New to FDMB but not to diabetes

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KimV

Hello!!!

My name is Kim. I have a 9 year old cat who was diagnosed with diabetes in Aug 2010. It has been a wild ride since then. He is on Novolin N insulin (which I have read is not the best) and he has ranged from .5-3.5 units twice a day during this 5 year period. It seems that he is sick with something else every six months and usually the vet doesn't know what is wrong with him. This time I had full blood work and a urine test done. They said he has a UTI which the vet says was caused by having too much glucose in his urine for too long. While looking to find a new home for Pete through DCIN I was informed of a few things. First, the insulin I am using is not the best. Second, he will do much better if he is a on a high protein low carb wet food diet. Third, it is easy to test his blood sugar at home and will help him get regulated. The vet insisted that I needed to put him on a prescription diet but I told her that I have read that it is not necessary and that I cannot afford it. I asked her what the benefit was and she said high protein and low slow releasing carbs. So I told her that I would find a food with high protein and low carbs. She also had me move his shot from 3 to 3.5 on the same day as changing his diet which from everything I read sounded like a bad idea but I did it anyway. So here I am, 4 days after switching him to Friskies canned pates with 7-8% calories from carbs (hopefully I said that correctly). I just did his first glucose test today which was as easy (actually even easier) than everyone said it would be (the hardest part was sliding my card to purchase the equipment at the pharmacy). Since last night he seems a little more lethargic then usual. Today I fed him at 730 and gave him 3.5 units at 750. I tested him at 1:45 and he was at 54. When I brought him to the vet on Monday at the same time he was at 344. Now I am wondering.... what do I do next? I started a spreadsheet which should be in my signature.
 
Hi Kim,

I am so glad that you posted here!

This board is pretty active so you should get some replies soon.

I still think Pete has a chance at OTJ.

You are correct that switching to low carb is the right thing to do and increasing the dose was the wrong thing to do. -Jenna
 
Welcome to FDMB.

Here is our primer on Humulin/Novolin NPH, to help you use it most optimally. The most important thing is to test, feed, wait 30 minutes, then shoot. This helps buffer the steep drop NPH often gives.

Testing:
1) Always test before giving insulin to make sure it is safe.
For now, your no shot level is 200 mg/dL on a human glucometer (230 for pet-specific); this will lower as you collect data around the middle of the cycle to know how low he is going.

2) Mid-cycle tests between shots - whenever possible, test around the nadir (lowest glucose level between shots) for your insulin, to see how low he's going. For Novolin NPH, this often falls between +4 to +6 hours after the shot. Some folks do this on weekends or set a clock for the middle of the night to get this test done as it helps determine dose adjustments. This number should be at or above 50 mg/dL on a human glucometer (68 mg/dL for pet-specific).

3) A before bed test is helpful in determining if you need to break out some higher carb food and steer the glucose level or go to bed with some peace of mind. Steering means giving 1-2 teaspoons of high carb gravy, waiting 30 minutes, and re-testing (repeating as needed) to make sure the glucose stays above 50 mg/dL.
 
Thank you. So I should be waiting 30 minutes after he eats to give him his shot? That's what I have been doing for years but the vet just said to give it to him right away so I started doing that. So tonight before I feed him I should check his levels and if he is under 200 I should not give him his shot?
 
54 is fairly low. We start intervening, to avoid a hypo, in the 40s. I am assuming he is fine as you posted quite a while ago. The next time you get a number in that range, feed hima little snack of regular food and retest in 20 minutes. You want to be sure he is headed up, not down.

Keeping a spreadsheet will be a great tool for you. Seeing when he drops lowest on N will help keep him safe. Yes, we suggest that new diabetics not shoot under 200, but stall. Wait 20 minutes without feeding and retest. You want him rising, not falling and over 200.

He might be low tonight or he might have bounced from the low numbers. When their body senses a number lower than they are used to, it releases extra glucose. So the preshot after a low cycle can be higher than usual.

But if he is lower than 200, do the stall and definitely reduce the dose.

Glad you are home testing!
 
Yes to the 30 minutes wait. NPH hits hard and fast, resulting in a steep drop in glucose levels that often triggers bouncing (a response that yanks the glucose right back up for up to 3 days). By buffering the impact with food, the drop may be less harsh and less likely to trigger bouncing, plus it won't feel so much like being on a roller coaster.
 
Ok I will go back to waiting 30 mins after feeding for shot. I know it is a long shot but I would obviously like him to be OTJ. Is that possible using this insulin?
 
It is time for his dinner so I just checked and he is at 290. I feel like I should reduce his insulin from 3.5 to 3 since it is almost shot time and he is not that high. However, he was just moved from 3 to 3.5 on Monday. Should I lower it?
 
Cats tend to go lower overnight; I might back off to 3 units.
Dose adjustments are made based on how low the glucose goes, with some consideration of pre-shot.
 
Thank you so much! I have a feeling he was much lower than that last night because an hour and a half after his shot he was lethargic and acting different than usual. I am going to give him 3 tonight and then check him right before he eats again in the a.m.
 
Hi, thanks for checkin in on us! Last night I gave him 3 units and he seemed fine. His preshot this morning was 357. Is that high for a preshot? I gave him 3 units 30 mins after he ate. I just tested him now, 6 hours after the shot, and it is 254. 200 points higher than yesterday. Is that normal? Is it too high?
 
With N, his nadir (lowest point) could be anywhere from 3-6 hours after the shot. It tends to run 4-6, but especially with N varies widely. Your +6 is possibly past the low point. If so, he could have rapidly jumped from that point. Some cats get a longer cycle with N, but the average for most seems to be 8 hours.

It would probably help to do a curve and get a test every 2-3 hours during a cycle. Then you might have a better idea of his nadir and how long it lasts for him.
 
Ok. I will probably be able to do one on Monday. Is there a post on here that tells how to do it?
 
Just give the shot in the am, record the test number. Then test every 2-3 hours from then until the pm shot and record. Feed as usual although recording when and what you fed during the cycle can sometimes be helpful.

You are looking to see when he starts down from the morning number, when he reaches the lowest point, when he starts back up and when he is once again in high numbers and climbing (that's likely when the insulin is done)
 
Last night Pete's preshot was 307 so I gave him 3 units. This morning his preshot is 234. Should I still give him 3 units?
 
Thank you for the advice. I ended up talking to Jenna from DCIN and she said the same thing. So I gave him 2.5 and I am going to try to do a curve today. So in the future if he is near the 200 range preshot I should lower him half a unit?
 
Today will give you that answer. If 2.5 gives you a nice, safe curve, then it's a good dose for a number in the low 200s. If he is high and flat, then maybe a little bit more. If he dips low, a little less. The way you work with the in and out insulins vs the depot ones is to look at past data to make future doses.
 
+2 was 164, +4 is coming up in 45 minutes. Which of the more effective types of insulin is the cheapest?
 
First, look in the Supply closet. There was some Lantus - not sure if it's all gone.

Someone else will give you the Lantus info. BCP PZI is a compounded form of insulin similar to Pro
Zinc. It is about $50. Your vet must order it for you. ProZinc should be about $125 a vial. It is only available either through your vet or, if your vet will give you a prescription, you can get it on line. Sometimes it is cheaper but watch for postage costs. Overnight refrigerated shipping can be $25 or so.
 
Uh oh... +4 is 37!? But he is up and about he isn't lethargic or acting weird at all.
 
Maybe an immediate retest is a good idea to be sure the first one was right. And if so, I think I'd smear a little drop of honey on his gums.
 
I dont have any food with high carb gravy but I do have honey.... how much should I give him?
 
I tested him at 12 and 1 it went down 6 points. I did not test 31 and then immediately retest
 
This is a rinse and repeat deal. Try the honey and retest in 20 minutes. If you see any behavior that is unusual, get him to the vet, rubbing honey on his gums. Or if you are worried, just go to the vet now.

He will probably come up fast with the honey. He might stay there or might drop again. You want 3 rising numbers before you relax.
 
Ok I just gave him the honey. Hopefully I gave him enough. He is acting normal, nothing out of the ordinary. I will recheck in 20 minutes.
 
I'd give him something to eat (not a while lot - a tablespoon full - and do more honey. He is still acting okay?

What do you think about going to the vet? He has been in very low numbers for about an hour, right? They can bring him back up quickly.
 
I can't afford to take him to the vet. I will give some more honey and a lil food. He is acting totally normal, cleaning himself, walking around, purring, etc..
 
I gave him 1/5 of 1/2 a can if that makes any sense. I put about 1/2-1 teaspoon of honey on it. I will check again in 20. His ears are red though here is a pic. Am I doing something wrong?
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I do hold it for about 20 seconds while I love him with the other hand. Poor boy! 52 this time.
 
You can put a tiny smear of Neosporin with pain relief on it. 52 is better. Your choice - a little more honey to be sure it continues to rise, or a little food to see if that will work.

You will need to buy some hypo food. Fancy feast with gravy works well. Then you can just give a tablespoon of the gravy, not fill him up but give him lots of carbs. It's better than honey because it lasts longer.

Hopefully he will continue to rise.
 
Ok. I will give him a little more honey and next time I am at the store I will by some cans with gravy for just in case situations. Should I continue to do the curve? Also, what does all of this mean for his shot tonight?
 
You want three rising numbers before you relax. The honey can be a temporary fix. So three more tests 20 minutes apart.

My guess is that he will be very high tonight. Not only will the honey impact his numbers but he will probably bounce from the low numbers. BUT, I would lower the dose. I wouldn't continue with a dose that gave you the 31. You could try 2 if you can monitor carefully overnight. Or 1.5 if you want a calmer night.

I am guessing the low carb food is starting to impact his levels. It may mean a lowering over the next few days so you will need to be careful, getting each pre shot and deciding what to dose based on what the dose did before.
 
It is 74 now, so that is 3 rising numbers since the original fall. So the curve is basically nil now right?
 
:D The numbers you got definitely told you the dose was too high. I am glad you are home doing it; it could have been bad if he dropped any lower without any intervention.

I'd think you can quit the curve. Maybe a number in an hour to be sure he is sure still rising.

Great job. You were very calm and did all the right things. Congrats - you've survived your first hypo. Hopefully it's your last.
 
Sue and Oliver (GA) said:
:D The numbers you got definitely told you the dose was too high. I am glad you are home doing it; it could have been bad if he dropped any lower without any intervention.

I'd think you can quit the curve. Maybe a number in an hour to be sure he is sure still rising.

Great job. You were very calm and did all the right things. Congrats - you've survived your first hypo. Hopefully it's your last.
Click to expand...

Sue, I feel like I've learned so much just reading your responses to other members.
Thanks for being here!

Joan
 
Luckily, I'm a teacher so I am off right now. Hopefully he is regulated before school begins again otherwise I will have a problem. Thank you so much for your help!!! I don't know what I would have done without you @Sue and Oliver (GA) !!!
 
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