? Urgent: Using Novolin to bring glucose down (ketones)

sarahlynne1

sarahlynne1

Member
Hello, my old kitty (18.5) is very sick and there might not be anything I can do but I want to try. Her glucose isn't responding to insulin (Lantus 2 units) and is just in the 300s the past day and a half. She has moderate ketones in her urine (Ketostix). I want to try using Novolin R as a last ditch effort to bring her numbers down today and see how she feels. We have an appointment for euthanasia, but I want to see if she will feel better with lowered numbers before that. Can anyone give me advice on using Novolin R to act as a bolus with Lantus or on its own to bring her numbers down better?

She was sick this week with low potassium (but negative ketones) and on Tuesday and Wednesday she spent about 10-12 hours in the hospital getting IV fluids with supplemented potassium and potassium supplements at home overnight. She wouldn't eat while hospitalized and they didn't syringe feed her, though I thought they were going to... On Wednesday they had me come do it once in the middle of the day and she ate some and I syringed some, but it wasn't enough. Also, they had me stop her insulin starting Tuesday night to help get her potassium numbers up (she supposedly was 1.1 on Monday and .1 on Tuesday morning, though I am skeptical now because her blood is extremely lipemic and their machine was struggling with it. It was supposedly 2 at the end of Tuesday after IV according to their machine, and then after coming home with me and getting oral supplements, it was 5 on Wednesday morning according to the lab (Antech or Idexx, I forget. So who knows if her potassium was as dire as we thought). I restarted insulin Wednesday night, so she missed three doses.

It turns out, according to the actual lab results, that she's also having a flare of pancreatitis and liver disease, which I didn't find out about until Thursday morning and started treating with antibiotic and prednisolone (sigh).

So she's feeling really badly. The IV didn't help because the stress of hospitalization and also not eating and not having insulin counteracted all that. The ketones were negative Wednesday morning, and then I tested Friday morning and they were small, and now they're moderate. I've been syringe feeding since yesterday afternoon when she lost interest in food, giving sub-q fluids, and she's on cerenia and buprenorphine, and potassium gluconate every 4 hours. But her glucose just refuses to move -- she is often insulin resistant so this is bad timing and I'm sure the pred doesn't help (she has IBD and has taken pred before without too much effect though).

Anyway, all that background to say that I'd like advice on using Novolin R. I just want to try a couple doses over the day and see if it helps. She's a sensitive cat and she's hard to read, so she might be acting sicker right now than she is because she just feels so bad from everything and I'd hate to make my euthanasia decision on that. I don't have a lot of hope, but I do want to try. The vet agreed with me that I shouldn't put her through more hospitalization and it did more harm than good, and said she'd need a feeding tube for it but she can't have anesthesia due to her many issues. Can anyone point me to some instructions on how to use Novolin (R is the one to go for I believe?) to bring glucose down more quickly yet safely? I home test constantly so that's not an issue and I've dealt with hypo before. I'm terrified to try something new with insulin like this but I will because she deserves a chance to get better. I've pulled her through very bad pancreatitis and liver disease flares at home at least three times, and the vet has said she might not be DKA yet, so I'm hoping for the best. Thank you.
 
sarahlynne1 said:
It turns out, according to the actual lab results, that she's also having a flare of pancreatitis and liver disease, which I didn't find out about until Thursday morning and started treating with antibiotic and prednisolone (sigh).
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I'm so sorry she's so sick. Moderate ketones really need to be treated in a hospital setting. Anything over trace is an emergency.

Pancratitis is usually treated with cerenia for nausea, bupe for pain and daily sub q's at home so you are doing that right.

I'm hoping someone with more experience with ketones can jump in and help.

Do you have a spreadsheet or log of his bg numbers you can share?? How long has he been in the 2 units dose? If his numbers are suck why wasn't the lantus dose raised? How long ago was he diagnosed?
 
I don't have time to do a spreadsheet - I just joined and have kept it all written in a book. The history on why her numbers and dose are what they are is long and no time for that either, sorry. I'm just looking for info online and tending to her. The vet knows her ketone level and recommended against her being hospitalized because of how poorly she responded to the two days of hospitalization this week. She would need a feeding tube and can't have it. The ketones came on after not eating for two days in hospital. It's not an option. the choices now are euthanasia or trying to bring her glucose down and see how she fares. Ultimately the choice probably will be euthanasia but I want to give her a chance at feeling better if possible, however unlikely.
 
@Sandy and Black Kitty and @Wendy&Neko and @Marje and Gracie are experienced with R insulin.
To combat the ketones she needs insulin AND food.
Have you tried ondansetron as an antinausea medication. It often works when cerenia doesn’t. It can be given at the same time as cerenia as well,
Can’t they put a nasal feeding tube in without a full anaesthetic?
Pancreatitis is a very treatable condition. Do you think you may need to see another vet for a second opinion?

@Bandit's Mom can set up the spreadsheet for you I am sure to save you time and it will help the people who can help you with the R dosing. Would you mind doing that Bhooma please?
 
Regarding eating, can you syringe feed you cat? The cat has to eat as well as get insulin.

I have used R in the past to help bring high BGs down. You have to start low like 1/4 unit or less and monitor at hourly intervals to see what is happening so you can take action if BG drips too low and to see in more R is required.. The key is to fine out how cat responds. so dose can be adjusted as necessary.

Creating a spreadsheet will hep caretakers her giver you advice on dosing.
 
I would create the spreadsheet but I'm using the time instead to be with her. I've done them in the past and they take a lot of time! We have an in-house euthanasia appointment at 3pm today so not a lot of time. We got the Novolin R and gave .1 of a unit and are monitoring. I have been syringe feeding her and she swallows most of it, so maybe 20ml at a time every couple hours. I don't know the spreadsheet would be helpful right now, I mean if you're referencing historical numbers. She's been erratic for a year due to her many issues including dental issues the vets won't touch, so she's generally in the 300-200 range most days and dips into the 100s at least a few times a week and sometimes lower, regardless of dose of insulin: range of 1unit to 2 units. She's frustrating. She used to be regulated under 200 on a drop of insulin but then she had a stroke or fall/injury last year and it all fell apart. But the issue now is the vet had us withhold insulin for three shots and she didn't eat in hospital too, so she was starving and in her weakened state that has had very bad results and now she has ketones. She's never had ketones, at least discovered ones, in the 4 or so years she's been diabetic.
 
Please get your kitty to the vet. There's more than a good chance that you're dealing with diabetic ketoacidosis (DKA). As Janet mentioned, any reading above trace ketones needs veterinary attention. It's not manageable at home. The potassium values being off are also worrisome and indicative of an electrolyte imbalance which is typical of DKA.

DKA is serious and can be life threatening. Your cat can also recover but you need to get your cat to the vet.
 
sarahlynne1 said:
I don't have time to do a spreadsheet - I just joined and have kept it all written in a book. The history on why her numbers and dose are what they are is long and no time for that either, sorry. I'm just looking for info online and tending to her. The vet knows her ketone level and recommended against her being hospitalized because of how poorly she responded to the two days of hospitalization this week. She would need a feeding tube and can't have it. The ketones came on after not eating for two days in hospital. It's not an option. the choices now are euthanasia or trying to bring her glucose down and see how she fares. Ultimately the choice probably will be euthanasia but I want to give her a chance at feeling better if possible, however unlikely.
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Just snap a picture of the last couple weeks of the book. It will help us help you.

I think bringing the glucose down is key. So start with a half unit of the Novolin and see what happens.

The Novolin R should take effect with two hours but it doesn't last long.

Ask the vet for an appetite stimulant
 
My vet is not going to do anything for her - we've already talked. He agrees with what I'm doing. He doesn't think she'd improve being hospitalized because being hospitalized this week for IV fluids is what sent her spiraling downwards. I'm not a novice - I have had three diabetic cats who have lived a long time/gone into remission/etc. and I've gotten two through severe pancreatitis and liver disease multiple times. My vet trusts me and I wish some of you would read what I wrote in the entirety because I keep having to repeat myself about the vet not wanting her to come in. The potassium values were low BEFORE this happened and then normalized and then this happened.

Thank you to those that helped me with Novolin dosing suggestions.
 
Sorry, I should clarify - the vet agrees on not bringing her in and doing supportive care at home and euthanasia. He didn't suggest the Novolin.
 
sarahlynne1 said:
entirety because I keep having to repeat myself about the vet not wanting her to come in.
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I did read this. Several times. Often the best and only chance is by using iv. I will stop suggesting it. If you have sub q's at home that will have to do. Did you do any sub q's today? How much? How long has it been since you gave the Novolin? What was her bg readings for today so far? What food are you assist feeding? A/d food might give the calories she needs.
 
JanetNJ said:
I did read this. Several times. Often the best and only chance is by using iv. I will stop suggesting it. If you have sub q's at home that will have to do. Did you do any sub q's today? How much? How long has it been since you gave the Novolin? What was her bg readings for today so far? What food are you assist feeding? A/d food might give the calories she needs.
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Sorry if I might have seemed snippy - you're trying to help I know. I would like to take her to the hospital and put her on IV and just have them fix this, but it's not an option. She wouldn't survive the trauma of that, and my proof is that going in for IV this week made her weaker and sicker and she ended up with ketones for the first time ever (that I know of). She's extremely sensitive. I came home once to find her cowering under a chair shivering in her own urine puddle because a smoke detector was chirping from a low battery. She yells at us when we talk loudly or laugh loudly or sneeze. She apparently just stayed in one place in the cage at the vet's and wouldn't move and was just terrified the whole time. I don't think any of that is helpful for her pancreatitis flare. Plus, she has very "brittle blood vessels," per a vet tech who drew blood recently, and it was really hard for them to get the IV catheter in this week. They tried one leg, and had to switch to the other one and both have huge bruises on them now. I was told they wouldn't be able to get another catheter in anytime soon. And she can't be put under for procedures safely so a feeding tube is not an option, which means her being hospitalized isn't either since they don't want to syringe feed her. Sigh. It's very frustrating. But the vet and I agreed that for her, trying supportive care at home and then doing euthanasia if it doesn't work is more kind than subjecting to all that and having it make things worse. Plus they're suspecting she has cancer so they're not optimistic about her future even if we save her now.

We scheduled at-home euthanasia for noon today but backed out once the vet came. We had given .1 of the Novolin R at 7:30am and by noon she had gone from 300 to 192. In the hour before the vet came she had perked up and seemed more interested in the world than she had been and almost ate something on her own (she licked it). We took her outside to meet the vet and talked with her, and in the end we just couldn't put her to sleep yet. She managed to stand for the first time in days and started walking around the yard a little (fenced!) and I'd throw acorns and sticks past her and she'd quickly follow them with her head. She almost batted at a long leaf too, which is pretty amazing since she hasn't batted at a toy in a long time. She's still sick but it just seemed better to give her another day to see how she does now and regroup tomorrow with the euthanasia vet. Fingers crossed.

She did continue to fall from the Novolin while we were outside talking to the vet, which I assume was because I hadn't syringe fed her since maybe 7am because she hates it and we thought we were putting her to sleep. When we came in she was 130 and I syringe fed and then an hour later she was 116. I fed again sometime later (hours days are blurring together from lack of sleep but I'm keeping a log thankfully) and then at last check about 45 minutes ago she was 120. Now she is 173 after that big meal 45 minutes ago. I can see why Novolin R is described as harsh and people say to be careful with it - it's intense. I hope to never have to use it for her again!

She has IBD (triaditis actually) so I can't switch her food without causing other problems that work against her getting better. The food she eats is Merrick LID turkey in cans and it has 150+ calories a 5.5oz can, so hopefully that is ok. It works well in the syringe.

Oh I got a ketone meter too and tested her and it was 2.8mmol/l, which isn't good, but I'm hoping that the findings from this article hold true and she's is just DK and not DKA (https://journals.sagepub.com/doi/pd...2#:~:text=In healthy cats, the β,: 7.9 mmol/l).) I'm hoping the ketones go down now that she's had more food and the insulin is working. If they continue to rise that will one of the factors tomorrow that makes us choose euthanasia.

Sub-q fluids were done yesterday (100ml Normosol) at 1pm, and today (100ml Plasmalyte with added K) at 2pm> The vet said I can push it to 150 in a day if I spread it out so I might do another 50ml later at night.

Right now she is resting but is more responsive and alert than this morning. Though now that he glucose is rising again I'm unsure how to approach her insulin. She was due for Lantus at 10 am, which we skipped because of the Novolin R, so I'm unsure of when it's safe to give the Lantus again. Now? Also, I think maybe an issue is that Lantus just doesn't work for her anymore. She varies wildly in how she uses the insulin every day and is completely unpredictable so that one day she might be in the 300s all day, the next she is 300-200, the next 250-200, the next 300-100, and then occasionally she might plummet to something like 60 -- all on the same dose. I'm wondering if she needs a different insulin like ProZinc that is more flexible with changing the dose each time? Sadly she once went into remission on Lantus, and then later only needed a drop once a day to stay under 200. She had an episode last year -- stroke or fall/injury, that affected her ability to walk and since then she's been erratic.

My partner and I are both incredibly sleep-deprived from this week of taking care of her and worrying about her. I fell asleep for a couple hours last night face down on the terrazzo floor next to her bed, and I don't remember the last time I slept before that. Thursday? We've been forgetting to eat or drink too, and just focus on taking care of her.
 
sarahlynne1 said:
. I'm wondering if she needs a different insulin like ProZinc that is more flexible with changing the dose each time?
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You certainly could try a different insulin. I have been using ProZinc for a few years and like it.
sarahlynne1 said:
My partner and I are both incredibly sleep-deprived from this week of taking care of her and worrying about her. I fell asleep for a couple hours last night face down on the terrazzo floor next to her bed, and I don't remember the last time I slept before that.
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It's so so hard... Sleep is important though so take naps when you can. After a few nights of no sleep I'm like a crazy person and way overly emotional. I really feel for what your going through. :(
 
JanetNJ said:
You certainly could try a different insulin. I have been using ProZinc for a few years and like it.

It's so so hard... Sleep is important though so take naps when you can. After a few nights of no sleep I'm like a crazy person and way overly emotional. I really feel for what your going through. :(
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Yeah, he's going to nap soon, then I will, then hopefully he can sleep through the night and take over for me in the morning. But he's a lot less confident in taking care of her and can't syringe feed her or give meds, so I'll have to wake up to do those things. She only lets me do it. I think I've had maybe twelve hours sleep since Monday night. I spent Tuesday shivering uncontrollably from adrenaline as I tried to research conditions that make a cat lose potassium. And then she came home that night from IV fluids and seemed 100% better, but then Wednesday returned from IV fluids barely able to walk and it's been downhill since. It's been a crazy, emotional week.
 
JanetNJ said:
Can you see if the vet will give uou an appetite stimulant such as marizapine?
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Well, I'm sure he would. I've had bas experiences with that with other cats and am really leery of it. I had to rush a sick cat to the e-vet in the middle of the night after giving it because she started panting and her heart was racing. She had to be put in oxygen at the vet's. And my mom had a bad experience too that I can't remember the details for and can no longer ask her about, but I think it also involved breathing heavy or a racing heart. So I'm scared to use that particular med, especially on this frail old girl. I wonder if a tiny tiny dose would have any impact? She is spitting out some of the syringe food but is swallowing most of it. I do sort of like knowing how much she is eating by doing the syringe feeding so I can be sure she is getting enough, though I also hate doing it. She hates it too, but luckily she's so used to me doing weird things to her for her health issues that she doesn't hold it against me too much.
 
sarahlynne1 said:
Well, I'm sure he would. I've had bas experiences with that with other cats and am really leery of it. I had to rush a sick cat to the e-vet in the middle of the night after giving it because she started panting and her heart was racing. She had to be put in oxygen at the vet's. And my mom had a bad experience too that I can't remember the details for and can no longer ask her about, but I think it also involved breathing heavy or a racing heart. So I'm scared to use that particular med, especially on this frail old girl. I wonder if a tiny tiny dose would have any impact? She is spitting out some of the syringe food but is swallowing most of it. I do sort of like knowing how much she is eating by doing the syringe feeding so I can be sure she is getting enough, though I also hate doing it. She hates it too, but luckily she's so used to me doing weird things to her for her health issues that she doesn't hold it against me too much.
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Well the fact that she’s fighting it shows she still has some spunk.
 
Even if you did take her to hospital, I hope it's a different one. Since previous didn't give insulin, not feed her, she declined quickly.

Pancreatitis is painful. Will cause her not to eat. If your up to it, and she seems to be somewhat accepting, then fight for her.

Subq fluids go a long way. She needs cerenia and pain meds, which will help get her eating. Get the insulin going again. Don't worry if food is high or low carb at this time. Whatever she will eat, let her have it. The rx food a/d is easy to syringe and very tasty for kitties. Baby food meat with no onions or garlic. It can be really rough on you for awhile. But you might be able to make her comfortable and turn it around.

Wow, just got kicked out and it's all messed up now.​
 
Olive & Paula said:
Even if you did take her to hospital, I hope it's a different one. Since previous didn't give insulin, not feed her, she declined quickly.

Pancreatitis is painful. Will cause her not to eat. If your up to it, and she seems to be somewhat accepting, then fight for her.

Subq fluids go a long way. She needs cerenia and pain meds, which will help get her eating. Get the insulin going again. Don't worry if food is high or low carb at this time. Whatever she will eat, let her have it. The rx food a/d is easy to syringe and very tasty for kitties. Baby food meat with no onions or garlic. It can be really rough on you for awhile. But you might be able to make her comfortable and turn it around.

Wow, just got kicked out and it's all messed up now.​
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She is getting 100ml plasmalyte with added potassium once a day (vet said I could do an extra 50 ml later in day if she needs it), cerenia, buprenorphine every 8 hours, potassium gluconate every 4ish hours (plus her regular meds of amlodipine, denamarin, tylosin, vitamin B, budesonide). I'm syringing Merrick LID turkey every few hours and aiming for at least 2 5.5 oz cans a day (she's about 8.5 lbs but should be more like 9) - she eats most of it but there's some loss do to spitting. She had Lantus last night at 10pm and it didn't do anything -- she stayed around 340 from the shot until hour nine and then went to 302. That's when I gave her .1 of Novolin R and it took an hour to do anything, but then it brought her down to 116 at the lowest. It probably wouldn't have gone that low but since we were planning on euthanasia today in the morning I hadn't subjected her to syringe feeding more than once so there was less food in her than ideal. Once we decided to give her another day at least I got a meal in her and she held steady around 130 for an hour or so and then climbed to 223 when the Novolin wore off (at hour 10!). I didn't do Lantus while the Novolin was working so she got it late (1.25) once she hit 223. I am thinking, if she makes it through all this, that I might want to switch to ProZinc since it's more forgiving with the dosing and Lantus hasn't been working great for her for a while. I assumed it was just her conditions making that so, but maybe it's the Lantus and how she absorbs it. Anyway, hoping the Lantus behaves for her since I'm grateful for the Novolin's help but its potency scares me. Oh, I'd give her AD but she has IBD and doesn't tolerate diet change well, and chicken and corn are two big no-nos for her and I believe AD has at least one of those (unless it has changed! I'll look into it because I know cats love that stuff). A diet change in September is partly responsible for all this now actually! I gave my girls some freeze-dried raw food and they loved and one has done really well on it but the one that is sick now got really constipated from it and then that turned into an IBD flare and she had diarrhea for a long time and I'm pretty sure that lowered her potassium and the flare sparked a pancreatitis and liver disease flare and all of that put her in the hospital this week as a weak, sick kitty. And then the hospital didn't feed her and had me withhold insulin to help get her potassium up. If only they had syringe fed her I think we'd be in better shape right now!! Ugh. Sorry, this got long.
 
With the lantus being interrupted a lot, I don't think it's doing much right now to help her. If your set on the appt today, just love and cuddle with her, let her be relaxed and calm and do what she wants.
 
You are probably not going to like what I'm going to say, but we really cannot help you with dosing if you do not give us blood sugar data in the spreadsheet. We have people who can help get you set up with the spreadsheet, and we'd only need at most the last couple weeks worth of data. Without that data I can't tell whether the drop in numbers today is due to the R, or the Lantus depot, or her breaking a bounce, or something else.
sarahlynne1 said:
Though now that he glucose is rising again I'm unsure how to approach her insulin. She was due for Lantus at 10 am, which we skipped because of the Novolin R, so I'm unsure of when it's safe to give the Lantus again. Now? Also, I think maybe an issue is that Lantus just doesn't work for her anymore. She varies wildly in how she uses the insulin every day and is completely unpredictable so that one day she might be in the 300s all day, the next she is 300-200, the next 250-200, the next 300-100, and then occasionally she might plummet to something like 60 -- all on the same dose
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Without that data, I also can't say whether Lantus is right or wrong for her. Missing insulin, like they did at the vet, or you did this morning, interrupts the Lantus depot and you'll get wonky numbers. Normally we'd start by giving Lantus and R at the same time. Anyway, since you skipped the Lantus this morning, you can give it any time now cause it's been more than 12 hours. Of course, if I could see the data, I'd have an idea what to suggest as a dose.

JanetNJ said:
So start with a half unit of the Novolin and see what happens.
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I'm so glad you started with a smaller R dose. At times I was giving Neko just a drop. She was at times a higher dose kitty and 0.5 units was the max I ever gave her. I've seen a kitty on 30 units of Lantus who couldn't take more than 0.5 units of R, and another at 30 units that needed 3-4 units. Every cat is really different on how they handle R, and as you commented, it can be a very powerful tool and it can be used incorrectly. Which is why we do not have instructions written on how to use it and ask that you get direction from someone who has used it before. R can also be a great tool, we use it so it only brings the numbers down no more than 100 points. We have guidelines on when to use R, and more importantly, when not to.

sarahlynne1 said:
being hospitalized because being hospitalized this week for IV fluids is what sent her spiraling downwards
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This is concerning to me. Did the vet check to see how her heart is? Fluids can be a bad thing in a cat with a heart condition - as I know from personal experience. Can you count her resting respiratory rate? (the number of complete in and our breaths per minutes while at rest). It should be 30 or under.[/QUOTE]
 
Wendy&Neko said:
You are probably not going to like what I'm going to say, but we really cannot help you with dosing if you do not give us blood sugar data in the spreadsheet. We have people who can help get you set up with the spreadsheet, and we'd only need at most the last couple weeks worth of data. Without that data I can't tell whether the drop in numbers today is due to the R, or the Lantus depot, or her breaking a bounce, or something else.

Without that data, I also can't say whether Lantus is right or wrong for her. Missing insulin, like they did at the vet, or you did this morning, interrupts the Lantus depot and you'll get wonky numbers. Normally we'd start by giving Lantus and R at the same time. Anyway, since you skipped the Lantus this morning, you can give it any time now cause it's been more than 12 hours. Of course, if I could see the data, I'd have an idea what to suggest as a dose.


I'm so glad you started with a smaller R dose. At times I was giving Neko just a drop. She was at times a higher dose kitty and 0.5 units was the max I ever gave her. I've seen a kitty on 30 units of Lantus who couldn't take more than 0.5 units of R, and another at 30 units that needed 3-4 units. Every cat is really different on how they handle R, and as you commented, it can be a very powerful tool and it can be used incorrectly. Which is why we do not have instructions written on how to use it and ask that you get direction from someone who has used it before. R can also be a great tool, we use it so it only brings the numbers down no more than 100 points. We have guidelines on when to use R, and more importantly, when not to.


This is concerning to me. Did the vet check to see how her heart is? Fluids can be a bad thing in a cat with a heart condition - as I know from personal experience. Can you count her resting respiratory rate? (the number of complete in and our breaths per minutes while at rest). It should be 30 or under.
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[/QUOTE]

She had bloodwork on Monday that included a test for the heart. I can't remember the name of it and they still haven't given me a copy, but I know it came back fine. I also took her to Blue Pearl for emergency services about 8 hours after the second IV episode to get a good reading of her electrolytes (the vet office that did the IV had a machine that had trouble dealing with her blood lipemia so they hadn't done a reading in the evening after the IV and were telling me to give potassium supplements still! She'd be at 5 that morning for potassium, something we didn't know until the lab results came back late in the afternoon, so I was worried she was hyperkalemic). At Blue Pearl her electrolytes were happily all normal and during the exam they did a free fluid ultrasound and listened to her heart, etc. and said it was all fine.

I'm not against doing a spreadsheet, I just don't have time at the moment. It's pretty hectic over here right now! But if someone really wants to start one for me using photos of the pages from my book that's fine and I'll work on photographing them soon. I'm pretty sure that Lantus just isn't right for her now that her diabetes is worse. When it was better she did so well on Lantus and needed barely any to regulate, but now that she has all these other conditions affecting her glucose it's too variable for the Lantus. I wish I'd thought of that sooner. Her mother and brother were on ProZinc back in 2011 and did well -- her mom almost went into remission until IBD sidetracked us, and her brother did go into remission and stayed that way for five years until his death. The whole family of cats has had the same pancreas, cholesterol, and liver issues, so maybe they'll also share the same affinity for ProZinc. I'm going to talk to my vet about switching to it soon, though maybe when she's more stable.

I couldn't find the R instructions -- just posts here and in a group on Facebook. edit to add: It was 6am when we decided to try the Novolin, and our euthanasia was scheduled for 11am. My partner rushed out to buy it ($168 at CVS, ugh, because Walmart wasn't opened yet), and I frantically looked for info on dosing. I found enough to know to do .1 and to check a lot, so we did every 15 minutes! It literally was just a last-ditch effort. I joined this forum and tried searching for advice and probably in my haste just missed whatever instructions there are somewhere.

She's doing amazingly well. She was at 223 for her shot at about 6pm (Lantus, 1.25 - her normal dose) and I was sad because at 8pm she was 280 (I'd fed her a lot at about 4). But at 10pm she was back at 200. And, she has been eating on her own! Just small amounts but she's doing it and drinking and she got up on her own to have a bowel movement. Right now I see her sitting in her bed in a curled up position with her head up looking around, whereas this week she had always been laying completely stretched out with her head resting on the arm of her bed and when she'd lift it she'd drop it back down after a few seconds. She's just hanging out right now looking pretty normal for a cat. She did pee in her bed at 10pm but she never has great control over her bladder even on good days so that's not too worrisome. I'm going to clean her up, and then syringe feed, then start our routine of meds and monitoring again until our next nap! Oh, her ketones are down to 'small' according to the Ketostix. I haven't yet rechecked the ketones meter number.

I just can't believe the transformation. We were laying in bed with her this morning petting her and cuddling her while we waited for the in-home euthanasia vet to arrive and I honestly kept hoping they'd hurry up because I thought she was dying in front of us and worried it would be difficult for her. She seemed awful and was nonresponsive and incredibly weak. We kept checking her glucose even though we thought we were putting her to sleep soon, and once it got to about 200 she seemed different. She was 190 when we went outside to meet the vet and I could tell something was different and she was better somewhat. She got out of her bed outside and walked around the yard some and almost played with a leaf. It was a tough decision but I'm so glad we waited on the euthanasia and tried the Novolin. She'd be dead now if we hadn't tried it. I know she could have died from it had we done it wrong, so I'm thankful I found enough info to do it right! She's obviously still very sick and has a lot of issues to overcome so she's still not out of the woods, but she has a chance now and I'm so grateful for that. Cats are amazing in their resilience. We have pushed the Novolin to the very back of the refrigerator so it's hidden and no mistakes are ever made, not that they would be but still, and I hope to never ever have a reason to pull it out again.
 
Paws crossed you are seeing a turn around.
sarahlynne1 said:
I'm not against doing a spreadsheet, I just don't have time at the moment. It's pretty hectic over here right now! But if someone really wants to start one for me using photos of the pages from my book that's fine and I'll work on photographing them soon.
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@Bandit's Mom Up for the spreadsheet challenge?
 
Sigh. Her blood ketones are 3.7 but the Ketostix is saying "none." I'm reading about the different ketone tests and it seems that since they test for different ketone bodies it's possible for there to be ketones, particularly of one type, yet the urine test can't identify them because it only tests for one body. I'm thinking that she's been having ketones for a while since her glucose is so erratic on Lantus nowadays, but the urine strips didn't pick them up, and that might explain why her potassium got low. I'm really annoyed that the vets didn't check her for ketones when they were puzzling over her low potassium. I just fed her and gave her insulin and am going to just monitor and see how her glucose and ketones go throughout the morning. She's a little blah right now and I recognize it as a more extreme version of how she seems some days and I really think she's been having ketones for a while but luckily hasn't become DKA ever. I definitely want to try ProZinc so I can adjust the insulin dose to her numbers each day and have a better regulation that way. She's just so erratic on the Lantus.
 
sarahlynne1 said:
Sigh. Her blood ketones are 3.7 but the Ketostix is saying "none." I'm reading about the different ketone tests and it seems that since they test for different ketone bodies it's possible for there to be ketones, particularly of one type, yet the urine test can't identify them because it only tests for one body. I'm thinking that she's been having ketones for a while since her glucose is so erratic on Lantus nowadays, but the urine strips didn't pick them up, and that might explain why her potassium got low. I'm really annoyed that the vets didn't check her for ketones when they were puzzling over her low potassium. I just fed her and gave her insulin and am going to just monitor and see how her glucose and ketones go throughout the morning. She's a little blah right now and I recognize it as a more extreme version of how she seems some days and I really think she's been having ketones for a while but luckily hasn't become DKA ever. I definitely want to try ProZinc so I can adjust the insulin dose to her numbers each day and have a better regulation that way. She's just so erratic on the Lantus.
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I think the blood ketone meters probably pick them up quicker than the glucose. I am glad she was looking a little better yesterday. What is the bg this morning
 
Does this mean you canceled the euthanasia?

FWIW, use the ketone meter. It picks up ketones faster than what shows up in urine. It's more accurate.

Are you back on schedule using lantus? Do not skip a dose, post and ask advice before doing so. Someone helping you with the R?

Keeping glucose down and getting pancreatitis under control are key. You can do this.

Just had another person go through same thing. Ketones kept jumping up, they were all over the place. I can't think who it was, maybe someone will remember.
 
Yes! Third time this week we cancelled euthanasia.
I had my vet prescribe ProZinc and am going to switch to that. I just spent two hours calling various places to get it because no one has it or shipping is long because of Christmas. Finally got it through the specialty/e-vet she went to this past week, for twice the price. Sigh. Going to get it once it's ready. Her glucose is high today. The Lantus did well yesterday, staying under 300 all day but then she was 300 at her shot today and it won't go down. She has more ketones again, 3.8 meter, and now trace on strips. Weirdly she's acting better than the previous couple days, maybe from the one good day she had yesterday and its after-affects. She's eating and walking a little better, and peeing a lot. Oh, and swallowing her syringed food better too, which is a nice change for me. I'm frantic to get the new insulin to try with her tonight. I think the flexibility of ProZinc vs. Lantus and the ability to do TID if needed will make a big difference with her.

Yes, I read that the meter picks up beta-hydroxybutyrate and the strips do acetoacetate, and the beta-hydroxybutyrate is the more common or abundant body when the liver is making ketones, or something like that - I forget the specifics. So it's important to look at the blood and get the beta-hydroxybutyrate count early to know what's really happening because it will let you know about problems sooner. I thought the strips were enough and could just scream to know she's probably had ketones without me realizing because the strips said none. The things you learn after the fact that you wish vets knew and told you in the beginning...
 
Good luck with the Prozinc Sarah, I hope it helps your kitty.

JanetNJ said:
Why not try a half unit of the Novolin?
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I will take this as a general question about using R, and not as a suggestion to actually try half a unit of Novolin. The experience of those of us who have used R, and helped others learn to use R is that it really is ECID (each cat is different) in how much R they need. Some need just tiny amounts, some need a lot more. For that reason, and because R is a powerful tool that can really drop the numbers fast, we start slowly, with no more than 0.1 or 0.25 units, especially with a kitty on smaller doses. R should not to be used as a tool to hammer down the numbers. That just sets up a bounce and results in even higher numbers.

What little data we have on Sarah's kitty from yesterday shows that 0.1 unit of R may have taken her down over 100 points in 5 hours. That's a sign that 0.1 units of R is more than enough insulin, at this point in time.
 
She is feeling lousy so glucose and ketones will fluctuate. Can you give some R now until you get the prozinc?

I don't know about using R at alk. Just asking if you can.
 
Wendy&Neko said:
Good luck with the Prozinc Sarah, I hope it helps your kitty.


I will take this as a general question about using R, and not as a suggestion to actually try half a unit of Novolin. The experience of those of us who have used R, and helped others learn to use R is that it really is ECID (each cat is different) in how much R they need. Some need just tiny amounts, some need a lot more. For that reason, and because R is a powerful tool that can really drop the numbers fast, we start slowly, with no more than 0.1 or 0.25 units, especially with a kitty on smaller doses. R should not to be used as a tool to hammer down the numbers. That just sets up a bounce and results in even higher numbers.

What little data we have on Sarah's kitty from yesterday shows that 0.1 unit of R may have taken her down over 100 points in 5 hours. That's a sign that 0.1 units of R is more than enough insulin, at this point in time.
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Ah yes. I thought she gave 1 unit yesterday. I didn't realize she actually gave 0.1. Then definitely yes do just a drop.
 
Hi all. Yes, I did give .1 of the Novolin yesterday, and did end up giving it today because her numbers were frozen in the 340s. The ProZinc is still being obtained -- waiting on a courier to bring it to my vet's office, hopefully soon, and I will try that when the Novolin starts to wear off. I believe I'm to give 75% of the dose I'd been using with Lantus (1.25), so about 1 unit of ProZinc (converted to U100). Today so far the Novolin has done less, but still brought her down and she's seeming much better. Last check was about 40 minutes ago and she was still holding at 250, down from 347. I gave her two 35ml meals, one before the shot and one about 2 hours ago, and after the second one she laid in bed cleaning her feet and face, which is rare for her, and now she's curled up sleeping on her heating pad under a blanket. She seems much more comfortable. I'm really, really looking forward to the ProZinc and not dealing with a depot insulin anymore - I hope it agrees with her body.

I have to say, cats are amazing. I can't believe that given how sick she is, how much fight she has in her, and how much she tries to just do things as normal like use the litter pan and clean her face when she's feeling ill and wobbly. She reminds me of a different cat I once had, one that this cat looked up to when she was younger. That cat, Abby, lived to 21 and had CKD and it was before vets told you much about treating it so the poor thing didn't get much care for it other than canned food and some epakitin. Towards the end she had bad anemia and probably hypokalemia and she could barely walk or stand upright. But I still had to take all the furniture she could reach out of the room because she'd try to get on it. She'd stand by a stool in front of a loveseat and do this weird toss of her body sideways to get on it and then land wildly and then do it again to get on the loveseat, all so she could look out the window with the other cats. I had to stop her though because she kept hurting herself, but she didn't care - she wanted on that window! When she stopped being able to walk on her own I'd lift her up and support her belly, and not only did she walk but she would practically be running and I'd have to move quickly to keep up. She'd zoom all over doing things. She was also blind and deaf but always knew where we were somehow. Anyway, this kitty now reminds me of Abby in spirit and I'm hoping we can conquer this period of illness and get her back on her feet and yelling at us for attention.
 
I have the ProZinc now, and she's an hour into a Novolin R. After the first shot of Novolin wore off at hour 5 she went to 366. Sigh. I had fed her a big meal around hour 3, so maybe that's why it went up so much? It never went below 250 on the first shot. I gave her .1 Novolin an hour ago and she went down about 30 points since then. She seems to feel like garbage right now.

Should I give the ProZinc shot when she's 4 hours into the Novolin, depending on her number, to keep her from having such a big jump up?
 
So, I haven't yet done the ProZinc but I am doing the .1 Novolin and I've charted it out and it's incredibly predictable and even so I have been able to predict the numbers for each hour. It's more gentle than yesterday, maybe because she's not also on Lantus right now and she was still at the end of a shot cycle yesterday when on the Novolin. Anyway, today .1 is bringing her down only about 80-100 points each shot, and it's usually 3 0points at hour 1, 30-60 at hour 2, and then hour 3 it stays the same or starts going up, and then by hour 4 it's gone and she's back up to 300+. I like how predictable this is - I'd accepted that all her inflammatory conditions and dental issues prevented her from using insulin well, but this is showing she can use it just fine and after the erratic numbers with Lantus this is really nice to see. I've been doing each shot at hour 3 and might move to hour 2.5 next to keep her in a nice window in the 200s. As soon as she is 300 or more she gets warm and lethargic and feels bad, but in the 200s she's feeling much better. I want to give her a good block of time of feeling good before I start the ProZinc just in case it takes a while to figure out that dose. Sadly this means I can't ever sleep other than 2 hour naps and that's only if my partner is awake to monitor her numbers each cycle. I'm looking at a long night once he goes to bed, but whatever! It's nice to see her feeling better. I was so terrified of using this insulin after speaking to my vet I almost didn't try it but I'm so glad I found positive stories here and elsewhere of people successfully using it because this might save her life.
 
Probably best to start the Prozinc in the AM, when you can monitor better, given that it's a new insulin to her.
 
Wendy&Neko said:
Probably best to start the Prozinc in the AM, when you can monitor better, given that it's a new insulin to her.
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Yes, that makes sense! Though now that I say that I realize my sleep schedule is completely ruined this week so morning and afternoon and night all blur together for me. I'm tempted to keep pulsing the Novolin for a while though because it's so predictable and it's keeping her in a nice 260-200 range right now by me shooting every 2.5 hours at .1 units. I think maybe the consistency of that coupled with me getting enough food in her with the syringe is important and I hate to even lose it for a few hours if the ProZinc dose isn't enough. There's no harm in using the Novolin R for a while longer, right? As long as I keep testing to make sure it doesn't go too low? The only drawback I see is I can never sleep more than 2 hours because my partner can test her but I'm doing all the shots so they are consistent in the dose and injection to rule out any user-error. Big drawback admittedly but maybe worth it for a while. She's curled up right now with her little paws covering her face and sleeping. She hasn't been able to control her front feet well enough to cover her face all week, so it's one of those nice, little victories. If this little cat pulls through this I don't think I'll ever have been as happy about anything in my life.
 
sarahlynne1 said:
So, I haven't yet done the ProZinc but I am doing the .1 Novolin and I've charted it out and it's incredibly predictable and even so I have been able to predict the numbers for each hour. It's more gentle than yesterday, maybe because she's not also on Lantus right now and she was still at the end of a shot cycle yesterday when on the Novolin. Anyway, today .1 is bringing her down only about 80-100 points each shot, and it's usually 3 0points at hour 1, 30-60 at hour 2, and then hour 3 it stays the same or starts going up, and then by hour 4 it's gone and she's back up to 300+. I like how predictable this is - I'd accepted that all her inflammatory conditions and dental issues prevented her from using insulin well, but this is showing she can use it just fine and after the erratic numbers with Lantus this is really nice to see. I've been doing each shot at hour 3 and might move to hour 2.5 next to keep her in a nice window in the 200s. As soon as she is 300 or more she gets warm and lethargic and feels bad, but in the 200s she's feeling much better. I want to give her a good block of time of feeling good before I start the ProZinc just in case it takes a while to figure out that dose. Sadly this means I can't ever sleep other than 2 hour naps and that's only if my partner is awake to monitor her numbers each cycle. I'm looking at a long night once he goes to bed, but whatever! It's nice to see her feeling better. I was so terrified of using this insulin after speaking to my vet I almost didn't try it but I'm so glad I found positive stories here and elsewhere of people successfully using it because this might save her life.
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You're doing an amazing job with her.
 
sarahlynne1 said:
Yes, that makes sense! Though now that I say that I realize my sleep schedule is completely ruined this week so morning and afternoon and night all blur together for me. I'm tempted to keep pulsing the Novolin for a while though because it's so predictable and it's keeping her in a nice 260-200 range right now by me shooting every 2.5 hours at .1 units. I think maybe the consistency of that coupled with me getting enough food in her with the syringe is important and I hate to even lose it for a few hours if the ProZinc dose isn't enough. There's no harm in using the Novolin R for a while longer, right? As long as I keep testing to make sure it doesn't go too low? The only drawback I see is I can never sleep more than 2 hours because my partner can test her but I'm doing all the shots so they are consistent in the dose and injection to rule out any user-error. Big drawback admittedly but maybe worth it for a while. She's curled up right now with her little paws covering her face and sleeping. She hasn't been able to control her front feet well enough to cover her face all week, so it's one of those nice, little victories. If this little cat pulls through this I don't think I'll ever have been as happy about anything in my life.
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I would suggest getting just a little more in her to aim to get her into normal range for some time every day. Normal on a human meter is 50-120 and on a pet meter it's 68-150.
 
JanetNJ said:
I would suggest getting just a little more in her to aim to get her into normal range for some time every day. Normal on a human meter is 50-120 and on a pet meter it's 68-150.
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Yes, I'd like to do that but I've been conservative with the Novolin to be on the safe side since she's not used to lower numbers and I thought it might be a shock to her system if she was suddenly in the 100s. She is 193-198 right now on Alphatrack. She seems a little more tired than I expected considering her number but she seems comfortable so maybe she's just tired! I haven't checked her ketones since yesterday because I don't want to see some and get discouraged. I'm just assuming they're there in some amount and trying to get food and insulin in her to change that as quickly as possible!

I suppose I should put a post in the ProZinc group about how to manage that with the Novolin if need be today. Thanks for all your help so far!
 
sarahlynne1 said:
Yes, I'd like to do that but I've been conservative with the Novolin to be on the safe side since she's not used to lower numbers and I thought it might be a shock to her system if she was suddenly in the 100s. She is 193-198 right now on Alphatrack. She seems a little more tired than I expected considering her number but she seems comfortable so maybe she's just tired! I haven't checked her ketones since yesterday because I don't want to see some and get discouraged. I'm just assuming they're there in some amount and trying to get food and insulin in her to change that as quickly as possible!

I suppose I should put a post in the ProZinc group about how to manage that with the Novolin if need be today. Thanks for all your help so far!
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Oh yes I forgot you were using the alpha. So the normal range is 68-150. I totally understand taking it slow. You are amazing. I'd love to see a picture of her.
 
sarahlynne1 said:
I added her photo as an avatar! It's from some years ago.
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Oooh. So pretty!! I have two grey cats. She looks most like my Lita.
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JanetNJ said:
Oooh. So pretty!! I have two grey cats. She looks most like my Lita. View attachment 58756
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Aw, she's pretty. She reminds me a bit of a cross between my cat and her sister, who is also gray.

Good news today! I'm still doing Novolin and got her to a nice 160-250 range for a while (I was 30 mins. late with the last shot and she went to 314, sigh). I tested her ketones an hour ago and she was negative on the urine strip and .5 on the blood meter, which seems to translate to about 'small' using the same scale as the strips do. Huge improvement. She was 3.8 on the meter yesterday around the same time. I'm getting tired of syringe feeding though! I have to do it about 8 times a day with the 35ml syringe to get two cans of food in her for enough calories and it's hard to do that much.
 
sarahlynne1 said:
Aw, she's pretty. She reminds me a bit of a cross between my cat and her sister, who is also gray.

Good news today! I'm still doing Novolin and got her to a nice 160-250 range for a while (I was 30 mins. late with the last shot and she went to 314, sigh). I tested her ketones an hour ago and she was negative on the urine strip and .5 on the blood meter, which seems to translate to about 'small' using the same scale as the strips do. Huge improvement. She was 3.8 on the meter yesterday around the same time. I'm getting tired of syringe feeding though! I have to do it about 8 times a day with the 35ml syringe to get two cans of food in her for enough calories and it's hard to do that much.
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.5 is actually a trace on the blood meter. Fan-freaking-tastic!!!!!! Will she eat on her own of you put some tuna on top? Or cheese? Or FortiFlora?
 
JanetNJ said:
.5 is actually a trace on the blood meter. Fan-freaking-tastic!!!!!! Will she eat on her own of you put some tuna on top? Or cheese? Or FortiFlora?
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Oh, I didn't realize it was trace. That's great. I was scared to test all day in case it was still elevated despite my efforts -- I wouldn't have been able to handle that! I just got a shipment of more meter strips so I can test a lot more often now.

She has triaditis and is in an active flare of pancreatitis and liver disease so I shouldn't give her anything like those toppers. I did make the mistake of listening to the vet who suggested I let her eat anything she wanted to get her to eat and I let her eat a little of the duck flavor of the food she normally eats in turkey, and now she has diarrhea. Sigh. She didn't eat much so hopefully it will subside soon. That's the last thing she needs is to lose nutrients, especially potassium, that way. I'm probably going to have to add budesonide back to her meds and I hope it won't affect her glucose too much. She is eating, it's just very tiny amounts. I'm about to go syringe feed her again. It's exhausting doing that. She needs about 1.5 of the 5.5 oz. cans a day, but maybe should have a bit more given her age, etc. That's like 8 feedings with the 35ml syringe! I have a larger syringe but am afraid it would hurt her pancreas physically if her tummy was that full. Sigh.

I'm planning to start the ProZinc tomorrow. Fingers crossed!
 
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