post-ketones, 3u Humulin N BID, advice please

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HouseGirl

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NOTE: Per the suggestion below I've changed the title of my post to solicit more feedback. I will also pop in on the insulin support board. Thanks to everyone!

My beloved kitten, Ali, was just diagnosed with feline diabetes over the weekend. He's not even two years old yet so I'm beyond concerned.

The vet kept him in-house on IV this past weekend. He's been home now for about five hours and I am due to give him his first injection in another four hours. (I don't even know which brand of insulin he will be on as my boyfriend is due home with the insulin and syringes any time now.)

I haven't had much time to read much of what I'm sure if very good advice on this board. (I've spent most of the last few hours following Ali around worried that he's going to dip into a diabetic coma or hypoglycemic shock or something equally horrid.)

At the vet's office I went through a brief 15-minute "pet education" program on how and where to do the injection and was sent home with some prescription wet and dry food.

Based on a couple of posts I had read earlier I did pick up some of the Fancy Feast varieties suggested and some Karo syrup.

Ali is eating and drinking well but seems very weak and tired.

I'm due to go back to work tomorrow and I'm scared to leave him alone for 9 hours.

I appreciate any advice and will continue to read the board as I'm able to tonight.

Leslie
 
Re: New in New Mexico & Scared

Someone will be along with some great advice, but I just wanted to stop in and say I know you're scared. We all were. And I know you feel overwhelmed. We all did. And I know you're hovering, waiting for the worst. We all did.

So. Take a breath, kiss Ali on the head, tell him you will both be fine, and then let him rest a bit while you read and learn. The most important thing you can do first is to get a home meter, and test strips, and learn how to test Ali and what the numbers mean. Home testing is key. It really is.

When injection time comes, ask the board for help...there will be many, many people around to give you a hand.

In the mean time, know that we're here for you, we've been exactly where you are, and we can help you help Ali.

Best-
Michele
 
Re: New in New Mexico & Scared

Hello from Colorado!

Know that we all felt just like you do - overwhelmed and scared. It is a steep learning curve, but this disease is very manageable and many kitties go off insulin - as Oliver did.

The three basics are food, insulin and hometesting.

Sounds like you have already read about food. Wet lo carb food is best - as it is for human diabetics. It just makes sense for all cats - no cat would eat grains by choice. You can return the dry food to your vet and tell him Ali wouldn't eat it.

What kind of insulin? What dosage/how often? Treatment with the various insulins can be different although we always urge you to start low (.5 or one unit twice a day) and go slow. We have Insulin support groups where you can "talk" to people who use your insulin; they also have stickies at the top of the page with lots of good info on how your insulin works: viewforum.php?f=5

Hometesting is vital. We figure we won't just give insulin blindly to our child, and take him/her in biweekly for checkups. We use human glucometers. This site explains a lot about the process and the video shows how it is done: http://www.sugarcats.net/sites/harry/bgtest.htm http://www.youtube.com/watch?v=_zE12-4fVn8 This is especially important as you are switching to all wet. That can bring his bg levels down fast. Oliver came down 100 points overnight when we changed diet. If we hadn't been hometesting, we would have given him too much insulin.

The best thing you can do is read and read some more. Ask questions when you don't understand. This is an international board and there is someone here day or night. We were all newbies once and are paying it forward by trying to help others.

Welcome!
 
Re: New in New Mexico & Scared

Hi and welcome,

Scared and hovering... yup, we've all been there. I kept waking Odie up at first just to make sure he was okay. I think he thought I was crazy and of course he was tired, I wouldn't let him sleep for more than 20 minutes without checking :)

It's overwhelming at first, there's a lot to learn... but within a few weeks it'll just be a regular part of your life and will just take a few minutes a day to deal with.

The best way to get over the hovering and fear of low or high blood sugar is to start home testing. You can get a regular human glucometer from the pharmacy and the accompanying supplies (test strips and lancets). That way, you'll know whether there's any danger, you'll know how he typically reacts and what his patterns are, and it'll all become much less scary. (btw, many places have glucometers for under $10 (Walmart) or free (Costco) when you buy the test strips... don't pay $40-50 for the machine)

Breathe, get comfy, ask questions. It'll be okay.

Odiesmom
 
Re: New in New Mexico & Scared

Hi Leslie, and welcome to you and Ali --

Okay, you've already taken the most important step in keeping Ali healthy, by seeking treatment at your vet's and looking for information on how best to help him here. And other folks have mentioned two of the other most important things you can do for him: low-carb wet food and home-testing, so I'll leave those alone.

When you find out what type of insulin your vet has prescribed, scroll down to the bottom of the page and look for that insulin under 'Insulin Support Groups'. (If your vet gave you ProZinc, that's part of the PZI group; NPH is part of the Vetsulin / Caninsulin / Humulin N group.) Near the top of each Insulin Support Group is one or more sticky threads, giving you information about how that particular insulin works and what you should do to use it to the best effect in your cat. You'll want to read the stickies for whatever type of insulin you're using; if you've any questions, please feel free to ask questions, either here or in the ISG forum.


I do have a question for you: you mentioned Ali being at the vet's with an IV over the weekend and being very tired and weak at home now. What happened with Ali that he ended up spending the weekend at the vet's? Did he have ketones, or diabetic ketoacidosis (DKA), or something along those lines? I'm asking because, if Ali did have ketones / DKA, then it's very important that you test for ketones until such time as he becomes regulated on his insulin. Unregulated / under-regulated diabetics should be tested for ketones anyway, but it's very important to do so in a cat with a history of ketones / DKA. Ketones are a not-common but still-possible side effect of unregulated / under-regulated diabetes. Low levels of ketones may be treatable at home; high levels of ketones may require hospitalization at a 24-hour care facility. You can read more about ketones here

You test for ketones using ketostix, which you can find in the diabetes section of most pharmacies. (Some folks report that their pharmacies only carry them behind the counter; I've always found them in the aisles.) You stick the ketostix in fresh urine and, if ketones are present, the stick changes color. The more ketones are present, the darker the stick becomes.


When you get the stuff from your vet, could you please check in back here and let us know what type of insulin was prescribed, how much insulin you're supposed to give, and how frequently? I'm asking this because some vets tend to treat cats as if they were small dogs. But cats and dogs utilize insulin *very* differently, so we've ended up with the occasional vet recommend wildly inappropriate courses of treatment. It's just a sanity check against what your vet has suggested you do.

In the meantime, take a break -- go outside and look at the sidewalk / birds / kids / sky / smog / whatever, and breathe. Give yourself a few minutes away from the situation, the go back inside and tell Ali how much you love him. You'll both feel better for the break.

-- Jean and her Gwyn
 
Re: New in New Mexico & Scared

First off let me say thank you to all who responded to my post. I have given Ali his first injection and begun breathing again.

Right now Ali is resting and I am "monitoring" (aka: hovering).

In answer to your question, the vet prescribed 3 units of Humulin N every 12 hours. When last weighed (Saturday @ 4 PM) Ali weighed 6.5 pounds.

I do not yet have the home testing supplies or the ketostix but will pick some up tomorrow.

As far as Ali having been on an IV all weekend, yes, I do believe he had ketones in his urine. His breath had a slight fruity smell to it when we took him in to the vet's office. This is the third or fourth time Ali has been in for an all-day stay with IV fluids. It's just the first time he's been diagnosed with diabetes. I'm not sure what they thought was going on the other two or three times. I believe they also had him on some type of antibiotics during those visits and just thought he was dehydrated because of whatever was making him sick.

I love my vet and trust him completely. That being said, I live in New Mexico where pets (and animals in general) are thought of as rather expendable. This type of thinking bothers and worries me.

I'm off to do some reading (and monitoring) but I will check this thread again soon.

Best of blessings to you angels of mercy and all your little "sugar kitties":)

Leslie
 
Re: New in New Mexico & Scared

3 units every 12 hours is a HUGE amount of insulin to start off a kitty with. That could potentially lead to hypoglycemia, (a VERY dangerous complication)
Perhaps you might want to speak to your vet about starting at a lower dose since you are home monitoring and feeding him lo-carb canned food now?

~M
 
Re: New in New Mexico & Scared

I agree with Mary that is a lot of insulin. Please start hometesting as soon as possible to keep Ali safe.

Humulin N is not a popular insulin on this site. In most cats, it hits fasts and doesn't last long. Slower, longer lasting insulins like Lantus, Levemir and PZI are easier to regulate with. Here is a primer on N that will give you info on how it works: http://www.felinediabetes.com/phorum5/r ... 241,831241

It is hard to get advice from strangers on the internet. I love my vet also, but she had not dealt with many diabetic cats and she started us on too high a dose of insulin. I took the advice of people here, learned to hometest and lowered the dose. I think it saved Oliver's life. I consider her to know a little about a lot of things, like a GP for humans. All the people responding to your post either have or have had a diabetic cat and treated him/her successfully. They have an enormous amount of collective experience with diabetic cats.
 
Re: New in New Mexico & Scared

Based on what I've read thus far on the board (and based on Ali's weight) 3 units every 12 hours seemed like a very large dose to me too.

How much insulin would you suggest? And how do I approach the vet about changing the brand of insulin and the amount?

I've yet to find the posts on what a normal blood sugar range is for cats. Perhaps someone could point me towards a post?

I've been watching Ali very closely and he seems alert although he is drinking a lot of water and urinating quite a bit.

FWIW, over the course of the day he's eaten an entire can of Fancy Feast plus a couple of tablespoons of dry food.

Leslie
 
Re: New in New Mexico & Scared

Hi Leslie --

Okay, can you do me a favor? Can you go to your first post in this thread and ciick on the little 'edit' button. When you get brought into the edit screen, can you change the title of this thread to something like "post-ketones, 3u Humulin N BID, advice please". That'll hopefully bring in some more experienced eyes to look at this thread -- I've never had to deal with a cat that was prone to ketones, nor have I used Humulin N. I know that N is considered a 'harsh' insulin, that caused steep drops in blood sugar levels, but that needs to be weighed against the the risk of ketones and the balancing on that is something that I simply don't have the knowledge to handle. I will say that 3 units is a *big* dose to start on, and you'll probably be advised to lower the dose until you get some blood sugar readings.

Please do stop by the pharmacy tomorrow and pick up ketostix. I'm not sure how big a town you're in; if there's only one pharmacy you can visit and they don't happen to have ketostix in stock, ask if they have ketodiastix in stock -- those will also give you a ketone reading.

Some folks can just stick the ketostix under their cat's butt while they're peeing; others use a ladle to catch urine in flight. Some folks give the litterbox a thorough cleaning, and then replace the litter with fish tank gravel. Some folks will put a clean glass or ceramic bowl in the place where their cat usually pees, and some wrap half of the litterbox with Saran Wrap.

Or, if there's a fresh puddle in the litter, you may be able to test that for ketones. If that's what you decide to do, you'll need to check that the litter itself doesn't cause the ketostix to change color. To check that, wet some of the litter with plain tap water, then test the litter with a ketostix. If the ketostix doesn't change color, the litter's fine. If it does change color, then you'll need to either change to a different litter or try one of the methods mentioned above.

For blood sugar testing supplies, you'll want a glucometer, lancets and test strips. When I got my first set of supplies, I went to Walmart and picked up their house brand (ReliOn). The meter was $10, the lancets $4, and a box of 50 test strips was $22. Ketostix should be somewhere between $15-20.

If you scroll to the bottom of this page, you'll find a pop-list labelled 'Jump To'. If you use that and go the Health Links section, you'll find a post there on home-testing; it has some tips and tricks on doing home-testing, and links to videos that show you how it's done. Additionally, if you need it, if you post your locale (just the nearest big town will generally do), we may have someone nearby who'd be willing to come over and help you in person.

Also, if you go to the Jump To box again, there's a forum in the Insulin Support Groups section labelled Vetsulin / Caninsulin / Humulin N. If you go to that forum, there's a post at the top of the forum with information on how best to use Humulin N most effectively -- and safely!! -- in your cat. Please read that over, especially the bits about feeding before giving the shot, to cushion the effect of the insulin. If there's someone at home tomorrow to monitor Ali, that'd be great. If not, please please leave food out for Ali to eat.

Also, given the harshness of N and the amount you're giving, I would *not* recommend that you change Ali's food yet. If the vet had Ali eating dry kibble, then keep on that, at least until you can start blood testing. I posted a message over in the N forum, asking for anyone who might be able to help to check in over here.

I will say that there are some cats who do absolutely wonderfully well on N (there are cats who do wonderfully well on each of the insulins), so it's possible that this is the perfect insulin for Ali. But there are a lot of cats who do better on other insulins. If it turns out that N doesn't work well in this case, you might talk with your vet about trying glargine (Lantus), detemir (Levemir) or ProZinc. We have a lot of folks using those insulins very successfully.

You may also want to read up on ketones; the pet diabetes wikia article is here. Give Ali some ear scritches from me, 'kay?

-- Jean and her Gwyn
 
Re: New in New Mexico & Scared

> Based on what I've read thus far on the board (and based on Ali's weight) 3 units every 12 hours seemed like
> a very large dose to me too.

Many vets were taught to treat cats as if they were small dogs, and it sounds like your vet may be one of them. Unfortunately, successful treatment of diabetes is very different in the two species.


> How much insulin would you suggest? And how do I approach the vet about changing the brand of insulin and the
> amount?

Generally, we recommend starting with one unit twice a day, and working from there. That's what I'm really, *really* inclined to suggest that you do, but the history of ketones (and the possibility that your vet may have sent Ali home with trace amounts of ketones) worries me. Please get the supplies as soon as you can.

You'll definitely want to get a blood sugar reading before giving each shot (and before you give any food -- food will artificially increase the blood sugar levels). Please, please *please*, if the pre-shot BG reading is under 300, do *NOT* give any insulin! It *is* possible to give insulin at numbers less than 300, but you need a bunch of data to make that decision safely, and you simply do not have the data right now.


> I've yet to find the posts on what a normal blood sugar range is for cats. Perhaps someone could point me towards
> a post?

You can find blood sugar guidelines here.


> I've been watching Ali very closely and he seems alert although he is drinking a lot of water and urinating quite a bit.

That's normal for an unregulated / under-regulated diabetic. The drinking / peeing will decrease as his diabetes comes under control.


> FWIW, over the course of the day he's eaten an entire can of Fancy Feast plus a couple of tablespoons of dry food.

Cats need insulin to properly digest their food. Without enough insulin, they get all the nutrients they need from their food, so their bodies are reporting that they're literally starving (and they may be). Please let Ali eat as much as he wants during the period that he's under-regulated; his appetite should shift back to normal once the diabetes is under control.

-- Jean and her Gwyn
 
Could you check in here when you get a BG reading, a ketone result, or both? Once we have some more information, we can give you some better guidance. Thanks.
 
HI
Its been a while sense I have been posting, but we used Humilin N and yes it is faster acting than Lantus and other insulins but it isn't a bad insulin. 3 units is high but if you are feeding higher carbed food that might be what is needed, but without testing you don't know. If you have a preshot number under 200 I would be careful shooting to much. Gizzy was started on 1.5 units and we dropped to 1 unit but we were feeding low carb Fancy Feast. Gizzy came off insulin after an infection was cleared up but he is still diabetic and I have to keep his food low carbs and keep infections cleared up. So for now I would start testing see what numbers you get before he eats then feed him, and with humilin N you need food on board before shooting my vet said a half hour before shooting to feed. Because Gizzy was a good eater I could shoot while he ate and just made sure he ate all his food. But to start with I would test, feed and then shoot.
 
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