Problems on Humulin N and not sure where to go

I'm hoping that with all the education here someone can offer some solutions. My Baby went on a combo of wet and raw after diagnoses and responded great. All symtoms went away and she returned to her old self. Then after about 3 months she went way, way down hill. Loosing a lot of weight down to skin and bones and just seemed miserable. The vet has her on Humulin N, mostly started because of cost, but there are signs it's just not right for her maybe. Her BG at the vets at 1 unit twice a day was over 300 about 45min to 1 hr after shot, and the next time was over 400 at about the same time. She was increased to 2 units but I'm not seeing any difference.
At about 6hr post shot she starts leaking pee. She doesn't seem to realize at that point that she needs the litter box, after she does go or at any rate after a couple hours it stops.
I did try home testing, but I just was horrible at it and am afraid to try again. It takes both of us, I don't know how anyone does it alone.
Anyway, we don't seem to be getting anywhere and I see where I can buy Lantus quite a bit cheaper from a Canada Pharm, should I try that? I have just read more on PZI, and haven't seen that listed in the meds at those same pharm. Would that be better to try? Can I be farily sure if I'm careful to get 6 or 8 weeks from a bottle? That would sure help keep costs down, as we just retired and do not have the money to spend $100 plus per month.
I did see something about shooting into the scruff, is this not a good idea? It's where my vet said to shoot.
OH, also, something fairly new for her, she does some yowling at about 2 or so hrs post test, which always seems to be when I turn out the lights and got to bed.

 

Another PZI option is BCP Pharmaceuticals in Texas. Your vet can get the first bottle for free. Many people here have had success with it.

I'll dig up the link for you in a few minutes. Right now I'm outside walking my cat.

 

That would be awesome, thank you.

 

Ok, we're done walking!

Here's the link for you. Your vet has to be the one to request the free bottle but after that, you can request it directly with a current prescription on file.

http://www.bcpvetpharm.com/products_bovine.htm

BTW, I did scruff shots with Boo for nearly 5 years and they worked just fine. That's the only place he would tolerate shots.

 

PZI is an insulin for pets only -- so available thru vets or the vet pharmacy.

Humulin N, Lantus, and Levemir are human insulins -- available at regular people pharmacies.

 

Thanks so much, taking her in for a BG this morning and will see if we can get a bottle.

 

We have been to the vet twice today and gotten BG's. I told her this am that I didn't think the Humulin N was working for Baby and she disagreed as she was down to 188 this morning, but that is after raising her amount to 3 units. I told her there was a problem about 6 hrs post shot and that I thought she wasn't doing well on the short term meds.
So this after noon around the 6 hr point we had her tested again and her first words to me when she saw me was that I was right. She was at over 400. So, we will change her. The vet is resisting my suggestion for Lantus, and is checking on something else, so we shall see what she comes up with. They do keep suggesting Vetsillian, but again, it's a short term med. So, for now, she stays on Humulin as she was just switched, will do something next week.
I do have a question. She wants me to give some kibble type food with lots of fiber, but from what I've read here, that doesn't seem wise. Any thoughts?
She also suggested a curve on monday, but if we are going to change her meds I would rather wait until after that change.
Thanks everyone, and for the link this morning. I printed it all out and gave to the vet, need to find out how much that one is too.
Lynn

 

well -- the high fiber idea is quite old -- outdated in fact. The recent studies are showing high protein - low carb canned food is best for all cats - not just diabetics.

http://www.catinfo.org is a website about Feline Nutrition published by a veterinarian - Dr. Lisa Pierson.

It is an excellent resource and discusses why cats need a "species appropriate" diet (high protein - low carb moist food -- canned or raw) and can solve a number of health problems ranging from crystals in urine to obesity.

If you learn to test blood sugar at home, you can save money and do your own curve. A curve is merely checking blood sugar every 2 hours for an 8 to 12 hour period (depending on the vet's clinic hours)

 

Hello,
First of all, I want to say that the support you will find on this board can not be surpassed. I had a kitty on humalin N then switched to PZI and and he was OTJ within a week. Secondly, a low carb diet is essential as others have suggested. Low carb fancy feast wet (chopped grill, classic chicken feast and classic beef feast are what I use and supplement and chicken breast at 1/4 c. per feeding... this is what I feed religiously. I know at first it is difficult to try and test, but the results are really worth it. My kitty is asthmatic and has wheezing issues whenever I test, so find a reward like walking outside or a low carb snack and they will acclimate shortly.

 

Vetsulin is no longer being prescribed, for the most part, due to manufacturing issues.
You might want to make your vet aware of that!
http://www.vetsulin.com/vet/Vet_ProductAlert.aspx

~M

 

What you're dealing with, I think, is lack of knowledge about how blood sugar acts in general, and how it's acting in your cat.

You're right that you need to change insulin, but it will help a lot if you know *why*. Please please start testing blood sugar at home, without that you're flying blind.

The yowling you're hearing a couple of hours after shot time is quite dangerous and is likely a near-hypo incident.

Insulin works this way: It begins lowering blood sugar after an "onset" time, continues lowering blood sugar, sometimes very effectively, until it "peaks", then blood sugar begins rising again. When blood sugar is back up to where you started, that's one way to measure the 'duration' of an insulin dose.

Humulin N is known (in cats) for having a rather fast 'onset' (about 45 minutes), a very strong and fast 'peak' (3 to 4 hours before peak), and then a short duration (total 6-8 hours).

So it's quite likely that you've given a dose of insulin, your cat's blood sugar has plunged and within 2 hours is dangerously low (yowling), then starts rising again fast (even faster if her own body starts trying to compensate by releasing extra glucose from the liver), and by the time you shoot again in 12 hours, is long gone. And her blood sugar is by then higher than before.

What a horrible thing to happen!

Other insulins have different action profiles. This is why it matters which one you use. But they also act differently in each cat, which is why you need to test blood sugar at home to make sure it's working as it should. Curves at the vets won't say much because when kitty is stressed, extra cortisol and epinephrine in her blood make her blood sugar rise, sometimes dramatically, and so you don't' see the real effects.

Some examples of typical actions:
N: Onset fast, Peak 3-4 hours, Duration 6-8 hours
PZI: Onset 1-2 hours, Peak 4-6 hours, Duration 10-12 hours
Lantus or Levemir: Onset 3 hours, Peak 9-11 hours, Duration 12-14 hours
Don't take my word for these -- test on your own cat, since they're all different.

In general the longer-lasting and smoother the action, the easier it is on kitty. Lantus and Levemir are the smoothest currently available, PZI is not bad and gives a bit more control for beginners.

Please let us help you test blood sugar at home and next time you hear yowling, be prepared to test and treat for hypo.

see youtube http://www.youtube.com/watch?v=_zE12-4fVn8

[youtube]<object width="480" height="385"><param name="movie" value="http://www.youtube.com/v/_zE12-4fVn8&amp;hl=en_US&amp;fs=1"></param><param name="allowFullScreen" value="true"></param><param name="allowscriptaccess" value="always"></param><embed src="http://www.youtube.com/v/_zE12-4fVn8&amp;hl=en_US&amp;fs=1" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="480" height="385"></embed></object>[/youtube]

 

honestly, if you can, go for the lantus from canada. one of the pharmacies there has great prices at around $129 for 5 cartridges. be mindful of the weather when you get it shipped tho, because it may go bad if the heat is excessive (or it's freezing) and it can take close to a week to get to you.

i've been getting excited about prozinc as well but i think lantus is more economical and tried and true at the moment. the cartridges cleo uses last us about 8-10 weeks each. some people toss them at the 28 day mark but by keeping it at a relatively constant temperature in the fridge it has lasted us much longer. very occasionally i've gotten a bad cartridge and it's been clearly bad because it has an overwhelmingly bacon smell as opposed to the normal lantus smell. but so far (knock on wood) i have never gotten a bad cartridge from a canadian pharmacy.

many many vets have fallen for sales reps' advice that vetsulin is the new go-to insulin as pzi vet is no longer available. but there have been problems with it and frankly more cats are doing well on lantus and levemir. if you check out the lantus forum you will see how many diabetic cats have gone into remission on lantus (we call that diet-controlled, as the lower carb food and only a short period on insulin has brought many cats into normal blood glucose levels but increasing the carbs will likely bring the diabetes back).

i shoot in the scruff only when cleo's starting number is low or the next shot will be late. every cat is different but for her her numbers don't go as low with scruff shots but the insulin stays in her system a wee bit longer. i use the shorty needles (5/16" length), so i can shoot directly into the flank/belly without tenting, and the insulin is absorbed quicker and fuller there. things always depend on the kitty, tho. most cats don't seem to mind flank/belly shots with short needles. other cats/humans feel more comfortable with scruff shots.

cleo does the yowling when her blood sugar drops faster than normal. she's very sensitive to it. she did it more on pzi vet, tho she still does it occasionally on lantus.

 

Thanks Everyone, lots of info there. Yes, I am pretty much understanding what is happening, it's just making the vet understand, and yes I think a lot of their info is old and they are not updating themselves. I have gently suggested they come here and see what goes on.
I actually seem to know more from reading here then they do, and not sure why she is insisting on checking on some other kind of insuline. She used the pharm name and they at this point all sound alike to me, so I wasn't sure which one she was talking about. But I did see a canada pharm that has lantus for $229 for 3 bottles. Now, we need it asap and it's HOT, so should I be ordering it now? The cheapest I saw was at North pharm, is there a cheaper place?
It's pretty clear to me that your discription of the problem with short term and what is happening is quite accuate, and yes I'm helpless to do anything except give her the same product until I can get a rx from the vet or get an order in. I would like for it to be with the vet's backing, but she is clearly having serious problems ( the cat, not the vet) after the shot. I don't get the yowling during the day, but increasinly more at night. And her # was not that low when tested yesterday about an hour after shot. But I'm just not liking this see saw she is on.

 

regarding insulin --

Lantus and Levemir can both be ordered from Canada for less $$ than buying it local (generally).

DO - order the 5-pack of 3ml cartridges "for use with injection PEN". We don't actually use the pen, but syringes.

The 3-pack for $229 may be 3 10ml VIALS, which will probably go bad before you can use it up.

Buying 3ml cartridges keeps the insulin "fresher", since it starts to age once you pierce the rubber seal with a needle.

I got a 5-pack of Levemir from an Ontario Walmart for $120 in March. (I live nearby in Michigan -- well worth the 1 hour drive)

PZI is for pets, and can be ordered in different strengths / concentrations. Most pet insulin is U40 or 40 units per 1 milliliter of liquid.

All human insulins are U100, or 100 units per 1 milliliter of liquid.

U100 and U40 insulins have different syringes because of this difference in strength.

Human diabetic products are less expensive because there are so many people -- the production volume is very high.

U40 syringes must be purchased from the vet or a vet-supply, and cost more.


A 10ml vial of U100 contains 1000 units of insulin.
A 3ml cartridge of U100 contains 300 units of insulin.

Let's say your dose is 1 unit twice per day (BID). That is 60 units per month.

Since each container may go bad after ~6-8 weeks of usage (Lantus), you're only using about 120 units.

With Levemir, I've been able to use a 3 ml cartridge for 3 months or more -- using it up without it losing effectiveness ("pooping out")

 

canadadrugsonline: $119 for 5 lantus cartridges, with $10 shipping = $129
you just insert a syringe into the tiny grey nub at the top of the cartridge and remove the insulin that way before injecting.

so far that's the best price i've found. i paid $170+ at costco. i've gotten from both globaldrugsdirect.com and canadadrugsonline.com and the insulin was great, as was the shipping/packaging. but since january they've required a prescription. before that US residents didn't require a prescription to buy lantus/levemir in canada. and recently globaldrugsdirect raised their prices so canadadrugsonline is a better deal. here's the link to the lantus page there: http://www.canadadrugsonline.com/DrugMoreInfo5636.aspx

i think possibly the reason the vets are so gung ho on vetsulin and pzi is that they're dispensed by veterinarians. lantus or levemir can be purchased at regular pharmacies. so can humulin, tho, so i don't really know what the holdup is at the vet. lantus is also called glargine, and levemir is also called detemir.

 

Hi,
You've received some great info here, but if you have to be teaching a licensed veterinarian how to best treat feline diabetes, it's time to find a new veterinarian. It's as simple as that. Call around. You will also get better support from a more up-to-date clinic. look for one that is AAHA registered. They recently have received new FD treatment guidelines. http://www.aahanet.org/PublicDocuments/ ... elines.pdf
If you're in a situation where you cannot change vets (none closer, etc) perhaps print that out and present it to them.

Good luck.

 

I'm finding it strange how little they know about any drugs other then Humulin N and Vetsillian. She didn't know the name Lantus. But they at least work with me, and I've had vets for the most part get totally turned off when I wanted to be a part of the process. I insist on that from my Dr and I don't know why it shouldn't be the same for my vet.
so, you are saying we now need a RX for Lantus from all Canada pharms?

 

The prescription doesn't need to specify who or where you buy it ...

Basically, when you place the order, you will just need to fax or scan/email the prescription. (unless of course you walk in to a store / pharmacy to buy it)


Yes -- the law changed as of Jan 1, 2010, to require a prescription for orders shipped to the U.S.

That said -- any person can walk into a Canadian pharmacy and buy it without a prescription. (assuming you don't have to show ID)

 

I don't think my vet has a rx pad. She says if it's order online they just call. I'll talk to her. We only have 3 vet clinics here in town and I'm on #2 and just moved here in Feb. LOL. So if she will work with me and I can get done what needs to be done that will work. I just keep thinking how much I may be helping those new patients she gets with the same problem. There are 4 vets in the office and I've seen two of them and liked them both.
Gave first shot of Lantus, we shall see.