Change in dose, how long to see impact?

[LLS8000]

Sam, my 14 year old miniature poodle, was diagnosed with diabetes on 5/12, started injections on 5/14. It's been going well, but it does seem that injections are becoming more difficult, but certainly manageable. Tonight, he ate all of his food, he's always starving. Then I gave him his insulin dose, which seemed to go fine. About an hour later, I let him out in the back yard. He was out in the heat (low 90's and humid) for about 30 minutes, and started stumbling. Husband grabbed him, and I grabbed the Karo syrup. We got him into the house, with the AC on. He licked up the syrup, and I gave him a few organix treats. He seemed better fairly quickly. I'm glad I was home, and noticed the stumbling pretty much right away, this is our first hypo episode. We're early on in the regulation stage, and the vet is taking him on Friday to do official curves. He seemed to be doing so well.
I'm sure it could be many things at this point, but does anyone else notice heat having an impact on your pet? That's the only thing that I can point to that was different tonight.
Still keeping an eye on him tonight. Thanks.

[Patty]

Hi and welcome to you and Sam!

So glad you knew what to do in the event of a hypo and that you'll be keeping an eye on him. Heat, exercise, sunbathing can all increase circulation which can increase insulin absorption. You may want to consider decreasing Sam's insulin a bit.

Let me ask a few questions to help us better help you:
- How much does Sam weigh?
- What type of insulin did your vet start Sam on? 2 injections? 12 hours apart?
- What dose is he currently on?
- What are you currently feeding?

Glad your vet is doing a curve Friday :) One of the greatest things I did was learn to home test my dog's blood sugar. It will truly give you peace of mind and allow you to manage your dog's treatment better.

If you are up for it take a look at the home testing information here: http://www.k9diabetes.com/monitoring.html as well as the videos of testing: http://www.k9diabetes.com/bgtestvideos.html. You can use a human meter to test your dog's blood. Most will register a bit lower than the actual value due to the difference in a dog's red blood cell. But you can do a comparison by testing as you normally would at home with a sample your vet runs on his lab machine to know how far off it is.

It's a lot to take in at first. Feel free to ask questions as they come up. :) Again welcome!
Patty

[LLS8000]

Thanks, for the additional info. It makes sense that the heat would have an impact, his reaction just seemed so early after his nightly feeding, I didn't expect to see a hypo reaction until much later after feeding. That through me off. I'm fairly sure my vet was trying to not overwhelm me with too much info early on, I didn't take the diagnosis very well. But we're doing ok now, and ready for more info. :) I'll likely reduce the dose just a touch in the morning, and call the vet in the morning too. He seems much better now.
Here are some additional details.
He weighs 13 pounds. He's on Humulin N. 2 injections, 12 hours apart, 6 Units twice per day. He's on food from the vet, DCO. I've been feeding a heaping 1/2 cup twice a day. Was feeding just the 1/2 cup, but he's still really hungry. I'm recognizing that I need to do some more exact measuring of his food, for consistency sake. Thanks again!

[k9diabetes]

Yikes! Is that truly 6 units per injection so 12 units total for the day?

If so, 6 units in a 13 pound dog is an awfully high starting dose and potentially way more insulin than he needs. I'd cut it in half at least.

There's no way you could have gotten to that high a dose this quickly if his dose was being moved up carefully.

So I'm worried about him and future hypos.

Also, DCO has not always been a good food among diabetic dogs here and can be causing large swings in blood sugar.

I'm going to email you when I hang up here in hopes you get this message. I'm hoping I'm wrong but if you truly are giving 6 units per injection, that dose really needs to drop down to about 3 units tomorrow and then we can talk more about how he got to that level of insulin.

Natalie

[Patty]

He weighs 13 pounds. He's on Humulin N. 2 injections, 12 hours apart, 6 Units twice per day. He's on food from the vet, DCO. I've been feeding a heaping 1/2 cup twice a day. Was feeding just the 1/2 cup, but he's still really hungry. I'm recognizing that I need to do some more exact measuring of his food, for consistency sake. Thanks again!

I have to tell you personally I am concerned about a newly diagnosed dog that is 13 pounds and on 6 units of insulin twice a day. The typical starting dose is 1/4 unit per pound of dog which would be 3 units.

I would reduce his dose to 3 units and watch him carefully.
Patty

[LLS8000]

Thanks so much for the info. I'll reduce the dose and call the vet prior to giving him his morning dose. I double checked his script, and it says 6U twice per day, and when I went in for the shot demo, I know the tech also showed how to give 6 units. I feel that someone (the vet) may have made a very dangerous mistake when he wrote the script.
Again, thank you!!! -Lisa

[CarolW]

Hi Lisa,

Yes, that dose - 6 units twice daily, for a 13-pound dog, as a starting dose, is truly scary. I guess maybe Natalie reached you by email; I hope so.

Indeed, do call your vet in the morning, but also, under no circumstances would I give more than 3 units in the morning.

It does look as though your vet miscalculated the dose. I've heard of that happening before. Very sorry it happened to you and Sam.

And yes; by all means, measure the food with care; you may also need to look at a possible change in food, which you would make gradually, so as not to upset Sam's tum.

Diabetic dogs are, indeed, always hungry till their glucose levels begin to come under better control; you'll be glad to know they then tend to settle better, and not feel starving all the time.

The idea of 3 units makes sense. Please keep us posted. I'll be here watching and cheering you on.

Tue, 25 May 2010 02:12:50 (PDT)

[LLS8000]

I tried to call my vet this morning, but none of them were in yet. I talked to a tech, and she'll have the vet call me later. So, I fed Sam his normal portion and gave him 3 units. Then I had to go to work, but can likely stop home at lunch to check on him. He seemed fine this morning (prior to food and injection), he ran up and down the stairs, went outside, was excited to eat, just like normal.
Thanks again everyone! –Lisa

[CarolW]

Lisa - thanks for reporting; glad Sam is okay for the moment. REALLY appreciate you letting us know. Sam should be okay on the 3 units, but I'm glad you can check on him later.

We'll be watching for your next report.

Tue, 25 May 2010 06:50:39 (PDT)

[k9diabetes]

I'm so glad you got our messages! :)

I wondered if they mixed up kilograms and pounds - saw a recommendation maybe for 0.5 units/kg and read it as pounds instead. 0.5/kg would be 3 units and I definitely would not want her to started any higher than that. Some recommendations are to start 0.25/kg. (Thirteen pounds is 6 kgs.)

Natalie

[LilyBell]

Lisa,

How are you doing today? I really feel for you because I was in your shoes a couple of years ago. My vet prescribed 21 units, once a day, of vetsulin for my furbaby. She is now with a different vet and has settled into 6 units twice a day. I'm SO glad you found this forum when you did. I didn't find help until after a very scary trip to the emergency vet where we almost lost her. The people on this board know what they are talking about, trust them. I liked and trusted my vet for many years before this incident, but he did NOT know a thing about diabetes. Please keep us posted and ask about anything that comes to mind. Once the shock wears off, you'll find diabetes can be controlled and managed. We've been at it over two years now.

Take care,
Tricia

[LLS8000]

I finally caught up with the vet yesterday. I explained what had happened, and she said that she couldn't be sure that the hypo wasn't caused by the heat. Told her that I gave 3 units yesterday morning, and she confirmed that I could keep him at 3 units. It's like she just said, yeah ok, and moved on. I'm thinking, "Isn't the dose super super critical...? I just told you that I cut it in half, and you don't want to discuss that, explain the reasoning behind 6, or try 4 of 5 units...?" I should have said something, but I think I was more shocked than anything. Anyhow, I'm now giving 3 units. He still seems fine, but will keep an eye on his drinking. And I'm starting to investigate home monitoring. Thanks to all of you who are SOOO knowledgeable, caring, and helpful!

[LLS8000]

Thanks Tricia. It is overwhelming right now, but just taking it one day at a time. I'm not sure if I'll be changing vets, it's difficult to know at this point if we'd be moving to someone with more knowledge or not. The clinic we go to, actually has four vets on staff, I'll certainly be calling and pretending like I'm a new client, and asking if any of them specialize in diabetes care. ;) I have a few other options in town too. So, it's probably worth checking out. Thanks again!

[peggy0]

I'd be very careful with this vet, as I'm sure you are. Making a mistake is one thing; not admitting to it is another. Home monitoring will put you in control which is where you want to be

[Tikobird]

Why is it so hard to find a vet who understands what these "fur babies" mean to us?? Wouldn't you think at least one of the reasons people become vets is because of their compassion for animals???? I know they are out there but they seem to be difficult to find!

[LLS8000]

Hi everyone – My 15 year old miniature poodle was showing signs of being ‘not quite right’. He was diagnosed in May, and has been fairly stable until about 3-4 weeks ago. He’s 13 pounds, and has been getting 3U twice/day. Feeding ½ cup DCO twice/day, with a treat (usually liver treats or chicken jerky) after injections.
He’s been thirsty again, and has had a few accidents in the house at night. I’ve seen very slight signs of clumsiness just a couple of times, but he’s never been a very graceful dog. I took him in for a curves yesterday and just over an hour after his insulin dose he was at 68. The vet gave him some food at that point. These are his numbers: 8:15 68, 10:15 270, 12:15 369, 2:15 330, 4:15 317.

So, now the vet is suggesting that we try 2U twice/day, out of fear that Sam’s rebounding. My question is how long can I expect it to take for him to adjust to the change in dose, so we can determine if what we are seeing is a Somogyi effect? Vet mentioned leaving him at 2U for 10 days. That’s a lot of nights that I’ll be up cleaning urine off the bedroom carpet. Not that Sam’s not worth that, but…

I know I should home test, and will start looking for a monitor. I’ve been reluctant because I’m not sure how well he’ll tolerate it. Thanks for any input, Lisa

[eileen]

Lisa,

The 'signs of clumsiness' could very well have been low glucose levels.

Once the vet gave your boy food after seeing the low 68 all readings to follow were thrown off and not as they would have been, obviously without that added food.

It's usually said that it takes 6 doses or 3 full days to begin seeing the effects of an insulin change...then a week or two for it to really settle in.

It sounds very likely that you were seeing rebound...by the peeing and the reading of 68.

You said it best....the very best thing you can do is to learn how to blood test at home then you can easily find the answers to so many of your own questions.
You'd be surprised how well they tolerate testing but important that you go into it with a very upbeat and positive attitude.

[k9diabetes]

Hi Lisa,

It's nice to see you back here and to know that he's done well on 3 units for a while.

Is he still eating DCO?

A new curve will be needed - we can't say a lot about how well his food and insulin match from the one at the vet because of the extra food they had to give him.

Sometimes the food and insulin aren't well balanced. DCO and other foods like it are intended to be digested slowly and release small amounts of glucose from the food into the bloodstream over a long period of time. It could be that his insulin is being absorbed quickly, before the food gets going, causing the blood sugar to dip shortly after his injection to a low level.

If a curve shows that to be the case, it's possible to add some quickly digested carbs to his meal and perhaps cut off that dip in blood sugar.

Also, you can get syringes with half unit marks, which are really nice when you're working with small doses of insulin. Cutting a 3-unit dose by a whole unit is a 33% reduction in his insulin. With the syringes with half unit marks, you could adjust by half or even quarter units. I used to do quarter unit adjustments with Chris, who got between 7 and 8 units per injection.

It sure would be great if he would go for home testing. Most dogs tolerate it really well and you would have so much more information about how he's doing. I suspect personally that 2 units won't be enough and 3 will be too much.

The effects of a rebound take a minimum of two to three days to subside and then it's good to let the new dose just kind of settle for three or four days after that. Whether waiting 10 days is too long will depend on how close 2 units is to the right dose. If it's not nearly enough and his blood sugar is just high, high, high all the time, I wouldn't wait that long.

But if it's a better dose for him, he should stop having accidents and do better. So see how it goes and get in touch with the vet if it's not going well.

Natalie

[pgcor]

Hi Lisa:

I read your posts and wanted to let you know about something. I have been taking care of my diabetic for 3 years and have not been able to blood test at home.

Recently we changed Vets (for the 6th or 7th time, can't even remember). This Vet prescribed a cream we put on the area we intend to prick with the lancet. My dog is extremely hyper and it seems to be helping quite a bit.

I know you're overwhelmed right now, and I wish I could take that away from you. With time, you will feel better.

When and if you decide to test at home - and if Sam is hyper - you may want to keep this cream in mind. It's lidocaine and it temporarily numbs the area so you can test without pain!

Good luck Lisa!!!!!

Pam

[LLS8000]

Thanks to all of you for your advice and support. Sam seems to be doing ok so far on the lower dose. No accidents, not drinking like crazy, it’s a good day. :)