Glucose Curve and Humulin N?

[JennyBankers]

Marbles had her vet visit this morning for some additional blood work - testing for thyroid, etc - before the vet determines a recommended treatment for her. Now, I have questions/concerns for you wonderful people.

If all tests come out negative (i.e. no underlying factors causing the blood sugar increase), the vet wants to watch her blood sugar for 1-4 weeks to see how her new diet effects her blood sugar before starting any insulin. He also made the comment that as long as she is in the low 200s he doesn't strongly encourage insulin shots but was willing to prescribe it if I insisted. This worried me because I don't want any long term complications from her consistently running in the low 200s. In your experience, would you push for insulin injections in your cat at Marbles current readings? Her SS is in my signature.

If we start on insulin in the future, he recommended Humulin N (He said it is cheaper, is always available, but can be hard to regulate). I asked him about Lantus but he didn't seem familiar with it, so I'm going to push him for that when the time comes for insulin as most people here seem to like that the best.

Also, he mentioned doing a glucose curve which I know a lot of you all do at home and that would be my preference due to vet stress. When should I do her first curve and when should I do subsequent curves? Also, is a curve just 12 hours with her b/g reading done every 2 hours?

Sorry for all the questions, but I have one more. I work full time and am usually gone from 830am until 530pm every day. Is it possible for me to regulate her with this schedule? I worry about not being able to take the +5 +7 hour readings after her AM shot that everyone else likes to take because of my schedule. Does anyone have any recommendations?

Thanks for all the amazing input and patience with this newbie as I learn what's best for my sugar kitty!

 

[Shelly & Jersey (GA)]

Here's the link to your first post on FDMB in case others want to go back and see some of the topics that have been discussed: http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=125807&p=1301882#p1301882.

As I mentioned in that post, we started out trying the food switch (for about two months) and then started on Humulin. I personally wouldn't recommend it based on my experiences and what I have learned from this site (and especially if cost is not a significant factor at this point). Humulin kicks in quickly, brings the numbers down quickly, and wears off quickly. A much better option would be Lantus, Levemir, or Prozinc. They last for about 12 hours in cats (versus the 6- to 8-hour duration often seen with Humulin).

Personally, I would probably give the food change no more than a week and then start insulin if necessary. I was a member of the Lantus - Tight Regulation (TR) forum. The TR protocol is based on a study published in the Journal of Feline Medicine and Surgery. According to that study, cats have the best chance of going into remission if they are started on the insulin/protocol soon after diagnosis. Here's a link to information about that study (including remission rates): http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581. You can always print that research out and take it to your vet if he is hesitant to prescribe anything other than Humulin.

This worried me because I don't want any long term complications from her consistently running in the low 200s. In your experience, would you push for insulin injections in your cat at Marbles current readings?

That's a tough one to answer. If my vet would have told me at the time of diagnosis that we didn't need to give insulin if Jersey stayed in the low 200s, I would have probably gone along with it. After reading and learning more on this site, I would have to say that I would start insulin if Jersey was in the 200s. That's out of normal range, and since the scientific community can't seem to agree on where the renal threshold is at for cats, I would be concerned about long-term organ damage if Jersey stayed in the 200s.

It's always so much tougher when you have to work and take care of a diabetic kitty, but it can certainly be done. (One kitty, Tyler, went into remission a few months ago. His owner, Brian, went to school during the day and then worked at night.) I usually couldn't get home until a +7 check at the earliest. I just tried to set our shot times so that I could get a +2 before I left for work (so I would have an idea of where Jersey might be headed for the day) and then tried to get a check when I walked in the door. On those days, I may have missed her nadir (low point), but those other checks helped give me an idea of where she had been, at least. I also invested in a timed feeder that I could set to open throughout the day. That way Jersey would have access to food if she started dropping too low.

So....that's my 2 cents' worth. Hope it helps in some way. I look forward to hearing what other members have to say, too.
Shelly

 

[BJM]

So, your vet is out of date (recommending Humulin). That being the case, you'll want to get him educated somewhat or you risk improper management of your cat.

Print out this copy of the 2010 American Animal Hospital Association Diabetes Management Guidelines for Dogs and Cats

Provide him with the links for ProZinc and BCP PZI which last longer than Humulin, and otherwise act similarly - they don't build up a depot, you can develop a sliding scale for them. This means that what he has learned using Humulin will be similar to what he needs to know for using longer acting, non-depot insulins.

You should provide him with the Tight Regulation and the Start Low, GO Slow protocols info on Lantus and Levemir, too, from the stickies in the Tight Regulation Forum.