Is it time to change insulins?

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Alison & Sarge

Alison & Sarge

Member Since 2014
Sarge and I are now down to the smallest dose of Novolin N I feel I can accurately measure with a U100 syringe, just O.50 units, and he is again dipping below 50 at only +3.5. Novolin just drops him like a stone. In the short time he as been treated with this insulin, we have had three long nights heading off a potential low sugar issue. His PS numbers have come waaay down too which tells me the wet food diet is going him a lot of good. Overall, he is doing great. I see less pee in the box and less of him at the water bowl. This morning he was clowning around like his old self. I know we are definitely getting somewhere.

So, my quandary is I don't feel I can safely dose him with Novolin anymore and I wonder if this is a good time to make the switch to a "gentler" insulin like Lantus. I think he is still too high to give diet control a go but at what point do you "take the plunge" and start over with another insulin? Any thoughts would be appreciated :)
 
It is possible to measure tinier doses of insulin, from 0.25U to 0.1U to only drops. You need to practice with a used syringe and some colored liquid. Measure up your insulin dose, overdrawing the amount to 1U. Slowly twist the plunger to squeeze out drops, counting out the drops as you twist out drops of your test solution. Do this repeatedly until you get a consistent drop size and the same number of drops.

Say you get 12 drops out of 1U. You then would draw up the 1U and twist and squeeze out 9 drops to leave 3 drops which would be your 0.25U dose. Alternatively, using the 3/10 cc syringes with 1/2 Unit markings on the barrel, you can eyeball a dose that is halfway between the 1/2 unit mark and the zero mark on the syringe.

Here's a picture showing what that 0.25U looks like. Click on the picture for a larger view.

Here's a picture showing 0.1U


You're right in that the NPH insulins like Novolin drop cats like a rock, fast and furious. It can quickly get scary.

I see a couple of options for you.
1. Try to measure the smaller doses and keep using the Novolin.
2. Try not giving any insulin to Sarge for a couple of days. I don't think he's actually ready for an OTJ trial but you could see how it goes for a couple of days and then reevaluate.
3. Switch to a gentler, longer lasting insulin like Lantus, Levimir or Prozinc.
 

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Or ask your vet to prescribe the diluent for it so it is less potent.

You'll need:
NPH
Diluent for Novolin/Humulin
Sterile vial
Syringes
alcohol wipes

Approximate instructions for dilution to 50% concentration (pharmacist can clarify):
Roll NPH insulin to mix well. Wipe top of insulin and sterile vial with alcohol wipe. Draw out 1 unit with a fresh syringe and inject it into the sterile vial. Dispose of syringe.
Wipe top of diluent vial with alcohol wipe, draw up 1 unit of diluent with a fresh syringe, then inject diluent in into the sterile vial. Dispose of syringe.
You now have 2 units worth of U-50 insulin.
Wipe top of vial with alcohol wipe and roll well to mix before withdrawing a dose.
And note that all markings on the U-100 syringe must now be divided by 2.
 
Thanks so much for the input guys. After thinking over our options I'm torn. I was going to do a no insulin a couple days on very low carb food to give me a chance to find syringes with better markings (I thought I got syringes with half marks in my newbie diabetic shopping trip but I didn't) and track down some Lantus but tonight he is +10 379. Much higher than I would like to go without insulin. He has only had FF and other lower carb wet foods the last several days so I can't blame the higher than lately number on getting into the dry food. It could have something to do with going below 50 last night. As much as I hate to have him high, I am more scared he will go hypo tonight that I am that we will spend a night high.

I went all over today and tried to find him Tiki Cat. I was able to track down the Chicken and Salmon. I thought maybe if I fed a no carb or very low carb food tonight he might come back down on his own. So far he has only licked the juice out of it. His house mate Lobster tried to bury it. Best laid plans. Might have to move on to the Asian Fusion/Mack and Jack I picked up too. Always have a plan B right?

If I dose him tonight it would have to be soon or his next shot would come around while I am at work tomorrow. I will probably test him at +12 and decide. If he has gone higher I may try to work out 0.25 units for a night on the syringes I have. If he has dropped I will feel better leaving him be. I can't wait until I find the perfect combination of food and meds that will keep him regulated well enough to have a crack at regulating himself. Patience, it hasn't even been a month yet right?
 
Do the drop method to figure out how many drops in 1 unit, as Deb explained above.
Then go with something less than 0.5 units worth of drops.

Or

You can deliberately use a slightly higher carb food so there is less risk of hypo.
 
Thanks :) I just followed Deb's instructions and came up with 0.25. I am glad too. He was 400 PS and judging from the litter box he has been over 250 at least part of the day. Hopefully this smaller dose will keep us safe for a while and give me some time to work out what to do next.
 
I have to put parmesan cheese on top of the Tiki Cat chicken for one of my civvies to eat it. It is very bland on its own.
 
Well, I got thrown something of a curve ball on Friday. I finally found a pharmacy willing to sell me a single Lantus pen. Hurrah! They want a prescription. No biggie, I called my vet's office to get one. It was only when I called back to see how long it would be to get it did I find out that my vet was on vacation until June 9th. No one had told me this was coming and I told them Sarge was getting low on just 0.50 units of Novolin N and that 0.25 was ok for now but given his history this might only be true for a couple days. I need to get him on a "gentler" insulin now. So, about 5pm my vet calls. She says she in concerned that Lantus might bring him too low too. Frankly so was I.

She asked me if I wanted to bring him in and have them curve him on 0.50 units of Novolin N with their Alpha Track meter, I said no (we had just gone around and around human vs. the Alpha Track. I explained why my meter was just as appropriate and Sarge's behavior and trends back up my numbers). So, she said we should do a one week no insulin trial and I should call on day 8 with his curve numbers. Ok, that was something I did feel I needed to try but I am REALLY frustrated.

They made it sound like I could switch to Lantus when Sarge was ready but now she wants me to bring him to the clinic for two days of in office curving with Lantus when she gets back. I am trying hard to not be mad. So far all the curves I have done at their office have been a complete waste. I was already suspicious his initial dose after the first curve was too high. I told them my suspicion and gave them my data. At his 1 week recurve they INCREASED his dose and he bounced big time. Luckily he was too low when I got him home to even try this (not that I dared) and the vet said to give him a lower dose that night. After that I started to slowly adjust his dose based on his home testing and a few weeks later here we are looking a just 0.25 units. A far cry from the 4 units they sent him home on. I am not a vet and don't pretend to be but part of me feels like if I had followed their instructions I would not have a Sarge right now.

Well, three days into the no insulin trial Sarge is maintaining a BG of about 330 on no carb Tiki cat. Knowing that I'm not really excited about making this a one week trial. I really haven't seen much variation. No wild numbers is nice and the trend supports the the argument my meter is just fine but I'm not seeing a decrease. So, this may be his no insulin baseline at the moment.

So, what is a girl to do? Do I give the trial more time? Do I give him his Novolin back and try like mad/hope to keep him safe at 0.25 units. Do I really need a script for Lantus? I didn't for Novolin N. I am pretty sure if I bought a 5 pack of pens from any other pharmacy and didn't use the discount card I could buy them. Do I really need my vet to switch him to Lantus? Is it standard for the vet to do the first curve or am within my "rights" to insist on doing it myself? I already know I don't want to start him on anything more than 0.25 units 2x a day based on his home data and what I have researched. Knowing that, do I really need their curving?

Sorry, this is so long. My head is swimming. Also have a constipated cat on my hands due to it being harder to hide his daily Miralax in shredded Tiki Cat. When it rains it pours! But, life is good :)
 
Lantus is gentle ... and expensive.

If he is nearly off insulin, you might be better off getting the diluent for it to enable further dose reduction while being able to meSure successfully.
 
That is a really good point. I am kind of afraid I am going to get a whole bunch of Lantus and he won't need it after a month. I actually asked for the diluent on Friday. I'm not sure why but I didn't get very far. Something may have been lost in translation since my vet was on vacation when I called. Or maybe I was the first one to ever ask for it and it just got over looked in favor of other ideas. Not sure. Is this something I can get from a pharmacy on my own? I might be the perfect way to buy sometime. Though I am afraid if I don't get him leveled out consistently he won't have a chance to regulate himself. How possible is that on small doses of Novolin N he can get OTJ?
 
Hi,

I don't think I've welcomed you to FDMB yet. Welcome! My name is Shelly, and my cat's name is Jersey. Unfortunately, I have had vet issues, too, and I can relate to your frustration. Jersey was diagnosed with diabetes in November. The vet put her on Hill's w/d dry food and said the food alone could bring her into remission. In January, her numbers were still high, and the vet prescribed 2 units of Humulin twice a day, telling me 2 units was "nothing." He said nothing about home-testing and told me to bring her back in two weeks. It was only at that point that I found FDMB. I realized that I had done everything wrong. I immediately switched to low-carb canned food and started testing at home. The vet was not happy at all and said my numbers weren't accurate and that the food was designed for diabetic cats. I nodded and kept doing what I was doing. I am so thankful that I was testing at home because I realized that just .25 units would take Jersey close to that 50 "cut-off" mark. If I had kept giving Jersey the 2 units the vet prescribed (and especially without testing at home), I have no doubt she would have died. As it was, I was terrified to give Jersey a shot and leave for work. I ended up skipping a lot of shots because I couldn't monitor her. That's when I found a new vet who prescribed Lantus for us. That vet knew Lantus was the best insulin for cats but otherwise knew very little about it. (He wrote the prescription for 10 units once a day!) That's when I turned to FDMB. I "moved" to the Lantus TR forum here and posted Jersey's numbers every day. The experienced users then helped me figure out when it was time to hold the dose, increase the dose, etc. Just 2 months later, Jersey was in remission! I never went back to either vet. There was no need to do so - I had the numbers right in front of me.

I tell you all of this simply because I really believe Lantus (or another long-acting insulin) is the best way to go. Lantus will require a prescription, and I would (nicely) put my foot down with the vet and ask for the prescription. If the vet won't give you the prescription, perhaps it's time to find a new vet? In my humble opinion, I would not continue without insulin. I understand if you don't want to go back to Humulin, but I wouldn't wait to get the prescription for Lantus. Those 300s on the spreadsheet tells me that Sarge simply is not close to being in remission.

I hope this helps. Take my experience for what it's worth!
Shelly
 
Thanks so much for your input Shelly. It really means a lot. It's nice to know I'm not alone :) As much as my cats love their current vet this might be the perfect time to get a second opinion. I feel my vet is not current with her diabetes knowledge and treatment regimes. I too feel that Sarge is still insulin dependent at the moment. I'm ok with that. I just want an gentler insulin. I have a vet highly recommended by a friend I can call on Monday. Since he would be a new patient I have no idea how long it would be before he could be seen. Should I restart his Novolin in the meantime? Or are we better off being insulin free for the new vet/Lantus? I hate for him to be in the 300's much longer.
 
It does help knowing there are others who have "been there, done that." ;-) Unfortunately, it can be really difficult to find a vet who is truly knowledgeable about feline diabetes. I guess they just have so many disorders and animals they deal with that they don't have time to become "experts" in the field. I truly believe my vet, sadly, pushed the prescription food and discouraged testing at home because that meant a loss of money to him. He even wanted me to do a $300 fructosamine test, which shows blood sugar averages over a couple of weeks. (Why do that if I have her daily numbers?) When I went to the second vet, I told the (new) vet that I was simply looking for a second opinion. I never told the old vet anything. I figured I might have to use their services in the future, and I didn't want to burn any bridges.

In terms of the Novolin, it's hard for me to tell you to go ahead and restart it. It really depends on how comfortable you are with it - if you can eyeball a tenth of a unit (.10) or a quarter of a unit (.25) consistently and be home to monitor. I couldn't do that, which is why I skipped shots. I think it will also probably depend on how quickly you can get into see a new vet and/or convince your current vet to write the prescription.

In terms of switching insulins, I gave Jersey her Humulin shot in the morning and switched to Lantus for her evening shot. It was my normal 12-12 schedule, just with different insulin. There was no need to "detox" before switching.
 
I did go ahead and give Sarge 0.25 units. So far, this has been a safe dose. I just couldn't bear to have him in the 300's any longer. I gave him some of his higher carb-low carb food along with it for insurance. He likes it better anyway so he thinks he is getting spoiled. Bonus.

Keeping it as simple as a second opinion is a great way to explain my need to explore my options. I don't want to burn any bridges either. Doesn't hurt to get a second opinion and good docs actually encourage it. Thanks :)
 
I'm glad you're able to do the micro-dosing and restarted the insulin. Those 300s are tough. Please let us know how the vet visit/insulin switch goes!
 
About the food...

I will add that if you are adding Miralax to the Tiki - dilute the Tiki with water. I have a kitty who drinks the Tiki water first and then grazes on the chicken pieces throughout the day. She gets the Miralax when she drinks the water which is good because Miralax works best with hydration. I have also added tuna water to attract her to the Tiki.

I also add lots of water and Miralax to Wellness Core canned food. I add water several times until my water-drinker has consumed the entire content. She loves it like a runny soup. With this food, I also add Fortiflora. For some reason ALL five of my cats - sugar and civvies - love this food but only my CRF and sugar cats get it watered down.
 
My goodness has time flown! I wanted to follow up and let everyone know how grateful Sarge and I are for your help. Thanks to this community I had the courage to change vets and his new vet immediately changed his insulin. We are oh so close to getting him regulated on Lantus. A painstaking and surprisingly emotional process. I can't wait to get him in the green more often and see him regain some weight and his pre-diabeties coat. His attitude is awesome. He wakes me up 30 minutes before the alarm so that he can get his insulin, ok truthfully, he is in it for the chicken! His new vet is awesome and thanks to the FDMB habit of keeping a running spreadsheet in Google Drive I was able to easily share his spreadsheet with his vet. Every Saturday she checks his progress and we figure out what to do for the next week. I do his curves at home and he isn't going back and forth to the vet anymore. I know I still have a lot to learn but thanks to this board I already know what it would have taken years to research, try and discover on my own!
 
Yeah Sarge! Keep it up and you might get OTJ yet.

Thanks for the update on Sarge. It's been a while since we last heard from you and it's good to see you found another vet and are using a better insulin, the Lantus.

Please keep us posted.
 
:) I will keep you guys posted. I so hope we are close to regulation. He had three blue's in a row this week but then it was back to the pink and yellow. So want to leave the 300's behind for consistently lower numbers. Happy Thursday to all.
 
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