Out With The Old, In With The New

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Jackie & Ms. Soleil, Mar 20, 2019.

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  1. Jackie & Ms. Soleil

    Jackie & Ms. Soleil Member

    Joined:
    Mar 15, 2019
    Evening all!

    Today because I haven't been comfortable with the glucose numbers Soleil has been getting, I decided to look for a different vet to get a second look at her and possibly consider a different insulin. I always pass a pet hospital on my way home, and was excited to find that they accept Care Credit as a form of payment. Plus, instead of driving 20 minutes or more to Banfield, this drive would only be five minutes. We were able to get an appointment this evening.

    I really like this vet better than Banfield. I was worried that because they were a "private practice" that it would cost more. But the staff was super friendly, very informative, and even offered Soleil fluids when they took her to the back for a glucose reading. At Banfield when I pointed out that her nose had become dry and grey, they just stated it was because she was dehydrated. A small bowl of water would have been nice, but it doesn't matter now since I'll no longer be going to them going forward.

    I picked up a couple of cans of a different RX wet food, and her units were raised to 3 twice a day instead of two. Their glucose meter came back over 600. When I came home she was over 500. Not much of a difference, but still too high. Surprisingly enough, after testing her and giving her the insulin for the night, I gave her a little of the wet food and she went for it. I don't know if it's because the flavor was different, or maybe there's something about this brand that she actually likes (Hill's Prescription Diet; Glucose Weight Management m/d Pork Flavor) but I was happy to see her eating some wet food from a can. I'm currently monitoring her behavior because for her it's been a stressful evening with the car ride and then a higher insulin dosage (she also had an accident in the car from the stress and receiving fluids without having a chance to use the litter box). So she's decompressing in her "studio" apartment.

    The only thing I wasn't able to accomplish was to change her insulin from Novolin N to the next brand best for cats; which would have been Lantis. They quoted it at $300 a bottle which visibly made me cringe. I was expecting a higher price, but not that high. For that price diabetes should be destroyed with the first few injections. This is what prompted her to take a glucose reading, and decide if the current Novolin N dosage should be a little higher. I'm glad she didn't try to pressure me into spending money that I don't have. They looked over the entire insulin list I gave her and Lantis is the only one they confirmed they carried.

    But! While I couldn't change her insulin, I was happy to find that Soleil gained half a pound. Her first visit when she was diagnosed she weighed 9lbs. Her second visit when I opted to take the insulin route she dropped to 8.5lbs. So While Novolin N isn't the favorite of insulin options, it seems to be working slowly but surely.

    All in all, it's been a productive day.
     
  2. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    If you get them to write a perscription for the lantus you can order it for a lot less through Marks Marine pharmay
     
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  3. tiffmaxee

    tiffmaxee Well-Known Member

    Joined:
    Nov 15, 2013
    Definitely consider lantus from Marks marine and get the pens which I was able to use to the last drop.
     
  4. Lisa and Witn (GA)

    Lisa and Witn (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Also ask for the prescription for the pens instead of a vial. With the vial the insulin starts to lose its effectiveness around 8-12 weeks. You will use the pens like a vial. However since each pen contains smaller amounts than the vial, you can use every drop before it becomes ineffective. One pack of 5 pens could last 9 months or more.

    If your vet prescribes Leveou change insulins, it comes in pens also.

    If you change insulin I also recommend lowering you dose to 1 unit twice a day . Stay at that dose for at least a week before you increase it. If you need to increase it, only go up 1/2 unit at a time, waiting a week before increasing it again. The goal is to find the optimal dose that works best to keep the glucose levels in control.
     
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  5. Idjit's mom

    Idjit's mom Well-Known Member

    Joined:
    Apr 3, 2018
    Hi Jackie, I'm glad you had a better day and found this vet resource that you are happier with. I checked the Food Chart and the Hill's M/D is 13% carbs, but she's eating..and that's a good thing. Perhaps mix in a tiny bit of some other lower carb food into the next meal, add a little water and warm it some. This may be a way to transition her onto a totally low carb diet, which is going to have a better impact on her BG. I found the Hill's "prescription" food way too expensive, and Idjit wouldn't eat the canned food at all.
    I checked Marks Marine Pharmacy website and unfortunately they don't accept Care Credit as a payment option, but please keep them in mind when you can change Soleil to Lantus: https://rxcanada4less.com/index.html. Take a look at the website and read the information and prices. Maybe a family member can help with an accepted credit card?
    Lantus is very expensive in the U.S. and many of our members buy from Marks Marine.
    Be sure to keep checking her BG as often as you can to keep an eye on the effects since the vet advised you to up the dose by a whole unit. You may want to post in the Vetsulin/Novolin forum and see what the experienced members might suggest or advise.
    This from the Beginner's Guide:
    • 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.
    A whole unit might be too much and you don't want to have a hypo event.
     
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  6. ohbell

    ohbell Well-Known Member

    Joined:
    Apr 21, 2011
    Morning Ms. Soleil and her mom!
    Were you able to post on the vetsulin/novolin forum?
     
  7. Jackie & Ms. Soleil

    Jackie & Ms. Soleil Member

    Joined:
    Mar 15, 2019
    I haven’t, but I’m confident in the new vets decision to up her unit by 1 for the Novolin. She did a thorough exam of her since I wanted a second opinion on her diagnosis / current status and provided the numbers I had prior to yesterday vs the number she got when she did the glucose testing.
     
  8. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    The problem is that vets do not typically see what we see here.....high numbers taken at a vet’s office don’t mean the cat necessarily needs more insulin. Maybe, maybe not. We only do dose increases by 0.25u at a time unless the cat is a high dose cat or, through glucose curves or mini curves done at home, we can see the the BG is always above 300.

    Vets tend to be unaware of a common pattern we see here which is called bouncing. It occurs when the BG drops suddenly or goes lower than the liver is used to. The liver and pancreas then release counter regulatory hormones to drive the BG back up to what the body believes is “safe”.

    This is clearly shown on Soleil’s SS. She dropped to 83 on 3/17 and bounced back up high. On 3/19, p.m. cycle, she dropped from 503 to 135 in three hours. That’s a huge drop...and very fast. The numbers you are getting at preshot indicate to me that the last thing you should have done was raise the dose to 3u.

    Increasing the dose by 1u at a time can cause you to miss the correct dose. Most vets have no idea that you can buy syringes with half unit markings and dose lower doses in increments of 0.1u to 0.25u.

    My suggestion is that you drop the dose back to 2u and try to get a few more tests both cycles. If you work, try and grab another test before you leave and as soon as you get home in addition to the AMPS and PMPS. At night, a +2 and a before bed test will help figure out how low she is going.

    My concern is that at 3u, considering the BG she was getting on 2u, you are putting her at great risk of having a symptomatic hypo. We don’t raise doses here without knowing how low the current dose is taking the BG.
     
  9. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Tonight’s cycle is an exact demonstration of my point. I really hope you’ll drop the dose back for safety until you can test enough to know that she needs more than 2u.
     
  10. Jackie & Ms. Soleil

    Jackie & Ms. Soleil Member

    Joined:
    Mar 15, 2019
    I woke up to test her again this morning and she’s at 301. She was annoyed that I woke her up but was patient with me for an earlier reading.

    I only changed the dose based on the doctors instructions; it wasn’t a decision I made on my own. During yesterday’s appointment I was instructed to give her the 3U twice a day and just monitor her behavior, weight, and urination trends until I could get a different glucose meter. I agreed to it, but I’m not administering any brand of insulin blindly just because one meter gave a different reading than the other.

    She’s not scheduled for another dose (if her numbers even warrant it) until 6 / 6:30 am EST. She gets tested again at 5:15 / 5:30 am EST. At this point I don’t know what to give her. When we started insulin, she wasn’t getting the full dose because I was using the half lines on the syringe. So for a couple of days she was only getting 1.5U, and at one or two instance only .5U. When I got help with that, she started getting her full 2U dosage for a couple of days. 3U was nearly for two whole days after her visit to the new vet. Clearly 3U, while it was prescribed, is too much.

    I’m also unsure if I put the 301 in the right spot on the spreadsheet since I took another test around 12:30 am EST. To me that falls under AMPS. Let me know if I should move that.

    For the Novalin N dosage based on the current building trend in her spreadsheet, I’ll take the dosage inquiry over to that forum.

    Outside of my own confusion and struggles with getting a firm grasp on everything, Soleil is fine. She’s still eating and drinking (she’s really taken a liking to the RX wet food) and appears to still be in high spirits despite the fact I woke her up from her beauty sleep.

    It’ll take me a little time to get a firm grasp of this process. I’m a fast and eager learner, but I also get flustered when things don’t seem to be working or improving. I definitely appreciate everyone’s patience.
     
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  11. ohbell

    ohbell Well-Known Member

    Joined:
    Apr 21, 2011
    Hi Jackie,
    Your test at 12 would go in the chart for 3/21 at 6 hours after your shot that evening (in the +6 box).
    Then your AM test, before shot will go in the AMPS on the next day (3/22)

    You are doing great!
     
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  12. Jackie & Ms. Soleil

    Jackie & Ms. Soleil Member

    Joined:
    Mar 15, 2019
    Thank you! I’ve updated the spreadsheet.
     
  13. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    I gave you my two cents on your thread in the other Novolin forum.
     
  14. Julie and Honey

    Julie and Honey Well-Known Member

    Joined:
    Dec 22, 2018
    Not sure if it is just me, but for some reason your spreadsheet link is just showing google login and not the actual sheet. Just want to let you know so if someone needs to see it to help you and it is a critical event, you are not scrambling to get it back up:)
     
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  15. Jackie & Ms. Soleil

    Jackie & Ms. Soleil Member

    Joined:
    Mar 15, 2019
    Thank you for the heads up! I'm working with a fellow member now working to fix the link.
     
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