So...we're about 3 weeks into using Novalin-N for Max. This has been a new learning curve since we used Lantus the first time he was on insulin (and it was 9 years ago, so I've forgotten a LOT). Important bits: He's 17 and has CRF. The last 6 months or so before dx he'd been winding down FAST, and generally became "old." He lived in the main part of the house (living room, dining room, kitchen), stopped jumping up to our bed to sleep with us, never came in our room, and mostly just slept all day/night on the couch. Vet started him at 2U bid on Novalin because at the time he was sick enough we weren't sure he'd actually survive much longer. A week of antibiotics and starting insulin has made some great improvements. I also started him on Zobaline 6 days ago. We've also increased the amount of food, and last night I adjusted the feeder times so he's getting food at shot time, and 3 hours later (it was 1.5 hours later before). Positives: Shiny coat, purring, generally more activity. He's jumped up to our bed once (snuggled my face at 4:15am--startled the crap out of me!), and gone down to the basement to visit my son's room. He's starting to gain weight too, which he badly needed. Still drinking a lot, but that goes with the kidneys too. Puking a lot less. We are leaving for vacation in 9 days. He will be getting shots at 12hr intervals, but will not be tested for 10 days. Likewise, no one will be staying at the house to notice if something is wrong mid-cycle. So now what do I do about his dose? He seems to be settling into the 2U, getting some good numbers occasionally, but is obscenely high at pre-shot. We did 3U doses (vet increased) for about 3 days and then he started to crash mid-cycle and we went back to 2U. I'm guessing the best dose for him is around 2.25-2.5U on this insulin. I believe after we return from vacation I'm going to switch him back to Lantus. We had better success with more gentle curves on that one (I can remember that much, tho I no longer have his spreadsheet, but he went OTJ, so there's that). I will not switch his insulin before we go, I won't have enough data to have any confidence in dosing him without regular testing. Do I try increasing his dose at all before we leave, or keep it the same? And when we're gone, do we stick with 2U, or drop to 1.5U as a precaution?
Some people get up every night at 2AM to do a mid cycle test. That was something I could never do. Noah was unregulated and a bouncer so what I did was reduce his PM dose to 2/3 of what it should have been. Noah was boarded last May and my vet thought that was a good idea but every cat is different. Keep in mind it will be much easier to deal with higher numbers when you get back than getting some awful text about a HYPO episode in the middle of your vacation and do NOT increase his dose only because you'll be away. Best of luck.
Thank you! I don't get up to do a mid-cycle test either, but currently his mid-cycle hits when I'm still awake sometimes (we test/feed/shoot between 5 and 5:30pm). I have to start adjusting the cycle times, tho, because my mom will be feeding/shooting while we're gone, and she's requested an 8am/8pm cycle.
You mentioned your kitty was so sick at diagnosis the vet didn't know if he would survive. Did Max have ketones &/or DKA? Have you been testing Max for ketones at home lately? A good idea to do so with those high numbers. We never know what kitty is up to in our absence. Will they be eating the same amount or less? Probably going to be less active since they won't have you to chase into the kitchen multiple times a day. If there is no history of ketones/DKA I'd suggest you reduce the dose to 1.5u while away and would start the new dose a few days prior to your departure so you can see what numbers are like on the reduced dose. To make it easier on Mom, draw up a sample dose in a used syringe with coloured water. Mom can use that to compare to when she is administering insulin in your absence.
Thank you! I expect there will be wasted food while we're gone just so we can make sure he has access to it if/when he needs it. He's generally not active at all anymore, even when we are home. I did plan on leaving a sample syringe available for the caregivers along with a log sheet to note time of shots. I have a teenager coming to feed/shoot the first 24 hours we're gone as my mom will be out of town herself. Then my mom will take over for the remaining 9 days we're gone. Max's overall health had been declining for months before the diagnosis. He's 17, and has had CRF for about 3 years now, so it just seemed sort of normal. He'd been losing weight, looked terrible, no energy, and sometimes the watery vomit from the CRF was pink-tinged. Then he developed some sort of bacterial infection--vomiting, diarrhea, etc. The night before I took him to the vet the watery vomit was red. We thought we'd be saying good-bye the next day, but instead got antibiotics and insulin. The vet even thought it was nearly "time", until we did the blood-work just to be sure that whatever we did about the diarrhea and vomiting wouldn't push him into absolute kidney failure. That was when we found out his sugar was sky-high again. He's been OTJ for 9 years, so it never crossed my mind (should have, but didn't). Shockingly, his creatinine was back within normal bounds, though it's been high the last few years, so who knows what is going on in there--personally I think it's sheer stubbornness on his part. I've always joked he'd be the cat that lives to 25 simply be being too stubborn to leave me. He was not tested for ketones or DKA as far as I know. I've never tested/checked for that either, but he's been slowly gaining weight (his spine is not quite so close to the surface) and his coat has drastically improved, so that would indicate not having ketones/DKA, correct?
Sounds like whatever was going on when he was re-diagnosed was not DKA so that is good. Your observations that his coat has improved and he haw gained back some weight are both good signs but that doesn't rule out the possibility of ketones. His numbers are still high and for that reason it would be a good idea to check for ketones. Ketones can start and increase quickly and lead to DKA which is a very serious complication of diabetes, very expensive to treat and it can be fatal if not dealt with promptly. You can test Max's urine using Ketostix available at the local pharmacy. Some folks can simply hold a designated spoon under kitty's butt while he is in the LB and others use plastic wrap in the litter box to catch a little pee to test. Novolin tends to knock the BG down quickly and sharply and that can lead to bouncing into higher numbers. Since you got him into remission previously with Lantus, I would consider switching when you return from your trip to try to smooth out Max's numbers. I have an old guy who will be 21 next month so I can relate to having a quiet geriatric kitty although mine still follows me to the kitchen if he happens to be awake!
OH, yes, I've already talked with the husband about the insulin switch when we get back. I know the vet won't argue as it was part of our initial treatment conversation. I hate seeing the bounce, and I'm sure it doesn't feel all that great for him either. Everything was much smoother with the Lantus last time. I have changed the feeding schedule so he's getting food at shot time, but then also at +3 (Lordy, I've been writing +4 in other posts...sheesh!) in an attempt to smooth the curve a bit. We just started that yesterday or the day before (too much going on, I can't remember what day it is anymore!), and I haven't been able to do a curve to see if it is working. I am hoping for better end-of-cycle numbers when I get home today, tho. He didn't drop as fast this morning, and he wasn't as high to begin with, so I am hopeful he won't be feeling quite so yucky in the meantime until we can switch. I'll have to consider how to try to test for ketones. We have another cat, 2 dogs, and I've also got 9yo and an 11yo humans at home, so it's a fairly constant state of chaos, and I'm not sure how I'll know which cat peed in the box to try and test it. He's always used a covered box, so catching it with a spoon is not going to be an option. I'll keep puzzling on that one, tho.
I can see how having another cat, the dogs and kids could get a bit "busy". There are glucometers you can buy to test for ketones using a blood test just like you do for glucose. The strips are a bit more pricey but you won't use nearly so many. It's actually better than urine testing because ketones will show up in the blood before they show in the urine. The Nova Max, Keto Mojo and Precision Xtra are some options to consider.
Oooh, thanks! I'm not really excited about the meter I have, but it was cheap and available at the time, so I'll look into those options.
