Newly diagnosed questions about dosing

I might not be attaching the spreadsheet the correct way so if you want to see it and can't, please let me know.
Ricco came home on 7u of Novolin N twice a day. (I realize it is not the best choice, I even took the articles to the vet... but I agreed to try it and they agreed to change if it doesn't work). I am a nurse. I realize cats are not humans but I do at least have some working knowledge of diabetes, thankfully. (I am sure I drove the vet crazy over the initial 3 day span). I am using the Alpha Trak 2 monitor, I also have a ReliOn Premier Blu as a back up.

So, thankfully, I decided on Sunday to do more than spot checks... it took until about 6pm (with no insulin) to get over 300... (I am trying to wean 6 cats from kibble to wet food so I am sure he occasionally sneaks some in. Although, he does now seem to prefer the wet food. He is not eating a whole lot though... but he gained back a little weight so I am just watching that. It is all just so new and I am trying to monitor everything, while working 40+ hours per week.)

So, I adjusted his insulin lower and the next morning-80! So I skipped the insulin. Next night I went even lower because his glucose was even lower. Yesterday morning, 108. So I did not give insulin. His glucose was initially 247 but dropped before I gave his insulin, despite eating...

So this morning it was 243, but with him having those drops, I was afraid to give him any insulin... if it was the weekend where I could watch him, I might have given a reduced dose.

But I definitely do not think he needs 7u anymore... I am SOOOO glad I checked him Monday morning because if I had given him 7u without checking it...

Am I doing this right? is the main question behind this novel I wrote...

https://docs.google.com/spreadsheets/d/17r_9rHcDR9-tGgHsv1m7CV5Z2rz9fFgRn9gxV3LUzq0/edit?usp=sharing

 

PLEASE DO NOT GIVE YOUR KITTY 7 UNITS

That is a crazy high dose for a newly diagnosed kitty and could very possibly lead to a serious hypo which can be deadly.

Please read this information on Novolin at the link provided below:



http://www.felinediabetes.com/FDMB/threads/beginners-guide-to-novolin-humulin-nph.186097/


"
STARTING DOSE - N/NPH

Usually it’s best to start with no more than 1 unit of insulin, twice a day. Post on the forum for advice specific to your own situation.

Generally speaking, for newcomers to N/NPH it’s recommended that no insulin is given if the BG is below 250 [13.8] on a human glucose meter. And you may wish to use a slightly higher ‘no shoot’ number such as 300 mg/dL [16.6 mmol/L] in certain circumstances. (See ‘Blood Glucose Reference Information’ further down the page).

If you’re using a pet meter, such as Alphatrak 2, be aware that these usually give slightly higher readings than human meters, so you may wish to have a slightly higher ‘no shoot’ number.
There is no general formula for converting human meter numbers into pet meter numbers (or vice versa). You are therefore encouraged to perform your own side-by-side comparisons with a human glucose meter, and/or to consult your vet for information about the specifics of your particular meter.

Note: Because the ‘no shoot’ threshold levels are often slightly higher for N/NPH insulin than for other insulins, it is particularly important that you monitor your cat’s urine for ketones. See ‘Testing For Ketones’ section further down the page.

• If, after at least a week, and having reviewed your cat’s BG levels, the dose doesn’t seem sufficient, dose increases may be considered in very small increments. Increasing doses of N/NPH needs to be done with great care. DO post on the forum for advice if you are considering dose increases for your cat. And if in doubt consult your vet.
• If you have reason to be concerned about hypoglycemia, or if your cat won't eat, decrease the dose immediately and contact your vet.
• Don’t ever inject insulin twice! Sometimes we may not be sure if we’ve given an insulin shot correctly. Perhaps we notice that the fur seems wet where we’ve injected (a 'fur shot'). If this happens, never repeat the shot/ injection. You may give too much insulin and your cat’s BG may drop too low. We have a saying regarding BG levels: “Better too high for a day than too low for a minute.” Safety first!"

The fact that you are home testing is invaluable!!!! You need to test before each shot...making sure Ricco has not eaten anything for at least 2 hours before so that the readings are not food influenced. Novolin tends to start 'working' at about +1 or +2 and has a nadir (lowest number) between +3-+6 hours after the shot (every kitty reacts differently) so getting some tests in that range will be helpful to see how low a certain dose is taking him. Doses should be held for about 3 days to give the body a chance to 'climatize' to the insulin and raised in small increments...usually 0.25 units at a time.....unless the numbers are dropping too low. Also feeding a low carb wet food will make it easier to control glucose numbers.

You could change your title to "New to Novolin need dose advice" to get more feedback on your questions, but my thought is that you should drop the dose to 1 unit twice daily and continue gathering data from testing. 7 units twice a day is FAR too high for a newly diagnosed FD kitty.


ETA Please read through the information on Novolin

http://www.felinediabetes.com/FDMB/threads/beginners-guide-to-novolin-humulin-nph.186097/

 

7 units of any insulin is far too high a starting dose for any cat, whatever blood glucose number seen at the vet's or whatever the result of a fructosamine test. Over dosing is potentially very dangerous indeed and nobody knows what an ideal dose is without a period of trial and error dosing... START LOW is what we advise and what surely makes the most sense for safety reasons, and increase by small increments as and when necessary after a period of testing and gathering data to see how a kitty responds to a dose.

Mary Ann has said it all above and everyone on this board will agree with her.

 

The recommended starting dose is 1 unit.... Your vet is completely BONKERS . if you had blindly dosed your cat, your cat would be dead right now. No joke you need a new vet.

 

I completely agree about this horrendously high dose. Mary Ann has given you great information.

 

Thanks, I printed the Beginner's Guide today, I didn't see it before. But thankfully although diabetes has never been my strongest suit, I am a nurse so I was like, I can't give him that much/any/etc. At diagnosis he was 631 (with no ketones!), then for the first week he was going into the 400s, now his high seems to be low 300s, even without insulin. In my vet's defense, I think they started at 2u twice a day, because I was adamant about starting low. When he came home, he was starting the mornings at 400-something and ending in the low 100s just before dinner. But, since eating more wet food, he has dropped and dropped. I ALMOST gave 2u this morning but it scares me when I am not going to be there so I didn't. High for a few hours won't kill him but a low will, I know that much.

Is anyone else still using Novolin N or should I pitch a fit to change it? I agreed to try it, at least. I even printed the articles showing where N is no longer recommended. But he is a rural, country vet who is trying to save money and keep people compliant (and I appreciate that) so I told them I would see if it would work.

 

We still have people using Novolin N periodically but admittedly, they are few and sometimes far between. The longer lasting insulins like ProZinc, Lantus and Levemir tend to be used the most, Lantus being the most common. All things considered, it looks like the change of diet is helping so I think it would be fair to give the Novolin N a trial for now till the food transition is complete, albeit at a far more reasonable dose and see how your kitty does.

 

Thank you! I know the goal is no kibble but I did find a link on this website to a list and went and bought the 1 with 7 carbs to use while I try to transition my kibble only holdout cat, so that if Ricco does get a hold of some at least it's low carb and high protein. I really appreciate everyone's help! It makes it a little easier and less stressful to know there's help out there

 

While no kibble is the preferred diet, there is nothing wrong with the low carb when it comes to BG. It does make a difference as to which method you can use for dosing/regulation using the longer lasting insulins Lantus and Levemir. It doesn't matter with ProZinc or the Novolin N.

I had to laugh when I read your first post because I too am a nurse and apologized to my vet for being a PIA asking a multitude of questions. It took me back down memory lane to my early days at this dance. Just tonight I had to correct the vet when she told me a certain food might be an ideal alternative for my diabetic and when I looked up the food, the carb count was 22%. YIKES! Keep asking the questions! Vets have so many species and so many ailments to deal with they can't be experts at it all but we can keep them on their toes with our inquisitive minds.

 

If it were my cat I would give no more than 1 unit and only if the preshot is over 200-250

 

I am pretty sure he had the techs all talk to me after the first day because I took in articles and everything! 1 of my friends thinks I have gone off the deep end because I am researching everything and making all of these changes. But most of my friends know how I am about all of my animals. My friend brought me a Betta fish to "watch for a while". He brought him in a bowl... so I looked up Bettas and found they like warm water, so Shark Bait ended up with a 20 gallon aquarium with a heater, filter and "furniture"... So, of course, I'm going all out for my cat who literally crawls in the bed every morning to be held and snuggle.

I hope to get all kibble gone but in the meantime, I am hoping this 7 carb kibble will be ok.

 

Thanks! I gave .5 units last night for a glucose of 258. It was 158 this morning, soooo no shot for him

 

Can I ask you to put the link to your Spreadsheet into your signature? Copy the link above, and then paste it into your signature. That way it will always be available to anyone here offering assistance without them having to circle back to this thread to see it or you having to repost it.

 

I tried it... let's see if it works

 

Good job! Now you're all set!