? Novolin dosing while away after hypo

Just checked Diggy's blood about 7 hours after giving him his insulin. One ear said 36, so I rechecked the other ear and it read 35. It's an extremely hot day here so he was acting lazy and sleepy when I got home, but he usually does that on hot days. He had plenty of energy to beg for food. I gave 1/4 cup Hills M/D dry to try to get some carbs in him, since I thought syrup was for more dangerous situations with obvious symptoms. Idk.

Just checked again after 15 mins and he went up to 38. Both times he didn't struggle when I pinned him down to test, which he usually does. This time I put some maple syrup on his gums, which is a lot messier than I thought it would be.

He isn't showing any of the main signs of hypoglycemia that the vet talked about, so I'm not quite sure what to do. Just keep monitoring him?

 

How's he doing?

 

I just checked his blood again. He's at 69 now, so it seems like he's going in the right direction. Do I give him more food or anything? He's still just lying around in the sun, not really moving or anything.

 

Have you done another test, if not then do another one now - keep checking every 15 minutes and post the numbers - what meter are you using? Sounds as though he is still displaying symptoms - lethargy is one.

Read this http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/

 

I see from your spreadsheet that you are away on vacation for the next few days. The more tests you do today will help you decide how much insulin and what type of food to give while away. Can you do a curve?

 

He's at 97 now. I'm using ReliOn Confirm

 

Ok - keep testing until we are sure he is heading back up - how is he now? Looks like he has earned a dose reduction. When do you go on vacation?

 

Good job handling the hypo number. According to your spreadsheet you are leaving for vacation tomorrow for four days and there is no one to check the glucose levels. After these low numbers today there needs to be some sort of vacation dose figured out. Unfortunately not every kitty will show signs when they have a hypo. I have had one of my kitties drop down to 32 US (1.8 mmol) on a pet meter and she showed no signs whatsoever. So you can't always depend on looking for signs in order to intervene.

If there is not way that Ray can test glucose levels then the dose needs to be reduced. You can add the question "dosing while away after hypo" or something like that to your title and get some feedback on what dose to use while you are gone.

 

He's up to 110 now. Just gave him a few feline greenies treats as well.

I was supposed to leave tonight after his dose to stay with my parents since we are leaving extremely early tomorrow morning. I can hold off and leave later though.
I will definitely keep checking on him and do the rest of the curve up until his dose tonight, and then see how much to give him then, and then check for a few hours to see how quickly he is dropping.

My boyfriend has learned how to give the insulin but seems wary about checking the BG. After calling him and explaining what's going on, he said he can check him before meals. He works all day so he won't be able to get any other readings that that though. Since he'll be new to it, I might just have him give a lower dose, like 2.5 or even 2. I'd rather have Diggy's levels up a bit higher than they should be than have them be too low.

 

I reduce the dose if someone else is giving insulin as they can't always get blood to test, I'd rather sort out higher numbers when I am back than run the risk of going too low. I also leave the hypo instructions, the vet and emergency vet numbers, together with some guidance about dose changes if the level is running lower than expected.

 

Some kitties become more sensitive to insulin after a hypo event. It is great that Ray will check the preshot numbers but when you look at how low Diggy went at +7, you might want to drop the dose even further than 2 units in order to prevent another possible hypo. A few days of higher numbers will just take time to get Diggy back on track, but a serious hypo could be very dangerous. Do you have an automatic feeder? If you do you could set out some higher carb food during the day when there is no one able to check the glucose levels.

 

He's still at 110.

I don't have an automatic feeder yet. Should he just feed him more in the morning? Diggy's a little glutton and will always eat all of the food in front of him, so there's not way to leave food out for him to snack on later.

Maybe 1.5 units?

 

I would put the question about dose in your title. I personally am not familiar with Novolin N although I believe it is an intermediate insulin with faster onset and shorter duration than Lantus, Levemir or Prozinc.

 

He's at 144 now. Is he out of the danger zone?

 

That looks ok - so he is now at +9? When did he last have anything to eat?

 

That number is safe. The main question is what to give as a dose over the next number of days. Some kitties can drop quite quickly on Novolin N/Humulin N. With no one around to monitor the next 4 days I am really wracking my brains about what to suggest as a dose. Already with the low numbers today, that would have called for a dose reduction under normal circumstances.

@Wendy&Neko @Sue and Oliver (GA) @Marje and Gracie @Larry and Kitties @BJM

I will try tagging some of the longer term members and see if they have better knowledge of Novolin N.

 

+10, and at 195. He ate 1/4 cup dry food three hours ago, and some treats about an hour ago.

 

Thank you. I also posted on the Novolin/Humulin forum to see if there were any experts that might notice my post there.

 

I have been doing some reading around as I am not familiar with Novolin N either and I was about to suggest @Larry and Kitties as he seems to have used lots of different insulins over the years. What I have learned is that it is quite harsh in dropping glucose levels so erring on the side of caution I would think is best.

ETA I do use it in humans but cats are of course very different!

 

There are not many people using that forum since very few members use Novalin N/Humulin N.

Hopefully one of the members I tagged will be able to help out with some dosing advice.

 

Bumping this post up to keep it active

 

@julietb19 can you add Novolin N to the thread title, and hopefully people familiar with that insulin will spot it and join in.

 

Juliet

Are you able to do 1/2 unit dose changes??? If no one responds before you are leaving tonite I am thinking that doing 1.5 units might be a safe way to go. When you were using the 2 unit dose before the numbers were fairly flat, but that dose was not used long enough to see how it would work before it was increased.

This is just my own opinion...I am trying to figure out a safe dosage for the 4 days that Diggy will not be monitored.

 

Another thing that may help. If your boyfriend is able to feed Diggy 30 minutes to 1/2 hour before giving the shot that will help to have some food on board before the insulin starts working,

 

@Larry and Kitties

Can you offer some dosing advice for Diggy. Juliet will be away for 4 days with only shots being done...no monitoring during the day. Not sure what the best appraoch is after the hypo today. Thanks

 

@julie & punkin (ga) Do you have any information on how to proceed with this situation. Using Novolin N Juliet will be away for 4 days with only shots being done...no monitoring during the day. Not sure what the best appraoch is after the hypo today. Thanks

 

Let me read up on the story - I'll be right back.

 

My needles are capable of doing 1/2 units, and I have already showed my boyfriend how the different markings work, so I'm confident he'll be able to do 1.5 units. To be on the safe side, I can have him give 1 unit though. That's what Diggy got when he was first diagnosed. It won't do much, but I guess it's better than nothing.

 

If no one else comes along with other advice before you leave tonight, then sticking with the 1 unit might be best. It may throw Diggy's progress off for a bit, but it should also keep him safe.

ETA I see Julie is checking in. Let's see what she has to say first.

 

ok - the bottom line is that I am not experienced in dosing with Novolin. Anything I suggest about a dose would just be a guess, and this is too important to just guess.

I definitely think he needs less insulin, however - that much is obvious. 38 is very low. The question is how much less.

Print out that link that Alexi gave you and tape it somewhere very obvious for your boyfriend/you to have next time. Just an fyi, usually people resort to putting syrup on the gums if a cat is unconscious. You said he's a reliable eater, so next time put some syrup - honey/corn/karo/maple - on one bite of food and he's very likely to eat it. Most cats like it just fine. Not quite as messy as putting it in his mouth for him.

The dry food was also fine. Sometimes syrup will work more quickly, but the dry food will sustain it longer.

Juliet, can you make certain your BF knows how to test before you leave? That's really important.

One caution about reducing the dose too much - has he had any ketones or diabetic ketoacidosis since he was diagnosed? You would know because it's expensive to treat. Ketones can develop if the cat isn't getting enough insulin. DKA is that + an infection or systemic stress, + the cat not eating enough.

Can you call your vet and ask what they would suggest for a dose while you are away, given that he got to 38 on today's shot?

 

By the way, I think there are people who check the Novolin support group board, so I think it's fine that you posted there. It would be best if a Novolin user could help you with the dose.

 

Juliet, can you answer the question about DKA or ketones when you get a chance? That might affect the suggestions people will have.

 

Thanks for coming by Julie. I am not familiar with Novolin N/Humulin N and was trying to find someone who either was familiar or who knew someone who used it. Her boyfriend will be giving the shots for the next 4 days but has never tested before. He feels e should be able to do the preshot tests but is not available during the cycle to do more testing. I was really grasping at straws to try to find a dose that would be safe, especially after the hypo today.

 

I totally understand!! I'm so glad you're here to help her! It seems like there aren't too many experienced people around today.

I did post a link on the facebook group as well to see if we could find any N users.

 

I just had a testing crash course with my boyfriend, he hit the vein, but seems to get the basics of testing. I'll have him do it at least one more time before I leave to make sure there are no questions.

He has not had any ketones or DKA.

The vet is closed right now, but I'll call tomorrow or have Ray do it if he gets a chance.

 

That is great that Ray has got the hang of it so quickly. Kudos to Ray for volunteering to help out with Diggy while you are away. He's a keeper

Since there is no history of DKA you would be safe to reduce the dose..either to 1.5 units or 1 unit. These doses may be a bit too low, but considering the day Diggy (and you) had with the hypo, best to keep the numbers in a safe area.

 

Diggy's BG is back up to 344. I gave him 1.5 units tonight and will check him before I leave tonight. I might give him some extra food to help get him through the night depending what his numbers are later.

 

The higher number was to be expected after the hypo today. Hypo numbers can cause the glucose levels to "bounce" up quite high...this is very normal and can take a day or so to clear the system. With Novolin N according to what I have been able to determine..."Cats seem instead to experience a 1-2 hour onset, a peak action of 4-6 hours, and a total duration of 8-12 hours maximum"

http://petdiabetes.wikia.com/wiki/Novolin_N

although this can vary with each kitty. The 1 1/2 unit should be fine. If Diggy stays in higher numbers for a day or so that comes at a good time. But Ray will be testing before each shot, so that will give a good indication of how the numbers are doing.

 

Here is the spreadsheet for a new member who is using Novolin N. They were at 3 units and dropped to 2 units because of the lower numbers.

https://docs.google.com/spreadsheets/d/10gMywUlGhvfY0yt40szFVwW-uVjdD1e5INOm4xyVke4/edit#gid=0

It was even suggested to cut back to 1 unit and continue testing.

http://www.felinediabetes.com/FDMB/threads/question-about-hiding.161275/#post-1724140

Just to give you something to compare with using the same insulin you do.

 

Frequently, the nadir for Novolin/Humulin NPH is around +6 to +4 hours post-shot.
Cutting back the dose to 2 units while watching for signs of dehydration or ketones while doing so is reasonable.
See my signature link Secondary Monitoring Tools for methods to check dehydration and ketones.

(I've been online a few hours this evening and I'd be posting more quickly if I weren't limited to 1 post every 7 minutes)

 

I'm out of town...lets tag @Sue and Oliver (GA).

 

I'm sorry we haven't dug up a Novolin user for you.

Best of luck with your trip this weekend!

 

Thank you everyone for being so dedicated to helping us! His reading this morning was 493. I had him given 1.5 units since it was before I got a chance to check in here

 

That higher PMPS was to be expected after the hypo number yesterday. When a kitty drops into low numbers the body produces counter-regulatory hormones which cause the body to release stored glucose (glucogen) which cause the glucose in the blood stream to "bounce" up higher. This "bounce" can sometimes take several days to clear the system. The 1.5 units will hopefully keep the numbers in check and keep Diggy safe at the same time.

Enjoy your holiday and keep posting if you have any questions or concerns.

 

Ladies, nice job bring up those low numbers!

Given the circumstances and the lack of suggestions from any experienced N users, this suggestion is right on point. I hope it wasn't lost in the shuffle! It's also important to let your vet know what happened whether or not there are any FDMB members experienced with N offering advice.

Enjoy your holiday!

 

Thank you! I spoke to the vet and she said 1.5 units will be ok while I'm gone, as long as his numbers are below 250 when tested. On Monday I'll do a curve and then we'll figure out a game plan for his new dose.

I just want to thank everyone again for being so supportive! It's really a great community here

 

It is a good community!

One thing to consider as you move ahead - as you can see Novolin isn't a common insulin for cats at this time on FDMB. The three most common are Lantus, Levemir and ProZinc. When you are at a point where you need to buy more insulin, I would seriously consider switching. There are a lot of members here and we couldn't even find one experienced user to help you. Take a look at the ProZinc support group and the Lantus/Lev insulin support group, read the stickies at the top of each group, and consider what you might want to do. It's just rather important to be able to get help when you need it, not to mention someone with experience coaching you in how the insulin works.

Take a look at this link and at what the experts say about which insulin is best for cats:

• 2014 ~ 39th Congress of the World Small Animal Veterinary Association (WSAVA)
  • Which Insulin in Cats - p 156
  • Management and Monitoring of the Diabetic Cat - p 160
  • Feline Diabetes - p 229
  • Diabetes Mellitus and Quality of Life - p 730
  • Acromegaly in Cats – p 733
  • Insulin Resistance – p 737 (description of mechanisms of resistance on p 738 under heading Pet)
  • Medical and Nutritional Management of Diabetes Mellitus – p 739 (description on p 741 of glucose toxicity and lipotoxicity)

While it suggests ProZinc or Lantus as the first choices for insulins in cats, we've also seen great responses with Levemir.