Need some help.

Hi guys. New here.

My cat's blood sugar dropped low the other day to some where around 26. The vet had him on 5 units of insulin after testing at the vets over the course of a day or two. He's been on this for probably a year? This is my moms cat so sorry if my details are not 100%.

Anyhow, I brought his sugar up. I purchased a tester for home to get a better idea where he was, previous to a week ago we didn't have one. I bought it because about 3 weeks ago he also dropped very low and lost use of limbs and was very weak.

So, I've been trying to get his sugar under control which has been seemingly difficult. This morning he was at 333 right before feeding so I gave him 4 units. My thinking was the vet had him on 5 and that 4 shouldn't be too much considering he was higher than he should be and being fed.

That was around 6-6:30am and I have just checked him at 10am and he was at 67! Now, I assume that means that 4 units is also too much. I gave him some food so hopefully he should be okay.

I guess my question is, what if he peaks higher than he should in a day and also drops below where he should when fed every 12 hours? He is eating fancy feast with liver.

 

I can't help with dosing advice, but some others will be along soon to help. They'll need to know some more details: what brand of insulin are you using? Are you using a human meter or Alphatrak (pet meter)? That affects how people will provide advice. You can also update your signature with these details so people can see at a glance. Click on your user name on the top right of the page, then on Signature. Add the details then save the changes. Best of luck with your kitty.

 

Thanks. I am using the Alphatrak 2 meter. The Insulin is Novolin.

I just checked him after an hour since he was at 67 and I fed him some and he is now at 81.

I am down to two test strips also. I have ordered more but don't expect them to be here until late in the week. What would be the best use of these last 2? I was thinking he should be safe until I feed him and give him another shot and then maybe use one after his next feeding tonight and maybe one tomorrow morning before his next. What makes the most sense?

 

I don't know much about Novolin, but I do think it's a good idea that you're reducing his dose. The current dose seems to be dropping him too low, way too fast. Someone else will be along to give better advice on this, I'm sure. Glad to see the food is helping to steer his numbers in the right direction. Is there any way you could get to a vet, today, and get some more test strips for the Alphatrak 2? Being down to only 2 test strips isn't a good idea, especially since they won't be here until the end of the week. And if you can't get to a vet to get more strips, have you considered an inexpensive backup meter, perhaps a ReliOn Micro from your local Walmart... assuming you're in the US. Lots of folks here use that meter. It's a good choice and it'll run you about $15 for the meter itself and about $20 for 50 test strips. So, for about $35, you'll be able to test and keep your sugar kitty safe until those Alphatrak test strips arrive.

 

Hi Ozzy

67 is below the hypo threshold on an Alphatrak meter. Have you any honey or karo/corn syrup? If yes, squeeze out a teaspoon and rub some on your kitty's gums now.

Then come back here to let me know it's done.

 

I was not aware of that. I am a bit broke right now but will see if I can manage to get one.

 

I gave him some food and last I checked about 30 minutes ago he was at 81.

 

A curve obtained at the vet is typically unreliable and results in too high a does since vet stress can artificially raise BG by 100 points or more. The usual starting dose is 1 unit twice daily.
5 units is a very high starting dose especially when using N since it ony last 8-110 hours and thus you get a steep drop.
I would reduce the dose to 1 unit or maybe 2 units twice daily.
This symptom "lost use of limbs and was very weak." indicates the dose is too high

Most of us here test or cats blood glucose at home using a human meter. We test before each shot and periodically between shots. We record our reading and other info in a spreadsheet. See:http://www.felinediabetes.com/FDMB/...te-a-ss-and-link-it-in-your-signature.130337/

 

By Novolin do you mean Novolin N?
Novolin is Novo Nordisk's trade name for a family of Recombinant DNA origin insulins. They include N (sometimes called NPH), and R (very fast actions) and mixture of the two. Only N/NPH is OK, but not that good, for cats.
Better insulins are are the human Lantus and Levemir and the pet insulins ProZinc and BCP PZI. For those two human insulin it is best to get the 5 pack of 3 ml disposable pens via a 10 ml vial. Although per ml the vial is less expensive most cats will not use up a 10 ml vial before the insulin goes bad/becomes ineffective.

 

I'm glad you gave him some food but he's still quite low and the numbers may dip again when the food wears off. Also, you've only got two test strips left so the normal routine of only boosting numbers a little at a time is IMO too risky because you can't test enough to make sure your kitty doesn't drop again. A little bit of honey on your kitty's gums right now should help to keep his numbers up for a little while and keep him safe till we can help you to work out a plan of action. Does that sound OK to you? If yes, please give a little bit of honey and update us when it's done. Otherwise post again and tell us what you would prefer to do. (Sorry to be so brief in reply - responding to the urgency at the moment.)

 

Thanks. I am going to reduce his dose tonight to 3 units as I think 4 was one too high. It seems he drops about 100 per unit.

Are the human testers as accurate as the Alphatrak?

 

Novolin N, sorry. Can I obtain those other ones from walmart?

 

@Larry and Kitties - Can you help Ozzy to make sure his cat is safe? Unfortunately I am unable to stay with him.

 

Oh, please TRY to do that! You won't regret it, trust me on this!! And it could save your kitty's life. And if you do get the ReliOn Micro (human meter), please refer to BJM's post to learn how to interpret the range in numbers/glucose reference values. The link is here. And good luck to you and your sugar baby.

 

Oh, I just thought of something else... While you're at Walmart, pick up some high-carb food to help steer his numbers quickly upward when blood glucose drops too low. Lots of us use Fancy Feast Gravy Lovers. It works like magic for boosting numbers... been there, done that.

 

Hi,

Unfortunately I can't stay online with you this afternoon. Please watch your cat carefully and have honey/karo to hand. Here is a guide on how to treat hypos. I've alerted the mods to your thread to see if they might be able to find a member online familiar with your insulin type to keep an eye on your thread in case you need emergency help.

Your cat definitely needs a dose reduction because he went below 68 today. Also the recent symptomatic hypo episode may possibly have made him more sensitive to insulin.

If in doubt this afternoon feed your cat. If he gets very, very hungry give him some honey or syrup as well as food.

I strongly recommend that you ask for dosing help PRIOR to giving the next dose of your Novolin N insulin and also advice on what to do for safety given your cat is going low and you only have two test strips.

You can change the title of this thread by going back to the opening post and clicking Thread Tools then Edit Title. I suggest "Novolin N Dosing Advice Needed - Current Dose Too High" as a title. Also if you click on the thread prefix icons to the left of the title then select the Question Mark icon it will attract more attention to your thread. Then save the changes.

I'm sorry I can't do more to help.



Mogs
.

 

You can get Lantus and Levemir from Walmart but those require a prescription from your vet. Also, you will have sticker shock. A 1 ml vial of Lantus or Levemir is about $250. A a per ml basis the disposable pens are even more.

 

I really feel for you! Last week my cat had two hypo episodes in as many days. Listen to the excellent advice you will get here, these folks helped save my cat's life on those days, and continue to help me, even more than my vet, to get him safely regulated. Definitely buy another glucometer, I have the Relion and love it, much less expensive to use than the Alphatrak (I use an Alphatrak for numbers for my vet), especially if you will be testing frequently. And you NEED to keep testing your kitty frequently until you get him sorted out, you can't afford to wait till the Alphatrak strips arrive. You also need to set up aspreadsheet, if you haven't already. There are people here who will help you with that, not sure but I think @BJM helped me, along with @Brashworks. It is an invaluable tool to have, believe me!
Best of luck with your kitty! You and he are in good hands, here.

 

Another more affordable option might be ProZinc. It's about $110 for a 10ml bottle at our vet. It was designed specifically for cats and is a U40 insulin... 40 units per mL. You use U40 syringes. Another option is to use U100 syringes using a conversion chart.

 

Just remember that there is only 400 units of ProZinc in a 10 ml vial. At $110 for a 10 ml vial, 1000 units would cost $275, about same price at Lantus/levemire.

BCP PZI is less expensive. A purchased a 10 ml vial of U100 a few months ago for $97 including shipping.
http://www.bcpvetpharm.com/products_bovine.htm
You vet can order a free sample of U100
http://www.bcpvetpharm.com/pdf/sample.pdf
but expect for it to arrive in weeks. If you purchase it, it is shipped overnight. You need a prescription

 

Yes, true! But I'm just sayin' it might be easier to plunk down $110 to get started in the right direction than it is to plunk down $250.

 

Tagging some people who may be able to provide more advice:
@Sue and Oliver (GA), @Carl & Polly & Bob (GA), @Shiloh & Rhonda, @pevsfreedom, @Cat Ma, @Jan Radar

@Ozzy, please do go get a human meter and strips today. Your kitty is still at risk. You don't have to change insulins to Lantus or PZI right now. Lots of people use Vetsulin with sucess, but you WILL need to reduce the dose. Hopefully some of the people I've tagged can weigh in and give dosing advice.

 

Agreed! The concern right now is to obtain a human meter and strips ASAP. The insulin debate can be worked out later. Good point, @granadilla!

 

What you want is the 'ReliOn' brand 'Confirm' or 'Micro' meter and a box of strips for it - it will have those names on the front of the box, a 50 count box is about $19.98. DON'T get the 'Prime' meter right now altho' the strips are cheaper, it takes more blood and errors are more prevalent.

PLEASE figure out how to get that as quickly as possible - your family kitty desperately needs you to do this. Until you can get a meter, I suggest that you drop that dose down to 1-2 units or so. Better to run high for a LONG time than low for minutes.

HUGS!!!! Good job raising that 67 number!

 

Yeah that's nearly worst case scenario. You're giving too much insulin, plain and simple. Another dose of 5 units could kill her.

Wal-Mart sells the Reli-on and test strips for a bit of $. Even cheaper is a Bayer contour Next and buying test strips off of Amazon.com - if you have plenty of alphatrak strips I'd order the reli-on and however many strips you can afford since it's the cheapest option.

Contour kit

1) Take 5-10 minutes and set up a spreadsheet like most of us have in our signatures so we can better see what's going on. Link

2) READ and print out this hypoglycemia information because if you ever see low #'s like that again you need to take action immediately. You'll want some GRAVY LOVER super high carb food for treating low #'s specifically - but don't feed this regularly. Honey and a feeding syringe is also important to have around.

3) What kind of food are you guys feeding? You want something low carb, under 10% per this chart. A lot of people here use Friskies Pate which is mostly under 10% and pretty good or Fancy Feast CLASSICS which is even better.

4) You want to basically be testing, feeding, and then shooting your insulin. Test again at +2 at least once a day (+2 is 2 hours from when you gave the shot) and try and get a few more tests in after that, between +4 and +9 specifically. Then test again at +12 (pmps) before feeding/shooting again.

5) DO NOT GIVE 5 UNITS AGAIN. I would probably cut that 5 units in half until you get more substantial data about what a safer dose is doing.

 

How are both of you doing right now?
And what city/state/country are you in? Some of the options available depend on state and country, plus we may have members near you

 

Okay, so tonight about 2 hours before feeding he was at 173.

Fed a normal meal at 6pm and gave him a shot of a hair less than 3 units.

Checked him with my last strip at 7pm and read 242.

Tonight around 10pm I noticed him acting sluggish again and gave him sugar. I ran to walmart quick and got a test kit as recommended in this thread, came home and tested him and he was at 25-49, i tested a few times within 10 minutes and got varying results, seems this test is not as accurate as the Alphatrak. So that put him at around 32.5 - 35 to 63.7-68.6

Regardless, he was too low and I am monitoring him still.

Tomorrow I am going to only give him a single unit and go from there monitoring him through the day.

 

I'll build a spreadsheet when I have more info to build it and post. I've been cutting his doses back each time but he's still dropping too low. I don't know why, he has been on 5 units for 2 years now. What would cause him to need less?

I am feeding him fancy feast classic. He's been on pretty much the same diet for 2 years. Vet told us he may be anemic also last time he was in. He was in the vets just a few weeks ago to have his fangs pulled along with one other tooth.

 

Dental issues (infection/inflammation) can raise BG's. Once the problem is fixed BG's can drop hard and fast.

 

Here's the thing. He had his first low BG issue between the 10th-14th of July. He went on ABX the following week the 16th and then had surgery on the 21st of July.

So he had the BG episode before surgery and also before the Antibiotics.

 

Anything can change really. Perhaps the 5 units got his body to start producing a better amount of insulin, thus it was overload after time and the dose needed to be lower. You can't really just give a certain dose for X amount of time because the cat's needs can change on almost a daily basis especially with something fast acting like vetsulin. If you look at Squallie mom's posts on the main forum she's been trying to figure out a good dose on nearly a day to day basis since her vet was giving her pretty awful advice.

One note that helps me understand this is that insulin is a hormone, not a medication. You're not really injecting and expecting 1+1 to be 2. It's more like 1+x=y with insulin. The variables of course are the dose, and how the cat reacts to the dose, along with food consumption, etc. Testing allows you to figure out these ever changing variables. 5 units might have been a perfect dose 2 years ago, now it is clearly way too much.

 

Right. I get that. The issue could have been compounded after the surgery too. I also wonder if his UTI (reason he initially went on ABX) caused his immune system to boost up and fight off the infection in his teeth for a bit possibly making the insulin dose too high.

Well, hes at around 150 now and tomorrow morning he will only get one unit and I will test throughout the day.

 

Very well could be - I'm not sure. Only thing I know is the dose is too much. You're doing the right thing by starting testing and figuring it out.

 

Good idea, starting with just one unit. I'm glad you got another meter and strips so you can keep testing tomorrow. If you can build that spreadsheet with today's info and tomorrow's info, then people can see the data and weigh in with more dosing advice, if needed. Good luck, and you're doing the right thing by the kitty! There's a wealth of knowledge on the board. I know it's probably overwhelming right now, but you're on the right track!

 

So I tested him around 4am and it read around 280 on the human scale which translates to 364-392, I gave him one HALF of one Unit. Tested now, right before feeding at 7am and it read 180 which translates to 234-252.

So, after feeding I am again going to give him one half of one unit and check him at +1, +3, +6, +9, +12

 

Do not do a translation. Just say the value and that yo are using a human meter.

 

From the limited amount I know, insulin should be given at 12 hour intervals. Am I right in thinking you gave half a unit at 4am and half a unit at 7am?

 

For info, Ozzy advised in an earlier post that he is using Novolin N insulin. (Easy to miss with all of the discussion about different insulin types earlier in the thread. )

.

 

Yes because he has been off schedule, last night dipping and having to give sugar and then getting too high. My new dose is starting at 1 unit, I split that up in half this morning to 1/2 unit at 4am and 1/2 at 7am. He needs to get on a regular 12 hour schedule. The 3 hour split seems to be working.

Checked at 9am at and (human) levels at 72 using the .3-.4 conversion 93.6-100.8.

Planned on testing at +1 after feed/shot but slept an hour too long so I will test at 10am.

 

Trying to figure out this curve, if I give him a shot and food at 12 hours, do I want the high point in the day to be right before he gets fed and a shot?

 

So glad you made the trek to Walmart and got a meter and test strips. Well done... and it appears, just in time to keep your kitty safe. And, just so you know, you'll get varying results "within 10 minutes" on any meter, including the AlphaTrak2. I say this, because I have an AlphaTrak2 as a backup meter, so I speak from experience. It's also not unusual to test the left ear, test the right ear, or test the same ear within seconds, and come up with a different reading... on either/any meter. And you should also keep in mind that when using the human meter, forget about doing a conversion to what the AlphaTrak2 "might" read. It's not necessary. Please refer to this link to learn how to interpret the range in numbers/glucose reference values on human and AlphaTrak meters. You're doing great. I know this can be overwhelming, but you're making progress... just by going out last evening and getting that backup meter and test strips was a huge step. Hugs.

 

10am tested at 53 (human) gave some higher carb food to get him up a bit. Will try to get him to peak for tonight at 6pm feed and shot.

 

That's the link I used and that's how I converted by listing the 30-40 percent differences. Thanks.

 

That's what got me!

Good job. The 53 is from 0.5 units? Very smart thing you did starting the home testing - the 5 units would have killed him.

 

I'm gonna say basically yes, amps/pmps should typically be the high point, besides maybe +2 right after they eat where BG's rise usually. If +2 is lower than amps/pmps it usually means you're gonna have a 'busy' cycle where #s start going down fast.

Remember the amps/pmps is mostly to tell how safe it is to shoot any amount of insulin, the nadir or low point is how you adjust doses.

 

Tested him again near 11am and he was at 90. I think that's closer to where I would want him to be at his low at 12pm. I think I am on track now so long as he doesn't get too high before feeding tonight.

 

I'm kinda a bit angry (other words I could use here) that my vet did not recommend having a tester at home 2 years ago. Diabetes runs in my family, I am hypo, my cousins are all diabetic. I know damn well a human could never make it without testing. I guess I didn't think about it and trusted them that this was enough, now I find it completely irresponsible that they did not say "Get a tester at home, it is essential" because it is.

 

Don't worry if he does go "too high" before feeding tonight. What is too high? Frankie has been in the 600's before now. It is better to be high for a day than low for a minute is a popular saying here.

 

It seems like very few vets recommend home testing. Some of them support us when we say we're going to test, but I haven't heard of any vet saying "your cat is diabetic and now I'm going to show you how to home test to keep the kitty safe." I WISH my old bad vet had told me to home test. My cat went hypo and I didn't know what was going on. When I called the vet, he said "whatever you do, don't stop giving insulin." I could have killed her! The next day I found a new vet who supports home testing.

The good thing is that you're now testing. I don't think you need to split the dose if he gets off schedule. Just wait until the next dose time and give the full dose then. It's okay if he goes a little longer than 12 hours between doses, so I would have just waited until your regular dose time of 7 a.m. and given the full 1 unit then.

Good luck today and hopefully Ozzy will surf along in good numbers!

 

Okay so as of now, about 4pm he is at 297 (human), should I just hold off another 2 hours or as close as possible and then feed and give a shot since 6pm is where I want to be be feeding him every 12 hours?

 

Yup, hold off until 6 p.m. Then test, feed, shoot. That's the sequence. You want to test first in case he has a low number that isn't safe to shoot.

 

Also, take away his food 2 hours before his PM shot. You do this to make sure his PMPS (p.m. pre-shot) number isn't influenced by food raising his BG.

 

Saw that message a bit late. He was 348 (human) and so I fed him and gave him 1 unit.

So, what you're saying is I should have given him food, and then waited 2 hours to give a shot? He gets fed twice a day, no food laying around throughout the day to eat usually.

 

Sorry if that was unclear. If there was food sitting out, you would take it away 2 hours before his evening shot (so at 4 p.m.). Then two hours after removing the food, you test (at 6 p.m.) to make sure he's not too low for a shot, then give him dinner so there's some food in his system, then shoot the insulin.

Since you don't leave food out, then no problem, you did the sequence right!

Get a +2 test to see how he does on that 1 unit. If he has dropped a lot by then, you may need to test every hour throughout the night to make sure he doesn't go below 50 on the human meter. If he does go below 50, then he will have earned another reduction in insulin, and you would drop the dose by 0.25 units.

 

Okay, here are the last 24 hour numbers so far. I think maybe he could go a bit higher in dose, maybe to 1.25-1.5. Any thoughts?


12:30pm / 146 (human)
4pm / 297 (human)
6pm / 348 (human) - fed + 1 unit
8pm / 221 (human)
9:30pm / 126 (human)
11:00pm / 159 (human)
12:00am / 244 (human)
4:00am / 342 (human)
6:00am / 339 (human) - fed + 1 unit
8:30am / 226 (human)
11:30am / 155 (human)
12:30pm / 272 - AlphaTrak

 

I'm tempted to just increase by 0.25 because when he drops, he drops fast. If he were my cat, I'd increase 0.25 for a couple of cycles and see how he does. With more data, you'll be able to find the right dose!

 

I say it is OK to go to 1 1/4 units. As you data shows the N insulin only lasts 8-10 hours.

 

Okay I will increase just a hair.

Wanted to also say THANK YOU to everyone who has helped, I really appreciate the quick responses here.

 

@Ozzy, I have to get offline for a while. It seems like you've got everything under control for the evening shot, but if Ozzy throws you a curveball and gives you a weird number for his PMPS test, create a new thread with a subject line like "need dosing advice ASAP" and whoever is online at the time will try to help you out.

 

CJ was on Novolin N and the day I learned to home test, she went hypo. Then she went into remission so I am not familiar with how to adjust doses. I can say that Novolin did not last longer than 6-8 hours in CJ. If you want optimum benefits from this insulin, you'd need to give it every 8 hours. But few caregivers can do that.

From looking at your latest numbers in your post above, though, the #'s are looking good at the lower dose. Ozzy doesn't appear to bouncing from one extreme to another.

See this primer for feeding. Feeding should be an hour before shooting per primer, not 2 hours before. http://www.felinediabetes.com/FDMB/threads/humulin-n-primer.303/

Note: Humulin and Novolin are the same. They are just made by different manufacturers.

What are you feeding Ozzy?

It will help us help you if you can put the date Ozzy was diagnosed, insulin using, dose, food you are feeding, and any other medical conditions, if applicable, in your signature line (go to your Profile and click on signature). That way others here can help you more quickly.

Cost-wise, you want to look at which insulin is going to work best for your cat. You can get Lantus, a longer-lasting, more gentle insulin at a great price from Mark's Pharmacy. Your vet just has to fax in an RX. https://rxcanada4less.com/search.php (type in Lantus in the Enter Product Name Here box. Many members here order from Mark's Pharmacy. You can also check the For Sale section in this forum; there are often members selling insulins. Other options are seeing if a phamarcy, nursing home or hospital will sell you a single pen.

The one good thing about Novolin is that it exits the body quickly so if you switch to a longer lasting depot insulin like Lantus, there's no need to wait a few days. You also don't have to wait if you decide to switch to ProZinc.

There is no need to use more than one meter. Most of us use a human meter (ReliOn Micro or Confirm). Stick to one meter. It will be confusing to us if you go back and forth between meters.

Again, here's BJM glucometer chart. You can show it to your vet if necessary. It is an excellent guide to help you in a hypo crisis and tell you when to shoot insulin or not:

https://docs.google.com/document/d/1oI_34_EgqeKdpyttFW0oLoG1mbw16IkATAWHhoQD2JU/pub

And here's a link to creating a spreadsheet. This will help us help you faster.

http://www.felinediabetes.com/FDMB/...te-a-ss-and-link-it-in-your-signature.130337/

 

@Ozzy, CatMa makes a good point about Novolin not staying in Ozzy's system for 12 hours. If it's at all financially feasible, I'd look into switching his insulin.

A vial of Prozinc is $95 on ValleyVet.com. Your vet will need to fax in a scrip and they'll ship it overnight with cold packs for free. The vial would last probably 3-4 months. You'll also need U40 syringes,which you can find for a decent price online.

Also look at the link CatMa provided for Lantus. You'll need U100 syringes for Lantus, and I think you can buy them cheaply at Walmart. (Sorry, I don't know which syringes you use for Novolin so you probably already have some syringes.)

Ozzy is doing better on the lower dose, but he'd probably do even better on an insulin that stays in his system for the full 12 hours.

I know all this is overwhelming and you're doing a good job for your furry friend!

 

If you have some time try and set-up the spreadsheet, only takes a few minutes.

 

For what it's worth Mark's pharmacy isn't accepting new patients. I've used 77canadapharmacy.net with good success, little bit more $ than Mark's but $200 cheaper than US pharmacy.

 

The u100 syringes are used for Novolin. If ProZinc is preferred, I believe there's a handy conversion chart somewhere here so the u100 syringes can still be used. They come in handy when half doses are needed.

 

Mark's Pharmacy had a Lantus shortage and a waiting list a few months ago but that has been lifted. I don't see any notice that they are not accepting new patients. Good to know about the other website you mentioned.

 

U40 conversion chart: http://www.felinediabetes.com/insulin-conversions.htm

 

@Ozzy, how did the increase go?