Mischief's glucose curves [Archive] - Diabetes in Dogs: The k9diabetes.com Forum

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optimystic

03-31-2010, 07:28 AM

The only answers I have are to the general details about my dog, in fact.
His name is Mischief & he's a mix (don't know what breeds.)
He was a rescued dog & full grown when we got him 10 yrs. ago.
He was diagnosed with diabetes one year ago, almost exactly. At the time, he weighed 47 lbs. Now he's down to 36- mostly due (I hope) to a low cal food & no treats. He eats Science Diet Lite- 2 cups twice daily.
He gets insulin injections after both meals- roughly 12 hours apart.
He started out on Vetsulin (18 units), but we switched to ReliOn N in Dec. He's up to 17 units now, still not where he should be.
I don't believe he was ever regulated on the Vetsulin, although his health seemed to improve fairly quickly with insulin use. I have little understanding of diabetes & ignorantly believed the improvement meant he didn't need more BG curves at the vet.
He's had curves done about every 2 weeks since Jan. bringing up to his current 17 units a couple of units at a time. We (my husband and I) are interested in home monitoring now, but don't really know where or how to begin other than asking for help here.
Last night, we bought a ReliOn Confirm monitoring system at Wal-mart. The box hasn't been opened yet, in case I need to return it in favor of another kind on your advice.
Please give me all the basics, in simple layman's terms so I can get a good understanding of what's in store for us and for Mischief.

Thanks,
optimystichttp://www.facebook.com/#!/photo.php?pid=278402&id=1568826260

ozzi

03-31-2010, 07:58 AM

My experience is almost exactly the same as yours! I feel like a fool admitting this, but when Ozzi was first diagnosed, I was told to give him 15 units NPH twice/day. He initially responded well, and I foolishly thought I was done! I did not realize that he would need further adjustment, and frequent glucose monitoring. He has not really been adjusted (at least consistently), and I am still working on that and making great headway. So, you are definitely in the RIGHT PLACE, and welcome!!!!!!!!!!!!!!!!

I was scared to death to home test and didn't for the first 6 months of Ozzi's diagnosis. I didn't even know I could! My vet was very layed-back about the whole thing, so I didn't worry! When Ozzi had all kinds of crazy glucose numbers, I felt I needed to take control, and with the help of the people and resources here, I learned to home test, and I could not manage him if I weren't doing so. I am so very happy that you are willing to learn to test Mischief!!!!! That is probably (at least in my opinion), the BEST thing you can do for him!

Please check out the videos here on how to test...they will help you a great deal to understand the process. They can be found at

http://k9diabetes.com/bgtestvideos.html

There are several places that you can test depending on what works for you. The lip is VERY easy and has fewer nerve endings so it doesn't hurt so much. Ozzi doesn't like anyone in his face, so I can't do that. I test from his elbow callus. Others test from the paw pad or the back, just above the tail. I can tell you that the first time was VERY scary for me, and now it's NOTHING to test him. I felt the same way when first injecting him too, and now that's nothing, which I am sure is the same for you now.

In general, after choosing a site to test, you can use a lancet device to poke Mischief, or you can hold the lancet in your hand and prick the area. The device works really well on the lip, and I found it doesn't work so well on the elbow callus, so I hand hold the lancet. You insert the test strip into the meter and when the machine is ready (it says ready or beeps depending on the unit), you touch the end of the test strip to the blood to draw it up, and the machine will calculate the amount of glucose in the blood and display the result. Every meter is a little different, so you need to read how yours works, but those are the basic steps. It feels overwhelming, until you have done it twice, then it is nothing!

I'm not sure how much you paid for the meter, BUT, you can get them for free if you choose to return it. Here are a few sites and there are MANY where you can get a free meter. Of course, you are locked into using their test strips, but many get them cheaper on Ebay, so it might be worth it to you.

https://www.onetouchgold.com/simplestart/
http://www.diabeticlive.com/pages/Free-Glucose-Meter.html
https://offers.bayerdiabetes.com/CouponReg.aspx?product=contour

A lot of people use the One Touch. I use the Bayer Countour.

I would encourage you to post any and all questions you have, even if you feel like they are stupid! I assure you they are not, and no one here will think that!

Please keep us updated, and we'd love to see a pic of Mischief! Love that name!!

Kevin

Patty

03-31-2010, 11:08 AM

Hi Optimystic and welcome!

I love the name mischief. Too cute.

That's great that you're interested in home monitoring. It really gives you better control over what's happening with your dog's blood sugar and is truly piece of mind. Kevin's given you some great links to start out.

I'm a fan of the OneTouch Ultra meters.

"A recent study of six blood glucose meters reflects favorably on the OneTouch Ultra."
ACVIM 2008 Abstract

Evaluation of Six Portable Blood Glucose Meters in Dogs.
T. Cohen, R. Nelson, P. Kass, E. Feldman
School of Veterinary Medicine, University of California, Davis

The purpose of this study was to evaluate six portable blood glucose meters (PBGMs) - AlphaTrak, OneTouch, Elite XL, AccuChek, Precision, Contour - for use in dogs. One hundred fifty-eight venous blood samples were asayed for glucose using all PBGMs in randomized order and by a reference hexokinase method. Results from the PBGMs and reference hexokinase method (HM) were compared.

HM blood glucose concentrations ranged from 41 to 639 mg/dl. There was excellent correlation between PBGMs and HM results (table). Results were consistently low for 4 PBGMs compared with HM results. High and low results were common with the AlphaTrak. The difference in results between PBGMs and HM increased as blood glucose concentrations increased. Difference in results between PBGM and HM were significantly (p<0.0001) less for the AlphaTrak and OneTouch and significantly (p<0.01) higher for the Contour compared with other PBGMs. Problems with correct identification of hypoglycemia (<70 mg/dl), normoglycemia (70-120 mg/dl), and hyperglycemia (>200 mg/dl) varied between PBGMs (table).

Percent Incorrect from Reference Range
AlphaTrak -- 18
OneTouch -- 21
EliteXL -- 45
AccuChek -- 45
Precision -- 49
Contour -- 73

Results of this study support use of the AlphaTrak and OneTouch glucose meters based on significantly closer results with HM.
http://k9diabetes.com/forum/showthread.php?t=957

Really with any meter you use, once you get the hang of testing you can compare it with your vets results run on a lab machine to find out the degree of difference for your meter.

Also if you have any of Mischief's past curves you can post, we could offer suggestions to help with regulation.

Again, welcome :)
Patty

CarolW

03-31-2010, 11:23 AM

Hi Optimystic and Mischief, and a big, fat welcome to you! I see you already have some great replies. Hope you'll keep asking questions as they occur to you.

In my Quite Unbiased Opinon (really!) this is the best possible forum on which to learn about canine diabetes - and to get additional information that can help you and your dog. The reason for that is that people are careful and attentive about posting here, following the superb leadership of site and forum-owner, Natalie (k9diabetes).

Just wanted to add my welcome to the others, and also, remark that I use the OneTouch Ultra2 meter. I prefer that one to the other OneTouch Ultra models, because it practically tells you, right on the display, how to do things like setting the date and time, or change other settings you might need to change.

I also like the consistency and reliability of the OneTouch Ultra meters; I see Patty has pointed that out.

And if you consult the pharmacist whee you buy the meter (and test strips), and/or get in touch with OneTouch Customer Care, I believe you can get a full rebate on the price of the meter. That's because it's the TEST STRIPS that cost! There are other good meters as well, and lots of information about them, here on the forum.

You can look over the Answers section, too; see what you find there.

I'll be here cheering you on! My Kumbi, and my RB dog Kwali, join me in welcoming you and Mischief.

Wed, 31 Mar 2010 11:18:55 (PDT)

optimystic

03-31-2010, 11:30 AM

Thanks, Kevin for the welcome, encouragment and advice. I'd be glad to post a picture of Mischief, because he's a sweet, dear old guy...black, with a graying snout. For some reason, the posting rules say I may not post attachments, maybe because I'm new? Regarding the cost of the monitor we bought, it was $12 with additional lancets & strips bringing the total up to less than $20. Of course, if the meter isn't a good one- or not good for dogs- it doesn't matter how inexpensive it was. I'm hoping someone on this forum has some knowledge of ReliOn Confirm.
My husband has agreed to test Mischief until I feel comfortable doing it. He did the first few insulin injections, also. He's not an unfeeling person, but a little less tender-hearted than me, thankfully.

OK...figured out how to show off my Mischief, so that's progress. And I appreciate the information from Carol and Patty about recommended monitors. Since I've read several references to strips being costly, should I assume that the ones I bought for the ReliOn Confirm aren't good quality, maybe? I bought it based on using the ReliOn-N insulin.

Well, this is my second edit but I've got to correct myself: it was $22 for 50 strips. The lancets were less than $4 & for some reason, I thought the strips were also. I finally realized that my husband had paid for the strips when he bought 100 more syringes & I just checked the receipt. For some reason, the fact that the strips weren't as inexpensive as I thought gives me hope...

Taylor

03-31-2010, 12:49 PM

I think the ReliOn meter and strips will be good to start with. My vet who is diabetic himself uses the ReliOn. The important thing is that the strips are easily obtained and afordable. Pat

ozzi

03-31-2010, 07:57 PM

Nice pic of Mischief!! What a cutie! The fact that the strips are cheaper does not imply they are of a lesser quality, just as the Relion Novolin N insulin is cheaper but essentially interchangeable with the more expensive Humulin N. So don't worry about that. The accuracy of the meter is more important, which is what Patty was pointing out. I just don't happen to know anyone who uses a Relion meter and have never used one, but I don't think there would be an issue with it. If you don't like it, you can always get a free one, and that was the only thing I wanted to mention. Again, testing is so important, I think the meter you use is secondary at this point, and whichever one you use, you can get an idea of its accuracy by testing your dog at the vet's office when he has his blood taken and sent to the lab (not using their meter), as others have suggested. Good luck and let us know what you decide!
Kevin

k9diabetes

03-31-2010, 09:10 PM

Welcome to you and Mischief - he looks so sweet!

Every member of the forum also has available a photo album. If you click on the UserCP link at the top of the forum, that takes you to your Control Panel and you can start a photo album and upload pictures directly from your computer. It's nice because they show up full size.

It would be very helpful if you would get copies of Mischief's last two curves from the vet and post them here so we can see how his regulation is on NPH.

Pretty much every dog we have seen switch over has needed about the same number of units of insulin so he may need 19 or 20 or even more if he wasn't actually well regulated on 19 units of Vetsulin.

You can start with the Relion Meter and then if you want to switch later you can. The strips are the real cost over time. I think you will probably love home testing once you master it. If you watch the video I made of Chris, you will see that he didn't care a bit about being tested. They generally accept it really well and it's more our human imagination that is worried about it.

My first diabetic was a cat and I was SO SO SO scared to inject her! I wanted to cry and throw up and pass out all at the same time just at the thought of it! But I lived alone and she needed me so eventually I sucked up the courage and did it. She didn't even notice! Didn't flinch, didn't cry, didn't blink. I had to laugh at that point given all the drama my brain went through!

There will come a time when giving Mischief his injection is about as stressful to you as brushing your teeth, so much a part of your daily routine that you hardly think about it.

Natalie

ADDING: Sorry about my little mind wander there about injections! That happens sometimes when I respond to too many people in one sitting.

optimystic

04-01-2010, 07:07 AM

Natalie- I'm already comfortable with Mischief's injections & have taught my 22 yr. old son to do them when my husband & I aren't available. I'm sure home monitoring will become routine, also, once we get started. I'll admit that I dread bringing up the subject of home monitoring with the vet. They might be receptive to the idea, I don't know. Either way, I can't make an appt. for the next curve until this coming Wed. which will be 3 wks. since the last one. On my own, I've already raised the insulin dose by 1 unit (from 16 to 17) and plan to do it again beginning this weekend. I watch Mischief carefully for signs of trouble & am ready with Karo. Like you mentioned, I imagine he will need a higher dose than he took of Vetsulin because he wasn't regulated yet back then.
What I need to decide in the next few days is whether or not to change vets. Mischief was diagnosed by a vet close to home & we used them until the end of the year when the whole problem with Vetsulin came to light. They had continued selling it to us, without ever mentioning a possible problem & didn't monitor Mischief closely as the FDA had suggested. They claimed that they'd still be prescribing Vetsulin if it was available, despite the "little quality control issue" the company suffered. What made it worse was that we had discussed with the vet the idea of switching Mischief from Vetsulin to a human insulin weeks prior to the problem. Our motivation was saving money as the Vetsulin was costing us $45 per vial & wasn't lasting 2 weeks. For months they had sold us the needles- $40 per 100 and prescription Science Diet food at $60 per bag and we needed to save some money, if at all possible. I did some research and found that Science Diet Lite food was fairly comparable to the prescription-only formula & the vet reluctantly agreed to the change. Mischief seemed to do well on the less expensive food, so that was progress. But the vet refused to change to a human insulin, giving us vague reasons like "Vetsulin is concentrated differently & would need a different size needle" and "we would have to start all over trying to get Mischief regulated" which was all true. Except he led us to think that using human insulin would definitely be more expensive & it wouldn't work as well. And Mischief wasn't regulated, anyway. They had only done 2 curves on him in 8 months. Then, we got a message on our voicemail that we had to switch over from Vetsulin to NPH due to Vetsulin being discontinued. After that call, they even sold us 3 bottles at a time so we could postpone switching to what they led us to believe was an inferior insulin. I learned of the Vetsulin problem via the net & felt we had been taken advantage of. At the very least, we should have been fully informed & allowed to make a decision about continuing to use a product that had a "little quality control issue."
So I switched to a vet recommended by a co-worker & that's where we've been going since Jan. I just want to find one a little closer to home & wonder if that should be done at the beginning of home monitoring or not.
Any advice would be welcome & I apologize for the length of this post. I will try and get Mischief's curves to share with you. And I'm really glad to have found this forum.

Melanie

peggy0

04-01-2010, 08:42 AM

Hi Melanie and welcome. Mischief looks alot like my forbes who is a lab/border collie/shepard something or other. Your story is a familiar one. We've all had vets that had their way of dealing with diabetes with a certain insulin, food and way of monitoring. The fact is, you need to do whats best for you and your dog. Many people on this board have regulated their dogs without changing the food. Others, like me, have experimented with many brands of food trying to find the one that matches the dog and insulin. And it really is a match of all 3 things as all dogs are different. Home monitoring is peace of mind and I would insist on it. Its really not up to the vet to decide. I was hesitant to change to Human insulin from vetsulin and had a very positive experience with Humulin N. Everyone on the board is here to help!!

k9diabetes

04-01-2010, 09:54 AM

Hi Melanie,

Pardon my mind wander in the previous post - I was thinking of someone else who mentioned fear of injections.

From what you have said, the relationship with the first vet is not one that's supportive of you as an important part of Mischief's care so probably not an ideal arrangement for a diabetic dog.

There are two common problems it seems... one is that a lot of vets have been taught that you don't need to regulate a diabetic dog "well" - you just get them to the point of being an acceptable pet again and that's good enough. I can't tell you how much I hate that philosophy...

And then there's the sales pitches for Vetsulin from sales reps.

Vetsulin reps have been known to do a hard sell to veterinarians and managed to convince them that Vetsulin was better than NPH. Perhaps because the insulin molecule in Vetsulin is an exact match to a dog's natural insulin molecule.

But that molecular match has not actually equated to better blood sugar control. In fact, many dogs here who switched from Vetsulin to NPH wound up better regulated.

Some vets had never really used NPH. They used to use Humulin L, which is structured the same way as Vetsulin but with human insulin molecules instead of pork-based. When Humulin L was discontinued, Vetsulin was also hyped to vets as a replacement - both are lente insulins. But they don't work the same way necessarily.

So a lot of vets I think bought into those sales pitches and have been really reluctant to change their patients over to NPH.

But NPH is a really wonderful insulin for dogs. Most of them do great on it.

And for large dogs, I much prefer NPH to Vetsulin because the more concentrated solution means injecting a lot less fluid plus saves money.

When the prices of Vetsulin and NPH are compared, sometimes the fact that a bottle of NPH has 2.5 times more units of insulin gets left out. Even if you pay $60 for a 10ml bottle of each kind, you get only 400 units of Vetsulin for that price and 1,000 units of NPH.

In some ways, I'm almost glad this problem with Vetsulin came up because it will help train vets to use and like NPH.

As you take on more and more decisions about Mischief's diabetes, you will need a vet who appreciates that willingness to learn and desire for good regulation for your dog. One who is interested in what you want for him in terms of quality of regulation, expense, etc. I don't know that it matters exactly when that vet steps into the process. You can do just what you are doing now - learning to manage it day to day yourselves - and then a more flexible and helpful vet will just improve what you have already accomplished.

As far as home testing, I never suggest asking for permission. Just go for it. A lot of times vets who would have been opposed to it in theory are happy to have the information when they see how helpful it can be and become converts to home testing.

Natalie

k9diabetes

04-01-2010, 09:58 AM

I LOVE the pictures in your photo album! :) Meatwad, huh? LOL

Natalie

ozzi

04-02-2010, 07:18 AM

Melanie,

I just want to echo the great advice from both Peggy and Natalie! I never asked my vet about home testing, nor did she ever bring it up! I just knew that I had to do something myself to manage Ozzi's diabetes since his numbers were out of control, (in the 500's) and the vet was not nearly as concerned as I. As Natalie pointed out, many vets feel that getting the BG into an "acceptable" level for them is the goal, and my vet felt keeping him in the 300's was fine. I did not feel that way.

I didn't realize I could home test until I came here, and I watched the videos, researched various areas to test, and bit the bullet. Now I could not be happier, and Ozzi is the beneficiary of that! So I cannot encourage you enough to home test, on your own. I can tell you that my vet is now happy to get the graphs I give her when I do a curve, and she is much more receptive to my "participatory management" of Ozzi's diabetes. We now have much more of a partnership in his management than the typical Dr./patient relationship, and I couldn't do it any other way. I sense you feel the same way, which brought you onto the Internet for help!

It's never too early or too late to start home monitoring, so changing vets does not impact that at all. Regarding the syringes, you mentioned buying them from the vet. I would encourage you to get a prescription for the syringes...it will be a lot cheaper that way! Also, in case you are not aware, WalMart and Sam's Club sell Relion syringes, which are about half the cost of retail pharmacies, but you need to bring in a prescription. NPH is over the counter and does not require a prescription, and those two stores also sell Relion Novolin-N which is also about half the cost of other NPH's.

Kevin

Noodle

04-02-2010, 10:23 AM

Welcome Melanie & Mischief! :)

Like many others, my vet didn't bring up home monitoring. I found the information on this forum and others, and at the very next visit, I told him I would be testing and performing Noodle's curves at home from that point on. I personally think it's the single best thing you can do for a diabetic pet because it provides you with a wealth of information with regards to insulin, food, and activity and how they all work together. You will get more accurate numbers since it will reflect his regular home routine...plus, it will save you a bundle in the end. Unlike how most vets seem to be trained, it varies SO much from one dog to the next.

My vet didn't have anyone home testing but ended up loving it. I used to FAX him all of the curve information when we were first working toward regulation and he said it provided him with so much more information and gave him a real picture of what was going on.

It must have been so disheartening to deal with the first vet. I hope the new one (whether you stick with the current one or find one closer) works out and proves to be a much better partner in Mischief's care. :)

optimystic

04-02-2010, 03:22 PM

It was the syringes from the first vet that were expensive. You're right about the Wal-mart brand Relion being much more affordable. I'm very happy with the decrease in cost, since I can feel assured that I'm not sacrificing quality to save money.
I did it...! I called vet #2 and brought up the subject of home monitoring. In answer to my question, she said she didn't currently have any patients being monitored at home, but wasn't against it. She seemed reticent...after telling her to freely express any misgivings, she said that some people want to monitor at home to be able to adjust the dosages of insulin from injection to injection and she had some reservations about that. I told her my goal is to do Mischief's bi-weekly curves at home & that I planned to leave his feedings exactly as they are. I hope to avoid too many variables & since he's an older guy, Mischief isn't too active so I won't have exercise to factor into the equation. I just want to get him regulated & bring his glucose levels to as healthy a level as possible. She agreed to use my meter, along with the clinic's, so I can get an idea of how it runs. I will be taking him to her in two weeks (since I increased his dose by 1 unit since his last visit. I will talk to my husband about doing a curve on him Sunday since he'll be home all day (I'll work on Easter from 12-6.)
I got copies of his 1st two curves from vet #1 today & will post them soon. I'll get copies from current vet when I take him in.
On an unrelated note, I saw vet #1 today for an emergency visit with Annie, my 13 yr. old lab mix. My mother said she stumbled on the porch stairs & was having troulbe getting her legs under her, stumbling around, looking confused. It happened less than 1 hr. before I got home & I immediately took her to be seen. Vet #1 is less than 1 mile from home, so that's where I went as it was an emergency. Annie's been haviing problems with her dysplasia & is taking Meloxicam daily, which has helped. She had surgery on one hip 8 yrs. ago & has been trouble free until recently.
I feared it was a stroke today, but it turned out to be Old Dog Vestibular Syndrome? A jerkiness in her right eye, leaning her head to the left, walking sideways, sitting against a wall...the vet felt 99% sure, but ran some blood tests anyway. He says she had remarkably good lab results for a dog her age & found no other problem. So we're treating it with an antibiotic (in case there's some ear infection) and dramamine. He says she's just really dizzy and disoriented & that is so much less scary than a stroke!
I know he wonders what kind of person has 3 dogs- all on prescription meds. Mischief, with his insulin. Annie with the arthritis meds & now the antibiotic & Leon takes Clomipramine for OCD.
Anyway, I've written too much again, but it feels good to share trials here with people who probably understand all too well.
Thanks,
Melanie

ozzi

04-02-2010, 08:40 PM

what kind of person has 3 dogs- all on prescription meds. Mischief, with his insulin. Annie with the arthritis meds & now the antibiotic & Leon takes Clomipramine for OCD.

Melanie,
I laughed at that! Right now Ozzi is taking insulin, deramaxx and tramadol. Abby is on doxycycline. Where are our drugs??? LOL
Kevin

optimystic

04-15-2010, 01:25 PM

k9diabetes

04-15-2010, 03:51 PM

I took Mischief in to get a curve done today. The vet had agreed to use our glucometer alongside theirs, to let me know how it compares. I'll post today's curve first, then the ones from the past.

April 15, 2010 w/ 2 cups food @ 5:15 a.m. & 17 units Relion NPH @ 5:25
8 a.m. 256 (vet's) 205 (Relion Confirm meter)
10- 248 214
12- 312 212
2 p.m. 360 271
increase NPH to 18 units 2X daily

The vet said she expected our human glucometer to register lower than the one they use, and this test proved her right. Apparently, this is not uncommon. I'm a little confused. I expected it to be a matter of our meter being different by more or less the same amount at each blood draw. With the differences being 51, 84, 100, & 89 (from earliest to latest) how do we decide what the difference is? By an average?
I look forward to getting some good advice from those of you with more experience.

This is actually a pretty good curve - it's flat enough that the insulin dose can be raised to bring all of the levels down.

So did they do the curve with an AlphaTrak meter?

Human meters do typically read the blood sugar lower than it actually is due to a difference in blood cells in dogs.

Quite a few meters will show a bigger difference between the reading and actual blood sugar levels at higher blood sugar readings.

Human blood glucose meters, even for people, are considered to be most accurate at lower ranges of blood sugar and less so at higher ranges so it's partly just a functional matter of how the meters work.

The range you got on the curve is pretty common for that meter so you can establish some general guidelines... maybe add 50 points to the readings if under 300 and 100 points to the readings if over 300.

In reality, you're not trying to nail the blood sugar down to single digits anyway. Whether the blood sugar is 320 or 360 isn't going to change any decisions the vet would be making about an insulin adjustment. So whether the meter reading is 100 points low or only 80 points low isn't a significant difference.

Among the things I liked about our OneTouch Ultra is that it was consistently about the same amount off regardless of how high the blood sugar was. Under 80, it was only about 20 points low, went to about 35 points low on average until the blood sugar hit the 300s and then actually got more accurate again, down to about 20. So I just routinely added 30 points for any reading over 80 and 20 points for readings below... but any reading much below I considered potentially too low.

Adding 50 to the readings below under 300 and 100 to the readings over 300 would bring you really really close to the values on the AlphaTrak.

It is better to check the blood sugar levels at the vet on an actual lab analyzer to be sure they are accurate as the AlphaTrak can also be off. Meter to meter comparisons aren't ideal. But they are a start. If you go in for any spot checks, you could ask them to do those on a lab analyzer and check your meter against it.

Natalie