Running low, having to skip shots

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Susan&Alex

Member Since 2012
Alex is now running low bgl's in the PM, leading me to skip the PM shot. The last 2 days, the numbers have been between 73 and 137. By the next morning, he's back up to > 600 or close to it. (24 hours between shots.) I was trying to keep his dosage of Novalin N consistent for several days, but I even dropped it to 3.75U and he's 167 tonight (was 587 before AM shot). He was 300 at +3, so I gave insulin.

Could this mean that his insulin dependency is changing or he was bouncing back a lot to > 600 when he got low because the dosage was too high?
 
3.75u is still a lot of insulin. You want to find a dose that you can shoot every 12/12 consistently. You will have to drop the dose down until you can get to that. I am not sure what dose to recommend though as I don't know a lot about N. Low preshots with Novolin N is troublesome because it tends to be so harsh and short lasting and should be mostly worn off by the next preshot. Do you have more mid cycle (nadir) test numbers? Getting tests around +4 might be a good idea.
 
It is likely the dose is too high, and unless you check around +3-4 hours after the shoot, you don't know if he is going too low.

If he's too low to shoot half the time, dropping the dose so you can shoot consistently is advisable.
 
Y'all are probably right that it is still too much. I'll test today at +4. I bet vets hate this site...they are making less on diabetic cats because of home testing and the advice pool! The vet originally had him at 3U based on a curve...then continued to bump it. He bumped him to 6U based on a single bgl test two weeks ago, and I've been sliding it down ever since.
 
Your vet is out of date prescribing an N insulin which only lasts 6-8 hours in the cat.

Current treatment of feline diabetes uses Lantus, Levemir, ProZinc, or BCCP PZI insulin, over the counter low carb canned or raw diet, and regular home monitoring using a human glucometer. Following that protocol has a good chance of getting the cat to a diet-controlled state.

AAHA guidelines
 
Re: Running low, having to skip shots - new update

It seems a lot of vets are not keeping current with feline diabetes.

I ended up dropping Alex to 3U of N, and this morning he's at 124 after 12 hours. It appears that his requirement keeps dropping, or he's still not at the right dosage. He's feeling great, eating very well, jumping...but still drinking more water than he should. I switched him over to Fancy Feast classic from the vet's Science Diet low carb wet food last night after the SD ran out. I've not read of any cases of remission on N, but could it be possible he's falling into that?

There was a struggle last night getting him tested (normally he's really good about it), and it resulted in a hematoma in his ear. I switched to the other ear this morning for testing. When shining the light on his ear, I noticed it was dark all along the edge where I've been poking him...along with the pool of blood from the hematoma. Will this bruise heal quickly if it's left alone?
 
Yes, the bruise will heal with a bit of time.

The next time you give it, I would reduce the dose some more and then get a +3 or +4 to see how low he is going after the N.

And short of testing and dosing every 8 hours OR picking up the food at +6 (a timed feeder helps with this) you will always have 4-6 hours without insulin where the glucose is rising, especially if food is left out.

Also, please test for urine ketones (see signature link for Seconday Monitoring Tools).
 
Would you consider changing insulins to one of the longer acting insulins that seem to work better for cats? Prozinc, lantus or levimer?

You may find that you get better results with one of these and don't have the wild swings that you are seeing.
 
I agree with the others--it is nearly impossible to get a cat regulated and/or into remission with N. It causes very steep drops, which then causes the cat's liver to react by dumping glucose back into the bloodstream, which then shoots BG up very high. It also doesn't have an adequate duration of action (meaning how long the insulin works lowering BG) in cats, because cats have metabolisms that are twice as fast as people and dogs. N only lasts 6-8 hours, while Lantus or Levemir last a full 12 hours. I would strongly recommend switching the insulin asap. The longer you wait, the more you risk another incident with your cat, and the less of a chance you have getting him into remission with a better insulin. In newly diagnosed cats, Lantus/Levemir have an 81-84% remission rate. The remission rate with NPH is less than 25%, and it's far more dangerous because it has a much higher incidence of severe hypoglycemic incidents.

Here is the dosing protocol for NPH, which I would print out and bring to your vet, because he is also not dosing it correctly: http://www.uq.edu.au/ccah/docs/diabetesinfo/link2.pdf. I would highlight the part where it says "Lente is the 3rd insulin of choice and NPH the 4th of choice insulin for control of diabetes mellitus in cats, behind glargine [Lantus] or detemir [Levemir] (1st choice) and PZI (2nd choice), Lente and NPH result in lower remission rates compared to longer acting insulins."
 
Hi Susan. I agree with several of the other posters that switching Alex to a different insulin would be better for him. Our vet started our cat on Humulin N @ 3U BID (twice a day). After discovering this forum we asked him about Lantus. He said he wasn't familiar with it and always uses Humulin N. He also said that home testing wasn't necessary. Our visit was on a Friday so we ask him if he would research Lantus because that is what we wanted to use and really liked him and didn't want to change vets. He agreed to do the research and very early Monday morning called all excited and said he totally agreed with us and to come by to pick up the Prescription for Lantus. He also said to definitely keep doing the home testing.

Our cat, PurrFace, quickly did better after the switch. The vet prescribed 2U BID but we started at 1U BID. He didn't get upset that we weren't following his advice because he saw how much better PF was doing. Take the time to read all that you can about Lantus and Levemir, I believe ProZinc is hard to find. Once you did your research talk to the vet about switching. Both of these insulins last longer and aren't as harsh as N. You will need to realize that dose adjustment is done based on the nadir rather than the preshot number.

If you switch, and I hope you do, post on the tight regulation board. Their protocol is pretty straight forward and the folks there are always willing to help. They also have some people there that are, what I would call, experts on FD.

I hope you and Alex have a great day and hope to see you over on the TR board.
 
PurrFace...I love that name. I'm taking everyone's advice and getting off the Novalin N.

Alex has been under 200 the last 1-1/2 days, and this morning is the first time I could give him insulin. I thought 1U would be safe. I checked him at +5, and he was 41. I gave him food and some Karo syrup since that seemed scary. 1/2 hour later, he tested at 35. I took him to a nearby vet quickly...they tested him at 66. The vet tech told me that 6U of N was not out of the ordinary, and they shoot at low numbers to make the number go up. This makes no sense. They wanted $500-1000 to do what my current vet has already done...all the same testing ("something else may be going on") and still use Novalin N.

I called BJM's North Arlington referral and talked to the vet there. He was highly knowledgeable and told me ProZinc is what he is now recommending first. We have a consult with him tomorrow. I told him that BJM referred me and he had great things to say about her! Just from our phone conversation, I can tell that Alex will be in the right hands.

Susan & Alex
 
that's great that you have a good vet recommendation - and sounds like he is an already broken in model of the fdmb philosophy!

you will get much better results with prozinc and find it easier to use and better for the cat. be sure to visit the pzi forum for dose specific guidance, etc.
 
If you can, take in his records and your data to show how he's been doing on the N. They can use that to help guide the ProZinc dose. It would be OK to start with just 1.0 units too and adjust from there, too.

And say hello to the clinic cats, Ernie & Pickles! They're adorable :-)
 
Alex's update after being seen by the new vet:

Alex's bgl tested at 105 (he has had only 1U of N in 2-1/2 days). His urine tested negative for sugar and ketones. Since Alex is no longer showing diabetic signs, the vet will not be converting him over to ProZinc until he has bgl over 300 consistently. He said ProZinc is intended to be given in the 300 range, with peak at 100. Hopefully, I can post in a few weeks that he is OTJ! If not, I"ll be pleased that he's on ProZinc and not that nasty N! His original diagnosis and treatment started 6 weeks ago...it will be nice to finally get 8 hours of continuous Z's!!
 
Alex tested at 65 this morning. The only concern the vet has for him now is elevated BUN, which the previous vet never mentioned or considered a concern. He'll be retesting him next month to see where he's at.
 
Look for low carb canned foods that also have lower phosphorus levels. The Friskies Special Diet line might work.
 
Alex has tested between 60-105 for the last 9 days. I was doing checks twice a day, and now I am checking once a day. In a week, I'll bump it down to testing every other day. He's more active now and seems to be gaining weight.
 
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