Insulin not lasting as long? Higher 'resting' numbers?

[Becky and Toby]

Hey,

We've been on a bit of a rollercoaster with Toby. He's using Caninsulin, and at first our results were very typical - steep drops, short duration, a cat who was all over the place. We changed him to low carb wet food only (it took a little while, he used to be on a prescription urinary diet and we were a bit scared of changing it), and his numbers improved dramatically. He started having issues again, and we realised he was getting more carbs than he should from his treats. We took them away, and he seemed to be improving, but now he's all over the place again.

I'm just looking for opinions on where to take it from here. We're considering a few factors... we know for a fact that his diet affects him quite dramatically, and there's a couple of ways that he could have been sneaking carbs (he's developed a system of getting up by the sink in the kitchen, a place he couldn't reach due to age and neuropathy, for example), we've implemented some diet changes, his insulin has just about been open for a month now... Or it could just be time to try a different insulin.

I don't want to bark up the wrong tree for too long, but does it mean anything that the Caninsulin worked for him for a while? Does that actually make it likely to be an outside factor affecting him now, or was that just a streak of dumb luck? I hate seeing high numbers from him, but feel there's not much I can do about them - he's still dropping as low as before, he's just resting higher, so a dose change doesn't seem appropriate.

My apologies if this is disjointed, this issue makes my brain go a mile a minute!

Thank you in advance.

 

[Sue and Oliver (GA)]

Hmmmm. He has room to drop at nadir - about 100 points. How about increasing the dose by .25 and see if that changes things - when you can sure monitor. I have never seen this as a given, but I certainly have seen cats that seem to become used to a dose and stop dropping or flatten out. Sometimes increasing by a bit gets them on track again.

I am imaging your vet would argue against an insulin change as his numbers arengenerally in regulated range?

 

[Elizabeth and Bertie]

Hi Becky,

Hmmm, that boy is a puzzle, isn't he?

Sue has given you some great advice there.
I know you are worried about Toby's occasional steep drops, but maybe it is worth trying increasing the dose when you are there to monitor.

Incidentally, if you are monitoring and you notice that the drop seems a tad too steep/fast, a first action could be to give a small snack of ordinary low carb food. Sometimes that is sufficient to slow down the drop. If he is still dropping and you are concerned (given the rate of drop and the time until the peak of cycle) that he will drop too low then you can try a second low carb snack or, if the situation warrants it, a small snack of slightly higher carb food. Food can be a really helpful tool in controlling the blood glucose in this way....

Curiously, Toby's insulin duration is really like my Bertie's at the moment. Bert had been getting great duration all summer until the weather turned colder. (This happens every year...). And it always seems to me that his pancreas isn't so capable of putting out insulin at this time of year. I've no way of substantiating that theory, but there is no other way I can explain that the duration is so much shorter.... Curiouser and curiouser.....

Oh, regarding the Caninsulin, it should last longer than a month (maybe even a few months) unless it's a dodgy batch.
And I do agree with Sue, I think your vet may well think that Toby's numbers are sufficiently well regulated. But if you really want to try an alternative (longer lasting) insulin DO ask and see what the vet says.... The most likely one you'd be prescribed is a PZI (protamine zinc insulin) because that is the type that most UK vets understand (apart from Caninsulin). Currently, the only suitable PZI in the UK is Hypurin Bovine PZI, but it is showing itself to be a very good insulin for cats as long as the caregiver is hometesting. ('Hypurin' has a very long duration and therefore doses can overlap, so it is vital to test before giving shots.)

Eliz

 

[Becky and Toby]

Hmmmm. He has room to drop at nadir - about 100 points. How about increasing the dose by .25 and see if that changes things - when you can sure monitor. I have never seen this as a given, but I certainly have seen cats that seem to become used to a dose and stop dropping or flatten out. Sometimes increasing by a bit gets them on track again.

I am imaging your vet would argue against an insulin change as his numbers arengenerally in regulated range?

I'm not too sure what the vet would make of it. He was quite agreeable when I brought up the subject of a different insulin, but that was around a month ago when Toby was all over the place. Hm... all I can do is try.

I'm very hypo paranoid, admittedly, but I am aware that even at his best Toby could do with being lower... but then he throws me a 3.8 with seemingly no rhyme or reason nailbite_smile If a bit of a jumpstart could help, though, I guess it has to be done. Thanks for the advice.

 

[Becky and Toby]

Hi Becky...Eliz

He sure is. I'll try it, though, on a day when I can do a bit of a mini-curve... whilst hugging my LC food, my HC food, and my syrup nailbite_smile :lol:

Maybe it's just hibernation mode and a bit of a slowing down of the body's processes in general? Maybe they really do require the warmest spot in the house at all times?
I have no idea, really, but it's definitely interesting, and it really does seem that Toby has read Bertie's Guide to Being Diabetic.

Yes, my vet has already confirmed that it would be pro-zinc he would prescribe. I'll consider that a last option for now, but still an option for sure.

Thanks for the help.

 

[Elizabeth and Bertie]

...If a bit of a jumpstart could help, though, I guess it has to be done. Thanks for the advice.

Becky, only do what you are comfortable with doing.
If you do decide to increase the dose just make sure you try it when you can monitor the blood glucose frequently (maybe starting testing at +1 and +2..). And ensure you have some higher carb food available if you need to slow down a 'too steep' drop.
If you test sufficiently early in the cycle you should be able to get a good picture of how things are going, and intervene if necessary. But it is your choice.

We will (of course!) be here to support you, whatever you do!

Eliz

 

[Becky and Toby]

...If a bit of a jumpstart could help, though, I guess it has to be done. Thanks for the advice.

Becky, only do what you are comfortable with doing.
If you do decide to increase the dose just make sure you try it when you can monitor the blood glucose frequently (maybe starting testing at +1 and +2..). And ensure you have some higher carb food available if you need to slow down a 'too steep' drop.
If you test sufficiently early in the cycle you should be able to get a good picture of how things are going, and intervene if necessary. But it is your choice.

We will (of course!) be here to support you, whatever you do!

Eliz

I know it doesn't really need to be done, but I don't want to sit idly by if there's more I could be doing for Tobes. It's just... knowing what should be best and knowing what can go wrong... It makes it hard to decide what I am comfortable with.

I'll work something out though. Maybe even a .6 on a U100? It sounds silly, but drops of insulin are used in other scenarios... slow and steady!

Thanks again.

 

[Diana&Tom]

Becky, you're a great bean (as they say!) to be trying so hard and I can well imagine what you're going through with these dilemmas. I don't have anything to add to what the others have said, apart from suggesting that you sit back and take stock of how far you've come in this 'sugar dance'. It is not always straightforward or easy by any means and it does take a dedicated person like you to stick with it.

I guess the best thing is to try what you're comfortable with and take any changes slowly - and just see what happens.

Sorry I can't offer more hard advice, just cheering you on from the sidelines!

Diana

 

[Elizabeth and Bertie]

...and it really does seem that Toby has read Bertie's Guide to Being Diabetic...

Becky, I do hope that's not the case. Bertie has been a really difficult diabetic and I wouldn't want him giving Toby any ideas.... nailbite_smile

...Yes, my vet has already confirmed that it would be pro-zinc he would prescribe...

Did your vet actually say "Prozinc" and not "PZI"...?

I didn't know Prozinc was available in the UK yet!
If it is then that is fantastic news for care-givers of diabetic cats here, because it gives an obvious alternative to Caninsulin...

The rule here is that vets have to prescribe a veterinary medicine before they can prescribe a 'human' one. So, people have have been forced to use Caninsulin first (Caninsulin has been the only veterinary insulin for a few years now in the UK) before being prescribed an alternative.

But if Prozinc is available here then it shouldn't be necessary to go through all that pallaver. Prozinc is a veterinary insulin, and it is specifically made for cats... So, if it's available, then it seems a complete no-brainer to me that vets should be prescribing a feline insulin for cats rather than a canine insulin for cats.... :?

So... Becky, if Prozinc is available from your vet....maybe you could just say, "Actually, I'd really like to try that insulin that's made specially for cats..."
confused_cat

 

[Becky and Toby]

Becky, you're a great bean (as they say!) to be trying so hard and I can well imagine what you're going through with these dilemmas. I don't have anything to add to what the others have said, apart from suggesting that you sit back and take stock of how far you've come in this 'sugar dance'. It is not always straightforward or easy by any means and it does take a dedicated person like you to stick with it.

I guess the best thing is to try what you're comfortable with and take any changes slowly - and just see what happens.

Sorry I can't offer more hard advice, just cheering you on from the sidelines!

Diana

Thank you, it's much appreciated We definitely are still doing better than we were, and Toby's acting no different for the higher numbers, at least.

I didn't...confused_cat

It seems he's already got some of the same ideas though... besides, it wouldn't be all bad if he did take after Bertie. I understand that he's been difficult, but he's still happy and healthy after being diabetic for so long, which is certainly something. I'm sure you're hugely responsible for that, but he's not doing bad really

I don't mean to get anyone's hopes up, but the words pro-zinc were definitely used. In fairness, I think I asked if it would be a "pro-zinc type" (meaning a protamine zinc insulin)... even if my terminology was wrong, the vet agreed and said it would be. Hmm, it's the only way that makes sense, because otherwise surely Toby would be on Prozinc now confused_cat

 

[Elizabeth and Bertie]

... Hmm, it's the only way that makes sense, because otherwise surely Toby would be on Prozinc now... confused_cat

...Not necessarily...

...I suddenly remembered when I woke up this morning that even when there was another veterinary insulin available (back when Bertie was dx) the vets at that time still usually prescribed Caninsulin first. I don't know why... But maybe it was because Caninsulin was cheaper than the alternative (which it certainly was)... Or maybe Caninsulin was more aggressively marketed to vets than the alternative...?

Anyway, re Prozinc, I've just found this interesting little snippet which suggests that Prozinc - if not available in Europe now - is likely to be available soon.... Here's a quote:

"On 16 May 2013, the Committee for Medicinal Products for Veterinary Use
(CVMP) adopted a positive opinion, recommending the granting of a marketing authorisation for the veterinary medicinal product ProZinc..."

And here's the page that came from:
http://www.ema.europa.eu/ema/index.jsp? ... 058008d7aa

It would be truly wonderful if care-givers of European kitties could have more insulin choices available.... nailbite_smile

 

[Becky and Toby]

... Hmm, it's the only way that makes sense, because otherwise surely Toby would be on Prozinc now... confused_cat

...Not necessarily...

Yeah, I must admit I didn't quite believe it as I said it... It's pretty much the same as "If hometesting was easy, the vet wouldn't recommend you take a gamble with your cat's life" :roll:

That is very good news, I do hope it lands soon!


We gave Toby a couple of skinny .75s... and they pretty much did nothing that the .5s didn't do confused_cat And then he threw me a yellow this evening anyway :lol: Perseverance it is then.


EDIT: Right, and then a .5 that's basically done nothing. I'd wonder if he was doing some weird bounce (maybe at +7/+8) if it wasn't for that practically non-existent drop. Quite stressful now =/ I think I'll print his spreadsheet off and talk to the vet about another insulin... the only other thing I can think of is that the insulin itself is compromised. Maybe a new bottle is a better option? Hmmph grumpy_cat

 

[Elizabeth and Bertie]

I think I'll print his spreadsheet off and talk to the vet about another insulin.
...the only other thing I can think of is that the insulin itself is compromised. Maybe a new bottle is a better option?...

Hi Becky,

Was thinking about Toby's chart in the wee small hours of the morning (I'm a bit of an insomniac but try to make good use of the time!) and I absolutely agree with you. In fact, I was going to post this morning and suggest both of the courses of action that you're now considering!

It is possible that the insulin has sparked out. That could certainly account for the numbers that you're seeing.
But if a new vial doesn't produce better results then I think it could be well worth trying a different insulin.

In fact, I think you may have grounds for trying a different insulin now.
Your main fear about increasing Toby's Caninsulin dosage is the fact of his having occasional and unpredictable steep BG drops (some of which have resulted in dangerous hypos). That means you are - for the main part - having to err on the side of caution and keep him in a range that is a little higher than you'd ideally like.

Caninsulin has a short duration in cats and can drop the blood glucose quite steeply. The longer-lasting insulins usually have a gentler action and produce longer shallower curves. So, you could ask to try a longer-lasting insulin on the basis that you want to try to keep Toby's numbers in a better range and at the same time lower the risk of hypoglycemia. (Of course, using a longer-lasting insulin is no guarantee of reduced hypo risk, but the fact that they drop the BG more slowly means there is more time to intercept if need be, and raise the BG with food.)

The PZI the vet would have been thinking of as an alternative would be Hypurin Bovine PZI (made for humans). This started to be used in the UK for cats after the sad demise of a veterinary PZI a few years ago. It seems to be a very good insulin for cats and generally produces nice long gentle curves. It was recommended to me by a vet who used to be a chemist working in animal medicines, and he said it was the closest to a cat's own insulin.
'Hypurin' is the longest lasting of all the insulins. And because of this you'd find it slightly different to use than Caninsulin. Hypurin doses will overlap to some extent (one dose wearing off as the next one comes 'online').

'Hypurin' is pricey compared to Caninsulin. From my vet a vial costs me about £80. But they are bigger than Caninsulin vials (I think!) and I've had vials last as long as 8 - 9 months. Some folks find they can save a few quid by getting the vet to write a prescription and then getting the insulin from a normal pharmacy (as its a 'human' medicine).

Don't lose heart, Becky. I'm sure, one way or another, Mr Tobes will be back on track soon.

(((Hugs))) to you,

Eliz

 

[Becky and Toby]

Insomnia? Snap! I have quite a few posts put up at 3, 4 o'clock in the morning on here :roll: It's the perfect time to one-man debate the viability of insulins :razz:

Thank you very much for the information and the advice. I'm still interested in Hypurin, still have a nagging feeling that even if Caninsulin will 'do', the PZI will be better... but went to the vet this morning and picked up another bottle of Caninsulin anyway. I figured since they're only open until 12 today and then won't be until Monday, and it was a case of catching the vet today and having the insulin on hand, it was easier to not have the new insulin debate. As it happens he was milling around for once, but he was quite into the idea of it having sparked out, so it might have been difficult to get him to see it our way anyway.

You make a very good point concerning the gentler curves. Whenever I think I just need to be "braver" with the Caninsulin, Toby does something plain old weird, and I sometimes think we're never going to get optimum numbers with this. But... for £16 it's worth the peace of mind for now, because it is a bit worrying that we may as well have injected him with water last night. I'd certainly rather have him coasting along a little higher than he should be, than ill from no insulin!

We'll start this new bottle tonight and see how he goes.

Thanks again

 

[BJM]

Keep in mind that Caninsulin is actually a blend of 2 different duration insulins and may have 2 peak periods. Rolling the vial before use is critical to get them blended properly.

Depending on your schedule, you could try dosing 3 times a day (TID). You would sum up the daily dose, then divide by 3 for the amount to give every 8 hours. It can be difficult to do if you're as busy as many of us are, so it may not even be an option. A plus to it is you wouldn't be giving as much each time, so he might not drop so low. There would likely be more overlap between the doses which also might help keep him from swinging a lot. The cons, of course, include scheduling and using more supplies for testing and shooting.

 

[Becky and Toby]

Keep in mind that Caninsulin is actually a blend of 2 different duration insulins and may have 2 peak periods. Rolling the vial before use is critical to get them blended properly.

Depending on your schedule, you could try dosing 3 times a day (TID). You would sum up the daily dose, then divide by 3 for the amount to give every 8 hours. It can be difficult to do if you're as busy as many of us are, so it may not even be an option. A plus to it is you wouldn't be giving as much each time, so he might not drop so low. There would likely be more overlap between the doses which also might help keep him from swinging a lot. The cons, of course, include scheduling and using more supplies for testing and shooting.

We do mix them. Our vet did suggest that one of the reasons for truly whacky numbers - aside from ineffectiveness - when it starts to go bad is because it won't mix properly and you end up with uneven amounts of the two... which kind of makes sense.

I think we could just about manage to shoot 3 times a day, but it would definitely be difficult. I'm aware I'm paranoid, but I really feel the need to check at +4ish (it's a good thing I can come home for dinner-breaks, otherwise I might well be a hermit by now :lol: ) so that'd be at least 6 times a day I was on Toby's schedule. Hmm. I'll wait and see if he levels out a bit now, because hopefully he won't need it more than twice, but I'll be thinking about either that or getting a new prescription from the vet if I'm not happy with the results.

Thanks for the advice.

 

[Becky and Toby]

I think it's safe to say that Caninsulin can indeed spark out after a month :mrgreen:

 

[Elizabeth and Bertie]

I think it's safe to say that Caninsulin can indeed spark out after a month :mrgreen:

Ahaaa, now that looks better!

 

[Becky and Toby]

Spoke a little too soon :roll: He's definitely more consistent now though, so at least I can feel safer giving him the higher dose he clearly needs. And maybe he's only a little haywire because he didn't get proper insulin for a few days? One can hope...

 

[Elizabeth and Bertie]

Aw, (((Becky))), sometimes numbers just go haywire for a time and we never know the reason why.

Does Toby seem OK in himself? Is he healthy and happy?

This could be just a little glitch and his numbers may improve all on their own. But if they don't, then you may want to consider trying a teesny dose increase at some point (when you can be around to monitor).

And, if you're not confident that Caninsulin is working for Toby you could ask the vet about trying another insulin. But there's no rush to do that.

Chin up, sweetie. You're doing a great job. And Toby is lucky to have you care for him like this.

Big reassuring (((hug))) to you,

Eliz

 

[Becky and Toby]

Aw, (((Becky))), sometimes numbers just go haywire for a time and we never know the reason why.

Does Toby seem OK in himself? Is he healthy and happy?

This could be just a little glitch and his numbers may improve all on their own. But if they don't, then you may want to consider trying a teesny dose increase at some point (when you can be around to monitor).

And, if you're not confident that Caninsulin is working for Toby you could ask the vet about trying another insulin. But there's no rush to do that.

Chin up, sweetie. You're doing a great job. And Toby is lucky to have you care for him like this.

Big reassuring (((hug))) to you,

Eliz

Thank you very much, Eliz. Toby seems perfectly happy, without any increased thirst or hunger, so at least there's that. I'm going to see how low he goes with .75 tonight (he got a 6.5 this morning, which isn't bad), and take the dosing from there. Even if I try the new insulin route, I'll probably need to show some consistent evidence without contributing factors such as crappy insulin, so all I can really do is keep at it. It's not so bad