Thinking of changing insulin after 4 years

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Neese & Juju

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Hi all,

I haven't been on this board for a few years for various reasons--my cat was diagnosed 4 years ago this month. He's done pretty well on Humulin-N, though occasionally having significantly lower numbers usually at the evening test (I have only tested pre-shot morning and evening). He had a long "honeymoon" of 9 months early on, then two shorter ones, now has been on insulin for over 2 years. Anyway, my reasons for thinking of a change are that most vets (other than 3 of the ones I work for) don't use Humulin for cats and (the main reason) the ups and downs have gotten more frequent over the past couple of weeks. I'd really like him to have a smoother curve than he's getting. His vet okayed me to change to Lantus if I want to, so I'm just getting info. beforehand. I'm hearing both that it's easy and that it's hard, and now I'm nervous. : ) Other than weekends, I can't do multiple tests during the day without bringing him to work with me and he LOATHES it there. I'd be interested to hear others' experiences. Thanks!
 
Hi Denise,

Glad you posted here. Like I mentioned to you, it's not hard so much as you just need to relearn everything :lol:

Okay, yeah that is a little hard.

For my own cats who were long term diabetics I went with Levemir, for newly dx kitties I usually go with Lantus. The only kitty I have on insulin now just switched over the Levemir. It's a preference thing for me, but in the beginning when I did my research it seemed that Levemir was a bit more stable.

When you get a chance, check this link on proper storage and handling: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=151
Another good link: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581
 
Lantus is very likely to even out the glucose levels because it is a nice, gentle, long-lasting insulin that many cats do well on.

Lantus is somewhat specific in how you do shots - every 12 hours, and changing shot times needs to be no more than 30 minutes total in 1 day. If your schedule is erratic, that can be difficult for some to manage.

Tests may be as few as 2 in a day when the cat is very well regulated, with a few mid-day spot checks. They tend to be more frequent while you are determining the best dose for your cat.

Dose changes are based on the nadir (lowest glucose after the shot) - usually around 6 hours after the shot - so getting a test around that time is important to know how the insulin is working for your cat. It may be helpful to get a test at 2 hours after the shot, or 2 hours before the next shot, to see how the insulin starts or wanes.

When you are just starting out, doing a curve - tests every 2 hours, or every 3 hours for a mini curve - helps you see how Lantus works throughout the day for your cat. You do not do a curve until you have been on the same dose for 3-5 days, as it can take that long for the Lantus level to stabilize and give consistent results.
 
The problem is that I can not do multiple tests during the weekdays, as I work. As I said, I could bring him to work with me (I work in a vet office) but he hates it there and I have no doubt his numbers could be stress-skewed. He also would be a PITA to test multiple times a day even if I am home (I could probably get away with 4). Is it going to be impossible for me to make this change under these conditions? If so, I likely won't do it.
 
Hi,

Just yesterday I replied to a query about changing insulin after XX amount of time on a different, less-long acting insulin. My reply in that thread is here: http://felinediabetes.com/FDMB/viewtopic.php?f=28&t=58512#p635893

You may find some of my comments and the links informative regarding the use of the insulin Levemir.

Let me explain about testing - if you intend to practice "tight regulation" blood glucose control, then yes, testing sometimes more than 3 or 4 times in one cycle may be necessary. However, it sounds like you are in a similar situation to what I was - work a lot of hours and away from home. I was gone 10-11 hours per day. However, when I had time off I tried to test more and I could get a pretty good idea how well he was doing on a particular dose. I could not practice tight regulation as such, but I think as bad as my schedule was, I did the best I could.

We have set up a new Insulin Support Group on this message board for people like us who cannot practice tight regulation. It is called "Relaxed Lantus" and is open to those using Lantus or Levemir, although we do the same thing on the Levemir ISG, so you are welcome to post in either ISG with questions.

But if you decide to switch to either one, rest assured you can get help from others here who have learned how to work the diabetes around their life and not their life around the diabetes.
 
Vicky, thank you so much! There is no way whatsoever I can do the tight regulation with my work schedule and his temperament, so it's good to know that it can be done without so much testing. I can definitely do more checks on the weekend, but during the week I'm working from early a.m. to early afternoon right now (next week I might be going to work at noon and getting home at 6, so I never have a set schedule for long). I may spend another week just doing research and getting feedback, then try to start next weekend. I'll definitely check out the link you posted.
 
Denise,

I would recommend the Levemir insulin for your kitty, it's what I chose for my own who were long term as I noted. I would also highly recommend checking out the Levemir ISG, the folks there can help you with learning how the insulin works, finding the right dose and have worked with many in similar situations as yourself.

As Vicky mentioned, there's the new relaxed ISG, but you're already great at hometesting and know more than just the basics, the Lev ISG would be a perfect starting place. http://felinediabetes.com/FDMB/viewforum.php?f=10 You can head over there with a quick intro and get a feel for things if you'd like.
 
I don't know if my replying now will bump the thread up or not, so hope this gets seen...I put off changing insulin as Julius' pre-shot numbers stabilized for several days. He is ONLY tested pre-shot and that's how I've tested for most of 4 years. Anyway, he's done relatively well on Humulin over the years, having a 9-month remission after his first week on insulin and having other shorter periods off of it, as well as months where .5 unit every few days kept his pre-shot numbers below 200. What made me consider changing was getting pre-shot numbers in the mid-200's followed by low 100's followed by close to 300. This had gone from an occasional occurrence to happening much more frequently as of a few weeks ago, and his vet said she had no problem with my changing his insulin if I wanted to (they trust me with his care).
The point of this rambling is to ask if switching to an "L" insulin should resolve this issue for him at some point. I hate seeing him go from 150 preshot (where I won't give anything) to 305 at the next one. As I said before, I can not test multiple times a day, except maybe on a weekend. Not that I don't want to (though he wouldn't want me to) but I work and am not home. It sounds like this won't necessarily be easy, so I want to feel it would be best for both of us if I do it. Thanks!!!!

ETA: Juju has never had a hypoglycemic episode (which it seems has been a problem with some other cats on N).
 
Come on over to the relaxed Lantus group.

What may work for you is to make dose changes that require a curve on a weekend, so you have the time to see what happens without worrying about something happening with you not there.

You do the best you can with what works for you and your cat.

Supplemental monitoring tips:
Measure the water you put out and how much is left at the next fill. Divide the amount consumed by the number of hours. Keep track over time and you'll notice the water consumption goes down as the diabetes gets controlled, and vice versa.
Appetite - Unregulated cats will be very hungry because then cannot make use of all the food they eat.
Weight - a digital baby scale may be helpful to track loss or gain of weight
Breath - does it smell like nail polish? that could be ketones and could be an emergency
Review the 5 Ps:
Purring?
Playing?
Preening (grooming)?
Peeing? wet litter volume decreases may indicate improved control. Urine dipsticks for glucose and ketones give a clue about what was going on in the 3 or so hours previously.
Poohing? Formed, not diarrhea, nor rocks.
 
Tight regulation may not be as hard as you think. I work 60-70 hrs a week with two jobs (one of which has an hour commute there and back), so it was impossible for me to get a mid-cycle test during the day. So I would set an alarm to get a test between sometime between 12am and 2 am (Bandit's shots were at 7am and 7pm), and then go right back to sleep. Yes, it's kind of a pain in the butt at first while you're adjusting to the wake up/sleep test/go back to bed part, but for me it became routine after a few weeks, and I was fine. On the weekends when I was home during the day, I'd do a curve and get some daytime spot checks.

I would consider this possibility first and see if it can work for you before dismissing Tight Regulation right off the bat.

Also, if you have anyone at home with you that you can teach to test, it's a great help as well. My brother moved in with me about halfway through Bandit's year on insulin, and made my life so much easier by helping me with testing. Before that, I found that students (both high school and college) are extremely cheap labor who were willing to come test at your house a few times a week in exchange for various bribes. For example, I bribed a college student with free admission to the music venue my boyfriend manages if she would come test during the day three times a week. It cost me nothing, and the college student got in free to shows she couldn't otherwise afford for the rest of the year.
 
If you haven't switched to one of the "L's" yet, have you considered prozinc? It acts more or less like humulin, only it is less harsh and has a 10-12 hour duration.
Carl
 
carlinsc said:
If you haven't switched to one of the "L's" yet, have you considered prozinc? It acts more or less like humulin, only it is less harsh and has a 10-12 hour duration.
Carl
Click to expand...

His vet says her experience with ProZinc has been"underwhelming," though we only have a few cats on it (I work for my cats' vet clinic). She's heard better things about Lantus. The Humulin used to last my cat 24 hours--he was continually too low to dose in the evening, so for a long time he was on only one shot a day ( with occasional exceptions). That stopped a few months ago, and now he usually needs a shot 2x/day. He's also become really unpredictable--I never know what pre-shot number I'm going to get. He's healthy otherwise--just had a dental in Sept. and BW was all normal (other than BG of 211).

As for doing anything in the middle of the night, I honestly can't. I have so much trouble sleeping as it is, that if I get up in the middle of the night I may not get back to sleep (and I can't function when sleep-deprived). Some weekdays I could test mid-day, it just depends on my erratic work schedule. I either work from early a.m. to early afternoon or from about noon until between 5:30 and 6:30, and my schedule changes periodically.

I keep hearing everyone say how horrible Humulin-N is for cats, and that others are so much better, so I guess I need to decide if we both will benefit from this or if I should just keep him on what he's on and deal with the inconsistency. Thanks for everyone's input, I truly appreciate it!
 
When it comes to insulin the old "Every Cat is Different" thing really is true. Lantus has a very high remission rate in newly diagnosed diabetic kitties. The rate is lower for cats that have been on another insulin for a while, but it still is probably the best shot at improvement, even if remission doesn't happen. My cat Bob was on PZI for 10 weeks or so and went into remission. Some kitties currently on prozinc have been on it for many months. Some kitties on the L's go a long time, becoming regulated but not OTJ, while others are on insulin for a month or two and go OTJ. ECID for certain.

When you were seeing those extra long durations with Humulin, what sort of dose was he getting? With the "one shot" insulins like H, PZI and Prozinc, sometimes a "too high" dose results in long duration rather than steep drops.

With any kind of insulin, getting a test "somewhere in the middle" is important. With the L's, the nadir is key to determining the right dose. Although many people consider the preshot numbers the "key" to Humulin or Prozinc, the nadir reading is still very critical to determine the right dose, because you have to find one that pushes the BG down enough, but not so high a dose that the nadir number is too low (which can set off "bouncing" and higher numbers at the next shot time). It doesn't have to mean up all night to get tests. If you can get a mid day reading or two, that's terrific. You can save the "heavy testing" days for the weekends or for when you have a day off in the middle of the week.

Lantus, Lev, and Prozinc all work best on a 12/12 shot schedule, with Prozinc being the one with the most flexibility on the strict 12 hour schedule. Each insulin has its good and its bad points. I have seen one or two kitties in the 6 months I've been on the board who were on Humulin and went OTJ. The "problem" is that not too many current members use Humulin, but there are a few who post regularly that used to use it, and they can help you out with some advice that isn't "change the insulin". You'd most likely want to continue to post in this forum if you stick with Humulin, because the ISG forum for that insulin tends to be very rarely used.

Carl
 
Thanks, Carl! Juju has never been on more than 1.5 units twice a day. When he was testing mid-200's or lower every 24 hours, this was usually only on 1 unit. The 1.5 was during a couple of periods when he would test in the 300's every 12 hours. Eventually (after a few weeks to a month) he'd start dropping lower and his dose was lowered. His current numbers aren't really high for the most part, they're just very unpredictable, as I said. I can give 1 unit when he's at 240, 12 hours later get a BG of 125, give no shot and 12 hours later get a BG of 285. Another day it might be completely different, with the same dose. I'd like him to respond more consistently to the insulin (which he used to do), but maybe that's not going to happen no matter what I use. I guess I'm still in the research mode here. : ) I have no problem with a 12/12 shot schedule, btw, since I do that already (give or take 15 minutes either way).
 
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