Still need help with Bailey

[waynorth]

Hi, I'm new here My Maltese, Bailey, has been diabetic for a year now after suffering from GME Encephalitis, which he kicked with a year of chemo and prednisone. The pred destroyed his pancreas. He was doing great on 7 units of Vetsulin twice a day, but in the past two months everything has gone haywire with his numbers. I know there is a recall on Vetsulin and I told my vet (who didn't know about the recall) and he said the problems were with previous batches, not the batches in recent months. I use an AccuCheck meter which has been tested with control solutions and it's working fine. I took Bailey in for a CBC and fulll panel profile and he's perfectly healthy, so the problem isn't there. In the past two months he has lost vision in his left eye and I'm desperate to save the vision he has left in the right eye. I test him often and here's an example:
400 before feeding in the morning (he can't stay down in the 200 range anymore 12 hours after his last shot) I feed him and give the shot and yesterday his seven units plummeted him to 34 within an hour of giving it!! I was rubbing Karo on his gums to bring him back up. Today he was 380 before his morning shot, fed him and gave the shot and an hour later he was 106. This afternoon when I get home he could well be 400 or more or some days he's at 138. His numbers suddenly are just all over the place and I don't know why as nothing has changed with his food.

I'm about to demand to be switched to another insulin, but what problems then will that bring on?

Does anyone have any advice or think it could indeed by the Vetsulin?

Thanks in advance!
Worried Mom!

[peggy0]

Re: All of a sudden out of whack!

Hi Baileys Mom. The vetsulin supply is gone with the exception of those who cannot be regulated on another insulin, so your vet is not informed and that is a worry to begin with. I'm assuming that you monitor at home given the numbers you have provided. Have you done a curve recently to see what Baileys numbers are over a 12 hour period? One of the vetsulin problems is that there are more long acting crystals and the hour after feeding could be an overlap situation with the insulin you gave at dinner time and the new insulin shot at breakfast.That would be my first thought. When my dog went low like that, he stayed higher for days. Their bodies release hormones to protect them against the low. I would definately tell your vet you want to switch to NPH or Humulin N. NPH is Walmarts generic version of Humulin and many dogs here have done great on it. My dog did not and I had to use Humulin N. He was regulated in 3 weeks and his BG was better than it ever had been on Vetsulin. There are many articles on the board here about Vetsulin explaining the issue. If the vet doesn't beleive it, tell him to go out to their web site. www.vetsulin.com. There is advise for vets and for dog moms . You will need a U100 syringe vs. the U40 you use with Vetsulin. This is very very important. Most folks here cut the dosage they are current giving by 25% just to be safe, so you would begin with 5.25 twice a day. The dosage on NPH usually ends up being the same as Vetsulin. Welcome to the board, and we are here to help you get Bailey back to normal. Ask as many questions as you need to!!

[eileen]

Re: All of a sudden out of whack!

The Vetsulin supply is very limited and being reserved for critical care cases. Intervet (the manufacturer of Vetsulin) has been telling veterinarians for months to switch their clients to another insulin...namely NPH.

http://vetsulin.com/vet/Vet_ProductAlert.aspx

You can use either Humulin N made by Eli Lilly or Novolin N made by Novo Nordisk. They are both NPH insulins.

Walmart's ReliOn Novolin N is NOT a generic NPH. It is made by Novo Nordisk and labeled ReliOn to be sold by Walmart or Sams Club at the discounted price. It is the SAME as other Novolin N that is sold in other pharmacies.

http://www.relion.com/information/faq-insulin.htm

There are NO generic NPH insulins. Just different manufacturers.

http://diabetes.emedtv.com/insulin/generic-insulin.html

My dog has been on NPH (Walmart's ReliOn Novolin N) insulin for almost 6 years now and has done wonderfully.

[waynorth]

Re: All of a sudden out of whack!

I am off tomorrow, so I'm planning to do a 12 hour curve myself with my meter. I talked to my vet today and he said since Bailey is so low one hour after his shot to drop the seven units to five, but I said that doesn't make sense if he's testing over 400 8 hours after the shot and even seven isn't sustaining him at a safe level for apparently very long.

With the twelve hour curve, would I start before his shot, record that, feed him and give the shot, and then begin testing at each hour?

Thanks for all the help! The year we battled GME encephalitis was long and expensive. I absolutely refuse to have something happen to him now!

Jackie

[Patty]

Re: All of a sudden out of whack!

I talked to my vet today and he said since Bailey is so low one hour after his shot to drop the seven units to five, but I said that doesn't make sense if he's testing over 400 8 hours after the shot and even seven isn't sustaining him at a safe level for apparently very long.

With the twelve hour curve, would I start before his shot, record that, feed him and give the shot, and then begin testing at each hour?

Jackie,
Yes, you would start with a fasting reading that's before food/insulin. Then if he's dropping so low one hour after his shot, if it was me I would test more frequently around this time period. Maybe at:
Fasting
30 minutes
1 hour
1 hour 30 minutes
2 hours
4 hours
6 hours
8 hours
10 hours
12 hours - fasting before food/insulin
30 minutes
1 hour
1 hour 30 minutes

You might be able to catch exactly what's happening that way.

However, it sounds like you already know he's in a pattern of dropping that far...

I test him often and here's an example:
400 before feeding in the morning (he can't stay down in the 200 range anymore 12 hours after his last shot) I feed him and give the shot and yesterday his seven units plummeted him to 34 within an hour of giving it!! I was rubbing Karo on his gums to bring him back up. Today he was 380 before his morning shot, fed him and gave the shot and an hour later he was 106.

I would tend to agree with your vet on this one as far as reducing the dose so there are no rapid drops to see if rebound is actually the issue. If the hormones are kicking in creating the highs as Peggy described, reducing insulin should be the answer.

But, because Vetsulin is no longer available and what's on the market is rapidly running out, I would seriously consider switching to NPH insulin.

Hope that helps,
Patty

[CraigM]

Re: All of a sudden out of whack!

Doesn't 7iu X twice per day sound high for such a small dog? Maltese are usually between 4 - 7 pounds?

Also, I THOUGHT insulin normally takes an hour, or longer, to kick in.

I'll be reading this thread and wishing you luck.

Craig & Annie

[waynorth]

Re: All of a sudden out of whack!

Bailey is ten pounds and I was told that because his pancreas is almost nonfunctional now after the high pred dosing for a year and his immune system doesn't function properly (the encephalitis was an autoimmune disorder) that he may need more than the average ten pound dog?

Once I do this curve, would it be ok if I post the results here to see what people think?

Thanks,
Jackie

[Patty]

Re: All of a sudden out of whack!

Once I do this curve, would it be ok if I post the results here to see what people think?

Absolutely

[CarolW]

Re: All of a sudden out of whack!

Jackie - a very huge welcome to you; I deeply trust you'll find this forum helpful. Of all the forums on canine diabetes I've been on, this one is by far the most accurate and useful (in my opinion, of course!)

Now, about Bailey - I thought Peggy and Patty and Eileen all gave you great info, and I have nothing in particular to add to what they said. Except maybe for one thing. If Bailey were my dog, I believe I'd make the change of insulin right now!

Don't know if you need a script from your vet - probably not for insulin, depending where you buy it, but you might need it for the U-100 syringes.

Dear Bailey - what a brave boy! And, what a FABULOUS Dog-Parent you are! Keep up the great work!

Forgot to say - yes, by ALL MEANS, please post his numbers! Have a look around the forum, and you'll see most of us do that! I'm curving Kumbi today, and getting STRANGE numbers!

Mon, 10 May 2010 15:27:09 (PDT)

[waynorth]

Re: All of a sudden out of whack!

I'm going to start the curve tomorrow morning, but this afternoon I had to come home from work and leave quick to make an appt. and I didn't want to not be here in case he dropped too low again with me gone. I tested him before the shot and food, which was twelve hours since his last one and he was at 420. My vet said lower him to five units from seven. I only gave him three knowing I would be gone. I tested him two hours later when I got home and he'd already dropped to 62 in just two hours. We have just never had this problem before. I think it has to be the insulin and I'm calling tomorrow to be switched even though I plan on doing the curve. That might give me more ammunition to present to my vet who is being very stubborn about this for some reason. I live in a very small town and there is not another one to go to for a second opinion.

I just started reading about the "rebound" which I knew nothing about and I don't know if it applies to him or not because we aren't increasing insulin, we're decreasing.

Thanks so much for the info. No problems solved yet, but I feel better already. I love this little guy so much and he fought a brave battle with the encephalitis - three kinds of chemo, MRI's, high pred to bring down his brain inflammation for a whole year. When that hit so fast, he was spinning like a top (circling) and couldn't stop, went completely blind (his vision came back) and didn't know his foot from the foodbowl. The vet here gave him a week, but I found a Dr. in Boston who has pioneered new research into this disease and he was Bailey's miracle.

I will post the curve results tomorrow. Thanks again everyone!
Jackie

[CarolW]

Re: All of a sudden out of whack!

Jackie,

I look forward to your next report.

Special hugs to you and Bailey.

Mon, 10 May 2010 15:58:07

[k9diabetes]

Re: All of a sudden out of whack!

Hi Jackie,

Please do move forward with switching to NPH. You can show the letters by Intervet, which are nearly begging vets to make the switch as they know supplies will run out to the vet. Especially point out the later ones in February or March where they make it really clear that vets need to be switching over.

You can download them here: http://vetsulin.com/vet/Vet_ProductAlert.aspx

At the bottom of the page are links to PDF copies.

NPH is a wonderful insulin for dogs and nearly all of the dogs here who have switched have been completely successful. So far, we have just one dog who can't use NPH and will need the Critical Supply program. There are some vets who have just never used it. But they undoubtedly used Humulin L in the past, which was human insulin too.

As far as Bailey's blood sugar...

It could be that Bailey has been rebounding for several months now because, for whatever reason, he needed less insulin than he was getting. And that rebound is the cause of his crazy blood sugar.

The really confusing part is that rebound can throw the blood sugar off for as much as 3 days after it occurs.
The best way to make sure rebound isn't involved is to cut the insulin as the vet has asked you to do, let things settle for at least three days and then do a full curve to see what the food/insulin balance is then like.

So your curve tomorrow could show high blood sugar that is partly a remnant of the last rebound. If the blood sugar is all high, I wouldn't assume that 5 units of insulin is not enough. I would want to see readings three to five days after the reduction.

The other thing I wondered about is the eye - is it definitely just a diabetes induced cataract?

The cataract itself tends to be inflammatory and that could be changing Bailey's insulin requirements and pattern. Or there could be something more serious going on since typically diabetes induced cataracts occur in both eyes more or less simultaneously.

The cataracts should be treated to control inflammation with eye drops, preferably nonsteroidal ones as the steroid versions can raise a dog's blood sugar even though there's limited contact with the bloodstream.

Do they feel his pancreas is still able to generate digestive enzymes?

Natalie

[k9diabetes]

Re: All of a sudden out of whack!

I just want to make sure I understood you - you gave only 3 units of insulin and Bailey's blood sugar fell to 62?

When did he go off of the prednisone?

If I understand it properly, then his insulin dose would need to be even less than 3 units to avoid rebound.

But I may be confused!

Natalie

[waynorth]

Re: All of a sudden out of whack!

He went off prednisone four months ago. The neurologist in Boston is the one who determined the cataract is diabetes related. It's just been in the past two months that it's gotten bad and that's when Bailey's numbers began to fluctuate. A high white count is an indicator in him that the GME (encephalitis) has returned and his CBC the other day showed a normal count. That is always a concern.

His lipase level is always high. He was hospitalized for ten days with acute pancreatitis after a high pred dose needed to bring his brain inflammation down during a relapse he suffered while on chemo. Right after that he began needing insulin.

I did his first fasting test at 3:00 AM and it was 514. I knew it would be high after only the three units I gave yesterday, but it has been that high before on seven units.

Thanks for the info on rebounding. I'm going to read more about that today.

Jackie

[waynorth]

Re: All of a sudden out of whack!

Now I'm not sure what to do. We began the fast test at 3:15 and he tested at 514. I gave him five units and fed him. At 4:15 he had dropped to 247. Just now at 5:15 he tested at 87. I may do it again in half an hour because I don't want it to drop any lower. If it does and I have to give Karo again, that will mess up the curve for the rest of the day won't it?

Thanks,
Jackie