? Using Novolin R with Lantus - dosing question

Hi Everyone.

I need some dosing help from anyone who adds Novolin R to their Lantus regimen for super high numbers. I've never tried it before, but she's been getting into the high 500's way to often lately, and it's really freaking me out. Her onset with Lantus is usally 4 - 6 hours, so what is a safe dose of Novolin R to get her out of danger?

Onyx has been on and off insulin so many time over the past 2 years, but her inflammatory bowel disease (and B12 deficency), is what now has her probably getting close to the end, which is killing me after everything I've done to help her. But...I know these things are out of our control sometimes.

Anyway, I know the Novolin R is a LOT stronger, so what is a safe first dose? I just gave her Lantus and she's 565.

Thank you in advance for any advice.

Brandi & Onyx

 

I am tagging some others with R experience ... I don't see anyone on at the moment who can help.

@Marje and Gracie , @julie & punkin (ga) , @Wendy&Neko ,

 

Brandi

I'm so very sorry to hear about Onyx's IBD progressing and her numbers getting so far out of whack. If you aren't a member already and you are on Facebook, there is an amazing group there called IBDKitties and also a great website at IBDKitties.net. Lots of experience on the FB page. My Gracie was just dx with IBD and I've learned so much from them.

Do you have a current SS? The one linked only shows numbers in 2014 as the last. Because dosing with R has to be done very carefully and at specific times, depending on the cat's cycles, it would be best to be able to see a current SS so we could help you decide when the best time to give R is. We also just suggest that one of the experienced R users be online helping you the first couple times you shoot it.

Some of the things that need to be kept in mind is that you need to know what Onyx's onset, nadir, and duration are. You want to be sure that the L and R nadirs do not overlap. You have to be very careful that the R doesn't drop her too much at one time because you could set off a diving/bouncing cycle. The goal is to only have the R drop the BG by 50-100 mg/dL in the cycle that it is used with the hopes that it will help the L then do its job.

We always start at a lower dose of R and see how they do. R doesn't affect every cycle the same so you can't get complacent and think if it only drops her 50 in a cycle, it will always do that. It doesn't. I also sometimes see a very active cycle the cycle after I shoot the R. ECID. And also ECID is when the R onsets and nadirs. It's "typically" active for four hours with the most movement seen at +2 and +3 but again ECID.

I hope this is some basic info that will help you. With the SS, we can also see how the Lantus dosing is and what she might need.

Again, I'm so sorry about the IBD. I'm learning what a horrific disease it can be. Sending hugs and prayers.

 

Do you have an updated SS? I don't see anything after 2014. For Tess who was a small cat .1u of R would bring her down 100 to 200 points and last about 4 hours. The vet suggested 1u but we knew that was too much, .1u is just about a drop. We would see it kick in in about an hour but it was gone after about 4hours. The really important thing to remember is to give it so that the nadirs do not coincide. We would usually give it to Tess at +10 or w/ the preshot. Much later that +2 and both insulins would be in effect at the same time.

 

Hi Marje.

I will definitely check out those groups. It's been a really rough past year with her. To be honest, since the IBD became the dominant factor, I stopped doing the SS. It just all got to be too much. Depending on the food she's eating, she'll go months with being OTJ, but then she refuses to eat the Young Again, so she goes back on insulin. Trying to keep her eating, hydrated, and not vomiting, has taken control of my life. So monitoring when to give her fluids, Cerenia, Famotidine and B12 shots, is what I track these days. I know how she responds now, so I don't try to get her OTJ, when I know there's nothing I can do. If she is eating carbs, I try to keep her under 200. With her, that's the best I can do, safely, with my work hours. And most days she'll be around 100-120, when her IBD isn't bothering her. The spreadsheet was great though when I was focused on learning her cycle, working to get her OTJ.

I don't plan to use the R insulin every day. I only got it to use for emergencies, like today, when she goes into the 500's. This happens every few weeks it seems when she's not feeling well. So I honestly just need to know a safe dose to occasionally use, for emergency purposes only. Normally, the lantus works just fine. But when her IBD flairs up, it shoots her numbers through the roof. And with my work schedule, I just need to know I can keep her safe.

Thanks again, Marje.

 

Hi Ann.

Wow, a single drop does that much? I've never had to measure something so small, so now I'm afraid. How do you even know you only have a drop in the syringe????

 

I totally understand....it's such a balancing act and keeping them eating and feeling well with IBD can be a challenge.

There are many other treatment options for the IBD. I'd definitely check in with the group because some of the members are using prednisilone and a chemo drug, leukeran, quite successfully to treat the IBD. While it's not ideal to have to give a FD steroids, if it helps, then you just have to adjust the insulin and might have to live with numbers in the 200s to keep her safe. Mike and I were just discussing that about Gracie. For the most part, she eats great but occasionally she doesn't and I don't want her hanging out in the 60s if she's not eating. There are also a lot of natural things that can help the IBD and probiotics and digestive enzymes are a big help.

 

I dose R using my calipers so I know what 0.1u is on the caliper. For me, a drop is less than that. If I am dosing just a drop, I push the plunger all the way down, insert the needle into the vial, and then release the plunger. Thst gives me a drop. To dose more than that, I use calipers and magnifying glass.

 

We used a caliper and I calculated the mm for .1u. You can just barely see light between the plunger and the end of the barrel. A good magnifier is a must too. Tess was only about 5.5pounds though.

 

When we were using R I tried drawing the dose and then slowly pushed it out just to see how much there was. A full fat drop rolled down the needle. The caliper reading was .15mm.

 

Yep....my 0.1u is also .15mm on my calipers.

 

We actually tried the prednisone, initially, but it made her numbers go WAY high. The problem with Onyx is, and this is NO exaggeration...she'll go into the 500s, then sometimes, and you never know when, she'll be in the 40's 12 hours later. She's totally unpredictable. So if she's on prednisone, she needs more insulin, which means when she drops erratically the way she's prone to, I could come home to a dead kitty. So I can't make that gamble. Anything that makes her require more insulin, I have to stay away from. Which is also why I only want to use the R for emergencies only.

At this point, I'm not sure if there is much I can do. She's now 7.5 pounds. I found out the hard way, that the Famotidine kept the B12 from being absorbed, so she got malabsorbtion. So now I only use it when she throws up. She used to get it twice a day. But she might be too far along now. So I'm just trying to keep her comfortable. Did the probiotics help your little one?

 

Looks like I'm gonna have to get some calipers.

 

okay, I tested it a bunch of times first, but I just did the single drop from pushing the plunger in once while inserted into the insulin.

Fingers crossed.

Thanks, ladies.

 

Hi Brandi - sorry to hear things are getting so complicated for you. My civie is now IBD and Neko of course FD and now up to 6.5 units and occasional use of R. Her R onset and nadir are later that Gracie and Tess's. ECID. Starting a small dose is the way to go. Lots of experiments are needed to figure out what dose works. I found the advice of an experienced R member invaluable at the beginning. A number of the high dose kitties use R with very widely varying amounts.

Even if you just start a spreadsheet for the last week, it'll help us help you.

 

Hi Wendy!!
How are you girl? Sorry to hear you know what the IBD is all about as well. It's a nightmare, isn't it? We actually now think her IBD is what started first, then the diabetes happened. They think that's why she pulls her hair out, because her tummy hurts so much. IBD is a CRUEL disease for sure.

I will definitely experiment with the R. We'll soon see how the 1 drop does. I can try to go back with my meter to get something on the SS. Right now with the food she's on, she never gets more than 1.5U. I believe it's 12 grams of carbs. I'm hoping she goes back to Young Again soon so we can take an insulin break. Those months are nice. My picky little girl gets tired of foods so quickly. Vet said that's an IBD thing. Do you guys notice that, too?

 

When Grayson was having severe IBD issues, the vet school said to give him "novel proteins" - duck, venison & rabbit. Have you tried any of these? I got the rabbit in the dog food section of a specialty pet store. EVO duck & venison.

We used R, but after many months of trials he finally started moving at 3u - mostly due to his insulin resistance. For a normal cat, you will not need anywhere near that much. And you should start with a drop.

Just like when you first practice drawing up insulin, and getting the dose right, I did the same with R. First, practice with a used syringe and a cup of water or water/food coloring. I also had to repeatedly test to see if the 1u marker on the syringe was really 1u. I would draw up the water to at or above the 1u mark, then pull the plunger down to another level, like 5u. Is the water JUST between the 4u-5u mark? Or is it a little more. Often times the "0" mark is not a true zero. Once you figure out where your true 1u is, then I practiced with the drops. A LOT. I could typically get 4 large drops or 8 small drops out of 1 true unit. I very slowly twist the plunger to see how many I could get off. Once I knew that, practice practice practice. Then I would get a fresh syringe, go into the R, measure the 1u, check it, then twist, trying to match the number of drops I needed for it to be the smallest possible dose. I also keep the R in a different place in the fridge - just so you don't get them confused.

Knowing where your nadir is is important as well. You don't want the two insulins to nadir together. We use Levemir, and G's nadir USED TO BE about +9 or +10. So we would shoot at the preshot. If Onyx nadirs around +4-5 you probably need to shoot R at +9 or so. You MUST be around to test every hour for the first 4 hours (ave life of R), just to ensure he/she isn't dropping too fast. DO NOT use R if you won't be around to keep a check. Some cats will drop 300 points at barely a sniff; others like G, use considerably more. But you need to start VERY LOW with R... it's very powerful, and when it kicks in, it can really drop them. Then gradually increase until you start seeing some movement. Some people have seen a residual effect of the R on a later cycle. Another reason to go very small with your increases.

Good luck. When G was on Prednisolone, I had to "fight" the fiercest enemy (eosinophilic leukemia - blood cancer). It did require increasing his Lev, but that was something I knew I could manage. It sounds like you're doing a LOT for your baby. Take a deep breath and go after those enemies. Onyx is lucky to have you!

 

Thanks, Lu.

Yes, it definitely sounds like a lot of trial and error is order. Hopefully more "trial". With the R, I would be happy if it gets her into the 300s. I'm hoping the 1 drop does the trick, so we'll soon see.

As far as the novel proteins go, believe me when I say I have spent countless hours researching the foods available. Novel protein foods are great for IBD, but NOT for IBD diabetics. They are REALLY high in carbs. The only ones that aren't, are the raw variety, which of course my little nut job won't eat. She doesn't make taking care of her easy, that's for sure.

My last kitty died of cancer, so I feel your pain on that battle. I tell ya, after having 2 sick cats, I don't know how you folks do it with taking in more ill felines. It's so hard on you. So you should all be commended!!!

 

The Evo (canned) was about 5 carbs I think - and the rabbit was just that - rabbit, nothing else. Evangers was the brand name. So none were terribly high carb. Unfortunately, G didn't digest red meat well, so we did a LOT of duck. But he did get over it, and never had another flare-up, despite getting back to a predominantly Fancy Feast (chicken & turkey) diet. I got the food from the "PHYDEAUX" store in Raleigh, NC. I know they ship, but that would add to the cost, but I found their foods to be very reasonably priced. Are you in the states?

Once you've had a diabetic (like potato chips), it's not hard to have another one or two or three! One of my civvies was on insulin for 1 week, and is now diet-controlled. One DCIN foster was diet-controlled from the time she came to me. And my last DCIN foster failure is on 1.25u of Lev (previously 11 or 13u of N). He's easy. He bleeds (Grayson didn't bleed well), he wakes me up if he's low, and he's just easy to care for. No underlying health problems. And he helps keep me connected to the groups I've spent the past nearly 4 years with. But what I learned from Grayson and have been able to share with others, has been priceless.

 

I had a hard time finding novel proteins as mine had been exposed to most everything.... except kangaroo.
Have you seen this new food http://www.mauripetfood.com/cat-food/wild-kangaroo-entree/
It's okay for diabetics.

also check out http://www.raynenutrition.com/default.asp
they have kangaroo and can also make custom foods.

Usually they give you Budesonide for ibd. I didn't see that mentioned.
Shadow was also trying out a new treatment, Gengraf ( modified cyclosporin) available at www.diamondbackdrugs.com
I didn't give it long enough ( it turned out) and we switched her off of it back to prednisolone. I wish I hadn't.

I also had luck with Stella Chewy's freeze dried turkey and Primal freeze dried turkey. She liked those , just ate them dry without me adding water.
Those are both raw freeze dried which raw is really good for IBD.

 

UPDATE: Great news...been almost 2 hours since the single drop of R and she's down to 406. so it's working. YAY!!! Hard to believe a drop can work so fast.

Hi Rhiannon!
I'll check out those 2 sites. I don't think they sound familiar. And as far as the meds go, sadly, my vet isn't the most proactive. I've had to teach him MANY things along the way. He didn't even know what MethylB12 was, and that is super important to IBD kitties because of their guts inability to absorb B12. I'll look into the Budesonide and Gengraf. Prednisone is what gave Onyx diabetes in the first place, so I'm desperate to stay away from steroids. Plus they shoot her #'s through the roof.

Unfortunately, I've never been able to get her to try the freeze dried treats. I just don't get her aversion to EVERYTHING that could help her. GRRRRRRR!

 

for ibd, it's actually cobalamin needed for absorption. not methylb12
ask you vet for injectable b12..... http://www.ibdkitties.net/B12.html

i meant to add that earlier , when you said 2x a day..... made it sound more like methyl b12.


i'm sure you've read the ibdkitties.net website.....
but it wouldn't hurt to go back and re -read it.
After I let Shadow go, I re-read many things that spoke to me differently after the fact.
Like how long it took gengraf to work......

I could mail you a sample of the two freeze dried foods, one of them really gets my cats attention . Send me your address.
That way you don't have to buy a whole bag.

Shadow wouldn't touch anything freeze dried chicken..... but turkey..... she liked. Apparently there is a huge taste difference.

 

Actually, Rhiannon, Cobalamin IS B12. Regular B12 has cyanocobalamin, which has small amounts of cyanide. MethylB12 is Methylcobalmin. It's just what the body converts it into to use, by removing the cyanide. IBD kitties have trouble converting it AND absorbing it, so the methyl form gives their body a bit of break. She doesn't take that twice a day though, that was the famotidine. She gets a shot twice a week right now of methylb12.

Yes, I've actually learned a lot from the IBD Kitties website this year. Very informative.

That would be awesome about the treats. I have literally NEVER been able get her to eat them. And I've tried tons. Thanks so much.

 

i knew cobalamin is b 12. My mother took it for years for energy.
it was the methyl b12 that I learned about here at fdmb for neuropathy.

all this time it thought it was cobalamin for the digestion issues and methyl for neuropathy. That's how my vet was prescribing it.
She didn't know about methyl b12 until I told her.

the two freeze dried items i mentioned are actually food.... not treats. But if she likes it, doesn't matter.

 

Well my vet didn't even know about it, so yours is better than mine...lol. I actually think I learned about it from the IBD Kitties page. Then I did TONS of research. It's also really hard to find in injectable form. Not many places can compound it "properly". Turns out I needed it as well for my own health issues. methyl is just better. Apparently, b12 in general is the most difficult vitamin for the body to use. I found that so crazy.

 

oh...
the other important medication is pain management.
I could tell Shadow's tummy hurt her..... or digestive tract, something did.

Is Fred getting bupenorphine for pain.
diamondbackdrugs gave me 10 mL for $40. much better than the price at the vets.

 

Something I read a while back... cyano has to convert to methyl in the body, so it's one extra step in the chemical process. But both are helpful and both are B12. If I recall correctly, the cyano is less expensive. Several years ago you could get it online - cyano about $50 and methyl about $150. It is technically a vitamin, so may not always need a script.

 

Wow, that's a great price. I think I pay $36 for a tiny amount at the vet. I will def look it up. I'm actually glad you mentioned it, because Onyx is out.

Thanks, Lu.

 

Keep testing every hour for at least the four hours after the R shot. What number was she at when you gave the R? Remember Marje's point above that you only want the R to take the BG down by 50-100, otherwise you could get another cycle of bouncing as a result.

You asked about food pickiness - my guy gets a rotation of raw kangaroo, venison and pheasant, with the occasional buffalo. The rotation means no more than two meals in a row of the same protein and I find that the rotation means he doesn't get "bored" of the food.

You might be interested in this article on Which Drugs are Used to Manage Feline IBD? My civie is currently on metronazidole but vetty is thinking about a switch to try a TCM (chinese herbal) soon.

 

Whoa...hold on...lots of misinformation here.

First, methylcobalamin is great for helping CKD kitties with anemia and also for neurologic issues. Typically, it’s been given orally as it is absorbed better but I understand there is now an injectable methylB12. Cyanocobalamin is the best form of B12 for the digestive system and it is given injectable. That is what should be used for IBD cats...not methylcobalamin.

You might also want to talk to your vet about using budesonide. It has less systemic effects than prednisilone. I also use aloe vera and slippery elm for acid tummy instead of pepcid. It’s ok to use pepcid occasionally but if you start using it regularly, it can do more harm than good because kitties need stomach acid to digest their food. There are only two aloe vera products that can be given orally to cats and the one most used is George’s 100% pure fractionally distilled aloe vera and it should be diluted 1:1 with water and not given more than a couple times a day. Start small....1/4 tsp:1/4 tsp water and slowly build up to 1tsp av:1 tsp water no more than twice a day or make slippery elm syrup. You should discuss all this with your vet before starting it. All of this is on the ibdkitties.net website and you should read it all and discuss with vet before making changes slowly.

Novel proteins are great but you still have to watch what is in them. I was feeding Gracie Mauri kangaroo and it started giving her diarrhea. It’s because Mauri is heavy...and I do mean heavy...on gums and gums are not good for IBD cats. Neither is carrageenan. Of course, the best food for a cat is the one it will eat. There are plenty of novel proteins out there for IBD and FD kitties. For example, I feed Ziwipeak venison, lamb, and lamb/rabbit. It’s not cheap but it also doesn’t have a lot of the gum or the carrageenan and it is LC. Nature’s Variety Instinct canned has the regular duck, venison, rabbit, diets plus a limited ingredient line of novel proteins which are all LC. But with IBD cats, you must make changes very slowly including the foods.

Also...I would never, ever recommend feeding a freeze dried food like Primal without water. They are made to add water to and without it, your kitty is not going to get enough fluids. Please do not feed these foods dry. There are freeze dried treats which help as toppers which are novel proteins and are zero carb....those are Orijen Lamb and Orijen Wild Boar. And it’s usually recommended to not feed an IBD kitty dry food.

And Brandi...it scares the *&#! out of me that you shot R today without someone with you and without any of the information or cautions I suggested. R can be extremely dangerous and can cause your cat to hypo if you do not use it correctly!!! You cannot just shoot it any time in the cycle. Please do not shoot R again without someone being able to help you figure out when it’s best for you to shoot it. Seriously. I gave you info so you could start thinking about doing it but not shooting it without some assistance.

 

good to know on the dry freeze dried.....
i was using it as a crunchy substitute for dry food ( but Shadow didn't want it if I added water) I was hoping for her to develop a taste for raw.


the raynes kangaroo is limited ingredients especially with the custom diet.


Thank you @Marje and Gracie for the clarification on the b12's.......

 

You’re welcome!

I looked at the Rayne Diets....I sure don’t like the ingredients. They all have dextrose in them which is not FD friendly. Also...potato starch ..and I’m suspicious of anything that says “vitamin and mineral mixture”. What’s in it?

 

You've already gotten good information, I'll just add that I wouldn't even consider shooting R without a spreadsheet to look at - even if it was just for me. It's a great tool, used correctly, but the potential for a disaster is huge if it's used at the wrong time, or with the wrong dose. When you say:

then I think having a spreadsheet and being careful becomes even more critical. We just don't want to see a disaster with Onyx. One of us that uses R would be happy to help you figure out how to move ahead safely - I would want at least 4-5 days prior in the spreadsheet to look at. Even if you just started putting #s in from this week - the memory of your meter would hep you do that easily.

Big hugs, you're dealing with a lot of things.

 

i hadn't noticed that with the rayne.....

i had the dx for ibd food.. which was custom.... there were only two ingredients and it wasn't to be used long term.
I hadn't looked at the pre-fab made stuff.

 

thank you for updating the spreadsheet - that's so helpful!!

It's not uncommon for the cycle FOLLOWING the use of R to be lower. I'd make sure and get some tests in tonight.

 

Just looked over your SS. Given that you've had some really good (blue) preshots and even some green ones on the same 1.5u, I would NOT recommend using R - even when you get a 500+ number. You may have done a partial fur shot, or it may have been a bounce from something mid-cycle that you didn't see. That black is a blip, not a norm, and it could've been a really scary decision. We all hate to see the blacks, but when you're used to seeing better numbers, and one shows up, you should really stay with your dose. I see this with Spartacus all the time. He'll have a week of high numbers. Same dose given and another cycle he'll drop from 350 to 36; then level back out in the low 100s. Knowing & anticipating how they will respond is key - that's why we test. Mid-cycle numbers would be VERY helpful before you change (or add) anything. It may be that you're getting nice blues & greens - or maybe he's not moving. But knowledge is power.

 

Wow...lots of missed messages here. This site used to email you when you had messages, but it doesn't seem to anymore. Hmmmmm.

So I updated my SS as soon as you guys asked the other day. And the only reason I shot the R, is because I "thought" I was given advice above on a single drop. She was almost 600, so I wasn't screwing around. I just wanted it down so she was out of danger. It worked beautifully. As I said, I'm not giving this to her daily. It's only for emergencies.

And I am definitely going to talk to the vet about Budesonide. I think he mentioned it before, but was hesitant given how sensitive she was to prednisone. But I'll give it a try.

Thanks for the help folks.

 

are you able to get any tests in the evening? I really, really think she's bouncing - which suggests it's possible there are low numbers somewhere.

by the way, you can click "watch thread" from the top of this page (right side on my computer) and there is an option to get emails to responses.