? Dosing Help

[RayofSunshine]

Hi! I'm new here. Cat was diagnosed back in the spring. Doctor said no diet changes needed, continually increased insulin until we were giving 14 units every 12 hours! Of course that ended in a crash, and that's how I ended up coming here. We have switched to FF and Dr. Elsye's. We are monitoring blood sugar at home. Currently I'm in the process of lowering the dose. Last vet appt. they said we could do 12 units but we ended up with a big crash with 10 units and a lesser crash with 5. I know now it should have been a diet change and slow increase, but what's done is done and I'm moving forward. I think we have found a good dose at 4 as his numbers look stable. I do the mid day check when possible and was able to do 1 curve. I can't switch food or insulin type. Need to make it work with what I have. Does this look like we have found the sweet spot?

https://docs.google.com/spreadsheets/d/11v23Vkrefk5TcqE1zi6HEs1FVzk3SWozxSqwenKDgSE/edit?usp=sharing

 

[SashaV]

You spreadsheet looks odd. Can you make the blue writing white please?
Is your meter human or pet?
Why can't you switch insulin if needed?

@Critter Mom could you take a look?

 

[Wendy&Neko]

Hello and welcome.

Too bad you can't switch insulins, Novolin is not recommended for cats. Given you said you can't switch that, there are a couple things to do. First is to try and get a test at night before going to bed. Many cats go lower at night, so we try to get some tests in then to make sure we aren't missing any low numbers.

I can see your spreadsheet fine. The cells for the blood sugar values are a bit wide, makes it hard to see a day's worth of data on the screen at once.

 

[SashaV]

Hello and welcome.

Too bad you can't switch insulins, Novolin is not recommended for cats. Given you said you can't switch that, there are a couple things to do. First is to try and get a test at night before going to bed. Many cats go lower at night, so we try to get some tests in then to make sure we aren't missing any low numbers.

I can see your spreadsheet fine. The cells for the blood sugar values are a bit wide, makes it hard to see a day's worth of data on the screen at once.

I see it too, but it's really wide. And I can't see the blue numbers might just be me though.

 

[RayofSunshine]

Thank you. I made the cells narrower and text of levels bolder. Hopefully that helps. We move around often to remote locations so we need a widely available insulin type. This is a human meter. I can try to do a night test but I don't stay up much past 8pm. Kids make you tired!

 

[Panic]

Wow, yikes. So with Novolin you do not ever want BG to dip below 100. Novolin hits hard and fast, and those very scarily low numbers you're seeing are proof. A few things to check for you - are you feeding and waiting 60 minutes before giving insulin? You're not giving insulin if BG is lower than 250? Snacks of regular food every hour for the first few hours? These will help keep you safe.

I absolutely do not recommend staying on Novolin at all, it's very dangerous in cats. If the reason you cannot switch is finances, please reach out to Diabetic Cats In Need, there are several of us here who volunteer with them and many more who get assistance. They will provide you with better insulin.

 

[Wendy&Neko]

And I can't see the blue numbers might just be me though.

They are hard to see. That's why our current spreadsheet template has the numbers turn white for blue and green cells.

We have a dosing guide for Novolin BEGINNER'S GUIDE TO HUMULIN N/NOVOLIN N/NPH which says that the 4 unit dose is too high. You should reduce if you get a number below 90 and you got a 73 yesterday. That would make 3.75 units the next dose.

A lot of us use(d) insulins like Lantus of Levemir. Those are both human insulins and available at any pharmacy.

 

[RayofSunshine]

I don't mean remote in the US/Canada/UK. I mean like Oman, Kenya, etc. Thank you though. I wish it was an option, but it's not, so I'm making it work as best I can. Hoping for remission.

He's free fed up until 2 hours before. I test him first and then feed him prior to giving insulin. Then he can eat as he wishes again. I've seen both methods here that they need twice daily shots and another that they shouldn't have one if test is under 200. Which is correct? We haven't had a pre shot test under 200 in awhile. My syringes don't show partial units. Should I drop to 3 units until I can get some that do or stay at 4?

 

[RayofSunshine]

They are hard to see. That's why our current spreadsheet template has the numbers turn white for blue and green cells.

We have a dosing guide for Novolin BEGINNER'S GUIDE TO HUMULIN N/NOVOLIN N/NPH which says that the 4 unit dose is too high. You should reduce if you get a number below 90 and you got a 73 yesterday. That would make 3.75 units the next dose.

A lot of us use(d) insulins like Lantus of Levemir. Those are both human insulins and available at any pharmacy.

Thank you for this guide. It's helpful.

 

[Wendy&Neko]

My syringes don't show partial units. Should I drop to 3 units until I can get some that do or stay at 4?

Which brand of syringes are you using? For the BD Microfine there is a paper syringe ruler that can help. Or you can eyeball the difference, fill a used syringe with coloured liquid and use that as a reference amount. Or last option, some people use digital calipers. Measure the size of 1 unit in mm, then divide by 4 to get the quarter units.

 

[RayofSunshine]

It's a store brand from a local pharmacy. I will try to eye ball. Do I not shoot if under 200 at AM or PM test time? What if it spikes midday or midnight?

 

[RayofSunshine]

Wow, yikes. So with Novolin you do not ever want BG to dip below 100. Novolin hits hard and fast, and those very scarily low numbers you're seeing are proof. A few things to check for you - are you feeding and waiting 60 minutes before giving insulin? You're not giving insulin if BG is lower than 250? Snacks of regular food every hour for the first few hours? These will help keep you safe.

I absolutely do not recommend staying on Novolin at all, it's very dangerous in cats. If the reason you cannot switch is finances, please reach out to Diabetic Cats In Need, there are several of us here who volunteer with them and many more who get assistance. They will provide you with better insulin.

I understand that it's not ideal, hence why I mentioned it. I think it would be more helpful to use gained knowledge to help people do the best they can with what they have, than to judge the circumstances around it. Say a mom asks for help finding the best formula- do we say "YIKES! You really should breastfeed. I'd never give formula." Or if someone comes into a weight loss group and asks for the best way to make progress while only being able to get to a gym 2 times a week, do we say, "YIKES! You are really going to need to change that." We'd say, we understand you made this choice for a reason. Here's some info on how to make it work as best as you can within your limitations.

 

[Panic]

Copied from the NPH/Novolin guide:

If and when to shoot: Generally speaking, if you are new to managing your cat’s diabetes, it’s recommended that no N/NPH is given if the BG is below 250 mg/dL [13.8 mmol/L] on a human glucose meter. You may wish to use a slightly higher ‘post and ask for help’ number such as 300 mg/dL [16.6 mmol/L] in certain circumstances. Experienced members will guide you through your options if your cat has a lower than expected pre-shot number. As you gain experience, you will be able to lower your threshold for when to shoot.

 

[SashaV]

I don't believe Panic meant it in that way.
She only thinks of your cats safety

How is your situation with mail?
You can buy the good insulins and they'll last you a year.

No one is judging you. We only wants what's best for you and your cat

 

[Panic]

I understand that it's not ideal, hence why I mentioned it. I think it would be more helpful to use gained knowledge to help people do the best they can with what they have, than to judge the circumstances around it. Say a mom asks for help finding the best formula- do we say "YIKES! You really should breastfeed. I'd never give formula." Or if someone comes into a weight loss group and asks for the best way to make progress while only being able to get to a gym 2 times a week, do we say, "YIKES! You are really going to need to change that." We'd say, we understand you made this choice for a reason. Here's some info on how to make it work as best as you can within your limitations.

My yikes was actually from reading how high a dose he was on, not that he was on Novolin.

A lot of people come here with their cats on the cheaper insulin and say it's not optional to switch (usually due to not being able to afford the good stuff) so you'll have to excuse me for assuming!

Unfortunately the reality is there are almost no helpers here with experience using Novolin, maybe less than 5 or so, which makes it difficult to have readily available help. NPH is treated very differently than Lantus or Prozinc, which I'd say a good 90%+ of the people here use. We of course have the NPH guide for those that are on it, but not many experienced members here who can offer advice. We're happy to help where we can though, but that is another reason why we push the better insulins, so you have more people able to help you.

 

[Ann & Scatcats]

Nice and warm in Kenya! Is he A Leopard or A Simba!?

How old is he?

 

[SashaV]

I ask about mail, cause people often has leftovers when they switch or if their kitty passes.
I for instance have 2 pens in my fridge.
They'll go bad quickly if not kept cool.
We're really only trying to help!

 

[RayofSunshine]

Thanks for clarifying. I will note the under 250 portion. Obviously I don't have an informed vet and we move again in 6 months, so I'm trying to figure out all I can from the info here. Scary to think the vet had him on 14 units twice daily. Thankful a neighbor directed me here.

Kitty is 14. Not an actual lion, but don't tell him that.

 

[RayofSunshine]

I ask about mail, cause people often has leftovers when they switch or if their kitty passes.
I for instance have 2 pens in my fridge.
They'll go bad quickly if not kept cool.
We're really only trying to help!

Usually have mail access. Can just be slow. I'm in the states now, but move again in six months.

 

[SashaV]

Usually have mail access. Can just be slow. I'm in the states now, but move again in six months.

Why are you moving so much, if I can ask? I'm really curious, sorry
If I were you, I'd stock up on the good insulin. And IF you end up running out, I'm sure there's a solution if that happens.
I'm totally ready to ship insulin across the world! I sound like a crazy person who never leaves home... I'm not leaving home that is.....

 

[Critter Mom]

Is refrigeration hit and miss in the places where you travel?


Mogs
.

 

[Panic]

What if it spikes midday or midnight?

Just saw this - you never want to give more insulin between shot-times, so if you end up with high numbers during the day you just need to roll with it and wait until shot-time. While it doesn't appear like your kitty has a relatively short duration, USUALLY Novolin peters out within 3-5 hours and then it's high numbers until shot-time. So if he does get midday high numbers, that's just Novolin being Novolin.