? Insulin not working

C

Candice Cottle

Member Since 2019
Just a quick thank you to you all. The info is unbelievably helpful.

My 15 year old female orange tabby was diagnosed with diabetes in September last year.
They put her on Lantus 1unit twice a day. Her BG numbers have been up and down the whole time. I have not managed to keep them under control. They kept putting it up and she was eventually at 3 units twice day. Still not great.
Went for a second opinion and he switched her insulin to Novulin 70/30. She's been on that for a week at 5units twice a day and she is still in the 700"s.
Im really worried as i know the constant high numbers can cause a lot of damage.
 
Hi Candace,

Some folks here with more knowledge will respond and help you get her under better control. There can be several reasons for numbers that are high even when giving higher doses of insulin as it sounds the vets have recommended. It is possible it is too much insulin vs not enough and may need to decrease and monitor BG to find the right dose. Hang in there. The senior members will chime in soon.
 
First things first - welcome to FDMB! You have found a fantastic resource for managing your diabetic kitty, and there is a wealth of knowledge, experience, and wisdom to be found here.

I am not a senior member, but I have a few questions for you to help clarify things. First, have you been testing at home? Have you kept a record of her BG numbers? It would be most helpful if you could set up a spreadsheet, that would give all of us a better picture of what's going on; otherwise we're just guessing. Spreadsheet info can be found here:

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

Second, please change the title prefix from 911 to "?" - the 911 is for true emergency situations, usually when a cat is hypoglycemic and the issue is time critical - sometimes even life-and-death. This is more of a "wondering what to do - please help" rather than an emergency situation.

Third, what is your cat's diet? Have you got her on low carb wet food? Food can have a significant impact on BG levels - if she's eating a high-carb diet, you're going to have trouble getting her BG under control.

Finally, please create a signature containing your cat's pertinent information - e.g., name, age, date of dx, diet, BG meter, and insulin (look at Julie and Honey's signature in the post just above this one - it's a perfect example). To edit your signature, hover over your name in the upper right of the page, and click on Signature.

We'd love to be able to help you, but in order to do so we need more information. Any suggestions that are given here are heavily data-driven, which is why we set up spreadsheets, and why we do so much testing and record the results. Without that kind of data, it's impossible to tell what's going on with your cat, or to give any kind of advice as to how to get her back on track.
 
Hi Candice, Welcome to you and your kitty (what is her name?)!

First of all, please take down the "911"! This is only for immanent emergencies. Replace it with the "?". OK?

Second, please tell us a bit about your kitty. Does she have any other health issues? What are you feeding her? Have you kept a record of her blood glucose numbers?

The best thing for you to do right now is to create your signature, set up our Google spreadsheet, and link it to your signature. People here who will want to help you need to be able to see your kitty's numbers and her trends. Instructions for creating a spreadsheet are here:http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

Oh, I just see that all of this information--and much more-- has already been given you by @Erin & Scott!

Follow the spreadsheet instructions to the letter and you will soon be up and running!

Welcome to the Lantus/Basaglar/Lev forum. In my opinion you will have much more success with Lantus than you will with Novolin. Since your kitty has only been on Novolin for a week, you can easily switch back to Lantus.
 
Welcome. You have come to the best place you never want to be at. We can help but we do need some data and info to help you as stated above. Lantus is a really good insulin for cats. I suggest you read the yellow stickies as they contain a lot of valuable information. Going up and down, bouncing, is quite normal until a cat is regulated. My cat bounced his whole first year on lantus. It happens until a cat gets used to normal bg numbers. Then he became tightly regulated. We use two protocols here, TR and SLGS. We feed a low carb diet and suggest canned or raw and no dry food if at all possible. If feeding dry, then only SLGS is the only possible protocol. Did your cat ever have DKA? Keytones should be tested for with numbers that high.

So if you have been testing at home please set up a spreadsheet with data from the last few weeks. Were numbers better or worse on lantus?

Soy the more info you can provide the better. And ask as many questions as you have.
 
Welcome to the group!

Unfortunately, Novolin is not the best insulin for cats. A cat's metabolism is too fast and the duration of Novolin is too short. More importantly, the American Animal Hospital Assn does not recommend it for the treatment of feline diabetes. Here is a copy of their guidelines. My best guess is that the dose of Lantus was not raised quickly enough. You increased to 3.0u over a period of 6 mos. If a cat is sitting in numbers that are undesirable over an unduly long period of time, the cat's body starts treating the high numbers as the new "normal" and it's harder to get the numbers to come down. The technical name for this is glucose toxicity. Even with the more conservative of the dosing protocols we use, your dose would have been up to 3.0u in less than 3 months from when your cat was diagnosed.

If you are not testing at home, this may also be a concern. You would not know if your cat's numbers have been dropping at some point and then bouncing to a higher range. In addition, Novolin is very different than Lantus. It can cause numbers to drop fast and hard and dosing is based on your pre-shot numbers. You need to be home testing to effectively use Novolin and to insure your kitty isn't dropping into dangerous numbers.

As Erin pointed out, if your cat is not already on a low carbohydrate diet, this may be the culprit for keeping numbers in a higher than desirable range.
 
I'm really concerned that your vet has you using Novolin 70/30. The 70/30 mixture (mix of NPH and R) has a very hard driving component that sends numbers spiraling down then zooming back up horribly all in a few hours. 70/30 isn't ever an insulin to use as a 'regular' insulin unless all other insulins have been exhausted, the owner is testing often at home and has a lot of experience in recognizing signs of a potential issue. No it's not as critical as straight 'R' insulin but you're not likely to achieve regulation using it as your base.
 
Thank you for all responding.
I do test at home, twice a day and more if there is a problem. I also keep track of all the numbers. I have them all since November last year.
I have been feeding Merrick beef and chicken pate. High protein, low carbs. When I checked the food chart it had higher protein and lower carbs than the Purina DM they were trying to give me. Just yesterday started introducing fancy feast as I see a lot of people are feeding.
Her name is Alley. She is a 15 year old ginger Tabby.
Would it be advisable to go back in to the Lantus.
I will do the spreadsheet as soon as possible
Thanks for all the help. I really appreciate it
 
Hello to you and sweet Alley.

The Merrick beef and chicken pate's are fine. There is nothing better about Fancy Feast. Many people feed it due to the cost. If she likes the low carb Merrick, stick to it. Personally, I fed low carb raw food.

The spreadsheet is a great start. Looking forward to seeing it. It's a good idea to test more than twice a day. Once before each shot, as well as some time after the shot to see how low the dose is taking the cat. It's possible to be in really high numbers before the shot and really low several hours later. And yes, either Lantus or Levemir are much better long lasting insulins in the cat. The only reason I mention Levemir, is that if for some reason your kitty should have a condition that means she needs a higher dose, Levemir may be better. My girl had two what we call "high dose" conditions, though not every cat with them needs a high dose. My girl had acromegaly and IAA (insulin auto antibodies). She got up to 8.75 units.
 
I didn't realize that Novolin 70/30 is a mix of N and "R" (see @Squeaky and KT (GA)'s post above). That is scary! Please switch back to Lantus and return to your original vet! Alley will thank you.
If you read the informational posts ("Stickies") at the top of this forum you will learn how Lantus and Levemir work on the blood glucose. Most importantly, you will find out that Lantus dosing is based on the lowest number of the cycle (the nadir), so it is important to get in at least one test somewhere in mid cycle.
 
I'm not a senior member either, but my cat Orlando is also a high dose cat. We started out with Caninsulin, then Prozinc, and then Lantus, where the starting dosage was 2 units twice daily. When that didn't bring his numbers down, we were referred to a specialist and she set up the dosage to 4 units twice daily straight away (note, I'm NOT saying this is the way to go for you), then 5 units twice daily after four days because his numbers were still very high. At 5 units twice daily, his numbers started dropping a little, and then she slowed down. Right now we're on 6 units during the day and 5.5 units at night and it's taken us two months to reach this point from when we first started with 5 units.

Orlando's numbers are still not as they should be, but we're slowly getting there.

I'm with the others that say switch back to Lantus or maybe Levemir (my specialist prefers Levemir, but says Lantus is also good). If possible try to find a vet that specialises in diabetes. My regular vet was great for my other diabetic cat, Murphy (who is now in remission), but he was a better than text book case. If I knew five months ago what I know now, I would have taken Orlando to the specialist as soon as it became clear he wasn't reacting as he should to the regular insulin dosages. His organs are luckily still fine, but he has horrible neuropathy, which I'm not sure he'll ever completely recover from, and that might have been avoided.
 
Candice Cottle said:
I do test at home, twice a day and more if there is a problem.
Click to expand...

Great that's you're testing twice! Good job! There are 4 'usual' critical times during a full day (2 insulin cycles). 1) Pre-shot morning to be sure it's safe to shoot 2) mid-cycle to see how low that dose is taking them 3) Pre-shot for night cycle 4) Right before going to bed to spot potential problems with the night time cycle. Dosing is based on how LOW a dose takes them rather than the number seen at pre-shot.

Definitely switch back to Lantus or change to Levemir. AND run from that new vet...
 
Thank you. I really appreciate it. My vet just put her up to 6units today of Novulin70/30 because it’s not working properly. Thanks to all of you I know this is not good and am going to go else where for a 3rd opinion
 
Candice Cottle said:
Thank you. I really appreciate it. My vet just put her up to 6units today of Novulin70/30 because it’s not working properly. Thanks to all of you I know this is not good and am going to go else where for a 3rd opinion
Click to expand...
That vet seems dangerous. I don't think you need to find a 3rd opinion. For the moment stick with your original vet; she/he has Alley's records and can write prescriptions for Lantus (or Levemir). Many of us have found that the best way to cope with Feline Diabetes is to "agree" with the vet but not necessarily to follow her dosing advice. Instead we have relied on the experience of this board, where everyone does Feline Diabetes 24/7. Vets have to deal with so many problems and we need them for all those other health issues that may come up, but vets get very little in their training about Feline Diabetes. You are testing and you know your cat. You don't have to show your vet Alley's numbers every day!
 
Without testing several times during any cycle, there's no way to even know if it's 'working properly' or not. Using that insulin, within an hour or so, numbers begin diving hard as the fast onset part hits. It holds it there while the second, longer acting but still hard driving insulin begins working. It has to have a really good stable food load on board as well as a high enough number to handle the coming dive. The potential of a hypo is more likely. When that second insulin wears off, the glucose zooms right back up as there's no insulin support remaining. The NPH portion by itself IS used with cats, it's the R portion that's a real danger.

70/30 is truly designed for diabetics with unstable blood sugars that needs to bring down the immediate effects of a meal.
 
Okay thank you. Should I just go back onto the lantus immediately without the consult of the vet and start her at 2units twice a day with testing. I feel like you all know better than my vet.
 
Candice Cottle said:
Okay thank you. Should I just go back onto the lantus immediately without the consult of the vet and start her at 2units twice a day with testing. I feel like you all know better than my vet.
Click to expand...
Yes!

She’s your cat, and now that you’ve educated yourself and gotten some good support, it’s your call if you want to keep her on Lantus and do a more thorough tracking of her numbers before changing things up.
 
If she were my cat I would definitely go right back to Lantus. Since Novolin is an "in-and-out" insulin there would be no problems in doing an immediate switch. Lantus is a "depot" insulin, which means that it leaves some of itself in the cat's body--as a reserve, or "depot". This depot will have to be rebuilt and that will take about a week. During this week you may not see any improvement in numbers, because some of the insulin is going into the depot (and not going right to work on the blood glucose). The depot reflects the dose, so every time you change the dose the depot has to recalibrate.

I don't know what Lantus dose to recommend, since we don't have access to your spreadsheet yet. Alley was on 3 units of Lantus twice a day previously. Perhaps go back to that to re-start Lantus (?) @Wendy&Neko ; @Sienne and Gabby (GA) ; @tiffmaxee ; @Marje and Gracie ; @Chris & China (GA) I hope some of these experienced dosing people can help you.

Hang in there and ask as many questions as you need. Start reading the "Stickies" (informational posts at the top of the forum) and try to set up your signature and spreadsheet as soon as possible.

It is all overwhelming at first, but soon all will fall into place. Everyone here wants the best for you and your Alley.
 
Thank you. I really appreciate your advice. My intuition told me to get another prescription of the Lantus and you have all convinced me that I was right
 
I agree with Wendy....the SS will help us make sure you get to a goid starting dose but I would not shoot 6u of Novolin without having enough data to know how low the current dose takes her.
 
Welcome to the forum! Great group for getting information (tons of it!!) and support!

So many times we've seen folks come here - with the vet story so similar to yours. Same for me - I knew nothing about feline diabetes before my Luci was diagnosed and discovered soon thereafter that my vets didn't know much more than I did.

Thanks to this group I have a healthy happy Luci - still with me after almost a year and a half after her diagnosis! You can save your kitty too...and you've found the right place with the right information to do it!

We'll be looking for your posts to let us know how your kitty is progressing - tomorrow, hope your post will look like many of our daily threads - date, kitty name, AMPS number; Look at other folks' posts and how they format - and take a look at our spreadsheets to see how often we test - some more often than others but always always before giving insulin...feel free to ask questions in your daily thread and read those stickies - you'll feel like you're in information overload - but it'll come together for you soon - I promise.

:bighug::bighug::bighug:
 
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