Need long acting insulin?

I posted prior (but can't find my original to continue). It was about Milo being on NPH twice a day but not having what I consider good control. He experienced a few episodes of hypoglycemia. I stopped the NPH as a test and went strict low carb diet with seeing his glucose levels staying in the same range without hypoglycemia occurring.
I then contacted the vet about changing him to a long acting insulin. She declined with the reasoning being since he had episodes of hypoglycemia on NPH to have a long acting insulin in his system hypoglycemia could occur and then the lasting effect of the insulin could not be counteracted. She was aware that I stopped the NPH and do strict low carb. Not sure where to take this. I know in the other thread there was something about posting his chart of numbers. (I would have to create this chart.)
I am considering going to another vet for second opinion on this.

 

Previous post
https://www.felinediabetes.com/FDMB/threads/nph-dose-not-seeming-to-give-consistent-control.250625/

 

Can you fill out your signature please so members won't have to keep asking you
I hope you are feeling better



Go all the way up top to you name tap on it and a drop box will appear , you will see the word signature, tap that and just add all your information about Nani and hit save.

Take a look at my signature all about Tyler all signatures are at the end of everyone's posts in gray

Add info we need to help you:

• Caregiver & kitty's name
• DX: Date
• Name of Insulin (do not include dose or frequency)
• Name of your meter
• Diet: "LC wet" or "dry food" or "combo"
• Dosing: TR or SLGS or Custom (if applicable)
• DKA or other recent health issue (if applicable)
• Acro, IAA, or Cushings (if applicable)
• Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.

 

https://www.felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/
Can you please set up your spreadsheet so you can track Milo's BG numbers
It will also explain how it works
If you have trouble setting it up just ask we have members who can help you just ask

Also tagging
@Wendy&Neko

@Sienne and Gabby (GA)

@Chris & China (GA)

 

NPH is not a recommended insulin for cats. If you look at this link AAHA 2018 Guidelines for Managing Diabetes you will see that Lantus or Prozinc are recommended as initial insulins for cats. I think you would be well served finding a vet who would switch you to one of those two.

 

I am working on setting up the spreadsheet.

 

In my post , I wrote how Milo's current vet does not want to put him on long acting insulin due to a few past episodes of hypoglycemia. The thought being since it occurred before with a long acting it could be a problem for it lasting longer in his system should hypoglycemia happen. So, here's the question- does anyone know of a vet the has a focus on diabetes in animals that is around Reading, Harrisburg, Allentown in PA? I am near any of those areas. I just feel that a second opinion is needed. Thank you.
(I do not have his spreadsheet done yet to add to my signature.)

 

I did a Google search. There's a clinic outside of Reading that says they have veterinary endocrinology available. It looks like the only vet school is at University of Pennsylvania which would be some distance from you. You could call their vet clinic and ask if they could provide a referral for an internal medicine specialist or endocrinologist in your area.

Honestly, I don't know why your vet is suggesting NPH. It has not been recommended for treating feline by the American Animal Hospital Assn for th treatment of feline diabetes since 2018. A cat dropping into low numbers is a matter of adjusting the subsequent dose or using higher carb food to bring numbers into a safe range. There's actually a greater danger of numbers dropping fast and low with a shorter acting insulin like NPH. In addition, because it's a shorter acting insulin, there are wide swings in the blood glucose numbers due to the insulin essentially running out by the time of your next shot.

My kitty had an early nadir (low point in the cycle) and was a drama queen. Our spreadsheet is attached to my signature. (Don't get overwhelmed -- I was a testaholic.) I used Lantus for 6.5 years. We were fine!

 

Carolyn -- I'm going to merge your two threads.

 

Well, after checking the area there is no true endocrinologist. Many vets list all diseases as ones they treat. So, I have decided to try a new vet to the area for a second opinion. It took over a month to get in as a new patient but appointment upcoming on Dec. 1. Whether Milo gets NPH on not his sugars stay in the same range with elevation at times. I keep him on strict low carb diet and am more or less spot checking with coverage depending on the result. No further hypoglycemic episodes. I am just looking for better control so fingers crossed.

 

Good luck with the new vet.

 

I hope you find the new vet is helpful in prescribing either Lantus or Prozinc.
One thing I think you need to do is not only test before each dose … which is so important… but to also test during the cycle as well to see how low the dose is taking your kitty.
Please let us know how you get on with the new vet.

 

If you get Lantus, I would get the a lot less expensive Semglee insulin. It is a biosimilar of Lantus and the pharmacist can dispense, with your agreement, Semglee when the script says Lantus.

 

Here is the coupon for semglee
https://www.goodrx.com/semglee
Just put in where you live and the prices will come up for 5 pens

 

It has been a while but here is update for Milo and insulin. We saw the new vet in December, reviewing his numbers, doing labs and discussed insulin. She understands my concerns as she has a diabetic cat who is brittle. After talking, she prefers to start on Prozinc and then do a curve and see the response. We started 1 U bid but I started lower as I was concerned for any reaction. The new insulin is working much better. I did an insulin curve at home and sent in the numbers which she made no changes. As of now Milo continues on Prozinc and his numbers are not all over. Also, no hypoglycemic episodes. Blood work that was done found that Milo is now hyperthyroid so he has been started on Methimazole to regulate his thyroid and we continue to regulate that dosage.
Unfortunately, my other issue continues to be my husband who will still give Milo some dry food that our other cat eats which spikes his glucose. My battle continues with him over this.
Lastly, I want to thank everyone who contributes to this board which has been immensely helpful. I so appreciate the work you all do and especially the database on the different cat foods and their nutritional content.