Diego glucose update

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ja9390

ja9390

Member Since 2016
I bought the testing supplies and tested him for the first time this afternoon at 1pm, and it read 166. He had eaten at 8am, 1 unit of Novolin N at 8:30. I do leave a can of wet food out for both of the cats to snack on while I'm gone, however, so I know he probably ate a little since this morning.

Some wonderfully helpful people were very adamant about me testing him at home, and this is his first ever reading that I've done. How many times per day should I be testing him? When should I test him? Will it always be multiple times a day for the rest of his life? I am gone a lot, either in class or I'm working, so Saturdays will really be my only day to consistently test him throughout a 12 hour span.
 
You can always test right before the insulin shot. Are you planning on having a spreadsheet? I find they're helpful.
 
Good job on starting testing!!

Since Novolin is a faster acting insulin which tends to bring glucose levels down faster than the long acting insulins, you would want to test before shooting with at least two hours of no food before the test. If he has eaten two hours before the test it could show higher numbers because the food will temporarily increase the levels. You are feeding 30 minutes before giving the shot which is good when using Novalin. You should test at +2 hours after the shot and see how the glucose levels are doing. You do not have a spreadsheet set up yet, but it can be helpful to see trends and patterns quickly. After testing, since you ar just beginning with home testing you could post your results on your thread here. To get more attention you can change your title and add a "?" icon from the drop down box and perhaps change the title to "dosing advice" or "question about testing result" or whatever.
 
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So when I test him first thing tomorrow morning before he's eaten breakfast, if his number is below 200, I shouldn't give him any insulin that day? I will be picking all food up later on tonight when I go to bed so that he'll be on an empty stomach in the morning.

I do plan on setting up a spreadsheet eventually
 
What we usually suggest is to stall. Wait 20 minutes, without feeding and retest. You want the number to rise, not fall and be over 200.
 
Here are the three numbers I've gotten from him since yesterday. I am away from home most of the day during the week, so I won't be able to test him every 2 hours until Saturday.

2/14: 1:00pm (+5) 166
2/15: 7:45am: 334 followed by insulin at 8:15. Left for class at 8:45 so did not retest.
2/15: 11:15pm: 449

I'm worried about the 449 I just got. He just woke up and drank some water for a while I so tested him and sure enough...I've only been instructed to give him 1 unit in the mornings until I take him to have a curve done (which will be this week--calling in the morning). I'm nervous that if I do give him another unit right now, what if he drops when I'm asleep? @Tuxedo Mom @Sue and Oliver (GA) @Ken & Tara
 
As you already know, Novolin N may not last a full cycle so an elevation in BG numbers is to be expected. There is a possibility that the higher reading you got tonight may be due to Diego bouncing off the earlier 166 (and there is always the possibility that he may have gone even lower at some point in the cycle).

I've not used Novolin N so I can only give you general principles. I know only too well how disheartening it can be to see higher numbers but Diego did not become diabetic overnight and it will take time to regulate him. Without more data you need to be cautious. High numbers may not be ideal but going too low is dangerous. If Diego were mine and I were in your situation I think I would keep following the vet's instructions (unless data showed that a dose reduction was needed in which case I would speak to the vet as a matter of urgency before the next dose was due). Other members may have a different view.

Better too high for a day than too low for a minute.


Mogs
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I checked him again an hour later and it went up to 455. I know that I don't have much to go off of other than those four numbers and the vet's instructions, and I'd rather not give him anything and hope it goes down a little than to shoot insulin and then fall asleep and not be able to help him if he needs it. Totally calling the vet in the morning though...I know that cats can handle high blood sugar much better than dogs or humans but a 455 reading makes my skin crawl. The irony is that I constantly preach the benefits of a low carb, low sugar diet and my own cat gets diabetes.
 
ja9390 said:
I checked him again an hour later and it went up to 455. I know that I don't have much to go off of other than those four numbers and the vet's instructions, and I'd rather not give him anything and hope it goes down a little than to shoot insulin and then fall asleep and not be able to help him if he needs it. Totally calling the vet in the morning though...I know that cats can handle high blood sugar much better than dogs or humans but a 455 reading makes my skin crawl. The irony is that I constantly preach the benefits of a low carb, low sugar diet and my own cat gets diabetes.
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Just to clarufy

Are you only giving one shot of 1 unit of Novalin each day or are you giving 1 unit every 12 hours?

As Mogs (Critter Mom) said in her comment above this Novalin can have an even shorter duration than some of the other long lasting insulins. Novalin is usually done as a twice a day injection.

The higher numbers could be the result of either only doing one shot each day and/or from hitting lower numbers than Diego is used to which causes a response "bouncing" up to higher numbers.

If you are only doing one shot per day you should question your vet about splitting the dose into two injections. Also setting up a spreadsheet and getting more testings will show how Diego's body is responding to the insulin.
 
N insulin only last 8-10 hours and is NOT a one shot a day insulin at all. Only a very very very few cats can get by with one a dy dosing with the loner lasting insulins like Lantus or Levemir. I would got with twice daily dosing with the N now.
 
I agree with everyone else. Insulin needs to be given twice daily. Your testing has shown you that. (Congrats on getting that done!). The insulin does make him drop but it is gone after one 12 hour cycle. Your 166 at +5 is encouraging as it shows the insulin was working then and does take him down around 5 hours after the shot. But once he rises (the cycle should look something like a smile - from pre shot down to the lowest point and back up again) he needs more insulin. If no shot is given once the insulin is gone, he just continues to rise, up to the 400s he is in this morning. It probably feels like a roller coaster, from highs to lows with unfortunately most of the time in high numbers.

Being blunt, your vet should know this. I know it is hard to hear people disagree with him/her, especially people you don't know on the Internet. But your testing shows you that it doesn't work to give it once a day.
 
Yes, when he was diagnosed on the 2nd, I was instructed to give him one shot per day of the N every morning for now. They were supposed to have contacted me about when I should take him in for the curve by now. I'm actually going to ask if I can do it at home and just send them my data, and in the meantime get "permission" to give him another shot 12 hours after the last one
 
No I absolutely agree. Not to say that vets are misinformed but...they're not specialists. They're general practitioners with a huge amount of broad knowledge on lots of animals. That's why I was reaching out last night. It frustrates me that a human would be immediately set up with support groups, resources, strict guidelines and dietary advice upon their diagnosis but my cat gets sent home to suffer for two weeks until "we do a curve".
 
ja9390 said:
Yes, when he was diagnosed on the 2nd, I was instructed to give him one shot per day of the N every morning for now. They were supposed to have contacted me about when I should take him in for the curve by now. I'm actually going to ask if I can do it at home and just send them my data, and in the meantime get "permission" to give him another shot 12 hours after the last one
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Novalin N insulin is what is considered an intermediate insulin. In kitties its effects normally last 8-10 hours but can vary with each cat. So in only doing one dose per day you are only covering the high glucose numbers at best for 1/2 the day. Your vet should be aware of this fact although many vets have limited experience with diabetes, especially feline diabetes. Novalin will have a longer effect in dogs and may only be used once a day in some cases, but because a cat's metabolism is much faster than a dog the insulin will not cover an entire 24 hour time period.
 
Also....

Since you are already home testing you can do the curve at home. It will be less stressful for Diego and much cheaper for you. Many cats will have higher glucose levels at the vets because of stress, so testing at home will give more accurate results.
 
One more thing...if you get "permission" (which you really don't need) to do 2 shots a day, you need to ask ...the vet and people here who use Novalin...what dose to start at. Whether to do 2 doses of 1 unit or 2 doses of 1/2 unit. Either way you will need to monitor his numbers.
 
Yes. I think spreading it out will be the common sense thing to do but I need the support of my vet. I don't want for it to seem like I'm trying to take the reigns from her hands or imply that I know more than she does, which is why I'm really caught on having a consult or at least a phone convo with her. If at the very least, I'll be informing her that I'm giving insulin once per 12 hours. There's no other way around that issue regardless whether we do a curve now or later. They can think I'm crazy all they want but I'm not willfully allowing him to go into DKA
 
ja9390 said:
Yes. I think spreading it out will be the common sense thing to do but I need the support of my vet. I don't want for it to seem like I'm trying to take the reigns from her hands or imply that I know more than she does, which is why I'm really caught on having a consult or at least a phone convo with her. If at the very least, I'll be informing her that I'm giving insulin once per 12 hours. There's no other way around that issue regardless whether we do a curve now or later. They can think I'm crazy all they want but I'm not willfully allowing him to go into DKA
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When you show the vet Diego's numbers it should be pretty clear that the insulin is not lasting 24 hours. Many vets use Novalin for dogs and for dogs it can often last a full 24 hours, but not for cats because of their faster metabolism. Diego's numbers should be all you need to show the vet to get your point across.
 
Btw...his BG was 514 this morning before insulin. Last night and this morning he was throwing up foamy water. I gave him his insulin after his glucose test, waited 35 minutes to feed and 20 minutes later he puked. I called the vet, got ahold of a tech and asked to either speak with her in person or over the phone, explained that I'm home-testing, that his numbers are unacceptably high later in the evening and that I am wanting to either split the dose or repeat it twice a day. Waiting for my call back.
 
Just reread your last comment. Did you test him then give him insulin then feed him?

With Novalin you should test first, feed THEN give the insulin 30 minutes later. Novalin hits much harder than some insulin and you need to have food in him before you shoot.


ETA I would do a retest since he ate late and threw up
 
I gave the insulin and had food down but he gave it a few licks and walked off probably due to the stomach. I wasnt expecting him to deny it. Not like him lately because he usually will inhale it. But 30 minutes later I tried another brand and he ate the entire can. Didn't seem like he threw the whole thing up. Just checked him at the +1 hour mark and its at 403. As I type this he's loving and rubbing all over me--I know he must feel so much better. Will try and get some more food in him and now I'll be sure to feed BEFORE the shot should this ever happen again.
 
That may be exactly what it was @Tuxedo Mom. I usually leave a small FF can down for both boys to nibble on through the night but tonight I picked everything up at midnight because I wanted an accurate reading of his BG this morning. I think you're right about the stomach acid.
 
ja9390 said:
I gave the insulin and had food down but he gave it a few licks and walked off probably due to the stomach. I wasnt expecting him to deny it. Not like him lately because he usually will inhale it. But 30 minutes later I tried another brand and he ate the entire can. Didn't seem like he threw the whole thing up. Just checked him at the +1 hour mark and its at 403. As I type this he's loving and rubbing all over me--I know he must feel so much better. Will try and get some more food in him and now I'll be sure to feed BEFORE the shot should this ever happen again.
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Oh good! With Novalin Diego must eat before the shot. Since Novalin hits faster and harder than the long acting insulins, without food it could possibly drop his numbers too much and too fast. Since he dropped from 514 to 403 in one hour you can see that it does act very quickly. Even though the numbers are still high that is a big drop for only one hour. It would be a good idea to retest again in an hour. This will make sure he is not still dropping too fast AND give you more data about Diego's responses to the insulin. If he has eaten his usual meal you do not need to feed him right away, since food will influence his glucose numbers when you do another test.
 
Yes, always feed before his shot. With the harsher insulins like Novolin it's usually best to wait at least 20-30 minutes after he eats to give him his shot, just to make sure the food stays down and is on board to help buffer sharp drops in BG. To assure you're getting an accurate reading when you test, just make sure that he has no food for two hours before test time.

Since you are testing at home it might be helpful to you to set up our spreadsheet. It helps you keep track of BG numbers and dosing information and really is an invaluable tool to have. It also helps us if we can look at it when you have question or need help. I found it tricky to get set up so if you need help with it just sing out and someone can walk you through it.

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

You can share the link to Diego's spreadsheet with your vet, which might help open up better communication with her in regard to Diego's treatment.
 
Novolin N drops blood glucose really hard and fast. I would wait 20-30 minutes after feeding to give Saoirse Caninsulin when she was being treated with it. If she were being treated with Novolin N I would wait significantly longer after the preshot feed before giving that particular insulin since it can drop blood glucose levels harder and faster than Caninsulin/Vetsulin.

Here's the spreadsheet for Woody, one of Mum of Two Felines kitties. Have a look at the data for the morning of 2nd Feb and the evening of 4th Feb to see how fast Novolin N can really tank blood glucose levels. (NB for MO2F's meter type, the hypo threshold BG level is 68!).

According to the FDMB Humulin N Primer, a delay of 1 hour is recommended between the cat eating a meal and the administration of the insulin. I've not used either insulin but I understand from my reading here that Humulin N and Novolin N have similar characteristics in terms of their blood glucose lowering action so the advice in the primer should be worth your consideration.

If you can run a full curve on Saturday that will help you a lot. I suggest that you do preshot test, feed, wait 1 hour then give insulin. Then every hour for the first 5 hours to see whether Diego might go low early in the cycle when the Novolin N really tends to kick in. (Other members may have different suggestions.) If you need advice on testing when running the curve, just kick off a thread in Feline Health on the day and members will be able to assist you as you go along. :)



Mogs
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