New diagnosis need advice regarding insulin and dosing

[Elise Marie]

Hi all I’m new to this board and not sure if I’m even posting in the right place but I need help. My senior kitty girl, Lickety Split, is 17 1/2 and recently diagnosed on February 28th. To understand more I need to give her backstory. She has mammary carcinoma that has been controlled with chemotherapeutic drugs. Her oncologist said she isn’t an surgery candidate because of her age and heart murmur but would most likely outlive her cancer. She was doing great with perfect bloodwork up until diagnosis. Unfortunately I had to board her for 5 days with my vet while recovering from surgery because she is difficult to medicate and on lots of meds for cancer, heart and arthritis. I have extreme guilt because I know that the stress caused her downward spiral. At her oncologist checkup on Feb 28 she had reading over 650 and I was told she’s diabetic. She also had elevated creatinine. My vet didn’t have insulin and told me to call around and find vetcillin. I could only fine ProZinc so she was put on that at one unit twice a day along with fluids for her kidneys. Three days later she was rechecked and still over 500. My vet increased to 2 units twice a day. Four days after that she was still over 500 and increased to 3 units twice a day. Four days later she was having trouble walking and standing up. She was at 700. My vet told me to increase to 4 units twice a day. Two days later I brought her back in and she was still over 500. My vet changed to Novolin N 3 units twice a day. I was nervous because I heard this insulin isn’t great for cats and it was so cheap. I heard that it is harsh as well. Her levels were getting down around 250 and sometimes still around 500. Then two days ago she was over 600 and today is back to being unsteady when walking. My vet increased to 4 units twice a day. I’m so upset thinking all of these changes so quick has compromised her. She’s also urinating a lot and was put on Clavamox in case of infection. She’s eating and drinking ok. It’s also hard to know how much is neuropathy from her levels and how much from her severe arthritis. I’m wondering if I need to go to another vet as her oncologist is the one dosing her. Times are tough right now as I’m not working due to current events. She eating some FF pate as well as some on her brothers low phosphorus renal foods. What insulin is best? What is normal dosing increases? How often do I need to test? I was using AlphaTrak but just switched to ReliOn classic for cost purposes. I’m so lost and feel like it’s making it worse on her. Thanks for reading.

 

[Bron and Sheba (GA)]

Hi and welcome Elise and Lickety Split.
Normal increases in insulin dose is 1/4 unit increments. Going up in 1 unit increments to too much.
Prozinc is a better insulin than Novolin N.
Novolin drops them hard and fast and has a shorter duration than Prozinc which is a good insulin for cats.
Are you testing before every shot? This is very important to do this to see it is safe to shoot.
You also need to test during the cycle to see how low the dose is taking her. Try testing at +2 up to +7.... not every hour, mix it up during different cycles. Don’t neglect the pm cycle. Always get a before bed test and if the BG is lower than the Preshot you will need to test further.

Are you feeding a 1/2 to an hour before giving the Novolin insulin. The routine is test, feed then shoot.

Feed a low carb diet only. Renal diet is high carb and not suitable. But you need to be careful because swapping to a low carb diet can drop the BG levels more than 100 points so it needs to be done slowly and you most be testing the BG levels to see the numbers are not dropping.

If you could set up a spreadsheet and put in the BG numbers we can help. I’ll put the link at the bottom. Also a link for new members. Read through it and follow any advice
I’m going to tag @Deb & Wink because I do not use either Novolin N or Prozinc.

Good luck. You have definitely come to the right place.
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

http://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/

 

[Juls and Billy]

I'm not a dosing expert, but I can give you some advice until more experienced members come in. First off, we all know just how overwhelming all this is at first, but you can totally do it. Yes, her sugars are high, but with some patience and know-how, you can get her feeling better.

ProZinc is a much better insulin for her. Do you still have the vial? There's a section of the forum for ProZinc users, and the sticky posts at the top are super informative. Go read them. The more you know, the better you will feel about all this, I promise.

Now, many vets aren't as knowledgeable with feline diabetes as they are with canine. No worries. There are very experienced members on this board that can help advise you.

Insulin: The first issue I see in the vet advice is that increases were too big. Yes, you want to get the sugar levels down, but if the increases are too big then you could skip right past the optimal dose. Too much insulin can often look like too little. It might be a good idea to try the ProZinc again, and follow the SLGS (start low go slow) protocol. Try 1 unit for 3 12-hour cycles, see where she is blood sugar wise. Increase by .25 of a unit, waiting at least 3 cycles between increases.

Testing: You are testing at home and I can't tell you how awesome that is. It will make the dose easier to determine, and help keep your sugar girl safe. The ReliOn is fine. Most of us use a human meter, and most of the info you find here will be for human meters. It's imperative to test before every shot. In the beginning, if pre-test BGL is under 200, skip the shot. Better for a day of high sugars than risk a dangerous low. As you get more experience with how your girl reacts to insulin, this "no shoot" number might lower to closer to 150. In addition to pre-shot tests, getting a few tests mid-cycle also is very important. With ProZinc, the dose changes based on the lowest readings, not the pre-test readings. You can stagger these tests, maybe one day get a +3 and a +5 (3 hours after shot/ 5 hours after shot.) Maybe the next day you get a +5 and a +7. The idea is that you are painting a picture of how the insulin is effecting your kitty during a cycle. PM mid-cycle tests are also important, even if it's only a test before bed, or maybe some nights you set an alarm to get a +6 or +7. Of course, all this depends on your schedule. If you work, get what tests you can and do more on days off.

Spreadsheet: Having a spreadsheet set up is imperative to get advice on this forum tailored especially for Lickedy Split. It's super easy to do. There's a template already set up, you just follow a few simple instructions to make one of your own. If you have trouble, give a shout, and one of the members can help you. Look down in my signature and click on Billy's Spreadsheet. You can see when I tested, when I adjusted dose, and when I had to skip shots. Super cool. You'll find spreadsheet instructions here: New? How you can help us help you!

I'm going to post this for now, so it doesn't end up a wall-o-text, then make a second post.

 

[Juls and Billy]

Okey dokey. I see Bron already brought up diet, which was the only other thing I was going to talk about. Sugar cats do much better on a low carb wet diet. It could have a major effect on Lickedy Split if you got her diet switched over. There's a great food chart here. You could look through the options and make choices that work with your kitty's other health issues.

 

[Deb & Wink]

Hello Elise and welcome to you and Lickity Split.

What insulin is best? What is normal dosing increases? How often do I need to test? I was using AlphaTrak but just switched to ReliOn classic for cost purposes. I’m so lost and feel like it’s making it worse on her.

Prozinc is a good insulin for cats. Not sure how long your Lickity Split was on that particular insulin. We normally do dose increases in 1/4 unit increments (0.25U). Those dose changes are for any of the insulins, unless your cat has a high dose condition. That is unknown at this point, and testing for that usually does not need to be done until your cat is getting more than 5 or 6 Units of insulin in each 12 hour dosing cycle.

NPH insulins like Novolin N or Humulin N do drop a cat's blood glucose levels very fast and very steeply. If you are using that insulin, you need to feed your cat 45 minutes to 1 hour before you dose the insulin. Many cats only obtain 6-8 hours of blood glucose control on the NPH insulins. Some cats get a longer duration.

I think you need to choose one insulin, and stick with it. That will help you feel less lost.

 

[Elise Marie]

I was never told to wait any period of time before shooting Novolin. I was shooting right after she ate. Lately she is picky with her food because is not a fan of pate and before her diagnosis she loved her gravy FF. What other foods are good? I've heard Friskies and FF Pate but is there anything else? How about Dry food? Can I mix some pate with gravy types to get her to eat more? I do feel like I want to get her off of the Novolin because to me it doesn't feel safe for her. I know their are other types besides ProZinc, but how does one determine which one is best without trying them all? My vet also mentioned Glargine and Vetcillin? How do they compare with ProZinc? I'm going to take her to my regular vet tomorrow but don't know if I should stick with the Novolin tonight and in the am in case she doesn't want to use the ProZinc. I don't feel good about the 4 units tho. My kitty is off today.. lethargic, back leg weakness and I'm sure it's from this insulin being all over the place.

 

[Deb & Wink]

I know their are other types besides ProZinc, but how does one determine which one is best without trying them all? My vet also mentioned Glargine and Vetcillin? How do they compare with ProZinc?

The best insulin for your cat is the one she does the best on. But it takes time to see if a cat can do well on a particular insulin. How long was your cat on the Prozinc? How long did you and your vet give it to work before you changed to NPH insulin?

Vetsulin (also called Caninsulin) is made for dogs. Some cats can do ok on it, but others only get 8 to 10 hours of duration from Vetsulin. Feeding 20 minutes or so before the shot of Vetsulin can help to keep the quick onset from dropping your cat's blood glucose too fast, too steeply.

Glargine (aka Lantus or the generic similar insulin is called Basaglar) is a good insulin for cats. It is what is know as a "depot" type insulin. The other insulins you mentioned are all what we call in-and-out insulins. That means their effects rarely last more than one dosing cycle.

More info for you in my next reply. Stay tuned. While you are waiting, if you could reply to my questions at the beginning of this post, I'd appreciate it. Thanks.

 

[Bron and Sheba (GA)]

I like Glargine for cats myself but Prozinc is good too. I would not use Novolin or Vetsulin myself because there are better insulins for cats.
Have a look through the food chart Jules sent you and look for 10% or less carbs. dry food is generally high in carbs except for a couple of exceptions.

If your kitty is lethargic I would go and buy a bottle of Ketostix from Walmart or a pharmacy so you can test the urine for ketones. It’s a simple test. Just collect a urine sample , dip the test strip into the urine and read Exactly 15 seconds later against the colours on the side of the bottle. Anything above a trace needs vet attention.

 

[Deb & Wink]

Lately she is picky with her food because is not a fan of pate and before her diagnosis she loved her gravy FF. What other foods are good? I've heard Friskies and FF Pate but is there anything else? How about Dry food? Can I mix some pate with gravy types to get her to eat more?

Was it the gravy in the FF that she liked? Try mixing in a bit of water in with the pate style food, to make it a bit like a gravy.

There are a huge number of foods that can work for a diabetic cat. Look for foods that are 10% carbs or less from that food chart back in post #4 from Juls and Billy.

Does your cat have renal issues? Some sort of kidney disease? Like CKD? or something else affecting her kidneys? HyperT? (hyperthyrodism)

Dry foods tend to be very high in carbohydrates. You do want a food with sufficient protein also. The carb content is not the only factor to consider, in selecting a food for your cat.

Does your cat like a more chunky or flaked texture?

 

[Elise Marie]

Hi all I’m new to this board and not sure if I’m even posting in the right place but I need help. My senior kitty girl, Lickety Split, is 17 1/2 and recently diagnosed on February 28th. To understand more I need to give her backstory. She has mammary carcinoma that has been controlled with chemotherapeutic drugs. Her oncologist said she isn’t an surgery candidate because of her age and heart murmur but would most likely outlive her cancer. She was doing great with perfect bloodwork up until diagnosis. Unfortunately I had to board her for 5 days with my vet while recovering from surgery because she is difficult to medicate and on lots of meds for cancer, heart and arthritis. I have extreme guilt because I know that the stress caused her downward spiral. At her oncologist checkup on Feb 28 she had reading over 650 and I was told she’s diabetic. She also had elevated creatinine. My vet didn’t have insulin and told me to call around and find vetcillin. I could only fine ProZinc so she was put on that at one unit twice a day along with fluids for her kidneys. Three days later she was rechecked and still over 500. My vet increased to 2 units twice a day. Four days after that she was still over 500 and increased to 3 units twice a day. Four days later she was having trouble walking and standing up. She was at 700. My vet told me to increase to 4 units twice a day. Two days later I brought her back in and she was still over 500. My vet changed to Novolin N 3 units twice a day. I was nervous because I heard this insulin isn’t great for cats and it was so cheap. I heard that it is harsh as well. Her levels were getting down around 250 and sometimes still around 500. Then two days ago she was over 600 and today is back to being unsteady when walking. My vet increased to 4 units twice a day. I’m so upset thinking all of these changes so quick has compromised her. She’s also urinating a lot and was put on Clavamox in case of infection. She’s eating and drinking ok. It’s also hard to know how much is neuropathy from her levels and how much from her severe arthritis. I’m wondering if I need to go to another vet as her oncologist is the one dosing her. Times are tough right now as I’m not working due to current events. She eating some FF pate as well as some on her brothers low phosphorus renal foods. What insulin is best? What is normal dosing increases? How often do I need to test? I was using AlphaTrak but just switched to ReliOn classic for cost purposes. I’m so lost and feel like it’s making it worse on her. Thanks for reading.

 

[Elise Marie]

My cat was only on ProZinc from Feb 28th- March 13th. During that time she started at 1 unit twice a day and increased progressively a unit every three days and quickly to 4 units twice a day before switching to Novolin N. Now she takes 4 units of Novolin.

She does prefer gravy types of food that are flaked, chopped etc. so the pate has been hard for her to adjust to. She does enjoy dry food as well. My vet had told me should could eat my other cats food that is renal and intestinal. Sadly this is not my sickest kitty that I’m taking care of. My other cat needs to eat as much as possible so it’s hard to withhold food from her until feeding times.

She is not renal but she did have elevated creatinine at time of initial diagnosis. She was on 200cc sub q now 100cc. Her creative went back to normal than was elevated again last week. My vet says it’s because her diabetes is not regulated yet. She has normal thyroid levels as well.

I’m going to take her to a different vet hopefully tomorrow. I want to get her off of the Novolin. Should I still give it tonight and tomorrow morning? I don’t feel great about the 4 units. I don’t think I should go back to ProZinc just incase she is switched again to Glargine. Would it cause a problem if only for one day? Does switching so much cause issues with the cat?

Also, is there a supplement I can give for her neuropathy? I was told there was something available that may help. I’m not certain what it is called.

 

[Bron and Sheba (GA)]

The vet increased the dose far too fast.
I would not withhold the insulin for 24 hours but I will let Deb talk to you about the dose.
You can buy Zobaline from lifelink.com for the neuropathy. It is tasteless and you can sprinkle it on the food.

 

[Deb & Wink]

I want to get her off of the Novolin. Should I still give it tonight and tomorrow morning? I don’t feel great about the 4 units. I don’t think I should go back to ProZinc just incase she is switched again to Glargine. Would it cause a problem if only for one day? Does switching so much cause issues with the cat?

Switching insulins so fast does not allow you to see if a particular insulin will work for your cat.

Personally, I'm hesitant for you to give your cat the full 4 unit dose of the Novolin. She would probably be ok for tonight and tomorrow morning with 2U of the Novolin. I'd test her to make sure. Somewhere around +3 to +4 is the usual nadir or low point with the NPH insulins like the Novolin you are using.

Plus, you should be testing for ketones in the urine. That takes a simple urine ketone test strip to test for ketones. Available at your local pharmacy, in with the diabetic supplies.

 

[Deb & Wink]

Agree with Bron that your vet increased the insulin dose far too fast, plus raised it in full 1 unit increments.
Too much, too soon.

 

[Elise Marie]

Ok thank you. I’m going to give 2 units. She was 508 before food at 7:45. She was 280 at 4 o’clock. She just ate 15 mins ago even tho not much. I’m going to have to get her to adjust to new diet somehow. I’m sorry I’m still very new to this... what does +3 +4 nadir refer to?

 

[Deb & Wink]

We express time here in a + hour format. +3 is 3 hours after you gave insulin, +4 is 4 hours after you gave insulin, etc.

We live all over the world, so we have found that knowing how long it's been since your cat had insulin helps us to put the blood glucose numbers you provide into perspective.

Nadir is the lowest point a dose of insulin takes your cat. During the middle of the cycle.

 

[Deb & Wink]

Food. Diabetic cats can eat more than twice a day. Since you are using the Novolin N insulin, you do want to feed her at least 45 to 60 minutes before you give her the insulin shot. That is so that the food has time to be digested and get some glucose into the blood stream to counteract the quick onset (1 hour or less) of the Novolin insulin.

Dry food takes longer to digest, since it lacks water and takes that much longer to break down and have an effect on the blood glucose. Also because it's lacking in water, the dry food is hard on the kidneys.
Cats do better on several small meals a day. Could you split her meals up into 4 portions or more? At least 2 meals in the morning 12 hour dosing cycle, then 2 more meals in the evening 12 hour dosing cycle.
Fancy Feast and Friskies make some flaked and chunky style foods.

I'll need to look up some of that food info. Be right back.

 

[Deb & Wink]

Ok, here are some foods that are low enough in carbs, but have more of a chunky, gravy texture to them.
Fancy Feast Chunky or Roasted or Flaked are all fine.
Friskies Flaked comes in Tuna and in Tuna and Egg flavor.
There are other foods too, that are not the Fancy Feast or Friskies foods.
Look on this food chart below for other options. This chart contains many different canned foods. So there will be a lot of foods listed that are >10% carbs.

Remember, you want to find foods that are 10% carbs or under and have good amounts of protein.

https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

There are also some newer foods released in the last 3 years, that you will not find on this chart.

 

[Elise Marie]

Thank you so much for all the great info. I gave her 2 units tonight and will recheck her. I’m going to do the same in the morning. I’m hoping to get a second opinion on the insulin with a different vet tomorrow. Hoping to go back on ProZinc since I have it but not sure how to proceed with dosing. Not sure if I’d start at 1 unit and for how long etc. My current vet seems like she wants to stay on this Novolin but I don’t like what I see from my cat on it. I’ll be trying other foods as well that are on the list and that you recommended. I’m going to have to implement a feeding strategy as I have other cats with other diet restrictions and none are the same. I’m sure I’ll be reaching out again on this board. I have a lot to learn! Thanks again!

 

[Deb & Wink]

Keep asking away. We may be able to suggest foods to meet the diet restrictions for your other cats.

How many cats live with you?

 

[Diane Tyler's Mom GA]

My cat was only on ProZinc from Feb 28th- March 13th. During that time she started at 1 unit twice a day and increased progressively a unit every three days and quickly to 4 units twice a day before switching to Novolin N. Now she takes 4 units of Novolin.

She does prefer gravy types of food that are flaked, chopped etc. so the pate has been hard for her to adjust to. She does enjoy dry food as well. My vet had told me should could eat my other cats food that is renal and intestinal. Sadly this is not my sickest kitty that I’m taking care of. My other cat needs to eat as much as possible so it’s hard to withhold food from her until feeding times.

She is not renal but she did have elevated creatinine at time of initial diagnosis. She was on 200cc sub q now 100cc. Her creative went back to normal than was elevated again last week. My vet says it’s because her diabetes is not regulated yet. She has normal thyroid levels as well.

I’m going to take her to a different vet hopefully tomorrow. I want to get her off of the Novolin. Should I still give it tonight and tomorrow morning? I don’t feel great about the 4 units. I don’t think I should go back to ProZinc just incase she is switched again to Glargine. Would it cause a problem if only for one day? Does switching so much cause issues with the cat?

Also, is there a supplement I can give for her neuropathy? I was told there was something available that may help. I’m not certain what it is called.

Since you are not working and times are tough right now the Zobaline is expensive. 33.90 and you only get 60 tablets , have to crush them up
Alot of members use this , you can buy it on line from Vitacost
Vitacost Vitamin B-12 Methylcobalamin -- 5000 mcg - 100 Capsules
It's 17.99 just be sure this is the one you buy
The only difference is the Zobaline has 200 mcgs of folic acid
So I buy the folic acid at the supermarket and crush it up and add it to the B-12
If you can't find the 200 mcg get the 400 mcg and cut it in half
The Vitacost brand is a capsule so just open it and pour the powder on the wet food
Has no taste, no need to crush it up
Wishing you all the best with your kitty, you have found the best place to be for help and advice

 

[Elise Marie]

Keep asking away. We may be able to suggest foods to meet the diet restrictions for your other cats.

How many cats live with you?

I have two with me.. my other boy needs a renal diet and needs to be able to graze. He eats wet and dry foods. Most of it is renal but he can also have I/d gastrointestinal as well.

 

[Elise Marie]

I called my regular vet and without seeing her she suggested staying with the Prozinc starting at 2 units. How long should she stay on this dose? She was up to 4 units on it before and was on Novolin 4 units too. She still is getting readings of over 600 pre shot.

 

[Deb & Wink]

It's not the pre-shot tests that we go on for adjusting the insulin dose.
It's the mid-cycle test, the nadir or lowest point in the cycle that this insulin, this dose takes your cat.

That is going to be really hard, to get your diabetic cat eating only diabetic appropriate foods, if you free feed your renal cat renal food. If your diabetic cat is eating foods that are high in carbs, her blood glucose will continue to stay very high.

What stage of kidney stage is your renal cat? What I.R.I.S stage? 1, 2, 3, 4?
Have you ever considered finding a cat food that would be appropriate for both your cats?
Have you seen Helen's site, for CKD cats? http://www.felinecrf.org/

There is a food chart there. Depending on the stage of renal disease in your other cat, there are options for foods, to meet the needs of both cats. Lower in phosphorus is what the CKD cat needs. Lower in carbs <10% is what the diabetic cat needs.
http://www.felinecrf.org/canned_food_usa.htm

There are basically no dry foods, that will be good for your diabetic cat.

Would you please take a few minutes, and set up our standard color coded spreadsheet, to track the Blood glucose levels and insulin doses for your cat? It's really hard to help you much, without that information for us to see.

There is a template you copy, so you do not have to "reinvent the wheel" and create your own version. Simple, clear setup includes diagrams and instructions to setup using a pc, tablet, or smartphone. You do need a google account first.

Directions on setting up the SS is here: FDMB Spreadsheet Instructions
Directions on what the cells mean is here: Understanding the Spreadsheet/Grid