Newbie to FDMB, Need Guidance, Using Novolin NPH

Hi everyone,

My name is Abdullah, and my kitty's name is Billo. She was diagnosed about 2.5 years ago, starting with Caninsulin, Vet switched us to Novolin NPH about 6 months ago. The vet has prescribed 3.5u of Novolin twice a day.

I switched Billo to an all wet diet today (Fancy Feast), and have been monitoring her insulin levels. I wasn't able to get a Pre-shot reading, however I gave her a shot, and measured her insulin +2 hours and it was at 201.6 (11.2 mmol/L). I measured her BG again at +7 and it was at 153 (8.5 mmol/L).

I feel very overwhelmed, I do not know if these values are in the ranges that they should be in. I am still 4 hours away from last shot of the day, however I am confused and I do not know whether or not she will be needing it based on the reading that I get. I will be testing her levels before the shot, feeding her, and then testing again 30 min after (as I should have done this morning but didn't, I know, my fault).

Any help is appreciated!.

Thank you.


Abdullah & Billo

 

Welcome to FDMB We are glad you found us! This is a loving caring community of kitty cat lovers that all have one thing in common Feline Diabetes I am not an insulin expert but I can send you here:
BEGINNER'S GUIDE TO HUMULIN N/NOVOLIN N/NPH

To get you acquainted with our site. There ARE Novlin users here so be patient They will show up to help you with specific questions with good advice

Again welcome to the best site on this planet to help you help little adorable Billo.
WELCOME TO OUR FAMILY!
jeanne

 

Welcome, Abdullah. Waving to you from Ontario.
There are much better and gentler insulins to use than the ones your vet has prescribed.

I'll tag a few members who have experience with the insulins you are using.
@Deb & Wink
@Panic

 

Thanks Kel my brain not in gear.

 

Thank you Jeanne and Kel! I really appreciate your warm welcome

 

Hello Abdullah! Welcome

A few things. NPH and Vetsulin work differently than longer-acting insulin such as Prozinc and Lantus. NPH works differently than Vetsulin as well. I personally think your vet took you backward switching you to NPH. blech.

With NPH you need to test, feed, wait 60 minutes, then shoot. Vetsulin has the wait 30 min rule, NPH is double that. They are very harsh, fast-acting insulins to be used in cats, and food must be on-board before shooting.

For new diabetics, it is not recommended that you shoot below 250 (13.8) on NPH. Since Billo isn't a new diabetic though, perhaps @Deb & Wink has different advice. I think that rule would still apply since (I assume?) you haven't been home-testing until recently. Data is key!

Be sure to give Billo small snacks throughout the cycle, especially a snack early (around an hour afterwards) to help slow the drop. You also do not want Billo dropping below 100-120 on NPH. As I said, it's a really harsh insulin, so you don't get much wiggle room in good numbers on it. A non-diabetic cat's numbers (on a human meter) are 50-120. Unfortunately NPH doesn't allow us that grace.

Kel, do you know if there is a Canadian-equivalent of the AAHA Diabetes Management Guidelines? This is the paper we use to show our vets when they try to prescribe NPH or Vetsulin in cats. They are not good to use. Most of us use Lantus from Marks Marine Pharmacy. Very successful in kitties, lots of them go into remission on it.

 

Not to my knowledge. It's the AAHA Guidelines and the Roomp-Rand study that are important. Wendy might know.

 

Ah okay. I just know my vet was skeptical about Marks because it was "from another country". Um it's Canada, not China. So I'm not sure if Canadian vets poo-poo US guidelines.

 

Thank you for your reply Elizabeth!

Would it be beneficial to change her insulin? or should I keep Billo on Novolin for the duration of this treatment?

That sounds good! I'll make sure to wait 60 min. Should I still give her 3u or should I increase/decrease the dose?

Thank you once again!

 

I just checked her BG at +10, and she's at about 394. She did just have food about 40 min ago. Should I be concerned?

 

I definitely wouldn't increase ... you gave 3.5 this morning but you want to give 3 tonight?
I would think if she is over 250 then you're safe to give full dose tonight ... but NPH makes me nervous, I'm not completely comfortable offering dosing advice on it.
Why don't you post when you get the test before feeding tonight? We'll take a look together.

And yeah, I would change insulins yesterday. I know NPH has been able to get a few lucky cats in remission but I just really hate to see any kitty using it. It feels like playing with a hand grenade that may or may not go off, oof.

I do recommend Lantus - it's a wonderful insulin, very gentle, gives great low, flat numbers. The only thing is it's a little strict on time. Lantus craves consistency - it works best if you shoot as closely to 12 hrs apart as possible. You don't want to shoot more than 15 minutes difference each cycle, or more than 30 minutes in a 24 hr period. So, ideally, if you shot at 10 every cycle, you won't want to shoot earlier than 9:45 or later than 10:15. Lantus just functions best that way. Prozinc is good as well, doesn't do AS amazingly as Lantus, but if your schedule doesn't allow you to stick close to the schedule it has about an hour's worth of wiggle room IF needed. I stayed on Prozinc for a long time because I didn't think I could stick to the 15 minute guideline but it was surprisingly easy.

Not really. Could be a food bump, could be starting to bounce from the blue number today. Sounds like Billo will be high enough tonight!

 

NPH insulins are just about the worst choice you could make for your diabetic cat. (IMHO) It's true that Novolin N or Humulin N are cheap, but that is the only thing going for them.

The problem with NPH insulins (Novolin or Humulin) is that they rarely last longer than 6-8 hours in a diabetic cat. My recommendation would be to switch to a better insulin for cats, either the Prozinc or Lantus. Since you are in Canada, I highly recommend that you try the lantus insulin first. Nice, gentle, long lasting, lots of experienced users here. An entire ISG (Insulin Support Group) on this message board devoted to lantus/basaglar/levemir. Check out the stickies over there.

Imagine taking some pain medication for your headache, and having it stop working after 4-5 hours and having your headache return too soon. But you can't take any more pain medication until the next dosing cycle. That is what using such a short acting insulin is like. But the lack of insulin leaves you feeling groggy and wanting to sleep all the time and have no energy and feel horrible. Plus, you can't seem to get enough to eat, and keep losing weight because there is no insulin to help your body process the food. So you feel like you are starving all the time.

Most of the lantus insulin sold is made in Turkey or China. Other insulins are made in different countries around the world. We are truly a global community, for drug manufacture these days.
The pharmacy where you purchase the insulin really makes little difference, except for the price and service. And Canada is WAY less expensive than the US for Lantus insulin.

Since you live in Canada, you should be able to walk into a drug store/pharmacy/chemist and buy lantus insulin over the counter. No prescription needed, except in the province of Ontario I believe.

 

Boy that would make my vet roll. That's interesting though!

 

Sure that sounds good! It’s about 45 min before I test, I will get back to you asap! @Panic

I really didn’t know about NPH being so harsh prior to today. I’m really starting to question why my vet chose to prescribe it. I love your analogy, and it really does put into perspective how harsh (and maybe?) dangerous NPH is. I wish I had known earlier and been more knowledgeable so that I could have made the change.

I feel relieved to find out that Lantus is easily accessible in Canada! I’ll drive over to the pharmacy tomorrow morning and see if I can get my hands on Lantus insulin. How should I gauge the dosage? I’m not concerned with the precision of the timing for the shoot, I tend to shoot at the exact same times during the cycle.

Thank you guys so much for getting back to me and helping me so much, I really appreciate it and I am so grateful

 

Only for lowly humans. Cats don't need a prescription.

 

Will be waiting!

My vet prescribed NPH because it was cheap. I can see where she was trying to do me a favor in that regard but, yeah. A lot of what she learned was from me telling her and sharing research.
Most vets are treating dogs, and dogs do best on NPH and Vetsulin. They are honestly probably just sticking with what they know.

Yes, you lucky duck! Jealous American over here.

I believe the switch from NPH to Lantus is the same dosage, I would go over to the L&L forum to confirm, they may recommend something a little lower.

Since we got the timing issue out of the way (great!), a couple things about Lantus:

• When first switching over it will take 5-7 days before the depot fills, so don't expect good numbers immediately. Some cats do react quickly though!
• You will not need to feed, wait, then shoot. You can do it all within about 10 minutes. This is because Lantus doesn't kick in for a couple hours, so it's okay if your cat doesn't eat much, as long as they are showing an interest in food and will eat later.
• There are two methods you can choose from for Lantus: Start Low, Go Slow, and Tight Regulation. TR is more aggressive and strict about getting tests in and allowing BG to drop lower before reducing. You may be more comfortable starting with SLGS, which is the method you would be on with NPH (NPH is too harsh to allow TR). Look over them when you have time; later on when you want to request help with dosing, the members will base their advice on which method you're using. If you're not using either, they'll assume SLGS.
• When you do start Billo on Lantus (hooray!!), make a post in the L&L forum each day, something like 9/9 Billo Day 1 of Lantus AMPS (###). The members there will keep an eye on you two and help you with dosing.

Oh! And pick up the pens, not the vials. They last longer for cats.

 

Hahaha thank you!

I'll definitely head over to that L&L Forum! I looked into the SLGS method, I think I would like to go that route as well. I really appreciate the insight, I look forward to making this change and updating you all


So I've just tested Billo. Her PMPS is 304. Haven't fed yet. What are your thoughts?

 

Very excited for you two!

I'd say she's high enough for a full dose. I would monitor though ... interesting that she dropped a bit but maybe that was a mini bounce? I'm hesitant about it ... not sure if 3u is a safe bet with NPH or not.
Could you get a +1 test in to check her?

 

Sounds good! So I'm about to feed her now, and I will give her the dose afterwards correct? I can definitely get a +1 test.

 

Should I give her a lower dose of NPH, is that a safer bet?

 

An hour after she has eaten.

 

Technically she's high enough for 3.5 but she is going down ... I would do it just to be safe. Unless someone has better advice.

 

PMPS was 304. BG test at +1 is 250. Any thoughts?

 

Ah sorry, long day for me last night. 250 for +1 isn't bad, definitely good to give her a snack then since she drops early.

 

Just got her AMPS reading, she is at 347.

 

I'll feed her, and then give her a shot after an hour. I will record her BG at several hours today and get back to you

 

Hi guys, I just checked Billo's BG at +4 and she is at 140. Is this level too low? Is there a range that I can refer to, in order to make sure that her levels are in a "safe" zone?

 

Sorry I wasn't online. With NPH you don't want them dipping below 100-120. They're not in any danger per se if they dip lower, but with how fast NPH can drop kitties you want to keep them a little higher than we allow on Lantus. I think depending on how early she is in the cycle, if she goes under 150 or so you want to feed extra and monitor every hour to be sure.

 

Is there anything else other than feeding extra that I should do if she drops below 150?

 

Not really. If she's really early in the cycle though (first 3-4 hours) you might want to give her high-carb wet food (Fancy Feast Gravy Lovers are good). Kinda counter-productive when we want them to be below 150 but gotta be safe with NPH.

 

That sounds good! I'm keeping an eye on her and I'll make sure to do that if it drops

 

Billo's BG dropped to 59 about a half hour ago, and I just tested again after feeding her a high carb wet food and it has risen to 68. I am a little worried, should I feed her again or should I wait another 30 min - 1 hr and test?

 

I would feed some more food and recheck in 20 mins.

 

Should I add honey to her wet food?

 

Hmmm try the high carbs food first but if you have none a little honey will work. @Panic

 

I tagged Panic to come confirm.

 

I tested her again (haven't fed yet), she went up to 72. Do you think it may just be increasing slowly? I think I should still feed her but I'm just a little worried

 

yes feed again 68 72 relatively the same number

 

Back in 2007 we used NPH It was a wild ride but we did make it to remission. BUT It could have been much easier with a gentler insulin.

 

Definitely..I've been doing a lot of research since yesterday and that's exactly what I have gathered too. I got a hold of Lantus Pens at my local pharmacy, so I will be starting that tomorrow. I don't want to use NPH anymore

 

Sorry, just now seeing this. Keep feeding and testing every 20 minutes until she's over 100, we'll go from there. THANK YOU for stepping in Jeanne

 

Thank you panic (which is what i am in right now) I have a freind being evacuated

 

from the fires in oregon

 

UGH I MEAN ELIZABETH geesh

 

It's terrifying! I have a friend that lives in San Fransisco and she was showing me the skies and how scary they look. I hope things get under control and that your friend is safe to go back home soon!

 

Yikes! Stay safe Jeanne

How are Billo's numbers looking, Abdullah? We're going to want to reduce the dose tonight ... at least .25u. I wonder if Deb would recommend dropping to 3u.

 

Billo levels were:
40 min ago - 82
20 min ago - 95
Just now - 100.8

It's increasing but very slowly. Any suggestions or anything that I should change?

I think so too, but honestly I think 3u might even be too much I've been really worried ever since her BG dropped below 100

 

Okay good. Stop feeding for now, check in maybe 30 min. Usually we'd wait an hour but we want to keep a close eye on her since it's NPH. We want to see if she's maintaining on her own or dropping again.

Let's see what Deb says, she should be online soon. How long until PMPS, a few more hours?

Here's how to fill in those numbers on your spreadsheet, I'm assuming those were all done in hour 8?

82, 85 (+8.20), 95 (8.40)
And then 100 in cell for +9.

Or under whatever correct hour. You will have to manually color the cell green.

 

That sounds like a good plan, thank you so much for walking me through it, I really appreciate your help.

That’s correct, just two more hours until PMPS.

Sounds good! I’ll fill it in correctly. Thank you so much!

 

her BG after 30 min was almost negligible, about the same at 102.

 

Yes, Deb would recommend dropping the dose to 3U, maybe even down as low as 2.5U of NPH insulin.

As you see, the NPH insulins can drop a cat's BG levels really hard, and really fast.

p.s. Only able to on for about 30 more minutes. Early night for me, to get some sleep.

 

Thank you Deb! You're right, its really harsh. I think I will drop it to 2.5u tonight, and then switch to Lantus SLGS tomorrow morning

 

Elizabeth is glad! Thank you for popping by to confirm!

Please tag me when you make your thread on the L&L forum tomorrow; I'm eager to watch Billo's progress!

 

Whew See Abdullah youve landed in the safest place you could ever find THANKS LADIES!!!!!!

 

I truly have, I'm blessed to have found you guys! I will forever be grateful for all that you have done for me


Billo's PMPS is 133! I'm about to feed her and I will give her a shot after waiting 60 min. going with 2.5u with the shot. Let me know if there is anything that I should change

 

I would just follow the dosing advice then post.

 

133? I would skip! No more NPH for you!

 

I agree with Elizabeth. Skip the shot.

What dose did your vet give you for starting Lantus?

 

Noted - I'll skip!


My vet felt as though NPH is sufficient and that I shouldn't start Lantus, he didn't give me any reasoning for it though. I'm sort of taking it upon myself to make the change.

 

Unfortunate, but at least you don't have to ask for a prescription!

 

Tagging @Tracey&Jones (GA) for vet recommendations.
Tracey is not on the forum much anymore but hopefully she will see the tag. She is in your part of the province.

 

Agreed! I was looking at the L&L Forum and it says that for the SLGS method, 0.5u might be sufficient, but it also states that because I'm coming off of another insulin, I should take prior data into consideration. Doing more research as we speak to figure out what dosage is appropriate starting tomorrow.

 

I think 0.5 might be a little low since Billo isn't starting insulin, just switching. Usually you switch over with the same dose (the 2.5u).
Have you ever checked for ketones? Might be wise to do with the dose reduction + switch.

 

Oh crap I totally forgot that.

 

I haven't checked for ketones!! Thanks for bringing that to my attention. I will make sure to do that tomorrow morning, I have yet to purchase the strips