newby with questions before first insulin dose

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cbrown1

Member Since 2013
Hi All
Mr. Pink was diagnosed by our vet with diabetes yesterday. Our vet said his glucose levels were extremely high.
He is 8+ years (we are not sure, he joined our family in 2005) and a fairly hefty fellow- weighing in at 17 pounds.
Our vet originally provided a prescription for Glargine Insulin. Unfortunately, as we have a daughter on 7 daily medications, $146 was out of our budget at the moment. As an alternative she has recommended Novalin N. I purchased a glucose testing meter today, and after a couple of trys today, I was just able to succesfully get a result. Sadly, it only said "Hi".
I am planning to give him his first dose at 7 tonight, but after reading through many of the links on here, I am a bit concerned about the dosage. To start of, the vet has recommended 4 units, 12 hours apart. I am...well- terrified that I am going to overdose him on the first dose nailbite_smile . Any thoughts would be greatly appreciated.

We are in Texas, I used the relion prime meter.
He is currently on Dry Iams Weight Control (now know I need to change that... wondering if I should do it before I start insulin or wait??)
 
Hi and welcome to FDMB.

Novolin is a short acting insulin and it probably be harder to get your cat regulated. You are right, 4 units is a very high dose. We recommend starting low & slow. I would recommend that you start with one unit 2x a day.

Getting him off of the dry food will also help bring down the BG levels. Between the insulin & switching to canned food, you should begin to see lower numbers on your meter. Great job for starting to hometest immediately.
 
N type insulins last roughly 6-8 hours in cats. We always test before giving insulin, for safety. If he is less than 200 mg/dL, stall 30 minutes without feeding and re-test. He also needs to eat 30-60 minutes before giving the N, as it hits hard and fast. Some folks using N insulins will give it every 8 hours (TID) to get the best control.

An alternative perspective than the preceding post follows.
He's so high that you'll want to bring that down sooner rather than later. When the glucose can't be used, the body breaks down fat for calories. A by-product of fat breakdown is ketones; too many cause diabetic ketoacidosis or DKA. It can be fatal and.is very expensive to treat.

You've started testing, so what you might do is go with 3 units and gradually change the food 25% a day. Gradual food changes help reduce the chances of diarrhea, vomiting, or inappetance. That will also let you gradually shift the insulin downward. You might decrease the insulin 0.5 units for each 25% food change.
 
Hello and welcome to Mr. Pink. What is your name?

I agree with BJM on the starting dose of the Humulin N. You need to test before every shot, and then get another test in the middle of the cycle. With Humulin N, this middle of the cycle test could be anywhere between 3-6 hours after you give the shot.

We strongly recommend that mid-cycle test, because it tells us how far the insulin is dropping the BG numbers.

There are ways to save on the glargine (Lantus) insulin. The manufacturer has a savings card program for their Lantus Solostar pen, a mini 3mL version of the normal 10mL vials. $25 for the first 6 prescriptions filled. Enough to last you 10 months or so.

You need to have your vet write the prescription for the pen and state one pen at a time. Other people have said that has enabled them to buy the pens singly, where as they are normally sold in a 5 pack.
 
Thank you so much for the replies! And the information on the lantus savings option!! I am starting with the 3 units dosage this morning, and will check mid cycle.
 
Here are some glucose reference ranges used for decision making using a human glucometer:

< 40 mg/dL
- Treat as if HYPO
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50.
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s; if not on insulin, this can be safe.

> 150 mg/dL
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

180 - 280 mg/dL
- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.
 
You may not know but the Glargine insulin (lantus) will last you six months if you keep it in the fridge - and its the best choice for your cat with a high chance of remission if you give it along with home testing and a low carb wet food.

we recommend you track the blood readings on a spreadsheet so you can see trends etc. Especially with Novolin as thats a tricky insulin to dose. Most of us use this spreadsheet which also can be shared with us if you want more advice, as well as your vet. http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

Let us know how you get on with the spreadsheet and let us know if you need help.

Wendy
 
You are all so helpful! I have been tracking 3 times a day- I will get that in the spreadsheet and starting using it. We started transitioning Mr. Pink to canned food yesterday. We are on about 50/50 dry wet today. Between the insulin and the food I am already seeing a difference. Came home from work over lunch right now to check on him. His pre-insulin test this morning showed 254, home test right now showed 194- 7 hours later. That is the lowest he has been since his diagnosis last week! Not great- I know- but it gives me hope. ;-)
Couple of questions on the Lantus. We absolutely want to give him the best options, but in reality also have to keep on a budget due to daughter's medical situation. We are going to try the $25 coupon that was mentioned above. It was mentioned that Lantus can last up to 6 month refrigerated... on average is that how long one pen/ vial would last? We are currently on 3 units twice a day. Or how long does one pen/vial last on average? Another patient of my vet said the lowest they have been able to find it is at walgreens- $154 for the vial, so just trying to figure out how long that will last me to determine if the cost is going to be do-able with the budget.
 
Swiching to low carb food will drop the insulin requirement, so that's great.

Note that the lowest point between shots of Humulin N will be about 3-4 hours after the shot. That is the number to test!!! You do not want him lower than 50 mg/dL. If you wait a full 12 hours between shots, note that he will zoom up - Do not increase the dose! based on that! Dose adjustments are based on how low he goes.

Lantus is also a U-100 insulin, with 100 units in 1 milliliter volume.
A vial has 10 ml, or 1,000 units
A pen has 3 ml, or 300 units

The dosing between the 2 insulins is not 1 to 1.

@ 1 unit, twice a day (BID):
With a vial, that is 500 days and the insulin may wimp out before you get to the bottom.
With a pen, that is 150 days and you'd be able to use it to the last drop without waste.

@ 2 units BID
With a vial, that is 250 days and the insulin may wimp out before you get to the bottom.
With a pen, that is 75 days and you'd be able to use it to the last drop without waste.

@ 4 units BID
With a vial, that is 125 days and you'd be able to use it to the last drop without waste.
With a pen, that is 37.5 days and you'd be able to use it to the last drop without waste.
 
If I'm not mistaken, each pen is 3ml? So that would be 300 units of Lantus per pen.

Even if shooting 3u per shot, that is 100 doses, so 50 days per pen.

A vial contains 10ml, or 1000 units. Six months is reasonable as far as how long it would last.

And also, 3u twice a day is a higher dose than many cats ever need with Lantus.

What you might try is calling local pharmacies to see if one of them would be able to sell you just a single Solostar pen - they usually are sold in sets of 5 pens I think. That would minimize your "up-front" cost.
 
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