Humulin N - need dosing advice

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H

Hawthorne

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Our 12 year old male cat was diagnosed with Diabetes 3 weeks ago. He is receiving Humilin N insulin.

He started at 2 units. We have been taking him to the vet once a week for BG testing. Have not attempted to do it ourselves.

Each week, the sugar levels dropped but were still high so each week his insulin was raised by 1 unit. He is now at 5 units (4 days). It was raised to 5 units last week since his BG did not drop for the first time since he was diagnosed. He does not object at all to the shot each time.

This morning there was diarrhea in his litter box. He seemed perfectly fine. He has been very much himself, especially since he was upped to 5 units this past Wednesday. He is now jumping up on beds and laps again. He is playing again and seems much better. We gave him his insulin at 7 am, as usual, even though there was 1 incident of diarrhea in the litter box this morning. At around 10 am he had another bout of diarrhea - no worse that the one we found early this morning but no better.

It is now 2 hours later and he appears just fine - behaving normally and like himself.

It is a weekend and we would rather have him see his regular vet tomorrow. Right now, we are just watching him and plan to give his insulin injection, as usual, tonight and tomorrow morning. If he still has diarrhea, we will take him to the vet. Other than the diarrhea, he seems just fine and is eating well.

Any advice or thoughts? Thanks.
 
Re: Diarrhea

I am a newbie to cat diabetes, so wait until you hear from people with more experience, but your insulin dose sounds very high. Especially that you give him N, which is fast acting and not the best choice for cats to begin with. I don't know if diarrhea is related to insulin, but watch for the dehydration- that can create issues with his response to insulin.

Also- what food are you feeding him and have you made any recent food changes, that may have contributed to the diarrhea?

Eva
 
Re: Diarrhea

Thanks for your reply and I will add more detail here that might be helpful, as you suggested with your comments.

He is on diatetic food from the Vet - Purina Dietetic Management - wet and dry.

He has been eating 1/3 can of wet right before each insulin shot and we were told to leave 1/4 of the dry for him, twice a day. He eats both but it is always a struggle to get 1/3 of a can of the wet into him at one time. He starts out well but then has to be coaxed and spoon fed.

He had crystals in his urine about 5 years ago and went on "Urinary SO" wet and dry and has done very well up until the diabetes diagnosis. When he was first diagnosed with the crystals, he was to have 1/4 can of the wet, 4 times a day. I've forgotten how long we did that but it was a struggle since it seemed to be too much food for him - same as now.

I know that people on this board generally feel that Humilin N is not the best choice for cats but he responded well the first week or so. We are in Canada so BG numbers are a different scale. His was at 24 when he was diagnosed and started on 2 units of insulin. We took him to the vet 2 days after he started for a BG and he was down to 23 and had gained 3 ounzes. He had dropped 5 pounds in weight at diagnosis. We took him the next week and his BG was down to 19 and he had gained back another 6 ounzes. Then, on Wednesday, his BG was still 19 and he had gained maybe an ounze. Each time he went for a BG the insulin was raised 1 unit.

When we were there on Wednesday, the Vet said that we may have to change insulin and she thought 5 units was a bit high for his body weight but to go ahead and give 5 anyway. She was the most inexperienced of the Vets in the practice (one of the Vets has a diabetic cat) and she said she would discuss it all with the the other 2 Vets the next morning and call us. That would be 2 shots of 5 units before we heard from the Vet.

She called to say that she was wrong to tie his body weight to the insulin dosage and that the other Vets agreed he should go to 5 units. They want to do a Fructosamine blood test this coming Thursday, at 6 hours after his insulin dose. She said it would tell them more and negate the possibility of the BG being high because of the stress of a Vet visit.

It appears that the diarrhea happens about 3 hours after his insulin shot. We are not really sure about the first one during the night, since we were asleep but this morning's diarrhea episode was just about 3 hours after his shot. We have been watching him today and it is one "episode" diarrhea at about 3 hours after the shot and then it is done. He is drinking normally and seems fine other wise.

Thanks again!
 
Re: Diarrhea

Hello!
I can't help with specifics, as I am still learning about managing the disease. I can tell you that the wonderful people on this board are truly lifesavers!

Both my cats (one diabetic and one non-diabetic) had diarrhea and soft stools after starting d/m. I am learning that there are much better foods out there--but with the crystals you have to be careful about your guy's diet.

Do you have info on recognizing and treating hypos? With such a high dose, this info is crucial.
Be sure to check out this link:
http://www.felinediabetes.com/FDMB/viewtopic.php?f=3&t=4982&p=55053#p55053

Is it possible for you to work more closely with the vet who has more experience with diabetes? Perhaps they can both meet with you the next time you are at their office? That way the newer vet can learn, and you can get more immediate answers to your questions.

Good luck and its great that you are learning all you can to help your kitty!
 
Re: Diarrhea

Hi a couple of things.

If you multiply your BG # by 18 you will get the US number. It will be easier if you like to provide both numbers for people to see. Maybe put one in parens.

I'm going to give you my standard welcome message and hopefully you will find it helpful.



WELCOME, this forum is a great place to gain knowledge and really learn how to manage feline diabetes. By doing just a few things each day (that really won't take up much of your time at all), you won't need to worry about losing your precious cat, not where feline diabetes is concerned.

There are three key factors to managing diabetes: food/nutrition, home testing and insulin

1) Feline Nutrition: Now, as far as diet - definitely dump the dry food (if you are feeding any) and if the vet recommends purchasing prescription food like DM just say "no thank you". ALL cats, and especially those with diabetes, do best on a species appropriate diet that is high in protein and low in carbs. Dry food DOES NOT fit that bill and DM food, even canned, just really isn't that great as far as quality. Most here on FDMB feed low carb/high protein canned, raw bought from a pet store or they make there own.

Here great links, one is to a food chart put together by one of our board members that breaks down the carb % and protein % of most of the commercial brand foods. You want to keep the carb % below 10% and around 7% is great. The other link is to a site by a vet "Dr. Lisa DVM" ... who also posts on this board from time to time ... there is in-depth info. there about many things, including nutrition and how to make raw food.
Nutrition/food info

The good thing with feeding your diabetic cat this way, is that it is ALSO good for any non-diabetic cat too. All your cats can safely eat the same food without worry and it may save you some costs and headaches of having to do separate feedings and keeping track of what they are eating.


2. Home testing: It is impossible to convey the value of testing your cat's BG (blood glucose) level at home. Some vets will "suggest" this, but most won't even mention it. They will send you home with insulin and an amount to shoot and maybe some instructions about hypoglycemia (blood sugar dropping to a dangerously low level).

Well, the thing is, human diabetics don't EVER give themselves insulin without checking there BG to make sure it is safe to do so, so why shouldn't it be the same for our kitties. Here on FDMB it is. You will notice that the vast majority of people here test their cat's BG at least 2x/day (before giving each shot to make sure the level is safe enough) and periodically at other times to see how the cat is responding to the current dose. We use a human glucometer, test strips and lancets - which are all very readily available and easy to use.

Our kitties get lots of love and treats for "putting up" with this and most of them actually come out to be tested on their own 'cause they want those treats . Here is a collection of great links that "Carolyn and Spot" pulled together about hometesting. See what you think ... it truly is the best way to not only keep Your cat safe but also really get a handle on this disease and help him to live a healthy life with FD (feline diabetes).

Home testing Links

3. Insulin: There are several types of insulin available. Many people, myself included use Lantus or Levimer both of which are great insulins. They are gentle insulin and given twice (BID) per day in 12 hour increments.

Please read up on the insulins available, here is a link to the Insulin Support Groups:

Insulin Support Groups

However, one caveat and again this shows how these three things are inter-related:

If you are feeding dry food or even a high carb food, BEFORE removing these foods, please make sure of your insulin dose as it will most likely need to be reduced, so as to avoid a possible hypoglycemic situation due to the removal of the dry/high carb foods that will lower the BG’s and reduce the amount of insulin required. Again, another reason why home testing is important.

I know this all seems like a lot, and that's because it is ... there is a learning curve here. But as long as you are determined and keep at it, you will have it down before you know it and you'll be seeing the results in Your cat' overall health and happiness. Ask all the questions you can think of - that's why we are here!

Also, if you haven't done it yet, take the time and fill out your profile. It will help when others come on and read this. Also, let us know where you live - city/state as there are probably people in your area who can provide on the ground support and help you to learn home testing, etc.
 
Re: Diarrhea

I have read all this over the last few weeks since my cat's diagnosis and I found this board.

I have not changed anything, except the insulin dose each week on the Vet's recommendation. That's because things have been going so well and Pumpkin is pretty much back to his old self (playing, jumping into laps, onto the bed), especially since the raise to 5 units of Humulin N twice a day. When his sugar was still the same as the week before - 19 (342) this past Wednesday she raised it to the 5 units from 4. We started at 2 units when he was first diagnosed. So he has increased by 3 units in 3 weeks. The best drop in BG from 414 (23 in Canada) to 342 (19 in Canada) came in the second week when he was on 3 units of insulin. He is not like his "old self" today since he has had the 2 diarrhea type bowel movements. I expect he is tired. He has slept a lot today but then he is a 12 year old cat and has a play with me in the evenings.

He has been steadily getting back to his old self -that is until the diarrhea episodes today.

It is now 4:30 pm - no diarrhea episode since 10 am this morning (6 1/2 hours)- which was about 3 hours after his insulin shot. I think the night diarrhea episode was probably 3 hours after his injection as well but cannot really tell.

It appears that the very loose (diarrhea) bowel movements came only twice and it appears that each time, it was about 3 hours after his insulin shot. We had no such episodes from Wednesday until today. He went from 4 units to 5 units of insulin on Wednesday.

Could it be related to the insulin dose? Has anyone had this experience with any insulin?

He is due for another injection at 7 pm this evening and another at 7 am tomorrow morning before we can speak to the Vet.

Should he get his injection at 7 pm tonight and again at 7 am in the morning? Would it harm him to not give the 2 next injections until I can speak to the Vet? His BG might well be lower than 342 since he has been on 5 units since Wednesday.

Another question - should I give him a lower dose this evening and in the morning - say 3 or 4 units - until I can speak with the Vet?

I am wondering about 3 units tonight or is that too much of a drop? I base this on the fact that his best drop in BG came with 3 units.

So basically - would anyone suggest I skip the injection tonight and tomorrow morning? Drop the dosage tonight and tomorrow morning? Drop to how many units?

Thanks
 
Re: Diarrhea

I haven't used this insulin and therefore am not comfortable giving dose advice about it.

May I suggest that you change your subject in your initial post to Humulin N - Need Dosing Advice and add the triangle/explanation point icon. That should get the eyes you need to help you with this specific issue.
 
He may appear to have improved, and he may well be improved, but you cannot base the safety of this dose on the testing at the clinic nor should you ever base a dose on a fructosamine. If he is on a rollercoaster ride his fructosamine results may look great, but that doesn't mean he's not being overdosed.

I really think you need to consider testing at home; 5 units is a lot of insulin!
 
Jen - Do you have any suggestions for me until I can talk to the vet?

Should I lower the dose tonight and in the morning? He is due in 1/2 hour. Should I lower it by 1 unit?

Do you think the insulin dose is the problem?

Do you use Humulin N for your cat?
 
hello and welcome to the board.
I am Canadian also, here on Vancouver Island. If you are as well, I would be happy to show you how to hometest :)

Now my concern is that I suspect that 3 hours after the shot your kitty is having quite a steep drop that is too much for your cat's body and putting at risk of hypo. This is showing up as distressing the system and causing this diahrrea.
The BG levels starts high at time of insulin injection and then drop quickly and steeply. This has been seen over and over with both caninsulin and Humulin N with users here.

My concern is that Humulin N is known to have a shortish duration and tends to peak ( lowest point if blood glucose ) around 4 hours after shot.
I strongly urge you to get a second opinion from another vet. That is soooooo much insulin this early on.

Meanwhile, I would encourage you to learn to hometest. You get a real life level, without the possible stress of a vet visit artificially raising the blood glucose levels, and you can see for yourself exactly how high and low he is going over the course of the cycle of the insulin.

Would you feel comfortable dropping the dose back down, and learning to hometest?
The biggest thing I needed to understand is that blood glucose levels will rise and fall and then rise back up when the insulin runs out of steam. i thought it would lower the levels altogether and needed to really see the different points of the cycle to get that part of the picture. Therefore the readings at the vet, are only one piece of the puzzle and do not accurately reflect what is happening over the 12 hour cycle, Does that make sense?

My cat hypo'd on 4 units caninsulin, similar acting insulin and I also had a vet that each week increased the dose by 1 unit.
Thank goodness I learned to test and could show the vet the levels were plummeting, even though they read in the 24-30 range at preshot. it sets up something called somgyi rebound
It is counterintuitive, but lowering the dose actually is the answer to this dilemna, not more insulin.
7 days after I lowered dose to 1 unit and then 0.75 of a unit, and removed dry food, it turned out that my cat became diet controlled.
Something I would not have discovered without hometesting and without going against my vet's advice to keep raising the dose.

here is a great primer to help with this viewtopic.php?f=19&t=303

It will also really help to offer a snack about 1 hour after shot as well as getting cat to eat about 20-30 minutes before the shot.

I know it is hard to come to a group of strangers and hear things that go against the advice of a vet, but in our shared experience here, many vets dose by weight, and time and time again it proves to be too high.

Please keep asking questions and while considering lowering that dose, do pick up some ketone sticks and do a simple pee strip test to ensure ketones do not develop.
I am heading out for dinner, but will be happy to help answer questions when I return.
 
You are the one giving the shots and you can choose how much you feel is safe.

There is a lot of information here, and a lot of experienced people. Usually people will let you know straight out their experience level. You may get advice that doesn't agree --- we keep it in a public forum so that everyone can see the advice you are getting and can comment if they feel it is wrong or incomplete.

I used Humulin N for 18 months with my first diabetic cat, Norton.

The peak action time of Humulin N is relatively short --- the diarrhea occurring at +3 hours after injection may be the peak action time for your cat.

Blood sugar increases due to stress, so the blood tests at the vets may be "falsely" high because of stress...
so then you go home and inject, and it is too much insulin for the calm home environment.

It is safer to give less insulin for the next two shots while your vets consult and get back to you.

Please consider learning to test blood sugar at home. It is the best way to take care of your kitty and learn to treat his diabetes. Most of us use a regular human glucometer.
 
No, I didn't use N. I used L, which is now discontinued. Like you, I tried testing at the vets, mostly just fructosamines and it backfired.

In the faq, there are links to veterinary journal articles that support home testing OVER clinic testing. Imagine being a human diabetic...would you do what you are doing ? Not likely!!!

My suggestion is to read the faq, think seriously about starting to hometest this week, adn talk with your vet on monday about the diahrea and the concern over the high dose (5 is pretty high even with the dry food you are feeding) and talk about cutting the dose in half and testing prior to each shot and also anywhere between 3 and 6 hours post shot to start learning how YOUR cat uses N

Jen
 
Dry food and history of bladder crystals

Hello and welcome!

I see that you have already been given great advice by experienced members so I will not repeat the advice about home testing, lowering the dose, and wet food switch.

Actually I will repeat one - the switch to wet food. I repeat this only to add that as well as Purina DM not being the best food available I see that your kitty has also had a history of bladder crystals and that the vet has you feeding both wet and dry foods. I would strongly suggest that dry food is not only not the best food for a diabetic (although if you check my profile in my signature line you will see that my Moochie eats dry for other reasons) but it is absolutely horrible for a male cat with a history of crystals in his bladder.

That said, on the current dose that you are shooting I would not eliminate the dry immediately because the switch to wet food alone demands a dramatic reduction from that dose to start with.
 
"She called to say that she was wrong to tie his body weight to the insulin dosage and that the other Vets agreed he should go to 5 units. They want to do a Fructosamine blood test this coming Thursday, at 6 hours after his insulin dose. She said it would tell them more and negate the possibility of the BG being high because of the stress of a Vet visit."

I saw this and wanted add a fructosomine basically takes the average over about the last two weeks and gives you a number.
It will not necessarily show you if a cat shows a preshot of 28 and then a peak level of say about 4 , for instance. Just averages the whole thing out. Another good reason to be hometesting.

There is more science involved than that, but that is the nutshell version :)

As to the crystals, it is really good the diet has been working, and that should be addressed.
Diet change is not always indicated and insulin can be worked around existing conditions like this.
Dr. Lisa's site that has been posted to you is a font of info.

Okay, now really am running out to Sunday dinner :)

It is a lot to take in these first weeks, but it gets a lot better.
 
Thanks all for your replies!

I dropped Pumpkin insulin by 1 unit (back to 4 units) this evening and will do the same tomorrow morning.

I have always fed his wet food right before his insulin shot. He eats about 6:30 am & pm and has his shots at 7 am & pm. It takes him a while to eat all the wet food the Vet wants him to have at a feeding. We put the dry food down right after his insulin shot (twice a day) so he can eat it when he feels hungry. Tonight he immediately went and ate some dry food (about 1/2 hour after his injection).

As I read your replies, I feel I want to go lower even than 4 units or maybe get a different type of insulin altogther. The Vet we saw on Wednesday did consider that. He actually had his biggest drop at 3 units (from 23 (414) to 19 (342) and the Vet upped it to 4 units. On 4 units, it was the same the next week so she upped to 5 units. The Vet wants him between 6 (108) and 10 (180).

We are basing our opinion that he is improving on his behaviour since we are not -yet- home testing. He is MUCH more like himself since we started the insulin and, after going up to 5 units, he began to jump up on the bed and into laps again. His urination frequency had decreased vastly and he has not been drinking nearly as much water and his neuropathy was much better (hence his ability to jump up again I guess). Actually the decreased thirst and urination happened almost immediately after we started insulin at 2 units.

Generally, we have seen steady improvement since treatment began, This diarrhea was a real surprise.

I will be calling the Vet at 8 am when they open and she and I have a lot to talk about, thanks to you folks!

I am in London Ontario so can't take up your kind offer, Sweetgrass, to come and show me how to home test.

Thanks again, all!
 
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