Converting from Vetsulin to Humulin-N

[Docfxit]

Hi,

I have a dog named Kipper. He has been on Vetsulin for a long time now. Every time we take him in to get tested the VET increases his dosage one more unit. He is currently getting 12 units twice a day.

Note: I realize only a doctor can prescribe medication. I will not change any dosage based on anything that is suggested here without the doctors prescription.

I'm just wondering if this dosage sounds reasonable. I'm a little leery of how the VET determines the correct dosage for Kipper. Why is it every time we go in he increases the dosage by one more unit? Does he ever stop increasing?

Kipper is 18.2 lbs. 14 yrs old blind and can't hear.

Thank you,

Docfxit

[We Hope]

Before anyone can try to answer, we need some more information from you.

Are you testing his blood or urine for glucose and if so what type of readings are you getting?

What type of readings is the vet getting? This is what he/she is apparently basing these insulin increases on.

How often does Kipper visit the vet for a check and get his insulin increased?

What is Kipper eating and what quantity of food does he get for breakfast and dinner? Have there been any changes to his food?

Is Kipper overweight? Excess weight can mean more insulin resistance.

Does Kipper have any other endocrine-related diseases which would possibly interfere with his becoming stable on X units of insulin?

Does he take medications for any other medical conditions? Some of them can have an effect on blood glucose levels.

Since you say "his", I'll assume that Kipper is a male so we don't need to ask the question about spaying.

There are a lot of variables that go into getting and keeping diabetes regulated. I would also suggest that you might want to think about seeing someone else if you're not comfortable with the way Kipper's currently being treated.

http://www.acvim.org/websites/acvim/index.php?p=3

American College of Veterinary Internal Medicine find a specialist link--select small animal to search, as large animals are cows, etc.

We'll try to help, but we really need more information to be able to do that.

Kathy

[Docfxit]

Thank you for the reply...

Before anyone can try to answer, we need some more information from you.

Are you testing his blood or urine for glucose and if so what type of readings are you getting?

No we aren't. No one has ever suggested we do. Should we?


What type of readings is the vet getting? This is what he/she is apparently basing these insulin increases on.

He doesn't share that with us. Every time we take him in he has to stay for the entire day.


How often does Kipper visit the vet for a check and get his insulin increased?


He goes in about once every 10 vials about 7mos.


What is Kipper eating and what quantity of food does he get for breakfast and dinner? Have there been any changes to his food?


He is eating ½ cup twice a day
Kirkland Super Premium Adult Dog chicken, rice and vegetable formula

He has been eating this for 1 ½ years now.


Is Kipper overweight? Excess weight can mean more insulin resistance.

No. He is just fine.


Does Kipper have any other endocrine-related diseases which would possibly interfere with his becoming stable on X units of insulin?


I don't know enough to answer this question.


Does he take medications for any other medical conditions? Some of them can have an effect on blood glucose levels.


No.


Since you say "his", I'll assume that Kipper is a male so we don't need to ask the question about spaying.

Yes


There are a lot of variables that go into getting and keeping diabetes regulated. I would also suggest that you might want to think about seeing someone else if you're not comfortable with the way Kipper's currently being treated.

http://www.acvim.org/websites/acvim/index.php?p=3

American College of Veterinary Internal Medicine find a specialist link--select small animal to search, as large animals are cows, etc.

We'll try to help, but we really need more information to be able to do that.

Kathy

Thanks,

I hope this will help narrow down the posibilities.

Docfxit

[We Hope]

You should be testing Kipper's urine or blood for glucose on a regular basis so you are aware whether he is having highs or lows. If he's having highs, you need to know whether or not he has ketones present in his urine, which can be a life-threatening situation for any creature with diabetes.

http://petdiabetes.wikia.com/wiki/Ketoacidosis

Low blood sugar can be dangerous also, so if you aren't aware of the signs of it and what to do, please ask us.

http://petdiabetes.wikia.com/wiki/Hypoglycemia

The easiest way to start testing would be to buy some Ketodiastix (they test for both glucose and ketones in the urine). You can get them in just about any pharmacy, though you may need to ask the pharmacist for them; a lot of things are kept behind the counter to prevent them walking out without being paid for. You don't need a prescription for them.

http://petdiabetes.wikia.com/wiki/Urine_testing_stix

They are read by using the color graph on the package--you match the colors and this gives you an idea as to how high the glucose is and if there are any ketones present.

Then you can set yourself up with a 3 times a day monitoring program like this:

http://www.vetsulin.com/vet/Monitoring_Urine.aspx

"Have pet owner test urine three times a day: before the first meal (test 1), before the second meal (test 2), and late in the evening (test 3)."

There's a table on the page which indicates the recommended action regarding the day's results of the testing.

Then Kipper does a curve when he's at the vet, with blood being drawn every 2 hours and tested for glucose. You're entitled to know the results of this curve, and if you want to learn how to use a meter for blood glucose testing, you can do some of these yourself at home. Many of our people here have dogs who stress at an entire day at the vet's; some have high blood glucose as a result of stress and others wind up with lower than normal readings from it.

With the blessing of their respective vets, these people perform regular blood glucose curves at home, share their results with their vets, and together they decide whether more insulin, less insulin, or no changes at all are needed.

So basically, Kipper doesn't see the vet very often and when he does go in for the all-day curve the results of that are getting his insulin increased by a unit--no follow-up appointment within a reasonable period of time to see how Kipper is handing the insulin increase?

Please feel free to ask any more questions you might have! ;)

Kathy

[k9diabetes]

You and Kipper would benefit from taking a more active role in his diabetes regulation. Knowledge is definitely power in this case.

First thing tomorrow, please request a copy of all of Kipper's tests and of the doctor's notes - Kipper's whole file - from the vet. (This should not be a problem. Sometimes they think you're firing them when you make this kind of request but just tell them you want to educate yourself about Kipper's diabetes if they ask.)

That way, you will have in front of you his whole history of what his blood glucose curves have been (that's what the vet does when he keeps him all day - a curve) along with when the insulin was increased.

Next thing I would do is the urine tests with ketodiastix and consider learning how to do home blood glucose testing.

There are video and picture tutorials of how to do a home blood glucose test here: www.k9diabetes.com/bgtestvideos.html (http://www.k9diabetes.com/bgtestvideos.html).

And then if you go to www.k9diabetes.com/monitoring.html (http://www.k9diabetes.com/monitoring.html), there is a discussion of the various ways to monitor your dog's regulation and some information about curves. Also, at www.k9diabetes.com/insulinfood.html (http://www.k9diabetes.com/insulinfood.html) you can get a sense of how food and insulin should work together.

Once you have his records, please post the results of the curves done by the vet, along with results from any lab tests such as a blood panel - you could just list the items on a blood panel, if any, that were abnormally high or low. Include his weight when each curve was done.

Once you have all that information, we can help you assess how well regulated Kipper is and help you start to monitor his regulation at home. Then you will know whether Kipper needs these increases in insulin.

Kathy asked about other endocrine disorders (low thyroid levels and high cortisol levels are the two that most commonly affect blood sugar levels) because other body hormones have such a big influence on insulin use. Could be that something else like Cushings disease (high levels of cortisol production), which is fairly common in diabetic dogs, has been driving up his need for insulin over the past year.

I'm anxious to hear more about Kipper's history!

Natalie

[Debbie & Apollo]

Hi Docfxit and Kipper,

I have to say I totally agree that since you are wondering about Kipper you might want to take a more active approach to his care. If for no better reason than peace of mind :)
The Urine strips are an excellent start -- easy to use too ;)
If you need help -- many here will be glad to give support and guidance.

Debbie and Apollo

[eyelostit]

Welcome Docfix and Kipper :)

You'll find lots of info and support here

You had mentioned regarding the vet and the increases and Office visits.

"He goes in about once every 10 vials about 7mos."

Is this what the vet has been suggesting, to come in around 7 months after the last increase in insulin?

I am so happy you found us, search our topics on the board, there is so much info on canine diabetes.

Again Welcome, Dolly

[Docfxit]

Our current Vet suggested we switch Kipper from Vetsulin to Humulin - N . I don't know what the conversion is but his prescription doesn't sound correct to me.

He prescribed 2 units twice a day.
Kipper is currently getting 7 units of Vetsulin twice a day.
He weighs 14.8 lbs.

Also his advise which doesn't sound correct to me is:
After he is on it for 3 weeks I should bring him in for a curve test which he says will cost between $250 and $300.

I don't feel comfortable waiting 3 weeks without any testing at all.

Any thoughts?

Thank you,

Docfxit

[Patty]

Hi and Welcome back Docfixit! I pasted your post to your previous thread so it would be all in 1 place...will respond in another post. :)
Patty


Our current Vet suggested we switch Kipper from Vetsulin to Humulin - N . I don't know what the conversion is but his prescription doesn't sound correct to me.

He prescribed 2 units twice a day.
Kipper is currently getting 7 units of Vetsulin twice a day.
He weighs 14.8 lbs.

Also his advise which doesn't sound correct to me is:
After he is on it for 3 weeks I should bring him in for a curve test which he says will cost between $250 and $300.

I don't feel comfortable waiting 3 weeks without any testing at all.

Any thoughts?

Thank you,

Docfxit

[Patty]

Docfixit,
There are many vets who are essentially starting over with the minimum dose with switching to NPH. There was a web seminar held during the fall of last year in which Dr. Nelson recommended the following:

"His recommendation for a starting dose when switching to NPH is to cut the dose "a few units" - from the examples he gave, he would reduce the dose about 20%, for all the reasons we have discussed... the insulin action may be different so best to start on the low end and work up."
http://k9diabetes.com/forum/showthread.php?t=1490

If Kipper is getting 7 units of Vetsulin, a 25% decrease would be 5 1/4 units or rounding down = 5 units. If you wanted to be very conservative, you could start at 50% of the current dose at 3.5 or 4 units. But personally I wouldn't go any lower than that. I think most people wind up using around the same number of units as they did on Vetsulin.

The cost of your vet's curve does sound very high. Maybe others can comment on their experience with price. Have you thought of home testing? It would save you quite a bit of $ and can really give you peace of mind.

I wouldn't wait 3 weeks either. It may take a couple of weeks for your dog to adjust to a new insulin but at the lower dose he would run quite high for an extended period of time. You don't want to see him develop ketones. Do you have some KetoDiastix you can use for urine testing?

You want to be sure that you get the right syringes as well. NPH insulin requires U100 syringes. You won't be able to use the U40 syringes you currently use with Vetsulin. With the dose you're using you could get the U100 3/10cc, 5/16" length, 31 guage syringes with the Half Unit markings. The half unit markings are really helpful because you'll want to move in small increments as you get close to the correct dose.

I hope that helps!
Take care,
Patty

[eyelostit]

Your starting dose of 2 units would sound right, I think the vet will increase it slowly.

Your vet is charging you way to much for a curve, I think I pay about $50.00, have you tried home testing yet?

Dolly & Niki

[k9diabetes]

It is really unfortunate that the protocol was issued basically asking vets to start over at tiny doses of insulin.

I personally advocate reducing about 25% - even that seems fairly conservative given that every dog we have seen do the switch so far has wound up needing a very similar dose of NPH as they were on with Vetsulin.

But I have firsthand experience with how different a dog's reaction can be to two different insulin preparations so I generally prefer to be a little cautious.

It also depends somewhat on high well regulated your dog is now. If the regulation is extremely tight on Vetsulin, such as all BGs in the 100s, then it is better to be a bit more conservative with the starting dose of a new insulin.

But if the blood sugar on Vetsulin has never gotten below 250, then it's not such a concern.

Long way of saying I would go no lower than 4 units to start and would be pretty comfortable with 5 units.

I can't take time to go back through your thread right now... if you haven't tried home testing BG, I really recommend it. You can do curves yourself at home for about $5-$10.

I also would NOT wait three weeks on such a small dose. I wouldn't wait that long starting at 5 units. I would wait three to five days, assess, and increase. That is WAY too long to leave a dog on what is in all likelihood not nearly enough insulin.

Home testing is really the solution here...

Natalie

[Docfxit]

Hi,

Per everyone's recommendation I am going to try to home testing. I have a OneTouch Ultra mini.

1. Is there a setting on the OneTouch Ultra mini for dogs?

2. I went to the vet today and ran a test with my new meter and their Acutrack.

B/4 eating in the morning
32 ml OneTouch Ultra mini
52 ml Acutrack
I realize the difference between the two isn't that great and is a little low.

Still on Vetsulin 7 units twice a day
I just wanted to check to see where he was before starting Relion.

I will be checking him tonight before he eats and 2hrs after just to get a feel for where he is at.

They showed me how to draw blood with a syringe at his arm. Is that the way most people do it? It seems cheaper to use the lancets that come with it.

Thanks,

Docfxit

[k9diabetes]

If that 52 was with the AlphaTrak, that is awfully low - did they run an actual blood sample through an analyzer to see if that was accurate?

Their AlphaTrak could be reading the blood sugar low too. But even if you add 50 to the OneTouch, that gets you only to 80.

Did you talk about reducing the insulin dose?

My dog's blood sugar did tend to go low at the vet. But even then I'd be opting to reduce the insulin dose to give you a little more cushion for days when things are going lower than normal.

I'm not sure what you mean by a setting for the OneTouch... you use the meter as you normally would.

And even with the lancing device, the setting required for that varies from dog to dog and with where you test. If you test on the lip, I would set the lancing device on a low setting and work up. If you test elsewhere, a lancing device may not work at all. It's usually easiest to hand lance places like the back at the base of the tail or a carpal pad.

You definitely do not need to draw blood using a syringe. I think of a hundred people I know who test or tested, only one did that, and I'm not a big fan of that at all.

If you look here: www.k9diabetes.com/bgtestvideos.html (http://www.k9diabetes.com/bgtestvideos.html)

There are video or picture tutorials for all of the most popular test sites:

-- The inside upper lip
-- The back at the base of the tail
-- Carpal pad on the foot
-- Leg callous for dogs who have one

The videos, especially mine of Chris being tested on the lip, are large files so give them time to download.

The ear also can be used and we have a link to Abbott's video on home testing which demos that area. With this video, you have to sit through one video that shows a variety of techniques: http://www.alphatrakmeter.com/en_US/en_US/video/obtaining_blood_sample_video.html

I need to add this to our list.

Natalie

[eileen]

Just a thought.....

Is this reading in US measurements of mg/dl or outside of the US and set to read in mmol/L in which case the 32/52 reading would be much higher.
When I read my numbers on the Alpha Trak (US) it indicates them being in mg/dl.

I, as Natalie, have only heard of 1 person over the years who has used a syringe to withdraw blood for testing.
It is not a way in which I would recommend to anyone.

Eileen/Mildred

[CarolW]

Source of blood samples for testing - the venous blood draw your vet showed you is the vet's way of doing that, but those samples are usually tested with a lab analyzer. Glucometers "expect" fresh, whole capillary blood - it's blood that has some different qualities from blood withdrawn (drawn) from a vein (venous blood draw).

I learned this, talking to OneTouch Customer Care; i've talked to them at least a dozen times now, and learned a lot.


When I say I'm using the meter on a dog, they stop talking to me, except to say, it's not recommended to use these meters on animals. They HAVE to say that; it's a matter of potential liability for them.

But as long as I say nothing about using it on the dog, they're fine!

Tue, 9 Mar 2010 15:46:48 (PST

[AlisonandMia]

I would think that there would be a considerable risk of damage to the vein(s) if they were stuck on a frequent and regular basis - as happens with IV drug users and people on dialysis etc.. Once in a while for the blood samples is ok but I'd think that doing it as often as you may need/want to for home monitoring could cause a problem. There is also the risk of infection with IV access.

As far as I know human diabetics always access capillary blood for their everyday testing.

Alison

[Docfxit]

And even with the lancing device, the setting required for that varies from dog to dog and with where you test. If you test on the lip, I would set the lancing device on a low setting and work up. If you test elsewhere, a lancing device may not work at all. It's usually easiest to hand lance places like the back at the base of the tail or a carpal pad.


Natalie

Thank you all for your great information. I'm having trouble getting blood to test with. He doesn't like to touch his face so the lip is out. Natalie mentioned "If you test elsewhere a lancing device may not work at all."
How does one hand lance? I have tried the lancing device set on it's highest setting. The lances that come with the unit don't have a gauge on them. Do they come in different gauges?

Thank you,

Docfxit

[Patty]

Docfxit,
I used to hand lance. I use the AccuChek lancets on Ali's lip and I haven't seen a gauge listed on their box either.

Not all lancets are created equal. You can find different brands that will list the gauge size. I liked the AccuCheks because they seemed to have more of a beveled edge. I couldn't get a good drop with the ones that came with the OneTouch. It's really all trial and error.

To hand lance, just hold the lancet with your fingers and push into the skin. I used to do this very quickly and only went part of the way in, but I was using the delicate lip area. I know Dolly twists hers (I think she uses the tail area). And I think Carol pushes hers all the way in. We each do it a little different.

Hope that helps,
Patty

[Ladybug]

Hi Docfxit,

I finally wound up doing the lip. I thought, just as you, that Ladybug wouldn't let me even close to her mouth because she wouldn't let me look at her teeth!

I started with the AlphaTrak 25 gauge lancets, then changed to the 33 gauge BD lancets because I didn't want to hurt Ladybug. But, with the 33 gauge, I couldn't get any blood. I went back to the 25 gauge and it doesn't hurt her at all. I get blood on the first prick and I hand lance. Ladybug doesn't like the "click" or the "look" of the lancing device!

As everyone says, it will get easier and it truly does! Trust me! I look back on my past posts and think "wow, nothing to it!".

I wouldn't even think of touching her vein. If my vet had told me to do it that way, I would have found another vet pronto!

Good luck! :)

Linda and Ladybug