Biscuit - new answers to old questions..

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ShannonandBiscuit

ShannonandBiscuit

Member Since 2019
Hi everyone,
Biscuit has come out of remission after 5 years and I have a lot of the same old questions and wonder what the new answers are in 2019....

We are used to home testing so that is easy enough to get started. Our old meter was a Contour next but the battery is dead and the strips were expired and it seemed to need so much blood that I began researching here for a new meter. Biscuit is not a good bleeder. Sadly, I went to get the ReliOn Micro only to realize it was discontinued. For now, I picked up the ReliOn Premier with bluetooth, just so I always have a record of his readings (and it was $18 and the strips were cheap).

My first issues are these:
1. Our vet (new to us and biscuit) suggested starting with 1u twice a day. It took me a bit to find reasonable insulin and pick a meter so I was prepared to start this morning. However, when I did the first AMPS test his BG was 260 so I was a little hesitant to start out with 1u, not knowing how he'll react to the Novolin. Should I go ahead and dose? I know its over 250 but just slightly and with 10%-20% meter fluctuation issues....

2. He has lost some weight.. his normal is around 11.5-12, and he is down to 10.5. Vet first suggested Purina DM, but I'm not going to go that route. I was wondering if a higher protein count would be better for him. His sister has Thyroid issues and needs to continue putting on weight too. Currently they eat 9 lives pate mostly the Chicken & Tuna, Super Supper, and Ocean Whitefish, all under 5% carbs but only in the 30's for protein. However, with the new insulin.. should I try to change food too.. or wait till BG is more under control?

3. We travel. We are scheduled to be away for labor day weekend. With him being newly back on insulin I feel uncomfortable having someone come and and give him a dose and me not be here to see how he reacts. In the past we have just fed Dr. Elsey's clean protein chicken dry food in the auto-feeders while we are gone. Should I stick to that for this trip as its so close? other suggestions or options? I could have someone come by and give wet food while we are gone and just skip insulin? Thoughts? (For context, we have dealt with a major hypo incident before (many years ago) including a seizure and BG of 38. It was not fun and I really don't ever want to ride that rollercoaster again if possible.)

4. Any other things that have drastically changed in 5 years? Anyone know of cats that go back into remission a second time or are we out of luck on that one?

Thanks again for all the advise and the forums which are so helpful... Eventually I'll upload a spreadsheet link but right now it just has the one number on it.

-Biscuit't mom, Shannon
 
Hello Shannon! Some more experienced members should be along shortly but I just wanted to say I've seen a few kitties around here who have hit remission more than once ^-^
 
The GA prefix means that your cat has passed, so it might be better to change the prefix to a ? instead!

Sorry that Biscuit is out of remission, but hopefully he can make his way back! I saw from your intro post that Biscuit used to be on lantus - lantus is a much superior insulin for cats than novolin. It’s very expensive in the US though, so many members here buy it from Canada for a lot cheaper. There’s info about that in the lantus forum if you’re interested! If you do choose to stay with the novolin, definitely read up on how it works because it’s quite a bit different than lantus

If you’re going to change diet, usually the best time to do it is before you start insulin so that you don’t have to worry about it potentially affecting the dosage. But if you choose to wait, home testing definitely makes it a lot safer.
 
From the Novolin stickie:
Generally speaking, for newcomers to N/NPH it’s recommended that no insulin is given if the BG is below 250 [13.8] on a human glucose meter. And you may wish to use a slightly higher ‘no shoot’ number such as 300 mg/dL [16.6 mmol/L] in certain circumstances.

Novolin hits hard and fast. The test/feed/shoot sequence is different than Lantus.
1. Test - to see if the number is high enough
2. Feed - to make sure there is enough food on board
3. Wait an hour - to make sure food stays down (no scarf and barf)
4. Shoot

http://www.felinediabetes.com/FDMB/threads/beginners-guide-to-novolin-humulin-nph.186097/

Tagging @MrWorfMen's Mom for you.
 
because of a sale locally, I was looking at different foods, if you want low carbs but slightly higher protein, look at Friskies "shreds with tuna" --

am sure you're aware of Dr Pierson's food chart (link at the top of the main forum); she's updated it periodically

yes, be very cautious with Novolin, it hits even faster than Vetsulin, both of them work better if you feed multiple mini meals early in the cycle, and be ready for it to last only 10 hours or so .. IMHO if you can afford Lantus, it's far easier both on you and Biscuit
 
oh yes, if you search you can find either the ReliOn Confirm or Micro, or the original mgf Arkray Glucocard01 -- online from another vendor (probably bought the stock on a closeout but price is now higher) -- the strips for these are still available at Walmart online
 
CandyH and Catcat said:
because of a sale locally, I was looking at different foods, if you want low carbs but slightly higher protein, look at Friskies "shreds with tuna" --

am sure you're aware of Dr Pierson's food chart (link at the top of the main forum); she's updated it periodically

yes, be very cautious with Novolin, it hits even faster than Vetsulin, both of them work better if you feed multiple mini meals early in the cycle, and be ready for it to last only 10 hours or so .. IMHO if you can afford Lantus, it's far easier both on you and Biscuit
Click to expand...


Would you recommend using the Novolin till the Lantus could come from Canada? I didn't know anything about the Novolin when the Vet wrote the prescription but after reading on here I definitely think I'd be happier with the Lantus given that is what he had before and it worked. (and thanks for the suggestion on the meter.)
 
Many people use the Freestyle lite meter which takes a .3 microlitre blood drop, but the strips are relatively expensive. There are some other meters that take the smaller sample size as well. I didn't want to start out with a discontinued product since sooner or later the strips won't be available. Who knows why they would discontinue the micro / Confirm :(

I asked about human meters several weeks back and got some useful replies. If interested see: http://www.felinediabetes.com/FDMB/threads/suggestions-for-human-meters.216471/
 
I'm so sorry to hear Biscuit has come out of remission. I can only imagine your disappointment but there have been lots of cats here go into remission on a second time around so never lose hope.

As already mentioned Novolin unlike Lantus, tends to drop BG swiftly early in the cycle and often doesn't last through the entire cycle . That said, some cats do fine with it but if you can consider the Lantus, I think you would find it easier to work with especially since you've successfully used it before.

Diet wise what you are feeding is fine and so is the Dr. Elsey's dry. Wet is definitely preferable but for a weekend I don't see any reason not to feed the Dr. Elsey's. The diet your kitties are eating is fine but if you want to try something with higher protein that's fine too. It's the carbs you need to watch for Biscuit and higher protein shouldn't affect BG.

I'm assuming you didn't give Biscuit any insulin this AM. 1u might be OK BUT with BG being right at the edge of the no shoot mark, I'd be inclined to try 0.5u for starters and see how that works for Biscuit. What is your availability for monitoring? With the quick drops Novolin can cause, I would suggest starting insulin when you can grab a couple of early cycle tests between +1 and +5 hours post shot to see how he reacts.

Did Biscuit ever have ketones or DKA in the past? Will you be gone for the whole long weekend or just an overnight?
 
MrWorfMen's Mom said:
I'm so sorry to hear Biscuit has come out of remission. I can only imagine your disappointment but there have been lots of cats here go into remission on a second time around so never lose hope.

As already mentioned Novolin unlike Lantus, tends to drop BG swiftly early in the cycle and often doesn't last through the entire cycle . That said, some cats do fine with it but if you can consider the Lantus, I think you would find it easier to work with especially since you've successfully used it before.

Diet wise what you are feeding is fine and so is the Dr. Elsey's dry. Wet is definitely preferable but for a weekend I don't see any reason not to feed the Dr. Elsey's. The diet your kitties are eating is fine but if you want to try something with higher protein that's fine too. It's the carbs you need to watch for Biscuit and higher protein shouldn't affect BG.

I'm assuming you didn't give Biscuit any insulin this AM. 1u might be OK BUT with BG being right at the edge of the no shoot mark, I'd be inclined to try 0.5u for starters and see how that works for Biscuit. What is your availability for monitoring? With the quick drops Novolin can cause, I would suggest starting insulin when you can grab a couple of early cycle tests between +1 and +5 hours post shot to see how he reacts.

Did Biscuit ever have ketones or DKA in the past? Will you be gone for the whole long weekend or just an overnight?
Click to expand...

No, I did not give him any. I wanted to get a response or two first and didn't think a few more hours at a borderline BG level would be harmful. My one major take away from the first time around was better too high than too low. My husband and I work from home so monitoring is easy most days. I think I'll start him off tomorrow morning with 0.5u and then test almost every hour to see how he reacts.

He has not had DKA or ketones that I am aware of. We are leaving Friday evening and will be gone till Monday around noon.
 
Glad to hear there is no history of ketones or DKA. Starting tomorrow morning sounds like a good plan. If his BG is sitting at the edge of shootable, then I think it's fine to skip for the weekend as long as Biscuit is eating well and acting normally but I would, just to be on the safe side, test for ketones before you leave on Thursday or Friday. Better safe than sorry. Let us know what Biscuits BG is tonight at usual shot time. Might as well get some baseline data for comparison when you start the insulin tomorrow. :)
 
His PMPS number was 254 and +2 was 272, but no actual insulin. (and that was 2 hours after food as well. 1/2 a can of his normal wet food) 1. test, 2. feed then I tested again 2 hours later.
If it helps, his number at the vets office was 307.

I am definitely going to call the office tomorrow to get a prescription for Lantus given everyone's comments but with the cost it looks like I will have to order it from Canada as others have suggested. Would you suggest even starting on the Novolin just to keep his sugar down until it arrives? or will the change in insulin be hard at all?

I don't want to run the risk of high sugar harming him any more than it already potentially has but I also don't know what if any are the effects of switching insulin. Also, as a side note, as far as condition goes. He has lost some weight, is more lethargic, and is drinking more than I would like, but still is eating (comes when called), hanging with the family, playing with toys, etc.
 
The sooner you get Biscuit on insulin the better the chances of getting him into remission. He's already going to have to go without over the weekend an you don't have time to put any plan together to get someone to test and give insulin. His BG is not horribly high but it is in a grey area of possibly being above renal threshold meaning he's may be spilling sugar in his urine. Is the litter box a sticky mess? Cement slabs to clean up? Is there a sweet odour? Prolonged high BG is damaging to the kidneys but that said another few days isn't going to be make a critical difference. I'd be more worried about ketones developing due to the lack of insulin.

It's really your call. The Novolin works quickly and pulls BG down a lot, early in the cycle and quite often doesn't last the whole 12 hours. This can make for some bouncing and possibly make kitty not feel particularly well but some cats do fine. Each cat reacts differently. Yes it works a bit differently from Lantus in that it's an In & Out insulin. What you give in the morning has no effect on BG in the next cycle whereas with Lantus you get a gentler drop, the insulin lasts the full cycle and you have the depot to keep the insulin level more stabilized. Testing routines are essentially the same and both are dosed based on how low a dose takes BG. Some folks will suggest Novolin is dosed based on pre-shots but that is not true and would be extremely dangerous. Pre-shots in both cases will tell you if it is safe to give insulin. The big difference is in the action of the insulin and when the nadir (peak action) of the insulin usually occurs.

Where are you located? There are a few folks with postings in the Supply Closet here with Lantus to sell. If someone is near you, you could possibly get your hands on the Lantus sooner than a shipment from Canada. All you need is one pen. Even if it was mailed, there wouldn't be any holdup in customs etc so it might be faster. That way you can order from Canada going forward with lots of time for delivery. You could just start off with Lantus without having to learn how to work with the Novolin. Just a thought.
 
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