Newbie looking for advice

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20Merlin24

20Merlin24

Member Since 2024
Hello everybody!
My name is Anna and I have a newly diagnosed male named Merlin. He had a rough start in life and almost died from panleukopenia when he was a baby. He was brought to me as a rescue that the local shelter wouldn't take because they didn't have the resources to look after him. Anyway, that was about six years ago.

In the last year or so he had a dental and ALL his teeth removed after some had already fallen out by themselves. Since this he has not been eating much kibble, but mostly Friskies and Fancy Feast pate, as well as boiled chicken and jarred baby food.

We live in a very rural area and the closest vet (as well as everything else) is an hour away. It's a small office with sparse tech. The vet is a skilled diagnostician but as far as newer information, he is not very up on it.
We're actually in the process of moving out of state next month, to a more populated area. The added moving stress is maybe not a good thing for any of us...

Merlin was initially put on 3 units "1/2 Strength NPH". (They will not prescribe anything else, I asked.) Three days later (before I had any info) I brough him in for a re-check in the morning. He had just eaten a large meal because I was told to do whatever is the normal routine. He was extremely stressed and tested 327 on their human glucometer. Based on that - and nothing else - they increased his dose to 4 Units and gave the shot right there. Knowing what I know now I would imagine his meal (and stress level) possibly could have influenced that reading. I had no "before food" reading. They didn't ask anything at all regarding food, or even if he had eaten at all.

I didn't have a glucometer yet, but based on how he acted all day after, especially early afternoon, I started getting really concerned about hypoglycemia. When I called the office for advice I was told to give Karo or something - if I was worried. And skip the evening dose - if I wanted. Or I could just skip the injections entirely until I had my meter.

I opted for safety first. Skipped the evening dose and then resumed at 1 Unit the next day. Yesterday we started at 2.5 Units. AMPS was 302 and one hour after injection 305. The low for the day was 278 at 3+. PMPS was very difficult to obtain so now my schedule is off, but reading was 294. Concerned that this reading was lower than before I only gave 2 Units.

I have some questions if anyone is up for it:

1. Re the AMPS and PMPS at this early stage - should another reading be taken immediately before the shot...? I'm just testing an hour before, and then feeding. A little unsure how to properly log it.

2. This morning AMPS is 290. He then ate a full jar of beef baby food and half a can of Fancy Feast pate. How much should I shoot? Is it OK to jump right to 3 or 4 like the vet's office said? I was thinking 2.5 again but am looking for input.
 
I am still very new to this so I cannot properly advise you.

I always test my cat’s blood then I administer insulin. The time between the blood test and the shot is usually less than 3 minutes unless I cannot get rid of an air bubble.

I do not have enough experience to advise you on your second question.
 
@Larry and Kitties I honestly don't know. The vial has a handwritten sticker on it that says "1/2 strength NPH". I didn't know to ask about it at the time, and assumed it's just that, a diluted form. I had no prior knowledge whatsoever about diabetes.
This is a very rural area of Colorado, which I can't wait to get out of...

@LionHeartTX But is that without food or an hour after feeding...?
 
Hi Anna! Don't worry, you'll get plenty of help here :bighug:

As for the type of insulin you've been prescribed, I think it's one of the faster acting ones. You can find all the info here: https://felinediabetes.com/FDMB/forums/caninsulin-vetsulin-and-n-nph.19/

1. Regarding your first question, the guide says:

With an insulin with an early onset, it is important that your cat has eaten before you give a shot. Generally, you want to feed your cat and give a shot an hour after your cat has eaten. The order for this process is:

(1) test, (2) feed, (3) wait 60 min, (4) shoot

So I think what you've been doing is correct.


2. I think 3 - 4U is a very high dose to start with. Based on what the kitty is fed, 0.5 - 1U is a recommended starting dose. I wouldn't go back to what the vet suggested right away.


Unfortunately, I have no experience with NPH so I'm tagging @Suzanne & Darcy. I believe she's an expert on it and can explain things better.
 
@Gabi & Stela Thank you so much. :bighug: I'm really stressing over this. I'm guessing "1/2 strength" means the 2 Units I gave was actually 1? He was started at 3 at the vet, so that would still have been kind of high then.
 
20Merlin24 said:
@Gabi & Stela Thank you so much. :bighug: I'm really stressing over this. I'm guessing "1/2 strength" means the 2 Units I gave was actually 1? He was started at 3 at the vet, so that would still have been kind of high then.
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We will get through this :bighug: it can be extremely overwhelming but it really does get easier with time. I would cry on the kitchen floor because I was unable to get a single drop of blood from the kitty's ear after an hour of trying and now I can test her half asleep. You'll soon create a routine and Merlin will very likely get used to it - kitties are creatures of habit after all. With a bit of practice and time you'll get the hang of everything and the more comfortable you are, the more relaxed he feels too.

As for the 1/2 strength - my guess would be it is diluted so yes, that would make the 2U actually 1U. I'm not sure why the vet would start with such a high dose but it is not uncommon to obtain unhelpful, borderline dangerous advice from vets. It was my case as well. Let's wait for someone more knowledgeable to reply but I think it's still better to start low and increase the dose gradually based on the numbers you get.
 
Yeah, yesterday felt like an absolute disaster. This morning was easier because I was so tired and he was cooperative and calm. I'm lucky he's such a mellow and kind soul.

How long should it take to somewhat regulate him? How often should I be testing? I'm really aiming for remission, but if I can at least get him controlled I'll be happy.

He is acting so much more normal already. Comfortable, relaxed, even cleaning himself and playing. Haven't seen this for a while. :) Is it dangerous to stay in the high 200s - low 300s for weeks or months on end though?
 
It’s great to hear he feels ok, I’m so happy for you both!

It’s hard to say because every cat is different and there are many factors in play. With the insulin and protocol I’m using I’d say we are talking weeks, maybe months to obtain a steady regulation.

I test as much as I can. When working from home and during weekends, I try to test every two hours during the AM cycle. It might not be necessary with other protocols. You definitely want to get a preshot test no matter what insulin/protocol combo you follow.

I think once you find the proper dose, it’s unlikely he’ll stay in dangerously high numbers for that many days in a row. However, if you do get high numbers, you should be testing for ketones - it’s done by dipping a test strip in a urine sample. The strips should be widely available, I believe they are called Ketostix in the US.
 
20Merlin24 said:
@Larry and Kitties I honestly don't know. The vial has a handwritten sticker on it that says "1/2 strength NPH". I didn't know to ask about it at the time, and assumed it's just that, a diluted form. I had no prior knowledge whatsoever about diabetes.
This is a very rural area of Colorado, which I can't wait to get out of...

@LionHeartTX But is that without food or an hour after feeding...?
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It is with food. Usually about 15 minutes after he eats to make sure he doesn’t regurgitate. I tried feeding him only twice a day, but it didn’t work. I also tried to switch him to canned only, but that also did not work. So he has access to dry food at all times and canned food while I am awake.
 
I am also using Novolin NPH. I wanted Lantus, but the vet wanted to start with NPH. My vet recommended I use the Walmart ReliOn Novolin NPH. The insulin starts working quickly! The peak is normally at +2 hours after injection, but I have seen it peak at +3 once.

Once I found a good dose, 3.5 units, he stopped having symptoms (drinking frequently & frequent urination). He has only been on 3.5 units for a week. The lowest his blood glucose has been was 86. It would have dropped more, but it was late at night, & I didn’t want to worry about hypoglycemia so I gave him a few treats. He is gaining his muscle back and his fur is silky soft and glossy. We still have a long way to go. Unless I am able to get good numbers for the entire 12 hours I am going to ask my vet for a prescription for Lantus. Right now the last few hours are high +200s or +300s.

I try to test him every hour, but it starts to stress him out after the 4th hour/test. I don’t even try a 5th test because stress hyperglycemia might ruin the result.
 
I did get the keto strips, as well as urine glucose strips. The trick now is collecting the urine. There are eight other cats in the family. Got a new clean box that I'm hoping he'll start using. Without litter and just some used in a plastic bag so he knows what this box is for. He just stops and leaves if I try to collect with a cup.

How high is high enough to worry about ketones, and what do I do if they are present? Is that an emergency??
 
@LionHeartTX So you test his glucose 15 minutes after he eats? How do you know that the reading is accurate and not elevated by the food then...? Am I missing something?

I wanted Lantus too, since I had read that it had the best results for remission. But my vet doesn't know anything about it and won't prescribe it.
 
To avoid misunderstanding you spreadsheet and in new posts yu make you should identify the volume of the ½ straight NPH vice the # of units since you really do not know what the U of the insulin is but it is likely U50. For the volume I would say drawn up to X unit marking on a U100 syringe. Otherwise I a afraid some readers will think you are giving X units vice X/2 units (we think)
 
20Merlin24 said:
@Larry and Kitties I honestly don't know. The vial has a handwritten sticker on it that says "1/2 strength NPH". I didn't know to ask about it at the time, and assumed it's just that, a diluted form. I had no prior knowledge whatsoever about diabetes.
This is a very rural area of Colorado, which I can't wait to get out of...
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I would not use insulin that is not in it's original container. A vial with a handwritten sticker and vague wording is sketchy and big red flag to me. You don't know what exactly is in the vial. It could be saline for all you know. Can your vet just write you a prescription for insulin that you can take to a pharmacy and fill?

Is your vet an older person who set in his ways? Sometimes it takes a bit of nudging the vet and a discussion about newer treatments for feline diabetes to change a vet's mind. There are articles and studies published in well known veterinary journals that you can use to discuss with the vet.
 
@Larry and Kitties Can you give me an example of what you're saying? On the spreadsheet I have it noted as 1/2 strength, and at the vet's office they were showing me on a U100 syringe. So when I say 2.5 U I should also note 1.25 U full strength?
 
@squeem3 I assume this is for the purpose of coming up with the correct dose. Yes, he is older, and only uses this one insulin. After this I think I can just buy it without a prescription. Going back on Monday or Tuesday.
 
I would agree that a vial with a handwritten label is a big red flag. It means that the insulin has been repackaged. You have no way to know if this was done under sterile conditions. Ideally, if half strength NPH was even a "thing," the vet would have you purchase it from a compounding pharmacy where they have the equipment to maintain sterile conditions, have the ability to measure and calculate concentration, etc. Also, for a vet to refuse to discuss the choice of insulin is another red flag. As Larry noted, you can purchase NPH without a prescription. The downside is that it's not a great insulin for managing feline diabetes.

This is a link to the guidelines, including their update (2022) that were published by the American Animal Hospital Association in 2018 for treating diabetes. The guidelines were also updated. They recommend either Prozinc or Lantus (glargine) for the treatment of feline diabetes. If you opting to use this vet, I'd bring a copy of the guidelines and let him know you expect he will follow the recommendations of a veterinary association. NPH is fast acting, drops blood glucose numbers early in the cycle, and doesn't have adequate duration given a cat's fast metabolism.

If you weren't moving, I would suggest finding another vet. I rarely make that recommendation but the red flags make me apprehensive. I'd encourage you to see if you can find a cats only practice when you move.
 
Question: are you sure the vet is actually a licensed vet with a DVM degree? Just wondering because I have worked with people who claim to be a vet but only have a Bachelor's degree in Veterinary Science which is not equivalent to an actual DVM degree earned from a veterinary school. Vet licenses can be checked with your state licensing board. You can also see if the vet is listed on the Colorado Veterinary Medicine Association web site: https://members.colovma.org/membership/findAVeterinarian

Does anyone know if BCP PZI is still a good insulin to use? There is a free sample request on the BCP web site but it has to be requested by the OP's vet who doesn't seem to be willing to use any other insulin.
 
Sienne and Gabby (GA) said:
have the equipment to maintain sterile conditions, have the ability to measure and calculate concentration, etc.
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It is very easy to dilute NPH isulin. One can purchase sterile, empty 10 ml vials. One just take a new needle and syringe and draw up 5 ml of the U100 NPH insulin and inject it into the empty vial. Then with new needle/syringe draw up 5 ml of diluent and inject that into the vial. Years ago one could purchase special diluent for old insulins like NPH. I thnk you need a special diluant so the insulin particles do not clump together.

Note the BCP compounds there insulin and injects it in empty vials./ One can tell since the BCP vials do not have the metal cap ;l\\like commercial insulins. Commercial insulin fiill the vials w/o cap in a sterile room/enclosure and them after filling the cap is added, With BCP insulin one can see where the rubber stopper in the already has a needle hole.
 
Larry and Kitties said:
Yes.
As others have said, If the vet would only prescribe NPH and not the beter glargine m(Lantus) or ProZinc I would go to Walmart and get their N insulin which is abut $28 or so for a 10 ml vial. A script is not required for N/NPH
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I will be doing just that in the next couple of days. I suspect this may have been diluted for ease of administration. But I got the syringes with half unit markings instead of the regular ones they gave me. So I should be able to do this regular strength, right?
 
squeem3 said:
Question: are you sure the vet is actually a licensed vet with a DVM degree? Just wondering because I have worked with people who claim to be a vet but only have a Bachelor's degree in Veterinary Science which is not equivalent to an actual DVM degree earned from a veterinary school. Vet licenses can be checked with your state licensing board. You can also see if the vet is listed on the Colorado Veterinary Medicine Association web site: https://members.colovma.org/membership/findAVeterinarian

Does anyone know if BCP PZI is still a good insulin to use? There is a free sample request on the BCP web site but it has to be requested by the OP's vet who doesn't seem to be willing to use any other insulin.
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Thank you for making me aware of this. I checked, and he is. His old-fashioned way of doing things has as lot to do with how (most of) his clientele is I think. Most people here will simply not be compliant if it involves any effort on their part. You're lucky if you can get them to give antibiotics or even food on some kind of schedule.
 
Larry and Kitties said:
It is very easy to dilute NPH isulin. One can purchase sterile, empty 10 ml vials. One just take a new needle and syringe and draw up 5 ml of the U100 NPH insulin and inject it into the empty vial. Then with new needle/syringe draw up 5 ml of diluent and inject that into the vial. Years ago one could purchase special diluent for old insulins like NPH. I thnk you need a special diluant so the insulin particles do not clump together.

Note the BCP compounds there insulin and injects it in empty vials./ One can tell since the BCP vials do not have the metal cap ;l\\like commercial insulins. Commercial insulin fiill the vials w/o cap in a sterile room/enclosure and them after filling the cap is added, With BCP insulin one can see where the rubber stopper in the already has a needle hole.
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Not familiar with BCP. This vial they gave me has a metal cap. But as far as a sterile environment, I am highly doubtful... Besides just getting my own at Walmart, is there anything else I should be aware of? I use a new needle every time, and I disinfect properly. I am used to doing my own IV infusions at home (on myself), so I'm very aware of protocol.
 
20Merlin24 said:
Not familiar with BCP. This vial they gave me has a metal cap.
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What do you mean a metal cap? For commercially packaged products there is metal (or some a plastic disk) that must be removed to insert a needle in the vial. If plastic like the Levemir below, the plastic has to be removed to insert a needle and it can be put back on. If metal, the center of the metal cap that holds the rubber stopper has to be removed to insert a needle.

Did yoyu vial have either the removable plastic or removable metal disk in the center of the metal?
Insuln vila with meter cap.jpg
Insulin vial with metal.jpg
 

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@Larry and Kitties It's a vial with a metal "cap" holding the rubber stopper in the middle - it has NO cap/lid.

I'm so glad I'm leaving this area. No amount of disinfection and fresh needles can make this ok on my end. Hospital care for humans is questionable here as well. What I saw in the infusion center (at the hospital) made me never want to set foot there again. Public Health did nothing.

Heading to Walmart pharmacy tomorrow morning.
 
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