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Erin Lewis and Boops

Erin Lewis and Boops

Member Since 2015
Ok- I need help. We have had a devil of time getting my Boops regulated on Humulin-N. I feel like my vets are sweet, but inexperienced. It's like the blind leading the blind. I know it would be easier to link that spreadsheet here, but I don't have the time right now. Here are some of his numbers:
Curve done on 3/1/15- beginning - 360
+2- 169
+5- 74
+9- 155
+11- 328

We've had a few oddballs of giving insulin a bit later than usual, so morning numbers were way off. For example, gave insulin one night at 9:30 and morning read +9 hours later was 100.
Also, gave shot last night at 8:20 (should've has it at 7:00) and morning read was 46 at +11 hours!!
I don't understand any of this! There seems to be no rhyme or reason to his numbers at times and I'm terrified of going out of town and leaving him in the care of others. Any insight or suggestions?
 
Erin, we really need to see Boop's ssheet - just these numbers don't give enough of a picture to really be able to help you. If you'll put the ssheet link in your signature, it will always be there and you won't have to post it again. I'm sorry....not what you wanted to hear.

HUGS,
 
With the numbers you just displayed, I would not raise the dose. N hits hard and fast, so you haven't much room for error.
Also, you should feed 30 minutes before you shoot, to take the edge off the rapid drop.
As N typically lasts only 6-8 hours in most cats, good regulation with N may require dosing every 8 hours. A better choice in non-depot insulin would be ProZinc or BCP PZI. They are slightly more expensive and last about 12 hours in the cat.
 
To be honest, I don't have many more numbers than this. We haven't been testing every single day. In the very beginning, my vet acted like that was silly. Now I know differently, but we still don't test everyday.
 
With N insulin, it has such a steep and fast curve, that knowing the preshot numbers is very important to remain safe when giving it. It's more prone to cause hypos due to its faster action. The every 8 hour dosing, mentioned above, might be the only way with this insulin as it tends to wear off fast.

If you want an insulin that is less prone to hypo, lantus and levemir have much gentler curves. Once you know how Lantus or Lev. are acting in your cat, you don't have to test as often (unless you want tight control). PZI or prozinc is in-between, but you'll probably want pre-shot tests with this insulin. These are all more expensive insulins.

Also, if you want to save money, there are glucometers that use a very small amount of blood, that have test strips much cheaper than the freestyle lite. Many use the relion from walmart, I use the up&up (rebranded OnSync) from Target. My strips are about $20 for 50 strips. The relion are similar priced I think.
 
If you are giving the pm shot 2 hours late for example then your AM "normal" shot time will actually land at about +10 in the cycle. At that time, the insulin is still active, but starting to wear off. I don't know how you are feeding, but some cats eat more during the day, so at night tend to be lower anyway. Your dose is too high if he is that low at +10 in your night cycle. If you decrease the dose, you'll probably end up with high numbers at the 2-4 hours at the beginning and end of the cycle, and maybe normal numbers from +4-+8. That leaves a lot of time where the insulin isn't working.

http://api.ning.com/files/CyOHPK6ju...9uJ4p2cLHsw0gRWyi-abOI8IIZjnkxQ__/figure7.png

This image is a good comparison of the insulins. In cats, insulin is metabolized faster than in humans (up to twice as fast), but the comparison is roughly the same. Your insulin would be similar to the NPH on the graph.
 
Testing am and pm is kind of a pain, but it's really necessary. It'll take a while to get him regulated, then testing every other day is possible. We've reached the point where we test every 3rd day, mornings only, but I'll continue to do that until we reach (hopefully) that magical day of OTJ.
 
I see you are using a freestyle lite meter - does that use the butterfly strips? Some people have experienced problems testing cats with that meter. You may want to consider changing meters, you can purchase an inexpensive one from Walmart - Relion Confirm, Micro or Prime are three options.

Also, while you may not want to do it, it is vital that you test every day, especially when you are giving N. As others pointed out, this is a fast acting insulin that can cause steep drops quickly and you need to be aware of when that is happening, so that you can manage it with food and avoid possible hypo situations.

You may also find that changing insulin to a longer lasting one will work better for your cat and avoid the yo-yo affect that he is experiencing with the highs and lows that must make him feel like crap.
 
Ok. Just tested with the relion confirm and there was a HUGE discrepancy. My freestyle said 240 and the relion was 428!!! Oh my god! I am so confused- is the freestyle that off? And have we been building up ketones due to inaccurate readings? I really hate the relion test strips, and he is really starting to hate getting tested.
 
We suggest sticking with 1 meter that we know works well. You might try the Target Up and Up, if you don't like the ReliOn Confirm or Prime Meters.

And I'd go with what you got on the ReliOn, whichever it was.

See my signature link Glucometer Notes for more details on using human glucometers with cats.
 
I used to use alphatrak, which is the cat version of the freestyle light. I did like a 40 reading compare with my new meter, and often on the same drop. Let me tell you, I wasn't thrilled at the alphatrak's consistency (>20%, sometimes 40-50% difference on the same drop). My new meter sometimes read the same number on the same drop. Once you like a meter, stop comparing, it will drive you crazy. The relative changes in BG are more important than spot on accuracy.
 
Before night insulin read was 477 on the new meter. That sounds so high! I feel like I live in constant fear of hypo and DKA. I have keto diastix, but haven't yet exactly worked out how to test his urine. I bought a special litterbox, but he isn't interested in it yet.
 
Meya14 said:
If you are giving the pm shot 2 hours late for example then your AM "normal" shot time will actually land at about +10 in the cycle. At that time, the insulin is still active, but starting to wear off. I don't know how you are feeding, but some cats eat more during the day, so at night tend to be lower anyway. Your dose is too high if he is that low at +10 in your night cycle. If you decrease the dose, you'll probably end up with high numbers at the 2-4 hours at the beginning and end of the cycle, and maybe normal numbers from +4-+8. That leaves a lot of time where the insulin isn't working.

http://api.ning.com/files/CyOHPK6ju...9uJ4p2cLHsw0gRWyi-abOI8IIZjnkxQ__/figure7.png

This image is a good comparison of the insulins. In cats, insulin is metabolized faster than in humans (up to twice as fast), but the comparison is roughly the same. Your insulin would be similar to the NPH on the graph.
Click to expand...
Since she is using the N insulin, it''s very unlikely the duration is lasting to +10 and is still active. The NPH insulins rarely act that way but there is the occasional cat that gets longer duration with the N insulins than the normal 6-8 hours.
 
Is Lantus the best way to go? I read somewhere that some vet said that Lantus has killed more cats than any other insulin with hypos. Any feedback?
 
The concern with lantus is that if you overdose them, the insulin continues to remain active for a long time. If a cat is near a hypo, you have to monitor for a few hours to make sure they continue to stay in the normal range. That being said, lantus has a much lower peak, so swings in blood sugar are minimized, and that helps -prevent- hypos. Hypos from lantus come on slowly, you can usually see the blood sugar go down over a period of hours. This makes them easy to prevent with food. Shorter acting insulins like the one you are using are more likely to cause a sudden hypo event which can be dangerous.

Most vets treat cats where the owner is not home testing. The advice for someone who home-tests, and can monitor is going to be a lot different than from someone who doesn't. Some vets don't understand that difference. It might be worth asking your vet how many diabetic cats she treats, how many home test, and how long the cats she treats usually live for. This might give you some insight into how experienced she is with diabetes.

A longer acting insulin (PZI, Lantus, or Levemir) will probably help you get the BS more stable. If you are home testing, you should start a spreadsheet (Others on here can get you going on that), because it's easier for people here to help if they can see the BS patterns.
 
I think I may have successfully attached his spreadsheet. This new meter is freaking me out with crazy high numbers. Do you think they are reliable? These are higher than his initial BG at diagnosis. Just now, he got a reading of Hi, which means over 600 on this meter. He is acting pretty normal though. What to do?
 
Did your meter come with control solution so you could test it? You might be able to get it online or at the pharmacy if your meter didn't come with it.

You could also test yourself and see where your BS is in comparison (normal human is 60-100, or up to 120ish after eating).

With the spreadsheet, you'll have to make it public for others to see it.
 
It won't be 100% accurate if it wasn't the solution for that meter, but it should still be near the range on the solution bottle.
 
I had huge problems with the freestyle lite meter testing too low in higher numbers and resulting in DKA. To test the urine you want it fresh, ie not some time later. The best way is to put the strip straight into the urine stream as the kitty is going. Or you can stick a dessert spoon under him while he's going and catch some that way.

To avoid hypo on any insulin it is essential to test before each and every shot to make sure that it's safe to shoot. I'm not sure that lantus/levemir would be the right insulins for you because, being depot insulins, they both tend to get the best results with pretty strict 12 hourly dosing. Prozinc/pzi may be the better options for you. But for the record we have never had a cat die from hypo on the lantus/levemir board where the proper protocols are followed and appropriate testing is undertaken.
 
Ok, I can see your spreadsheet. You are doing pre-shot tests which is good, but this is also where his sugars are going to be the highest with the insulin you are using. If you could get a couple readings somewhere between +4 and +8, that will help you figure out how the insulin is acting after you give it.
 
Do you think that the Relion is still correct even though it's so high? I'm just surprised because he was only 366 at diagnosis, which fits more in line with the numbers that the Freestyle is giving us. The control solution read in the normal range for both, but ranged about 30 points difference on the Relion (tested it 3 times). It was 2 points difference on two tests on the FS.
 
Please see my signature link Glucometer Notes.
All over the counter meters in the USA must read within +/- 20% from what a lab would get.
Examples follow:
a test of 50 means the test is somewhere between 40 to 60, a span of 20 mg/dL
a test of 100 means the test is somewhere between 80 to 120, a span of 40 mg/dL
a test of 250 means the test is somewhere between 200 to 300, a span of 100 mg/dL
a test of 500 means the test is somewhere between 400 to 600, a span of 200 mg/dL
 
Updated spreadsheet. Tested 2.5 hours post shot last night. I'm worried about DKA, but we work all day. I can't figure out a practical way to get his urine.
 
You do the best you can.
Here is a primer on using N insulin, in case no one linked it for you yet (Humulin and Novolin N or NPH are essentially the same thing).

You'll notice in the curve you did on 3/1 that the insulin has worn off around +10 hours post shot and the glucose has zoomed up. This is typical of N use. If you can shoot every 8 hours, it can give a little bit more level glucose control.
 
I really want to switch insulins. Someone mentioned PZI would be best for me? Lantus isn't a good option for me because I work all day? Is that true?
 
Hi Erin,

Lantus is fine if you work all day. Many people who use the longer acting insulins have full time jobs. The best insulin is the one that works for your cat. The longer acting insulins last (typically) about 12 hours so they onset (start working) around +3, +4 for Lantus. Levemir, which is another long acting insulin, has a later onset (+6, +7).
 
I do find I prefer the flexibility of ProZinc, a non-depot insulin, over Lantus. With test data on pre-shot vs midcycle values, I can adjust my dose based on the pre-shot test. Shooting a bit early or late is less of a hassle for me.
 
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