? Should I Be Smelling Insulin Though I'm Sure It's Not a Fur Shot?
- Thread starter bambinaki
- Start date
It's also possible when you draw the dose, if you push out some insulin to get the right dose, that a drop of insulin is left on the needle. And that's what you are smelling. This post has some shooting tips and video.
Sorry I didn't have any feedback on the labs from your last post. Not much I could say. Did your vet say anything? Looks like things that were out weren't out by much (except glucose of course).
Glad you increased, but you should have six cycles of data where you have that second test in there too, just to make sure you aren't missing anything. In only see two cycles with two tests at 4.5 units.
Sorry I didn't have any feedback on the labs from your last post. Not much I could say. Did your vet say anything? Looks like things that were out weren't out by much (except glucose of course).
Glad you increased, but you should have six cycles of data where you have that second test in there too, just to make sure you aren't missing anything. In only see two cycles with two tests at 4.5 units.
bambinaki
Member Since 2010
Hi Wendy-
Thanks for your reply.
It's also possible when you draw the dose, if you push out some insulin to get the right dose, that a drop of insulin is left on the needle. And that's what you are smelling.
No, that's not what happened. And I've smelled it more than once.
This post has some shooting tips and video.
Seen it, thanks.
Sorry I didn't have any feedback on the labs from your last post. Not much I could say. Did your vet say anything? Looks like things that were out weren't out by much (except glucose of course).
Yes, she did. Phosphorus is up.
Glad you increased, but you should have six cycles of data where you have that second test in there too, just to make sure you aren't missing anything. In only see two cycles with two tests at 4.5 units.
I thought those first 2 cycles were sufficient given Maxi's history (my knowing Maxi) to show me how he was at that dose. I'm trying to conserve supplies (not use up all my lancets and test strips) in this crisis we're in.
So, is smelling insulin OK?
Thanks again
Thanks for your reply.
It's also possible when you draw the dose, if you push out some insulin to get the right dose, that a drop of insulin is left on the needle. And that's what you are smelling.
No, that's not what happened. And I've smelled it more than once.
This post has some shooting tips and video.
Seen it, thanks.
Sorry I didn't have any feedback on the labs from your last post. Not much I could say. Did your vet say anything? Looks like things that were out weren't out by much (except glucose of course).
Yes, she did. Phosphorus is up.
Glad you increased, but you should have six cycles of data where you have that second test in there too, just to make sure you aren't missing anything. In only see two cycles with two tests at 4.5 units.
I thought those first 2 cycles were sufficient given Maxi's history (my knowing Maxi) to show me how he was at that dose. I'm trying to conserve supplies (not use up all my lancets and test strips) in this crisis we're in.
So, is smelling insulin OK?
Thanks again
At 3 units, Maxi responded on the 4th cycle. Cats are tricky, they don't like being predictable. I would have quite a few lancets and test strips in stock, especially now. Personally, I felt nervous when I got below 250 test strips.
Depends how strong the smell is. If I smelled anything other than a faint whiff, I considered it a partial fur shot.
bambinaki
Member Since 2010
At 3 units, Maxi responded on the 4th cycle. Cats are tricky, they don't like being predictable.
Well, yeah, but doesn't that mean we should all be testing mid-cycle all the time forever?
I would have quite a few lancets and test strips in stock, especially now. Personally, I felt nervous when I got below 250 test strips.
I have 200+ strips, but now I'm worried that's not enough with the craziness that's going on.
Depends how strong the smell is. If I smelled anything other than a faint whiff, I considered it a partial fur shot.
Hmm, I would call it a faint whiff but undeniably of insulin.
It would be nice to know if it's normal -- if lots of people get that whiff even when not giving fur shots.
Well, yeah, but doesn't that mean we should all be testing mid-cycle all the time forever?
I would have quite a few lancets and test strips in stock, especially now. Personally, I felt nervous when I got below 250 test strips.
I have 200+ strips, but now I'm worried that's not enough with the craziness that's going on.
Depends how strong the smell is. If I smelled anything other than a faint whiff, I considered it a partial fur shot.
Hmm, I would call it a faint whiff but undeniably of insulin.
It would be nice to know if it's normal -- if lots of people get that whiff even when not giving fur shots.
Sarah and Blaze
Member Since 2019
Sometimes when I draw up too much insulin and have to squeeze some out, I can smell it on Blaze too. If I smell Blaze’s fur where I gave the shot and it has a strong smell of Lantus, it’s possible I gave a fur shot. But usually if it’s a faint smell, it’s usually just from squeezing a little bit of excess insulin out before the shot. That’s just my experience.
bambinaki
Member Since 2010
I'd like to ask you...
I got so excited today during Maxi's first cycle at 4.75 that his glucose finally went down significantly at both +3 and +7. But then devastated at the horrible PMPS test. Do you have any thoughts on today's test results?
(By the way, I did test twice since it was his first cycle on the new dose.)
I got so excited today during Maxi's first cycle at 4.75 that his glucose finally went down significantly at both +3 and +7. But then devastated at the horrible PMPS test. Do you have any thoughts on today's test results?
(By the way, I did test twice since it was his first cycle on the new dose.)
Without seeing mid cycle tests for the four previous cycles, any explanation for tonight's number is pure speculation. It could be a bounce, from either today's flat numbers or unseen lows previous cycles. Or it could be New Dose Wonkiness.
bambinaki
Member Since 2010
Thanks, Sarah.
Neither of those is the case here, so I'm still wondering if people who are sure they haven't given a fur shot and didn't push out some insulin to adjust the dose before shooting still smell insulin.
bambinaki
Member Since 2010
If the test results I'm waiting for from the lab in Michigan do show that Maxi is insulin resistant, what's the next step?
It doesn't have to be mid cycle. A before bed test at night if at least +2 is sufficient. With most cats on Lantus, the +2 is an indicator of how the cycle will play out. A +2 higher than preshot means a quiet cycle and you don't need to test more. A +2 a lot lower than preshot means definitely more testing as it'll be quite an active cycle. A +2 around the same as preshot means a normal Lantus curve with some downward motion.
If you can't do two tests per cycle, preshot and one other, then either slow down the increases until you have more data, or move to SLGS. TR is an aggressive but safe protocol. The testing is what makes it safe.
Depends on the results. There is no treatment for IAA but time. Acromegaly has some treatment options.
bambinaki
Member Since 2010
So, to confirm, even after 2 cycles at a certain dose with 'sufficient' testing, I should keep testing more than just pre-shot during every single cycle at that same dose?
Judy and Freckles
Member Since 2019
Hi Karen,
Even though Freckles is a pretty 'flat curve' cat and primarily in the yellow, if you look at her SS and compare 02/02/20 and 02/09/20 PMPS I was shooting the same dose 7.5 u throughout. I had a difference of 260 points at PMPS time with the same dose at the exact same time on different days. These critters like to keep a person on their toes. I find myself trying to catch low numbers because: 1 it's nice to see some progress 2. I want to keep my Freckles safe. The more you test, the better you learn about your cat.
Just my 2 cents.
bambinaki
Member Since 2010
Thanks, Judy.
On 2/9, you tested at +2 and +3 and her glucose was rising. So that testing suggested (per the thinking) that she was fine at that dose. And then it dipped really low all the way at the end of the cycle. The +2 that Wendy mentioned wasn't useful in this case.
To me, this suggests that post-shot testing doesn't really give useful info. to predict future reactions to insulin.
The testing is useful to catch hypoglycemia and treat it at the moment.
If it's so unpredictable, shouldn't we test mid-cycle in SLGS too? (By mid-cycle, I don't mean +6; I just mean anytime between shot times.)
NB: My intention is not to be contrary. It's to figure out a sensible way to take care of Maxi.
Thank you!
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Judy and Freckles
Member Since 2019
Right. I may have missed the 45 if it happened mid cycle and I didn't test. Since the amount of insulin given to the cat is based on how low the nadir is it's good to know how low they go. So in my two examples, even though the dosage was the same, Freckles had very different numbers on different days. If Freckles would have had the 45 at mid cycle, I would have decreased her next shot by .5 u. Since the 45 happened at preshot time, I ended up skipping the shot and then her numbers were high the next morning. Also, Freckles may have even went lower than 45 on Feb. 9 - I don't know what really happened during the day because I was at work. If I was concerned that she may go lower when I wasn't home, I could put a higher carb food in her automatic feeder so I knew she would be safer when I was away.
As I understand it, SLGS is for people who aren't able to test other than preshot times (or rarely able to test multiple times in day) or for those who are feeding kibble. If you test more frequently and are feeding wet or raw, following TR protocol is an option. It also depends on how comfortable the CG is with increasing insulin at a faster rate if they go with the TR protocol.
Keep asking questions.... I'm learning right along with you!
bambinaki
Member Since 2010
Right. I may have missed the 45 if it happened mid cycle and I didn't test. Since the amount of insulin given to the cat is based on how low the nadir is it's good to know how low they go. So in my two examples, even though the dosage was the same, Freckles had very different numbers on different days. If Freckles would have had the 45 at mid cycle, I would have decreased her next shot by .5 u. Since the 45 happened at preshot time, I ended up skipping the shot and then her numbers were high the next morning. Also, Freckles may have even went lower than 45 on Feb. 9 - I don't know what really happened during the day because I was at work. If I was concerned that she may go lower when I wasn't home, I could put a higher carb food in her automatic feeder so I knew she would be safer when I was away.
As I understand it, SLGS is for people who aren't able to test other than preshot times (or rarely able to test multiple times in day) or for those who are feeding kibble. If you test more frequently and are feeding wet or raw, following TR protocol is an option. It also depends on how comfortable the CG is with increasing insulin at a faster rate if they go with the TR protocol.
Keep asking questions.... I'm learning right along with you!
Judy, I edited my post. Could you take a look again?
What is CG?
Thank you!
Judy and Freckles
Member Since 2019
Yes it would have been useful. Getting the +2 showed me that her +2 number was lower than her preshot number. Even though her numbers looked like they were rising, the amount the rose a +2 to +3 was really negligible - within the 10% meter variance. Had I paid attention to the +2 number and realized it was lower than the the preshot number would have given me the heads up that things could have gotten exciting which they ended up doing.
Yes, it's helpful to catch really low numbers as well but it is also helpful to get to know how your cat will react with insulin. By the testing I do with Freckles, I know that she is a relatively flat cat. Sometimes she surprises me. The other day she had a pink number - which is unusual for her. Sure enough, I found the latch to the dog kibble open. I knew the pink number was unusual and went searching through the house to find what she got into. If I didn't find anything, I would be watching for some kind of infection.
Yes it's good to fill in the blank spots of the SS. Not only does it give you more information about your cat, it also helps the experienced people on here help you understand the little creature.
Judy and Freckles
Member Since 2019
I don't smell insulin if I gave the shot properly. Sometimes when I'm dosing I draw too much insulin in the syringe and when I shoot it out, the droplet may land on my finger... that's the only time I smell insulin unless I give a fur shot.
CG means caregiver/owner.
bambinaki
Member Since 2010
So then I can't figure out what's happening with the insulin smell. I guarantee it's not a fur shot. Maxi has short hair so it's easy to see the injection site. There's no wetness. That's why I asked before if I might be giving the shots too shallowly. Could the smell be because he's getting so much insulin now?
bambinaki
Member Since 2010
I do understand that it's good to know the numbers at as many points in time as possible. But if there's no regularity or predictability, it doesn't really matter when we test, does it? Just matters that we test pre-shot. Unless we test every hour or 2, which we don't want to do to our kitties (or ourselves).
Remember that I said "with most cats" when I talked about the +2 indicator. Neko was not "most cats". On Lantus I saw her above her preshot at +3 and earn a reduction later in the cycle. That is because she onset later than most. Know they cat. I looked at Maxi's SS and the +2 seemed to work for him.
SLGS peeps should get some mid cycle tests too, and for them we also recommend a before bed test. But they have a higher reduction point, which gives a little more margin of safety.
Good plan. At some point Maxi will start responding better to the insulin.
Astexcat
Member Since 2019
I occasionally get a whiff of insulin and I suspect that it happens when I withdraw the needle a little to fast. Sometimes Smudge does not like the spot I picked and then I tend to pull the needle out as soon as I press the plunger. Typically though, I wait a second after fully depressing the plunger to withdraw. I suspect that the extra second gives any residual insulin time to leave the needle. Kinda like getting that last drop of gas after you stop pumping, it's not a lot but enough to smell.
bambinaki
Member Since 2010
Thank you, Bridget! That might be it! I'll try to hold the needle in a moment longer.
bambinaki
Member Since 2010
Wendy, we got blood test results that show Maxi has acromegaly.
Do you have any advice for me?
Judy and Freckles
Member Since 2019
That would explain why he's insulin resistant and you aren't seeing much change in his numbers. Did you get the IAA test done as well? Freckles got the same diagnosis about 1 month ago.Wendy, we got blood test results that show Maxi has acromegaly.
bambinaki
Member Since 2010
Yes, Judy, we are awaiting the IAA result. Can you offer advice on best steps now?
Judy and Freckles
Member Since 2019
Well, I had a conversation with my vet and did not get very far as he was not very familiar with acromegaly. There is a lot of information on this forum
http://www.felinediabetes.com/FDMB/forums/acromegaly-iaa-cushings-cats.12/
There are 3 forms of treatment that I know of: SRT - which is radiation to the tumor; surgically removal of the tumor; and treatment with cabergoline.
Wendy is the expert on acromegaly so I'm sure she will chime in with more information.
There is one forum member who only continued with insulin increases and her cat eventually went into remission!
http://www.felinediabetes.com/FDMB/forums/acromegaly-iaa-cushings-cats.12/
There are 3 forms of treatment that I know of: SRT - which is radiation to the tumor; surgically removal of the tumor; and treatment with cabergoline.
Wendy is the expert on acromegaly so I'm sure she will chime in with more information.
There is one forum member who only continued with insulin increases and her cat eventually went into remission!
I am sorry to hear the result, 
but now we have an explanation for why his numbers don't move and can think about next steps. Judy listed most of the treatments. Surgery (available only in New York that I know of now) and radiation therapy (available many more places) are rather expensive and involve travel. At the time of Neko's diagnosis, the only option was radiation therapy (stereostatic radiation therapy or SRT). Cabergoline is a daily medication that a few people here are giving to their cats (Olive, Amethyst) - here is a link to a discussion on cabergoline. Not all cats respond to it, though it seems the majority do. Most see some reduction in acro symptoms, including insulin dose. We have had three cats go off of insulin because of cabergolione. There isn't a lot of literature out there on it's success, so some vets are reluctant to try it. Though there really isn't a down side.
The most common treatment is really just to give the cat they insulin they need to stay under renal threshold as much as possible, and manage any side effects from the excess growth hormone. That is what people have to do regardless of any additional treatment. Lyane just got her positive results for Ti-Mousse today - you could look at his spreadsheet as another example of a fairly well regulated acrocat.
Can you tell me what the IGF-1 number is? Did the vet comment on it.
but now we have an explanation for why his numbers don't move and can think about next steps. Judy listed most of the treatments. Surgery (available only in New York that I know of now) and radiation therapy (available many more places) are rather expensive and involve travel. At the time of Neko's diagnosis, the only option was radiation therapy (stereostatic radiation therapy or SRT). Cabergoline is a daily medication that a few people here are giving to their cats (Olive, Amethyst) - here is a link to a discussion on cabergoline. Not all cats respond to it, though it seems the majority do. Most see some reduction in acro symptoms, including insulin dose. We have had three cats go off of insulin because of cabergolione. There isn't a lot of literature out there on it's success, so some vets are reluctant to try it. Though there really isn't a down side. The most common treatment is really just to give the cat they insulin they need to stay under renal threshold as much as possible, and manage any side effects from the excess growth hormone. That is what people have to do regardless of any additional treatment. Lyane just got her positive results for Ti-Mousse today - you could look at his spreadsheet as another example of a fairly well regulated acrocat.
Can you tell me what the IGF-1 number is? Did the vet comment on it.
bambinaki
Member Since 2010
I am sorry to hear the result,
The most common treatment is really just to give the cat they insulin they need to stay under renal threshold as much as possible, and manage any side effects from the excess growth hormone. That is what people have to do regardless of any additional treatment. Lyane just got her positive results for Ti-Mousse today - you could look at his spreadsheet as another example of a fairly well regulated acrocat.
Can you tell me what the IGF-1 number is? Did the vet comment on it.
The number was over 500!
The vet talked about putting Maxi on a short-acting insulin in addition to the long-acting one.
My vet knows about the surgery and radiation as treatments for this.
I've had very sick kitties before. Done surgery and radiation. Won't do that to another kitty.
We didn't speak about other treatments (cabergoline), but I will ask her about it.
We're waiting for the other test result and after my vet's consultation with the endocrinologist at that university lab in Michigan, we'll talk about what to do.
I would like to get as much input as possible from you in the meantime.
I asked if acromegaly causes pain, and she said no.
I asked if his high glucose causes discomfort, and she said she wasn't sure.
Any and all input, please!
Thank you.
bambinaki
Member Since 2010
Thanks, Judy. I perused the info. It's vast. Is there any concise info on the effectiveness of cabergoline? I still haven't looked outside this site, but I will. Like another member posted, I am overwhelmed with the total paradigm shift this virus has caused. I'm working from home yet working more than ever. This diagnosis sort of pushes me to the edge. Thanks again.
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bambinaki
Member Since 2010
@Wendy&Neko
@Judy and Freckles
Someone here previously (days or weeks ago) asked me if I noticed anything about Maxi's breathing, and I said yes.
I just read in the info here on this site that acromegaly can cause narrowing of the air passages. I have noticed that Maxi is snory, but when he shifts position, there's no more snory sound. So, at the moment, I think his breathing is ok. But this narrowing of air passages scares me. Can you tell me more about this? Thank you.
@Judy and Freckles
Someone here previously (days or weeks ago) asked me if I noticed anything about Maxi's breathing, and I said yes.
I just read in the info here on this site that acromegaly can cause narrowing of the air passages. I have noticed that Maxi is snory, but when he shifts position, there's no more snory sound. So, at the moment, I think his breathing is ok. But this narrowing of air passages scares me. Can you tell me more about this? Thank you.
Judy and Freckles
Member Since 2019
I had asked you if you seen any changes in Maxi since I saw positive changes in Freckles after starting insulin. Keep in mind, as wise people on here told me about Freckles, that Maxi doesn't know he has any kind of condition. He's still the same cutie pie as he was yesterday before finding out the test results. He's not worried.
The growth hormone that the pituitary tumor produces may affect soft tissues. Wendy's Neko has some soft tissue growth prior to being diagnosed. I haven't noticed any changes in Freckles at all, so I think it's one of those every cat is different kinda of things.
Here is more information about acromegaly that I found in researching it.
https://www.vin.com/apputil/content/defaultadv1.aspx?id=7054862&pid=12886
http://zimmer-foundation.org/sch/csf.html
http://www.diabeticcatinternational.com/acromegaly/
https://aprendeenlinea.udea.edu.co/revistas/index.php/rccp/article/viewFile/328389/20785242
https://www.mspca.org/angell_services/feline-hypersomatotropism/
http://www.veterinaryirelandjournal.com/images/pdf/focus/focus1_sep_2018.pdf
The growth hormone that the pituitary tumor produces may affect soft tissues. Wendy's Neko has some soft tissue growth prior to being diagnosed. I haven't noticed any changes in Freckles at all, so I think it's one of those every cat is different kinda of things.
Here is more information about acromegaly that I found in researching it.
https://www.vin.com/apputil/content/defaultadv1.aspx?id=7054862&pid=12886
http://zimmer-foundation.org/sch/csf.html
http://www.diabeticcatinternational.com/acromegaly/
https://aprendeenlinea.udea.edu.co/revistas/index.php/rccp/article/viewFile/328389/20785242
https://www.mspca.org/angell_services/feline-hypersomatotropism/
http://www.veterinaryirelandjournal.com/images/pdf/focus/focus1_sep_2018.pdf
The only soft tissue growth I saw before diagnosis, was in her tear ducts. She started to tear more in one eye. I didn't find out until much later that this was the acro. She didn't have any issues breathing but did have a faint breathy sound from narrowing of the pharynx in her last six months. My civvie snored worse than she did. Her worst symptom was probably the arthritis from bony growth until later, when heart and kidneys and GI were impacted. Each acro cat is different in their symptoms, but there are some common ones. Pot belly from organ growth and breathing sounds are common.
Lots more here: Acromegaly, the basics
At some point, you may want to consider a switch to Levemir. It can have a bit better duration, but most important, high doses of Lantus can sting due to it's acid base. Just keep an eye on how Maxi is doing on the Lantus. I've also seen some get to 25 units with no problem. ECID again. And yes, some people also use R or Regular insulin in addition to the L's. Sounds like your vet has done some homework!
As for pain, besides arthritis, there is some though there may be headaches. Most acros go on either buprenorphine or gabapentin eventually.
Lots more here: Acromegaly, the basics
At some point, you may want to consider a switch to Levemir. It can have a bit better duration, but most important, high doses of Lantus can sting due to it's acid base. Just keep an eye on how Maxi is doing on the Lantus. I've also seen some get to 25 units with no problem. ECID again. And yes, some people also use R or Regular insulin in addition to the L's. Sounds like your vet has done some homework!
As for pain, besides arthritis, there is some though there may be headaches. Most acros go on either buprenorphine or gabapentin eventually.
Unfortunately no. Just two studies published, both with small numbers of cats and conflicting results. We've got more data on FDMB.
bambinaki
Member Since 2010
Thank you, Judy, for the info. Looks like another late night for me. It seems, though, that even once I read all the info, I will still be left with the fact that there are only insulin, cabergoline, radiation, and surgery as treatment options for acromegaly. Right? (and turmeric) Are you planning to start cabergoline, Judy? For a while (many weeks, months?) Maxi's eyes were goopy. Not teary, but goopy (not yellow infection goop, kind of clear goop). Strangely, for the last few days, they haven't been as goopy. Does the acromegaly cause goopy eyes or just teary eyes? @Wendy&Neko
bambinaki
Member Since 2010
@Judy and Freckles
Thank you, Wendy. Wow, this scares me. Looks like acromegaly causes a lot of bad effects, including pain. I'm wary of gabapentin. I think buprenorphine made my cat Teddy (RIP my gentleman and scholar) feel better after a surgery that I know caused pain. But I don't know if Maxi has pain. When does one start giving buprenorphine for acromegaly?
I saw this:
"Indeed, should the HS be diagnosed and treated, most cats will enter a state of diabetic remission."
"Additionally, many acromegalic cats once effectively treated for the acromegaly, will go into diabetic remission, possibly suggesting their endocrine pancreas has not yet been subjected to overly long periods of the insulin resistance associated with acromegaly, leading to beta-cell exhaustion."
What effective treatment are they referring to?
I think maybe the Lantus is burning Maxi already. He never used to pull away, but now he does. But he doesn't pull away every time. Many times he doesn't flinch at all. Why isn't Maxi on Levemir already if it's better than Lantus? What kind of Regular insulin do you think is best? If Maxi were your cat, what treatments would you want him to have?
Many thanks.
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Judy and Freckles
Member Since 2019
Right now, Freckles is not having any noticeable symptoms, so I have a hard time with giving medication. I have phoned around to a few vets and they are willing to give me a referral to an internal specialist, but none of the vets I phoned are willing to give me a prescription for cabergoline - they cite not enough scientific studies/research.
This was the same with Freckles. Sometimes she would flinch and other times she wouldn't. I'm hoping with less flinches, I'll have less fur shots with Levemir.
I'll keep the Lantus that I have for when Freckles starts on the downward turn of insulin reductions. I'm thinking positive!
Times
are very precarious right now, but it's easy enough to get absorbed in the research on cats, Feline diabetes, and acromegaly. At least it gets one's mind off of what's happening in the rest of the world right now.
Don't feel that you need to read everything at once. If you follow my example, I read tons initially but my mind really wasn't focused on it - I kept drifting to the damn diagnosis which doesn't really do anyone any good anyways. So after all of the mass reading, I end up going back and rereading stuff a little bit at a time.
I take heart in believing that animals live for quality of life and not quantity - but there are some acro cats that have a good quality of life for many years with this condition and some that were finally diagnosed after having it for many years - there are lots of unknowns.
Acromegaly causes soft tissue growth. That growth can block or partially block the tear ducts, that allow tears to clear out of the eyes. The tears will overflow if there is blockage. I actually found it got better if Neko's numbers were better, worse when higher. Dunno why.
I didn't give buprenorphine until it was obvious Neko's arthritis was hurting her. We tried other things first, Cosequin, fish oil, cartrophen (US equivalent is Adequan). After some time it was obvious they weren't enough. Neko was becoming quiet and not interacting as much. Once I started buprenorphine, she started interacting and playing again.
It was my vet's suggestion on the timing. We also tried gabapentin, but it didn't do much for her. Levemir is much more recent than Lantus in being used with cats. Few vets have experience with it. I used Humulin R. If you do want to try R, wait until an experienced person can be with you and help you out. There are some guidelines to learn. Equally when not to use R as well as when to use it. Initially you will have to go through more test strips. You have to learn how R works on top of how Maxi used Lantus (or Levemir if you switch). You want to avoid big drops which can cause bounces. It took me a couple years before I started using R. Mostly because there wasn't anyone around to help at the time and after I treated her, she didn't really need it.
Do take it easy on yourself.
You don't have to learn everything at once. Maxi has had acromegaly for a while and it's a slow moving condition. We do get cats that die with acromegaly, not because of it. Neko had acromegaly over 5.5 year a lot of it good quality. Keep asking questions, though maybe start another thread cause this one isn't really about smelling insulin anymore. 
Judy and Freckles
Member Since 2019
I could but I had just started a vial of Lantus before I switched to Levemir, so I would just want to use that up.
Judy and Freckles
Member Since 2019
Grief is totally normal.
There are the well known stages of grief - denial, anger, bargaining, depression, acceptance - not necessarily in that order and it's common to bounce around the stages. I look at grief as a loss of what was common or normal before - so it can be in many situations.
We are all in this together, even if it is virtual... talk about social distancing!!