Testing and Dosage Advice Redux

Discussion in 'Feline Health - (The Main Forum)' started by Richard P, Mar 2, 2019.

  1. Richard P

    Richard P Member

    Joined:
    Dec 17, 2018
    I need some advice on testing and dosage. This is where I'm at with my cat Big.

    Test 1: This all started with my vet checking his BG and it being 380. We had some hic ups in the beginning on dosage and a little confusion on both our parts so in the end he was started with 2 units. They said 1 unit but they also said first line and the syringes I used put the first line at 2 units. The reason this was caught by me was because I ran out of syringes. Being new to this I bent a bunch, dropped a few more, etc. They were suppose to give me the same syringes but ended up giving me different ones size wise by mistake. My friend is a nurse and he explained the markings to me. So I corrected the dosage problem.

    Test 2: This was given 2 weeks later at vet. Big was up too 480. Increased dosage by a unit. He is now at 3 Units.

    Test 3: This was given 4 weeks later at vet. Big was down, but only to 418. Increased dosage to 4 units.

    Test 4: This is happening this week. They wanted to do this in 6 weeks but I had them change it to 4 weeks.

    My Question and statement: First, I'm a little confused by the testing and such. It seems like many are testing after each meal and daily. There is a log sheet and everything. Should I be doing this too? Why is the vet doing the testing so far apart if it seems everyone else is doing it daily? I just don't understand this. I've read posts but can't seem to find the info I need. This is where I standing with dosage:

    Insulin: Novolin N
    Dosage: 4 units
    Times: 2 per day, morning and night


    Like you my cat Big means the world to me. I've been with him through some rough bits other than this so I'm determined to do whatever it takes. He was up to 24 lbs but is down to 21.5 pounds now. I was told that once the insulin started he would be gaining some weight but that hasn't happened and I can tell he's down some more. He does need to lose weight but not like this. It's coming off too fast and not by diet. He's been eating the Fancy Feast pate that I've switched him to once this has begun. Please, any information would be helpful. Thank you from a desperate cat Dad.

    Best,
    Richard
     
  2. Idjit's mom

    Idjit's mom Well-Known Member

    Joined:
    Apr 3, 2018
    Richard, glad to see your post here! As you go along, the board and forums will become as familiar as home.
    My Question and statement: First, I'm a little confused by the testing and such. It seems like many are testing after each meal and daily. There is a log sheet and everything. Should I be doing this too? Why is the vet doing the testing so far apart if it seems everyone else is doing it daily? I just don't understand this. I've read posts but can't seem to find the info I need.
    Here is some information that you need: create a signature so that advising members can see Big's pertinent information with your posts.
    Set up your signature (light grey text under a post). Here's how:
    click on your name in the upper right corner of this page
    click on "signature" in the menu that drops down
    type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using and dosage amount /glucose meter you're using/what (s)he eats/any other meds or health issues (s)he has. You can add your name, and a geographic location (sometimes the time zone matters)

    We do advise testing at home, after all human diabetics always test blood sugar before injections to be sure it is safe to do so, to track the blood sugar levels between injections and to prevent any hypoglycemic events (low blood sugar which can be very dangerous) Same applies to our furry kids. Protocols here are based on human glucose meters, but many do use a pet meter. However pet meters and strips are more expensive and you do have to order online. You can get a low cost meter and strips at Walmart, the ReliOn Prime. This will do if or until you decide to use something else. Testing is the best way to keep Big safe.

    We do use a spreadsheet to track the insulin injections and tests. We can all see it and look at it before offering advice: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
    http://www.felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/
    If you have any difficulty with spreadsheet setup, let us know. There are members that can help.

    There are a couple of places you need to visit first:
    The insulin specific forum for Novolin: http://www.felinediabetes.com/FDMB/forums/caninsulin-vetsulin-and-n-nph.19/
    Look for the Beginner's Guide to Novolin.
    You need to understand how this particular insulin works and how testing is a critical part of effective treatment.
    The FAQs forum: http://www.felinediabetes.com/FDMB/forums/health-links-faqs-about-feline-diabetes.14/
    scroll through the Index, not everything is going to apply right now..but there is Hypo information and testing information that you need right now. There are also lots of testing videos on YouTube. Other members can chime in and offer what works for them if you need more help.

    It's a lot of reading and absorbing, I know. But you love Big and want him better, we can help answer questions and help with the rough bits. We all started in the same place and we are on your side.
     
  3. Bron and Sheba

    Bron and Sheba Well-Known Member

    Joined:
    Feb 21, 2015
    Hi Richard and Big.
    @Idjit's mom has given you lots of good info.
    I have never used Novolin N but from what I’ve read it is not a very suitable insulin for cats. Where do you live? I think you would be better swapping over to a more suitable insulin like Lantus or Prozinc.
    Also I think 4 units is a very large dose for a cat of that type of insulin. We also recommend only increasing the dose in 0.25 unit increments.
    I would highly recommend you go out and buy s human glucose meter and start testing at home. Test before EVERY shot to make sure it is safe to shoot and test again around +4 and +6 after the shot to see how low the dose is taking Big. This will allow you to keep Big safe. Typically cats get stressed at the vet so any readings done there are often higher than they would be at home. Another good reason to home test
    Do you have plenty of high carb food and honey in case of a hypo event? Are you feeding a low carb diet?
    I am going to tag @Elizabeth and Bertie as she is experienced with Novolin N. She is in the UK so may not be online for several hours.
    Keep asking lots of questions and reading all the info on this site.
     
    Idjit's mom likes this.
  4. Richard P

    Richard P Member

    Joined:
    Dec 17, 2018
    Hello and thank you Idgit's Mom and Bron and Sheba,

    I live in Epsom NH right now. Just moved a several months back and will be moving back down to the Boston area in the near future. You are right about Big being stressed at the vet. To be honest he's stressed about almost everything. When I rescued this sad boy he would sit in a corner and pee without moving. He hid for the first month from me in a cubby in the dinning room. He's not like that now for the most part but will still run under the bed when I come in sometimes. Going to the vet is a nightmare. I carry with me a cleaning kit because he will project every substance you can think of out of himself from fear. If I can make it back and forth without anything happening it is a great day.

    I wish they explained the differences in insulin to me in the beginning. I just thought insulin was insulin. I do have some hi carb food and honey. Not sure I would recognize a hypo event. I'm just trying to get him on the right dosage but I see that's complicated as well. I can see I have tons to learn. If the next test is still high I think I'll need to change insulin. I think I'll change to Prozinc. To be totally honest I feel overwhelmed by this. I thought the vet was suppose to guide me but that doesn't seem to be happening. I have a test with the vet this Thursday. I guess I'll just read as much as possible and go from there. Thank you for your help.
     
  5. Idjit's mom

    Idjit's mom Well-Known Member

    Joined:
    Apr 3, 2018
    There is information about hypos HERE, however many cats are not symptomatic until the situation is critical. Testing your cat's blood sugar is the very best way to know if the level is going (or is) too low. No matter what insulin you are using, testing is the best way to keep Big safe. He's eating the low carb food now and that can significantly reduce the blood sugar, you need to be testing before you give a shot. If his BG is low and you shoot those 4 units, that could be catastrophic. 4 units is a high dose.
    It does seem overwhelming at first, there is a lot to learn, but you have come this far with Big and he's obviously very important to you. You can do this and we will help.
    Read about the other insulins and how they work. If you are going to use ProZinc you need to be sure you have the correct syringes, they are different than the syringes you are using now for the Novolin.
    Just go back to the menu page and scroll down to the insulin specific forums.
    Get a blood glucose meter and strips and test him, starting now. You will not have to take him to the vet for testing or curves which are very stressful for him. Vet stress can and does raise the BG. You can do the curves at home and have real time, more accurate information.
    Testing is a process of patience and practice, but can save your kitty's life. It becomes just part of your daily routine and you will have the comfort and knowledge that Big is safe.
    http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/
    There are lots of testing videos on YouTube also.
     
  6. Richard P

    Richard P Member

    Joined:
    Dec 17, 2018
    Idjit's Mom,

    I want to thank you for the last post. GOD, the amount of information is staggering. I'm getting a testing meter as soon as possible (scared to death by the way). I'll probably go with Human over Pet one. It seems many use those. I really wanted to use Lantus from the beginning but the cost was so high. I just don't have funds for that. I just noticed a forum about getting the prescription in Canada at much lower rates. This is Amazing!!! I never new this. I'm a pretty healthy person so I'm not on any regular medicines so it never occurred to me. Even if I had to do a run across the border every now and then I could do that. I'm from Syracuse NY so a 2 hour car drive and I'm across into Canada. Insulin and a case of beer for a friend of mine and I'm good to go. I'm very worried about Big right now. I'll be doing a separate post about that in a minute. This is reference to hypo I'm afraid. I'll be chatting with all soon and hope to see a change soon.

    Best,
    Richard
     
  7. Idjit's mom

    Idjit's mom Well-Known Member

    Joined:
    Apr 3, 2018
    Richard, you are more than welcome. It hasn't been that long since my first encounter with FDMB. The information here and this community set us straight on effective treatment. I know the amount of info IS staggering, but every bit that you can read, understand and put into action is going to get you where you need to be. One step at a time. Do get that glucose meter and strips, lancets gauge 26 or 28, a bag of cotton balls, some vaseline, and some pain relieving ointiment (Equate or Neosporin). Do a couple of practice runs with the meter on yourself, so you know how it works. Just put a little rubbing alcohol on a cotton ball to clean your skin, you won't need the vaseline or ointment for yourself.
    Start getting Big used to the process. Choose a testing station, where you are both comfortable and has good lighting.
    A rice sock warmed in the microwave helps bring the blood to the surface.
    (Just a cotton sock with 1/4 cup raw rice or oatmeal, knot it and warm carefully. I would rub it all over Idjit's face, under his chin. He really liked that) Fondle and handle his ears, then give a treat. Give a treat with every practice & every test, successful or not. Pure Bites Freeze dried chicken is good, or just small pieces of boiled or baked chicken breast w/o seasonings. Practice as many times a day as you can manage. Testing is not always successful at first, this is all new to both of you, but it does happen. And it is so incredibly important.
    If you can get a prescription from the vet, you can order online from Marks Marine in Canada https://rxcanada4less.com/

    http://www.felinediabetes.com/FDMB/threads/buying-insulin-from-canada.203498/ Check the website for prices.

    That would save you the drive. Many of our Lantus users get the insulin that way. Get the pens, not the vial. More cost effective and lasts much longer. You have a better chance of using all the insulin in the pens than using up the entire vial. Lantus is a depot insulin and works very well for our kitties. Read about that too ( I know...more reading!!! :rolleyes:) The more you know, the more you will be able to do. Prozinc or Lantus is better than the Novolin.
    Don't be scared. This is all manageable and we will help.
     
  8. Richard P

    Richard P Member

    Joined:
    Dec 17, 2018
    Hello all,
    Took my boy to the vet and he's still has a high BG. Just a reminder of where he started and his numbers.
    Test 2: This was given 2 weeks later at vet. Big was up to 480. Increased dosage by a unit. He is now at 3 Units.

    Test 3: This was given 4 weeks later at vet. Big was down, but only to 418. Increased dosage to 4 units.

    Test 4: This was given 4 weeks after the previous one at the vets. Last Thursday. He was back up to 470.
    Took multiple suggestions and advice and we are switching to Lantus. The vet wants to keep him at 4 units once a day since that’s what he’s on with the Novolin I guess. I’ll be seeing her again in 2 weeks. She wants me to do a curve 5 to 6 days after he begins. Not starting till Monday, the 18th. Waiting on insulin which should be here on Friday. Just need to get a meter. Was going to use one from my father but decided to use a pet one after speaking with vet but the strips are ungodly expensive. Switching back to human meter I think. Worried that the amount of insulin is too much but she’s the vet not me.
    I think testing him will be my own test. I’m not going to like this very much and he is going to hate it. He hides all the time with me and he trusts me the most. Not going to be easy. Still trying to wrap my head around this. I’ve read tons about testing and shots but haven’t seen much on what to do if I give him a shot and test and he’s way off. Do I Test first, give him a shot and then feed him? The food is how I lure him out to give him his shot much less test him. Just not sure how this is going to work. Any thoughts about this will be helpful.
    Thank you
     
  9. Erin & Scott

    Erin & Scott Member

    Joined:
    Jan 11, 2019
    Yes - test, feed, shoot, in that order. Many of us shoot while feeding - Benny is so busy eating I don't think he even notices us giving the injection. Ideally, we want to test first before feeding, in case the pre-shot number is lower than expected and we decide to delay (or skip) the shot. But if you need to give him a small, low-carb treat to lure him out, then test him immediately, it won't be a problem. It takes a little while for the energy from his food to get into his system.

    Testing is challenging, and even though it may feel like a nightmare the first few times, you'll work it out - we all have, and we all started from exactly where you are starting from. 4 units is a huge starting dose - I'm not familiar with Novolin at all, but the recommended starting dose for glargine (i.e., Lantus) is 0.25 u/kg of your cat's lean body weight. For a 10-lb cat, that's a little more than 1u. Home testing (and yes, go with the human meter, they're cheaper and work just as well) is essential. The goal is to determine how low a given dose takes your cat. I don't know how much reading you've done in the Lantus forum (yes - it is overwhelming!), but I would encourage you to check it out, and read through the stickies. By the time you're ready to start, you'll have a much better idea of what you'll be doing, how to do it, and why you're doing it.

    Remember - start with baby steps, and eventually you'll soak it all in and put it all together. We did some dumb stuff when we started because we didn't know. Best move I made, though, was to find this forum and educate myself! Also while you're waiting for the insulin, you can get your signature set up, and get a spreadsheet set up. Those are two of the most essential tools we use here in order to be able to give you appropriate feedback.

    For the signature, hover over your user name at the top right of the page, and when the dialog window opens, click on Signature. Include (briefly) pertinent info on you & your cat - age (cats!), date of dx, type of insulin, meter type, food, dosing protocol (find in Lantus forum stickies), etc. Check out several of the members' signatures to see how they've done it.

    Looks like someone has given you a link upthread to the Spreadsheet set up, so I won't repeat that here.

    Good luck - I think switching to Lantus is a good call.
     
  10. Richard P

    Richard P Member

    Joined:
    Dec 17, 2018
    Thank you for the info. I have a 19 lbs. cat right now so I’m hoping the 4 unit dosage is going to be fine. May take it down to 3 unit dosage to be a little safer maybe because of the transition from one to the next type of insulin.
     
  11. Julie and Honey

    Julie and Honey Member

    Joined:
    Dec 22, 2018
    Hi Richard,

    Lantus is a different type of insulin than the Novalin, it is very good, but acts differently. I would suggest waiting to see if someone here can advise you so you start on the right dose. It is possible the 4 units on the Novalin may have actually been too high, high readings can be seen with too much insulin (bouncing) a protective measure the liver puts out sugar in response to too much insulin taking sugar too low, then sugar will read high even if cat is on too much insulin. Even starting 3 units of Lantus sounds a little high, even for a large cat. I am hoping someone more knowledgable will respond to help you. Better to start off with the right dosing. People here have seen vets just increasing insulin doses just off one number without taking the whole picture into consideration. It is unfortunate, but it happens. There is a lot of knowledge here and this group has better guidance than many vets on the topic of Feline diabetes, just because of many years dealing with it and looking at the whole picture for each cat.

    You can also post to Lantus board asking for dosing advice, giving brief background of past insulin, dose and changing to Lantus dosing advice.

    I also see you have in your signature “Lantus 1x a day” Lantus should be given 2x a day for best results. Again, I think you need some more info for best results for you and Big. Check out the info on the yellow stickies on Lantus board and get some info from more senior members to make for a smooth transition.
     
  12. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    I'm giving you the guide I wrote a while ago for newbies. It repeats a lot of what @Idjit's mom has told you but it's all in one place in condensed for. What you're feeling - overwhelmed, afraid, don't know what to do - is very, very normal. We all went through the deer in the headlights phase and we can all promise you that it gets better.
    __________________________________________________________________________________________________________________

    It would help us if you set up your signature (light grey text under a post). Here's how: (mentioned above by others)
    • click on your name in the upper right corner of this page
    • click on "signature" in the men that drops down
    • type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using /glucose meter you're using/what he eats/any other meds or health issues he has.
    Another thing that will help us help you now that you've started BG testing at home is to set up a spreadsheet like the one we use here. We can all see it and look at it before offering advice: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

    .............................................................................................................................................................................................................


    Here's the basic testing routine we recommend: (do what you can on work days - before bed is useful along with the essential pre shots)
    1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
    2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
    3. do extra tests on days off to fill in the response picture
    4. if indicated by consistently high numbers on your spreadsheet, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
    5. post here for advice whenever you're confused or unsure of what to do.
    This is useful: http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

    .............................................................................................................................................................................................................

    Here's an explanation of what we call "bouncing". It explains why a kitty's BG can go from low to sky high:
    (possibly contributing to your kitty's high BG at the high dose he's on)
    1. BG goes low OR lower than usual OR drops too quickly.
    2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
    3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
    4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
    5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
    6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.
    .............................................................................................................................................................................................................

    Here are some tips on how to do urine ketone testing (VERY important if BG is high and kitty isn't eating well!):
    • put the end of the test strip right in his urine stream as he's peeing
    • slip a shallow, long handled spoon under his backside to catch a little pee - you don't need much
    • put a double layer of plastic wrap over his favourite part of the litter box and poke some depressions in it too catch pee.
    Most test strips have to be dipped and allowed to develop for 15 seconds before viewing the colour change in very good light.
     
  13. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    It's rare that the dose is related to weight except in a very general calculation of starting dose. Even then, most kitties are started on 1 unit twice a day regardless of which insulin is being used. There are large cats here on tiny doses and vice versa.
     
  14. Bron and Sheba

    Bron and Sheba Well-Known Member

    Joined:
    Feb 21, 2015
    Hi Richard. I’m glad you are swapping to Lantus.
    Just a couple of things. Big is probably stressed at the vet so the BSLs are probably higher than they would be at home. This is very common in cats.
    Lantus is a twice a day insulin, not a once a day insulin. All once a day will do is take him down for 12 hours and the next 12 hours he’ll be without insulin in higher numbers. You would be much better giving 2 units twice a day.
    Are you testing for ketones ? If not, I think you should be doing so while Big is in high numbers. You can buy a bottle of Ketostix from Walmart or a pharmacy for about $10. Test the urine with the test strips. Anything above a trace needs vet attention.
     
    Kris & Teasel likes this.
  15. Julie and Honey

    Julie and Honey Member

    Joined:
    Dec 22, 2018
    You have gotten a lot of good advice. As Kris mentioned normal starting dose is usually 1 unit 2 x a day (every12 hours) usually regardless of weight. Especially since you have him on low carb food already.

    The only question I would have is starting dose because cat is already on some type of insulin.

    Also Lantus gradually builds up an “insulin depot” and a few days down the road on too high a dose may compound the effects of the insulin. Lantus is a very effective insulin and many people have had great success and has taken many cats into remission, just need to be aware of how it works.

    Experienced Lantus users on the Lantus board will be able to guide you on where to start. I recently started with Lantus myself and will be over there for input on my cat too. You are at the right place to get help for your Big boy (name fits :)). It is a lot, but after awhile, it gets easier.
     
  16. Julie and Honey

    Julie and Honey Member

    Joined:
    Dec 22, 2018
    And you want the u100 3/10 cc/ml syringes for Lantus. Since you are in the states, Monoject work well, 30 or 31 gauge needles are the smaller ones.

    ADW Diabetes supply has decent prices. For Lantus you want u100 (3/10 cc/ml) for proper dosing. Only variable is needle size and thickness. 31g is thinnest, but 30g is still very thin and cheaper. Best bet for your money. These are a safe bet and reasonable price and have the 1/2 unit markings for easier dosing options when needed. Depending on state laws, you may or may not need a script for syringes. If you do, you can scan or take a picture and send to them, give them a call and they are happy to help.

    https://www.adwdiabetes.com/product...100-syringes-30g-3-10cc-5-16in-100ct-1-2-unit
     

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