Help on NPH (And sorry, also posted under Newly Diagnosed)

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HarleysGirl

Member Since 2014
Hello Everyone:

First of all... apologies, as I posted under another topic, Newly Diagnosed Cat. I've copied the post here.

I am a caretaker for two cats, one of which was recently diagnosed with FD. I also have two cats of my own, was in the veterinary field (many moons ago), was a humane officer for years, and I also have two cats of my own. First, I appreciate all the info available here. Now, if I could only convert the owner and vet, I would be a happy camper.

Here are the issues I am dealing with: I make two trips per day to care for my second family. I have been taking care of them for over a year and it was me who suggested the owner get some blood and urine work up for Harley, the one who is now diabetic. I was suspicious and was trying to convert the owner on diet. Of course, it usually takes a crisis to get anyone to listen. I weighed Harley and he had lost 3 pounds. He isn't a touchy-feely cat, and it was just the way he looked at me that told me something was amiss.

Fast forward to the vet visit where his bg was tested at 450 (I think. I know it was over 400). I went with the owner to the vet's, so we could all learn together. Prior to the visit, I asked what type of insulin was being prescribed - Humulin N. I was given the vet's email address after stating my concerns to his receptionist. I emailed AAHA recommendations and peer review opinions. Well, none of that got through. He is insisting this is the way to go because, in his opinion, it is the lowest cost and once diabetic, always diabetic. I even rounded up a glucometer and all the paraphernalia to take with us. To no avail. He suggested 3 units of NPH, BID based on his weight and bg levels (He is now 13#.) My eyes flew open and I balked. I got him down to 2 units BID. I asked how he came to this dosage without doing a fasting bg and taking into consideration the cat may be stressed and now is on a lower carb diet. He told me that I was way ahead as far as doing curves. ( I managed to get the owner to change to Fancy Feast and pull the dry, since he was already eating FF.) I also ordered a timed feeder, since I am going at 8 a.m and 8 p.m. to give his injections.

Here is my question: He has now been on the insulin 3 days. I feel like this is a poke-and-hope situation. Can anyone tell me how often the cat should be fed to keep his bg levels as stable as possible? There is a 12 hour time lag between shots, I am not around for more than an hour at a time for each visit, and God help us all if he has a hypo episode while nobody is there. I should note that the owner is smitten with this vet and his clinic. I personally would never take my cat there after reading up on this and dealing with someone who isn't open to the latest information. He is in practice with his dad, and he is fairly young, so I know he hasn't been out of school that long. I made sure there is Karo syrup and honey available, but I am hoping he can regulate himself with food. I got the timed feeder, because I don't want him gorging and tossing it up (he's done it), but according to his owner, he doesn't seem as ravenous. I go tonight for my first shift on since the insulin began on Tuesday night (now Friday). Thanks so much for everything here! - Harleys Girl
 
Re: Help on NPH (And sorry, also posted under Newly Diagnos

Thank you for starting your own post on here and welcome to the message board. With your own post, it will be less confusing as to who we are talking to when we say something and we will tailor our suggestions to your own situation.

That's tough dealing with an owner that may not understand the seriousness of a hypo. The situation is compounded by a vet that appears to think cats can not go into remission, that is become diet controlled, with diabetes. I personally know this can happen, because my diabetic cat Wink has been in remission for more than a year now.

Would it be helpful for us to provide you with some vet journal articles on remission in cats to share with this vet?

Can anyone tell me how often the cat should be fed to keep his bg levels as stable as possible?
Click to expand...
With the NPH type insulins, it's very important that the cat eats 30-45 minutes before you give the insulin. This is so you know the cat will keep the food down and also to have the food start to be digested and ready to counter the impact of this very fast acting insulin that drops the BG levels like a rock.

After that initial pre-shot feeding, you don't want to feed much past +4 or so since this insulin only lasts about 6-8 hours in most cats and any food after the lowest BG point in the cycle will simply cause the BG levels to rise that much more quickly.

There is a NPH primer here, Humulin N Primer. It's from over in our ISG forum for Vetsulin/Caninsulin/Humulin N.

So few of us here have any experience with the NPH insulins, because it has such a poor success rate with our kitties and their faster metabolisms. Yes, as this caregivers vet said, it is cheap, but that's about all it has going for it.

Bless you for trying to help this other person take care of their diabetic cat. We'll help as best we can.
 
Re: Help on NPH (And sorry, also posted under Newly Diagnos

One more thing. Is the owner willing to test before every shot? To make sure the BG level is high enough to give the insulin?
 
Re: Help on NPH (And sorry, also posted under Newly Diagnos

Thanks so much. I'm printing out as much info as possible to take to the owner. She is 75 and still works as a caregiver, so she is gone 4-1/2 days and then home 4 days. I'm worried sick about this boy. That info is so helpful! And I promise to catch on. :-)
 
Re: Help on NPH - (reply on home testing)

I think the owner would have been willing IF the vet had taken the time to show us how. Like I said, I rounded up a glucometer, lancets, etc., but his attitude was a wait-and-see approach. He did say the cat should return to do a curve there or a fructosamine check. When she returns, I will push for home testing and maybe that will happen.

It's all so frustrating to me, because he's not my cat so I don't have a say-so. Personally, I would pay more and get what is appropriate. I think her attitude is she will just do the best she can and see what happens. Her other cat is the favorite, which I guess is why I am so attached to Harley, the "under cat." I've suspected this for a while because, as I pointed out to her, he has been drinking a lot and pees a river. Coupled with Science Diet dry cat food (CD), which I preached against, the odds caught up with him. She took him in for a check up in September and the elder vet told her then that he was at risk for FD. He weighed 16# at that point and he is 10 years old. So we are 6 months down the road now and he is full blown. I'm just so glad I weighed him when I did. Oh, he tested negative for ketones, which was the positive in all this. I was so hopeful to start Lantus because I truly hoped he could get this under control with the correct diet. But at $206 per vial vs. $25 for three NPH, I was pretty much overruled.

Bless you. The wealth of information here is outstanding!!
 
Re: Help on NPH (And sorry, also posted under Newly Diagnos

There are some tips on getting Lantus less expensively. Diabetic Cats in Need (DCIN) put together this writeup.

With the caregivers schedule, Lantus may not be the best choice. It sounds to me from what you are saying, that the caregiver is away from home at least 4 1/2 days a week? You are taking care of the cats on the days this person is away? Did I understand that correctly?

ETA: Ask as many questions as you need to. We were all helped immensely at the beginning of this sugardance and are simply trying to "pay it forward" to help other new members.
 
Re: Help on NPH (And sorry, also posted under Newly Diagnos

Thanks Deb. Here's the schedule: The owner leaves (as today) in the a.m. on the first day. I come in the p.m. to feed, etc. Then the next 3 days the owner is gone and I go a.m. and p.m. On the 5th day, I go a.m. and she returns around noon, unless she makes some stops along the way, so she is home for the p.m. feeding. (So I get paid for 4 days.) She is then off for the next 3-1/2 days (she job shares), and the cycle repeats itself. There are also times when there is an emergency or she wants to go somewhere and I step in. She is a live-in caretaker for a 97-year-old woman who is now bedridden, and she commutes about 90 miles, so she is out of the area - way out.

That being said, I do not know how long I will be caring for the cats. I retired early and the extra cash is great, but I think this will be my last gig. I still am involved with the Humane Society, as time and my disability permits. Plus, I have my own critters. Knowing I will be out of the picture eventually, I would like to get her up to speed. If anything good has come of this, it is her other cat who clocked in at 18#. I think she now sees the seriousness of the situation and what she will be dealing with down the road if she doesn't get him on the proper diet and get him to lose some weight. Get this....during our visit with the vet, he mentions that he has an obese cat that he thinks will eventually be diabetic. It took all I had to bite my tongue. I thought, "Dude, you're slaying me with this info!!" Isn't prevention worth a pound of cure?? I feel like the voice of reason in the nut house. LOL
 
Re: Help on NPH (And sorry, also posted under Newly Diagnos

Reasonable alternatives to Lantus are BCP PZI or ProZinc which last about 12 hours compared to NPH and may be less expensive than Lantus. They work similarly to NPH in that they do not carry over between shots.

The PZI has to be order by the vet then the client can get it shipped to them after payment.
ProZinc is available through a number of pet pharmacies online.

Either of these may be preferable due to the amount of time the cat is unsupervised.
 
Re: Help on NPH (And sorry, also posted under Newly Diagnos

Thanks BJM. I also mentioned PZI to the vet. I did my homework here and additional research before we went to the vet. I looked at prices online for PZI and, it still doesn't match the Humulin N. Of course, if something goes awry, maybe he will consider that alternative. I will shop around and see how much it is in the event Owner and Vet are open to switching. Right now, I am doing he best I can with what I've been given to work with. Not my cat, not my vet, and not my pocketbook. If it were, things would be different. My main concern is feeding on this insulin. On Fancy Feast, it says about one can per 3-1/2 pounds body weight. I bought a timed feeder to prevent overeating and possible throwing up with subsequent hypo if I am not there. I've downloaded the Humulin primer. I'm figuring it this way, since it is fast acting:

13# CAT = approximately 4 cans.
Feed, go about my business and then give him the insulin 30-45 minutes after one can.
Set the timer for the second feeding of one can about two hours later.
Return in the p.m. and repeat.

Does this sound reasonable? I also have to factor in the OTHER cat on the premises. I am feeding him on the counter, since the owner still gives him some dry food. I also give him as much canned as he will eat. To my knowledge, Harley has never jumped up there, so the dry is off limits. I hope.
 
Re: Help on NPH (And sorry, also posted under Newly Diagnos

Because of the usual duration of only 6-8 hours with NPH, good control may require dosing every 8 hours.
You should aim to go no lower than 100 mg/dL, given that monitoring will be infrequent mid-cycle.
 
Re: Help on NPH (And sorry, also posted under Newly Diagnos

Yes, I like your plan for the feeding schedule.

Unless and until you can get the cat's owner on board with some better treatment, you are doing the best you can in the circumstances. Continue your education efforts and hopefully some of this information will make an impact for the owner.

I think if I were in this situation, I'd want to take the kitty home with me but I realize that just isn't feasible. Wouldn't you like a time share kitty? :lol: :lol: :lol:
 
Re: NPH One week in...Question on BG levels and food/hunger

Thank you Deb and BJM. Here's my update on Harley. I bought a timed feeder for him, but he is afraid of it. I left it on the floor, so he would just get used to it being there, but it looks like I bought it for nothing. Here's the weird thing... I've fed him and given him his injection, then I made sure he had some food on hand while I was gone. I return about 11 hours later, and he hasn't touched ANY of his food. But when I show up, he gets animated and sits patiently in the kitchen while I open a couple of fresh cans. It's like I am his cue to eat. What he does when his owner is home, I haven't a clue. I'll have to check with her later when she returns.

I took my digital scale and weighed him. So far, a week in, he has maintained his weight to the ounce. As long as he maintains his weight, isn't as ravenous and drinks and urinates less, would you say things are looking good so far? I guess my question is what to expect on the NPH as far as his urge to eat. If it peaks fast then levels off, would his BG levels then rise to where he wouldn't feel as hungry? He is 10 and pretty sedentary, so I guess he doesn't need the 3-1/2 to 4 cans I thought he would need to maintain his body weight. He is drinking a lot less, and the box has less urine. (But, again, I am dealing with two cats.) Along with the insulin, a change in diet was made. The dry food he was on was Science Diet CD for crystal control in his urine, which makes them drink more, and he was also on Fancy Feast canned. Now it is solely the canned food and a few Greenies treats to get him to cooperate with the injection. So his carb intake was severely reduced. Overall, he seems to look and feel better. He's a bit more playful and just has a brighter look about him. I know without a secondary workup by the vet (yet) or doing home curves, this is a best-guess situation. But it is what it is.

Please forgive me if I ramble, but I'm trying to summarize, so you don't have to look through the prior posts to refresh your memories. Thanks again for all your advice. Best wishes to all!
 
Re: Help on NPH (And sorry, also posted under Newly Diagnos

Don't know what to tell you as far as Harley not using the timed feeder. I've never used one myself. The only idea I have is that you feed Harley the meal when you are there in the timed feeder. So he comes to associate the food with the feeder location and the feeder dishes.

As long as he maintains his weight, isn't as ravenous and drinks and urinates less, would you say things are looking good so far?
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What you are describing are some of the "clinical signs" that vets and we watch for that tell us the cat is feeling better. Yes, these are all good signs.

BJM has some links to Secondary Monitoring Tools in her signature (at the end of her posts) that you can use when you aren't able to test as much. They are an alternative to home testing that can gauge how the cat is doing. In the situation you are in, they at least give you some benchmarks for seeing how Harley is doing.

I guess my question is what to expect on the NPH as far as his urge to eat. If it peaks fast then levels off, would his BG levels then rise to where he wouldn't feel as hungry?
Click to expand...
Some cats will have a natural urge to eat if their blood glucose levels drop too far. So at peak (aka the nadir or lowest BG reading), he might go seek some food. With the NPH insulins, it's more like a sharp dive down, then a sharp leap back up. Not much of a level curve, more like a steep V shape to the BG readings. You asked would he feel less hungry when his BG levels go back up? I don't know for sure.

Were you going to be able to home test on the days that you were there to be his caregiver? Have you been able to start the home testing yet?

I'm a little concerned that the insulin dose may be too high for Harley, especially since you have switched him over to the low carb canned food. Insulin needs often diminish when the food is changed to a lower carb food.

What is the Insulin dose now?
 
Re: NPH One week in...Question on BG levels and food/hunger

When the NPH wears off - usually quickly - the glucose in the blood cannot be used and the hunger increases, even as the glucose increases.
 
Re: Deb and BMJ last posts

Greetings Deb and BJM:

Thank you both SO much for your advice and replies. I have printed out the secondary monitoring tools, along with many other pages from the forum to give to Harley's owner.

In response to Deb: I tried feeding Harley in the automatic feeder and he wouldn't go for it. That's when I decided just to leave it sitting there, so he would get used to seeing it. But since he isn't even eating the remainder of his canned food, I felt there was no point to it at all and brought the feeder home with me today. The vet wanted to start him on 3 units BID. I was very uncomfortable with that dosage and told him that Harley's diet had been changed to can and he was off the dry. This dietary change went into effect for a week before his owner could get him back to the clinic after he was tested and diagnosed. (I pushed for the change because he couldn't start treatment right away, and I wanted to help him as much as possible in the interim. I know by making this change at almost the same time, we really won't know what's brought it down, but I felt it was imperative to do SOMETHING. The poor guy was ravenous and wasting away.) I also asked the vet to take into consideration the fact that he may have been stressed and his BG levels increased. He tested at 450 (I think - I know it was over 400.) with no ketones. So the vet agreed to start at 2 units BID, which he has now been on for one week. I have not been able to home test. First of all, I have never done this before and would like some guidance. I thought we would be getting this when we went to the vet, but he was taking a wait-and-see attitude. Secondly, I have only outdated test strips. Thirdly, I think Harley will be a two-person job. He isn't a lap cat and getting him to sit still long enough for his injection has now become a problem because he moves away. I think his owner hovers over him when injecting and he is now suspicious. I have to give him a couple of treats and act fast. He loves to be brushed, so I try doing things he likes as a reward or incentive.

And thank you, BJM, for your information. It is clear and an "aha" moment went off in my head. I told his owner that he may need a lower dosage TID in order to remain stable, after doing a blood curve for accuracy, of course, but I don't think that is going to fly. His owner will not question the vet at all and just do the best she can. If we were neighbors, I wouldn't even mind making an extra trip on my own, but he is across town, so the schedule will stay at BID. I may be able to talk her into the urine strips. I can get a clean catch on my own cats, so I think I could manage Harley in the box. Again, thanks so much. Your advice is invaluable. Bless you both!
 
Re: Help on NPH (And sorry, also posted under Newly Diagnos

You may be able to desensitize him to the timed feeder by being there and feeding him on a regular dish when the device runs.

Work at it gradually - maybe set up the timer so that it runs after 15 minutes of eating, then 10, then 5, then none, then before the food is down (which will associate the sound with food being available). It may take a bit of time.
 
Re: Help on NPH (And sorry, also posted under Newly Diagnos

Thanks for the clarification! Good to know you got him switched over to the low carb wet food before you started him on insulin for his owner.

As far as using outdated test strips, I've done that before with strips that were past expiration date of a year.

Maybe break down the testing process into small steps, giving treats with each step to get him to associate the testing process with something good.
 
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