Need some experienced advice with idea from vet (Novolin)

Vet and I are working on getting tests done thru MSU for Acro and IAA. Pumpkin bottomed out last night to 74. I caught it when I got home. He ate, had his 11 units of Lantus. But for some reason he bottomed out last night...?? This morning he was so high it wouldn't register on the Alpha Trak...................................
Vet and I are at a loss.

He wanted me to put this out there to the message board and see if anyone has tried this................
He has had luck with switching insulin to Novolin 70/30. He said its 70 percent normal long acting insulin and 30 percent regular short acting insulin. He has used with success in dogs that have been persistently high on above average appropriate dosages. But he has NEVER tried this with a cat. Has anyone tried something like this?? If so did it work/help?

Bless my vet.......he is trying so hard to help Pumpkin and I. I mean how many vets give you their personal cell number nowadays...........He knows you guys have given us some good advice. Any info you have about this or Novolin. Saw some info that it is harsh.......any help is appreciated.

 

Hi Katrina,

There have been some cats here who have been treated with both basal insulin (Lantus or Levemir) and also given bolus insulin (to the best of my knowledge the second insulin was Novolin R, not Novolin N).

I'm tagging @Sienne and Gabby (GA) and @Wendy&Neko to ask if they might be able to give you some information to take back to your vet.


Mogs
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@Critter Mom
Mogs are you feeling any better, that damn cold is just lingering

 

@Diane Tyler's Mom -

Alas, no, head's still full of cotton wool and now my digestive system's playing up. Feel so ill.

Thank you for asking after me, Diane. I'm keeping you in my prayers.

(((Diane)))




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Following...Novolin is very harsh, I know it is an excellent choice for canines though.

Would love to hear results on the IAA/Acro tests ... bet that will explain a lot.

 

Have you updated your SS? I can’t see the 74.

I don’t think switching to Novolin N is the answer but how great that your vet is interested in what FDMB recommends.

Most cats here that are high dose switch to levemir insulin, which is very similar to Lantus except it has a later onset and it doesn’t sting in high doses like Lantus does.
There are a few people here who can help you with a dosing technique where they give the dose of levemir 12 hourly routinely and then they give a dose of R insulin (starting very low and monitoring closely) at specific times to help bring down the BG. @Marje and Gracie can also help you with this as well as Wendy.

 

I have seen just one person use N with Levemir, but not in a high dose cat. None of the Novolin insulins are particularly long lasting. At this point, I would strongly recommend a switch to Levemir. If needed R could be added later, but I would wait to see the results of the IAA or acro tests say, unless you are seeing ketones.

As Bron said, we can help more when the spreadsheet is up to date.

 

Meant to add, cats have much faster metabolisms than dogs, so a solution that works for them, doesn’t in cats. That is why the AAHA guidelines on treating diabetes in cats and dogs suggests different basal insulins for each one.

Good to see your vet is an out of the box thinker though.

 

@Wendy&Neko - Thank you!

I have a question that maybe you could answer: what sort of action profile does Novolin R have in cats (onset, peak effect, duration)?


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Novolin 70/30 is 70% N and 30% R, which is stacking a super-short acting insulin on top of a short-acting insulin. In other words, you’d be dosing a harsh and extremely harsh insulin simultaneously. And I doubt you’d get 12 hours of duration given the higher metabolism of cats, so you might have to look at TID dosing as well. *Shudder* I think it’s a creative idea but there are probably better options. (And to be honest, if I were even remotely considering such an aggressive combination, I’d probably buy separate bottles of N and R so I could dose individually and control the timing).

I know of one person who tried 70/30. I don’t think it turned out well.

I’ve used R with Lantus as well as with Prozinc, but you have to be very, very careful with it. I agree that you might want to consider Levemir.

Hopefully the IAA and Acro tests will be enlightening.

As for reasons for the unexpected low number... it’s possible you finally broke through if he has IAA, or that the tumor is pulsating if he has acro. Was anything different? Tubby used to have a crazy drop after he had a bath. He’d also throw me lows when I took him to the vet. And of course the obvious: there’s no chance you accidentally double-dosed him or inadvertently used a u-40 syringe, right?

 

Sorry you're still not feeling better

 

Not Wendy but I’ll answer since Bron tagged me in this thread. First, I agree with trying to switch to Levemir and then possibly use Normalin/Humulin R (same thing but latter is much cheaper) and not the N version.

R has a very quick onset, typically nadirs by +2, and is waning by +4. Of course, ECID so there are some cats that can get a longer duration out of it up to even +6 but in all the time I used it, the numbers were usually headed back up by +4.

 

@Marje and Gracie -

Thank you for the information about R. I knew that it was rapid-acting, but that was about it.

Hope you're feeling better, Marje.


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@Marje and Gracie -

Forgot to ask, does it drop BG as hard as N does?


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I used Levemir and N with my MurrFee. At the end he was on 25 units Levemir and 25 units N twice daily. He had acromegaly. Levemir was used sine Lantus tends to sting at high doses. I used N since it was a lot less expensive and Levemir. Other acromegaly cats have used Levemir and R but I was too scared to use R.

My Snuffles is becoming a high-dose cat. Presently he is on 4 units Levemir and about 4 units N. I am going to get the IGF-1 and IAA test done next month during his annual exam.

 

What I would do based on your SS wouod be to go to Walmark and get some N insulin and add the N in addition to the Lantus you are currently using. I would start with 1 unit. I you are brave you could use R instead of the N.

 

Not Marje, but I can answer. I don't have familiarity with N, just what I've seen. R can set up some good drops. The goal of using R, when you do it as a bolus, is very small doses so you don't drop more than 100 points over its duration. BTW, Neko was one of those odd ball cats on R, later onset, later nadir. Some cats are very sensitive to R. I have seen a cat on 30 units of Levemir need no more than 0.5 units R, which was also Neko's max dose, and also cats on 60 units of L with 25 units of R. Very much ECID.

I would NOT start at 1 unit. I also would not start a bolus insulin until you have an experienced person willing to "sit" with you as you did it the first few times. There are guidelines about when and how to use R, and more important, guidelines about when NOT to use it. Do not try this alone.

 

But I haven't seen the spreadsheet.

 

Wow! Very different indeed.

Thank you for the additional info, Wendy.


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