General question

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Ozzy

Member Since 2015
How long of a period during a day can a cat remain above "x"

I am asking, what is "x" as well.
 
In relation to what?
I can generaly maintain my Patches II below 100 all day. My Badger below 350 most of the time. My MurrFee under about 275.
 
Are you asking what the highest limit is that a cat's BG can go to safely? They say the renal threshold is 300 and after that the kidneys get affected. But Every Cat Is Different (ECID). Some vets say as long as the cat is below 300 they're fine, but my cat had diabetic symptoms (drinking and peeing like a racehorse) in the 200's so my gut says that even though the vet said she was okay, she wasn't.

Ideally you want to use an insulin that will give your cat flat numbers, meaning they don't spike up and down. Then you can regulate the cat on a certain dose and his numbers won't bounce around, and you can keep the cat in healthy numbers.

Hope that helps. If I didn't understand your question correctly, let me know. Hope Ozzy is doing well.
 
A general guideline might help. To be regulated, the general range is mid 200s at preshot and double digits at nadir (but not below 50) Once they are in that range and you have more data, you can fine tune the dose and shoot lower pre shots. Many cats are in the 400-500 range at diagnosis, and after insulin if they bounce up from a low number.
 
Here's an example of what I am dealing with.


12:30pm / 146 (human)
4pm / 297 (human)
6pm / 348 (human) - fed + 1 unit
8pm / 221 (human)
9:30pm / 126 (human)
11:00pm / 159 (human)
12:00am / 244 (human)
4:00am / 342 (human)
6:00am / 339 (human) - fed + 1 unit
8:30am / 226 (human)
11:30am / 155 (human)
12:30pm / 272 AlphaTrak
2:15pm / 252 Vets
6:00pm / 444 AlphaTrak - fed + 1.4 unit
7:40pm / 252 AlphaTrak
9:40pm / 75 AlphaTrak
10:35pm / 111 AlphaTrak
12:00am / 174 AlphaTrak
3:00pm / 283 AlphaTrak
6:20 / 440 AlphaTrak - fed
7:20pm 1.4 unit
9:00pm / 347 AlphaTrak

I have to go through the log and update these but basically... I tried 2 units at 1-2 hours after feeding and he dips too low. Though, he gets too high even on 2 units today he was at 420 at feeding time. The Novolin N just makes him dip rapidly and at 3.5 hours in he hits bottom then climbs back up.

It's like I would need to give him 4 smaller shots a day or something. I don't know what the best solution is.
 
First up, that 75 on the Alphatrak is just above the hypo threshold. I'd suggest requesting dosing advice. (I've not used Novolin N so can't suggest anything.)

Going forward, I'd also suggest switching to a more cat-friendly, longer-lasting insulin. How is your cat doing in terms of clinical signs? That glucose roller coaster can't be fun.
 
Yes. he's gone below that a few times but I was tightly monitoring him at his lows and bringing him up fairly quickly.

The only thing I can think of is to give him more insulin but give him a short term boost at his low point to get him through it. That doesn't seem reasonable or safe though either. What's the other solution to keep his numbers low while not increasing his insulin?

Should I consider giving an extra shot in a day?
 
The safe thing to do would be switch him to another insulin (Lantus, Levemir or Prozinc) that is longer lasting. All of those are designed to last 12 hours. Novolin doesn't last that long and it seems pretty harsh, as in causing some steep drops. You could ask your vet if you could dose TID (three times per day, every 8 hours) but that seems really hard on the caregiver since you'd need to monitor non-stop. Also I'm really not sure if Novolin can be done every 8 hours because if I remember your previous post, on some days it seemed to last 10 hours.

The insulins that I mentioned above will give you sticker shock at first but they last for 12 hours and they give the cat less up-and-down numbers, which ultimately may allow you to sleep through the night without constant monitoring 24/7.

If you are interested in switching insulins, post a thread for where to find them more cheaply and people will give you ideas.
 
Okay thanks. That might be the only reasonable option. Will they give a more evened out lowering instead of hitting so hard right away like Novolin? Also, how expensive are we talking?
 
Ozzy said:
Yes. he's gone below that a few times but I was tightly monitoring him at his lows and bringing him up fairly quickly.
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If he has gone below that then the dose is too high. As I said above, I've not worked with Novolin N myself, but other insulins like Caninsulin/Vetsulin or Lantus will produce bounces to high numbers if:

(a) a cat goes lower than its body has become familiar with.

(b) has steep drops from peak to nadir BG level.

(c) drops very low.

If you are in a financial position to switch insulins, I strongly recommend you consider doing so. You seem to be very much in command of testing and monitoring and I think you would have no problems following one of the recommended protocols for one of the better insulins. You might be able to pick up some reasonably priced Lantus from the FDMB Supply Closet. Then you could choose to follow either the Start Low/Go Slow Protocol or the Tight Regulation Protocol. The Lantus and Levemir insulin support group have a lot of stickies at the top of their board for you to learn about the insulin and the protocols; and you would be able to get a lot of assistance on that board to help you better regulate your kitty.

If the insulin change is not an option, I recommend that you start a new thread asking for help with Novolin N dosing so that members experienced with that insulin may be able to better guide you.

For now, I strongly recommend you reduce the dose you're using. All those low results (less than 50 on a human meter, and less than 68 on an Alphatrak) show you that the dose is too strong. Indeed, with a harsh insulin like Novolin N I think regular nadirs that are approaching the hypo threshold are not wise to aim for. Caninsulin is less harsh and I would not be comfortable aiming for nadirs that low on that particular insulin - too dangerous.


Mogs
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Ozzy said:
Okay thanks. That might be the only reasonable option. Will they give a more evened out lowering instead of hitting so hard right away like Novolin? Also, how expensive are we talking?
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Lantus is a depot insulin. It works by building up a little store of insulin in the cat's body which releases over time, allowing for superior BG regulation compared to the likes of Novolin N and Caninsulin/Vetsulin. The depot is built up gradually to an optimal level by increasing the dose from the starting point in small increments. The Lantus action is gentler, producing smoother, shallower curves. If you were to look at a typical Novolin N curve and a Lantus curve side by side, it would be like comparing the cross section of a bucket with the cross section of a saucer.

.
 
Ozzy said:
Okay thanks. That might be the only reasonable option. Will they give a more evened out lowering instead of hitting so hard right away like Novolin? Also, how expensive are we talking?
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About $300 dollars in the US for a vial of Lantus. BUT that vial will last longer than the 28-30 days recommended. The Solostar Lantus pens, seem to work out better as the insulin is good until the individual pen is opened, as long as it before the expiration date.
 
Some members have had luck getting pharmacies to sell one pen cartridge at a time. It might be worth posting a thread asking for help getting better prices on Lantus.
 
Yes, these insulins are more gentle than Novolin. He won't drop so hard so fast. On both Lantus and Prozinc, the nadir (the lowest point in the cycle) typically hits near the middle of the cycle. For many cats it seems to hit between +5 and +7 (keep in mind that ECID!).

The cheapest I could find Prozinc was $95 at ValleyVet.com. Your vet would have to fax in a scrip and then they'll ship it to you overnight for free. The vial will last about 3-4 months, depending on what his dose is. You can use your existing U100 syringes but you'd have to use the conversion chart to make sure you're giving the right dose since Prozinc is a U40 insulin.
http://www.felinediabetes.com/insulin-conversions.htm

Lantus is a human insulin that works well for cats. You can get it with a scrip at any pharmacy. I've heard Costco has a decent price on it, but don't know for sure since I never used Lantus. A lot of people here buy their Lantus from Mark's Pharmacy in Canada because it's cheaper there.
 
It sounds like you have a very good grasp of exactly how your insulin works. It isn't a very good choice for cats, better than nothing, but hard to get any type of regulation. It does go down hard and fast and wear off quickly. Dosing more often is about the only way to make that insulin work in a cat and it is so harsh and quick acting it would take some experienced help and close monitoring (not sure we have too many experienced Humulin users on the board).

If you switch to a human insulin like Lantus and you can't handle the up front sticker shock, you can call around and look for a pharmacy that will sell you one pen (instead of the larger vial). It costs a little more that way, but you buy less at a time so its easier to budget. Mark's Pharmacy hasn't been taking new Lantus clients for a while, but you can get on their waiting list.

granadilla said:
They say the renal threshold is 300
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I've not seen it listed as high as 300, usually I see 220 to 280 as the renal threshold in cats.
 
@Ozzy, check out adwdiabetes.com for a good place to order supplies at a good price. They carry the Arkray testing strip which is the *same* strip as the Relion, just without the Walmart branding. Just a thought, since having a sugarcat is expensive.
 
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I've not seen it listed as high as 300, usually I see 220 to 280 as the renal threshold in cats.
Are those the values for a human or a veterinary glucometer, Melanie?

Because of the +/- 20% meter accuracy and that the renal threshold is not really known (there is a wide range), whether BG is measure with human or pet meter is not really relevant.
 
Critter Mom said:
Are those the values for a human or a veterinary glucometer, Melanie?
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I've not seen it listed that high anywhere. With no reference to meter. Meaning, the ranges I have seen are likely not referring to glucometer readings, but vein/lab readings and glucometer error and difference is a nonissue. I've never seen it written in any of my reading that renal thresh hold goes as high as 300.
 
It depends on the cat, how long the numbers have been elevated, if any other issues are happening. Cats may tolerate 330, or even higher for a while, but eventually, must start breaking down fat for energy, which creates ketones, which may shift the body into acidosis, and from there it can become diabetic ketoacidosis, which can be fatal.

Which translates into breathe, keep following your insulin protocol, be patient, and monitor for problems like not eating, or vomiting, or dehydration.

See my signature link Secondary Monitoring Tools for some other assessments you may make to evaluate your cat's health.
 
I was giving him around 1.25 or a tad less, i upped it to 1.5 and he dropped too low, so it seems the most he can handle is 1.25 or a hair under. With that amount his BG levels at next feed are 330-380 so that seems the best I can do on this insulin.
 
Yeah, that's one of the issues with Vetsulin. It does work in that it drops BG, but it doesn't last the full 12 hours. :(
 
@Ozzy - if you pop some details into your forum signature it would be really helpful. To update your signature (on a desktop computer) click on your name up at the top right-hand side of the screen (near where your alert notifications appear). You should see a little drop down menu. Select 'Signature'. Then you can add you and your kitty's names, plus your insulin and meter types. It's also helpful to add details of any medications and other conditions if applicable.


Mogs
.
 
With insulin like Novolin N, cat's preshot numbers are generally higher (often over renal thresh hold). With a short acting insulin, they come down so fast and hard you cannot tightly control them at the lower levels all the time like the longer lasting insulin. You get more of a curve that is dipping lower earlier in the cycle. Try to get some tests 2-5 hours after the shot to see how low you are getting before increasing the dose. He could very well be in 100s soon after that shot and you don't want to risk too low at the bottom of that curve. Your aim with an insulin like Novolin N is to have as much time as possible under the renal thresh hold, it may not be all of the time to be safe.
 
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