HUMULIN N and Luga

Hi Everyone
I'm new to the group. I'm hoping there is someone out there that can help me. I have a Tonkenese 10 years old. He has had a very hard life. When we neutered him, he was allergic to the anestesia and died on the table but they revived him several times. Because of that problem, he became blind and couldn't walk. He had seizures frequently. But because of his determination and persistance, he taught himself how to walk, and a little eyesite came back, be he compensates just fine. He is a sweet boy. His name is Luga. We found out Luga had diabeties in May of 2009. He was drinking more and urinating frequently and gaining alot of weight. I suspected diabetes. One day there was urine and blood all over. He had a very bad bladder infection from the diabetes, so we took him to our regular vet and she confimed it. She told us to start him on Lantus - 1unit a day. I didn't know anything about home testing and it really wasn't explained how important it was. So we did that for about a month or so, brining him in frequently for tests, but his levels never went down. Unfortunatley he developed Diabetic Neuropothy. One day I came home and he was so low on his back legs he was having difficulty walking. The vet told me to rush him to emergency. She didn't know if it was neurological or something pertaining to the diabetes. When we got there, it was confirmed that it was the Diabetic Neuropothy. I was crushed to think I did this to my cat. The doctor suggested home testing and taught me how to do it. Luga was then put on Lantus 2 units twice a day. I started home testing and his numbers were all over the place. High - Low - in-between. I called the vet and he said that Luga was probaly having a smoji effect (new to me). He explained that when Luga's numbers go to low, the body compensated and released more insulin. That's the body's way of keeping you alive. A hight number is safer than a lower number. They also neglected to tell me that the Lantus doesn't have much of a shelf life. 4-6 weeks at the most. So we kept trying with the lantus and nothing was working. Even the specialist was perplexed. I suggesed PZI. We tried it and it did absolutely nothing for him, even adjusting doses. In fact, he was so high for that month, his neuropothy became so bad that on my wood floor, he was flopping around like a fish. Pathetic. So now the vet suggested Humulin N - the last choice. He told us to give him 2 units 8 hours apart. After reading some of the postings and learning that the Humulin N can be harsh, I decided to play it safe and only give him only 1 unit. When I took is bg before the shot at 8:30 it was 411. At 2:00 it was 82 (5 1/2 hours later). Because I'm not familiar with this insulin, I was afraid to give him another unit 2 1/2 hours later because I couldn't figure out how low it might have gotten but I tested him at 6:00 p.m. and it was very hight - 469. So I gave him another unit at 6:00 p.m and test again at Midnight and he was 128. I did read on the message board that you should wait a week for the body to get adjusted before you do a curve, so I'm kinda at a loss. I do feel that the 2 units my vet suggested would have been way too much so I think it was the right decision to only give the 1 unit. Can someone out there give me some direction. I really think my "specialist" is just learning along with me. It's been 10 months and Luga is still not regulated. I wouldn't really mind his numbers being a little elevated if it wasn't for his neuropothy. Poor thing can't jump, play or hardly walk. Thank You, Linda
LAMDZINE

Joined: Thu Jan 21, 2010 10:15 am
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Hello, apologies for the not yet answered post here...

I have to run out, but will spend time tonight to answer your questions and bring some N users in to have a look as well.

Good job on reducing to 1 unit.
Start low and learn how the insulin works, let each dose settle in body and see its full potential. This can take 3-5 days. Then you can make decisions based on real info and not risk the shooting past the ideal dose.

Have a good read of the humulin primer, stickied above.

I really suggest not giving insulin early right now. Need to understand when onset, duration and peak are happening.
You can shoot as needed with this insulin, but not before peak, ( usually 3-5 hours after shot) and not without knowing it is rising to a safe level.

I would encourage not shooting under 180 right now.

Hang in there.more to come

Kimmee

 

Hi, Linda. Wow, Luga sure has been through a lot.

Have you read through the N primer yet? Starting dose should be 1u bid - meaning 1u every 12 hours. I don't know why your vet is saying 8 hours apart. Is he meaning 3 doses in 24 hours? IMO, that is not a good place to start with this insulin, although with enough data it can be given that way if necessary.

Since he dropped to 82 on 1u you do not want to give more. However, as you are finding out he is starting high, going low and ending up high again. That could be from his diet or from somogyi rebound - the body releases stored glucose, not insulin because of the drop to what it senses is a dangerous number. 82 is not a dangerous number, it is a normal BG, but his body may not be used to it. He could also have been lower before that.

What I would suggest is testing before every shot and then get tests at 2, 4 & 6 hours after it. That may show you if he is dropping very low much sooner in the cycle. Beau, for instance tested in the low 100 at +2 (two hours after the shot) and I knew we were heading for trouble. He was in the 30s by +3 so I fed him some higher carb food.

Diet is very important in regulating a diabetic cat. Basically, almost any dry food will cause high numbers. Have you read the feline nutrition info on catinfo.org? http://catinfo.org/. You want to be feeding a low carb, canned food diet. I feed Friskies and Fancy Feast low carb varieties. All under about 7% calories form carbs. Here is a link to a page with lists of commercial foods and their carb content: http://binkyspage.tripod.com/canfood.html.

For the neuropathy, you want to start giving him Methyl-B12 (aka Methylcobalamin, Xobaline). I have not used it as neither of my diabetics had neuropathy. But many here have experience with it. Here is a link to some information on the Pet Diabetes Wiki site: http://petdiabetes.wikia.com/wiki/Neuropathy. You might explore that site for other feline diabetes information. It is a great resource. You might post on the Health forum for diabetic cats about the neuropathy - put that in your subject line. You will get help from people with experience with it.

Lastly, I think that "N" is one of the hardest insulins to make work for a cat. I used to use vetsulin and it is similar to N - shorter duration and tends to swing from high to low to high. I think that levemir and lantus are probably the best insulins. They work similarly, but they will also cause the rebound response if the dose is too high. You can buy both in packs of 5 penfills instead of on big vial. Apparently, lantus is not as fragile as was once believed. If it is handled gently, not ever rolled or shaken and kept in the fridge it will last longer. This is what I am reading here now. I do know that levemir will last until it is used up. I just used the same cartridge I opened in June and it was fine.

I think you need a start over with either levemir or lantus, looking into his diet and making sure he is on a low carb wet food, testing before each shot and starting at 1u bid.

Do you have any (more) questions? I was where you are after 6 months with Beau not being regulated. Once I came her, started home testing, changed his diet and lowered his dose, he was regulated in a month.