? My 1st GREEN! How do I regulate my doses to prevent hypo with Novolin?

Becky and Gray-Gray

Becky and Gray-Gray

Member
Hi everyone, I am so thrilled to get my first green number!!!! But now I have this overwhelming fear of hypo’s. The last three cycles have progressively dropped since I’ve upped Gray-Gray’s dose from 0.75u to 1.0u and have begun weighing out her food. I am very nervous going into tonight’s PMPS and whether or not to stick with the 1.0u or to go back to the 0.75u. I work Monday-Friday and am unable to monitor the am cycle (This is what scares me the most). I monitored both am and pm cycle yesterday because I was home all day and new I wouldn’t be able monitor this morning as I was not going to be home. As soon as I got home This morning I tested her and hit green. Green is good, but now I’m scared because the green was at +5 and her Nadir is usually at +3 leading me to believe her BG was lower than this hours earlier and it’s rising up now. If you use Novolin what are your thoughts on this me keeping her dose at 1.0 or dropping it back down to 0.75?
 
That green number that Gray-Gray got is still at the high end of the green range and a safe number. Scary though.

You do have that timed feeder that you use. Did Gray-Gray eat 1 or more meals in the timed feeder this AM?

Remember, you also stopped using the W/d food earlier this month and are using a much lower carb food now, plus you are feeding less food. My gut is saying lower the dose back to 0.75U for now.

You hold the needle. The ultimate decision is yours.

I haven't used Novolin N in years for one of my cats, and when I did, I quickly got them switched to Lantus.
 
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Yes, she did eat one of her timed meals prior to that reading. My gut intuition is telling me to decrease to 0.75 but it’s always nice to hear your thoughts bc I’m still not confident in my decisions yet. I Will be asking my vet Saturday about switching to Lantus. Gray-Grays SS confirms the Novolin wears off quickly, plus the AAHA document you shared has excellent info as well! TY!
 
Thank you!!!! I began giving her a teaspoon of pumpkin to try to loosen her stool today at her pm per shot meal and I was sort of freaking out bc I had my first reading ever over 500! Eek! Thank you for checking in!
 
Checked in on you and Gray-Gray again this morning. While it's not good and a bit scary to see those high numbers, it's hard to know the why behind them. Checking for ketones in the urine is a good idea when the numbers are high like that.

Saw your note on the SS in the remarks column wondering if the vacuum cleaner was causing wonky numbers. Or if the stress from running the vacuum caused the spike in BG. :smuggrin:

We know that stress can cause the BG levels to spike. Researchers have found that giving a cat a bath can spike the BG levels, especially if the cat is struggling or vocalizing. Spike was about 80-90 points in one study. The study went on to say, the glucose levels went back to normal for about half the cats within 90 minutes. Although Gray-Gray may not like the vacuum cleaner and runs and hides under the bed somewhere, you are not holding her while you vacuum and making her struggle. At least I don't think you are. Personally, I've never had a cat that liked the vacuum cleaner and would tolerate being held while vacuuming. ;)

As long as you are handling her gently and she is calm while you are BG testing, it's unlikely the BG readings you are taking are higher because of your handling. "Careful handling techniques that minimize struggling associated with blood collection may reduce the incidence of stress hyperglycemia in cats." Stress hyperglycemia is one of the reasons that home testing for our diabetic cats is so highly recommended.

If we could only figure out why BG readings one day were so inconsistent, we'd probably win a nobel prize. Did she play more? feeling a bit sleepier than normal? eat a bit more or less? saw a squirrel outside and ran around inside the house from room to room playing 'catch the squirrel' game? saw a strange cat at the window in 'HER territory'?

These are the types of questions we sometimes ask ourselves in this journey with our diabetic cats. The answer is, we'll never really know why the BG readings vary so much, day to day, hour to hour. We monitor the best we can, we feed the lower carb wet cat foods that are better for diabetic cats, we give our cats insulin. Those are the only 3 things we have control over. We do the best we can.

Becky! Please don't make me laugh too hard. But please keep making any notes in the SS you think may be relevant.
 
One other thought, because you noted the test strips look different. Did you get the Relion Prime test strips or the Relion Premier test strips?

Can you take a picture of old box, new box and strips and upload it here?
 
Deb & Wink said:
One other thought, because you noted the test strips look different. Did you get the Relion Prime test strips or the Relion Premier test strips?

Can you take a picture of old box, new box and strips and upload it here?
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Great idea! I will definitely do that when I return home from work and after I dig through the trash for the old box :facepalm:. Good thing trash day isn’t until tomorrow otherwise they’d be GONE:confused:
 
I will do almost anything for my kitty! A pair of rubber gloves, picking through trash, and Dumpster diving at the bottom of a trash bag I have found the old test strips and bottle ... here are the images of the original strips and container!
 

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With clean hands, no gloves, and no dumpster diving I have the new test strips images ☺️‼️Here are the new test strips:
 

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The bottles look the same, yes.... BUT do you agree that the strips are different?! The old original strips have a hole but the new strips do not‼️Weird?!?!
 
I saw that little rectangular block area on the end of the strips that gets pushed into the meter. Looks like on the old batch of strips, that area was punched out. Now on the new strips, that area is filled in.

Was looking on the internet searching for any recall info, and there is none for those test strips.
You could take them to the pharmacy and ask if there is a problem with the strips.
 
Deb & Wink said:
I saw that little rectangular block area on the end of the strips that gets pushed into the meter. Looks like on the old batch of strips, that area was punched out. Now on the new strips, that area is filled in.

Was looking on the internet searching for any recall info, and there is none for those test strips.
You could take them to the pharmacy and ask if there is a problem with the strips.
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Excellent suggestion! Thank you! I will do that Saturday!
 
  • Surfing in the blues for Gray-Gray at mid-cycle again.
  • See that you only increased to 1U of Novolin N. Your vet wanted you to double the dose, from 0.75U to 1.5U. Don't think I would have done that entire increase either.
  • Do you have the BG readings that were done at the vet on 1/18? Curve day? You could enter those in your SS.
  • Did you share your SS with your vet? Always good to do that.
  • Did your vet give you a prescription for the Lantus?
  • You want to buy the Lantus in the smaller cartridge size. Sometimes called an insulin pen.
  • You'll use the same U100 (insulin concentration), 3/10 cc capacity, 1/2U markings on syringe barrel, needle length is up to you as you do with the Novolin N.
  • Ordering Lantus from Mark's Marine Pharmacy in Canada will save you a lot of money. Many people here use lantus and order from there. Ordering Lantus, Basaglar, or Levemir from Canadian pharmacies They are reputable and very helpful to our members. Pharmacists are willing to answer many questions.
  • See Gray-Gray has gained some weight. Guess your estimate of weighing her at home on your scale was close to what she actually weighs. So now you can check her weight yourself at home regularly and note that on the SS. Once a week is enough.
  • Was the vet happy with Gray-Gray's weight? and body condition score?
 
Deb & Wink said:
  • Surfing in the blues for Gray-Gray at mid-cycle again.
  • See that you only increased to 1U of Novolin N. Your vet wanted you to double the dose, from 0.75U to 1.5U. Don't think I would have done that entire increase either.
  • Do you have the BG readings that were done at the vet on 1/18? Curve day? You could enter those in your SS.
  • Did you share your SS with your vet? Always good to do that.
  • Did your vet give you a prescription for the Lantus?
  • You want to buy the Lantus in the smaller cartridge size. Sometimes called an insulin pen.
  • You'll use the same U100 (insulin concentration), 3/10 cc capacity, 1/2U markings on syringe barrel, needle length is up to you as you do with the Novolin N.
  • Ordering Lantus from Mark's Marine Pharmacy in Canada will save you a lot of money. Many people here use lantus and order from there. Ordering Lantus, Basaglar, or Levemir from Canadian pharmacies They are reputable and very helpful to our members. Pharmacists are willing to answer many questions.
  • See Gray-Gray has gained some weight. Guess your estimate of weighing her at home on your scale was close to what she actually weighs. So now you can check her weight yourself at home regularly and note that on the SS. Once a week is enough.
  • Was the vet happy with Gray-Gray's weight? and body condition score?
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Hi there,

The vet vet was very pleased with Gray-Grays weight gain and happy with her size. The vet showed me the curve on paper, however she kept it and I did not receive a copy. I did share my SS with my vet. She liked it and particularly liked the green which is why she suggested upping dose to 1.5u. I received pleasant excitement about wanting to switch to Lantus. The prescription was faxed to Marks pharmacy today. I still need to call them or create an account on their webpage to place the order for delivery. I’m not sure quite how to do it as I haven’t looked into it yet online. I’m not sure whether the prescription is for the vial or the pen as I haven’t seen the script since it was faxed in. Vet suggested ordering a couple now to last me thru the summer (bc I live in the Southern California Mojave Desert and shipping in the summer with triple digit temperatures is not advised). She wrote the script for 1 unit bid but suggested I start off with 0.5unit to begin with to see how she’ll react. Any recommendations on how to proceed to place my order with Marks Pharm? Thank you so much for your guidance :)
 
The best I can do is point you to their facebook page. Please be aware they are backlogged, due to a blizzard.

See this post pinned to the top of the Feline Health Main and Welcome forum
Mark's Marine Pharmacy backlog in orders.

Order the pens. More cost effective. You do not need the pen needles. You will be using an insulin syringe to withdraw the insulin from the pen.

Video on how to do that is here.
 
Becky and Gray-Gray said:
Hi there,

The vet vet was very pleased with Gray-Grays weight gain and happy with her size. The vet showed me the curve on paper, however she kept it and I did not receive a copy. I did share my SS with my vet. She liked it and particularly liked the green which is why she suggested upping dose to 1.5u. I received pleasant excitement about wanting to switch to Lantus. The prescription was faxed to Marks pharmacy today. I still need to call them or create an account on their webpage to place the order for delivery. I’m not sure quite how to do it as I haven’t looked into it yet online. I’m not sure whether the prescription is for the vial or the pen as I haven’t seen the script since it was faxed in. Vet suggested ordering a couple now to last me thru the summer (bc I live in the Southern California Mojave Desert and shipping in the summer with triple digit temperatures is not advised). She wrote the script for 1 unit bid but suggested I start off with 0.5unit to begin with to see how she’ll react. Any recommendations on how to proceed to place my order with Marks Pharm? Thank you so much for your guidance :)
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I know you didn’t specifically ask, but I wouldn’t start at less than 0.75u. You’d likely be fine with 1u but if you want to be cautious, which is fine, 0.75u is good.
 
Marje and Gracie said:
I know you didn’t specifically ask, but I wouldn’t start at less than 0.75u. You’d likely be fine with 1u but if you want to be cautious, which is fine, 0.75u is good.
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Thank you for input. I think I posted about this in another place. I was curious about dosage and considering basaglar is a depot insulin I didn’t know how long after meal to wait to shoot?
 
Becky, the when to feed with using Lantus or Basaglar is quite different than it is with the Novolin N insulin you were using.

Because NPH insulins (Like Novolin N) onset very quickly and tend to cause a very steep and rapid drop in BG, you needed to Test, feed first, wait 45 min to an hour, test again to make sure the BG's were still high enough to give insulin and then give the Novolin N insulin.That waiting time after feeding was so some of the food could be digested and start to balance out the rapid onset of the NPH. You were trying to balance out the steep drops with the NPH insulin also.

Now, you do not have to do that waiting.

Lantus is a gentler and longer duration insulin. Test, feed, shoot all in a 15 minute window of time is what most people do that use Lantus.

When do you expect to receive your Lantus insulin? Do you know yet? You could contact Marks Marine Pharmacy to find out.
How soon after you receive the new Lantus insulin will you be using it for Gray-Gray?
 
Deb & Wink said:
Becky, the when to feed with using Lantus or Basaglar is quite different than it is with the Novolin N insulin you were using.

Because NPH insulins (Like Novolin N) onset very quickly and tend to cause a very steep and rapid drop in BG, you needed to Test, feed first, wait 45 min to an hour, test again to make sure the BG's were still high enough to give insulin and then give the Novolin N insulin.That waiting time after feeding was so some of the food could be digested and start to balance out the rapid onset of the NPH. You were trying to balance out the steep drops with the NPH insulin also.

Now, you do not have to do that waiting.

Lantus is a gentler and longer duration insulin. Test, feed, shoot all in a 15 minute window of time is what most people do that use Lantus.

When do you expect to receive your Lantus insulin? Do you know yet? You could contact Marks Marine Pharmacy to find out.
How soon after you receive the new Lantus insulin will you be using it for Gray-Gray?
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My Lantus is coming airmail Saturday. I was planning on starting on Saturday. What do you think? I’m apprehensive to start Saturday bc I am flying out of town next a Thursday and Gray-Gray will be boarded at the hospital while I’m gone for five days.
 
Bron and Sheba (GA) said:
Are they going to be testing the BGs while Gray-Gray is being boarded?
Do you think he will eat well for them?
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No, they will not be testing BG as she will be in the boarding facility and not the vets treatment facility. There will not be a problem as she will definitely eat but they will not be accommodating my feeding schedule and will only feed twice daily. Maybe it’s best I start Basaglar once I return back from my trip....
 
Yes I think it would be better to wait and start the new insulin when you get home. Also post the day before you board him and ask about the vacation dose.... we always suggest a reduction in dose if you are going to be boarding the cat where there will be no testing.... and if they are not going to be accomodating you with a feeding schedule ( that’s pathetic really) but common.
What meals will he miss out on?
 
Bron and Sheba (GA) said:
Yes I think it would be better to wait and start the new insulin when you get home. Also post the day before you board him and ask about the vacation dose.... we always suggest a reduction in dose if you are going to be boarding the cat where there will be no testing.... and if they are not going to be accomodating you with a feeding schedule ( that’s pathetic really) but common.
What meals will he miss out on?
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She eats a total of three-3oz fancy feast Classic Pate cans daily. My feeding schedule is 2.5oz. At 5:30, then 1oz in food timer that opens approximately at 9:00 & 12:30 for each cycle (sometime she breaks into the food timer and eats sooner). The boarding facility feeds twice daily am and pm. I’m not sure of the exact time. I’ve been shooting 1u twice daily and am surfing blues. She has only ever has 1 green.... I’m not too concerned with her BG dropping to low while I’m gone and will have them shoot 1u.
 
Have a safe trip. Gray-Gray will really miss you while you are away.
If you have an old piece of clothing, or a bed that Gray-Gray uses, see if the boarding facility will let you bring that so she has something that smells familiar while she is in a strange place.

She may be a bit standoffish when you first get back, but she may want to cling to you a bit also. Our cats love us so much and don't understand why they had to be someplace strange with people they didn't know.

She'll say "HEY! Home! I remember this place." She'll sniff and explore your place as soon as she gets back home and out of the carrier. Then she'll go curl up in her favorite spot. As least, that is what my cat does when coming back from a car ride to the vet and back home.
 
:nailbiting:
Deb & Wink said:
Have a safe trip. Gray-Gray will really miss you while you are away.
If you have an old piece of clothing, or a bed that Gray-Gray uses, see if the boarding facility will let you bring that so she has something that smells familiar while she is in a strange place.

She may be a bit standoffish when you first get back, but she may want to cling to you a bit also. Our cats love us so much and don't understand why they had to be someplace strange with people they didn't know.

She'll say "HEY! Home! I remember this place." She'll sniff and explore your place as soon as she gets back home and out of the carrier. Then she'll go curl up in her favorite spot. As least, that is what my cat does when coming back from a car ride to the vet and back home.
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Thank you!!! I have just received my Basaglar from Marks Pharmacy and I can finally rest and relax. Deb....... I had the most god-awful experience with the United States Post Office getting my Basaglar today :(!!!! I received my text alert saying “delivery attempted- no authorized recipient available”. I immediately ran out my front door looking around for a deliver person. The only person I saw was my neighbor wheeling their trash receptacle back to their house. I asked the neighbor if they saw a delivery person and they said yes, they never came up my driveway to the house, and put a note in my mailbox. At this moment I was frantic, it’s Saturday 2/1, Marks shipped the medicine on 1/28, if it sits in the post office until Monday it will for sure spoil. At this moment it was 2:00, and the post office closed at 1:00. I grab my undeliverable note from the mailbox, hop into my car, and drive over to the post office knowing well enough it’s closed. I hoped I could find a little white car with a man who fit the description my neighbor told me taking the package back to the post office:D. Sure enough the entire post office was closed and shut down :arghh:. So I start going around the back and find a gate open that says “authorized personnel only” and I drive in! :eek: After I drive in I see a loading dock with a door with a pin pad propped open that says “authorized personnel only”, so I enter :nailbiting:! I’m nervous I’ll get arrested and shout out “hello”. A lady comes and I explain my story, she says “ I know where it’s at”, turns and walks away. Moments later a mail carrier in uniform presents the package to me and I begin crying :smuggrin:. I thank the man and sign for it. I explained how nobody knocked on my door and he confirmed that they have been getting a lot of complaints about that. I walked back to my car and cried and laughed at the same time. I cannot believe I actually received my package and that I was able to enter in the back:woot:! On Monday I will go to the post office when it’s technically open and issue a formal complaint. I have the description of the car and delivery person from my neighbor who saw the entire thing and how they never came up my driveway to my door. This all just happened a few hours ago and I feel so very emotionally exhausted! It is time for puppy-dog snuggles! I’d snuggle with Gray-Gray, but she doesn’t like Snuggles very much :cat:! Time to rest, what a day!!!
 
I am glad you got the insulin. That is so annoying when that sort of thing happens. It has happened to me but not with such an important parcel.
Good on you for using your initiative!
I'd complain too.
 
Bron and Sheba (GA) said:
I am glad you got the insulin. That is so annoying when that sort of thing happens. It has happened to me but not with such an important parcel.
Good on you for using your initiative!
I'd complain too.
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Thank you! I honestly had no hope that I’d actually get it. I guess lesson learned that you never know unless you try! I never want to go thru this ordeal again, it was so emotionally exhausting :nailbiting:. Sort of funny now a little bit but oh so stressful!
 
Glad you got the new insulin for Gray-Gray. Even if you did have to chase around after the mailman and go into the Authorized Personnel Only Area, it was worth it.

Now, you will have the new Basaglar insulin waiting at home for you went you come back from your trip. Safely stored in the fridge. Way to go!
 
Hi Becky,

Haven't seen a post from you in a while. How are things going? Back from time away/vacation yet?
 
Deb & Wink said:
Hi Becky,

Haven't seen a post from you in a while. How are things going? Back from time away/vacation yet?
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Hi Deb! Thank you so much for checking in on me. I am actually flying back to Ca today and will be picking up GrayGray from the vets boarding facility when I get off work tomorrow. I figured I could fine tune my knowledge while on the airplane about glargine by reading the remainder of the sticky note posts.

When I pick GrayGray up Tuesday evening I didn’t know if I should start her glargine right away or start it Wednesday or Thursday morning.... I was thinking it takes about 2-3 days to build up into her body since it’s a depot insulin, so if I started on Wednesday or Thursday I could monitor her throughout the day while I’m not working on Saturday.... What are your thoughts on that Deb? Ps I was thinking of starting her in 1/2 unit.
 
SLGS. Start low and go slow.
Could you start a thread over in the lantus forum and ask that question. Let people know you are switching from Novolin N to Basaglar and what your Novolin N dose was.

I think somewhere between 0.5 and 0.75 U Basaglar should be right. I'm a bit conservative on the dosing then some people over there might be.
When you switch, you really want to be able to get some mid-cycle tests in those first few days. +3, +6, +9.

They'll let you know some of the differences between the 2 insulins.

Test, feed, shoot cycle. No more test, feed, wait 45 -60 minutes, test, shoot.

p.s. Everyone is being asked to remove any location identifying information from their User signature. So no location like west coast and no PCT.
 
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