New Member - cat Kirby, looking for advice regulating diabetes

Hello! I'm a brand new member and am grateful for this resource. My cat Kirby is 17 years old. He's a very special guy.

I am working very hard to try to regulate Kirby's glucose levels. He was initially diagnosed in Oct. 2019 and was regulated pretty well on just 1.5 units (twice a day) of Humulin-N, until a few months ago when things went downhill. At that time, the vet increased his dose to 2 units (twice a day), and within a few weeks I took him to the vet ER due to symptoms, dehydration, and significant weight loss. He was hospitalized for DKA and dehydration, and after about a day and a half, returned home for home management.

As part of my attempt to treat him, I have started home glucose measuring with Alpha Trak2. I am new to this and wasn't aware it was an option until now. As you can see in his spreadsheet (in my profile), his levels have been all over the map. After each time I test him, I text his bg level to our vet, who advises how much insulin to give him. Our vet also prescribed a vial of Humulin R so that he can have a dose (if needed) after the 6-hour test.

I am perplexed as to why his levels have been all over the map the past few weeks.

He is currently eating Instinct brand, lamb pate canned food (which I learned about on the food chart as being good for diabetic cats who need to gain weight). He loves the food but understandably is not as interested in it when his bg levels are high. I occasionally supplement with a little tuna or baby food. The vet also added a probiotic powder last week to help with the loose stools he's been having (likely because of the change in diet from this previous food - Royal Canin Urinary SO "rx" dry and canned foods, which I recently learned are high in carbs).

The vet tells me Kirby's blood work is pretty much normal and diabetes seems to be his main concern at this time.

Any advice or feedback on his #s would be much appreciated.

Staci

 

Welcome Staci and Kirby!

I’ve never heard of the insulin he’s on so let me tag someone who may here,
@Critter Mom humulin-n?

how often does your vet have you adjust the dose? I see a lot of dose adjustments on the spreadsheet and I think that may be your main issue. The insulin needs time to work and his body needs time to adjust to the new dose. When you change it up this often, neither happens. Most insulins do better with consistency meaning same dose am and pm. Also what do you currently feed Kirby?

hang on for more replies!!

 

Hello! Humulin is commonly used for humans but apparently is also prescribed for cats. However, my vet is considering switching Kirby to Glargine.

He is eating low-carb Instinct brand lamb canned food.

 

I missed on of your questions.... The vet adjusts his insulin before each meal depending on his level at the time.

 

Okay so what you’ll see here is that we don’t adjust dose based on the pre shot numbers. We do that according the nadir which is your cats lowest bg on a 12 hour cycle. So for instance, the days where he had the 53 or 52 would have suggested a dose decrease of .25. We also go by .25 increments. That didn’t happen so my guess would be that his numbers than shoot up because he’s body is bouncing from that low nadir it’s not used to... you test often which is great btw! I’d also suggest trying to get a few more pm +2 so you can see where he’s headed for the night since cats tend to go lower at night

 

Thank you!

 

We used Humulin but that was SO long ago I hardly remember. I DO remember not being able to get Troubles numbers down.

 

I cant stay so I just wanted to say welcome to our family. You've landed in a safe place for Kirby. Good people with excellent advice for anyone who comes to ask. You are in good hands!
jeanne

 

I would second the idea of switching to glargine. Where in the world are you? Not the US right?

tagging a few more for input

@Panic @Deb & Wink

 

We live in Arizona. From what I've seen so far on this page, Lantus is very popular!

 

Sorry for the possibly dumb question... How do you arrive at .25 units? Do you estimate or use a special syringe? My syringes have marks at .5.

 

Tagging @Marje and Gracie who has experience using R.

 

Humilin R is an emergency insulin used to treat cats with DKA, whose numbers need yanked down quickly. It's dangerous for daily use. I'm surprised your vet gave you some to use. Tagging @Sienne and Gabby (GA)

Your vet appears to be treating Kirby on a sliding-scale, and as Ale said, we don't dose based on pre-shots. It makes no sense especially for Humilin N (Humilin/Novolin are the same thing, think just different brand names), which does not last long at all in cats. By pre-shot the insulin is long since used up.

Kirby definitely needs a reduction, poor fella is way too low on an Alphatrak and his numbers are skyrocketing up afterwards (bouncing), leading to higher doses, leading to worse numbers, etc. ... with DKA involved I don't personally want to give dose adjustment advice, but 3u is too much. Switching to Lantus (glargine) is highly recommended.

Here is a 101 on bouncing I typed up:

Bouncing is a phenomenon that occurs when the body experiences (or at least thinks it does) hypoglycemia. Luckily the body uses bouncing as a defense mechanism against this where it attempts to compensate the low blood sugar by dumping excess glucose provided by the liver in an attempt to raise blood sugar back to “normal” numbers. Unfortunately, “normal” is a relative term according to the body. For a diabetic whose body has been untreated for so long that it considered very high numbers to be the new normal, lower numbers can often make the body overreact in attempt to save itself, even if it’s not in danger.

A cat who has been suffering from diabetes for some time may at the point of diagnosis have a new “normal” of 400. When insulin is introduced and brings it down, even to 200 (still diabetic levels), the body thinks it is in danger, dumps excess glucose, and thus the blood sugar skyrockets up to the 400-600s. After enough time has passed, the body will eventually realize that 200 isn’t such a bad number, and bouncing will happen less often. Note some cats are extremely bounce-prone and a switch to Lantus/Levemir is needed.

There are three main causes of bouncing: when blood sugar drops too low (hypoglycemia), drops lower than the body is used too, or by dropping too much too quickly. Typically if a cat drops more than 50% of their blood sugar a bounce is likely to happen, or if they drop 100 points within an hour.

While bouncing can be considered as a safety net in the instances of hypoglycemia, it can look very confusing on paper.

 

Oh you have 1/2 marked syringes already awesome! It certainly makes it easier when you’re at 2.5 or 1.5. But yes, when you are at let’s say 2.25 you have to estimate a half point in between the lines. Some folks here use calipers. Others will fill a “sample syringe” with a colored liquid and use that as a reference each time. No question here is a dumb question btw!

 

I’m going to copy this and save it. I can’t ever explain it! My version would be something like, when the bg drops too low and the body goes oh oh that was scary let me bring that all the way up again!

 

N for Novalin, I get to now!

 

Staci, you should read the sticky yellow notes in the Vetsulin and N forum. Here’s one:

https://www.felinediabetes.com/FDMB/threads/introduction-to-cannisulin-vetsulin-n-nph.231602/

and link to forum:

https://www.felinediabetes.com/FDMB/forums/caninsulin-vetsulin-and-n-nph.19/

 

You can get the lantus (glargine) insulin for a much better price from Marks Marine Pharmacy in Canada.
Here is a link, with the information you would need to order from Marks.
>>>>>> Ordering Lantus, Basaglar, or Levemir from Canadian pharmacies
So if you vet will email you a prescription or give you a written copy, you can email it on to Marks Marine Pharmacy.

You'll want to get the pens, and pay for the extra insulation and the overnight shipping.

I have used NPH insulins (Humulin N and Novolin N) but do not like them at all, as they drop the kitties BG levels very fast and very steeply.
No experience with the R insulin (Humulin R or Novolin R). But I have seen people give 1 drop sometimes, if the cats BG levels are running too high. Certainly not whole units of R insulin, like the 4, 3 or 2 units your vet is having you give your cat.

Don't recommend that you give the R insulin, without some VERY close guidance from someone VERY experienced in it's use in diabetic cats.

The DKA episode was months ago. Is that correct @Staci ?

No, N does not stand for Novolin. It's a shorthand abbreviation for NPH insulins.

Looks to me like your cat is being severely overdosed. That's all I will say for now.

 

Thank you. That's very useful information. I am picking up an rx for glargine tonight or tomorrow. Anything I need to look out for when switching?

 

Glargine/Lantus is a depot insulin, meaning it works sort of like a little pool under the skin that fills and depletes. Unlike Humilin, which is an in-and-out insulin, one cycle can affect another. So if you reduce or skip a dose, you won't see the full effect of the insulin until the depot "refills". It takes 3 days/6 cycles for the depot to fill when starting, so you won't see MUCH progress at first. Sometimes you do - my cat's numbers did a steady decline while the dose filled, it was very cool to see.

Unless someone here has a recommendation, I think going over to the Lantus forum and asking for assistance with deciding starting dose and having them watch and assist you while you start the new insulin will be beneficial to you. Normally you would start on the same dosage as you're already on but Kirby needs a dose adjustment first.

 

Yours is just a way easier way to say it LOL

 

My kitty was started on N by the ICU vet. My regular vet switched my kitty to Lantus since N is not particularly good for kitties. You don't get good duration and it can slam numbers down like you're seeing with those drops from the 500s to the 50s.

Please do not give your cat 3.0u of R. We do use R but with far more caution than your vet is recommending. If you use R, you need to do a curve to see what it's doing to your cat's numbers. It's faster and harsher than N. If someone needs to use R, we have experienced members working with them since it can set off lost of bouncing.

Please get Ketostix at a pharmacy. Given that Kirbyy was diagnosed with DKA, it's critical that you test for ketones. With a switch in insulin, it's important to test for ketones.

Lantus is very different than N.

• The Lantus cycle lasts 12 hours. N is out of most cat's systems by +8 or so. In addition, with Lantus, each cycle overlaps a bit with the prior cycle.
• Lantus is a depot type of insulin. This means that a small amount of Lantus forms microcrystals that are deposited into the fat tissue and gradually dissolves. This is what gives Lantus it's duration and makes it far gentler than N (which is an "in and out" insulin).
• It is essential that you always get a pre-shot test and also get at minimum, one test during both the AM and PM cycles. You need the spot checks because Lantus dosing is based on the nadir -- the lowest number in the cycle.
• @Panic -- with staring Lantus, the depot takes about 5 - 7 days to form and stabilize. When changing a dose, it takes 3 days for the depot to adjust to the new dose.

As Elizabeth (Panic) suggested, I think posting on the Lantus forum is a good idea. With the number of dose changes and the history of DKA, I want as many experienced Lantus users weighing in on a starting dose.

 

Oops - someone told me the depot took 3 days to fill when I switched from Prozinc. Thanks for clarifying!

 

I agree with Panic you might want to switch over to the Lantus forum for advice on the starting dose, and agree with Sienne about not giving your kitty 3.0 units if R
Please listen to the members here they do know what they are talking about and have a lot more experience than most vets do.
I don't know what I would have done with out all of them
Good luck with the new insulin

 

The DKA episode was about 3 weeks ago. Quite recent. And I have gotten such different advice from the ER vet, vs. my vet... I am confused. But what I am learning on here makes sense.

 

Thank you, I have started a Lantus thread here: https://www.felinediabetes.com/FDMB...itching-to-lantus-from-humulin-dosing.234141/

 

If the price of the Alpha Trak strips becomes too expensive you might want to consider switching over to a human meter, most if us use a human meter from Walmart , the Relion Prime is 9 dollars and 17.88 for 100 strips
There is also the Relion Premier

You could use the Alpha Trak if your vet wants to see a curve done

Most of us use human meters here and our dosing methods are based on human meters.
Try to get more PMPS tests in during the night if you can , most cats drop lower during the night

 

I just reordered Alpha Trak strips (yes, pricy!) and they won't arrive until Thursday. I have 5 strips left. Are the human meters as effective for cats?

 

Yes they are , none of us using them have had any problems.
Before they came out with the pet meter they used human meters
Most of us use human meters here and our dosing methods are based on human meters.
I used to use the Alpha Trak and switched over to the Relion Prime and love it.
In your signature you should also add the meter you are using

 

I’m one of those people. I use ReliOn Prime

 

I was looking at your spreadsheet and Kirby dropped pretty low , did you feed him any medium or high carb food then the is. take action" (give high carb food/honey) numbers: 50 on a human meter, 68 on a petmeter.

Just want to keep him safe

 

I fed him some of his regular food and some baby food when he dropped that low. I didn't notice any lethargy/unsteadiness so I didn't use honey. I do have some higher carb food that I could use in the future (13% carbs)

 

Fancy Feast Gravy Lovers Gourmet Beef Feast in Gravy 20% High Carbs

Fancy Feast Gravy Lovers Gourmet Chicken Feast in Gravy. 15% Med Carbs


Fancy Feast Gravy Lovers Turkey Feast in Gravy. 15% Med Carbs


Fancy Feast Gravy Lovers Chicken and Beef Feast in Gravy 15% Med Carbs

Good to have these on hand, it's really only the Gravy you would need to feed him, or just a teaspoon of the food.
Always good to have honey in hand

 

Are the numbers on your spreadsheet straight from the alphatrack then not converted? Diane is right anything below 68 then post here and ask for help. On human meter it’s anything below 50. You should feed high carb and retest in 20-30 minutes until numbers are going up to a safe zone. Members here can help you if that ever happens again. Even without behavioral signs of hypo, you don’t want to risk it. Mark the thread 911 and start with Help then enter whatever the low number is and the time, like @+4. And when I say feed, you want to give about a tablespoon of food. Not too much because you don’t want him to get full in case you need to keep feeding to bring the BG up

 

Hi. Yes, the numbers are from the Alpha Trak. that is what my vet is using. I asked her today about switching to a human meter ; she said they aren't calibrated for animals. Is it a simple matter of adding a percentage to the human-meter results, if I go that route?
Unfortunately i wasn't on this forum yet when his numbers dipped that low but if it happens again, I will definitely post. Thank you for the advice!

 

Human meters were being used on cats long before the Alphatrak came on the market. There's not really a comparison; human meters run a bit lower but we have adjusted to it as far as take-action numbers, and the entire forum is designed around the human meters. You can still get help here of course - just make it known when you need help with low numbers that you're using an Alphatrak. A 50 on an Alphatrak is more concern than a 50 on a human meter, for instance.

Ultimately the cost of the strips may drive you away from the pet meter; strips are $1 each and when you're testing 4-5 times daily (or 10+ during hypo numbers) the cost starts eating at you.

The ReliOn Prime is a popular choice here - strips are only $0.17 each and you can get those at Walmart verse having to order and wait for Alphatrak strips, which are specialty.

 

Hi again, Staci.

Just in case this question might slip through the cracks on your new thread in the Lantus forum, I thought I'd answer it here.

Your vet is correct that human meters are not calibrated for animal blood. However, they can be used safely to monitor a cat's blood glucose levels at home provided you are using the correct reference range appropriate to a human meter.

For reference:

Normal BG range for cats as measured on a human meter: 50-120mg/dL

Normal BG range for cats as measured on an Alphatrak pet meter: 68-150mg/dL

There is no direct relationship between the readings on the different meter types, you simply use the reference range appropriate to your meter type.


Mogs
.

 

thank you!

 

In addition, all the numbers used here like what you’ll find on the sticky notes, are based on human meters and a human range. So if I make a thread saying help Minnie’s amps is 112 what should I do? That’s a human bg number. You’ll see most members who do use a pet meter will highlight that on the thread title since it’s not the norm on the forum. Pet meters are quite recent and before all that was ever used was human meters