? 1/16 Yum Start Novolin R tomorrow? AMPS 602 +1 617 +2 598

Status
Not open for further replies.
MJW

MJW

Member Since 2017
Yum is on her second day of 8 unit Lantus shots.
Her curve is high and flat.
Unless she shows some dramatic improvement today, I would like to add Novolin R tomorrow.
My goal is to get her into better numbers faster than I can with Lantus and its 2 to 3 day dose increase limit.
It looks like people also use R to flatten curves, but Yum’s curve is flat at the moment.

From what I have read on the forum (@Wendy&Neko and others), I should:
1. shoot it in her scruff
2. shoot it at the same time as the Lantus to start (@Sandy and Black Kitty also did a +6 shot; @Bronx's dad does many shots)
3. start with .5 unit shots (although Black Kitty’s and Bronx’s scales suggest Yum will need at least 5u)
4. test her every hour post shot for at least 5 hours
5. have my hypo kit ready

The Novolin R instructions say its onset is 30 minutes and it lasts 8 hours.
I understand Levemir might work better with R than Lantus, but I want to start with Lantus.
I also want to stick with my AlphaTrak.

A possible plan?
Day 1: 3rd day at 8u Lantus shots, add .5u Novolin R shots with Lantus shots
Day 2: Increase Lantus to 8.5 units; add .5u Novolin R shots with Lantus shots
Day 3: hold Lantus, increase R—maybe by 1 unit
Day 4: hold Lantus, increase R
Day 5: increase Lantus, hold R
Etcetera
 
Start small with R and work your way up. I started at .25u and ended up similar to your examples giving multiple units of R after lots of smaller dose increases to make sure he didn't drop to fast from the R. You ideally want around 100pt drop at the most, too much and she can bounce or go too low. R is good at bringing numbers down, Lantus is better at keeping the numbers down.

When to shoot R can vary from cat to cat. Depending on how Yum's typical cycle goes, you can dose first thing or sometime during the cycle. In cats the insulin does not last as long, humans use Lantus once a day, we have to dose twice a day. R insulin action in cats is closer to 4 hours then 8 hours. It can also affect the next cycle.

Regarding your plan, I would start with .25R on day one and test hourly the first few hours after a shot to see how Yum responds and get some data. I would not increase lantus on day 2. You might be able to increase the R to .5u the next day if you see little to no action. Day 3 is a little quick in my opinion to jump to 1u. See how the cycles look and get some advice from other R users. Patience is key, I know all too well having a kitty stuck in high numbers, it takes time, but you will get her numbers down as you narrow in on the "right" dose.

When seeing how Yum does on R, I would keep the Lantus dose consistent. This eliminates one variable in seeing how Yum does during both the dosing cycle and the next cycle.

See if @Sandy and Black Kitty (Very experienced with R), or @Wendy&Neko ,or another R member can be around to monitor your progress using R with Yum.

Last in addition to the hypo kit, lots of test strips in case you need to test more frequently.
 
saltycat said:
In cats the insulin does not last as long, humans use Lantus once a day, we have to dose twice a day. R insulin action in cats is closer to 4 hours then 8 hours. It can also affect the next cycle.
Click to expand...
Aha. That explains why the med sheet says 8 hours and the forum says 4 hours. I was wondering about the inconsistency.
Thanks for your advice. I felt so lucky last year that Yum's chart didn't look like Jack's, and now here we are headed in the wrong direction.
I have over 100 strips, but maybe I should put in another order. I'm a little worried Yum might protest constant testing. I will need to have really good treats at the ready.
 
Here is the link to yesterday's post.

More importantly, here is the link to what Jill had to say about you starting R. I agree 100% with what she said. She gave some suggestions to you before starting R. The first is finding out what you are dealing with, and why Yum is in such high numbers. Any progress with your vet on high dose testing? If she was throwing ketones, then that's a different matter. Second, what do you think about her idea of changing meters to a human meter? Even if you test twice. As that is what the people experienced with R are used to. It'll be harder for us to help you. Also, what does your vet think about adding R to the picture?

We get people to start with 0.25 units, not 0.5 units. Some cats are sensitive to smaller doses of R. Do not shoot R on the cycle you increase the L. Slow down the L increases if you use R. Start with just shooting R once a day - some cats see effects the cycle following R use. Go very slowly and cautiously. You have a problem with patience but with using R, I cannot stress PATIENCE enough. Using R can be very dangerous. The most important thing about using R is learning when not to use it.

And before you start, could you tell me when Yum's Lantus onset and nadir are? You need to know when those are, so you know when it's safe to give R.
 
Last edited:
Yes, agree 100% with Wes & Wendy. I was up to 5u of R only after having experience over time and seeing what R was doing with Bronx at that time when he was very unregulated and stuck in the reds. ECID, especially when it comes to R. I also learned that R can react completely different from one day to the next. For example, there were times when the shot of R in the first cycle of the day did nothing, but the R shot on the second cycle was like a double shot and sent Bronx into lime greens way too hard. You don't want R to drop the BG numbers more than 100, or you will just set Yum up for a bounce. Jill, Sandy & Wendy were awesome in "coaching" me when we started R and I learned a lot. Make sure one of them is online when you start, good luck!
 
Last edited:
  • Like
Reactions: MJW
Wendy&Neko said:
Here is the link to yesterday's post.
More importantly, here is the link to what Jill had to say about you starting R. I agree 100% with what she said. She suggested some suggestions to you before starting R. The first is finding out what you are dealing with, and why Yum is in such high numbers. Any progress with your vet on high dose testing?
Click to expand...
Not yet. I requested it a 3rd time in an email over the weekend; she replied to other questions but she ignored the request. Aha. Update. Just now she emailed that the clinic is closed due to ice and she confessed she had a very negative experience in the past interacting with A&M for a cat with difficult diabetes and possible acromegaly. Now that were are past that story I think we can move forward with the test, once the roads are safe.
Wendy&Neko said:
Second, what do you think about her idea of changing meters to a human meter? Even if you test twice. As that is what the people experienced with R are used to. It'll be harder for us to help you.
Click to expand...
I am still resisting this. @Sandy and Black Kitty 's scales are for an AlphaTrak. Raffy is on an AlphaTrak. I just feel pretty overwhelmed as it is. Seriously. I'm not keen on adding another meter. My vet wants the AlphaTrak and I am used to the AlphaTrak, but mostly everything is already complicated enough.
Wendy&Neko said:
Also, what does your vet think about adding R to the picture?
Click to expand...
I copied the clinic on a version of my plan post this morning. She just said not to increase the Lantus on day 2 of the test. I got the update re the bad experience in a later email.
Wendy&Neko said:
And before you start, could you tell me when Yum's Lantus onset and nadir are? You need to know when those are, so you know when it's safe to give R.
Click to expand...
I typically say onset is at +3 and nadir is at +5. However, she often does go lower later than +5---but not always. Right now her curve is incredibly flat. She is on 0 carb food.

Thank you for the feedback. I will start at .25u. I will start with an AM shot only. Fingers crossed.
 
MJW said:
she confessed she had a very negative experience in the past interacting with A&M for a cat with difficult diabetes and possible acromegaly.
Click to expand...
She's doesn't have to send it to A&M, but rather Michigan State Univesity. Completely different lab.

I am pretty sure Sandy didn't use the AT. No one was using at AT then. It's a relatively recent thing. Even when I started they were rare. I'm not familiar with AT numbers and wouldn't feel comfortable helping you with those numbers.
 
  • Like
Reactions: MJW
Wendy&Neko said:
She's doesn't have to send it to A&M, but rather Michigan State Univesity. Completely different lab.
Click to expand...
I misread her email at first. She did the bloodwork at MSU but the followup at A&M went bad.

Wendy&Neko said:
I am pretty sure Sandy didn't use the AT. No one was using at AT then. It's a relatively recent thing. Even when I started they were rare. I'm not familiar with AT numbers and wouldn't feel comfortable helping you with those numbers.
Click to expand...
Oops. I was wrong about Black Kitty. Okay.
Yum did have a nasty spike today to 658 at AMPS +8. She had a weird spike to 688 at PMPS on 1/12 too. Not sure what those sharp spikes mean. She may have been stressed out today by going outside into the cold for 30 seconds. Maybe she has pain. Hope it goes down.
 
I am out of town tomorrow, but have put some feelers out to see if anyone else with R experience is available.
 
  • Like
Reactions: MJW
0.25U should be OK. Especially given that you've handled low numbers before. So many of the people starting R have never seen blues, much less low greens before. I presume you still have high carb food around. I was personally a little nervous if I had less than 200 strips.
 
  • Like
Reactions: MJW
Wendy&Neko said:
0.25U should be OK. Especially given that you've handled low numbers before. So many of the people starting R have never seen blues, much less low greens before. I presume you still have high carb food around. I was personally a little nervous if I had less than 200 strips.
Click to expand...
I have 175 strips after recounting. What do you think of the spikes I pointed out?
 
MJW said:
What do you think of the spikes I pointed out?
Click to expand...
It's best not to try to over analyze every single number. Was there thunder? Other loud noise? Hear a cat outside? And in the grand scheme of things, those highs don't really matter. It's just not a good dose. High is just "high".
 
  • Like
Reactions: MJW
I'll try to stop in tomorrow to check on things as a backup in case no one else can. Wendy has some good advice above and with how high Yum is running. I would also think .25u should be a pretty boring day, but these cats love to surprise us sometimes.
I see a number of high 500's on her sheet, the recent 600's are a little higher, but I wouldn't really call them a spike, just running higher then usual which was already too high.
It took some patience with my boy's high numbers to come down as well, but perseverance wins in the end.
 
Thanks! It's been a long time since Yum surprised me with a low number...
She has a scratch on her forehead. Maybe a tiff with a civvie pushed her BG up a bit.
 
What time is your preshot, and which time zone. Maybe I'll be in a ferry line up and can peek in. Sandy is out of town.
 
Wendy&Neko said:
What time is your preshot, and which time zone. Maybe I'll be in a ferry line up and can peek in. Sandy is out of town.
Click to expand...
This would be helpful to know as I am an experienced R user although Gracie did not have any high dose conditions. I’ll be in and out tomorrow but, depending on when you shoot, I can probably hang out.

I do agree with Wendy, though, on all points but especially on the one about patience. Besides shooting too much R at the wrong time and potentially causing a Hypo, the other thing you have to be really careful about is causing dive/bounce type of cycles. Using R takes some finesse.
 
Last edited:
I shot her with .25u R at 5:50 AM Central time. I can't believe that will do anything. She shifted higher yesterday afternoon. I almost changed my mind and upped her to 9u Lantus. But I didn't.
 
Hi there :cool:

I know you are desperate to get Yum out of that sea of relentless black. We are with you, rest assured.

For the record, I used the Bayer Contour , which is a human meter.
Speaking for myself looking at an AT ss is a bit like looking at a different language-there is a translation that needs to be made in my brain before I can evaluate. Knowing things do get lost in translation I will tend to be more conservative which may, to a greater or lesser degree deminish the T of TR.

Question-are you only feeding at +11 each cycle?

eta-Is there a chance your insulin is bad?

 
Last edited:
Sandy and Black Kitty said:
Hi there :cool:
Question-are you only feeding at +11 each cycle?

eta-Is there a chance your insulin is bad?
Click to expand...
I mix her food up twice a day. She used to free feed. Now she is so ravenous, I put about half out at shot time, then refill the dish with dabs at test times or when she "gets" to me with her begging.
I guess I need to test this insulin. I bought it in November when I thought her previous vial was bad. I used it once on 12/19 to determine if the previous vial was bad. Then I put it aside in the refrigerator. I have to say, she went really high on that shot on 12/19. While she was boarded, they used the old vial. I started her on the new vial at home on 12/31. It expires in 2019. The old vial expires next month. She did go much worse after the switch, but it is practically brand new. It would have to have been bad when they sold it to me. Does that happen? I will try the old vial tonight. I have been putting this test off for some reason but worrying about it. I just can't believe it was bad when I got it. Now I worry if it is a bad vial, she will go hypo on the old vial. She was at 5 units on the old vial. Things were going bad on the old vial. Just not this bad.
 
Marje and Gracie said:
Besides shooting too much R at the wrong time and potentially causing a Hypo, the other thing you have to be really careful about is causing dive/bounce type of cycles. Using R takes some finesse.
Click to expand...
Yes. I was thinking about R and bouncing.
 
Hi MJW, can you please post your numbers here hourly since you started the R experiment already? Perhaps change your title to something like “starting R today?”

I know Yum is in black numbers and you think perhaps you can do no harm with the R, but it was recommended to try it out for the first few times with someone that is experience with R if not R and high dose conditions for good reason. It’s concerning that you would choose not to do this as R is not something to take lightly, it can be very dangerous if used incorrectly, you need to have a proper respect for it to use it effectively in combination with Lantus.

A few others have started R recently and preplanned a date and their shot time in advance so someone like Sandy, Marje or Wendy could follow their progress and check in with them. This is for safety for Yum and for you, so you understand how R works. Everyone is concerned with Yum’s numbers and want to help you get them down, but safety is the priority. If it were as easy as just give Yum 5u of R at X time and voila, but it isn’t, please lean on the wisdom of others and do this safely and as recommended until you get a feel for it.
 
Stacy & Asia said:
Hi MJW, can you please post your numbers here hourly since you started the R experiment already? Perhaps change your title to something like “starting R today?”
Click to expand...
Saltycat was officially tasked with watching. And I know Wendy and Marje and Sandy are watching too. I will put the numbers in the title. I was going to start a new condo but too many conversations carried over from yesterday.
 
MJW said:
Saltycat was officially tasked with watching. And I know Wendy and Marje and Sandy are watching too. I will put the numbers in the title. I was going to start a new condo but too many conversations carried over from yesterday.
Click to expand...

That is unclear, it seems Wes suggested you have Sandy or Wendy monitor you using it the first time and said he would try to stop in if nobody else could. If you look at Raffy and Pig's condos, you will see they agreed in advance when to start with another experienced member. Your title doesn't even indicate you started R this morning and it's from yesterday, so it's easily overlooked and the right people might not even realize to check in because of that.

I hope the R gets Yum going in the right direction, but please do it with proper supervision going forward.
 
I'm in the office today and will keep an eye on the thread. THe other members mentioned are the ones who helped me, so I would defer to them if any questions come up. Like Asia mentioned, R insulin is potent and needs to be used with a light touch. This goes double for when you are first starting out, every cat reacts differently. The first few times I gave R it was low doses and didn't do much. That's OK. It might take a little time, but better to go slow then deal with an emergency by giving too much.

For housecleaning, I would recommend starting a new thread and linking to this one. It keeps things a little cleaner and gives you more room in the title to keep us updated on the numbers. Testing hourly for the first 4 hours is good to get some data on how much the R impacted her numbers.
 
Stacy & Asia said:
Your title doesn't even indicate you started R this morning
Click to expand...
I asked her to start a new condo when she could to keep things a little cleaner. She did shoot .25R at 5:50CST. From the SS(using AT meter)

AMPS 602
+1 617
+2 598

Judging by a few tests at +2 this seems like a typicalish pattern for her, maybe even a little less drop then normal but there is not too much data to go on in the first 1-2 hours.
 
Another suggestion concerning R, store it in a different area from your Lantus and figure out a way to visually or tactilely distinguish it from Lantus. I've read about someone using the spiky bit of Velcro tape, spiky side out wrapped around the bottle so as soon as you grab it, you know this is the serious stuff. Maybe a bit of red electrical tape on the bottle. Would be a good habit to shoot R in one space and L in another, not on the cat, but physically in a space like kitchen for R and living room for L, just some extra stopgaps to catch yourself from mixing them up.

You do not want to accidentally mix up your insulins and give 8 units of R instead of Lantus! It's happened before with cats on this board and it happens with people. With stress and sleep deprivation, it's not so crazy to think it could happen. Very scary stuff!
 
The R isn't supposed to be refrigerated after opened. It's cheap and an be tossed in 42 days. So I keep the Lantus in the refrigerator and the R in the pantry. The bottles are very different too. And the R is yellow on top whereas the L is grey. Also the R goes in the scruff and the L goes in the sides.
 
MJW said:
The R isn't supposed to be refrigerated after opened
Click to expand...
It is like Lantus, while it does not need to be refrigerated, but it will last longer in the fridge. Mine was fine after almost a year. Stacy has a very good point about making sure they are different in some way to prevent early morning oopsies. I kept mine in a big pharmacy pill bottle sealed. I had to go through the pill bottle first to get to it. Velcro, a rubber band, something to distinguish it easily is a VERY good idea.

How are we looking time wise for a +3 test?
ETA: Just saw the +3 on the SS. Keep us posted in the thread if you don't mind so we don't have to refresh your SS to monitor progress.

The +3 was 531, that is a good 70pt drop from AMPS. You don't want too much more action.
 
Stacy & Asia said:
You do not want to accidentally mix up your insulins and give 8 units of R instead of Lantus! It's happened before with cats on this board and it happens with people. With stress and sleep deprivation, it's not so crazy to think it could happen. Very scary stuff!
Click to expand...

I'm really curious about the response to this and how it was handled. Can you reference a thread for it? Or which cat and I can search through the archives? I so appreciate the depth of learning from others' experiences here!
 
MJW said:
The R isn't supposed to be refrigerated after opened. It's cheap and an be tossed in 42 days. So I keep the Lantus in the refrigerator and the R in the pantry. The bottles are very different too. And the R is yellow on top whereas the L is grey. Also the R goes in the scruff and the L goes in the sides.
Click to expand...

All that being said, it's still happened before, don't think it can never happen to you. It only takes such a small effort and almost no money to put safety checks in place, why wouldn't you?

People on this board have put test strips in to their iPhones and meters instead of rice socks in the microwave! :joyful: Being tired/stressed does funny things to your brain.

While those are comical examples, it's not the end of the world if those things happen, it could be the end of your cat's world if you use high dose basal insulin and accidentally give that amount of R instead. Respect it.
 
Status
Not open for further replies.
Back
Top