Novolin-N

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Cinderelly's Gus Gus

Cinderelly's Gus Gus

Member Since 2016
Hi, does anyone know about how often a bottle of Novolin-N should be replaced? My cat Gus has been on this for almost two months, but so far he is not stabilized and my vet won't change the type or dosage yet. He has had a high white blood cell count, but the urine culture came back negative. I asked for a recheck of the white blood cell count and it was still high, so something is definitely going on. He was given a long acting injectable antibiotic because he did not do well on the first oral antibiotic and my vet said to wait about 2 weeks and see how he does. I told her I switched his food to a canned food with low carbs and she said I need to put him on a veterinary glucose diet. I obeyed in hopes of getting a prescription for a different insulin when his blood glucose numbers remain high on this food. His first blood glucose curve in February before the injectable antibiotic, started out too high to read (ReliOn Micro meter- over 600) but came down after injection, peaked very low, at 59 and came back up to 411 by his PM shot. (tested every two hours, was my first time doing bg curve.) I did some intermittent checks pre shot over the next week or so, and the numbers were always high, in the 500 range (2 units at 12 hour dosing). Last week the numbers remained high with the glucose curve, 565 pre shot, 358, 464, 536, 415, 419, 362, 478, every 1 and a half hours. (I didn't bother with the final test before the evening shot because he was to wiggly. He was a feral when I trapped him 10 years ago, and he's a little difficult to handle.) Today, I started a curve with 510 pre shot and about 2 hours later it was 383. I'm going to try again, but he's really squirmy today, and I had to poke him 3 times before I got the drop into the meter. Since the level came down, should I assume that the bottle of Novolin N is still effective? (My vet is closed for the weekend holiday, so I can't bring him in for retest blood work until next week to check his white blood cell count again.) Also, his ketones have been negative on the test strips. Thanks for reading through this post. Sorry it's so lengthy.
Linda and Gus Gus.
 
I have had not problems with N/NPH insulin losing effectiveness after being punctured for well over a year. The via i however always refrigerated.
Your curve is showing that the insulin is working. Gus may be a high dose cat or Gus has an infection or other problem that is raising BG.

What was the dose for ". His first blood glucose curve in February before the injectable antibiotic, started out too high to read (ReliOn Micro meter- over 600) but came down after injection, peaked very low, at 59 and came back up to 411 by his PM shot. "
 
I can't answer your question about how long Novolin N lasts since so few people here use it, but generally, if it brought him down from 510 to 383, it must be OK for now. Most insulins will last at least 4-6 months if stored properly.

So have you got enough high numbers to convince the vet that the "veterinary glucose diet" isn't helping? Which one are you feeding? Dry or canned?
 
The vet wasn't willing to change the dose yet, so the February curve was the same dose of 2 units twice a day. That's what the vet started him on and so far, the vet doesn't want to change anything yet. I'm feeding him canned Royal Canin glucobalance, but give him a small handful of the dry glucose diet to try to keep him happy until I switch to an appropriate diet. I need to schedule another blood test next week to check his white blood cell count again. They are closed and won't reopen until Tuesday, so I'll have to bring him in then, and hopefully they will tell me I can change the dose, or whatever he needs. I was able to catch him again and got a reading of 235. I'll try again within the hour to see how low it is going. At least the readings are better than last weekend. It was only one week on the antibiotic, so maybe he's getting better now. Hopefully. My vet had told me not to swab the top of the vial with alcohol to clean it unless absolutely necessary. Has anyone received that advice? I know the top would have to dry completely after swiping with alcohol before puncture, but just wondering if anyone does this or not. I keep the vial in the refrigerator in the original box, and I'm very careful not to let anything except the needle touch the top.
 
Unfortunately, it is very difficult to regulate a cat on Novolin-N, and there are more incidents of dangerous hypoglycemic episodes which is why it's not a recommended insulin for cats. The duration of action of Novolin is only about 8 hours, so you have 4 hours in each cycle where it's not working to reduce BG.

Is there any way you can convince the vet to change the insulin to a longer acting insulin like Lantus or Levemir that are recommended for cats? I know cost usually ends up being the big issue since Lantus is so pricy in the US, but there are ways to source Lantus without breaking the bank! If you get a script from your vet, you can order from Canada, where it's a third of the price of what you'll pay in the US. A pack of 5 pens costs about $170 after shipping, but they'll last you well over a year, so it actually ends up being cheaper than Novolin in the long run. And it's safer and more effective than the Novolin.

I've attatched an article below that directly compares Lantus (glargine) to Novolin-N (isophane insulin) for you to print and bring to your vet if you need to convince your vet to change the insulin.
 

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Cinderelly's Gus Gus said:
The vet wasn't willing to change the dose yet, so the February curve was the same dose of 2 units twice a day. That's what the vet started him on and so far, the vet doesn't want to change anything yet. I'm feeding him canned Royal Canin glucobalance, but give him a small handful of the dry glucose diet to try to keep him happy until I switch to an appropriate diet. I need to schedule another blood test next week to check his white blood cell count again. They are closed and won't reopen until Tuesday, so I'll have to bring him in then, and hopefully they will tell me I can change the dose, or whatever he needs. I was able to catch him again and got a reading of 235. I'll try again within the hour to see how low it is going. At least the readings are better than last weekend. It was only one week on the antibiotic, so maybe he's getting better now. Hopefully. My vet had told me not to swab the top of the vial with alcohol to clean it unless absolutely necessary. Has anyone received that advice? I know the top would have to dry completely after swiping with alcohol before puncture, but just wondering if anyone does this or not. I keep the vial in the refrigerator in the original box, and I'm very careful not to let anything except the needle touch the top.
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Both my kitties were on Novolin and both started hypoing after every shot, especially after the change to wet food. Thankfully I had a spreadsheet set up here and the wonderful folks here helped me in recognizing the doses were too much for both cats. Both cats had infections when they started on insulin and when that cleared up the BG dropped. Would you like to set up a spreadsheet so the people here can help you more? Here is the link http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
 
Have you considered interviewing a alternative vet? Even with humans it is good to have another view especially with a progressive disease because although patience is required it is nice to know you are on the path to good control or remission.
You don't have to tell vet #1;)
 
Thanks for all the comments. I'll wait to see what his white blood count is next week and discuss other types of insulin before I consider changing vets. I've been using this veterinary practice for a long time and the main vet there works with me for many other issues with my pets, and she is treating my oldest dog right now who has inoperable cancer, so I'm sure she will work with me after the next blood test to decide on changing insulins. Regarding the document in the post above, it starts out with "unfortunately, bovine preparations are no longer available." Is the BCP Bovine insulin the same as the one that was no longer available? Being so close to cat insulin genetically, sounds like it might be a good choice? http://www.bcpvetpharm.com/products_bovine.htm Regarding the Lantus from Canada, it took 30 days to receive the chemotherapy medication from Canada for my dog; will it take that long to get the insulin from Canada, and is it safe and stable enough to be unrefrigerated that long? Thanks!!
 
Cinderelly's Gus Gus said:
Thanks for all the comments. I'll wait to see what his white blood count is next week and discuss other types of insulin before I consider changing vets. I've been using this veterinary practice for a long time and the main vet there works with me for many other issues with my pets, and she is treating my oldest dog right now who has inoperable cancer, so I'm sure she will work with me after the next blood test to decide on changing insulins. Regarding the document in the post above, it starts out with "unfortunately, bovine preparations are no longer available." Is the BCP Bovine insulin the same as the one that was no longer available? Being so close to cat insulin genetically, sounds like it might be a good choice? http://www.bcpvetpharm.com/products_bovine.htm Regarding the Lantus from Canada, it took 30 days to receive the chemotherapy medication from Canada for my dog; will it take that long to get the insulin from Canada, and is it safe and stable enough to be unrefrigerated that long? Thanks!!
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Yes, the former bovine BCP PZI is no longer available. The new Prozinc is a human recombinant insulin. But I wouldn't worry about that! Years ago, it was theorized that because bovine insulin was closer genetically to a cat's insulin, it worked better. None of the research done since then has supported that theory. Instead, what has been proven to have the greatest impact on treatment success is the duration of action of the insulin. Novolin's duration of action in a cat is only 8 hours, Lantus/Levemir's duration of action is 12+ hours. Prozinc has a better duration of action than Novolin (and the old PZI!), but not as good as Lantus or Levemir. (I've attached another article below that talks about treatment with Lantus.) It's been proven that with the right diet, a long acting insulin like Lantus or Levemir, and dose adjustments via daily home testing, 80+% of newly diagnosed cats go into remission. There is a window for remission, however, which is why it's important to start the current treatment guidelines as soon as possible.

When I ordered from Canada it only took about a week to arrive, but it can take longer if the shipment gets caught up in customs (but that didn't to me). It's shipped with special insulation and a freezer pack, and when mine arrived it was still cold.
 

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Cinderelly's Gus Gus said:
will it take that long to get the insulin from Canada, and is it safe and stable enough to be unrefrigerated that long? Thanks!!
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My last order was called in on a Monday afternoon and was in my mail on Friday

From everyone I've seen that ordered from Marks, about a week is a good estimate and it's always arrived in good shape. They will give you a tracking number so you can keep track of it while it moves through the postal system too
 
I didn't know they still made it. Regardless, I would consider it to be a fourth choice insulin, as Lantus, Levemir, and Prozinc all have a longer duration of action.
 
Cinderelly's Gus Gus said:
Hi, does anyone know about how often a bottle of Novolin-N should be replaced? My cat Gus has been on this for almost two months, but so far he is not stabilized and my vet won't change the type or dosage yet. He has had a high white blood cell count, but the urine culture came back negative. I asked for a recheck of the white blood cell count and it was still high, so something is definitely going on. He was given a long acting injectable antibiotic because he did not do well on the first oral antibiotic and my vet said to wait about 2 weeks and see how he does. I told her I switched his food to a canned food with low carbs and she said I need to put him on a veterinary glucose diet. I obeyed in hopes of getting a prescription for a different insulin when his blood glucose numbers remain high on this food. His first blood glucose curve in February before the injectable antibiotic, started out too high to read (ReliOn Micro meter- over 600) but came down after injection, peaked very low, at 59 and came back up to 411 by his PM shot. (tested every two hours, was my first time doing bg curve.) I did some intermittent checks pre shot over the next week or so, and the numbers were always high, in the 500 range (2 units at 12 hour dosing). Last week the numbers remained high with the glucose curve, 565 pre shot, 358, 464, 536, 415, 419, 362, 478, every 1 and a half hours. (I didn't bother with the final test before the evening shot because he was to wiggly. He was a feral when I trapped him 10 years ago, and he's a little difficult to handle.) Today, I started a curve with 510 pre shot and about 2 hours later it was 383. I'm going to try again, but he's really squirmy today, and I had to poke him 3 times before I got the drop into the meter. Since the level came down, should I assume that the bottle of Novolin N is still effective? (My vet is closed for the weekend holiday, so I can't bring him in for retest blood work until next week to check his white blood cell count again.) Also, his ketones have been negative on the test strips. Thanks for reading through this post. Sorry it's so lengthy.
Linda and Gus Gus.
Click to expand...
I read that Novolin N don't last as long as the newer insulins and should be replaced like every 28-30 days.i have used Novolin before and was trying to figure out when I should replace it also.i had one bottle last a tad longer than a month almost 2 months.i decided just to get it monthly to be on safe side.at walmart it is like $26 so didn't mind buying it every month.
 
I have one more question; I went to the Mark's Marine website and I'm not sure which Lantus I should ask my vet to write the prescription for. They have the Lantus Solostar pens and they have Lantus cartridges for pens (assuming the pens/cartridges are better than the 10 ml vial). Does it matter which one, and I'm assuming I can use the U-100 syringes I have? Thanks for all the help.
 
I think you need to order the Solostar pens. It is unlikely that you would use all of the insulin in the 10ml vial before it expired.


Mogs
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Cinderelly's Gus Gus said:
I have one more question; I went to the Mark's Marine website and I'm not sure which Lantus I should ask my vet to write the prescription for. They have the Lantus Solostar pens and they have Lantus cartridges for pens (assuming the pens/cartridges are better than the 10 ml vial). Does it matter which one
Click to expand...
You can get either the cartridges or the disposable pens. Get whichever is less expensive.
 
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