? My 1st GREEN! How do I regulate my doses to prevent hypo with Novolin?

Discussion in 'Caninsulin / Vetsulin and N / NPH' started by Becky and Gray-Gray, Jan 12, 2020.

  1. Becky and Gray-Gray

    Becky and Gray-Gray Member

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    Jan 2, 2020
    Hi everyone, I am so thrilled to get my first green number!!!! But now I have this overwhelming fear of hypo’s. The last three cycles have progressively dropped since I’ve upped Gray-Gray’s dose from 0.75u to 1.0u and have begun weighing out her food. I am very nervous going into tonight’s PMPS and whether or not to stick with the 1.0u or to go back to the 0.75u. I work Monday-Friday and am unable to monitor the am cycle (This is what scares me the most). I monitored both am and pm cycle yesterday because I was home all day and new I wouldn’t be able monitor this morning as I was not going to be home. As soon as I got home This morning I tested her and hit green. Green is good, but now I’m scared because the green was at +5 and her Nadir is usually at +3 leading me to believe her BG was lower than this hours earlier and it’s rising up now. If you use Novolin what are your thoughts on this me keeping her dose at 1.0 or dropping it back down to 0.75?
     
  2. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    That green number that Gray-Gray got is still at the high end of the green range and a safe number. Scary though.

    You do have that timed feeder that you use. Did Gray-Gray eat 1 or more meals in the timed feeder this AM?

    Remember, you also stopped using the W/d food earlier this month and are using a much lower carb food now, plus you are feeding less food. My gut is saying lower the dose back to 0.75U for now.

    You hold the needle. The ultimate decision is yours.

    I haven't used Novolin N in years for one of my cats, and when I did, I quickly got them switched to Lantus.
     
    Last edited: Jan 12, 2020
  3. Becky and Gray-Gray

    Becky and Gray-Gray Member

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    Jan 2, 2020
    Yes, she did eat one of her timed meals prior to that reading. My gut intuition is telling me to decrease to 0.75 but it’s always nice to hear your thoughts bc I’m still not confident in my decisions yet. I Will be asking my vet Saturday about switching to Lantus. Gray-Grays SS confirms the Novolin wears off quickly, plus the AAHA document you shared has excellent info as well! TY!
     
  4. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    If you think you may be switching to Lantus in the future, have you gone over to the ISG for Lantus and Levimir? Look at the Stickies at the top. The very first one, The Basics: New to the Group? Start here! is a good one to start with.

    Knowledge is power in my opinion. The more I know the better I can make decisions that will work for me and my cat.
     
    Last edited: Jan 12, 2020
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  5. Becky and Gray-Gray

    Becky and Gray-Gray Member

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    Jan 2, 2020
    Yes, I have begun going through the Lantus stickers, Thank You!
     
  6. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Just keeping in touch and checking up on you and Gray-Gray. SS looks ok.
     
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  7. Becky and Gray-Gray

    Becky and Gray-Gray Member

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    Jan 2, 2020
    Thank you!!!! I began giving her a teaspoon of pumpkin to try to loosen her stool today at her pm per shot meal and I was sort of freaking out bc I had my first reading ever over 500! Eek! Thank you for checking in!
     
  8. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Checked in on you and Gray-Gray again this morning. While it's not good and a bit scary to see those high numbers, it's hard to know the why behind them. Checking for ketones in the urine is a good idea when the numbers are high like that.

    Saw your note on the SS in the remarks column wondering if the vacuum cleaner was causing wonky numbers. Or if the stress from running the vacuum caused the spike in BG. :smuggrin:

    We know that stress can cause the BG levels to spike. Researchers have found that giving a cat a bath can spike the BG levels, especially if the cat is struggling or vocalizing. Spike was about 80-90 points in one study. The study went on to say, the glucose levels went back to normal for about half the cats within 90 minutes. Although Gray-Gray may not like the vacuum cleaner and runs and hides under the bed somewhere, you are not holding her while you vacuum and making her struggle. At least I don't think you are. Personally, I've never had a cat that liked the vacuum cleaner and would tolerate being held while vacuuming. ;)

    As long as you are handling her gently and she is calm while you are BG testing, it's unlikely the BG readings you are taking are higher because of your handling. "Careful handling techniques that minimize struggling associated with blood collection may reduce the incidence of stress hyperglycemia in cats." Stress hyperglycemia is one of the reasons that home testing for our diabetic cats is so highly recommended.

    If we could only figure out why BG readings one day were so inconsistent, we'd probably win a nobel prize. Did she play more? feeling a bit sleepier than normal? eat a bit more or less? saw a squirrel outside and ran around inside the house from room to room playing 'catch the squirrel' game? saw a strange cat at the window in 'HER territory'?

    These are the types of questions we sometimes ask ourselves in this journey with our diabetic cats. The answer is, we'll never really know why the BG readings vary so much, day to day, hour to hour. We monitor the best we can, we feed the lower carb wet cat foods that are better for diabetic cats, we give our cats insulin. Those are the only 3 things we have control over. We do the best we can.

    Becky! Please don't make me laugh too hard. But please keep making any notes in the SS you think may be relevant.
     
  9. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    One other thought, because you noted the test strips look different. Did you get the Relion Prime test strips or the Relion Premier test strips?

    Can you take a picture of old box, new box and strips and upload it here?
     
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  10. Becky and Gray-Gray

    Becky and Gray-Gray Member

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    Jan 2, 2020
    Great idea! I will definitely do that when I return home from work and after I dig through the trash for the old box :facepalm:. Good thing trash day isn’t until tomorrow otherwise they’d be GONE:confused:
     
  11. Becky and Gray-Gray

    Becky and Gray-Gray Member

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    Jan 2, 2020
    I will do almost anything for my kitty! A pair of rubber gloves, picking through trash, and Dumpster diving at the bottom of a trash bag I have found the old test strips and bottle ... here are the images of the original strips and container!
     

    Attached Files:

    Last edited: Jan 15, 2020
  12. Becky and Gray-Gray

    Becky and Gray-Gray Member

    Joined:
    Jan 2, 2020
    With clean hands, no gloves, and no dumpster diving I have the new test strips images ☺️‼️Here are the new test strips:
     

    Attached Files:

  13. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    They look the same to me. Sorry you had to go 'dumpster diving', but it was good to double check.
     
  14. Becky and Gray-Gray

    Becky and Gray-Gray Member

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    Jan 2, 2020
    The bottles look the same, yes.... BUT do you agree that the strips are different?! The old original strips have a hole but the new strips do not‼️Weird?!?!
     
  15. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    I saw that little rectangular block area on the end of the strips that gets pushed into the meter. Looks like on the old batch of strips, that area was punched out. Now on the new strips, that area is filled in.

    Was looking on the internet searching for any recall info, and there is none for those test strips.
    You could take them to the pharmacy and ask if there is a problem with the strips.
     
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  16. Becky and Gray-Gray

    Becky and Gray-Gray Member

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    Jan 2, 2020
    Excellent suggestion! Thank you! I will do that Saturday!
     
  17. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    • Surfing in the blues for Gray-Gray at mid-cycle again.
    • See that you only increased to 1U of Novolin N. Your vet wanted you to double the dose, from 0.75U to 1.5U. Don't think I would have done that entire increase either.
    • Do you have the BG readings that were done at the vet on 1/18? Curve day? You could enter those in your SS.
    • Did you share your SS with your vet? Always good to do that.
    • Did your vet give you a prescription for the Lantus?
    • You want to buy the Lantus in the smaller cartridge size. Sometimes called an insulin pen.
    • You'll use the same U100 (insulin concentration), 3/10 cc capacity, 1/2U markings on syringe barrel, needle length is up to you as you do with the Novolin N.
    • Ordering Lantus from Mark's Marine Pharmacy in Canada will save you a lot of money. Many people here use lantus and order from there. Ordering Lantus, Basaglar, or Levemir from Canadian pharmacies They are reputable and very helpful to our members. Pharmacists are willing to answer many questions.
    • See Gray-Gray has gained some weight. Guess your estimate of weighing her at home on your scale was close to what she actually weighs. So now you can check her weight yourself at home regularly and note that on the SS. Once a week is enough.
    • Was the vet happy with Gray-Gray's weight? and body condition score?
     
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  18. Becky and Gray-Gray

    Becky and Gray-Gray Member

    Joined:
    Jan 2, 2020
    Hi there,

    The vet vet was very pleased with Gray-Grays weight gain and happy with her size. The vet showed me the curve on paper, however she kept it and I did not receive a copy. I did share my SS with my vet. She liked it and particularly liked the green which is why she suggested upping dose to 1.5u. I received pleasant excitement about wanting to switch to Lantus. The prescription was faxed to Marks pharmacy today. I still need to call them or create an account on their webpage to place the order for delivery. I’m not sure quite how to do it as I haven’t looked into it yet online. I’m not sure whether the prescription is for the vial or the pen as I haven’t seen the script since it was faxed in. Vet suggested ordering a couple now to last me thru the summer (bc I live in the Southern California Mojave Desert and shipping in the summer with triple digit temperatures is not advised). She wrote the script for 1 unit bid but suggested I start off with 0.5unit to begin with to see how she’ll react. Any recommendations on how to proceed to place my order with Marks Pharm? Thank you so much for your guidance :)
     
  19. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    The best I can do is point you to their facebook page. Please be aware they are backlogged, due to a blizzard.

    See this post pinned to the top of the Feline Health Main and Welcome forum
    Mark's Marine Pharmacy backlog in orders.

    Order the pens. More cost effective. You do not need the pen needles. You will be using an insulin syringe to withdraw the insulin from the pen.

    Video on how to do that is here.
     
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  20. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    I know you didn’t specifically ask, but I wouldn’t start at less than 0.75u. You’d likely be fine with 1u but if you want to be cautious, which is fine, 0.75u is good.
     
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  21. Becky and Gray-Gray

    Becky and Gray-Gray Member

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    Jan 2, 2020
    Thank you for input. I think I posted about this in another place. I was curious about dosage and considering basaglar is a depot insulin I didn’t know how long after meal to wait to shoot?
     
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  22. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    May 30, 2010
    You’re welcome!

    You just have to feed before onset at +2 but pretty much everyone feeds while shooting. That also allows for food on board before onset.
     
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  23. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Becky, the when to feed with using Lantus or Basaglar is quite different than it is with the Novolin N insulin you were using.

    Because NPH insulins (Like Novolin N) onset very quickly and tend to cause a very steep and rapid drop in BG, you needed to Test, feed first, wait 45 min to an hour, test again to make sure the BG's were still high enough to give insulin and then give the Novolin N insulin.That waiting time after feeding was so some of the food could be digested and start to balance out the rapid onset of the NPH. You were trying to balance out the steep drops with the NPH insulin also.

    Now, you do not have to do that waiting.

    Lantus is a gentler and longer duration insulin. Test, feed, shoot all in a 15 minute window of time is what most people do that use Lantus.

    When do you expect to receive your Lantus insulin? Do you know yet? You could contact Marks Marine Pharmacy to find out.
    How soon after you receive the new Lantus insulin will you be using it for Gray-Gray?
     

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