all typical for how she reacts to N.

 

Larry, I'm pretty aware of ECID, but a dose increase of 5 UNITS a day is more than I've ever seen 'approved' here.

 

Humulin N is completely used up in less than 12 hours -- in some cases as brief as 7-8 hours or even less.

Yes, Jen, it was a big jump.

But we're clearly not getting any overlap and it doesn't look like rebound either.

 

I gave her 3 units of Humulin N 2x yesterday. (breakfast and dinner)
I will not give her a bedtime dosage unless her BG is near 500. Then I will just give her 1 unit.
BUT
I am going to talk to the vet today in person, she wants to change the type of insulin since it appears the Humulin N is making her go low too fast and then right back up too fast.
SO
Her dosages will totally change I assume, since I will be starting all over on a new insulin.

I am trying to get a urine sample to take into the vet to check for Ketones and some other test she wants to do.

I will keep you updated when I know more.

*** To the person that offered to send me insulin, Thank you, but we will manage here. (I do have a credit card. lol)
I want to get a new insulin asap. Either PZI or Lantus, which I will talk to the doctor about and tell her how everyone here seems to have really good results with the Lantus.

 

I am very relieved to read this post, have been bothered since yesterday about all of this. I truly think that another insulin and a more rational approach to dosing will help you A LOT.

FWIW, if someone offers some insulin, don't rush to turn it down...there is a belief in the principle of pay it forward here and sometimes people really can help make a difference and in turn you can help someone else out down the road in some way...just a thought

 

I talked to the vet yesterday and we decided on Lantus.
I will start her on it on Monday, since I will be home all day to do Glucose curve testing.

I took a urine sample in and there were no Ketones, PH was normal and another test she did (cannot remember what she said it was for) was negative.

 

Good news!

Now, there is LOTS of good information over at the lantus insulin support group. You do not have to post there, you can still post on health, but I'd check out their 'stickied' info posts on how to use lantus.

Good luck

Jen

 

Hi there,
I know I'm late to your posting - I'm just curious about some other info about your kitty - I too was mom to an acro cat. And aside from talking about insulin.....

have you ever noticed that your cat "snores" or breathes loudly?

does she ever lay there with her tongue sticking out?

is she always always always hungry?

how is she when it comes to jumping up on things? is it easy for her? does it seem to cause her discomfort? can she do it at all?

you say your kitty moans alot - does it ever seem as if she just might have a headache if you think about how she holds her head?

has she always just been "a big kitty"?

There are many acromoms who also post in lantus land and currently I'm over there too with a new diabetic kitty - Boris. I'll watch for you but we love to hear more about Ginger in the acro/iaa/cushings insulin support group too. We've learned so much more for these kitties now. We'd love to help if this is what Ginger has.

 

have you ever noticed that your cat "snores" or breathes loudly? (No)

does she ever lay there with her tongue sticking out? (No)

is she always always always hungry?( No, she always picks at the food. Her eating habits are the same as always, very picky)

how is she when it comes to jumping up on things? is it easy for her? does it seem to cause her discomfort? can she do it at all? (She jumps on bed, couch, etc just as she always did)

you say your kitty moans alot - does it ever seem as if she just might have a headache if you think about how she holds her head? (She is usually laying down)

has she always just been "a big kitty"? (Yes, and more so now because of lack of moving around the house. She just lays by the water bowl)

 

If PZI might be an option for you there is good reading in the PZI forum for PZI sourcing info and the cheapest ways to obtain it.

Please read the PZI Sticky here:
viewtopic.php?f=24&t=1979

BCP PZI is a good option too and might save you a few more $. The last I know of a 10 ml bottle of U-40 BCP was $44 + 13.50 shipping. If you stick to the shelf life recommendations for BCP of 6 months then that would be less than $10/month for PZI. It is also possible to get a free sample of BCP PZI: http://www.bcpvetpharm.com/news_bovineinsulin.html I'm sure you could ask them for the concentration you would like it is [like U-40 instead of U-100].

ProZinc can be had for less than $100 shipped to your doorstep and last for 2 years.

Unfortunately, I don't know anything about Lantus or Levimir sourcing tricks.

 

started a new Lantus thread

http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=26155