SonnyB said:
Lu-Ann,
Thank you. You're making me feel a lot better. Right now Sonny has his face in a can of FF...our other two are not amused
He misses his dry, but I pulled it up for now. Once we see some normal levels, we'll let him have a bit for a treat if he insists. Our other two are not amused at the empty hallway where we feed the crunchers. They'll get over it.
I appreciate what others are saying, I really do. But to be told that I'm treating him wrong, my vet doesn't know what he's doing...nobody has a right to say that about anyone else unless they are truly aware of the whole situation, the particular animal, the person and the vet. I've already been told I'm wrong for even letting the vet treat with insulin, then I'm using the wrong insulin, I'm wrong for allowing the vet to do testing, everybody here seems to think they are the only "right" ones. It's frustrating, and makes me consider just leaving altogether. (You haven't been like that, not at all! And there have been others who have been supportive). Our vet is less than happy about having so few options for insulins, and he hates that the better ones are in the $100 range. He agrees that starting with the least expensive and most available is the proper thing to do.
Going to go see what my eating machine is up to. At least he's not one of the cats who experience appetite loss. He used to be a big guy, 16 lbs...between this and the hyperthyroid, he's down to 9.5, but now that we know about both (we were just treating for hyper-T but he kept losing) hopefully he'll bulk back up. I'd like to see him back around 12 lbs.
If someone has said that you are treating Sonny wrong, I bet they mean that the advice and directions you have been receiving from your vet may not be the best, and that's likely based on their own experiences and what they have seen from other cats on this site.
I would like to address the insulin choice. While this N insulin is cheap, it honestly is not the best choice if you want to see some smooth progress with Sonny. I bet your vet would agree because of the mention of hating that the other options are so expensive.
I know it's tough in the beginning... just speaking for myself, I did not even know cats could have diabetes, and now I have two who are also insulin resistant which requires quite high doses. Go figure, huh? I got told by my vet to give caninsulin twice a day and then I find out later that it's better for dogs and that there had also been a problem with it and there was a warning out on it.
I think we all believe that our vets MUST know all there is to know, right? But, just like with our own drs, they know lots, but they are not experts in everything.
I know that there is a doc called N primer around someplace; I think I kept a copy, but have never used this insulin..
Here's some info on the diff types of insulin that may help you understand a bit behind what others are saying to you along the way:
Here are a few definitions of some terms that are used when talking about insulin and BG (blood glucose) curves.
The peak of any insulin means when it is strongest, or working the hardest. At this time, your pet's blood glucose levels will be at their lowest, or at their nadir. Once you know this time for your pet on a particular insulin, you know the ideal time for a peak blood test.
na•dir /ˈneɪdər, ˈneɪdɪər/ Show Spelled[ney-der, ney-deer] Show IPA
Onset is the length of time before insulin reaches the bloodstream and begins lowering blood glucose. Insulins with long onset (2 to 4 hours) are typically the long-acting insulins, or those that have long duration. Those insulins with the shortest onset times (30 minutes) belong to the fast-acting category, or those with relatively short duration. The intermediate-acting insulins have a 1-2 hour onset with 8-12 hours of duration.
Duration is the length of time an insulin continues to lower blood glucose.
The four duration categories are:
* Rapid-acting or Fast-acting insulin begins to work shortly after injection, peaks in about 1 hour, and continue to work for 2 to 4 hours.
* Regular or Short-acting insulin reaches the bloodstream 30 minutes to an hour after injection, peaks anywhere from 2 to 3 hours after injection, and is effective for approximately 6-8 hours.
* Intermediate-acting insulin generally reaches the bloodstream about 1-2 hours after injection, and is effective for about 8 to 12 hours.
* Long-acting insulin generally reaches the bloodstream about 2 to 4 hours after injection, peaks 4 to 8 hours later and is effective for about 12 to 18 hours.
Note that an insulin that is long-acting in humans may be intermediate-acting in cats. The duration classes used here are for humans and usually match those in dogs -- their classifications in cats are somewhat shorter due to cats' faster metabolism.
Carryover or carry-over refers to insulin effects lasting past the insulin's official duration. It's been observed that some long-acting insulins leave an insulin depot[1] under the skin that has a small residual effect that may last anywhere from 12 to 48 hours, after the principal action has ended. Note* this effect is primarily observed with insulins like Lantus and levemir.
Overlap refers to the period of time when the effect of one insulin shot is diminishing and the next insulin shot is taking effect. Caregivers can purposefully manage overlap to increase the effect of insulin on their pets' blood glucose levels and thus hold the curve of their blood glucose levels fairly flat.
Suppose a cat gets an insulin shot every 12 hours, gets 15 hours duration from each shot, and is on an insulin that has a three hour onset. During the 3 hours after each insulin shot, there will be two insulin shots working to reduce blood glucose levels: the diminishing previous shot and the rising current shot. This may mean that the ongoing insulin dose should be less than if no overlap was used.
*consider the principal action of the insulin to be its onset, peak, and duration. If you shoot insulin again before the duration has expired, there will be overlap. Carryover is whatever small residual effect is left after duration has expired.
And here's more info on the durations:
Most people are using the long-acting insulins today. Most of the other types are only used by humans or in some cats with special needs (ie. high dose cats with Acro etc.) Many of the short and intermediate insulins have been done away with.
Short acting insulins are usually designated by the letter R (Humalin R, Novalin R) they are never used alone, typically they are given as a bolus at Preshot to bring the BG down quickly in the first few hours of the cycle before the basal insulin (a long acting) begins to take effect. This is used by high dose cats with conditions like Acro or insulin resistant antibodies. It may also be used in an inpatient setting to manage a cat with ketoacidosis.
Intermediate insulins (Lente) are insulins like Vetsulin (Caninsulin) and NPH, some of the human insulins have N in thier name (Humalin N) although some vets are still prescribing them they are becoming less used. Espcially since Vetsulin has been taken off the market in many countries. The more successes with long acting insulins have encouraged many vets to avoid these once typical insulins. Many are however still used with good results in dogs with diabetes (dogs have a metabolism more like humans and these insulins work much longer for them) the animal approved insulin (Vetsulin, in Europe/Canada sold as Caninsulin) was made primarily for dogs.
Long-acting insulins are the synthetic analogs such as Lantus and Levemir. PZI and Prozinc are simular to these however thier duration is often somewhat shorter putting them "in between" intermediate and long-acting. Several other long acting insulins are no longer manufactured (Ultratard, Humalin U)
Here's the link to the Humulin Primer and it may help you with the insulin N you are using:
Humulin Primer Info
A couple points about food:
Some cats can take up to 3days to get the carbs from dry food out of their system, so you may find that Sonny is very carb sensitive like my Shadoe, so don't worry about the high numbers greatly as it may be the dry food just working out of Sonny's system. I fed all my cats dry food for yrs and felt bad when I found out that it was not good for them.... I sure saw a BIG difference in Shadoe with no more dry food, and there have been plenty of cats who go off insulin, just by changing form dry food to low carb wet food. Sure the dry may be OK for a few cats, but for sure NOT OK for diabetic cats.
It sounds like Sonny will be fine on the wet food though!
Now on the dose you are giving... a couple comments:
In most cases, when a cat is getting 5u twice a day of an insulin and STILL has such high BG numbers, the first thing some people think is TOO MUCH INSULIN. They think that way because MOST cats never need that much insulin, ever, except in a couple circumstances....
1. the cat's diet is very high carb (dry food). There was one cat who was getting 20u of insulin twice a day and people went WHOA! It was then found that the cat was eating dry food, and once switched to low carb wet food, that same cat dropped to 1u of insulin twice a day... big diff, huh!
2. the cat's possibly got an insulin resistance condition, like acromegaly, IAA, or cushings maybe. I have two cats with acromegaly, and one also has IAA. If you were to find that even with the switch to low carb food, your cat still needed ever increasing dose, there are tests that can be done to rule out or confirm such conditions.
Now, people may be saying too much insulin and they may be right. Let's say that Sonny actually needs only 2u twice a day (BID) and you started him at 5u... what could happen? I think there's a possibility of constant high numbers, like you are seeing.
Me, I am betting the dose is too high and once you are on all wet food, you may need to be giving much less insulin and you will start to see Sonny improve. Watch for his urine output to decrease, his coat to seem healthier, and very slowly, the weight will come back on. In most cases, you will see improvements in the cat before you see improvement in the cat's numbers, OK?
With your home testing, you will be able to see EXACTLY what's up with Sonny's numbers, and don't worry about that cycle of 500s.... EVERYBODY has had their share of fur shots, so we can relate! One thing that is most important:
If you think you have given a fur shot, NEVER shoot more insulin! Just say oh rats, and you can be more careful on the next shot. While we may think we gave a fur shot and may even smell some insulin on the cat, we have no way of knowing how much made it into the cat! For all you know, you just withdrew the syringe too quickly after injection and a drop was left on the cat.
For having just received the news last week, YOU are doing incredible already!
Pat yourself on the back and big hugs to Sonny, because you guys are on the way to a healthier and happier times for Sonny.
Please ask every question you have because I highly doubt you will have a question that has not been asked by many before you.
To know the road ahead, ask the man coming back.
