Two Days into Insulin, Need Advice?

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Beth_10

Member Since 2013
My vet started Oliver on NPH Monday night. I was telling him about the FDMB and he was very impressed with the amount of research and care I was putting into taking care of my cat. (He is an awesome vet and has been my family's vet for about 20 years). I mentioned that Lantus seemed like the most recommended insulin to use on this page, but I was concerned about the price. He had a vial of the Lantus in his office and was going to get it but I decided to stay with the NPH. I give 1u b.i.d. I got a meter this afternoon and--after many unsuccessful pokes to my poor cat--I finally got a sample large enough to test his BG level. I tested at 4:00 and it was at 469. I tested at 7:00 right before I gave him insulin and it was at 453. I tested an hour later and it was at 374. I have been reading more about NPH and I am getting really worried as I haven't seen too many good things about it. I am planning on doing a curve on Saturday since I will be home all day. By then I would Oliver would be about six days into receiving insulin and I will be able to see how the insulin is affecting his BG. I know that Oliver's health is my main priority, but I can't help him if I can't afford treatment and I also don't want to lose what I have already spent on the NPH. One vial (100u) of NPH at Wal-Mart was a little under $30.00. Does anyone know prices on Lantus?

Another question. I know that it takes a couple tries to get the hang of poking and testing the BG, but I was wondering if anyone has any tricks of getting a blood sample. I originally tried using the automatic pen, but that was hard to control where the lancet was going and also getting the depth of the needle to pierce the skin, but not pierce the ear. The last two tests that I did today I used Vaseline (which worked great with helping the blood bead up) and I had a cotton ball in one hand for one side of the ear and the lancet without the pen in the other hand. I got good samples both times, but I managed to pierce the ear, not just the skin, the last time I tested. The ears are so thin that I am afraid that I will do more harm than good.

And lastly (I keep thinking of more questions!), Oliver has seemed to lose his appetite. I switched him from dry to wet food on Sunday and he was fine both Sunday and Monday. He always thought of wet food as a treat before so he enjoyed it. On Tuesday, he was mostly just licking the liquid off the top and ignoring the rest. Throughout the day I saw him eat just a couple of bites. On Wednesday morning, I followed the suggestion of someone and put extra water in Oliver's food and he did eat a little bit more. When I came home from work (late afternoon) I got him a new can of food that was a fish flavor (he seems to like fish better than anything else) and it was a pate while the day before the food was in chunks. I added extra water to that food as well and Oliver ate about 1-1.5 oz of that. Has anyone else had problems with their cat losing his or her appetite after starting insulin even when the BG is high? The only things that have really changed in Oliver is his loss of appetite and his water consumption has gone down, his personality is still there.
 
Prices on lantus? Nope, but the manufacturer offers a savings card program that lets you pay only $25 for the first 6 prescriptions for the Lantus Solostar pen. Program explanation and sign up here: http://www.lantus.com/considering/save-on-lantus/default.aspx


Tips and tricks for getting a blood sample here: https://docs.google.com/document/d/13c_CPZVKz27fD_6aVbsguadJKvjSrSAkD7flgPPhEag/pub

And the psychology or making your cat more accepting of the process here: https://sites.google.com/site/michelangeloprofilefdmb/felinediabetes/ear-testing-psychology

Appetite can vary from day to day. He may simply not have liked the chunky style.

His water consumption has gone down because he is getting a lot of his water needs from the wet food.

With the rapid onset and steep drops that happen with NPH insulins, you will need to test, feed and then shoot. Do not shoot if BG under 200 for now. Do not shoot if he has not eaten, or eaten at least 1-2 ounces of food.

Many cats do not get the duration from NPH that they would with a longer acting insulin. The NPH insulin often only last 5-6 hours.

Since food raises numbers, you do not want to be feeding after the insulin is all used up. That will simply raise the numbers even higher. One recommendation is to stop feeding in the later part of the cycle.

You may need to go to T.I.D. dosing in order to get more control of the BG levels with this short acting insulin.
 
Lantus can be expensive for a vial, it depends where you live etc too but remember a 10ml vial (or pens) last up to six months. Pens last longer since they come in a pack of 5 (5*3ml) and you only "open" one at a time. Keep in the fridge. It is a much better insulin for cats though.

I don't know much about NPH but I think you need to get mid cycle tests in as they can drop fast and low and then go back to high for the next pre shot. And he could go quite low if he isn't eating properly.

I don't like the lancet tools since they don't give me enough control either. I do find though that I need something firm behind the ear to push against... Like a pill bottle lid. Going in at a 45degre angle will help stop going all the way through, as does practice. deb gave some good tip links.


Are you testing for ketones? Maybe also test his eating with his old food (whatever it was) to confirm its not the food he is objecting to?.
 
Are the pens over the counter or would I need a prescription? I will be calling my vet soon to let him know how things have been going so far and will talk to him about adding an extra shot of NPH.

I put about a half cup of dry food out last night and he ate half of that. I will be continuing to try different flavors and hopefully Oliver will find one that he likes and, once the insulin dosage gets figured out, gets healthier and gains the weight back that he lost when he was diagnosed.

Thank you for your help!
 
How close are you to the Canadian border? You can get a pack of lantus pens in canada without a prescription in costco for $99 (Canadian) or for a bit more (probably still cheaper than jn Michigan) from Walmart, or shoppers drug mart etc.
 
Wendy&Tiggy said:
How close are you to the Canadian border? You can get a pack of lantus pens in canada without a prescription in costco for $99 (Canadian) or for a bit more (probably still cheaper than jn Michigan) from Walmart, or shoppers drug mart etc.
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I live in the Southwest corner of the state, so too far to Canada! :) I can call around tomorrow to check out prices.
 
Wendy&Tiggy said:
How close are you to the Canadian border? You can get a pack of lantus pens in canada without a prescription in costco for $99 (Canadian) or for a bit more (probably still cheaper than jn Michigan) from Walmart, or shoppers drug mart etc.
Click to expand...

This kind of makes me want to ask MY vet for lantus, I'm basically in Detroit, half an hour from the tunnel.
 
Here is a NPH insulin primer.

http://gorbzilla.com/nph_101.htm

This next link has a protocol for NPH dosing. At the bottom of page 1 and top of page two is the dosing protocol for NPH type insulins. This is a article from the University of Queensland Centre for Companion Animal Studies, article title FELINE DIABETES MELLITUS: WHICH INSULIN DO I CHOOSE & HOW DO I ADJUST THE DOSE?

http://www.uq.edu.au/ccah/docs/diabetesinfo/article5.pdf

You will need to find out the nadir for your cat which will require more midday testing. It can vary from +2 to +6 on average, different for every cat. ETA: You want to find out how low your cat is dropping after the insulin shot, how fast he is dropping and how fast his numbers are coming back up. Only after we have more data would we know if your cat needs less or more insulin, needs TID dosing, needs some other change.

Which of the NPH insulins are you using? Novolin N or Humulin N?
 
Those pages are a big help, thanks! I tested Oliver this morning before he ate and his BG was at 516 and I gave him 1.5u of Novolin N. He didn't really touch his breakfast, mostly just licked the juice/water. I came home for lunch five and a half hours later to test again and try to get him to eat a little more. His BG was 147. I definitely noticed that Oliver was acting much more like himself, he felt a lot better than how he has been feeling the past couple of days. I gave him a new flavor of food and he really liked it and ate almost an ounce. When I came home from work again three hours later, I tested his BG and it was at 224. I tested again before giving insulin 12 hours after giving the first dose and it was at 434 (Oliver did have a couple bites of food about 45 minutes before I tested). I gave him another 1.5u. For dinner he ate about another ounce of the same food and seemed to enjoy it. Things are looking up!
 
I'm glad you found some of that information in those NPH links useful.

Also, thank you very much for sacrificing some of your lunch hour to test Oliver.

Here are the numbers I got from your post today. Please let me know if I goofed up on any of the times.
AMPS 516 1.5U
+5.5 147
+8.5 224
PMPS (aka +12) 434 with food influence

That +5.5 test tells me the insulin is still working. So does the +8.5, and tells me the insulin duration is still working but starting to peter out and stop having any effect. PMPS insulin has definitely been all used up, stopped working, somewhere between +8.5 and +12.

I definitely noticed that Oliver was acting much more like himself, he felt a lot better than how he has been feeling the past couple of days.
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That is good to hear. That is our goal, to make your cat comfortable enough to feel like his old self and to make you more confident with this crash course, masters degree level. in diabetes management. ;-)

How were the 5 P's today? Peeing, pooping, purring, preening and playing? All present and accounted for or were a couple of these signs missing?
 
The times are correct, thanks for writing it out that way.

You are definitely right about this being a crash course (I am currently going to school for business and I wish that I could take a class on feline diabetes, I'd ace it! :-D

All the p's were there that I know of. I have a dog that likes to eat Oliver's poop out of the litterbox and as much as I try to keep him from doing that, he still does it. So, I haven't seen any poop today, but, thanks to Tucker, that doesn't mean that there hasn't been any. I will be keeping a better eye on things from now on.
 
OOOHHHHH! You got a picture up!! Yeah, pretty marmie.

The 5 P's let us know how your cat Oliver is doing, how he is feeling. A cat is not simply their BG numbers and how much insulin they are getting. They are a loving, treasured part of the family. The 5 P's and how well the cat is eating make up the WCR (whole cat report).

p.s. By the way, you gained a couple of hundred relatives in the last few days because you are now part of the FDMB family. We'll try not to annoy you too much like my uncle Ed does to me. Think of us a good family members to have around.
 
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