NPH dose not seeming to give consistent control

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CAROLYN K

CAROLYN K

Member Since 2020
Milo has been on 2U NPH q 12 hour since diagnosed. His numbers are not consistent and I can't get him below the mid 200's. A couple times he was under 200 but not on a consistent basis. He also has had a few episodes of hypoglycemia despite eating as always(seems to occur at peak insulin time in early afternoon). He is not overweight and is maintaining weight around 12lbs.
Now, I was curious (and please don't criticize) but I stopped insulin for a 2 weeks and did strict diet control of low carb. (My husband was away who notoriously gave him no-no foods cause "it was just a little"). Milo's numbers stayed in the mid 200's with rare bump to high 200's. No hypoglycemic episodes. To me , the NPH is doing no good. I called the vet to discuss a long acting insulin and am waiting to hear back on her thoughts.
Is there a long acting insulin that is more often or is it trial and error for what works for each cat?
 
CAROLYN K said:
Is there a long acting insulin that is more often or is it trial and error for what works for each cat?
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Not sure what you mean about an insulin being "more often" but I'll assume you're asking about types of insulin that work better in cats than N.

The 2018 AAHA Guidelines for diabetes management recommend Glargine (Lantus, Basaglar) or ProZinc as the better insulin's for cats.

The best insulin is the one that works in your cat!

Lantus/Basaglar is pricey in the US but most of us buy ours from Canada where it's 1/3 to 1/2 the price. For $190 (including shipping) you can get 5 pens of Lantus which is enough to last most cats at least 1 year and some up to 2 years. Here's info on buying insulin from Canada By purchasing from Canada, you'd be paying about .13 cents per unit.

ProZinc is a veterinary only insulin that you can buy directly from your vet or from online pet pharmacies like Chewy.com. A 10ml vial is $108 from Chewy which gives you 400 units so it's about .25 cents per unit.
 
Sorry on that typo. I was questioning is there a long acting insulin that is used more often in cats.

Hopefully on Monday I will get to discuss with the vet on an insulin change. Is the pen used more for convenience and not having to draw from a vial? Thank you.
 
CAROLYN K said:
Is the pen used more for convenience and not having to draw from a vial? Thank you.
Click to expand...

Not exactly...we use regular insulin syringes and pull the insulin out of the pen, using it like a "mini-vial" because each pen only holds 300 units, where a vial hold 1000 units. With the vial, unless your cat is on a very high dose, you're not going to be able to use it all before it starts to lose efficacy. With the pens, you can use every drop out of each pen
 
That's an interesting insight. I have been discarding a lot of insulin with the NPH vial by expiration.
 
Carolyn --

We'd also be able to provide you with more insight if you are able to set up a spreadsheet with your cat's blood glucose data. While NPH is not the best insulin for cats, it may also be that you needed to make a dose adjustment. The information on setting up a spreadsheet and other useful information is in this link.

I agree with Chris, Lantus (or one of the biosimilars -- either Basaglar or Semglee) or Prozinc are the two types of insulin that are recommended by the American Animal Hospital Assn for treating feline diabetes. NPH has too short of a duration given a cat's fast metabolism.

Even though glargine is now a generic and comes in pens, the pens dispense doses in full unit doses only. As a result, you have to increase from 1.0 to 2.0u, for example. We raise doses and lower doses in 0.25u increments so. using a syringe is necessary. In other words, do not buy the pen tips!
 
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