Getting off Humulin N

Hello! I'm Kris from Pennsylvania and this is my first post here.

Some background: My cat 5 1/2-year-old cat Luke was diagnosed with diabetes a month ago. Our vet prescribed Humulin N as ProZinc was currently unavailable. I had my reservations, based on what I read here, but was willing to give it a try based on the fact this vet has treated our cats well over the years.

Luke's numbers were in the high 500's when I first brought him in to be diagnosed. They kept him overnight and did a curve, then sent him home. After a week on 4 units of N, a glucose check said his levels were back in the 500's. They increased him to 5 units, at which point he started looking and acting a lot healthier, but after two weeks, his glucose levels were in the high 300's. We tried another week at 6 units and they're still in the 300's. ProZinc is back and we're switching to it, starting tomorrow morning! I was told to give him no insulin with his daily feed tonight and start the insulin tomorrow morning. Does that sound right to you guys?

The vet also said that home testing "wasn't necessary" but I want to start it anyway. I have to admit, the idea makes me nervous. It seems so complicated. Luke is a very patient patient. it's me that's anxious. LOL.

Any advice would be welcome!

edited to fix numbers.

Can't help with the dosing question as my girl is on Levemir but let em go hunt up a few experienced Prozinc users to give you a hand.

And Welcome to the FDMB Family.

Mel, Maxwell, Autumn & The Fur Gang

Hello!
Home testing really isn't hard, and you don't need your vet's approval (although it helps). My vet actually encourages home testing. It saves me money and it gives her better numbers than she could get at the office. Stress can send BG values higher than normal so office testing can give them less accurate numbers.

My Chester is so good about testing - he knows the phrase "Test and Treat!" and he comes running to our spot on the couch. He doesn't LOVE theear sticks, but it's worth it for the treat. We use freeze-dried chicken breast but he also loves the freeze-dried shrimp.

There are a lot of videos online about how to get a BG test.
You don't need to get a special pet meter. Most everyone here uses a human glucometer, which is accurate enough to check trends and patterns. Some of the most recommended meters come from Walmart - the ReLion meters cost less than $20 and the strips are some of the least expensive out there. Not to mention, you can always run to Walmart in the middle of the night if you run out of strips. You can also order inexpensive meters online from the affiliate site American Diabetes wholesale (just click through the ad at the top of the page here). I use an Arkay Glucocard Vital. Anything that sips up a small sample and doesn't require coding works well.
You'll also need lancets (those are pretty cheap too). I use 28 gauge - they get me a good blood drop most of the time. I freehand my lancets. Some people use the lancet pen. It all depends what you are more comfortable doing. I can aim the lancet better by myself and Chester didn't like the CLICK right in his ear. You just aim for the outside edge of the ear. Some people recommend using a warm rice sock to make blood come just a little easier.

Welcome on!

I cant advise on prozinc but you definately want to home test. Its the only way to keep him safe from a hypo etc.. you dont want to shoot him when he is too low and cause a hypo and you want to know how low he goes during the day and adjust the dose accordingly.

Many people here home test. Here are some tips https://docs.google.com/document/d/13c_CPZVKz27fD_6aVbsguadJKvjSrSAkD7flgPPhEag/pub and below are the supplies you need.



Getting started shopping list
1. Meter ie Walmart Relion
2. Matching strips
3. Lancets - little sticks to poke the ear to get blood . new members usually start with a larger gauge lancet such as 28g or 29g until the ear learns to bleed. Optional - lancing tool.
4. Cotton balls to stem the blood
5. Neosporin ointment to heal the wound
6. Ketone urine test strips ie Ketostix or ketodiastix - Important to check ketones when blood is high
7. Treats for the cat - like freeze dried chicken
8. karo syrup/corn syrup or honey if you dont have it at home - for hypo emergencies to bring blood sugar up fast
9. A couple of cans of fancy feast gravy lovers - for hypo emergencies to bring blood sugar up fast

What dose does the vet suggest for starting with ProZinc? This can be tricky. He was on quite a big dose of Humulin but we really don't know how it was working. (We need preshot numbers and then midcycle numbers. It's the midcycle number that shows us how low the insulin is taking him.) It is always better to start on a lower dose and work your way up. If you start at a higher dose and he goes too low, you are in a dangerous situation and you have to guess how much to reduce.

What are you feeding?

Have you tried testing? That would influence my decision about the starting dose - whether you are confident you can get numbers when you need them.

Can you try testing now and let us help you get it going?

Thank you, everyone, for your warm welcome!

Thanks Wendy&Tiggy for the link and the shopping list. I bought all those things after first visiting this site--imagine my surprise when my vet said I wouldn't need to home test, and only needed to lay in some pancake syrup and their emergency number in case of hypo. But I tried it their way and it didn't work so well!

Sue and Oliver, here's my reply to your questions:

What dose does the vet suggest for starting with ProZinc? This can be tricky. He was on quite a big dose of Humulin but we really don't know how it was working. (We need preshot numbers and then midcycle numbers. It's the midcycle number that shows us how low the insulin is taking him.) It is always better to start on a lower dose and work your way up. If you start at a higher dose and he goes too low, you are in a dangerous situation and you have to guess how much to reduce.

The vet recommended 1.5 units of ProZinc.

What are you feeding?

He's eating the same thing he was eating before he was diagnosed, Iams dry and Fancy Feast with gravy. I know those are high-carb but the vet didn't recommend any change to his diet until I brought it up on a subsequent visit. Then they offered to give me a prescription for Hills. I went home to read more about it, and realized switching food while he was on so much Insulin could be dangerous and called to double-check. A vet tech told me I was right. So I haven't made any change to his diet. They don't seem too into that there!

Have you tried testing? That would influence my decision about the starting dose - whether you are confident you can get numbers when you need them.

Can you try testing now and let us help you get it going?

I got a testing kit from Walgreen's. I just read all the directions and will try it right now!

Thank you SO much for the help.

Make sure you have a big enough lancet (31 is what humans use - 25 to 27 lancets work better for beginning diabetics) and that you heat the ear.

Let's see what your number is. That might help with figuring out the dose.

How do you tell how big the lancet it? I used the one that came with the kit, but can't find anywhere in there that tells me what size it is.

Testing didn't go so well. His ears are black, making it hard to find the vein, and I don't have a flashlight, so I decided to go with the paw until I can get one tomorrow. I first tested the little gun on myself and it seemed to work fine (didn't even hurt!) then tried three times with his paw. Each time there was a little blood but the test strip wouldn't register it. Now he's in hiding and I'm getting pressure from my family to just "do what the vet says and don't worry about it".

Autumn's ears are black as well, so with her I test on the inside of the ear (the non-furry side) instead of on the outside (the furry side). I just kinda fold her ear back against the rice sock and use it to back the ear when I do the poke. It doesn't matter which side of the ear, and at least with Autumn the inside of her ear is white making it much easier to see where to poke.

Mel, Maxwell, Autumn & The Fur Gang

I would lose the lancet device and freehand the lancet -it gives you more control over depth and angle etc.

I am surprised your family would recommend you give up so easily! Many newbies have issues at first.. see my tips (in a prior post above)

How do you tell how big the lancet it? I used the one that came with the kit, but can't find anywhere in there that tells me what size it is.

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Its probably 30g. You should try and find 28-29g.

I got a flashlight from ebay - search "mini usb torch" from China for a couple of bucks. Charges plugged into your laptop and is nice and flat and small and easy to put behind the ear and press against.

Wendy

If it came with the kit, it is probably one of the smaller ones. You might be able to double poke (second quick poke) in the same spot and get a better sample. I can't emphasize enough the importance of heating the ear (or paw) until it is nice and warm and the blood has risen to the surface.

I'd give it a while, have some yummy treats out and let him eat them while you are heating the ear and then poking.

If you can't get it (and lots of us couldn't on the first try or first day or first week :mrgreen: ) I would give one unit tomorrow and keep trying. Your vet's 1.5 is probably fine but we like starting low and going slow. You can always increase but you can't get the insulin out once it is in.....

You should be testing for ketones as you are changing insulins and reducing the dose. Tomorrow, buy ketostix at the drug store (just like humans use) You are going to be sticking them in his urine stream. (I know, we do sound like we are completely crazy, but we have lots of tricks for getting samples if he is shy and won't cooperate.)

Now he's in hiding and I'm getting pressure from my family to just "do what the vet says and don't worry about it".

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Bad advice, but they've never had to deal with this like you are trying to. You're doing what's best for your sweet kitty!

The starting dose advice of 1.5u from your vet really isn't terrible. We normally suggest 1 unit, every 12 hours, for starters. 1.5u is certainly better advice than 4, 5 or 6 units of Humulin! Those high doses might be exactly why his numbers stayed up in the 400-500 range. Sometimes too much insulin can cause the numbers to get worse instead of better, and are also extremely risky. It's likely that a few hours after those doses, Luke's numbers were very low, maybe even dangerously so. Humulin works okay on dogs, but with cats, it is too harsh, and doesn't last long enough to do much good. Prozinc is a better choice for sure.

The lancets that came with the device are probably the smaller size, like 30, 31 or 33 gauge. I had the same problem at first, so I went to walmart and bought a box of 25 gauge, and was finally able to get blood on the first try with those. Mel's idea of trying the "inside" surface of the ear is a good suggestion. I've read lots of folks with black cats have better luck that way. If you manage to get a good sized drop, you can "scoop" it off of the ear with a fingernail, then let Luke go, and then you can "sip" it off the nail with the meter strip without all the stress of an unhappy cat getting in your way. Make sure to give him a treat after every test, whether you get blood or not. That'll make him more receptive of the idea that Mom is suddenly chasing him all over the house with pointy objects. ;-)

And your vet is just plain wrong on all of the food advice or lack of advice. Feeding Hill's dry is sort of like giving him Cap'n Crunch with syrup on top. It's really a terrible food for a diabetic cat. Worse even than the FF gravy and dry you were feeding. If you can convince Luke that FF classic flavors are the best thing ever, you'll see an improvement in his numbers just from that.

Carl

Check my signature link Secondary Monitoring Tools for urine ketone testing tips, and a description of some other things to monitor.

Thanks everyone! I really appreciate all the responses.


Carl & Bob:

I took your advice to “go slow” and started Luke on 1 unit of ProZinc this morning. I'll be watching him closely until I can get to the store, where I'll ask the pharmacist for a larger lancet and try testing on the inside of the ear. I like the idea of scooping the blood off with a fingernail—his wriggling was part of the problem the other test didn't work, I think.

Luke does like Fancy Feat Classic, not as much as the gravy, but he'll eat it—in fact, he had that his morning with a little dry food. I don't want to make drastic changes to his diet until I've got this testing thing down.



Carl & Bob and Wendy & Tiggy:

My family is concerned that I'm getting “all worked up” about the cat and doing unnecessary things that are just getting everyone upset. They mean well, but I'm having difficulty convincing them that just testing him once a week at the vet's isn't enough.



Sue & Oliver and BJM:

There are three other cats so ketone testing is going to be tricky. I suppose I'll have to isolate him until he goes? He's going to love that.

Sounds like you have a good plan. Sometimes mixing a little warm water to make a gravy makes the classic flavors more palatable.

For the ketones. Our Oliver would not let us watch him pee. So we filled a clean litter box with aquarium gravel and left him in there alone. He couldn't stand not "christening" the clean box so we got our sample in no time. The gravel didn't absorb the urine so we could get a good test.

Thanks! I'll try that warm water trick. He loves gravy so that might work.

He couldn't stand not "christening" the clean box so we got our sample in no time. The gravel didn't absorb the urine so we could get a good test.

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LOL! You're right, cats do that! Maybe that part won't be as hard as I thought. I'll add a small box and some gravel to my shopping list.

I think a lot of us had similar reactions with family and friends - I convinced my husband by comparing the numbers that it cost me to test at home with how much the vet would charge - he quickly became a believer!
Most friends just thought I was mad - apart from the couple who are cat-people

But now Honey is OTJ, has put weight back on, can climb, play and purr again - the doubters are changing their minds

Just keep hanging in there - the early days are the worse :thumbup