Dosing Advice Needed for Novolin

[MrWorfMen's Mom]

I agree that a longer acting insulin would seem to be the way to go with T.C. He's getting pretty steep drops with the Novolin and those high pre-shot numbers are likely being influenced by bouncing as a result making it hard to determine what his "normal" pre-shots at this time are.
Do you have syringes with the half unit markings yet or are you eyeballing 0.25u on a full unit marked syringe?

One method of paring down doses as Eliz mentioned is a drop method. Get a used syringe and draw up coloured water to what you perceive to be 0.25u then methodically push out a drop at a time to see how many drops are in that volume of fluid. Then if, for example you want a dose of 0.125u you draw up the quarter unit and let out half the drops you counted for the quarter unit dose.

Below is further information about tiny doses using the drop size and syringe markings as a guide.

Fine Dose Pictorial Guide

Fine dose gradations:

• 0.5U = exactly half a unit
• 0.4U = skinny 0.5 touching the line
• 0.3U = skinny 0.5 with daylight under the line
• 0.2U = fat zero with daylight over the line
• 0.1U = fat zero barely touching the line

Pictorial guide using a U-100 syringe marked with half units:

a pin (for comparison)..... a drop (.1u) .............. a half drop (.05u)...

 

[tcmeowmixtc]

I agree that a longer acting insulin would seem to be the way to go with T.C. He's getting pretty steep drops with the Novolin and those high pre-shot numbers are likely being influenced by bouncing as a result making it hard to determine what his "normal" pre-shots at this time are.
Do you have syringes with the half unit markings yet or are you eyeballing 0.25u on a full unit marked syringe?

One method of paring down doses as Eliz mentioned is a drop method. Get a used syringe and draw up coloured water to what you perceive to be 0.25u then methodically push out a drop at a time to see how many drops are in that volume of fluid. Then if, for example you want a dose of 0.125u you draw up the quarter unit and let out half the drops you counted for the quarter unit dose.

Below is further information about tiny doses using the drop size and syringe markings as a guide.

Fine Dose Pictorial Guide

Fine dose gradations:

• 0.5U = exactly half a unit
• 0.4U = skinny 0.5 touching the line
• 0.3U = skinny 0.5 with daylight under the line
• 0.2U = fat zero with daylight over the line
• 0.1U = fat zero barely touching the line

Pictorial guide using a U-100 syringe marked with half units:

a pin (for comparison)..... a drop (.1u) .............. a half drop (.05u)...

Thank you for the information on drops. And I did get the half-unit syringes, so I'm doing half of 0.5.

 

[tcmeowmixtc]

What hour did it go to 56? Can you write it into the spreadsheet? While it is low it's not quite a hypo on a human meter. If it was early you did the right thing. If it was at nadir you'd want to steer with just a bit of low or medium carb food so you don't over correct. It's crazy how sensitive he is to the insulin... He really crashes on just a few drops. Maybe levemir would be a more gentle insulin.

What other slow-acting insulins are there? You mentioned levemir. Is that the best one? I want to go into the vet with a lot of information. Would these be checked differently than Novolin? Like, would the nadir be way different?

 

[JanetNJ]

What other slow-acting insulins are there? You mentioned levemir. Is that the best one? I want to go into the vet with a lot of information. Would these be checked differently than Novolin? Like, would the nadir be way different?

Levemir and lantus tend to be about gentler. You can look at more info on that insulins specific forum and at the spreadsheets of people who use it.

 

[tcmeowmixtc]

Hi guys,
T.C.'s numbers have been all over the place. I'm in a tough place because my parents are the ones providing money for his treatment, but they want to keep it as cheap as possible, so I haven't been able to go to the vet or switch insulins. I'm not sure how to explain the problems to them, but they're not really budging. I don't know, I guess I'm just venting.

 

[Chris & China (GA)]

I'm not sure how to explain the problems to them, but they're not really budging. I don't know, I guess I'm just venting.

I haven't read through the entire thread, but is there any chance you could possible see a different vet? One that would be willing to use a different insulin?

A lot of us have had to switch vets when our original one refused to listen

 

[Yong & Maury GA]

Hi guys,
T.C.'s numbers have been all over the place. I'm in a tough place because my parents are the ones providing money for his treatment, but they want to keep it as cheap as possible, so I haven't been able to go to the vet or switch insulins. I'm not sure how to explain the problems to them, but they're not really budging. I don't know, I guess I'm just venting.

Hmm. How much are they paying for his Novolin N? Also, the human meter is going to be more affordable for daily testing. ReliOn Confirm/Micro from Walmart. Test strips in store are $0.36/strip whereas AT2 strips are about $1/strip. After initial supplies, ReliOn strips can be found online for even less.

 

[tcmeowmixtc]

I haven't read through the entire thread, but is there any chance you could possible see a different vet? One that would be willing to use a different insulin?

A lot of us have had to switch vets when our original one refused to listen

I would like to use a new vet we visited, but my parents didn't like them because they wanted to do a urinalysis for $250. I feel this vet is more knowledgeable and cares more, but it's been tough to get my parents to understand.

Hmm. How much are they paying for his Novolin N? Also, the human meter is going to be more affordable for daily testing. ReliOn Confirm/Micro from Walmart. Test strips in store are $0.36/strip whereas AT2 strips are about $1/strip. After initial supplies, ReliOn strips can be found online for even less.

I think they're paying around $30 for the novilin. And I will probably switch to human meter to save money once he is regulated.

 

[JanetNJ]

I would like to use a new vet we visited, but my parents didn't like them because they wanted to do a urinalysis for $250. I feel this vet is more knowledgeable and cares more, but it's been tough to get my parents to understand.

I think they're paying around $30 for the novilin. And I will probably switch to human meter to save money once he is regulated.

Could you add what food you're feeding to your signature?

 

[tcmeowmixtc]

Could you add what food you're feeding to your signature?

Like more specific? Sure!

Edit: added "Classic." Is that specific enough? It's the poultry and beef ones. Is FF okay, or do I write it out?

 

[Elizabeth and Bertie]

I think they're paying around $30 for the novilin. And I will probably switch to human meter to save money once he is regulated.

It would certainly be cheaper to use a human meter.
...I do agree though that it would be worth trying another insulin for TC. He's getting such steep BG swings on the Novolin. Other insulins will cost more though.... Might your parents be persuaded to get a different insulin if they knew they could save money on the BG testing supplies....?

Another option to consider is that it may be possible for your vet to get you a free sample of BCP PZI insulin for you to try.... This should typically drop the blood glucose more gently than Novolin, and may have a longer duration.
Vets can get a free 5ml vial of BCP PZI. I think the sample is a U100 insulin, so that would give you 500 units of insulin....for free.... So, if, for example a cat had 2 units twice a day that would last about 4 months so long as the insulin didn't lose it's potency...
I understand it can take up to a few weeks to get the insulin though, so you'd still be working with Novolin in the meantime.
The info that your vet needs is on this page:
http://bcpvetpharm.com/bcp-pzi-bovine-insulin/
.

 

[JanetNJ]

Like more specific? Sure!

Edit: added "Classic." Is that specific enough. It's the poultry and beef ones. Is FF okay, or do I write it out?

Ok thanks. Yeah just making sure it wasn't gravy.

 

[JanetNJ]

Some have been having good luck getting lantus cheap or free with the pet discount cards.

 

[tcmeowmixtc]

It would certainly be cheaper to use a human meter.
...I do agree though that it would be worth trying another insulin for TC. He's getting such steep BG swings on the Novolin. Other insulins will cost more though.... Might your parents be persuaded to get a different insulin if they knew they could save money on the BG testing supplies....?

Another option to consider is that it may be possible for your vet to get you a free sample of BCP PZI insulin for you to try.... This should typically drop the blood glucose more gently than Novolin, and may have a longer duration.
Vets can get a free 5ml vial of BCP PZI. I think the sample is a U100 insulin, so that would give you 500 units of insulin....for free.... So, if, for example a cat had 2 units twice a day that would last about 4 months so long as the insulin didn't lose it's potency...
I understand it can take up to a few weeks to get the insulin though, so you'd still be working with Novolin in the meantime.
The info that your vet needs is on this page:
http://bcpvetpharm.com/bcp-pzi-bovine-insulin/
.

Thank you for this info! I will definitely bring this to their attention.
My mother was reading a lot online about getting cats into remission, so I'm hoping she'll see that the way T.C.'s numbers are now are not good. And I will also talk to them about saving money with the human meter. Thank you for the suggestions!

Ok thanks. Yeah just making sure it wasn't gravy.

Oh yes I see! I was so sad to learn the gravy ones were high-carb because T.C. used to love gravy ones. I used to give one to him for his birthday.

Some have been having good luck getting lantus cheap or free with the pet discount cards.

Oh! This is great to hear!

 

[Elinor & Sibon]

@Elizabeth and Bertie Hi, I'm sorry to barge in on this thread but I seemed like I could learn a lot from it. I inject my cat with Humulin NPH. Is that the same as Novolin N?
I didn't know about the trick with feeding the cat an hour before the shot. Could you have a look at my spreadsheet and see if your recommendation applies for me as well?
Thank so much.

 

[Kris & Teasel]

And I will probably switch to human meter to save money once he is regulated.

Actually, you might want to switch now. Getting a cat regulated can take many weeks or longer. It's never a short term endeavour.

 

[Yong & Maury GA]

You can also still regulate him with a human meter and keep your AT2 for curves. Which insulin did you want to try? Since you're in the states, you could try the Lantus savings card which can get you 1 Lantus solstar pen each month FOR FREE! . And as Janet stated, there are some suppliers who charge $30 +S&H for 1 Lantus pen. And there's Eliz's suggestion to see if you could get a PZI free sample.

My mother was reading a lot online about getting cats into remission, so I'm hoping she'll see that the way T.C.'s numbers are now are not good. And I will also talk to them about saving money with the human meter. Thank you for the suggestions!

Maybe you can persuade her it's not a highly guaranteed event but because the best treatment was set for them, that they were able to succeed . We'll try to help you with any additional money saving tips .

Oh yes I see! I was so sad to learn the gravy ones were high-carb because T.C. used to love gravy ones. I used to give one to him for his birthday.

You could try a FF Roasted or Chunky flavour for his birthday treat , still <6% carbs and NOT pate

 

[Elizabeth and Bertie]

...inject my cat with Humulin NPH. Is that the same as Novolin N?

Hi Elinor, Humulin N and Novolin N are both brand names for NPH insulin, and so variants of the same.

Your cat seems be quite a bit more stable on 'N' than tceowmixtc's cat is. ...Some of those blue preshot numbers are rather intriguing, because N doesn't usually have a long duration... Hmmm....
I see that when you skip shots because of low preshot number the BG tends to rise (not unsurprising); although the rise seems fairly gentle...

I wonder if there's a case for lowering your preshot threshold to something like 180, and in that instance just give a teesny tiny amount of insulin rather than nothing at all, even it's only something like 0.25 of a unit (as long as you are able to monitor and take any action if the BG looks like dropping low...)
Going to tag a few folks to look at your SS, and see if we can get some other opinions on this.... @Kris & Teasel , @Yong , @JanetNJ , @Squalliesmom , @MrWorfMen's Mom , @Tuxedo Mom
.

 

[Kris & Teasel]

Hi Elinor, Humulin N and Novolin N are both brand names for NPH insulin, and so variants of the same.

Your cat seems be quite a bit more stable on 'N' than tceowmixtc's cat is. ...Some of those blue preshot numbers are rather intriguing, because N doesn't usually have a long duration... Hmmm....
I see that when you skip shots because of low preshot number the BG tends to rise (not unsurprising); although the rise seems fairly gentle...

I wonder if there's a case for lowering your preshot threshold to something like 180, and in that instance just give a teesny tiny amount of insulin rather than nothing at all, even it's only something like 0.25 of a unit (as long as you are able to monitor and take any action if the BG looks like dropping low...)
Going to tag a few folks to look at your SS, and see if we can get some other opinions on this.... @Kris & Teasel , @Yong , @JanetNJ , @Squalliesmom , @MrWorfMen's Mom , @Tuxedo Mom
.

When I see such a discrepancy between AM and PMPSs, I would suggest lowering the dose slightly and keeping it the same both AM and PM. I think a case could be made for trying 0.75 u consistently AM and PM for a couple of days, barring any very low PSs (below 200? 190?) The dose has been changed often in response to PSs but that's a technique that's better used when there's more data to look at. At this point I think it has led to more erratic numbers.

 

[Tuxedo Mom]

I wonder if there's a case for lowering your preshot threshold to something like 180, and in that instance just give a teesny tiny amount of insulin rather than nothing at all, even it's only something like 0.25 of a unit (as long as you are able to monitor and take any action if the BG looks like dropping low...)

I would agree with trying to have regular dosing every 12 hours even if it meant giving smaller dose amounts depending on the preshot reading. This may be a case where a sliding scale may be useful. @JanetNJ is experienced with sliding scale dosing so she may be able to give some more advice on this approach.

 

[Tanya and Ducia]

Hi TC mom, sorry I didn't get your name
JanetNJ said: ↑
Some have been having good luck getting lantus cheap or free with the pet discount cards.

Oh! This is great to hear!

I recently purchased 5 Lantus pens from Canada and when I opened the 1st pen on 07/20/2017 I didn't get the response I wanted right away, jumped in to the conclusion that the pen's gone bad and opened another one next cycle - seems working very well - check the SS/Remarks.
I don't know if the 1st pen is spoilt - most likely it is OK, I kept it refrigerated ever since.
I feels a bit awkward to offer something I suspected gone bad but it is yours for free if you want to give it a try. I am worry-wart and someone with experience has already told me that I rushed things up by opening the 2nd pen - chances are the 1st one was fine. But I love to imagine the worse case scenarios.

If you want it you'll have to drive to Escondido to pick it up - I do not have car at present and cannot meet you half way. PM me if interested.

Guys, are there any potential dangers to TC from using a pen opened about 3 weeks ago? Please correct me ASAP if so.

PS. TC looks like Ducia's litter mate - really, like twins .

 

[Elinor & Sibon]

@Elizabeth and Bertie @Kris & Teasel @Tuxedo Mom
These are exactly the two approaches I've been struggling to decide between. Whether I should be persistent with a certain amount of units for a certain amount of time, or if I should give smaller ones if the numbers are above 180.
If he's around ~200 during the AM and I give a shot before I leave for work, I'll be terribly worried that he would go into hypo while I'm gone.
I'm meeting a vet who specializes in Diabetes this Sunday, she's the best in the country. Should I persist with 1 unit until then and see what she says?
Sorry for taking over this post :\

 

[Squalliesmom]

I agree with Kris and Mary Ann, I think lowering the dose slightly and splitting it evenly between morning and nighttime is the best option to try at this point. Without more info on the spreadsheet I would be hesitant to recommend lowering the preshot threshold by very much; the little evidence that's there suggests he is dropping down into some nice greens when he gets his shot so lowering the threshold could cause him to drop lower than you want him to go.

Some cats do get a full 12 hour duration from the fast-acting insulins. Squallie always got very good duration on Vetsulin.

@Tanya and Ducia I think the first pen you opened is probably fine!

 

[Elizabeth and Bertie]

I'll be terribly worried that he would go into hypo while I'm gone.

Only shoot what you are comfortable with giving, Elinor; and especially so if you can't be there to monitor....
.

 

[MrWorfMen's Mom]

Another vote for splitting a slightly lower dose consistently between AM/PM. Sliding scales are fine once you get the bouncing under better control but right now I think it would potentially set off more bouncing which isn't going to help figure out what is working and what isn't.

I also wonder if it might be helpful to try TC on a diet of slightly higher carb food. FF Pate is around 2-3%. Roasted, Flakey or Chunky FF are between 4% & 6% so not much higher but that bit extra carb might help smooth out the drops somewhat. Not all cats do best on the lowest carb foods.

 

[Yong & Maury GA]

I wonder if there's a case for lowering your preshot threshold to something like 180, and in that instance just give a teesny tiny amount of insulin rather than nothing at all, even it's only something like 0.25 of a unit (as long as you are able to monitor and take any action if the BG looks like dropping low...)
Going to tag a few folks to look at your SS, and see if we can get some other opinions on this.... @Kris & Teasel , @Yong , @JanetNJ , @Squalliesmom , @MrWorfMen's Mom , @Tuxedo Mom
.

Hi Elinor,
I'm chiming in late but agree with the others to lower the dose. Also, you might want to create your own thread so we're not all hijacking T.C.'s and his Mum's thread

T.C.'s Mum,
I like what Linda suggested to see if those slightly higher low-carb foods help smooth the drops. The idea is to stay under 10% carbs but like Linda said, not all kitties fair well with the lowest carb options. Every Cat is Different (ECID)!

 

[Elizabeth and Bertie]

Shannon @tcmeowmixtc and Elinor @Elinor & Sibon , you can both also post in the Caninsulin/Vetsulin and 'N' subforum, which is specifically for questions about these insulins (link is below).

http://www.felinediabetes.com/FDMB/forums/caninsulin-vetsulin-and-n-nph.19/

But any emergencies or urgent questions should still be posted right here in the Main forum to get the most attention and the fastest response.
.

 

[tcmeowmixtc]

Hi guys,
Thanks for all the advice. I'm going to try the slightly higher carb food and see how that works. I'm also seeing the vet next week to talk about switching to Lantus.
I'm also switching to a human meter for everyday readings (One Touch Ultra 2.) Should I start another spreadsheet using the human meter and link that in my signature? Also, how would I make it obvious that I switched insulin in my spreadsheet once I do?
Finally, T.C. had a low preshot number, 189, last night. I'm not sure why. He ate and had 0.25 of his insulin that morning. So, I was too scared to inject because I didn't want him to go hypo. Any clue as to why this would happen?
And again, thank you to everyone that has helped. Y'all have been live-savers and help calm my stress. You're my support system, so thank you.

 

[MrWorfMen's Mom]

You don't need a new spreadsheet for either the meter or a different insulin. All you need to do is insert a row on your spreadsheet, merge the cells and type a note into the row "Switched to One Touch Ultra2 meter" or "Started NEW INSULIN name". That way the changes are obvious to everyone but you still have all your data in one place for reference. Anytime I make changes like this, I make a copy of the spreadsheet as a backup first just to be on the safe side.

T.C. is getting massive drops from the Novolin (often way over 50% of pre-shot numbers)which is setting off major bouncing. That 189 was likely his system just being a little slower bringing his BG back up. I'd stick with the 0.25u for the moment because you want to try to avoid setting off the bouncing as much as possible and get his cycles to level out. A bit higher carb food will hopefully help too.

One other thing......are you checking T.C. for ketones? With those high pre-shots, it would be a good idea to keep an eye on this just to be on the safe side. Ketones can be checked using dip sticks available at the pharmacy. Some folks can sneak up on their cats and hold a designated spoon (a $ store spoon is ideal) under their butts to grab a sample. Others use plastic wrap around the edge of the box to grab a small sample. You only need a few drops of urine to test.

 

[Elizabeth and Bertie]

I'm also switching to a human meter for everyday readings (One Touch Ultra 2.)

I've used the One Touch Ultra for many years and really like it. You will probably find though that it requires a slightly larger blood sample than the Alphatrak.

Also, with the OTU, the blood droplet goes on the end/tip of the test strip, and not to the side (as the Alphatrak does, I think...).
You will probably notice that TC's BG numbers look lower when you use a human meter. That's normal. Human meters usually 'read' lower than the Alphatrak.

You're doing great. Well done!
.

 

[tcmeowmixtc]

Hi everyone, just a quick update.
T.C. had a vet visit Tuesday where they checked for ketones - he was negative. We are switching to Lantus tomorrow morning. He LOVES the turkey chunky FF. Thanks for all your help!