Starting Hypurine after failed Vetsulin regime

Status
Not open for further replies.
Marlena

Marlena

Member Since 2015
http://www.felinediabetes.com/FDMB/threads/i-am-from-uk-and-feeling-very-overwhelmed.149970/
previous
After struggling with Vetsulin I finally managed to get Hypurin 100% bovine insulin and syringes.
Vet wants me to start with 0.5 unit bd but I can see how difficult it may be to draw such a small dose into the syringe.
His PSAM BGs are about 25 (450) with Accucheck Aviva meter and it was a similar number at the vet's. Rocky was on 2 units Vetsulin. I am going to start Hypurin tomorrow morning so I will have a fresh BG and I am going to use two meters: one as above and the other one is AlphaTrack lent by the vet.
I would like to ask you to help me start new regime for Rocky.
Any input would be most appreciated.
Best wishes to all of you and many thanks for your help.
 
Marlena. I'm not familiar with that insulin at all. As far as using two meters wouldn't that be confusing. Human meters read lower. Is your vet wanting you to use AT just for starting the new insulin so she/he can see how it's doing since that is what they use?
 
@Elizabeth and Bertie, is the Hyperin 100U? I am glad you got it, Marlena. It has worked wonders for Bertie.

For those reading this thread, it is an insulin similar to the PZI we had in the US years ago that, as far as I know, is only available in Europe - maybe just in the UK? The difference between it and ProZinc is that it can have longer cycles. Is that right, Elizabeth?
 
Sue and Oliver (GA) said:
@Elizabeth and Bertie, is the Hyperin 100U? I am glad you got it, Marlena. It has worked wonders for Bertie.

For those reading this thread, it is an insulin similar to the PZI we had in the US years ago that, as far as I know, is only available in Europe - maybe just in the UK? The difference between it and ProZinc is that it can have longer cycles. Is that right, Elizabeth?
Click to expand...

Thank you Sue. Didn't realize there are so many different insulins now. And some only in US and some only available outside the US.
 
Sue and Oliver (GA) said:
For those reading this thread, it is an insulin similar to the PZI we had in the US years ago that, as far as I know, is only available in Europe - maybe just in the UK? The difference between it and ProZinc is that it can have longer cycles. Is that right, Elizabeth?
Click to expand...
Yes, that's pretty much it, Sue. :)
Hypurin bovine PZI is a U100 insulin that's manufactured in the UK. It can be imported to the rest of Europe (and also to Canada for some reason!). Apparently it's the longest lasting of all the insulins, and some cats can have very long cycles on it.
.
 
Elizabeth and Bertie said:
Marlena, which syringes do you have? Do you have 100 iu syringes with half unit markings..?
I think most of us in the UK use these ones:
http://www.amazon.co.uk/MicroFine-0...-U100/dp/B00K86ZO20?tag=felinediabetesfdmb-20
Click to expand...
Dear Eliz,
I have exactly these syringes but I don't think it is possible to do 0.25.
It has been over 8 hours when Rocky had his first shot of Hypurin (0.5 maybe 0.75u) and his BG is now 22 from 16.4. So looks like his BG is not coming down. Do I give PM shot as normal?
 
Marlena said:
I have exactly these syringes but I don't think it is possible to do 0.25.
Click to expand...
There are some pics somewhere on the forum that show what a .25 looks like, Marlena. I'll try to find them for you. (But is Rocky getting .5 at the moment..?)

Marlena said:
It has been over 8 hours when Rocky had his first shot of Hypurin (0.5 maybe 0.75u) and his BG is now 22 from 16.4. So looks like his BG is not coming down. Do I give PM shot as normal?
Click to expand...
He's still got a few hours to go, Marlena, but yes, it looks at this point as though he should get his next shot as normal.

When you give the next shot it will quite possibly have more welly than the first shot. That's because of the overlap. The first shot will still be in Rocky's system even though it's appearing to have little or no effect at this point. The earlier shot will be wearing off as the new shot starts to work.
I found with Bertie that it took a couple of days to get into it's stride (but 'your mileage may vary' ;) ). And you're starting out at a nice low dosage, so, if this dose doesn't have an effect then you can increase it in a while. But it's better to start out low and work up than start with a higher dose and then have to back-pedal....
.
 
Woodsywife said:
Marlena. I'm not familiar with that insulin at all. As far as using two meters wouldn't that be confusing. Human meters read lower. Is your vet wanting you to use AT just for starting the new insulin so she/he can see how it's doing since that is what they use?
Click to expand...
Woodsywife, I am not going to use two meters at the same time although doing so wasn't really problematic. The idea is to see how they compare but I have to admit I really like AlphaTrak. Like everything with FD even the glucometers are not easy to understand and figure out. Human meters can be whole blood or plasma calibrated so there a difference in BG numbers between them, then there is animal one calibrated to plasma as well and there is laboratory measurement again different to everything else. So I don't think we can say that human ones always read lower but please correct me if I am wrong. At the moment I am happy with Accucheck Aviva Nano which gives me correct readings at least when it comes to higher numbers. Read somewhere that some meters give accurate high numbers but not so when comes to low numbers!
 
Elizabeth and Bertie said:
There are some pics somewhere on the forum that show what a .25 looks like, Marlena. I'll try to find them for you. (But is Rocky getting .5 at the moment..?)


He's still got a few hours to go, Marlena, but yes, it looks at this point as though he should get his next shot as normal.

When you give the next shot it will quite possibly have more welly than the first shot. That's because of the overlap. The first shot will still be in Rocky's system even though it's appearing to have little or no effect at this point. The earlier shot will be wearing off as the new shot starts to work.
I found with Bertie that it took a couple of days to get into it's stride (but 'your mileage may vary' ;) ). And you're starting out at a nice low dosage, so, if this dose doesn't have an effect then you can increase it in a while. But it's better to start out low and work up than start with a higher dose and then have to back-pedal....
.
Click to expand...
God bless you dear Eliz, many thanks for your message. It makes sense to me.
 
Marlena said:
Like everything with FD even the glucometers are not easy to understand and figure out. Human meters can be whole blood or plasma calibrated so there a difference in BG numbers between them, then there is animal one calibrated to plasma as well and there is laboratory measurement again different to everything else. So I don't think we can say that human ones always read lower but please correct me if I am wrong.
Click to expand...
As a general rule of thumb, human meters read lower than pet meters, *in lower ranges*. This is the reason for reducing at 68 on a pet meter, compared to 50 on a human meter.
Most all home meters, whether pet or human, are calibrated for whole, capillary blood. The pet meters are calibrated to match the venous plasma that would be lab tested.
Hope this helps:)
 
Marlena, I use Alpha Trac as I didn't know anything when I started home testing. Vet recommended it as he uses it. I have to say the number of times we checked results, my readings are spot on with outside lab readings. The only thing is that the strips are very expensive.
 
Hi Eliz,
Rocky seems to be doing well. His BGs are:
PSAM 14.5, +2 16.5, +8 4.3, +10 5.5, +12 7.4.
Now is the time to shot again but his numbers are too low (I think) so I am going to test again in 2 hours and then decide what to give. What do you think?
Many thanks, Marlena
 
Woodsywife said:
Marlena, I use Alpha Trac as I didn't know anything when I started home testing. Vet recommended it as he uses it. I have to say the number of times we checked results, my readings are spot on with outside lab readings. The only thing is that the strips are very expensive.
Click to expand...
Thank you
 
Marlena said:
PSAM 14.5, +2 16.5, +8 4.3, +10 5.5, +12 7.4.
Click to expand...
Hi Marlena,

Wowsy! What a difference!

Yes, I agree that those numbers are just a tad on the low side (given Hypurin's overlap, and given that these are early days and the effect may continue to be accumulative....) And it looks like a pretty steep drop too....

You may find that Rocky is too low to shoot tonight, and that you'd be better skipping the shot.
Yes, the BG does seem to be rising, but....the Hypurin - and the overlap - seem to be having a pretty powerful effect..... And I'm assuming you want to get some sleep tonight and don't want to spend the night testing his BG.... ;)

To be honest, given the situation, if it were my cat I might be inclined to skip the shot and see what the situation is in the morning. But see what happens over the next hour or two.

It may be that the dose is too high for you to be able to give 2 shots a day. But it's a little early to tell.
Can you confirm what dose you are giving? Is it still .5 of a unit?
.
 
Last edited:
Marlena, the general recommendation here for folks new to dealing with feline diabetes is that no shot is given if the blood glucose is below 11 (200). That's just until the caregiver can see how the insulin/dose is working in the cat's body. It allows some buffer of safety to prevent the blood glucose dropping too low.

Once data has been gathered to see how the insulin/dose is working, and a baseline has been established, many caregivers then start to feel more comfortable giving shots at lower BG numbers.

Remember, Hypurin isn't like Caninsulin. Caninsulin is an 'in and out' insulin. Hypurin can hang around in the system for a very long time; and even if the numbers are rising, there can still be enough in the system to boost the following shot.
.
 
Hi Marlena,

Glad to see Rocky is off to a promising start with his new insulin.

Really interesting thread: good to learn a bit about how hypurin works.


Mogs
.
 
Dear all!
Many thanks for your kindness and help.
I saw your posts this morning after I gave Rocky his shot.
We had good numbers yesterday and I waited +14 hours before making sure that his BG is rising and over 200 - it was 12.2 (220) - and gave him 0.5u.
This morning his number was a bit high at 21.5 (387) and I gave him a bit more - 0.75.
I have looked at Juliet's spreadsheets and it is helping.
Best regards to all of you,
Marlena
 
Marlena said:
We had good numbers yesterday and I waited +14 hours before making sure that his BG is rising and over 200 - it was 12.2 (220) - and gave him 0.5u.
This morning his number was a bit high at 21.5 (387) and I gave him a bit more - 0.75.
Click to expand...
Hi Marlena,
Did you get any additional tests during the night? Just wondering if Rocky's blood glucose might have dropped a bit low, and subsequently bounced?
.
 
Hi Marlena,
Looks like Rocky is responding nicely to his new insulin!
I see you raised his morning dose today as his preshot was 21.5? I would give him a couple of days or so on the 0.5u dose as his system becomes used to the PZI, and then think about increasing it if necessary. When switching insulins it's best to us the 'precautionary principle', just to be on the safe side, and to enable his system to adjust to his new regime.
How is he doing now?
 
Last edited:
Marlena,
Me again.
I've set you up a spreadsheet for Rocky (by copying Milo's). Have a look here: https://docs.google.com/spreadsheets/d/1Xwq1jBlV8aaJCGz_-wa6QMQfQ-Rb6rfwrCEBGBaEKM8/edit?usp=sharing
I've put it yesterday's & this morning's numbers. If you feel able, please add his subsequent numbers to it? It will give you a much more visual flavour of what is happening in Rocky's system, it will help out with spotting patterns, and readjusting doses, and it will also help those trying to advise you what to do next if you get in a pickle. If you copy & paste the link into your signature, it will be obvious for all to see.

Happy Monday!
 
Dr Schrodinger said:
I see you raised his morning dose today as his preshot was 21.5? I would give him a couple of days or so on the 0.5u dose as his system becomes used to the PZI, and then think about increasing it if necessary. When switching insulins it's best to us the 'precautionary principle', just to be on the safe side, and to enable his system to adjust to his new regime.
Click to expand...
Absolutely agreeing with Juliet here, Marlena...

As she says, "When switching insulins it's best to use the 'precautionary principle'... " And I think that's especially the case when switching to an insulin that has a long duration: It can take a little while to see the full effect of the initial dose.
Seeing what that initial dose can achieve will give you a sound baseline to work from.

I don't know whether you managed to get any tests during the insulin cycle last night....?
If you did get tests and Rocky's numbers didn't drop much, or indeed just went up, then I see why you would be tempted to increase the dose. But it may be that this morning's high preshot was just a 'one off'; or maybe it was a 'bounce' from yesterday's 4.3. And as a general rule (there are exceptions) it's not a good idea to increase the dose on a bouncing number. That's because things can get pretty tricky if the bounce wears off and there's too much insulin in the system.

If you didn't get tests during the cycle last night, then we can't know what happened. Maybe his blood glucose dropped. Maybe it didn't. So there's not really enough data at this point to make a decision about changing the dose.

A quick note on 'bouncing'...
When a cat's blood glucose drops too low it's liver can release stored glucose in order to raise the BG. It can also release counter-regulatory hormones, the purpose of which is to try to keep the blood glucose high for a while. It's a protection mechanism. This can look like insulin resistance, or it can look like the dose isn't sufficient.
The BG doesn't need to be in the hypo range for a cat to do this. It can happen simply because the BG has dropped lower than the cat has become used to. High numbers may have become it's 'new normal'. And lower numbers (even if healthy) can be perceived as a threat.
Bouncing can also be triggered if the BG drops too fast.

I know you want to see Rocky in better numbers (and we're all here cheering him on!), but you don't have to rush this. Rushing can be counter-productive. It's OK to relax a bit, and breathe. Patience, Grasshopper! ;)

I see that Juliet has made a spreadsheet for you! Brilliant stuff!!! :woot:

Eliz
 
Last edited:
Elizabeth and Bertie said:
Hi Marlena,
Did you get any additional tests during the night? Just wondering if Rocky's blood glucose might have dropped a bit low, and subsequently bounced?
.
Click to expand...
Eliz,
no, I did not check his numbers at night! I am desperate to see how this insulin is working so I will be getting up during the night to test him. That should give us some more clues.
Today his numbers were:
+0 21.5 (gave him 0.75 u approximately), +5 18.4, +7 12.5, +9 5.4, +11 4.2. Looks like onset is after 5hours, nadir 11 hours.
I will check him again at +12 and than need to feed him.
Marlena
 
Elizabeth and Bertie said:
Absolutely agreeing with Juliet here, Marlena...

As she says, "When switching insulins it's best to use the 'precautionary principle'... " And I think that's especially the case when switching to an insulin that has a long duration: It can take a little while to see the full effect of the initial dose.
Seeing what that initial dose can achieve will give you a sound baseline to work from.

I don't know whether you managed to get any tests during the insulin cycle last night....?
If you did get tests and Rocky's numbers didn't drop much, or indeed just went up, then I see why you would be tempted to increase the dose. But it may be that this morning's high preshot was just a 'one off'; or maybe it was a 'bounce' from yesterday's 4.3. And as a general rule (there are exceptions) it's not a good idea to increase the dose on a bouncing number. That's because things can get pretty tricky if the bounce wears off and there's too much insulin in the system.

If you didn't get tests during the cycle last night, then we can't know what happened. Maybe his blood glucose dropped. Maybe it didn't. So there's not really enough data at this point to make a decision about changing the dose.

A quick note on 'bouncing'...
When a cat's blood glucose drops too low it's liver can release stored glucose in order to raise the BG. It can also release counter-regulatory hormones, the purpose of which is to try to keep the blood glucose high for a while. It's a protection mechanism. This can look like insulin resistance, or it can look like the dose isn't sufficient.
The BG doesn't need to be in the hypo range for a cat to do this. It can happen simply because the BG has dropped lower than the cat has become used to. High numbers may have become it's 'new normal'. And lower numbers (even if healthy) can be perceived as a threat.
Bouncing can also be triggered if the BG drops too fast.

I know you want to see Rocky in better numbers (and we're all here cheering him on!), but you don't have to rush this. Rushing can be counter-productive. It's OK to relax a bit, and breathe. Patience, Grasshopper! ;)

I see that Juliet has made a spreadsheet for you! Brilliant stuff!!! :woot:

Eliz
Click to expand...
Oh my God Eliz, you are right - I am a b.....y Grasshopper!
I really like your explanation of "bouncing", it makes sense.
Many thanks
Marlena
 
Dr Schrodinger said:
Marlena,
Me again.
I've set you up a spreadsheet for Rocky (by copying Milo's). Have a look here: https://docs.google.com/spreadsheets/d/1Xwq1jBlV8aaJCGz_-wa6QMQfQ-Rb6rfwrCEBGBaEKM8/edit?usp=sharing
I've put it yesterday's & this morning's numbers. If you feel able, please add his subsequent numbers to it? It will give you a much more visual flavour of what is happening in Rocky's system, it will help out with spotting patterns, and readjusting doses, and it will also help those trying to advise you what to do next if you get in a pickle. If you copy & paste the link into your signature, it will be obvious for all to see.

Happy Monday!
Click to expand...
Dear Juliet,
you are a star!
Many thanks
 
Marlena said:
Today his numbers were:
+0 21.5, +5 18.4, +7 12.5, +9 5.4, +11 4.2. Looks like onset is after 5 hours, nadir 11 hours.
Click to expand...
(emphasis mine)

It's entirely possible that Rocky does have a late onset and late nadir. Some cats do.
But it might be that other factors are coming into play here... It could, for example, be the case that his blood glucose bounced up high last night in response to an earlier low number, and then 'dropped out of bounce' during the day. When that happens the numbers can come tumbling down, and down, and down.
And also, it may be that Rocky's nadir happens later when he's given a higher dose. That can happen too.

It is great to see Rocky in some better numbers. :)
He seems to be responding very well to the Hypurin.

If Rocky isn't shootable by +12 on a consistent basis, it may be that you need to reduce the dose in order to try to give 2 shots a day, especially if the alternative is that you find you need to either skip shots or give shots later in the evening (and then have to test during the night). The latter can be doable in the short term, but can get rather wearing if done for any length of time. (When my cat was on Caninsulin (and subsequently on a veterinary PZI) I was doing 3 shots a day around the clock, and testing during each cycle. And it does get pretty tiring when you're continually getting up in the night to test....)

Well done for adding your data into the spreadsheet! :bighug:
I've just looked at Rocky's spreadsheet and see that he's just starting to come up now at +13.
It's entirely possible that he won't reach a shootable number for a few more hours (or maybe he'll jump up fast - we just don't know!). But I guess you're going to need to make a choice about whether to skip this evening's shot, or wait and give the shot later...

I would suggest that you don't give more than .5 of a unit for the time being. (And in fact, I wouldn't be at all surprised if it turns out that the .5 dose actually needs to be tweaked down a tad in order to level things out a bit.)

How are you getting on with measuring these small doses, Marlena?

Eliz
 
I am going to skip tonight's shot.
What time, do you think, I should test during the night?
Shall I reduce his dose tomorrow am and try to give him 0.25?
 
Nice one, Marlena!
Good plan to skip tonight's shot. Start again tomorrow morning, and if he's bounced, then stick with the original plan of 0.5 units.
If he stays low, though, you may need to get that magnifying glass out to measure 0.25 units!
He may well stay low for a while, since he had a larger dose this morning. Or, he may bounce! Who knows? If his numbers are high tomorrow, keep him at 0.5?
Milo's rooting for him. Ive told him all about Rocky....
J
 
Dr Schrodinger said:
Nice one, Marlena!
Good plan to skip tonight's shot. Start again tomorrow morning, and if he's bounced, then stick with the original plan of 0.5 units.
If he stays low, though, you may need to get that magnifying glass out to measure 0.25 units!
He may well stay low for a while, since he had a larger dose this morning. Or, he may bounce! Who knows? If his numbers are high tomorrow, keep him at 0.5?
Milo's rooting for him. Ive told him all about Rocky....
J
Click to expand...
Juliet,
thank you as always.
Rocky is grateful that he's got a friend!
Sending best regards to you and Milo.
 
He bounced, then? Poor chap.
Good job with the 0.5 units, though. Still too early to tell whether this is the appropriate dose for him to keep on an even keel. I'll keep all my bits crossed for him today.
You're doing a grand job!
 
He is indeed, gorgeous!
Marlena, I can understand why you felt you should give Rocky 0.75u this morning, as he was high all day yesterday, and high this morning - however - that could have all been part of his 'bounce'. Sometimes it takes 24 hours for the BG to come down again, so you may find that after the 0.75u this morning, he will simply rebound once more from the higher dose. You may find that you are in the same position tonight as you were on monday night - and unable to give him a shot.
Please stick with the 0.5u dose tomorrow morning? He hasn't had a chance to settle yet, and his system has been experiencing inconsistent doses over the past 48 hours. What he needs is a consistent low level dose for a few days to get used to it first, and then think about changing it, depending on how he responds.
You're doing what comes naturally, and I can completely understand why, and totally empathise with you and now we need to take it gently...softly, softly, catchy monkey....
Big hugs.
J
 
Looks like Rocky reached peak of the cycle at +8 today.

And I didn't notice till Juliet pointed it out that you gave .75 this morning, Marlena.
Was that just because of the higher pre-shot number, or are you trying to use sliding scale dosage for Rocky?
If the former, then as Juliet said, don't be fooled by high numbers that may have been caused by a bounce (what bounces up will come down again at some point).
And if the latter, then it is a bit too soon to try sliding scale dosage...

When switching insulins it is a good idea to find out what a single fixed dose does before raising the dose.
FYI, my cat's BG hardly changed at all in the first few days after I switched to Hypurin. Initially it was almost like I was injecting water! But then, suddenly and dramatically, his blood glucose dropped and dropped and dropped; and I actually had to reduce his dose by about half. If I had raised the dose because of the high numbers I was seeing we could have got into big trouble...

It may turn out that Rocky is suited to sliding scale dosing. Some cats are. (After the initial couple of weeks, my own cat has only ever been on sliding scale dosage). And some cats seem to do better with a fixed dosage.
But at the moment probably the most useful thing you can do is to see what the effect of the .5 unit is. (In my view, at this point the only reason to change the dose would be to lower it if it was evident that the .5 was too high.)
Seeing what the .5 can do will give you a baseline to work from, whether you ultimately go with fixed dose or sliding scale. ;)
.
 
Last edited:
Oh, forgot to say...
The dose you give this evening will be influenced by dose you gave this morning (because of the overlap). This morning you gave .75; so, if you give a .5 this evening it may have a bit more welly than a 'typical' .5........
Are you able to get a couple of tests in this evening, Marlena?
.
 
Oh dear, I have just done Rocky and then read your post! Not good, see what happens, I hope everything will be all right but I was so upset about high BGs.
 
And another thing: I looked at Milo's scores and it looked like he was getting 1.5 u Hypurin for some time and it seems a high dose which worked so I thought that my 0.75u (and maybe not quite because it is so difficult to measure that, I rather give less then more) is a very modest dose indeed. And also don't you think that 0.25u (or not even that) is not very much? I am really straggling with Rocky's high BGs for sometime and I am worried what that is doing to his organs. Still haven't heard from the vet's about his blood work results.
It is all very "consuming" for me.
And another thing: I often listen to my "inner voice", I mean my intuition and I felt that 0.5u is a very small dose.
I can only learn but sometimes your personality takes over.
I hope you don't mind my "opening up" about how I feel.
Glad you are so patient!
 
Marlena said:
...I often listen to my "inner voice", I mean my intuition and I felt that 0.5u is a very small dose.
Click to expand...
Yes, it is indeed a small dose, Marlena. But even though small it had a considerable effect on 10th January.
To be safe, it is better to start with a small dose and work up. We often see cats arrive here on too much insulin. And sometimes the dose has to be cut quite dramatically.

Different cats need different amounts of insulin. And their insulin needs often change over time.
We've had cats here on really high doses; and some who've reacted so strongly to even the smallest dose that their caregivers have had to measure the dose in drops! :woot: ...Every cat is different....

The general recommendation here is that cats start out on .5 or 1 unit, and work up (or down....) from there. And in Rocky's case it dose look like the .5 unit is a good starting point.

As to your fears of organ damage, gosh, I used to fret endlessly about that. My cat was in very high numbers after diagnosis and remained that way for quite a long time. And I even stayed away from the forum for a few years because I thought we were such a hopeless case. But things got better for us over time (and with a change of insulin...).
My cat has now been diabetic and on insulin for 9 years. He's now 17, and is in pretty good nick for a 17 year old kitty (touch wood/ant-jinx). My vet says he has never had a diabetic cat live so long and so healthily after diagnosis. Because he's 17 I know I don't have a very long time left with him. But it seems that he has had a healthy life in spite of being diabetic for 9 years, and in spite of being in high numbers for a long time at the beginning. Cats aren't generally affected by high blood glucose levels in quite the way that humans and dogs are. Their bodies seem to be much more tolerant of high blood glucose...
.
 
Marlena said:
Could you please tell me more about sliding scale.
Click to expand...
With sliding scale the dose is altered according to the pre-shot number (and should also take into consideration the likely nadir of that dose).
Sliding scales can be particularly useful for cats that have very variable BG numbers; in that instance the varying dosage (if done well) can help to keep the kitty's blood glucose on a more even keel.

We don't have a 'set formula' for sliding scale dosage here; it all depends on the individual cat.
The type of insulin used also makes a big difference.

I think it's easier to use sliding scales with the intermediate-acting insulins like the US Prozinc and PZI, and indeed Caninsulin/Vetsulin also, because these insulins are out of the system faster then the longer-acting insulins, so it's less likely that any given shot will be affected by the one that preceeds it. With longer-acting insulins sliding scale is trickier because each shot is affected by the shot that preceeds it (or in some cases, maybe even by several shots that preceed it....).
Most people here who use the longer-acting insulins Lantus and Levemir find that these work best on fixed dosage, precisely because of the way that the insulin builds up in the system. However, in my experience the longer-acting insulin Hypurin can work with sliding scale. And in my cat's case it works very well. But it is always important to be aware of the long duration and overlap, and try to factor that into the equation when making dose adjustments. It can get complicated sometimes...:rolleyes:
.
 
Status
Not open for further replies.
Back
Top