Just Starting Insulin and Concerned About Humulin N

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Jenn & George

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Hi, I 'm new here. While I have some pretty good knowledge of human diabetes, I starting out new with my recently diagnosed little guy, George, who is a 10 yo SH. He was first diagnosed with Type II Diabetes in July 2010. Our vet immediately suggested changing him to low carb diet. At the time he weighed 17lbs, and we were both reluctant to try insulin before seeing if weight loss would not bring him back down into normal ranges. So all of our cats went on the low carb diet consisting of Friskies (low carb varieties) and we eliminated dry food for awhile. By December 2010, George had dropped to a healthier 12.5 -13 lbs and we reintroduced some low carb dry food with the wet, Blue Buffalo Wilderness. Last month (Feb.) we started to notice that George's weight was dropping off dramatically, and the ravenous eating and thirst began again. I suspected the diabetes and took him into the vet for a full run of blood work as well at a thyroid test to rule out any hyperthyroidism.

They had to sedate him with a low dose Telazol into order to get the bloodwork. He is just a feisty one in the vet office and always has been. They have used this method before to get blood from him and he seemed to do just fine. This time, however, things seem really different. It took forever to wear off and he was kept for observation overnight, just in case. He was a very different cat even upon coming home and stopped eating that night. Needless to say, we were right back in the office the next morning, which was yesterday. The vet had received the blood work back in the meantime, and his diabetes was definitely worse than before. Time for insulin. Since I have training as a nurse and have some comfort level with the shots, she gave me a quick primer and sent him home with the recommendation of Humulin N at 3cc BID and to do a curve (either by me at home or in office) in 3 weeks to see how he is doing. I have since hit the net looking for everything I can on this kind of insulin and others. After some careful reading, now I am concerned, both by the type and amount prescribed. I have no problem with starting with home testing and have a OneTouch Ultra Mini on hand. We tried it last night, and George was a little apprehensive about the whole process, though he seems to be fine with insulin shots themselves. Maybe with some time and practice he will come around.

I am worried whether I should continue on this insulin for the 3 weeks prescribed, or call back my vet and request one of the more suitable types like Lantus or ProZinc that I have read about. Most sites I have read discourage the use of the Humulin altogether, while others suggest that is might work for some cats who can get the full 12 hour range and a later peak. His initial levels when they did the blood work 2 days ago were in the 440's, and when they checked at the vet yesterday it was still 384 even after had eaten in almost 18 hours. My vet seems open to home testing and willing to listen. Just not sure how to approach this without implying that she is not educated or getting George's levels screwed up even more. I am trying not to be neurotic about following him around to the house in fear of a hypo reaction, but it seems possible with Humulin dosage.
 
Welcome George and George's parent (name helpful)

First off you are in the best place you never wanted to be, but will be so blessed that you have found.

Personally after having one cat on Humulin N and one on Lantus, I would definitely recommend seeing if you can switch George to Lantus. It is just a much gentler and long lasting insulin for cats. My guy that was on Lantus went into remission within just a few weeks with a diet switch to low carb canned food only, and Lantus.

I also would be concerned with that high of a starting dose especially on N, as it hits so hard.

Again only my personal preference but if George was my guy, I would see if I could get him on Lantus, Levermir or PZI, and I would drop the dry food altogether. I have 11 cats only one of which is diabetic, ( I lost the one that had been on N, but to cancer not diabetes), but they all eat exactly what my diabetic eats, just regular Friskies Pate flavors. It may be that just the addition of the dry food again is what sent George on the road to insulin.

Home testing is absolutely the very best way to keep your furry son safe while he is on insulin, at the very least you will want to test before each shot, and then if you can grab spot checks at about +6. Since you have a medical background you are way ahead on the learning curve. One of the best benefits of home testing especially since he is such a pill at the vet's, it will give you truer numbers. Since you already know that George is so stressed at the vet's and stress raises BGs.

Others will be along shortly to give you a ton of links to read through. But you will find there is a wealth of knowledge and day to day living with FD cats here.

Mel, Max & The Fur Gang
 
You should cut the dry food out completely and just go with a low carb wet food.

I had a cat on Humulin N and she did not do well on it. It would bring her BG real low and she would bounce way up again a few hours later.
They say that Humulin N is a faster acting insulin and thats why that happens.

Lantus or ProZinc would probably be a better choice.
With Lantus, the shots have to be strictly 12 hours apart, which doesnt always work for some people and their schedules.
Prozinc also is given 12 hours apart, but I do not think the schedule is as strict.

You should read all the sticky's in the Lantus forum and the Prozinc forum to make a decision.
* But first, do a BG curve testing every 2-3 hours to see what your cats BG levels are throughout a 24 period.
If the Humulin N is working throughout the day, then maybe you don't need to switch.

With my cat I switched her to Lantus, but apparently she had other problems caused by the diabetes and she did not last long enough for the Lantus to start working for her.

Many cats do very well on the Lantus tho.
 
First, I assume you mean 3 units, not 3 cc. (I made the same mistake at first and had some quick replies to make sure - 3cc would be a LOT of insulin....) Although 3 units is also a lot.

You don't need your vet's permission to home test, any more than you would need your doctor's permission to hometest your diabetic child. Have you gotten any numbers at home yet? We generally see that kitties' numbers at the vet are much higher than they are at home, because of the stress factor. And it certainly sounds like your guy is stressed at the vet. Having a curve done at the vet presents the same problems - the curve has high numbers so the dose is increased and it is too high once the cat gets home.

I would try to eliminate the dry and I would go down to one unit bid. We just figure it is better to start low and increase as testing indicates than to start high and perhaps have to deal with a hypo.

So the sooner you can get some numbers at home, the better. You can see how the Humulin is working and if you need to switch insulins. (It is possible that he may be one of the few cats who get a longer duration from it.) Test before the shot, every time, to make sure it is safe to give the dose you are planning. Test aout 3-5 hours after the shot to try to find the nadir. That will tell you how low he goes and how fast.

It sounds like you may be having some trouble testing. Let us know what the issue is. We have all sorts of tricks that worked for us. We put Oliver in a kitty burrito at first (towel wrapped around with only the head showing) that helped us.
 
Wow, I am overwhelmed by the responses already. Thank you, thank you. First, sorry I forgot to put my name in my first post....Jenn here. What most of you are replying about the Lantus and the ProZinc sounds right in line with what I have read. I did get brave and call my vet this morning after my first post to inquire more about switching him, and I am waiting for her to call me back. I figured his levels would be higher at the vet due to crazy stress that gets about even just being in the carrier to get there. Yes, the dosage is 3 units BID, not 3 CC (yikes, can't believe I wrote that...probably sleep deviation from checking him all night); it seemed high to me when I looking at one of the Humulin dosage charts online. At 350-400 it was only recommending 1.5 - 2 units.

As far as the home testing, I really want to give it a go, but I also don't want George to be hiding from me. Most of the videos and site suggest taking it slow, though I am anxious to get a curve for more proof to my vet, if necessary. The biggest problem so far has really been with trying to get enough blood and hitting that "sweet spot". We did get a prick last night from him, but there was no enough blood. I am assuming that adding heat might help with the flow. Secondly, while I have done BG readings on myself and others plenty of times, I am just down right slow and the cat starts to get a little anxious. I am sure he also picking up on my uneasiness.

So here are a couple of questions that come to mind regarding the testing.

1. Is it easier with two people? (My hubby tried to help last night, but he gets a little squimish.)
2. Better to bring the cat to your level (i.e. table), or get on the floor? Or lap? (George has never been much of a lap cat anyway)
3. Should I test before he eats a meal or after a meal? We are currently giving him meals 12 hours apart with the shot following about a half hour later. In people, blood sugar is usually done before eating and any insulin.)

And a food question....

1. If we switch all the cats (we have 2 others, Cuddles and Orion) back to wet only, would a 1/2 can (5.5 oz cans) twice a day be sufficient? We currently split the can 3 ways (1/3) for each cat twice per day, and then allow each a 1/3 cup of the dry to free feed between meals (mostly at night).
 
Yes, we found it much easier. One person to deal with the cat. One person to man the meter. Your husband could deal with the cat and turn away when the blood comes......

Testing is a matter of figuring out what works best for you and the cat. It is different for everyone. We used the couch and the burrito so we could lightly push him into the couch arm when he wanted to move away. Others have their kitties up on the counter, sometimes so there can be a treat at the same time. Some put the cat between their legs on the floor. The treats are a vital part of this whole thing. When they associate a treat with a poke, they do learn to come willingly. Here are some low carb treats: Lo carb treats


With Humulin, you want food in his stomach before insulin to try to avoid a steep curve on an empty stomach. But you want a test before the food, so it isn't influenced by the rise in bg levels that sometimes comes with eating. So I would test, feed and then shoot. Also, we advocate small frequent meals rather than 2 meals. They help support the pancreas and ease any drops in bg levels. Lots of us freeze the wet food and let them graze. Depending on how finicky your cats are, you can just allow them to graze on wet mixed with a little water. It helps keep it moist. I use an automatic feeder which makes my life easy, but I only have one cat.
 
limemittens810 said:
So here are a couple of questions that come to mind regarding the testing.

1. Is it easier with two people? (My hubby tried to help last night, but he gets a little squimish.)
2. Better to bring the cat to your level (i.e. table), or get on the floor? Or lap? (George has never been much of a lap cat anyway)
3. Should I test before he eats a meal or after a meal? We are currently giving him meals 12 hours apart with the shot following about a half hour later. In people, blood sugar is usually done before eating and any insulin.)

And a food question....

1. If we switch all the cats (we have 2 others, Cuddles and Orion) back to wet only, would a 1/2 can (5.5 oz cans) twice a day be sufficient? We currently split the can 3 ways (1/3) for each cat twice per day, and then allow each a 1/3 cup of the dry to free feed between meals (mostly at night).
Click to expand...

Hi Jenn! Hometesting seems so hard at first, but George will come around once he gets used to it, and it will be so much easier. Let me help answer your questions:
1. Yes. In the beginning it helped when my boyfriend was around to hold Bandit's head still while I got a drop of blood. Once George gets used to the testing and doesn't struggle so much, you'll find that you won't need two people.
2. My vet recommended (and this really worked) finding some sort of container with raised sides that's about the same size as the cat, like plastic dishpan, or a basket so that the cat doesn't have the urge to run away from you. I went out and bought a basket a little bigger than Bandit and 3 fleece blankets. I put two in the bottom of the basket so that it was comfy, and then I used the third to wrap him up like a burrito when he fought me. Testing was always and only done in the basket. He got a diabetic safe treat (freeze dried salmon or chicken) after every test. After a few weeks, he would run and jump in the basket when he heard me turn on the glucose meter. Oh, and the basket was on the floor. More stable.
3. You want to test him the same way you would a person...before eating and the insulin shot.

And the food question:

It depends on how big your cats are. How much do they all weigh (or are supposed to weigh)?
 
Hi Jenn (that's so much better)

I have 11 cats ranging in ages from 11 months to the diabetic at approx. 12 years old. They also range in weight from a slim 7lbs to Max at 14lbs, (he's very tall and long).

Max gets a can and 1/2 total per day the rest get a full can per day but I break up those cans into 4 meals a day. The kittens get slightly more as they clean up after the others. All 5.5 oz cans. I feed them at 7am, 11am, 5pm and then just before we retire for the night so somewhere between 10-11pm. On the days or nights that we are going to be gone at meal time I freeze their meals ahead of time and put it out frozen so they can nibble on it as it thaws.

I can't answer if it is easier or not with two people when learning to test, as my husband runs the other way at the site of blood, so with Max and I, it has just been me testing. Now I adopted Max from this very board as a diabetic so we had absolutely no history together before I started testing him. In the beginning he was a pill to test, he didn't know me, and had no reason to trust me stabbing him in the ear. So in the beginning I always tested him on a little pink baby blanket. First I would wrap him up like a burrito, then it got so I just put him on the bed on his testing blanket with low carb treats. Now all I have to do is get out Max's blanket and shake the container of test strips and Max will jump up wherever I put his testing blanket. If fact we just went to our vet's this last tuesday and did a demo on home testing, Max didn't even blink when I asked him to jump up on the table there to be tested. So it does get much easier and they really do learn to look forward to testing.

And others have already covered when to test. Just like a human diabetic you want to test before they eat. Also warming the ear really helps getting the blood flowing, I use a rice sock, which is basically a thinnish cotton baby sock filled about 2/3 full of plain white rice (not instant) and knotted at the top. I toss it in the microwave for a few seconds until very warm but not hot. I tested it on the side of my neck. Another thing that helped me, since Max has very long hair, was to put a very thin coating of vasalin on his ear to help the blood bead up and not disappear into his fur. I also found that using a lancet pen without the cap helped, So I could aim freehand, and then use the spring-loaded action to get the prick quickly.

But the very best advice I ever got here is to remember to just Breathe. The more stressed out you are the more stressed out George is going to be. If mom is relaxed and confident then George is going to be relaxed as well. Remember he loves and trusts you, your the Mommie and no one in the world is as good as the Mommie. =)

Mel,Max & The Fur Gang
 
while George is unregulated, he needs extra food -- because he is starving. It is ok to give more food than normal.

When the insulin is approaching the right dose, he will naturally need less food because he can get the energy out of the "normal" amount of food.

My 4 cats eat approx 8-9 oz of food each per day. (my diabetic is well-regulated - in normal range most of the day)

Since I have a bad back, I lift my kitty and test on a table.

Getting enough blood improved for me when i realized that the blood flows DOWN the outer edge of the ear back toward the body. So I squeeze / milk the vein BELOW where I prick to help push the blood backwards away from the heart and out the pricked hole.

I used Humulin N for 18 months with my first diabetic cat. Then we switched to PZI.

After Norton passed away, we adopted a diabetic cat through FDMB / just before DCIN Diabetic Cats In Need was established.

Tiggy was on PZI when we adopted him in 2009 --- when it ran out, we changed to Levemir and love it.
 
This all really helps. I think we are going to try a few things at a time with the testing and take is slow. After talking again this afternoon with my vet she seems really supportive of the whole home testing thing. That at least seems like a positive step unlike some other vets I have heard about. While she was completely aware of the other types of newer insulins though, she still seemed pretty stuck on using the Humulin N. She did listen to my concerns and points, but also proposed some seemingly good ones in return that at least have me considering a round with Humulin for a few weeks. I see such varying opinions on here and in other places that I willing to start with it and see what his "curves" look like in the next few weeks. Overall, he seems good and he is a larger cat, which might warrant the higher dosage at 3 units and maybe draw out a longer duration. She did support me in changing though if I absolutely felt it was not working or reducing the dosage once we have some good data from his curve. I am happy to be able to do it at home so that there is not a stress reaction being added to his numbers.

Being new at this, I still kind of feel torn in the middle with so much research and information to consider, but something is obviously better than nothing, and he is already showing such a good improvement even in just 2 days in the Humulin. It is readily available too, though that is probably also true for Lantus. She felt that ProZinc was harder to acquire, though most of the online pet pharms seem to carry it. Also mentioned something about it potentially being pulled from shelves, but I can't help wondering if she means the older forms of PZI. Frustrated a little, but gotta start somewhere.
 
The most popular insulins here are Lantus, Levemir and ProZinc. The 2 L insulins are human insulins with animal protocols. See the stickies on the Lantus forum; viewforum.php?f=9 PZI is not longer available but there is a similar insulin called ProZinc. It is sold mainly by vets. Here is the PZI info: viewforum.php?f=9

I think you will be able to see pretty quickly whether Humulin will work or not by hometesting regularly. We keep our data on this great color coded spreadsheet: Setting up a spreadsheet
 
Humulin N (and really NO insulin) should be dosed by the weight of the cat.

Dogs are dosed by weight because dogs can range from 200 lbs down to 5 lbs.

Cats should start at a low dose like 1u every 12 hours. Testing blood sugar will show whether you need to increase or decrease the dose.

My diabetic kitty, Tiggy, is a 15 lb neutered male, and he is Well Regulated on 0.5u BID. (blood sugar in normal range for most of the time)
 
I appreciate all the information on the other insulins and I think this will be good knowledge for the future if the Humulin doesn't work. Unfortunately, I feel trapped between what seems to be two schools of thought about diabetes in cats. This is at least the impression I get from reading and research. With a medical background, I also see this happen in humans, and it is equally confusing. I want to go with what seems to work, but my vet (as well as a recently graduated vet in my hubby's family that I spoke with) also provides compelling evidence too. I am left with two choices....trust my vet and give it a try with the Humulin (which seems to be having some positive effect on his condition already just from observation, though the curves will tell more once we get him up to speed) or try to start calling every other vet in the area to see who specializes. I live in a rural area, so my guess is that I would need to go closer to the city of Cleveland to find someone with the hassle of a long commute and probably additional testing expenses.

I live roughly 45 minutes southwest of Cleveland, Ohio. Does anyone know of a good vet who has specialized knowledge with feline diabetes in the area? Have any of switched vets before and been able to have records sent easily from one to another (like doctors do) without having to start the whole process over?

Also, how do many of you deal with the issue of overnight travel or vacations and caring for you animal? We do travel some weekends in the summer months, and I am trying to gauge how George's condition would effect this. I currently have a very kind neighbor who feeds and plays with cats when we are gone. He is really good about coming over several times a day, but I don't see him being able to follow a regimented schedule with insulin and blood glucose testing. He might be open to the shots if he isn't squeamish about the needles. (funny how I forget people are like that being in the med field) There is also a women a few houses down who works as a vet tech, though I don't know her very well.
 
I'll post over in Commmunity to see if anyone lives near you.

As far as traveling. When Oliver was diabetic, we took him with us. I know that is not always possible for every owner or every cat, but it worked for us. The vet tech is a real possibility for you. She should be able to give shots and learn to test, if she doesn't already know how. Some techs are eager for some work on the side as their pay is not usually great.
 
limemittens810 said:
I live roughly 45 minutes southwest of Cleveland, Ohio. Does anyone know of a good vet who has specialized knowledge with feline diabetes in the area? Have any of switched vets before and been able to have records sent easily from one to another (like doctors do) without having to start the whole process over?

Also, how do many of you deal with the issue of overnight travel or vacations and caring for you animal? We do travel some weekends in the summer months, and I am trying to gauge how George's condition would effect this. I currently have a very kind neighbor who feeds and plays with cats when we are gone. He is really good about coming over several times a day, but I don't see him being able to follow a regimented schedule with insulin and blood glucose testing. He might be open to the shots if he isn't squeamish about the needles. (funny how I forget people are like that being in the med field) There is also a women a few houses down who works as a vet tech, though I don't know her very well.
Click to expand...


Hi Jenn, I do know of a vet in Strongsville who I've worked with before. She is supportive of home testing and prescribes PZI. If she doesn't know something she is quick to refer you to someone who does. Which is what I like about her. Downside is if she doesn't know something...she's not prone to 'learn,' she'd rather refer. Although I do find her sufficient and very skillful with what she does. Strongsville Animal Hospital.

West of Cleveland but further north is the Westlake Animal Clinic run by Dr. Nappier and Dr. Love. I am in the process of switching my 3 cats over to these folks. I've been there twice now and have been totally blown away by the skill, care, and love they have for their work.

As far as traveling you can try your neighbors, especially the one that is a vet tech. Often the techs do pet sitting on the side. I often recommend reducing the insulin dose by 0.25 to 0.5 units. This reduces the chances of an unattended hypo and a weekend isn't long enough to cause real complications.
 
Waving hello from Twin Cities, Minnesota. I was born and grew up in Bay Village Ohio. Bay and Westlake were football rivals when I was in high school.. ANYWAY...

Please please please, take your boy to a vet that believes and encourages home testing.... and prescribes a longer lasting insulin.. Humulin N... works rapidly and drops the blood sugar quickly, but has no staying power. It puts him on a rollercoaster of feeling fine... then crappy far to often. Believe me going too low is very dangerous and a rollercoaster of highs and lows if just horrible. I know when my blood sugar gets low... I feel like heck and 'don't come near me I'll bite'... (well almost).

As for being less than a lap cat... my Charlie was soooooooo not a lap cat.. sort of like... "you may touch me when I come to you and tell you to" type cat. But... and this is a BIG but.... I found that putting him on the kitchen island.. (I made him comfortable on a old pink towel) (I told him pink was for boys)... I'd lay him on his left side, have a very warm paper towel ( one sheet folded to 2" square- and place under very warm water- and squeeze dry) in right hand... Fold the towel around his little ear, and sing. Honestly... I had the most wonderful "Charlie Songs"... I'd sing and sing saying his name and squeezing his shell like little almost black ear. Then I'd grab the lancet from the towel (everything laid out waiting for use)... I'd prick his ear by folding it "inside out" and punch it between the vein and the edge of the ear (about 1/8th inch from edge).. It took only a short few days for his ear to learn to bleed there. ANYWAY I would then take the OneTouch Ultra that I used, and push the strip all the way in and place the end next to the blood droplet... zip... it was sipped into the strip..... 5 4 3 2 1... and I had his blood sugar number.

THEN and only THEN did I KNOW it was safe for him to have his insulin injection. However, after the proper amount of kisses on his head, as I had him safely in my arms (I'd bend over and incircle him with my body to prevent him from leaving).... I'd place him back on the floor and feed him his Fancy Feast low carb food. No dry food at all.... (as he'd been a total Cat Chow cat) and had to learn to love canned, took him half a day to learn.....

About 1/2 hour (I'd set the timer on the stove) after he'd eaten, I'd pick him up... lay him on his side again and pull his skin into a tent and give him the insulin injection...

I could get dressed and ready for the day while he ate and the wait only made me feel more secure that he had food on board for the injection....

My boy was 12 when DX and passed on last year at 18+ from a blood clot in his brain.... He had become my cuddler and loved to linger over the 'ear warming' and shot time... we played games walking around the kitchen island until he was ready to be lifted up... (at 18 it was a long way up)... Sometimes, he'd come and get me at shot time, if I was late.... They know what you're doing is making them feel better.....

I will miss him forever... but am all but grateful for the DX that brought him the love and cuddling he had not known he wanted..

Edited to add..... I switched vets as his diagnosing vet wanted me to just shoot 2 units and never test... called Charlie Smokey, and told me he'd only live two more years..... WELL.... Charlie lived six plus and I mean lived... He ran he played and the day he passed played with his toys and begged chicken from my dinner... I'll forever feel his little paw on my leg... letting me know he was ready for another piece of chicken breast...
 
"Lori in Ohio"'s profile says she lives between Cleveland and Akron -- so she might have a good vet recommendation.

She already posted on this thread earlier.

Humulin N is better than no insulin at all -- yes -- you will see improvements in your cat on Humulin N.

There are better insulins for cats that cost more.

That said -- I did use Humulin N for my first diabetic cat Norton for 18 months. His quality of life was OK, but I wanted to do more, so I found this site and learned a lot. We switched to PZI and Norton was feeling better.
 
Carol, I really like your approach for the testing. My husband and I just tried it this way, except on the kitchen table, and he seems pretty cooperative. The only problem I am still having is actually getting enough blood for the meter, and I am using a One Touch Ultra Mini with one of the smallest samples required. Tonight we were not successful in getting much blood in two attempts, but let him go because we do not him to associate this as a punishment. Your detail in the ear folding helps. I will try that again tomorrow. I keep watching the videos on you-tube, but many of them are kind of fuzzing when up close. I also need to make one of those rice socks. Tonight we tried a one of the corn filled heat bags that works like a heating pad. It was kind of awkward. Oh well, one day at a time.

In the meantime, it sounds like Lori lives near me by the description. If she has a suggestion for anyone, that would be great. I live west of Akron, just outside Medina, Ohio. Strongsville though is also fairly close for me, about 20 minutes. Just not so sure about the referral thing. I would rather have a vet that is willing to work through things, but definitely a possibility if there is no one else out this way. I also talked with an aunt of my husbands today about her diabetic cat. While she doesn't home test, her cat has been regulated on ProZinc for about two years. She was interested in learning the home testing though once I can get the hand of this myself. It just helped to talk to someone about their routine and how the cat adjusted in the first few weeks. This also helps so much.
 
A friend of mine uses a vet for her dog in Strongsville.
She lives out by me and drives all the way there, so the vet must be good.
I sent her an email asking the name of the vet.
I'll let you know when I hear from her.
 
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