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Humulin N Primer

Discussion in 'Caninsulin / Vetsulin and N / NPH' started by Sweetgrass & the Furries, Dec 29, 2009.

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  1. Sweetgrass & the Furries

    Sweetgrass & the Furries Senior Member Moderator

    Dec 28, 2009
    The N Primer
    Posted by: Kimber & Bunny (IP Logged)
    Date: April 17, 2008 03:42PM

    HUMULIN 101

    NOTE: Although this was originally written as a primer for N insulin, much of this is a GENERAL HUMULIN PRIMER with advice and experience that pertains to any of the ‘human’ insulins, including Lantus which I have found works very much like Humulin U.

    There are four kinds of Humulin Insulin: R, N (NPH), L (Lente) and U (UltraLente). Novolin is the same as Humulin N, just a different manufacturer.

    R most often is used at the vet hospital when a cat’s bg levels are very high and other health issues make it imperative to the numbers down fast. Occasionally it is used in small doses in combination with a longer acting insulin such as U but more often with the animal based insulins. Personally, I would never suggest this protocol to a novice. I would NEVER recommend R as an “only” insulin as it’s drop is very fast (some cats it takes only 15-20 minutes), very steep and it’s duration is often less than four hours.

    In cats, N tends to be the faster acting, often with rapid onset and little duration.

    N is not the easiest insulin to regulate on. However, there are several cats on this board who have been regulated on it. Bunny was regulated on Humulin N for just short of 5 years. Bunny, unlike most cats, got 12 hours duration out of the N.

    L tends to have a gentler drop and longer duration. Many cats that have a reaction to the N do better on the L because of the slower drop and the fact it stays in their system longer. (This insulin has been discontinued by the manufacturer.)

    U tends to have an even slower drop and longer duration than the L. Again, many cats adapt well to this insulin that have experienced a roller coaster ride on the N. (This insulin has been discontinued by the manufacturer.)

    Every Cat is Different, and not every cat will react the same to any given protocol or dosage. It is VITAL that all changes be discussed with your veterinarian who can talk about these options with you so that TOGETHER you can find what is best for your cat.

    There are some very important issues/points to remember when using N, most of these are pertinent for the other insulins as well.

    1. FOOD. Always make sure kitty eats about an hour before his/her shot. This will insure that kitty has food on her stomach to counteract the typical fast drop of the bg's caused by N (some cats do not drop fast on it, which is, again, why hometesting is so important!).

    Feeding an hour ahead also leaves you relatively sure the cat is going to keep the food down. Warning: We are dealing with cats here, which means nothing is guaranteed. Bunny vomited at peak, while we were asleep, and that is how we had our first hypo in over 5 years of treating diabetes.

    NOTE: Bunny free fed and seemed to know when he needed to eat, so we did not have to worry about his eating before hand. However, kitties getting timed feedings should be fed as stated.

    2. DO A CURVE/HOMETEST. This is a must with all insulins, but can really save you from hypo on N. You need to know when the insulin peaks because you need to know just how low the bg's are dropping. N, in my experience, can peak at anywhere from 2 to 6 hours. Before Bunny got sick, his peak was at around 5 (depending on exercise and food consumption) and after his cancer dx and subsequent hypo, we dropped down to two hours after shot. Needless to say, we have switched insulins.

    The importance of your peak/nadir/low number is two fold: A) You do not want to hypo your cat. High blood glucose kills slow, low blood glucose KILLS FAST. B ) You cannot adjust a dosage on preshot alone. Preshot numbers can be deceiving in that if you are going too low at peak, you will have high numbers at preshot. It is kitty's body's way of saving it from overdose. Consistently high preshots without knowledge of your nadir number could mean rebound, at which point you don't need to increase your dosage you need to DECREASE.

    HORROR STORY: When we were newbies and our vet was learning this right along with us, we kept increasing Bunny's dose based on high preshots and vet visit readings. He was up to FIFTEEN UNITS OF N BID!!! Makes my stomach flip flop thinking about it now! Posted on this board that I was at my whit’s end because I could not get nice preshots. The posts I received back said, "That is WAY too much N! Start over and check your peak numbers!" He was going down to 26 at peak! YIKES! If not for the fact that Bunny free feeds, and can thus bring his numbers back up by eating, he would have died. ALWAYS FIND OUT WHEN YOUR PEAK IS AND CHECK THOSE NUMBERS BEFORE ANY INCREASE!

    When curving on N for the *first time*, in my opinion, it is good to check bg's at +2, +3, +4, +5 and again at +6. This will tell you exactly where your peak is. After the numbers start to rise, you can go back to every two hour checks. This is not the only way to do a curve; it is just my opinion on how to do your first with a new insulin, especially one as fast acting as N.

    Until you have a chance to curve, I do not recommend giving the shot at bg’s under 300 simply because you do not know yet how much of a drop you are going to get. I have sat up all night on hypo watch with several folks who were new and thus had not curved yet, only to find out their cat dropped 200 on a single unit…not good when preshots was 250.

    Hometesting Links and Tips FAQ:

    3. SETTLE TIME/ONE CHANGE AT A TIME. Speaking of increases, just like any other insulin, allow at least two weeks between changes/increases for the change to settle/body to adjust. This includes food changes. If kitty is starting a low carb diet, do not increase insulin until the cat's body can adjust to the change. Too many changes too close together will leave you wondering which change you made gave you the result you wanted. The only exception to this rule is a decrease in dosage. If kitty is going too low (I don't like Bunny to be anywhere under 100 and I, personally, do not “shoot” under 250), definitely decrease your dose.

    4. LOOK AT THE WHOLE CAT. Many folks on this board have lovely regulation numbers that are consistently between 100-200. Some cats will not regulate that way. Bunny was mid 300's preshot (never any ketones) and low/mid 200's at peak when he was regulated. Any other change took him too low (lowest I could take him without a rebound was 180ish). He was flat on his hocks with neuropathy at dx. Once we regulated him, he started walking normal, decreased water intake and peeing and started to put some weight back on. The vet said that even though his numbers were higher than the ideal, it was obviously what worked for him. His annual FULL blood work ups, until the cancer, always showed normal.

    5. GET A FULL BLOOD WORKUP AT LEAST ONCE PER YEAR. This is all insulin’s. Because diabetes affects so many other organs, it is very important to know the kidney, liver etc are functioning properly. This test lets you and your vet get a better picture of what is going on with kitty. It also helps catch other diseases when they may still be in their early stages and thus easier to treat.

    6. SYRUP. This is just too important! If kitty is catatonic, non-responsive or having seizures, IMMEDIATELY give karo syrup, maple syrup or honey. You can rub it on their gums or the inside of their cheek.

    Even if you are on your way to the ER, the sugar spike could save your cat's life or some of the organs that are damaged during such an episode. Do not worry about getting syrup everywhere, it will wash up later. Do not worry about taking kitty's bg's too high--high sugar @#$%& slow, low sugar @#$%& fast. If possible, have someone drive while you continue to apply the syrup on the way to the doctor. It could save your cat's life!

    High carb foods such as dry food or the semi-moists like Tender Vittles are good to keep on hand as well. Why? Because if kitty is conscious/with it enough to eat, then the this will help Keep the Bg’s up longer. Syrup is a temp fix and does not maintain the needed rise.

    7. SEMI-MOIST FOOD/TREATS. Tender Vittles and other semi-moist foods/treats, milk and carrots can also cause a major spike in the bg numbers, because they all contain SUGAR. I am not saying kitty can never have these again. Quality of life is very important. Bunny has always been allowed one or two a couple times a week. I am just saying to abstain from these treats until you achieve regulation.

    8. KNOW YOUR CAT. There may come a time when kitty does not want to eat what s/he is supposed to. It is important to know what foods you can give to entice eating, as it is crucial for the cat to eat while on insulin! Also, if you are curving and kitty’s numbers start dropping too low before and/or during peak, it is lifesaving to know what to give in order to start increasing numbers. Things that have worked for myself and others: vanilla ice cream, gravy, white bread, Catsip (the milk that is made for cats, not the stuff you put on hotdogs), donuts, popcorn, dry cat food or dry cat food with tuna water dumped on it, semi-moist cat treats. You will want to know beforehand what high carb foods your cat loves, and will readily eat, so that should you find yourself in a situation where your kitty's numbers are going too low, you already have a supply on hand, and won't waste precious moments experimenting with different foods.

    9. START LOW GO SLOW. If you start too high, you could “miss” your ideal dosage. Many people have found that ½ a unit BID or 1 unit BID ends up being the perfect dosage to keep kitty in the 100-300 range.

    10. BID (TWICE PER DAY) dosing: In all the years of being on and off the FD Boards (since 10/97) I have not come across a cat that got any more than 12 hours duration on N. It is NOT a single dose per day insulin by any stretch. Increasing dosage does not make the insulin last longer, it only makes the cat’s number see-saw more, dropping them lower which causes their glucose to go higher. If your vet wants SID (one dose per day) please explain this to him/her and if they refuse to listen, PLEASE INSIST that you do twice per day dosing.
    Even on slower acting insulins like L and U, MOST cats need insulin twice per day.

    11. EVEN AFTER YOU REACH REGULATION IT IS A GOOD IDEA TO PS TEST AND/OR DO PERIODIC CURVES. Insulin needs change. Throughout the six years I treated Bunny his insulin had to be adjusted. Just because 2 units BID worked for the past 6 months, you are treating a CAT, and cats change their minds all the time! His dosage varied from 7 to 5 units over the first 5 years because his body’s needs changed. Without periodic curves, I wouldn’t have known to adjust his dosage and could have easily hypo’d him.

    Copyright © 2003-2007
    Kimber, Bunny (Grey Angel) & Annie (Guardian Angel)
    (with much appreciated contributions from Debra & Care Bear(GA); Hope, (((Patches)))GA, (((Baby)))GA, Hope & Mishka)

    PS…since the subject has been brought up several times on the FDMB…Humulin insulins in the United States are ALWAYS U-100, and therefore should be used with “U-100” needles.

    Kimber, Bunny (Grey Angel 8/14/93-8/7/03), Sam & Dee (Guardian Angels), Miss Bisby (Gone Ahead) and Riley Nubb Bottom AND Annie Bananie (Guardian Angel ?/94-4/16/08)

    Bunny was dx'd with FD 10/97. Lymphoma 12/24/02.
    Bunny Riley Woody FIV+
    Annie FD DX 6/1/07. Adopted 6/16 & started 1 unit Lantus BID 6/17/07. As of 9/22 we are BID dosing 1/2 unit. November "07 Annie went to SID. 12/8/07 was her last shot, she is currently staying 70 to low 100's diet controlled. We noticed swelling in her cheek 3/20/08 and rushed her to the vet. They thought it was an abscessed tooth, so her SCC (mouth cancer) dx didn't come until 3/25/08 when they did her dental. Annie received her wings 4/16/08.

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