Confused about dosage when switching to nph

[somersault]

Hello, new member here. I've looked through earlier threads but am getting more confused so I hope someone can help me with my particular question.

My dog Somer was diagnosed w/ diabetes in February. It took a couple of months to find the correct dosage of Vetsulin for her, only to learn it's now no longer available. We gave her the last dose of Vetsulin this morning, and this evening begin Novolin.

She was receiving 17.5 units of Vetsulin (U40 syringes), and the vet has said we should start her with 10 units of the Novolin (U100 syringes). I understand the Novolin is more concentrated, but I'm still concerned this amount is too small.

Please tell me your thoughts and experience..?

Thank you!

[Noodle]

Re: Confused about dosage when switching to nph

Hello and Welcome to you & Somer!

My dog, Noodle, started right out on NPH insulin, so I'm going to leave your question to the experts who have been though this. Just wanted to welcome you and bump your thread to the top to make sure it doesn't get missed.

[Patty]

Re: Confused about dosage when switching to nph

Hi and welcome to you!

We do have many dogs here that have made the switch to NPH so you'll find a lot of helpful advice.

The general recommendation is to reduce the current dose by 20-25%. So if you are giving 17.5u twice a day now. I would start with 13 units twice a day.

I'm glad you know to use U100 syringes. You can buy syringes with 1/2 unit markings as well to make fine tuning the dose a bit easier.

Do you currently home test?

Again, welcome to you!
Patty

[eileen]

Re: Confused about dosage when switching to nph

Welcome to the both of you,

My dog, Mildred, has been using NPH for close to 6 years now, was never started on Vetsulin.

Most others who have made the switch are finding amazing results. Will have to leave any advice to them.

One bit of advice that I can offer...if you don't already, it will be a huge benefit to learn to home test.

[CraigM]

Re: Confused about dosage when switching to nph

Annie switched from Vetsulin to Novolin-N a few months ago. The dosage for her has been just about the same. Most start at a reduced amount for safety, but make slight changes every few days as indicated by their readings.

Welcome, and let us know more about Somer: breed, weight, diet, home tested, anything you want to share!

[CarolW]

Re: Confused about dosage when switching to nph

I see you're getting a nice welcome and some excellent suggestions. Like some others here, my Kumbi was started out on NPH insulin (Novolin-NPH, which is similar to Humulin-NPH).

Here's an article (largely for fun) on the loveliest 0.3 cc capacity syringes ever (could be those, or other imitations of them) - short needles, half-unit markings, THIN needles - so comfortable for the dog!

http://www.coherentdog.org/vek/syringes1.php

For a LOT of silly nonsense (but I hope it's fun) - and to give you a kind of intuitive feel for the difference in fluid volume (big difference!) between Vetsulin and Novolin-N or Humulin-N, you can page through this series:

http://www.coherentdog.org/vek/merrymeasure.php

By the time you do that (even if you use the Fast-Track, which skips a lot), you should have a very intuitive feel for the tiny amount of NPH insulin you inject, compared to the much larger amount (fluid volume) of Vetsulin - to get the same number of units of insulin.

I liked Patty's suggestion of starting with 13 units twice a day. The reason it's not good just to give 17.5 - same number of units as with Vetsulin - is that the two insulins work somewhat differently, so the shape of the curve will be different.

Best not risk letting your dog drop too low with the blood glucose levels just because the insulins work differently.

Let us know if you'd like help learning to test for blood glucose levels. We'll jump in to help you out.

And, my own big, fat, welcome to you and Somer! (love that name!)

Sat, 17 Jul 2010 12:17:08 (PDT)

[somersault]

Re: Confused about dosage when switching to nph

Thank you all so much for the very warm welcome!

You convinced me of what I was thinking anyway, that we should start Somer at a little higher dose. My husband gives her her insulin and decided 12.5 units was the right starting point. So now we will watch her closely, and get a blood check on Tuesday.

We don't currently home test, although from my reading here I know most of you advocate it. Part of our reason for not doing it is uneasiness about pricking her ear, and whether the results are consistently reliable. We will, though, get her levels checked at the vet every few days until we're confident she's regulated again.

Somer (short for Somersault, aka too many nicknames to list!) is an 11-yr-old lab or border collie mix, black/brown with a patch of white on her chest, cute floppy ears, about 45 lbs, the sweetest and also most neurotic dog I've ever known, and she has quite a few health issues.

She came into our lives at ~13 wks old, when my husband saw her get hit by a truck (thus her name, Somersault). He rescued her, and had her broken leg fixed. Unfortunately, due to a vet error, her leg was instantly re-broken after healing. In her later years, we have discovered she has a number of orthopedic issues she overcomes through sheer spirit and will.

She was diagnosed with Cushings disease last Fall, and as a result we give her Rimadyl only sparingly.

We began feeding her Hill's diabetes support food about a month ago. She devours it, and it seems to be very good for her.

Her diabetic cataracts developed rapidly, and we couldn't bear to watch our already-lame baby falling and stumbling and bumping, so even though money is very tight she had cataract surgery in May. She's recovered from it very well, but one eye was beyond receptivity for a new lens, so she has trouble focusing on near objects. But I am SO grateful she can see!

Thank you all again for the warm welcome, and thank you for the links. I really appreciate your feedback, and your help!

[eileen]

Re: Confused about dosage when switching to nph

Aw, My Mildred is an 11 yo Border Collie mx too, also a rescue. Found her at about 3 months old.

I use Mildred's upper lip to draw blood for testing, have every single day for 6 years with no doubt in my mind that it is because of home testing that she is going into her sixth year as a diabetic.

I am a very strong advocate for knowing how to home test. It is something that, even if you don't choose to do it every day, can sometime save their life.

In testing at home we carefully watch trends, it is a very reliable way to monitor their diabetes. Especially with Cushings which can cause other issues with their diabetes. I assume she is on medication for this.

As I have often said, "a doctor wouldn't send a human diabetic patient home without instructions to test and just blindly give themselves insulin...why would we do any less for our dogs (and cats)".

Glad to hear that you have started with a larger dose.

Will be reading your thread with interest.

[CraigM]

Re: Confused about dosage when switching to nph

Somer sounds like a real cutie! If you have a digital camera, we would love to see her!

I think I'm one of the few that test on the ear. Annie takes the poking without a problem, but I read the inner lip is probably an easier place for most dogs. Annie is just too small, and my fingers too big to do the lip. I might try it again sometime, but why mess with success?

Wishing you the best!

[Patty]

Re: Confused about dosage when switching to nph

Love the name!

You can find videos of blood testing here. There are several different places you can try. Ali didn't like nor did she bleed very well from her ear.

http://www.k9diabetes.com/bgtestvideos.html

Patty

[somersault]

Re: Confused about dosage when switching to nph

Craig, I would love to share a photo, but I'm too internet-challenged to figure out how! I'll keep trying...

Patty, thank you for the video link and thank you to both you and Eileen for your encouragement. We will do some more research and consideration. Somer seemed to be perfectly fine once we got the vetsulin regulated so we haven't had much concern.

Carol, I've read some posts about your precious Kumbi. My condolences to you. It's a tragedy and a blessing we outlive our canines, and just as hard to lose them as to lose a human companion.

Thank you all again!

[CarolW]

Re: Confused about dosage when switching to nph

I loved your history of Somer. What great people you are, to give such a wonderful life to a dog, who otherwise, would have suffered and likely died.

I'd pointed you to Kumbi's favorite syringes, but if you get closer to 20 units than 15, you might find the next syringe capacity up - namely, 1/2 cc (instead of the 0.3 cc I described), more workable. You can always try out, and find out.

I DO like the 0.3 capacity syringes because you can get them with half-unit markings, and I haven't heard of any 1/2 cc capacity syringes that have those half-unit markings. Novolin-NPH is a very concentrated and powerful insulin, and even the drop or two that are about a quarter-unit's worth can be hard to measure if you don't have those markings. So for THAT reason, if you're giving 30 units or less, you could stay with the 0.3 cc capacity syringes.

That drop or two is with 31-gauge needles.

About locations for testing, I think most vets tend to use the ear. With cats, they generally use the ear, as it's not wise to risk cat-bites if they try the lip; besides; a cat's mouth is small, compared to a dog! Cat-bites are notorious for getting seriously infected, with very nasty consequences for the bite-ee. Likely you knew that anyway.

I LOVE using the inner lining of the upper "lip" - because it's relatively easy to get blood samples from that location. Also, there are very few nerve-endings there, so it doesn't hurt the dog. It's EXTREMELY rare for a dog to feel any pain if you use the "lip" for testing.

Do check out the videos on the k9diabetes main site that somebody pointed you to. It seems most, or many, people, use a device to "shoot" the lancet. However, I don't like the jarring for the dog, so I always pricked by hand, just placing the lancet-needle-tip, and then pushing, to the full depth of the lancet-needle.

Without the impact of the device, though, the hole made seems to be smaller, even though I sink the needle to its full depth, and there were times I had trouble getting big enough blood samples for testing.

I found that I had to warm the prick-site, to make sure to get a sample big enough, so I'd fold Kumbi's lip down over a very warm, wet paper towel and hold it there about 15 seconds, then blot dry, then prick. I also found I had to use 25-gauge lancets (some might use 26-gauge), to get a big enough sample. But it was heaven when I found 21-gauge lancets, because with those, I didn't need to warm the site. Simply, one prick, up comes the sample, apply the test strip (in the meter), and we're done!

My vet thoroughly approved of this method, using the 21-gauge lancets - but - after I went through nearly 200 of them, I couldn't get any more! So we went back to the 25-gauge, and used the warming again.

There's considerable detail - even excruciating detail - here, on the LipStick I used with Kumbi:

http://www.coherentdog.org/vek/bgtest.php

When I include links, I don't intend anybody to memorize the stuff, nor even necessarily use it - just to have a look and see what might be helpful; you can always go back and look again later if need be.

Oh - thanks for looking in on Kumbi's thread. Losing him was, of course, a very large blow to me. I have to say, my vets and staff were heroes, throughout. Just fabulous care for Kumbi, and great attention to my own well-being throughout as well. One of their best features is communicating with their clients - they teach thoroughly, and from the beginning.

I AM looking for another dog, but have to wait a bit while my landlord takes down the dangerous trees from the yard - and then while we get the dog-fence back up again and secure. I'm a real nut about having really secure fencing, as I like to let my dogs use the dog-door pretty much at will, and allow them to tear around the yard!

Certainly my dogs did a lot of that, and Kumbi continued to use his little trails right up until he died.

Thanks for your empathy. I do think forum members here have the most utterly solid senses of reality, and the most wonderful communication with their dogs; therefore with other dogs (and humans) as well.

Sat, 17 Jul 2010 19:31:06 (PDT)

[somersault]

An update on Somer

Thanks again for all your advice, suggestions, direction, help, support, and friendly welcomes, everyone!

Somer has been on the Novolin now for five days, and I just returned from getting her glucose checked at the vet. I thought you might appreciate the story I am still shaking my head about.

When the tech took her back, he asked me when her last dose was, and how much. I told him 6am, 12.5 units (and that yes, I am aware the vet prescribed 10 units). (She had been at 17.5 units of vetsulin, and based on the (albeit limited) research I'd done and your help here, we started her at 12.5 units of novolin rather than the 10 the vet had prescribed.

After a few minutes, the vet came out and asked me why we'd decided to give her 12.5 instead of 10 units. I told him I'd done some internet research and found consistent advice that the difference in dosage should be 20-25%, which in this case equals 13 to 14 units, but we decided to start in between his recommendation and that, and go with 12.5.

He proceeded to lecture me like I was 4 years old, utterly disregarding that the internet could provide information of any worthwhile value or reliability. Now mind you, I wasn't born yesterday, and I know a person must be discerning and discriminating about their sources of information. And I am. Which is why I know we made the right decision in upping her dose. I don't take my baby's health lightly.

He insisted we must always confer with him, whenever we have it in mind to deviate from his advice. Frankly, I found him to be much like most of the human physicians I've ever encountered, who seem to consider themselves among the ranks of the gods. And personally, I have found intuition and my personal knowledge of myself serves me better. When it comes to my dogs, I think the same is true. Doctors have their place, but they don't have the intimate knowledge that comes from living day in day out with ourselves or our babies.

Anyway, he continued on by telling me that while that 20-25% may be an average based on a sample of 20-25 dogs, only he knows Somer's unique needs and history. Granted that might be true, if he had ever demonstrated he remembers anything about her each visit beyond a cursory glance at her chart.

In the final analysis...? Somer's glucose level today measured 318. And he advised we should start giving her 14 units of insulin.

I'm not sure he even noticed the contradiction.

[Tikobird]

Re: Confused about dosage when switching to nph

Don't ya love it!

[Patty]

Re: Confused about dosage when switching to nph

It's frustrating when the relationship between dr/patient or vet/owner isn't viewed as a team.

I will tell you that I wouldn't raise from 12.5u to 14u. A new insulin can create a completely different curve shape. I would want to know how food/insulin are working together. And have a full curve done to know where the high and low points are.

The most I would raise is 1 unit at a time when you have a number in the low 300s. It's hard to know if all the numbers are above that or dropping quite a bit lower.

Take care
Patty