So confused!

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tarams

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My 12.5 yr old cat is newly diagnosed & I've read so much info & watched youtube videos yet still have questions!

He was given 6 units at the vet, kept overnight with 5 units given at night and then upped to 6 units again in the morning before being sent home with instructions to administer 6 units every morning & night until his next appointment next month. He was prescribed Humulin N (for now?).

I presume I'll have to start monitoring & charting to figure out what his dosage needs to be since I've also changed his cat food (Fancy Feast Classics ok?), but I'm not sure as to the routine. Is insulin given before or after meals? How often should his sugar be tested?

Thanks for any advice!
 
Okay. First things first. Humulin N is an outdated insulin good for humans and dogs but not cats. Its duration is only 8 hours and it causes steep, harsh drops. Your cat might be more prone to hypo on Humulin N and regulation will be difficult. I don't see the point of just using it "for now". Here we use Lantus, Levemir, or Prozinc/PZI. The faster you can get on one of these insulins following a proper protocol, the better shot you have at remission.

If were previously feeding dry this might explain the VERY high insulin dose. Because of the extreme carb boost from dry food, you will need to inject dangerously massive insulin doses to bring down the blood glucose numbers.

PLEASE REMEMBER THAT IF YOU SWITCH HIM TO FANCY FEAST AND DROP THE CARBS FROM YOUR CAT'S DIET, HIS INSULIN NEED WILL SIGNIFICANTLY DROP AS WELL. INJECTING THE FULL 6 UNITS AFTER A DIET CHANGE COULD SEND HIM HYPO AND POSSIBLY KILL HIM. Please do NOT change his diet until you are home testing. Or better yet, drop down to 0.5u or 1u at the same time as the diet change.

On home testing, you want to test immediately before every shot. I believe with Humulin N, you test, feed, wait 30 minutes, and then shoot, to lessen the harsh drop of the insulin. But don't take my word for it... never used it. From there you want to grab, in the very least, one test 4-6 hours after the shot. Some like to get +2, generally a +2 that is lower than the preshot indicates your cat will have an "active" cycle and need to be tested more.

It really sounds like you have a VERY outdated and misinformed vet. Please, try to convince your vet to write you a prescription for a better insulin and start at a LOW, SAFE dose like .5u or 1u and increase slowly by .25u at a time from there. Keep in mind in the vets office cats are STRESSED OUT by new sights, smells, sounds. Stress can significantly raise blood glucose anywhere from 100-200 points, so many vets often OVERDOSE cats on insulin because their numbers are a false high.

I probably forgot some things but I just had to jump in before you give your cat 12 units of insulin in a day. That is INSANE.
 
Also - how was your cat diagnosed? What tests did they do? HOW did they determine such a high dose? Forgot those q's.
 
Ditto to everything Ry posted to you. Thank God your kitty hasn't had a hypo yet.......especially being given another 5 units that first night and then being alone at vet all night. Insane starting dose and everyone on this board will agree with that. N is old and not used for cats anymore UNLESS the vet is not up to date on feline diabetes.

Ry is also correct that you have to test first, then feed and then WAIT at least a half hr. before shooting with N. Fast acting, short duration insulin and food has to be on board.

Please, get a meter, learn to hometest ASAP, and drop that dose down to max of 1 unit of N till you can get some numbers on the meter. Would also suggest finding another vet who has at least an newer knowledge of feline diabetes.

If you would post your town and state, there might also be someone from this board close enough to you to help you learn home testing.

Please, don't give your kitty such a high dose of N. Even using the newer insulins that is a dangerous dose unless you are testing and through testing you have learned that your kitty needs that amount.
 
I agree with the others--6u is an INSANE amount of insulin. Most cats on a low carb canned diet never need much more than 1u of insulin. Humulin N (NPH) is also a dangerous insulin for cats because it causes very steep drops and huge highs. Please share this document with your vet: http://www.uq.edu.au/ccah/docs/diabetesinfo/link2.pdf. Point out where it states, "Lente is the 3rd insulin of choice and NPH the 4th of choice insulin for control of diabetes mellitus in cats, behind glargine or detemir (1st choice) and PZI (2nd choice), Lente and NPH result in lower remission rates compared to longer acting insulins...NPH insulin is only recommended when no other long acting insulin is available." Please also share this document, the current American Animal Hospital Association diabetes guidelines: http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf. Note on p. 218 (4) where it states the starting dose for even a very large cat should NOT exceed 2u, and in most cats should be around 1u. Giving 6u of insulin to a newly diagnosed cat is very dangerous, and possibly deadly situation.


Insist on a script for glargine (Lantus) or detemir (Levemir) instead of Humulin N. These insulins have an 80+% remission rate in newly diagnosed cats when combined with a low carb, canned diet and dose adjustments via home testing. The remission rate with Humulin N is awful--about 25%, which is most likely be attributed to the change to a low carb diet than the insulin itself. There is a window on remission, so this is not a situation where you want to try your vet's treatment first and then switch when it doesn't work--going that route will cause the cat's diabetes to worsen and risks the cat's health and safety.

As Ry stated, your vet is not up to date with current diabetes treatment. If your vet will not cooperate with you, I would look for a new vet who is more current.
 
Thank you for your replies! It could very well be that we went to a small rural vet (to the poster who asked, I'm just outside of Roanoke VA), or maybe it's because my cat had gone untreated & needed a high starting dose. I think only blood test/glucose monitoring was done to diagnose (in addition to all the signs of excessive drinking, peeing, & losing weight). I need to get test strips today & will put in a call to the vet to see if I can't get him to call in a script for Lantus.

He just his canned food & it's been a half hour so we're ready for a morning dose now. Without having been able to test yet I don't know what to give! I won't give 6u, but should I go with .5 or 1u? Or just skip it until I can get strips & test this evening before 2nd meal?
 
tarams said:
Thank you for your replies! It could very well be that we went to a small rural vet (to the poster who asked, I'm just outside of Roanoke VA), or maybe it's because my cat had gone untreated & needed a high starting dose. I think only blood test/glucose monitoring was done to diagnose (in addition to all the signs of excessive drinking, peeing, & losing weight). I need to get test strips today & will put in a call to the vet to see if I can't get him to call in a script for Lantus.

He just his canned food & it's been a half hour so we're ready for a morning dose now. Without having been able to test yet I don't know what to give! I won't give 6u, but should I go with .5 or 1u? Or just skip it until I can get strips & test this evening before 2nd meal?
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No matter how high blood glucose is, 6u is never an appropriate starting dose for a cat, and very dangerous. High doses like that are dangerous because unless you are testing frequently, you can see consistent high blood sugar even if the cat is dropping dangerously low. This is because when a cat drops too low, the liver dumps glucose into the blood stream as a survival mechanism. This can cause high blood sugar in the cat for up to 72 hrs, so infrequent and late-cycle testing will make it appear BG is high, when in fact the cat is experiencing chronic hypoglycemia. The cat can survive on a huge overdose like this for some time, until all of a sudden it's body can no longer keep up by dumping glucose, and the cat has a severe hypoglycemic incident. That's we we go slow, with small, gradual increases (.25u-.5u increments). This is a marathon, not a race. Hyperglycemia kills slowly, over a long period of time, where hypoglycemia can kill in an instant. So better too high for a while, than too low for a second.

1u is usually a nice, safe starting dose, but what is your cat's current and ideal weight? Is he overweight or underweight? The general recommended starting dose for Lantus is .25u per KG of ideal weight.

And are you continuing to give the Humulin tonight or starting over with Lantus? If you can manage to test before his shot this evening, that would be wonderful.
 
Vet was suppose to call in a script for Lantus & the office never got to it today (said they had many emergencies) - great! Meanwhile I skipped the morning dose thinking I'd be doing a bg test & giving Lantus tonight. So I wound up spending about an hour & sticking my poor cat a million times trying to get a single drop of blood with NO luck, finally fed him, & then gave 1u of Humulin N about 40 mins later. This stuff is so frustrating!!

I'm guessing I'll give 1u again tomorrow morning & hope I can get Lantus tomorrow - have no idea how to resolve the inability to draw blood problem, & then I'll need dosing instructions for Lantus too....am I stressing too much?!
 
There are videos floating around on the blood drawing, and I'm sure someone can point you to them, but mostly it's just practice. Are you warming the ear first? Many people find that it helps. Take an old sock and fill the toe with dry uncooked rice and knot it off, then heat in the microwave for 30 seconds or so until it's nice and warm but not hot, and then hold it against the ear for a few moments before poking the ear.

Also, try a bigger lancet-many use 26 or 28 gauge, especially at first. Remember that the smaller the gauge number, the bigger the needle. Bigger needle=bigger hole=more blood.

If you used the pen device without success, you can try freehanding the lancet-this really worked for me until we got better at it, now we use the pen. Make sure to hold something against the other side of the ear for support. I use a cotton ball, others use the rice sock or a folded tissue.

You'll get it. Just about everyone has gone through the exact same frustration!

Good for you for insisting on a better insulin. Lots of people on here use Levemir and will give you great help and direction. This board is so great-my cat is doing amazing with the help of everyone here. If I hadn't found the board I don't think he'd have made it; he had some scary low numbers early on because the vet didn't believe he could do well on a dose as low as he gets!
 
Thanks Mickey's Mom for the support! After many many tries with the lancet device we finally tried it freehand - on his ear (again, many many times!) after massaging it & warming it & then on a shaved area of his back. No luck. After an hour I was saying, "All we need is one tiny drop! How hard could this be?!" But also stressing that it was now an hour later & my cat needed to eat :)

I'm trying to use a OneTouch Ultra Mini tester & don't know what size lancets came with it but I bought a box & they're "ultra thin" 33g so I guess I'll have to return those tomorrow! Which also reminds me, the test strips say they're for something like 80-180 which made me think I had to either get a new machine or new strips since I presume my cat is running higher than that. I think all the mistakes or confusion in the begining is the costly part! (Sorry, just me venting!!)
 
tarams said:
Thanks Mickey's Mom for the support! After many many tries with the lancet device we finally tried it freehand - on his ear (again, many many times!) after massaging it & warming it & then on a shaved area of his back. No luck. After an hour I was saying, "All we need is one tiny drop! How hard could this be?!" But also stressing that it was now an hour later & my cat needed to eat :)

I'm trying to use a OneTouch Ultra Mini tester & don't know what size lancets came with it but I bought a box & they're "ultra thin" 33g so I guess I'll have to return those tomorrow! Which also reminds me, the test strips say they're for something like 80-180 which made me think I had to either get a new machine or new strips since I presume my cat is running higher than that. I think all the mistakes or confusion in the begining is the costly part! (Sorry, just me venting!!)
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I'm sorry but you won't be able to return the lancets- they have been opened and could possibly be contaminated (just by being opened)- just like you can't return syringes or test strips, either, so you need to make sure you always get the right ones that you need or you are stuck with them- and they are costly. Keep them so you can use later when you are good (it won't take that long!) and can use them again. The start-up learning is the costliest part because you don't get any feel that you have earned something :shock: . Though it shouldn't take long to become old hands at it. And don't stress- you stress and your cat picks up on it and gets stressed as well. Sing a little song, stroke the fur, deep breaths to calm you both- and reward with a TREAT! Sneakers loves her freeze-dried chicken treats (what an adventure it was trying to find one she would stick with :lol: )

The meter... i think that is a good meter to use, most of us here on the board use a relion (wally-world) micro or confirm or bayer contour but some also use this kind. I don't know about the strips though- I've never heard that they come in ranges... someone else will probably chime in for that one.
 
The lancets I bought are 33g and unopened, I was using the ones that came with the tester (no idea what size they are) but trying again this morning (using hot towel in a plastic bag on the ear this time) and still not having any luck.
 
tarams said:
The lancets I bought are 33g and unopened, I was using the ones that came with the tester (no idea what size they are) but trying again this morning (using hot towel in a plastic bag on the ear this time) and still not having any luck.
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33g lancets are really hard to get a drop of blood with when you're starting out--pick up a box of 26g lancets at the store. They will be FAR easier to test with. I've been testing Bandit for 2 years now and I still can't get a drop of blood with a 33g lancet.
 
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