Humulin N users please review... Dosing questions?!?

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shelly1212

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My cat was just diagnosed with diabetes 2 weeks ago. Her name is Boo Boo & is 9 years old. Shortly before my oldest cat passed away in June, I noticed Boo had lost weight. She's always been heavy and loved to dominate the food bowl! Anyway, I took her to the vet specifically about the weight loss, which also happened to corresponded with switching their food from Science Diet Active Maturity to Science Diet Hairball Control. Surprisingly, the vet didn't do blood work and chalked it up to switching the food and Payton passing away.

About a month later she started vomiting every night which is completely out of character for her. I took her back to the Vet and requested blood work to find that her sugar was close to 400! I took her in for a curve & was told to give her 3 units of Humulin N twice per day and bring her back for another curve in 3 weeks... that was it! There was no talk about @ home glucose testing or changing her diet!

I'm so grateful for the FDMB website and wealth of information available that I went out and bought the supplies needed to begin home testing her! After several unsuccessful attempts, I did get 1 successful reading last night which was 380...

I find at this point, I'm not proficient enough to accomplish testing on my own without the help of my son holding her, but won't stop trying! I just don't want her to run whenever she sees me coming!

I'm currently switching her food to the Friskies classic wet which she seems to enjoy but she's been accustomed to dry only which is all my other cat will eat.

All advise is appreciated!

Shelly
 
Re: I love this site! Clover, SC Boo Boo has diabetes!

Transition is hard for some kitties. You can always add some dry to the wet start slow with the switch if they are real reluctant. I found my ones (2) that hated wet before (and I mean sniffed, and backed away) liked it if it was soupy. So I mixed equal amount of water then gradually reduced the water - still add about a half can, but the water won't hurt them and they are happy with it.
Are you warming ear? and giving treats success or failure? There is also making a kitty burrito or catnip on a towel. I live alone so had to figure it out for a real Houdi. I set everything up for test on pillow that is at my right side on the sofa. I warm sock with rice, then pick-up kitty. I hold and pet her and rub her ears then add the warm sock. I have my left hand holding sock at ear (either one) and my forearm across Maisey's back - started with towel sprinkled with catnip on my lap. when ear is warm (and with Maisey this takes a really long time - nearly a minute - most kitties a few seconds i.e. 5-15seconds) . Prick ear, push strip in when I see drop of blood with right hand. Give treat - freeze dried chicken bite. test.
So glad your smart enough to know the importance of testing at home. You will make great progress this way.
Maisey was on Prozinc/PZI many kitties here are on Lantus and another that I always forget. I think Humlin may be one of the insulin's that's harder on Kitty because they metabolize insulin so much faster.
Everyone here will help you as much as they can- and that's alot!!! Maisey was 12 when diagnosed and only needed insulin for a month. Now she and all my other kitties are on lo carb wet food and all look the best they ever have. Everyone comments on how silky their fur is.
 
Re: I love this site! Clover, SC Boo Boo has diabetes!

Glad you are hometesting.....switching to canned is removing a lot of carbs and her insulin dose may be too much. N is a fast acting and short duration insulin and most cats now are started with either Prozinc, Lantus or Levemir. Please always test before shooting the insulin and with N you NEED to feed a good 1/2 hr at least before shooting the insulin. Food needs to be on board for that insulin. Ask the vet about using Lantus(Glargine).....with newly dx diabetic cats there is a high remission rate when switched to canned food and Lantus insulin. I would also try and get a spot check in about 2-3 hrs. after shooting to make sure with the food switch kitty isn't going too low on that N insulin.
 
Re: I love this site! Clover, SC Boo Boo has diabetes!

We were on Lantus and went into remission after a month (plus diet change). Cedric ate both canned & dry, and I don't think he misses the dry. I do feed him 4 small meals a day, and use an autofeeder for the 2 mid-day meals - I work 7 days a week, so this Cat mate C20 has been great.

YOu are being really positive and a great parent to your cat - glad tht your child wants to help!

See if you can get your vet up to speed on feline diabetes. This is important for your pet - his/her client....
 
Re: I love this site! Clover, SC Boo Boo has diabetes!

I truly appreciate the responses. I tested her @ 8:30 tonite & she was 363. I fed her some Wellness Core and gave her 3 units of insulin after she ate. I'll be taking another reading just to see how she responds. The tips & encouragement really Is helpful as this can become overwhelming... Off to test my Boo Boo, wish me luck!
 
Re: I love this site! Clover, SC Boo Boo has diabetes!

Welcome to the group! It sounds like you are off to a great start with hometesting (if at first you don't succeed, try, try again) and switching to wet food. The testing will get easier, and when Boo Boo learns to associate it with treats (low-carb, of course :lol: ), she will be more accepting of the testing process. Just make sure that you are giving a treat after every attempt, even the failed ones. Try to make each one a positive experience for her. It took me a week (plus the help of another FDMB mama who came over to show me some tips) just to get enough blood from charlie's ear to test. Then it took another 2 or 3 weeks before I could do it without my hubby's help. That's awesome that your son helps! My daughter wants to, and she "tests" her stuffed kitty's blood sugar, but she is only 2 and just ends up scaring charlie when she tries to "help".

My only other thought is on the Humulin N. That's not the best insulin for a cat since it is short lived and rather harsh. Lantus, Levemir, and Prozinc all last longer and have a gentler action. So you may want to talk to your vet about switching to one of those. All of those should be started at 1 unit bid (twice a day) regardless of the bg reading or weight of the cat. It's best to start low and go slow. When you are testing regularly you will be able to see for yourself when her dose needs to be increased. Very few vets are really up to speed with the treatment of diabetes, and some are outright negligent. The folks on this board are awesome. We've all been in your position, and we love to help! While very few of us are vets (i think dr. lisa is the only one), we have tons of real-life experience to back us up. And many many many cats who have gone Off The Juice (OTJ--remission from diabetes/no longer needing insulin).
 
Update on Boo's levels

Hi everyone! Since I was home yesterday, I decided to test Boo every few hours to see where her levels were.

8/21/11
8:43a - 425 - fed her Fancy Feast classic wet followed by 3 units of insulin
12:54p - 103 - fed her Wellness Core (concerned as she wasn't acting herself)
2:52p - 178 - she obviously reacts to the carbs in the Wellness Core
7:05p - 426 - Fancy Feast classic wet followed by 2.5 units of insulin (concerned 3 units was too much...)

8/22/11
6:35a - 321 - Fancy Feast classic wet followed by 2.5 units of insulin

Today, I left Fancy Feast classic wet & Wellness Core out for her as i'm at work... What are your thoughts?
 
Re: Update on Boo's levels...

You can really see how harsh the N is from Boo's curve. She dropped like a rock, then shot back up. I don't know anything about dosing of N, maybe if you change to title of your post to "help with N dose" or something to that nature, some N users will come out of the woodwork to help out! I do agree, though, that you were right to lower the dose a bit since you've started feeding lower-carb food. It may even need to be lowered further, but hopefully we can get some more opinions from beans who have experience with N to chime in. For the food...you're working on transitioning to all wet, right? How is she doing with the fancy feast? I agree that it's a good idea to leave food out while you're at work. Many cats can self-regulate their blood sugars if they are going too low, but only if the food is out for them to eat. So, if Boo is a grazer, by all means let her graze all day. That's the way wild cats eat. Some cats (hoovers) can't do that. They scarf down everything as soon as it's set in front of them (that's what my Charlie does).
 
Re: Update on Boo's levels...

Thanks for your insight Claudia. I'll definitely do as suggested to see what other "N" users might suggest. Thanks for the reply.
 
I'm too new to be giving dosing advice but I like the 2.5 better than the 3. Look at KT's spreadsheet in my signature...we're changing to Lantus later this week we hope.... :-D Maybe we can quit living in the yellows. I'm not sure what the 2.5 increase is doing yet, it hasn't settled down.
 
Not sure if any users around using N.

Notes on insulin from Monique:

Most people are using the long-acting insulins today. Most of the other types are only used by humans or in some cats with special needs (ie. high dose cats with Acro etc.) Many of the short and intermediate insulins have been done away with.
Short acting insulins are usually designated by the letter R (Humalin R, Novalin R) they are never used alone, typically they are given as a bolus at Preshot to bring the BG down quickly in the first few hours of the cycle before the basal insulin (a long acting) begins to take effect. This is used by high dose cats with conditions like Acro or insulin resistant antibodies. It may also be used in an inpatient setting to manage a cat with ketoacidosis.

Intermediate insulins (Lente) are insulins like Vetsulin (Caninsulin) and NPH, some of the human insulins have N in thier name (Humalin N) although some vets are still prescribing them they are becoming less used. Espcially since Vetsulin has been taken off the market in many countries. The more successes with long acting insulins have encouraged many vets to avoid these once typical insulins. Many are however still used with good results in dogs with diabetes (dogs have a metabolism more like humans and these insulins work much longer for them) the animal approved insulin (Vetsulin, in Europe/Canada sold as Caninsulin) was made primarily for dogs.

Long-acting insulins are the synthetic analogs such as Lantus and Levemir. PZI and Prozinc are simular to these however thier duration is often somewhat shorter putting them "in between" intermediate and long-acting. Several other long acting insulins are no longer manufactured (Ultratard, Humalin U)
 
One doesn't have to have used N to see that the insulin is not having a great effect on your cat's body. As pointed out, it has shown that it takes bgs down sharply and then wears off sharply. A human diabetic would tell you that this does not feel good at all. There is a document called Humulin N 101 that could help you if you continue to use this insulin, but I really see no point if you can convince your vet to switch. N is very old school and there are such better insulins now. If you need, people can dig up some great veterinary literature about lantus, levemir and even pzi.

Jen
 
I started out using N, and switched pretty quickly to BCP PZI (which I still use). N dropped Snickers too far, too fast, and any human diabetic will tell you that's not a good feeling. My vet had started me with 2 units, and I remember one time in particular, 2 units dropped her by 300 points in about 2 hours. Snickers gets a MUCH better curve on PZI; so much better, in fact, that she only needs one shot a day with PZI (however, that's pretty rare... most cats need two shots per day).

I would definitely consider switching to Lantus, Levemir or PZI, and in the meantime, possibly lowering your dose of N. It's good that you're testing, so you can see the kind of effect your dosage is getting.
 
You are getting the best results you can with N. Increasing the dose might drop the BG to too low of a value. I used N for my Twigie but she seems to be an exception. I could keep her BG below about 150 all day with a little over 1 unit of N.
 
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