Cat getting insulin every 6 hours.

Status
Not open for further replies.
L

lexie_woody

Member Since 2023
Hey! So I am completely new to this. About a week ago we put my kitty (Rollie) on novolin and I was given a paper to do my glucose curve at home. The paper states to check glucose every 6-8 hours and dose accordingly. So I do exactly that. Every 6 hours it seems my cat is getting 4 to 4.5 units of insulin. I don’t know what I am doing wrong here. He is getting 1 can of hills glucocontrol wet food and 1/4 cup of purina DM a day I feed that around 10 am and 10pm. And boiled chicken as his treats for his glucose checks and insulin injections. Can someone help me out here because 4 units every 6hrs just seems extreme but his glucose averages in the 600’s. I check it around 6-7 am, 12-1 pm, 6-7 pm, and 12-1 am. I’m currently pregnant plus I have a toddler so losing sleep over this is driving me insane.
 
Hi and welcome to the forum.
PLEASE DO NOT GIVE NOVOLIN EVERY 6 HOURS!!
That is dangerous and can kill your kitty.

All insulin for cats is given each 12 hours.
I think there has been a miscommunication with your vet.
And 4 units is far too big a dose to start with anyway.

Would you please go back to 1 unit of Novolin each 12 hours? That is the normal starting dose for Novolin when you are feeding dry food.
it sounds as if you are testing the Blood glucose so that is very good! can you tell me what type of glucose meter you are using. .

So the procedure is
  • Test the blood glucose (BG).
    If the BG is over 200 feed your kitty a main meal.
  • Wait one hour after your kitty has been fed, then give your kitty 1 unit of the Novolin
  • Test during the cycle around +4 to see how low the dose is taking your kitty.
  • Feed a couple of snacks during the first half of every cycle.
I have lots of other information for you but let’s get the dose and the number of times a day you give the insulin sorted out first.
I will wait foe your reply.
Bron
 
I agree that 4 units of Novolin N every is way too much to start and should not be given every 6 hours.
Maybe the paper said to dose every 12 hour (twice daily) and to check BG at about 6 hours after shot and base the next dose on the BG you got at 6 hours. However, N insulin typically only lasts 8-10 hours and thus BG should be checked about 4-5 hours after shot.
 
Hey all! There was definitely no miscommunication. It is exactly what my paper says to do. I verbally asked the vet “so this paper is saying dose him according to what my reading is every 6-8 hrs and the prescription you wrote says dose every 12 hrs?” He specifically told me “yeah I have to put instructions on the prescription but I don’t want you to do that I want you doing exactly what the paper says” we never started at 1 unit we dosed 4 units in office when he was teaching me what to do. I was told to get back with him in a month and if I’m consistently having to give 4 units we would up it to 5 and go from there. I do not feel comfortable at all only dosing 1 unit every 12hrs when 4 every 6 isn’t even cutting it because I definitely think dropping insulin that significantly would kill him. I can include a picture of my curve paper if that would be helpful? Perhaps I should call the vet and ask how long they expected the 6-8 hr checks and doses to last before we get consistency with sugar being not 600 and I’m at the more recommended 12hr check and dose point.
 
“The benefits of Tight Regulation are huge, and every one of my clients that has tried this method is glad they did. Their cats feel better, and more active and playful, and regain better body condition than they ever experienced using the ‘old’ methods. Further, over a few days or weeks, many cats require smaller and smaller doses of insulin, less often, and the majority go off insulin altogether over time. The extra time and effort invested in the beginning of Tight Regulation is repaid manifold as the patient becomes well again!

The following is a suggested ‘sliding scale’ for the cat just starting Tight Regulation. The protocol asks the owner to test at least twice daily, but optimally three or four times daily (every 6-8 hours), with doses of insulin given according to the reading at each test:

Blood Glucose / Units of insulin to inject
151-170 / .5
171-185 / 1
186-200 / 1.5
201-220 / 2
221-250 / 2.5
251-290 / 3
291-350 / 3.5
351-410 / 4 “

I couldn’t figure out how to post a picture so I just typed it all out. I think what I’m understanding is this is actually a type of method and not necessarily a “glucose curve” to figure out a constant dose. My vet specifically told me to do the 3-4 checks because it is the preferred way. And even though his readings are beyond the chart I’m still only to do 4 units until I get his approval for 5 in about a month. So I guess I am doing it right considering it says it could take weeks before I should expect him to take smaller doses less frequently.
 
Yes please include a copy of your curve.
It is very possible Rollie is bouncing from low numbers and you are seeing high numbers when that happens.
Here is what happens when bouncing occurs. From the yellow stickie The Basics
  • Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
Did the vet mention ketones at all at diagnosis?
Dropping the dose to 1 unit will not kill Rollie, but if you continue with 4 units it might do so.
Novolin is a harsh fast acting insulin which is not suitable for cats and a dose of 4 units could drop the blood glucose into hypo territory, especially if given 6 hourly. .
I am surprised your vet is prescribing Novolin N insulin to be honest, as he mentions the “old methods” and Novolin N is one of the old insulins. There are much more suitable insulin now for cats such as Lantus and prozinc.

I have just seen your post (number 5)
We do a tight regulation here and it is true that many cats can eventually need smaller and smaller doses.
but I have to say that the sliding scale that the vet has given you is dangerous especially when using Novolin and especially in a newly diagnosed cat when there is very little data.
I can only tell you what we would strongly recommend here and then it is up to you whether you want to risk giving Rollie such a big dose. We frequently get cats here that have been prescribed too much insulin by their vet.
I will send you the link to Novolin for you to read.
Introduction to caninsulin and Novolin ….note that this is a link to both Caninsulin and Novolin N insulin.

Beginners guide to Novolin N https://felinediabetes.com/FDMB/threads/beginners-guide-to-humulin-n-novolin-n-nph.231593/

I am going to tag one of the moderators to talk to you. I am very concerned about the advice from your vet.
@Sienne and Gabby (GA)
 
Last edited:
I do not say this lightly. Please find another vet who has a better understanding of feline diabetes. Tight Regulation is not a dosing method that is used with Novolin. It was developed for use with Lantus (glargine) and Levemir (detemir) and published in 2009 in a leading veterinary journal. (See Roomp & Rand, Journal of Feline Medicine and Surgery, 2009, vol. 11, pg 668-682). I can attach the article if you'd like.

My cat was started on Novolin. This was at a time when Lantus was a new insulin for humans and not widely used in cats. Novolin (also called NPH and Humulin N) is no longer endorsed by the American Animal Hospital Assoc. for the treatment of cats and hasn't been endorsed since 2018. They recommend either Lantus or Prozinc. This is a link to the AAHA guidelines if you want to share it with your vet. The issue with Novolin is that it is harsh, it can drop blood glucose (BG) numbers hard and fast, and it has insufficient duration (it doesn't last 12-hours) given a cat's fast metabolism. While dosing every 6 hours may address that issue, it's not sustainable for a caregiver who may have to go to work, has a family, or needs to sleep. More importantly, the dosing schedule risks your cat having an episode of symptomatic hypoglycemia. In other words, dosing four times a day is not safe unless your cat is hospitalized. And if your cat is anything like most cats, numbers will drop at night or on a holiday when your vet isn't around to clean up after himself. I'm also linking a 2015 paper that gives information on diabetes treatment. Please look at Table 2 -- it documents that all varieties of Novolin (it's also called NPH in the article) are dosed every 12-hours. My apologies for providing all of these links but I want you to have the evidence to back up what we're saying versus thinking we're a bunch of crazy cat people trolling the internet. Unfortunately, we have a good deal of experience with vets who do not keep current with the research.

Given where your cat's blood glucose numbers are, I can appreciate your vet wanting to be aggressive with dosing but this is scarily aggressive. There are better ways of managing your cat's diabetes. I would talk to your vet about switching to Prozinc or Lantus (glargine is the generic/biosimilar and is far less expensive than Lantus). Glargine takes a while to build up in your cat's system and given the high numbers, you may want to consider Prozinc as it may give you more flexibility and has a longer duration than Novolin.

It sounds like you're home testing. I'm very glad you're doing so. Part of why Rollie's numbers are remaining high is that the "diabetic" dry food is very high in carbohydrates. We consider low carb as under 10% carb. The Purina DM dry food is 18%. Do NOT eliminate the dry food especially if you are not home testing. It is likely that the only thing that is offsetting the amount and frequency of the insulin is the dry food. To be blunt, it's saving your cat's life. If you want to get rid of the dry, you will need to transition slowly so his numbers don't drop too fast.

I'm sorry that your vet is recommending a treatment that may work if a cat is being monitored 24/7 in a hospital setting and in unsustainable for a caregiver at home. I've been on this board for a long time - since 2009. I can probably count on one hand the number of cats that were being dosed more than twice a day and then, it's been 3 times a day and that's only after x2/day dosing wasn't working. Our cardinal rule here is to ensure a cat is kept safe. What your vet is recommending is not appropriate for diabetes management from the standpoint of the choice of insulin, the frequency of dosing, and keeping dry food in your cat's diet.
 
Last edited:
There's another potentially huge problem here. Sorry, I peeked at your profile and see you're just 23 so you probably haven't had many arguments with doctors or vets at this point in your life, I have. My chiropractor, vet, family doctor and neurologist are all women (because men don't listen) and not one of them likes to be called "doctor". It's the only profession where you'll hear "It's doctor actually" when introduced. Mine all encourage me to do my own research and are willing to learn new things even from a mere mortal. On your next vet visit we won't be there and whether you realize it or not the lab coat, stethoscope and all those degrees on the wall can be intimidating along with some built in arrogance.
It's a sad fact that only 0.2% to 1% of cats will be diagnosed as diabetic so veterinary colleges don't spend much time on this. I've seen a lot of bad advice in my time here and this is one of the worst examples. We're right, your vet is wrong. No type of insulin is meant to be given on a 6 hour cycle and those doses are way too high.

Sienne and Gabby (GA) said:
Please find another vet who has a better understanding of feline diabetes
Click to expand...
If this was a mechanic who told you your framastoft doohicky was connected to the whatcha-macallit wrong and the parts had to come from Zimbabwe you'd get up and leave without any guilt. For your own sanity and the life of your cat you need to get up and leave as soon as possible.
We don't sell things here, there are no ads, no one here gets paid for anything. Does it make sense we'd tell you this without a good reason?
Someone has made a big mistake. Maybe it's a typo but it's not your fault. Of the 28,918 members here many have been given bad advice so you're not the first and won't be the last.
 
Lexie - I am so glad you found this forum. Your instincts were 100% correct, there is most definitely something wrong with what your vet has proposed, and frankly speaking puts your cat in danger of having a symptomatic hypoglycemic event.

lexie_woody said:
I verbally asked the vet “so this paper is saying dose him according to what my reading is every 6-8 hrs and the prescription you wrote says dose every 12 hrs?” He specifically told me “yeah I have to put instructions on the prescription but I don’t want you to do that I want you doing exactly what the paper says”
Click to expand...
(Emphasis mine)

So the vet wants to lie on the prescription because he knows that no pharmacy would fill a prescription based on inappropriate dosing?

Both Sienne and Bron have raised some excellent points as to why there are major issues with what your vet is recommending on dosing and the links provide you with supporting information, but I'll add a few comments based on what caught my eye.

As Sienne said, Novalin hits hard and fast, often having an effect soon after it has been injected (often within 60 minutes). In the beginning, it would be important to get tests within the first 6 hours by doing a curve to see how the insulin is working. At the moment, based on the instructions you have, it would seem that you are being asked to only test at 6-8 hours, which means you cannot actually get a sense of any low numbers that are perhaps occurring. It is mind-boggling that a vet would not suggest getting tests to see how low the dose is taking the cat, particularly when they are suggesting an extremely aggressive starting dose and frequency. But more to that point:

Sienne and Gabby (GA) said:
I'm sorry that your vet is recommending a treatment that may work if a cat is being monitored 24/7 in a hospital setting and in unsustainable for a caregiver at home.
Click to expand...

Exactly this! in a hospital setting, the cat would be monitored 24/7 and intervention via glucose drip would be available to prevent hypoglycemia. But there are certain circumstances where a cat would NEED to be dosed more frequently and monitored in a hospital setting.

I was wondering - Are you using a pet meter or a human meter? I am glad that you are able to test at home, and would echo what has been suggested by some very experienced members above. Please do not give 4 units of Novolin every 6 hours, for safety's sake, until you are able to see about perhaps switching insulins, it would be better to start off at 1 unit every 12 hours and get some test data as I noted above to see how the insulin is actually working.

We have a saying here, which I think sums up how much of a focus we have on keeping kitties safe: "Better a day too high than a minute too low."

Please let us know how else we can help.
 
Lexie you sound like a smart young woman who wants the best for your cat, Rollie. Finding this group was the best thing you can do at this point. Know that there is so much experience here and endless dedication by members who are willing to share that experience. They offer careful guidance based on probably hundreds of kitties and their owners who have come before. There is a lot to learn in the beginning, but an unlimited amount of patience as we stumble through that onslaught of information. Sometimes I asked the same question a couple of times, before the answer sunk in! :)

Being pregnant, with a toddler especially over the holiday season, certainly the stress level is flashing red. Again, you have found the helpers that you and Rollie need. Let them guide you. It will get much, much easier. Welcome.
 
Here’s another way to think of it, a human person would never ever give themselves or their child insulin every 6 hours. It’s the same for a cat or a dog. There’s a reason your vet had to “lie” in the prescription and why no pharmacy would fill it and sell insulin to be administered every 6 hours and that is because it can kill when too much is given too often. I’m sorry you’ve been given such bad information and advice because just keeping up with that testing and shooting schedule must be insane and there’s no need for it at all. I think your vet just has no understanding of the TR protocol, which a lot of us here have used on our sugar kitties, including me. Minnie was on the TR protocol the last year. In addition to what Sienne already said, TR cannot be used if your cat is eating dry food. Sadly, you’re not the first person we’ve seen here that has received vet advice that puts their cat in danger. My friend’s sister’s cat was put on insulin and had normal numbers once I told her to start home testing. He was having seizures as a result and would have died if she hadn’t stopped giving him insulin. People are not perfect and neither are doctors or vets. Some are good at what they do and some are just not. I hope you’ll follow the spot on advice you’ve already been given here.
 
Last edited:
May I ask what typw of vwt you are seeinG. Is it a vet that only see companion animals or is it really a large animal (e.g., cows) vet that also see companion animals in the community. In small rural communities there may be only large animal vet that only occasional sees companion animals.
 
This is what a good vet does for you.
When Nigel was diagnosed diabetic it was a big shock but he was an Angel about it and I was already full time at home so I got lucky there. First I was not allowed out of the clinic until I could prove I could both test and inject. Then my vet phoned me every day and every night for two weeks advising me on what his dose should be. Nigel is gone now and when he died we got a card signed by the entire staff and an expensive floral arrangement.
If it sounds like we're ganging up on you that's not the case. You're getting all these replies because most of us have seen this kind of lunacy before and it has to stop. There are no stupid questions here and we don't shame people. Promise us you'll come back and we'll figure this out together.
 
Hello and welcome Lexie, to the best place you never wanted to be. I hope we can work with you to make your life less stressful with a diabetic cat. It's awesome that you've started home testing already. Good for you.

Can you tell me a bit about how Rollie was diagnosed diabetic? Did he have any other medical conditions at the time? And one last question, sorry about so many, but can you confirm it was Novolin N instead of Novolin R that you are giving?
 
Hi Lexie

Welcome to FDMB. You’ve gotten a lot of great info from other members so I won’t repeat but, it is important, as Wendy has asked, as to which Novolin you are using. Novolin N has a much longer duration than Novolin R. Also, while some other forums use sliding scales, we don’t do it here if the only insulin being used is Novolin N, Prozinc, or one of our long-duration insulins. Generally, we find that with all the insulins we use here, consistency in the dose works better and the dose is only reduced when the BG falls below the reduction level prescribed (which is 90 on a human meter for Novolin N).

We also use Spreadsheets (SS) here and I am happy to do one for you to take a lot off your plate. It will help us help you more efficiently. I will need some info from you so if you can send me a private message (PM), I can get that and do the SS and post it so we can all see it. To send me a PM. just click on “Marje and Gracie” under Gracie’s photo to the left and then “start a conversation”.
 
Status
Not open for further replies.
Back
Top