New forum member, thanks for all the help!

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Leslie and Jasper

Leslie and Jasper

Member Since 2012
Hello everyone,
We have been fans for a while, we are newbies who have been reading the info on the site on this site and lurking on this board since Jasper our 11 year old boy was diagnosed in early May 2012. Like others we were stunned, worried and sad for our baby and generally about to be overwhelmed. Luckily we found this board early on, all the info you have shared has been such a tremendous help to us and gave us confidence to handle this. Time to surface and say THANK YOU!

Our first vet bg was 355, lab result from the same sample was 514, and that vet had us to start him right away on Purine DM and on Humulin N twice a day. A week later we took him in to our regular vet for a follow up test and requested our vet to get lab result as well as their office meter. He was skeptical, he thought his office meter reads higher than lab, but based on the previous result we pushed and the data again showed the lab is higher. The vet was dubious we could do home testing, but the difference in their test method results plus vet visit stress did not inspire confidence. After studying all the great home testing info here, we got a Relion Confirm meter at Walmart and practiced on ourselves to get a feel for the lancet, how much blood, etc - as expected, we are not diabetic. Then we got going on testing Jasper, he tolerated the first stick well so we did a 12 hour curve the next day, testing every hour. Not the most enjoyable day, but we got a clear curve. A couple days later I took Jasper to the vet about 5 hrs after morning insulin to calibrate our meter with the lab and their office meter, our meter reads slightly lower than their office meter and noticably lower than the lab. Our curve convinced our vet about home testing and we told him about this site, hopefully he will direct other patients here. Our vet is now supportive of using our home data to adjust Jasper's insulin dose.

Next was food. Jasper and our other 3 cats had been eating only dry food forever, and all strongly prefer to eat the same food, and graze all day not eat on a schedule. Pixie is allergic to chicken so that presents an extra challenge. Years ago our vet was really into animal dentistry and pushed dry food. Based on the articles here we decided to transition Jasper and our other 3 cats to wet food. Our vet has come around, and agrees wet food today is OK for all our cats. So last week ago we weaned them off dry food to just Fancy Feast pates with no chicken and no wheat gluten. Jasper and 2 other have vomited some, but seem to be acclimating to it. They dont to eat as much as we expected but at this point we are all still getting used to the can routine. We test Jasper before each shot and adjust, his 12 hrs post insulin varies 115- 360 and his 5 hrs post insulin se are low 50 -100. We are still hoping but not really sure how to get him regulated and ultimately OTJ. We are still learning how to partner with our vet on this journey and maybe consider trying different insulin instead of Humulin. We still have lots to learn, but thanks to this site we are more confident we can figure this out.

Thanks again for all the great info and encouragement, especially for us novices! Its great to know we are not alone, and there is lots of help and support for whatever challenges come up.

Leslie, Andy and Jasper
 
Wonderful! You have all done your homework and made some great changes. The one thing that may be holding back your progress is the insulin. Yes, I would continue to push the vet to try something else. Humulin is difficult to regulate with in many cats, and impossible in many. As you have seen, it gives low nadirs and then bounces back up to highs; it rarely lasts the 12 hour cycle. If you adjust the dose for high preshots, you end up with too low nadirs. We suggest milder longer lasting insulins like Lantus, Levemir and ProZinc.

If you would set up a spreadsheet, the vet and you and we can see the trends and patterns at a glance. It is a great color coded tool which may help you use the Humulin to its best benefit until you change (hopefully) Here are the directions: http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207 If you need help, just ask.
 
Re: New forum member, please see spreadsheet

Thanks for your encouragement to publish and share Jasper's spreadsheet. Being engineers we were using an Excel sheet which is probably overly detailed but I guess old data habits persist. I transcribed Jasper's data into the template and hopefully published and linked correctly in my signature. I am also new to using Google docs, please let me know if the link is working or not? thanks! Here is the URL just in case https://docs.google.com/open?id=0B7I0xm ... npWMXJjM1U

Our meter reads about 30% lower than lab data from the same blood sample. Our vet advised us to try to adjust Jasper's Humulin dose based on our home test, give 1 U for high 100s, 2 U for mid-high 200s, and 3 units for 3 and above. Use judgement and be more conservative if no one will be home at his nadir. I really wish we had started home testing sooner! Our vet tried to show us how but he was unable to get blood from Jasper's ear and we didn't pursue it. Week later we finally gave it a try and voila! From the teachings here, I suspect our vet did not warm the ear enough and maybe poked a bit too far inland. Its great that everyone here encourages newbies to start home testing right away.

Today is more high and low for Jasper, I am trying to get him to eat enough and keeping an eye for hypo signs. All our cats suddenly lost interest in the current flavor of canned food they ate with gusto last week, go figure. I hope to get Jasper to a stable food regimen, also plan to review our data with our vet to get him onboard with trying a different, longer lasting insulin. I hope there is no harm in allowing a small lick of yogurt as a occasional treat. Any further advice and suggestions appreciated, thanks!
 
The spreadsheet is helpful. You are getting a fairly long cycle with Humulin which is unusual and may work in Jasper's favor. I know it is hard to get advice that is different from your vet, but I think his scale has dose changes that are too big and start at too low of a number.

We suggest that new diabetics (particularly when they have just changed to wet low carb) to be cautious with dosing. Our cut off number for a preshot is 200. If the preshot bg is 200 or less, we suggest waiting 20 minues without feeding and retest. Not only do you want a number higher than 200 to shoot into, you want to be sure the number is rising, not falling. Sometimes especially when a cycle lasts a long time, the preshot number can still be going down and you would not want to overlap insulin doses by shooting again. So your 1 unit at 100 seems dangerous to me.

Once you have data and a general idea of Jasper's patterns with doses, you might shoot a small dose under 200. But not until you have some more numbers. With Humulin, I would not shoot at all at 100. With the longer lasting insulins, experienced members might be shooting small amounts in 100 after they have data. But Humulin drops too fast. You run the risk of him dropping 60 points in a couple hours and you are in hypo territory. (We get nervous when a kitty is in the 40 range and we intervene with food and sometimes, if needed, syrup, to raise the dose fast.)

I would be comfortable with .5 to one unit at 200+ For 300+, you might increase to 2 units. So numbers between those two, maybe 1.5? If you start there and get lots of data, then you can see what he does at those doses. If it's not enough, then raise, but by .5 units, not a full unit.

You are seeing the usual Humulin pattern, dropping low and bouncing back up for the preshot. If you lower the dose overall, you may see a flatter, smoother curve. Or the lows may continue. Humulin works differently in different cats, but very seldom smooth or easy in any.

Just my two cents. I am not a vet, of course, just an observer of many diabetic cats and mother to one.
 
Humulin N is the last of the Humulins we used to use. Years ago majority of us used Humulin L and U but they were discontinued. Humulin N is still out there but a poor insulin for cats. With N you need to feed a 1/2 hr., at least, before shooting so food is on board. It is fast acting and short duration. Switching to Lantus, Levemir or Prozinc would be a great help in treating your kitty.
 
Thanks for looking at Jasper's data and giving your advice! We will make adjustments of 0.5 U instead of 1 U, makes sense and now that you mention it I am sure I read that on the site. We still have a lot to learn so thanks for your patience and pointing out 1-2 things at a time to focus on. We don't shoot Jasper if he is below 140 or so, and will see if lower doses help flatten out his curve.
I will also read up on how to switch Jasper over to a longer lasting insulin, recommended package, etc and local sources so we are well prepared to get our vet OK with changing the Rx. Vet seems pretty psyched that we got the hang of home testing and he even asked about the YouTube testing videos. He will not be surprised our research has surfaced more good ideas shared by cat people on the internet that are worth trying. We will get him intrigued that longer lasting insulin has helped lots of regular folks get their cats to a better state vs. accepting typical Humulin glucose roller coaster.
Thanks again for being here and for your support!
 
Here is the Queensland dosing protocol for Humulin N (NPH): http://www.uq.edu.au/ccah/docs/diabetesinfo/link2.pdf. I would print that out for your vet. Note where it says
Lente is the 3rd insulin of choice and NPH the 4th of choice insulin for control of diabetes mellitus in cats,
behind glargine or detemir (1st choice) and PZI (2nd choice), Lente and NPH result in lower remission rates
compared to longer acting insulins.
Click to expand...
I would also print this out for your vet: http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf. They are the current diabetes guidelines from the American Animal Hospital Association, and they strongly encourage using either Lantus or Prozinc, and do not recommend lente (vetsulin) or NPH (Humulin N) for cats. They also say that vets should strongly encourage their clients to home test (p. 218). I've also attached an article that discusses the safety and efficacy of Lantus, which includes recommended dosing guidelines (based on home testing).


The remission rate for Humulin N is about the same as the remission rate after a diet change, so if you've already changed the diet the chances are slim to none of Jasper going into remission on Humulin N. I would change to a recommended insulin ASAP. Lantus (glargine) and Levemir (detemir) have a proven 84% remission rate in newly diagnosed cats, and a 64% remission rate overall. The longer you wait to switch the insulin, the smaller your window on remission gets. Time is very important.

I have personal experience in this regard. A friend of mine has a diabetic cat whose vet put him on Humulin N, and which his diabetes gradually worsened on for more than 4 months, and the vet had him worked up to a dangerous dose of 5u. By the end of the fourth month, her cat could not walk or use the litter box because he had severe diabetic neuropathy, and he was urinating on a puppy pad on her floor where he would lay all day. Upset and frustrated, she finally got in touch with me because she had heard through the grapevine that Bandit was diabetic and in remission. I had her switch to Lantus, and today her cat is on day 7 of his remission trial, and he's made a nearly full recovery from his diabetic neuropathy and dashes around her house like a kitten. Check out his spreadsheet: https://docs.google.com/spreadsheet...DRYN1NZSkRfeU1zc1JKODBiMUlicEE&hl=en_US#gid=0

Once you do switch insulins, come back here so we can get you the recommended dosing guidelines for the insulin you switch to. :smile:
 

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Progress! Today we called the vet about switching Jasper from Humulin to Lantus. Our regular vet was out today, his partner was covering and she actually diagnosed Jasper in May. We explained that we have been home testing, Jasper is still not regulated with N, and we want to switch him to longer acting Lantus and needed a new prescription for that. She was OK with all that, told us she has had good results with Lantus and gave us prescription for Lantus pens which we just filled at a local pharmacy (whew). Vet said we need to start back at 1u twice a day. We have plenty of the 3/10 syringes so based on other posts we did not buy the screw on needles that go with the pen.
Today Jasper's appetite has been pretty good though he has been throwing up finally produced a large hairball so hopefully he is done with thowing up. We are reading more of the Lantus boards to prepare ourselves for this change. Our plan is start Jasper on Lantus instead of N this evening if his number is up when we test him around 8:45 pm tonight. If his number is low, no insulin tonight or until his number is up. Does 1u seem like reasonable starting dose of Lantus after he has been on Humulin at 1u - 3u for weeks? Is there any reason to continue with Humulin instead of switch to Lantus at next shoot? Any advice appreciated, thanks very much!
 
Hi,
I do not have experience with switching insulins.
But since your next shot would be the evening one and you probably would like some sleep tonight , I would think it would be better to wait and start fresh tomorrow and skip the shot tonite to let the system clear.
I 'm sure we have someone who has switched and can give you more sound advise.
I am just going wih logic and my own pharmaceutical knowledge of switching medications.


As for the hairballs, you can brush the cat and help eliminate the loose hair. Diabetes wrecks havoc with their coat . I noticed it's like the stress reaction
when going to the vet. There is always lots of excess hair falling off.
 
Hi,
Thanks good suggestion to start Lantus in the morning when we will be awake for the full 12 hours. Jasper's pm BG was 150 just now, we will retest soon and unless its higher, expect to skip his pm shot tonight.
We will give Jasper and our other cats extra brushing too, this recordbreaking heat has all of them shedding a lot and hairballing. Jasper is our dominant cat and he likes to lick and groom the other cats, that plus with switching them over to wet food seems to be a perfect storm.
 
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