Cara

[Cara's Mom]

I am new at this...so here goes:
2 weeks ago my 8 yr old English Setter, Cara, was diagnosed with diabetes and the world came tumbling down. The vet put her on new diet, new schedule and insulin, after a very traumatic 2 1/2 days in hospital. Cara was very, very upset and barked for hours!!! They let her go home and I started her insulin (Caninsulin, same as Vetsulin) 4 units twice/day. No problem there.
Her problem is she refuses to eat, mainly her first meal of the day. There is a trace of ketonen in her urine. Her glucose per yesterday at noon was 20.4 (we are measuring in mmol/l in Canada) Sorry, don't know what it is in mg/dl!
Have to go to vet for BG reading, so bought glucose meter yesterday (AlphaTrak for animals) and will do it myself Ofcourse I am little nervous drawing the blood(while it's just a little lancet!) and that makes Cara jumpy too. Have had no luck this morning, but will try again this afternoon. Any suggestions how to make this easier on the both of us?
Because of her refusal to eat, I can now start a store selling petfood :o !
But I always have Polly, (Cara's real mom) who will eat anything!
Would like some input from you, who have had to deal with this for awhile.

Thanks for listening!
Marion

[We Hope]

Hello, Marion!

First of all, what does Cara weigh? She's a full-grown English Setter and this seems to be a VERY small amount of insulin for her, even for starting insulin therapy. The old Intervet suggestions were for 1 unit (IU) per kg of body weight plus an extra unit. The new starting dosage is now for 0.5 unit (IU) per kg of body weight-- one-half unit of insulin for every 2.2 lb of body weight.

http://www.vetsulin.com/PDF/Vetsulin_Dear_Doctor_Letter.pdf

The daily dose of insulin Cara is getting now was the daily dose for my 4.5kg/9.9 lb Lucky; you can see from his photo he was not a big fellow. This kept his bg's at 4.7222 mmol/85 mg/dl 8-10 hours after breakfast and the first 4 units of insulin.

http://www.childrenwithdiabetes.com/bs_conv.htm

Here we have a handy bg converter which converts mmol to mg.dl and vice-versa. Measuring as we do here (and we seem to be the ONLY ones still doing it this way! :) ), Cara is at 367.2 mg/dl.

When you are seeing glucose in the urine, it means that she's over the renal threshold and staying there for periods of time:

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

"Urine only tests positive for glucose if the blood glucose concentration remains above the renal threshold for a substantial period of time. This occurs when glycemia reaches 180−220 mg/dL (10−12.2 mmol/L) in the dog."

Since she's not eating well, we don't have a lot of food going in which might account for yesterday's glucose reading. I do think Cara needs to get more insulin than she's presently receiving; when you post her weight, we can calculate what might be a proper starting dose so you have an idea.

I'd like to ask you to notify your vet about the trace of ketones in her urine if you haven't already. What we want to do here is to make sure Cara is receiving enough insulin so that they don't become worse, thus an emergency, and that they will disappear entirely.

Quite a bit of the time when they are running high, it's hard to get them to eat. What is Cara supposed to be eating and not? It's a problem because when they're not eating right, you can't give the full dose of insulin because there's no food there to handle it.

What was Cara eating before she was diagnosed and is she willing to eat that now? If so, you might be able to go with that in lesser proportion and start "sneaking" the prescribed food into that mix--a little more every day until it's all new food.

Some dogs will eat if you add low-salt, no fat chicken or beef broth to their food. Some will eat their food with a little low-carb, low fat baby food added to it; most of them like chicken. For others, it's chicken breast, and so on. You can heat up the broth or baby food; dogs eat with their noses and you want to make the meals smell as appealing as possible. Heating them up adds to the tempting aroma.

Please tell us more so that we can try to give you more help with Cara!

Kathy

[Cara's Mom]

Hi Kathy!
Thanks for your reply.
Cara is 22.4 kg. Lost 2 kg since diagnosed. She is supposed to be on high fibre, low protien diet. Before she became ill, she was on mainly fresh veggies, cooked chicken and chicken broth, with a 1/4 cup of Science diet adult. Snacks were carrots, halve apple. I have her back on Science diet and do bribe her with the chicken and veggies. Have no problem with her at night, it is only the mornings she is such a problem baby. Her morning meal is at her normal time, but evening meal is 2 hrs past her normal time. Vet is not in favour of mixing food...wants het to eat only high fibre with maybe little broth. No change!!!
Phoned vet Re: insulin......will be raised to-nite to 5 units. However, that is still very low, is not it? Looking for new vet?

Marion

[k9diabetes]

Hi Marion,

Welcome! I know you'd rather not have to have all these questions but we all can assure you that this "first part" is the hardest part. Once things get sorted out and Cara's feeling better, you will be able to look back on this time and smile, knowing that it was just a little bumpy transition!

Insulin

22.4 kg puts Cara at about 50 pounds, so yes, that is an extremely small dose of insulin for her size. Do you know if there is a reason why the vet started it so low?

A very general guideline (our dog did not fit the guideline, needing a lot less insulin) is 1/2 unit per pound, or about 1 unit per kilogram. That's average... some dogs need more, some less. That would put Cara as potentially needing 25 units of insulin per injection.

There can be a very wide variation. I know of 25 pound dogs who need 25 units of insulin per injection and our 60 pound dog, who needed about 12 units.

So perhaps the vet is acting from an abundance of caution but I wouldn't want Cara to be strung along for weeks on such a small amount of insulin. Your test readings should be a good argument for her needing more.

Food

The high-fiber lowfat diet was the mainstay of diets for diabetic dogs for years but we have seen that it is (1) often not necessary as insulin and food can be well balanced on many types of diets, and (2) it is not necessarily a diet that works well with Caninsulin.

Caninsulin can have a pretty potent effect during the first couple of hours, apparently because the insulin, which is an exact match molecularly to a dog's own insulin, can be metabolized fairly quickly. The lowfat, high fiber diet was designed to delay the absorption of the glucose from the food. And sometimes it's delayed so long that there's no food there when the Vetsulin needs it.

So...

When it comes to diet, I don't like to see vets be rigid about going to the lowfat high fiber, ESPECIALLY if they won't eat it! Sure doesn't do any good that way. The diet you were using with Cara might work just fine. Time and testing will tell. And if it doesn't, there are many many other diet choices available. I did a poll once before... guess I should do it again. It will give you a chance to see the wide variety of diets the diabetic dogs here are being fed.

Vet

It's not uncommon to need a new vet when it comes to diabetes. We had to change not too long after Chris was diagnosed because the first vet was unwilling to be flexible on the type of insulin used. The one we started with just wasn't working for Chris.

Primarily, you need a vet who is open to new approaches and human-based approaches to treating Cara, who listens to you and takes your concerns and desires for Cara to heart, and who is willing to go out and consult/research problems.

Then, the more you can understand all this yourself, the better off Cara will be. Eventually, we no longer needed the vet at all to manage Chris' diabetes, thanks to a long time learning and testing. That's not for everybody but it sometimes is needed, especially if your veterinary resources are limited. I'll go back, too, and see where you are in Canada and see if we know anyone who might be able to refer you to someone they like.

Hope you've had a chance to peruse the information pages...

www.k9diabetes.com (http://www.k9diabetes.com)

They will help you get through the basics of managing Cara's food and insulin and there are many links there as well.

This time really is scary but Cara can have a normal healthy happy life and lifespan with good management.

So try not to worry! We are happy to help you any way we can.

Best,

Natalie

[rhodesian46]

Hi Marion,
Welcome I also have a dog with diabetes but also has cushings and is hypothyroidI would try to keep her meals 12 hours a part or close to that Carrots are a little high on the glycemic index I would limit those What about some green beans You could try puree frozen green beans with say 1 c and 1 c of water and put some in her food And be consistent with your food. Pebbles was on Purina DCO(script food) It worked well for her until about 3 weeks ago she had a bout with pancreatitis and was switched to Purina OM She is ona human insulin that I get from Wal Mart for $21.96 It is Relion Novolin N I get 2.5 more insulin than the Vetsulin so it lasts longer A lot of dogs do really well on this No script needed Different syringes than the Vetsulin U 40. A box of syringes at Wal MArt is $13 compared to the U 40 Vetsulin at $30. You may want to check into that Also please make sure that you are comfortable with your vet and he is knowledgeable in Diabetes. I made the mistake and thought mine was and OMG I learned the hard way Keep a file on your dog with all tests and notes just in case you need this for an emergency If Cara has elbow callous you can get blood from there The Alpha trak's strips are real expensive ( I have one) I only use that if I am suspicious but generally use a human meter called One touch ultraYou can bring the human meter to the vets and compare bgs from his lab and yours This way you kinda know what her Bgs are throughout the day At first Dx a year ago I was testing at fastings and did weekly curves at home An increase will take about 3-5 days to work I know too much info I was overwhelmed at first All will chime in shortly You will get it. Bit if you have a bad feeing about your vet Run and find another one Don't be afraid to ask a new vet how many cases he has treated and if he has used human insulin. For me the cost of Vetsulin would be astronomical!

[Dollydog]

Hi Marion,
We're in Marathon, ON, just 3 hours east of Thunder Bay. My Lady became diabetic while we were living in Nevada...she had been diagnosed with Cushings just a year before the diabetes. We've had quite the journey to get both diseases regulated and it can be quite a struggle at first. Diabetes is definitely a challenge and can be very frustrating.
Lady had no problem eating her meals when she first became diabetic but did after a couple of months. I had tried to introduce some high fiber food in with her other food and she liked it at first. But somewhere along the line she caught on that I was desperate for her to eat in the morning and would do anything to coax her to eat. She would sit back and wait and watch while I would spend 45 minutes putting different things with her food to tempt her to eat it. There was never a problem with her evening meal and it was the same food!! We eventually came up with something that she would eat every morning and the problem went away. I also have discovered that if she's not that keen on her breakfast at injection time she will eventually eat a couple of hours later. But it rarely happens now and if it does I just give her some of the dog food that she will always eat no matter what! I understand about having enough food on hand to start a petfood store!!

I can't add anything to what Natalie and Kathy have already told you, except that I've been reading Natalie's posts for 18 months and if there's anything that she doesn't know about diabetes...it's not important. She should be teaching mandatory courses on diabetes for vets. ;) Her care for her dog Chris (who just passed away at the beginning of August) is absolutely awe-inspiring.
As for changing vets, members here can give you a good idea if you need to do that. The Nevada vet and his clinic were awesome and we were very spoiled. I like the vet in Thunder Bay but the clinic is too big and we don't fit them very well! :rolleyes: But they're learning :p

Lady is 15.5lbs and is currently on 13iu's of Caninsulin in am and 13.5 in pm. She eats a mixture of food, some canned, some dry and some human. She takes Trilostane for the Cushings, plus Metacam, Milk Thistle, fish oil and Cosequin. She is a 12 year old Australian Terrier, with emphasis on the terrier part!
I'll check back later to see how you're doing, take care,
Jo-Ann & Lady :)

[Cara's Mom]

Thanks Natalie, your way of thinking and mine are rather simular. But me being so new at this, I was not sure that my thinking was right!!! My vet is very rigid. There is only one way of treating Cara and that is her way. Have already contacted other vet, will see him on Monday. In the meantime going in to my vet in next half hour to have a talk.
Thanks again,
Marion

[Dollydog]

Hi again,
I've just read Marianne's post after sending mine. Some of the rules regarding the buying of insulin and syringes are different in Canada than in the US. Some things are easier to get and some are harder and I can't remember which ones are which. I know where to get supplies for Lady but our situation gets complicated because we live 200 miles(300km) from a vet clinic and a pet food store and we have to pick up her trilo in the US.
TTYL

[k9diabetes]

I don't know anyone in Calgary but with such a large metro area I imagine you have quite a few choices.

There are some pretty good manuals on treating diabetes in dogs. One is put out by the makers of Caninsulin and I have only a few quibbles with it. It's for vets but is not jargon heavy and I find it very useful, plus your vet(s) should view it as authoritative :

http://www.vetsulin.com/PDF/20585.pdf

Next is also a good article on treating diabetes. I've opened it at the page where it describes how to start treatment on a nonketoacidotic dog. Presumably Cara either is not or is over being ketoacidotic... it is an interesting little software set up that let's you page through the article like a magazine and you can download it as an exe file to save as well:

http://www.nxtbook.com/nxtbooks/advanstar/vm0907/index.php?startid=608

On page 612, it discusses diet and how prescription high fiber diets are not necessary.

http://www.nxtbook.com/nxtbooks/advanstar/vm0907/index.php?startid=612

You may have better experience with diabetes working with an internal medicine specialist... although they are more expensive and not always better.

Good luck with the new vet! Persevere until you find someone you can work with who will treat you as a partner in Cara's care. NO ONE will know Cara the way you do and with diabetes that's an essential point of view that the vet should never overlook.

Would love to see a picture... :)

Natalie

[Debbie & Apollo]

Hi Marion and Cara!

Just wanted to say hello -- I really can't add much except to say that when we first started this journey with Apollo eating was tough!
and yes the AM feeding was the hardest!! -- I believe the memory of the good old days was stronger than the hunger urge.

We spent a lot of time on the floor coaxing! No problem now :D

It gets easier!

Debbie and Apollo

[Cara's Mom]

Thanks Natalie!
Boy you guys are a "God sent"! You have no idea how much better I feel with all your info and advice!
Would love to post a picture, however do not know how yet. Will find out in near future!

[Cara's Mom]

Hi Debbie and Apollo,
Good to hear someone has had the same problems as we do right now! It is so nice to know you're not alone in this, with all you beautiful people and your problem babies sharing your experiences.

Marion

[Cara's Mom]

Hello everyone! If I missed anyone with a reply, I am sorry...I was overwhelmed by your support and advice! Cara says Thanks and so do I!!

Had a vet appointment this afternoon....we had a good talk...and we said "Goodbye" but not after she did BG reading...23.1.

Stopped at pharmacy on way home and found a nifty device to prick for blood..bought it and used it at home and it worked! Same reading as vet. It works almost like an eppy pen. You must know it, it's made in USA!!! Called "one touch Penlet Plus."

Went back to Cara's old food. Raw green beans, broccolli, chicken and 3/4 cup of dry. You should have seen her eat!! It was a joy to watch. Nose went down in her food and did not come up until bowl was empty. After that she got 5 units Cansulin. Phoned new vet about her dose. He told me she should be on 5 for 3-4 days and after that she could go up 6 or only 10%(that would make it 5.5.units)depending on her BG.
I have a bit more fait in everything now, thanks to you all!
Now I am going to look at all those websites you all mentioned.

Will keep you informed!

Marion and Cara Mia

[Debbie & Apollo]

I quote :

" Stopped at pharmacy on way home and found a nifty device to prick for blood..bought it and used it at home and it worked! Same reading as vet. It works almost like an eppy pen. You must know it, it's made in USA!!! Called "one touch Penlet Plus."

but here's the funny part -- if it's made in the USA we probably dont' have them in the stores! :D
all of our things are made in China :rolleyes:

I will look for it however -- thanks for the suggestion.

Debbie and Apollo

[Cara's Mom]

Debbie,can always sent you one!!!

[Cara's Mom]

Oh, you use it on the ear!

[We Hope]

Hello everyone! If I missed anyone with a reply, I am sorry...I was overwhelmed by your support and advice! Cara says Thanks and so do I!!

Had a vet appointment this afternoon....we had a good talk...and we said "Goodbye" but not after she did BG reading...23.1.

Stopped at pharmacy on way home and found a nifty device to prick for blood..bought it and used it at home and it worked! Same reading as vet. It works almost like an eppy pen. You must know it, it's made in USA!!! Called "one touch Penlet Plus."

Went back to Cara's old food. Raw green beans, broccolli, chicken and 3/4 cup of dry. You should have seen her eat!! It was a joy to watch. Nose went down in her food and did not come up until bowl was empty. After that she got 5 units Cansulin. Phoned new vet about her dose. He told me she should be on 5 for 3-4 days and after that she could go up 6 or only 10%(that would make it 5.5.units)depending on her BG.
I have a bit more fait in everything now, thanks to you all!
Now I am going to look at all those websites you all mentioned.

Will keep you informed!

Marion and Cara Mia

Marion,

Your new vet is right about the insulin. When you start increasing too much or too quickly, you can easily borrow trouble like Somogyi rebound:

http://k9diabetes.com/forum/showthread.php?t=203

You can always adjust the insulin to the food Cara's happily eating. People with diabetes do the same thing--they adjust their fast/rapid acting insulin to cover their meals.

The ear isn't the only place you can do bg tests. We have a lot of links at this thread, including an AlphaTrak video of "how to" for the ear, the lip and using a callus for the test.

http://k9diabetes.com/forum/showthread.php?t=126

Hope this helps!

Kathy

PS--Nice to see that Cara's "officially" here by photo! :)

[Cara's Mom]

Hi Kathy!
Thanks again for more helpull advice and suggestions. So glad I found K9diabetes!

Cara is doing very well, ate all her breakfast by herself! No bribes.

The vet and I tried Cara's lip when I got the Alphatak but were unsuccessfull, the fight was too tough! The ear did not bother her too much , I just had major problems with that little lancet. That nifty little device I got is for human use on the fingertip and you put the lancet in it, push it on the ear, push the button and Bingo!!When I used it the first time on Cara's ear, there was no reaction from her at all !

Back to reading all the articles!

[BestBuddy]

Hi Marion & Cara,
Welcome. I just wanted to wish you luck on your journey. It really does get easier and there is always someone here (or not far away) to "talk" to.
Jenny & Buddy

[We Hope]

Marion,

Everyone who tests finds there's a "right" spot, whether it's the lip, ear, base of tail, and so on. Many dogs are willing to be tested in one spot but absolutely NOT in another! :)

Some are frightened or put off by the "clicking" sound of the lancet device--for problems like that, you just use the lancets "by hand" with no device. Confession time--when my mother was diagnosed with type 2 at about age 89, I couldn't seem to get the lancet device to "cooperate" in my hands. So when it was time to do a bg check for her, I would just grab a new lancet for the stick and do it.

Lucky was a poor candidate for testing. When I began giving shots, I did it in the usual way of either pinching up the skin or drawing it up to make a skin "tent" for the injection. He became offended that I would do either of these things and started eluding me at shot time because of them. I had to work out a way that would get the insulin under his skin without doing anything like that. Since he was about 14 when that happened, he surely was entitled to be set in his ways. ;)

We felt that doing blood testing at home might damage the cooperation needed to give the two shots a day. Having known John and his family for plenty of years (Counting in the number of our dogs they've cared for makes us feel a bit younger.:) My present one who's not diabetic, is dog #5.), it wasn't difficult to arrange for regular professional testing.

Now that Cara is getting food she likes again, you should see her re-gaining the weight she lost when you get into the "neighborhood" of her being regulated.

I think there have been quite a few "steps" in the right direction and that's GREAT!

Kathy

[Cara's Mom]

Jenny and Buddy,
Thanks for the welcome! You don't know how happy I am to have found this site!
Today has been a nice, peacefull day with Cara snoring away in her bed beside her (doggie)Mum,Polly. Not begging for food and on a little vacation from ear pricks and vet visits!!

[Cara's Mom]

Yes, Kathy, things are looking better!
I can see a glimmer of light at the end of the tunnel :) I believe Cara can feel that too!

[Cara's Mom]

I contacted Vetsulin.ca over the weekend Re: changes to Vetsulin prescribing information in USA and if these changes apply to Caninsulin in Canada.
Just received reply:

Quote:
Recently, Vetsulin got its label changed. The cat claim has been accepted which has been valid for Caninsulin since its launch, 15 years ago. There is also a modification to the starting dose which will eventually appear in Canada. But registration process is different than in USA and takes a lot of time. Diabetes treatment and knowledge we have about the disease evolve faster than the registration process in Canada. New (for the US) recommendations have been used for years (differ slightly from our label) by our veterinarians as they are often active in continuing education events and because we have always forwarded this information to them. Older recommendations remain valid and new ones are offering a broader range of treatment. Canadian practitioners have the choice of using older or more recent recommendations as all may lead to diabetes control in pets
End Quote

All I can say is...Now I know!!!:D:D

[We Hope]

They said a mouthful! :) When we contacted Intervet at its Netherlands headquarters to be able to import it into the US for Lucky, they told us they were in the approval stages with FDA for the US. We had to apply for permission to import the Caninsulin for Lucky; about 6 months after we applied, it finally had approval.

The FDA approval for use in cats for the US came about only earlier this year. However, there's no laws in the US against using any drug for a non-approved, or "off label" purpose. So it was able to be used like this for cats since the insulin was sold in the US as Vetsulin.

Matter of fact, everyone in the US who is using any other insulin than Vetsulin for their pets is using it off label. ;) Before we were able to have Caninsulin/Vetsulin and we had the weak vials of Lilly's Iletin II Lente, this was the first thing out of Lilly's corporate mouth when I phoned about it--that the insulin wasn't approved for use in animals. My reply was that I was now calling them as a consumer who had purchased two flawed vials of their product--instant climate change on their end. :D

FWIW, when we switched to Caninsulin/Vetsulin with Lucky, we did so based on his weight and successful daily dose of Iletin II Lente--2.5 units per kg twice daily. There are only two differences between the two insulins--the pharma who makes/made them and their strength. Iletin II Lente was U 100 and Caninsulin/Vetsulin is U 40. Basically, the new dosing guidelines are the way we did it with Lucky. :)

Kathy

[ladysmom06]

Hi Marion and Cara,

Welcome to the two of you. This is a great site for info and support. Lots of very caring people here who understand what your going through. Good luck with Cara and hugs to the two of you.

Luv,
Lynne and Lady

[Cara's Mom]

Hi Kathy,
Yes,they sure said a mouthful ! But they are right, things are different in Canada. There have been so many simple medicines that we can onlyget with a perscription and in US they are sold over the counter! I use cortizone 10, 1 % hydrocortisone anti-itch ointment. Cost me $26.00 dollars here by perscription. My daughter travels to the States and brings it back for me, for less than half the price. I believe Canada to be a little too conservative! The approval will probably come in a year or so!!!

By the way, saw new vet, Cara has gained 2 lbs back. He is going to increase insuline by thursday to 6 units/twice a day. BG was 22. Before first dose this morning alphatrak said High! So we are still all over the board! Vet wants to do a curve, but found her too nervous and wants her to settle down more and gain some more weight, so maybe by end of week or early next week.
She was bit slow with breakfast but supper was gone in a wink!

[Cara's Mom]

Thanks Lynne and Lady!
Indeed I landed in a soft place, full with beautiful, caring people. The advice and info I have received in the last few days, have made my head spin. But it made Cara gain some weight and it's all about her, never mind my head!!!

[We Hope]

Marion,

Not sure if this will make you feel any better, but in the not so long ago days here, cortisone was Rx only. They decided to relax some of the rulings on what needed a prescription and what could be sold over the counter. If you need something stronger than the 1%, you need a prescription for it.

I used to get a sinus medication that was strictly Rx only; after they eased up on some things, it was OTC. In this case, they allowed the same strength medicine to go from Rx to OTC and in others, they allowed a less potent form of the prescription drug to be sold over the counter.

And from this side of the border, I thought FDA was archaic when Caninsulin was approved in CA but we still didn't get the nod for it here. :D

This is a VERY good sign--Cara's having re-gained some of her lost weight. :) Your new vet sounds like he's going to be super with her! In the "bad old days" when we were hoping to get either human or beef insulin to work for Lucky, we'd increase at about the same time frame to try to see if it would help this time.

I agree with him with regard to waiting for the curve; until Cara settles down a bit more, it's not going to give either of you any useful information. Blood glucose can be drive by excitement/stress.

http://petdiabetes.wikia.com/wiki/Hyperglycemia#Stress_hyperglycemia

The dog mentioned there is Lucky. For some reason, he didn't care at all for an associate. Everyone else could do draws and it would be fine with him. When we'd have to let the associate do it, we'd need to factor that into the reading we got. :D

When we were working with Lucky and nothing we were doing was working, I kept thinking about insulin all the time. Said at the time if I'd needed to see a psychiatrist/psychologist and play the "word game", where you're asked to say the first word on your mind, I wondered what my diagnosis from someone like that would have been when the word was insulin!

Hang in there--things are going the right way now!

Kathy

[eyelostit]

Just a Welcome to the board, glad things are looking better, Hang in there and breathe!!:)

[Debbie & Apollo]

Hi Marion and Cara

you said:
"Vet wants to do a curve, but found her too nervous"

just a thought...could you?????

I am able to do a 'drive by' curve :)
I stay with Apollo - we go in when they need to draw the blood and then leave for awhile.... visit the park, take a nap, or I just hold him while we are in the waiting room area.... etc....

nice to see things are looking better!

Debbie and Apollo

[Cara's Mom]

Debbie, we tried that with "old vet"! First two or three draws were fine. After that the fight is on and her anxiety hits the roof. Shakes the rest of the day and does not eat at all for her supper! So we had to stop.

[Cara's Mom]

Kathy, is there a difference between Vetsulin and Cansulin? I was told they are the same, only different name. :confused:We can not get Vetsulin here!!!

It's a complicated world!!

[Cara's Mom]

Have few more questions:

Before DM we (Cara, Polly and I) roamed the park for atleast an hour every morning. Cara was a lean-mean muscle machine:D:D. Now she is a skinny-no muscle, scared little dog! Still likes to go for wlks, but now we go 3 times/day for 20 minutes! Will adding more protien to her diet help? Or do I keep observing a low protien diet? Her treats were protien based or veggies, no wheats or sugres. Now she gets the occasional special diet biscuit, 1/4 of small apple,piece of broccoli. Her meals used to be higher in protien too.
Any thoughts?

I do know its important to keep her on a 12 hour schedule!:) But is that as rigid as my "old vet" was? Or is there a little room to move, like 1/2 to 3/4 or maybe 1 hour?
Appreciate your input:)

[Cara's Mom]

Niki and Dolly, it's not the breathing so much, but the eating!! Care gained weight.....I lost 6 lbs!
Thanks for the welcome, warms a persons heart!!

[We Hope]

Marion,

The difference between Caninsulin and Vetsulin is the trade name the insulin is sold under in a given country. Most of the rest of the world has Caninsulin--the US trade name for it is Vetsulin. Same insulin, different name and packaging.

Now I hope I won't make your poor head spin too much with this explanation--here goes. In anyone without diabetes, their bodies are able to "burn" or "use" the glucose produced from their food for energy. We without diabetes are able to have our pancreases produce enough insulin for us to do that. I think you've heard that some athletes are believers in "carbo-loading" (eating foods rich in carbohydrates) before a event. The body turns these carbohydrate rich foods into glucose--and they, in turn are able to use this for the energy needed for the big meet or the big game.

With diabetes that is either uncontrolled or poorly controlled, there's not enough insulin to allow the body to go about this process the right way. So it begins to convert other things, such as fat, for energy purposes.

[We Hope]

http://en.wikipedia.org/wiki/Diabetic_ketoacidosis#Muscle_wasting

Without enough insulin, there's nothing to stop the breakdown of the body's proteins (muscle is one), and so the muscles can waste, at times making the patient look like he/she is suffering from starvation.

http://images.wikia.com/petdiabetes/images/6/66/Eugenia-corwin.jpg

This young lady, Eugenia Corwin, was one of the first diabetes patients to receive insulin shortly after it was isolated in the early 1920's. The photo at left is before beginning insulin treatment; you can see that she is simply skin and bones. The photo on the right is Eugenia 4 months after regular treatment with insulin; she now looks like a normal, healthy little girl.

When you get the right amount of insulin to the body, it's able to use the glucose for its energy source. This puts an end to the muscle wasting and they're able to build up once again.

Have a look at Fran and Zak's story; I recall talking with her about Zak on another board:

http://www.petdiabetesmonth.com/living-1.asp

Now, with regard to the low-protein diet, I would suggest your asking the new vet if this is necessary. Low-protein diets are used to manage some medical conditions such as renal problems. Cara's new vet has reviewed her medical files and would be the best judge of whether she needs to keep with this or not.

The more consistent you can be with that 12 hour schedule, the better, but you do have about an hour's "window", where, let's say if you were up to an hour delayed with food and insulin, it wouldn't make for a problem.

I will take a stab at combining these posts later and removing my test ones.

Hoping your head isn't in orbit, :D

Kathy

[Denise]

Hi Marion and welcome! I'm sorry I haven't been here to lend a shoulder till now.

You've gotten great advice and I can't think of anything to add but wanted to say hello!

[Cara's Mom]

[url]
The more consistent you can be with that 12 hour schedule, the better, but you do have about an hour's "window", where, let's say if you were up to an hour delayed with food and insulin, it wouldn't make for a problem.


Kathie, I asked this because Cara seems the eat better a little later in the morning. By 7:30/7:45 AM I have more luck getting her to eat everything without a big to-do! But 2nd meal's limit is 7 PM, after that her appetite seems to be down!

Yes I will talk to my vet abt. protien, I was looking for your experience with it. Left over from old vet, who did not seem to have too much experience with DM.
I will never make changes in Cara's treatment without vet's permission!!!!!

I believe I can do this a little better every day! Greatly thanks to the advice from this forum!:):):)

Cara sends her love!!!!

[eyelostit]

I had to switch vets also, Niki is 50 lbs the vet started her out on 4U day and 3 at nite, doing 1 blood test per week, and just kept uping her insulin week after week and she was eating the Purina DCO special food for diabetes.

She had based her decision on that 1 reading, and never mentioned a curve, as time went by Niki was up to 18U and 14U by 3 mo. which was a disaster, if only that vet would have done a curve she would of seen when her lows were and highs.

So I found this board and another vet and took Niki's care into my own hands and never looked back.

Niki cannot eat all dogfood it does not work with her, I have to feed turkey, brocolli and a little dogfood.

Her food seems to get digested fast, and her insulin will kick in 1 1/2 hrs to 2 hrs.

You will learn this as you do your own curve.

Niki has been diabetic for 6 yrs now really 7 yrs she was undiagnosed for 1 year, with that vet thinking it was urinary incontinece (whatever that is called) and had me give her Detrol which made things worse. I never knew how sick Niki was until she got the diag. I didn't know why she was breathing hard, then I smelled the nail polish breath, thank God the first vet caught it, but she did not have that much knowledge on treating diabetes, some vets just want to keep uping insulin or say its hard to control, once you start doing curves you'll feel alot better and get a picture of what her BG levels are.

When you are comfortable do a curve.

Niki's insulin is 9 1/2 U of NPH and 9U at evening. 50 lbs.
Some dogs with the same weight get more insulin or less, all the doggies are different.

[k9diabetes]

Just catching up and checking in on Cara, who is such a beauty!

Natalie

[Ricksma]

Welcome to Marion and Cara!!! Sorry to be late to the party, but I haven't been online much the last couple of weeks. I have read about Cara, and it sounds as though you are getting terrific advice (as usual). I promise, in six months, you won't believe you were ever concerned about some of these things...it does get easier. So glad you found us!!:D

Love and hugs, Teresa and Ricky

[Cara's Mom]

Hi everyone!
Just wanted to update you all! Have not posted since Aug 20!
It's getting easier!!!!!! Have done my first curve yesterday(was holding my breath all day long....very long day:o:o):
7 17.6
9 12.7
11 23.4
1 20.0
3 23.1
5 26.8
7 HI (27.8+)
We start the day of beautiful! But by 11-11.30 the "beauty" (Thanks Natalie!) is fading and that's how it's been for long time.
There has not been any ketonen in urine anymore. Good sign!?
Has gained other .1kg, not much,but atleast no weight loss.
Eats like a pig (sorry, but that's true!!) Would love to give her more at nite, but will not eat everything in morning when I do that. And if I give her more at AM feeding, like 1/4 cup, that's what she leaves in her bowl. And no amount of coaching will make her eat that!!!
But I am not pulling my hair out anymore and that's probably why Cara seems to settle down a bit! Nice to see.

Any comment?

Love you all :D:D:D

PS Insulin up to 6U/twice day

[Cara's Mom]

Hello Teresa and Ricky, thanks for the welcome!
I am holding you to those 6 months!! And I pray your right!

[k9diabetes]

7:00am - 17.6 = 317 (multiply by 18 to convert to mg/dL)
9:00am - 12.7 = 229
11:00am - 23.4 = 421
1:00pm - 20.0 = 360
3:00pm - 23.1 = 416
5:00pm - 26.8 = 482
7:00pm - HI (27.8+) = 500+


We start the day of beautiful! But by 11-11.30 the "beauty" (Thanks Natalie!) is fading and that's how it's been for long time.

There has not been any ketonen in urine anymore. Good sign!?
Has gained other 0.1kg, not much,but atleast no weight loss.

Background:

Cara was diagnosed about 08.02.08 and was hospitalized with ketones.
Trace of ketones remained on 08.16.08.
Testing with AlphaTrak.
Weight: 22.4kg = about 50 pounds.
Diet: Fresh vegies, cooked chicken, 1/4 cup Science Diet Adult.
Insulin: 6 units of Caninsulin/Vetsulin


Hi Marion,

A couple of thoughts on your curve (Congratulations on completing it by the way!!! :) )

First, of course, she’s not on enough insulin as the lowest reading was in the 200s and most were much higher

BUT there’s also a mismatch of food and insulin, which you can change.

Looks to me like the insulin is giving a big oomph in the first two hours while Cara is still working on digesting her food so little of the glucose from her food has made it into the bloodstream. Then, hours later, when the insulin has very little to offer, she’s getting a big dump of glucose from her food finally being digested and it’s overwhelming what’s left of the insulin.

I say this in part because usually when “just” the insulin dose is too small, the curve is all high numbers, very flat shape but all too high. And then as the dose of insulin increases, the dips in the curve get sharper.

In this case, despite a lack of enough insulin, it’s got a very sharp dip at 2 hours and even sharper rise.

The good news is that there are several ways to fix this.

One is to adjust the diet by substituting some of what she eats with something that she digests quickly. Typically this is kibble or direct carbs like rice or oatmeal. Even a biscuit that she might have been denied now that she’s diabetic can work. You need something she’s going to digest quickly and convert to glucose right away to go with that surge of insulin.

The tricky part is that I can’t tell you what will work for Cara. With Chris, kibble was digested slowly and caused him to have a pattern a lot like Cara’s with a big burst of glucose into his bloodstream late in the day. Canned dog food he digested so quickly that it gave him a sharp rise right away, which is why we added protein (typically slow to digest) to his canned dog food to even out his blood sugar.

If diet adjustments aren’t enough, you can try NPH insulin, which generally has a flatter delivery of insulin into the bloodstream.

Caninsulin has a reputation for causing that sharp drop at about 2 hours. It seems like the molecular match of the insulin means that dogs tend to put the 30% semilente insulin in Caninsulin to work faster than they did the same semilente insulin that was from human origin.

When you succeed in tweaking the diet, the glucose levels will be higher during the first few hours, matching the strong insulin, and the whole curve will be flatter because you will have eliminated the big dump of glucose in the afternoon/evening. Then, when the curve is flatter, you can safely raise the insulin so that ALL of the numbers come down into a good range.

Hope that makes sense.

You will need to try to eliminate the sharp drop at 9am because with it there you can’t give a lot more insulin without sending that number too low... and still the evening numbers will be higher than you want. So it will help Cara’s regulation if you see if you can flatten out her curve with either diet or NPH.

Spot test that 9am to see whether you’re making progress.

Have I given you my phone number? I can email it to you. Sometimes sorting this out requires the kind of two way exchange you can’t do in a forum. But fire away with any and all questions. Happy to help any way I can.

Natalie

[k9diabetes]

Just to clarify, you would substitute some of what you're currently feeding with something more readily digestible.

And ideally you give the same number of calories - count how many calories she gets now and use the amount of food you substitute to come to the same number of calories so you don't under or over feed.

So, for example, instead of giving Chris a can of dog food, we gave him half a can of dog food and an equal portion of white meat chicken. That cut the amount of food being digested too quickly - the canned food - in half and added a food that was digested slowly - the chicken.

You might need to cut the kibble or the chicken and replace it with something like rice. A biscuit probably will not help if it's the kibble that's the slow-digested part.

[BestBuddy]

Hi,
As Natalie had been explaining it is so important to match the food and insulin. Surprisingly I have had success with the same food regime and both Caninsulin and NPH. I am very particular about amounts as a few grams can make a big difference. My choice of food came down to one I thought was of a pretty good quality, one he would eat and maintain his weight, and one that I could readily obtain. The answer for us was Science Diet Mature/Senior canned with a small handful of dry (20g). Buddy gets 125g (yes I weigh it all) of the canned with a teaspoon of Benfiber. I've found that any more of the dry even if I reduce the canned messes with his BG. I did use a site (I'll look for the link) to work out the basic amounts needed based on Buddy's weight and activity and fine tuned it from there.
Jenny & Buddy

PS Here is the link (If it works)

http://www.mycockerspaniel.com/mer.htm

[Cara's Mom]

Goodmorning everyone!!
I am back again. Had lots of troubles with Miss Cara! She now has Uti. Was of course dehydrated 3-5%. Spent few days again at doggie hospital, but picked her up last nite. And she's happy to be home again. On antibiotics:Baytril, one dose 200mg after evening meal. Urine test showed E-coli. But still waiting for culture.
Eating is a big ordeal!
But I will take all your suggestions and put them to good use.
Rice will be added asap. She won't eat ANY kibble!!!! Loaded up this morning on protien only.
What about cottage cheese? She used to love that and has not had it lately.
With the antibiotic, I am afraid she won't eat again! The weight she put on is all gone and some more!!
What you said about the insulin,food and the high peak in her curve made sense. Vet did not mention that, just worried abt it. And won't increase insulin until that's resolved!! Hopefully with all your good suggestions it will work.

A little shaky, but still determent to beat this last problem

[Cara's Mom]

Goodmorning everyone!!
I am back again. Had lots of troubles with Miss Cara! She now has Uti. Was of course dehydrated 3-5%. Spent few days again at doggie hospital, but picked her up last nite. And she's happy to be home again. On antibiotics:Baytril, one dose 200mg after evening meal. Urine test showed E-coli. But still waiting for culture.
Eating is a big ordeal!
But I will take all your suggestions and put them to good use.
Rice will be added asap. She won't eat ANY kibble!!!! Loaded up this morning on protien only.
What about cottage cheese? She used to love that and has not had it lately.
With the antibiotic, I am afraid she won't eat again! The weight she put on is all gone and some more!!
What you said about the insulin,food and the high peak in her curve made sense. Vet did not mention that, just worried abt it. And won't increase insulin until that's resolved!! Hopefully with all your good suggestions it will work.

A little shaky, but still determent to beat this last problem

[Cara's Mom]

Sorry, so anxious, post twice!!!

[k9diabetes]

Hi Marion and Cara,

Gee, I hope Cara's feeling better - did she go into ketones again? I was surprised she was hospitalized.

Did the UTI drive her blood sugar up still higher?

If so, you might find that she does better on the same dose of insulin once the UTI clears. They are infamous for raising blood sugar.

Cottage cheese is a good thing to feed - question is whether it would be much different in how fast it gets into the bloodstream. We used cottage cheese for a long time with Chris to slow down digestion of his meal. But every dog is different.

The rice should do the trick - will she eat it?

We started using cottage cheese when Chris was put on a bland diet of rice and chicken. He wouldn't eat the rice unless it was mixed in with something like cottage cheese. But for him the combination of chicken, cottage cheese, and rice worked well. We did 1/3 of each.

Chicken would be less fatty than cottage cheese.

Cottage cheese might be digested faster than chicken but not real fast as it's got a fair amount of protein and is not a simple carb.

Try a little bit of rice and you can certainly use some cottage cheese in place of either the canned food or the chicken. If she likes it that should help her put the weight back on!

[Cara's Mom]

Hi Natalie.
Yes her BG went sky high! Vet worked hard to get it to come down. When I got her back fryday nite she was 17.3 (311.4). As she is again very skiddish, have not been able to check myself since she is home. Do want her to feel little better.
Followed your and Jenny's instructions for feeding ....she loves rice (always has). Figured out she was getting 550 cal per meal.(need to get that weight back) Was able to duplicate that with 1c rice, 1 cup veggies, whole chicken breast and 1/4 c kibble hiding in there too!
Added some benfiber and little broth. And she ate all last nite. Same story this morning. The problem with her is, that she likes variety!!!! That makes it difficult to get her regulated!! Guess I spoiled her before DM!!
She likes cottage cheese. Is it better to get the low fat?
Do you suggest any supplements? She's been on cod liver oil her whole life.
Hope she has settled by tomorrow. Can start checking her Bg again. She now will not let me be...follows anywhere and watches me like a hawk!

Thanks Natalie,so glad I found you and the rest of this forum!! You all are getting me through some rough patches!!!!

PS Will they ever get their "wet" noses back?????(the dogs, I mean!!!!:D:D:D)

[k9diabetes]

Hi Marion, Cara Mia, and neglected Polly!!

I usually tried to go with lowfat cottage cheese. Although I liked using the large curds for Chris and it usually was not available in lowfat.

Fat's always a consideration if there's any tendency to pancreatitis.

We didn't use supplements much. We did use Fish Oil - usually salmon oil. Derm Caps were a good supplement when Chris was younger. For some reason in later years, they made him pant heavily about an hour after taking them. So then we switched to plain old Fish Oil or one that was mostly fish oil with little else added.

You might want to give a pet vitamin since most of what she's eating is people food.

Chris was sensitive to many things so we generally limited supplements or anything really that we wanted to add. Only added things when absolutely necessary. But Chris was unusual that way.

Hopefully some others will suggest supplements they have used.

Glad Cara's home and enjoying her new diet!! :)

Natalie

[Cara's Mom]

Hi Natalie,
Yes, she is enjoying her new meal. However this morning she left the 1/4 cup of kibble behind:(:(.
Did glucose test at 7 AM - HI , 9 AM - HI, 11 AM - 27.6, next one in half hour.
Would this be due to the Uti? Or do antibiotic create problems too?

[BestBuddy]

Hi Marion,

I just wanted to comment on the UTI. When Buddy has a raging UTI his BG spikes really high and he takes amoxycillin which controls the UTI and doesn't efect his BG.

As for supplements, we don't add much as Buddy eats his "Dog" food and I would hope it has the main things needed in it. I have been giving him vitamin B12 and glucosamine the last month and I'm not sure what good it is doing but it certainly isn't hurting.

And yes the wet nose does return.:D

Jenny & Buddy

[Cara's Mom]

Thanks Jenny, so pleased to hear wet nose will come back:D:D:D.
So Bg is affected by Uti. We'll just have to sit this out? Just started Baytril 3 days ago....have some time to go yet! She seems little sleepy in morning, but picks up later in morning.
Won't be too concerned with supplements for now....but B12 sounds good to me.

[k9diabetes]

Could be the diet change will require an increase in insulin. It's hard to sort things out at the moment with both things occurring at once.

Was her BG his high before the food change and around the time the UTI started? If so, you can likely attribute much of the high BG to the UTI.

You'll have to see over the next day or two what happens.

Are you keeping an eye out for ketones with urine strips?

Natalie

[Cara's Mom]

Natalie,
Her Bg was always rather high, but not this high. No ketones for the last couple of days!!
Here is the full curve:
6:45 - Hi
8:45 - Hi
10:45 - 27.6
12:45 - 26.2
2:45 - 20.9
4:45 - 24.9
6:30 - Hi
Have app. with vet for to morrow.Cara has been on 6U for 14 days, without any improvement. I believe it's about time to raise it. What do you think?

[We Hope]

Marion,

Those with diabetes are more prone to infections as a rule because the disease affects the immune system.

Admittedly, the UTI is partially responsible for these much higher than before bg's, but it also seems that Cara needs more insulin, period.

If we go with the weight you posted for Cara not long after you joined us here--22.4 kg--and we take that against the current Vetsulin dosing guidelines for a starting dose of 0.5 units per kg of body weight, here's where we come out-

22.4 X .5 = 11.25, which would then be rounded down to 11. As things stand now and we use the 22.4 kg weight to illustrate a point, Cara is presently receiving around 0.25 IU/kg.

One doesn't need to wait 2 weeks to increase an insulin dosage. While you can't increase too rapidly or too many units at one time without courting problems (Somogyi rebound/hypoglycemia), you can increase at a faster pace than this and do it safely.

Most of the time, any infection will raise bg's--this is why people with diabetes are encouraged to develop a "sick day" plan to cover the days when they're ill and their illness may mean a temporary bg increase/need for more insulin. BTW--people are urged to monitor their ketones during an illness too.

In order to do their job, antibiotics need to reach a given level in the system--this doesn't happen immediately. Many people make the mistake of stopping them when they start feeling better, as they believe this means the infection is gone. What can happen at that point is that if they don't finish the course of the treatment (taking all the medication over the number of days the doctor has prescribed), they never really get rid of the infection and it can bounce right back on them again.

My thought would be that even without the factor of the infection, Cara will need to use more than 6 units of insulin twice a day, based on her body weight.

Kathy

[Cara's Mom]

Hi Kathy, even with my limited knowledge ( I am getting better:):):)) I fully agree with you. Why is it so hard to convince the Vet? Going in this morning and will put up a good argument!!! I am around Cara 24/7 and see how she is doing from 1 hour to the next.
Her weight is not coming back. She was 21.4 kg as of last friday. Looks so darn skinny!!! Maybe the change in diet (which she seems to enjoy very much) will have put some back. Will find out today!
Up to the vet we go!!!!
Thanks, Kathy

[Cara's Mom]

Back from the vet! Insulin up 1U to 7 till end of week. New curve at that time will decide how much to increase at that time. Called me impatient!!! This takes time.....yes I know...but with no improvement...how much time?
Still nothing on urine culture! Have no lab here in town that can do it! Has been sent to Vancouver!!!!!! What kind of hick town am I living in!
Are you being charged for disposal of syringes? Just been hit with $20.00 charge for container. About gallon in size, so should last for a while. But I am just curious how you dispose of the used syringes and lancets.
Weight down again. 21.10kg (46.4 LBS?)
Sorry, am little upset :mad::mad::mad:

[We Hope]

Marion,

First of all, some of the bacteria can be difficult to "pin down" without doing a urine culture. This is why you've seen items on this site with regard to hidden or occult infections; they can be there and produce few or possible no clinical signs. One can do a standard urine work-up and on the surface, it will be negative and all seems well, so the need for more intensive investigation--the urine culture.

Many times, both disciplines of doctors have need to do cultures because some bacteria does not respond to treatment with certain antibiotics. In that case, you could be giving one that is never going to do anything abou the infection at hand. So they do the cultures to discover what strain of bacteria this is and can then prescribe an antibiotic which certainly will do something about it.

http://www.labtestsonline.org/understanding/analytes/urine_culture/test.html

"The presence of a single type of bacteria growing at high colony counts (greater than 10,000 colony forming units (CFU)/ml) is considered a positive urine culture. A culture that is reported as no growth in 24 or 48 hours or less than 10,000 CFU/ml usually indicates that there is no infection. If the symptoms persist, however, the culture may be repeated to look for the presence of bacteria at lower colony counts (less than 10,000 CFU/ml) or other microorganisms that may cause these symptoms.

"The presence of a significant amount of a single type of bacteria usually indicates an infection. Susceptibility testing is performed to guide antimicrobial treatment."

http://www.labtestsonline.org/understanding/analytes/susceptibility/glance.html

"When a patient’s immune system cannot rid itself of a pathogen, or restore its normal flora balance, then doctors turn to antimicrobials for assistance. These are drugs (antibacterial, antiviral, and antifungal) that have been developed to combat the offending microorganisms. They target different physical characteristics of the “bug” – such as its ability to multiply, its cell wall, or metabolism. Different antimicrobials are effective against different kinds of microorganisms. Some are narrowly focused, meant to eliminate one specific family of bacteria, for instance, without disrupting the balance of normal flora. Others are broad spectrum, developed to inhibit the growth of many microorganisms. When used, broad spectrum antimicrobials may affect both pathogens and normal flora."

So here you see how they do it. All vets don't have millions of dollars worth of various medical equipment for testing on site so when they need tests done which they don't have the equipment for, they need to turn to an outside lab who does.

Re: disposal of spent syringes--here's the US EPA guide for how we are able to dispose of them:

http://www.epa.gov/epaoswer/non-hw/househld/hhw/han-care.pdf

From Diabetes.ca--page 28:

http://www.diabetes.ca/files/ProductGuide2008--23May08--FINAL.pdf

"To dispose of your needles, use a sharps container, which you can obtain from your local pharmacy; there may be a fee associated with disposal. Ask your healthcare team about sharps disposal progams in your community. Some pharmacies have disposal programs; check at your local drugstore."

And now to the insulin--it sounds like you may have gotten somewhere, even though you were called "impatient", with the 7 IU standing until only the end of the week and based on the test results at that time. This is already Tuesday. :)

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

"Dose adjustments in the dog should be performed in increments of 10%. Following adjustment, wait to reevaluate until the new dose has been given for at least 5 to 7 days, unless evidence of hypoglycemia appears."

Hang in there!

Kathy

[Cara's Mom]

Thanks Kathy, very interesting websites! Boy, have lots to learn yet! New things every day!

[eyelostit]

I hope all is better today.

I dispose of my syringes in a large coffee can, taped shut with shipping tape then I put a label on the top with a big red x on it.

[Cara's Mom]

Hi Dolly, Checked with my City's Garbage collection....they suggested the same way of disposal!!!! Saves a few bucks again!!:D:D:D

[Cara's Mom]

Picked up new bottle of Caninsulin. This one had a package insert!! And this is what it says:

Recommended starting dose is 1 IU per kg of body weight per day, plus a body weight dependant dose supplement.
Body weight 20 kg and up- dose supplement 4 IU.

So does this mean that Cara , 21.4 kg, needs 21 X 1IU = 22 IU
plus 4 IU dose supplement which brings total daily dose to 26.
Twice/dailly halfdose is 13 IU, less 10-20%......10 IU!!! ( I calculated 20%)

Am I right?? :eek::eek: She has just been put on 7!!!

[We Hope]

Marion,

Don't panic--this is the old suggested dosing method which was around ever since we started reading about Caninsulin in early 2003. When we started Caninsulin with Lucky in December 2003, that was the official dosing information.

Lucky's previous insulin dose--the Lilly Iletin II Lente--was calculated by body weight/ X IU and he did extremely well with that. When we switched to Caninsulin, we did not use those dosing guidelines but continued to use body weight/X IU. Using the old guidelines would have meant that he received more insulin from the start of Caninsulin than the 4 IU 2 X daily which was his maintenance dose.

We reasoned that these two insulins were both pork Lentes, differing only in their strength (Iletin = U 100 Caninsulin/Vetsulin = U 40). As Lente insulins, they were also both classed as intermediate-acting. So we found no reason not to use Caninsulin the way we had used Iletin II Lente.

http://www.vetsulin.com/PDF/Vetsulin_Dear_Doctor_Letter.pdf

This is a link to the Vetsulin (US) "Dear Doctor" letter which details the change in initial dosing guidelines away from the one seen on your package insert to 0.5 IU/kg.

The letter goes on to say that one might receive Vetsulin with the old package inserts inside until the older stock has been depleted, and that one should refer to the new package insert (shown here with a copy of the letter).

What you also need to think about is that this older method is based on the use of Caninsulin/Vetsulin once daily. This method calls for the entire day's insulin to be given in the morning after breakfast, with a meal without shot to follow before the insulin "peaks", or is working hardest. The meal is meant to keep the dog from going hypo.

I have known people who began Caninsulin on the one shot daily regimen and none of them had any success regulating their dogs until they transferred to the split dose--two meals a day and an insulin shot after them. Lucky never took a single dose of insulin in all his diabetic life, regardless of who made it.

You can relax now, OK? :D

Kathy

[Cara's Mom]

Kathy, thanks ! That package insert had me going for awhile!!!:o:o:o

[BestBuddy]

Hi Marion,
Caninsulin has been approved in Australia for around 20 years and the last time I checked the Aust. website they hadn't changed the dosage either. Our last bottle of Caninsulin had the same package inset as yours (I am guessing). Buddy was started at those guidelines of 1iu per kg and because he is only 5kg there was a 1iu supplement. This was 6iu twice a day and it was only days before we (me and the vet) realized it was too much. The printed instructions also were very firm that only two meals be given and absolutely nothing between, this has also changed but I stuck to those rules religiously and we did have success. I still don't give Buddy treats between meals on the Humulin N and it works well for us.
Jenny & Buddy

[Cara's Mom]

Hi Jenny,
How do you get away with NO treats in between? Drives me nuts!! She starts begging and drooling around 3pm. Caught her doing her "business" in the run, turning around and eating it!!!!! If I feed her more in AM she won't eat it all. Those 12 hours in between is doing me in!!!!

[BestBuddy]

Hi Marion,

It was hard at the start because our dogs were allowed to graze all day until Buddy was dx. Buddy was very sick when we got the diabetes dx so the first few weeks it was a struggle to get him to even eat two meals and I guess he sort of got used to it and so did the other dogs.

He still tries to convince me it is time to eat around 4pm (his time is 5.30) and I have to stay out of the kitchen or he throws a bit of a hissy fit. I work 3 days so I don't get home until 5.15 and it's straight into the kitchen to fix the meals.

If I come home for lunch sometimes Buddy will try me out to see if I have changed my mind while I am making my lunch. He squeals like a girl (that's what I tell him anyway) and wacks me on the legs with his but I have learnt to be strong, I know it is the right thing for him.

Funnily enough he does not behave like that with my hubby! Guess we know the pack order in my house!

Jenny & Buddy

[Dollydog]

Hi Marion,
Lady can't go 12 hours without food so she gets a small lunch in the middle of the day. We tried the twice daily feeding but she was too rattled and upset. Haven't tried it since...but with our life more settled now it might be something to consider.
Jo-Ann & Lady :)

[Cara's Mom]

Hi Jo-Ann, but that does not create problems with BG? Did you adjust doses accordingly?

[Cara's Mom]

An other vet visit! Urine culture and sensitivity were in.
Uti confirmed, but Baytril not working on bacteria found( Forgot name!!) Now on Bioclav(Clavamox) 375/twice day. Noticed that vomiiting and diarrhea can occur. I give pill right after meal. Ask vet about probiotics. He did not think it would make a difference. What do you think? Would it hurt?
Can not afford diarrhea, have a hard enough time getting food into her..don't need any help getting it out!!:D
No weight loss since tuesday, stayed the same. No ketones in urine! BG still high but slightly down, 24.1 (433.8?) This was right after breakfast. Normally reads HI (above 27.8) at that time.

[We Hope]

Marion,

Have personally never needed either Clavamox or probiotics, so I can only tell you what others who have used them say. Many of those who need to use Clavamox have found the probiotic Culturelle helpful for coping with diarrhea:

http://petdiabetes.wikia.com/wiki/Medication_warnings#Antibiotics_2

A common full-spectrum antibiotic given for dental procedures is Clavamox, which is available in both tablet and liquid form. The liquid form is sweet, but the sweetness is from an artificial sweetener and should not affect blood glucose. The pill can be crushed and added to wet food if the animal is difficult to pill. Some animals, like some humans, get diarrhea on antibiotics. This can be minimized by the concurrent administration of a probiotic like Culturelle, which is available at vitamin stores. Consult with your veterinarian on the appropriate amount of probotic for your animal. Some caregivers report higher blood glucose levels while their pet is on antibiotics.

And, conversely, there are antibiotics that can lower blood glucose--

Oxytetracycline/Terramycin/Terak/Engemycin (UK)-low blood sugar

Chloramphenichol/Chloromycetin-low blood sugar/false urine glucose test results

Now that the culture's been done and an antibiotic that will get rid of the particular bacteria's being given, I think you'll see those numbers going down more as the Clavamox goes to work.

Three good things to think about here--now the antibiotic is a "match" for the bacteria, Cara has HELD her weight and has NO ketones! :D

Kathy

[Cara's Mom]

Thanks Kathy,I wll remind myself of the "Three Good Things" (TGT's) every time I start doubting that this will ever settle down within my lifetime!!

Up to the store we go to get some probiotics!!!!

[Dollydog]

Hi again,
Lady had lost at least 2.5lbs off her 17.5lb weight (which was a perfect weight for her) as she became diabetic. We upped her food and gave it to her in 4 meals at first. This was all going on while we were getting her regulated. So her doses of Caninsulin had to cover her food. Sometimes I think that she gets too much food and therefore needs too much insulin.

I haven't been able to home test her well enough to see if I could reduce the food and the insulin. Plus I am 300km from a scale that could weigh her accurately enough to see if she is losing or gaining weight.

Once things got stable enough with the Cushings and the diabetes and whatever infection seems to run through her, I didn't want to change anything. But I'm interested in seeing if I couldn't fine tune the whole process a little more. And I may be able to do that when we're in the US after Christmas! If we could do the home testing successfully we could try it here before that!
You'll get there...it just seems to take a long time at first.
Jo-Ann & Lady :)

[Cara's Mom]

Hi Jo-Ann,
Indeed, if things seem stable enough, do not fool with them!
Had a good day with Cara.....she only begged and drooled from 5 to 6 PM and 6:15 is feeding time!! So we conquered an other day!

[Cara's Mom]

Update:
We had bad week-end. Trouble with diarrhea, which did not help the curve I had to do! What curve? Was more a straight line:(:(:(!
7 - Hi, 9 -Hi, 11 -27.1, 1- 25.1, 3- Hi, 5- Hi, 7- Hi!!!!
Probiotics must have kicked in, no more diarrhea today and she is a happy girl today:):). PM dose of Caninsulin will be up 1 unit to 8UI:D.

That's all folks!

PS No ketones!

[We Hope]

Marion,

Now that the diarrhea's stopped, when you check Cara's bg's now without doing a curve, are you seeing any signs of them coming down? I'm thinking you would as it's been 3 days since she was put on the Clavamox and it should be at a fairly good level in her system now.

What you did get from your weekend curve is that when you see the non-"HI" readings at 11 AM and 1 PM, you are seeing some response to the insulin. Yes, they are still way too high, but we may still have the infection to blame. You stress when you don't feel well and that puts points on the meter--yesterday's bowel troubles could also be a factor here.

It may take 2-3 days before you see the effects of the 8 IU twice daily of Caninsulin on Cara's bg's so don't think because you don't instantly see better bg's that you're not getting anywhere.

Will that be enough for Cara and we can stop there? Right now it's not easy to say. I do believe now that the UTI has been found and is being treated with the right antibiotic, from here on in, you will be dealing with the diabetes without the bg-raising infection and this makes for an easier time to get regulated.

VERY glad Cara continues having NO KETONES!

Kathy

[Cara's Mom]

Hi Kathy,
Did a 9 AM reading.. 22.7 but at 1 PM was back to Hi.
Cara is scheduled for urine test on 17th, that's appr. 2 weeks into antibiotic treatment. We'll will find out at that time what the Clavamox is doing!! She is not drinking that much anymore and that does make her pee less!! That's good...the gravel in the dogrun is saturated:D:D:D!!!!!
No, I do not expect upping the dose to 8 will be a cure-all. But it is a move in the right direction. Might carry her a little further in to the day! And when the infection is under controle, we will have a better change getting her more or less regulated!!! Did not realize that an infection can make so much trouble:(:(:(!!

Thanks for your support!

[eyelostit]

Hi, this may or may not pertain to the urine or UTI, but I just wanted to add, when Niki used to be high when first diag for that 1st year, when I would look at her pee pee I could see small crystals that were on her hairs there, so I would wash her and get those crystals off her, I think my vet said it was from the high glucose in her urine.

Anyway to this day I take a look there, from there leaking at times etc, the hair length near there it can get kinda dirty, Niki has longer hair, so I trim around the outside of her pee pee, not the hair on her pp, but the larger area surrounding it that the urine would drip on.

I usually wash her with Summers Eve, do a good rinse and then go over the area with a Tucks pad (Walmarts brand) I have never had any urine track infections, I don't think alot of dogs get these crystals there because I don't see alot of posts about it.

Usually when I see her start to lick herself and her BG is in a normal range I know she needs washed. I haven't seen the crystals for years now but the constant leaking of urine will irritate there pee pee and so I wash it like I said and also will rub a tiny bit of vaseline on it.

Hope this helps in anyway

[Cara's Mom]

Most certainly will try this!!! Thanks, Dolly. Cara is little hairy down there right now, so a little "shampoo and cut" might be in order:D:D:D!!!

[eyelostit]

LOL, yes the things we do!! i washed Niki last week, and I always have to trim alot of hair from her bum and hips and under the tail where it hits her bum, she has so much hair, this summer I did not shave her being she does not stay out alot since she went blind.

Tried to do a nail trim last nite, ah no way, she don't go for it, and i get scared doing it, i just had them trimmed at the vet in june they said to come back in 2 weeks to do it again because they did not want to hit her quik, but I just cannot do that all the time, the vet is a 30 mi drive 1 way, I really like my vet, but maybe with just one dog now i should try another who is closer, before none of the vets who were close to me were accepting new patients.

Like a damn fool I thought of the Dremel tool my husband used and thought could I use this to file her nails down, so i brought it in the house and tried it on my nails, LOL but not funny ,no way!! even on low speed it, my nails are cut short but i tried it and then it burned into my nail and i felt that!!

Anytime I want to try something with my dogs whether it be something as foolish as this was, or a salve etc, i always put it on myself first. I used to mix homopathic salves for my doggie that passed and my other old doggies, if it did not hurt me I could try putting it on my dog. Most times I have to go to the vet anyway :(

I never had worry about nail trims when my dogs could run free when I lived out west, but now, ah, they just get older and slow down, but the nails don't.:)

[Cara's Mom]

I have been using a Dremmel for years!!Never had any problems. But you need special attachment for nails, something like sandpaper. Since Cara got sick, she will not stand for getting nails "done"! So probably have the tech at the vet do it pretty soon!!Have to go in for urine test next week anyway! Luckely my vet is only 10 min from my house!

[Cara's Mom]

This is Cara's 8th day on Clavamox...been a rough ride!! No diarrhea, but loose stool every day. Giving probiotic (2 hrs after meal) and tbsp no fat plain yogurt with meal. Thankfully she is still eating my home cooking! It's been 14 days of no eating problems. However, have 6 more days of Clavamox!!!!! Changed urine test to Monday, have to find out if it's worth it!!!
Her Bg's are mostly off the meter, by 11 down to 26.7 and at 1 - 26.6 but at 3 it's of the meter again and stays there!

She is just not feeling right:(:(:(!!

But with all the problems Marianne is having, we are not doing that bad:o:o!!

[We Hope]

Marion,

Good that you moved the appointment up to Monday. My thought is that Cara is not getting enough insulin for her size, even without an infection's ability to raise bg's.

Without the right amount of insulin, the bg's just aren't going to come down the way they should. Understand that there are many good reasons why one can't raise the insulin too quickly and too many units, but changes can be made more frequently when they're needed and with someone Cara's size, a 2 unit increase if warranted, shouldn't be too large a dosage increase to get a better "handle" on her bg's.

When we were working with Lucky, we made changes if needed after 3-5 days. His size said that we couldn't raise his dose by 2 units. This was before we went to pork insulin.

When you look at the numbers you have with testing Cara, you see there is an initial response to the insulin she gets--but there's likely not enough of it given to really tame her bg's.

My thought is that you should see just how much good the Clavamox has been doing after Monday's results. If those results show that the UTI has been substantially improved or gone, then the reason for her insulin resistance is that she's not getting enough insulin.

I think I'd risk being called "impatient" again and ask when it's expected that the insulin Cara's receiving will have more of a positive effect on her bg's. ;)

We're going to be all eyes and ears when you have those report results!

Kathy

[Cara's Mom]

Kathy, you are a girl to my heart!!!! My thoughts precisely!!!! But I was afraid you would call me "impatient" too. Already had hard time getting appointment put to Monday, because they were very busy, all booked up and now had to find time for me!! I did tell them it was NOT for me but for Cara!
My vet is on vacation!!! So I have to "train" the younger vet!!! Believe me, her insulin will be up, will mention a 2 unit increase and see what reaction I get. There is no movement at all at the moment. Antibiotics are no help with Bg's either, but hopefully they are doing their job on het Uti. I believe so, her pee-ing is less, no more licking ( haven't given her a "shampoo and cut" yet, because she does'nt feel right) and her eating has greatly improved.

Thanks, feel little better! Too bad Cara can't read........would have showed her your reply!!

Little over a month ago my and Cara's world came tumbling down..hit us on the head! Lucky for us, we found a safe place to fall....K9diabetes.com:D:D:D
Thanks, to all of you for being there!!!

[We Hope]

Marion,

When you have an infection and have been using the right amount of insulin, you should see that the bg's are becoming lower when the antibiotics have taken hold.

Because they most commonly raise bg's, those with diabetes may need to use more insulin temporarily when suffering from an infection. Getting the infection under control brings their bg's back to their normal levels and this means they can return to the amount of insulin they were using previously which gave them good control.

But if there isn't enough insulin, even without an infection, those bg's are going to be high. Cara is about 4 times the size of Lucky, yet she's only getting twice the amount of insulin he did to keep him well enough controlled that he'd give us a 4.72 reading 8-10 hours after breakfast and morning insulin.

From what you say about Cara's not needing to urinate as much, I'd say that the Clavamox has indeed done something about the UTI. The urination cuts back when the diabetes has been controlled also, but we know this is not yet the case with Cara, since we still see those high bg's. Therefore, that says it must be the Clavamox taking care of the UTI. (And it also points toward not enough insulin. ;) )

You know, you need to almost be a diplomat when bringing things up with some doctors--some think their judgment's being questioned. Asking when to expect the insulin will better control Cara's bg's is a very diplomatic way of saying, "When are we going to get Cara regulated?" without being that direct about it, thus hitting his "impatient" button. :)

I believe that if the test results show the UTI is either gone or close to being gone and Cara's insulin increases are stepped up with an eye to both getting control of her bg's and safety, you'll see some very fine changes within a short period of time.

You and Cara have the weekend to work on your "diplomacy". :D

Kathy

[Cara's Mom]

Kathy, diplomacy has never been my strong point! Usualy say it as I see it!
I am a do'er, get frustrated with people who in my eyes are procrastinating.
But I will spent this week-end honing my diplomacy. Cara does not need that, she's perfect the way she is:D:D:D!! (just a little skinny!!!)
Your advice is right to the point, as always!! Thank you!!

[We Hope]

Marion,

She'll get that weight back in a very short period of time once the amount of insulin is a closer match to what she needs.

Lucky did so well on the Caninsulin, he actually gained weight while eating the same amount of food every day, so we had to do a bit of reducing. ;)

Something tells me things will be changing on Monday...:D

Kathy

[k9diabetes]

Hi Marion,

I'm just catching up... sorry to hear her blood sugar remains so high. At least she's basically tolerating the Clavamox - it made Chris throw up multiple times a day.

I totally agree that it's time for the vets to start getting that blood sugar down.

Glad she's eating the home cooking well. It will be hard to know whether it will need any tweaking until after you get the BG lower.

Some diets require more insulin than others also, so the diet change may be part of why the BG is constantly high - it could be contributing another reason why she needs more insulin.

And, just to clarify, needing more insulin for a particular diet is not "wrong" or a "problem." As someone I know used to say, there's no "prize" for giving the least amount of insulin. If the diet works for Cara, then give however much insulin that diet requires. That everything works is what's important!

Anxious to hear how Monday goes,

Natalie

[Cara's Mom]

Thanks Natalie, nice to have you back:D:D:D!
I am hoping to-morrow will be the start of lower Bg's!!!!! She loves her food, been sneaking some kibble in there too and she's eating them. I do give her a "lunch treat" 1/4 cup green beans and that does carry her through most of the afternoon.
So, if we have to adjust insulin to accommodate this diet, so be it! Just have to keep a close eye on her (but have been doing that for last month already!!)
This mornings Bg's were ON the meter!! 26.7.....is this a start of something good?!?!
It will be great when we are finished with Clavamox!!!!

[Debbie & Apollo]

HI
I was reading and thought I would share...

the tool for the nails.... dremmel --- I use one that is meant for nail stylists.
I have a sandpaper type of attachement --- working great so far --
Apollo lets me do it just fine -
Now Atlas (our maltese) well it takes 2 of us. I am doing it once a week.

When Apollo was on Clavamox he had some strange days -- even a hypo day. the end is in sight! hang in there --

Debbie and Apollo

[Cara's Mom]

Thanks Debbie, I am hanging in there for dear life!!! (by my fingertips!!!) Patience is a virtue, where do I get some?

[Cara's Mom]

No sign of infection!!!!!!
Insulin up to 9 to nite!! New curve next week and if needed upto 10!!
Let her eat what she likes and we'll adjust insulin to her diet!!(like you mentioned before, Kathy or Natalie!!!) Give her some lunch!!!!(veggies)
Finish Clavamox (done Thursday PM), other urine test 14 days later!!!!
I LIKE THIS YOUNG VET:D:D:D!

This was Sunday's curve:
7 AM - 26.8
9 AM - Hi
11 AM -26.9
1 PM - 26.5
3 PM - 27.4
5 PM - 22.3 6:30 PM - HI 9 PM - 27.1
Atleast she was ON the meter most of the times!!!

Any comments?

I am walking on cloud # 9!!

[We Hope]

Marion,

I haven't met him but I like him too! Now I believe it's down to a matter of how much insulin for Cara and what she eats.

Something tells me neither of you even THOUGHT the word "impatient" today! :D

Kathy

[Cara's Mom]

You're darn right girl!!!
Thanks, Kathy!!!

[We Hope]

As one of the "old timers" on one of the Saturday morning kids' shows back when I was watching them used to say, "You're darn tootin'!" :D

Kathy

[Cara's Mom]

Sounds even better!!!!

[k9diabetes]

I am anxious for Cara's blood sugar to get into a better range! Glad to hear this young vet is moving things forward!! :)

At 22.4 kg or about 50 pounds, I suspect she's going to need at least 10-12 units before you see any significant progress - 12 units would still be only 1/4 unit per pound - on the low side. Chris at 58 pounds and infamous for needing very little insulin, required about 12 units when he was on a longer acting insulin.

Since she's getting such careful monitoring, you might see if the vet will let you go up 2 units next week given that all her readings are in the 20s.

Sending a hug to Cara,

Natalie

[Cara's Mom]

Hi Natalie!
This young vet told me, she would have been upped 2 units last week, but the diarrhrea was a problem!! That's why only 1 unit last week and 1 unit this week. Everything "tummy " is fine now, pretty wel normal again! Morning urine diastick is coming down......
Have substituted 2 oz of regular canned dog food (she was getting 4 oz) to 2 oz WD canned. Vet suggested that! Just little steps, but might make some difference.
Last day of Clavamox to-day!!!! Hopefully wil settle tummy completly! And the hard work can begin, putting everything together!! Food, insulin and the walks!!
We are keeping our fingers crossed!!(and everything else we can "cross":D!!!)
Will do curve on Sunday and I'll let you know!

[We Hope]

Hi Marion,

I agree with him re: not increasing too much when Cara had the diarrhea. When there's vomiting or diarrhea, both mean that the food leaves the system too quickly, so it's basically not there for the insulin to handle. Lucky had one minor problem with colitis when he had diabetes and while he had the loose bowel, we cut his insulin back a bit because of that.

It looks like now that both the infection and the Clavamox are out of the way, the "work" on getting Cara regulated can begin.

I think you need a new pair of shoes for those walks, though--because you certainly walked the floor with them quite a bit since Cara's dx! :)

You and Cara will get there, PROMISE!

Kathy

[Cara's Mom]

Hi Kathy!!

Do not new shoes!!! All my pasing was done on bare feet:D:D:D!!!!!

But I agree, the work is just starting, but WE WILL CONQUER!!!
She's already lot better what her demeanor concerns! Running around in the yard. Trying to steal Polly's food!!! I see the old Cara coming back!

And we have a wet nose!!!!!

[We Hope]

Marion,

When you look, you're looking at the "whole dog" and I'd say all of these things point to Cara's being on the road to recovery!

How about a new pair of slippers for when everything's going as it's meant to and you can RELAX! :D

Kathy

[BestBuddy]

Hi Marion,
Great news about the wet nose and it does sound like Cara is feeling much better. I'm sure it won't be much longer before you have the insulin all figured out.
Jenny & Buddy

[Cara's Mom]

RELAX??? I had to look that word up in the dictionairy!!!!!
Thanks, ladies! You all had your parts in this!!! So take a bow, while I clap my bare feet!!!!!!

Love you all!:D:D:D

[rhodesian46]

You never are able to relax! Keeps you on your tippy toes for sure .Hope Cara still has a wet nose and is feeling better!! Pebbles has had me on my tippy toes for way over a year.

[Ricksma]

So glad to hear that Cara is feeling better. Soon this will all be old hat to you, and you will wonder what all the fuss was about. Well, maybe not...but you will be more relaxed!! lol

Love and hugs, Teresa and Ricky

[BestBuddy]

Hi Marion,

With the shoe talk I would say no to army boots as they will wear you floor out and it sounds like you wouldn't know what to do with slippers and Marianne has suggested that you may need to be on your tippy toes so my thoughts are ballet pumps.:D

Jenny & Buddy

[Cara's Mom]

I will ignore those shoe suggestions! Ballet pumps:eek:!?!
Have a question:
How long does it take (on average) for Caninsulin to kick in after meal? Is it most of the time given right after meal? Some websites were talking 30 min after meal!?! Is that just to confuse me? Or could there be a legitimate reason to do it that way?:confused::confused::confused:
Sorry, that was more than 1 question.

Thanks,

[We Hope]

OK, my dear,

Here's where we need to get a little technical. :)

Caninsulin is an intermediate-acting Lente-type pork insulin of U 40 strength.

http://petdiabetes.wikia.com/wiki/Intermediate-acting

Here's Caninsulin and all the other insulins which are classed as intermediate-acting.

Lente insulin is made up of two types of other Lente-type insulins. There's 30% semilente insulin and 70% ultralente insulin that make up Lente insulin.

http://petdiabetes.wikia.com/wiki/Lente#Technical_details

Lente insulin is actually a combination of two other lente-type insulins in the fractions 30% semilente insulin and 70% Ultralente insulin. And so the short-acting semilente and the slow-acting ultralente combined produce an insulin that is intermediate-acting.

Semilente insulin is a short, or fast-acting Lente type insulin that has a profile a lot like R (neutral) insulin:

http://petdiabetes.wikia.com/wiki/Semilente#Technical_details

Semilente's time activity profile is very much like that of R/neutral. It begins working within 45 minutes, peaks in 2-4 hours and has a 4-6 hour duration.

The semilente insulin is 30% of Lente. The largest part of Lente insulin is ultralente insulin, which is a slow, or long-acting insulin:

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

Ultralente insulin crystals are large and slowly absorbed because of their size, making this a long-acting insulin.

http://images3.wikia.nocookie.net/petdiabetes/images/7/7f/Lentetap.gif
This is what the time-activity profile of Lente insulins looks like.

Have a good look at the graph in the 0-2 hour segment--you'll see that the Lente starts working in around an hour.

OK--now we'll look a one of the Caninsulin graphs--keep your eye on the red line--the glucose:

http://www.caninsulin.com/images/insulinactivitydog.jpg

Now we'll take the Lente time activity profile from above, turn it upside down and rotate it horizontally:

http://images4.wikia.nocookie.net/petdiabetes/images/8/8f/Lentetapflip.GIF

See how it mirrors the red glucose pattern in the Caninsulin graph?

People with diabetes who aren't using insulin pumps generally use two types of insulin--a fast acting one like R (neutral) or one of the rapid-acting analogs Apidra, Novolog or Humalog--and an intermediate to long-acting one. The short/fast acting one is to cover the meals they eat (this is called a bolus dose of insulin and they take this at meal time); the longer acting one is to take care of the body's need for insulin without considering food--this is called a basal insulin dose. Some people take their basal insulin once or twice a day--it depends on their needs and the insulin they use.

When semilente insulin was available on its own, many people used that for their mealtime insulin.

The semilente (30%) of a Lente insulin is the fast acting part of it and that's what can begin working within an hour.

When you get to about 2 hours after a meal, bg's start rising with both people and dogs because the meal is starting to be digested:

http://petdiabetes.wikia.com/wiki/Post-prandial

In humans and dogs, food begins to pass through the system starting at about two hours after eating. The system also begins turning it into glucose at this point.

Fast-acting insulin like semilente, R (neutral) or the rapid acting analogs, keep the bg's from a meal in control. If we had the 70% ultralente all by itself, here's what it would do alone:

http://images2.wikia.nocookie.net/petdiabetes/images/0/01/Ultralentetap.gif

The ultralente doesn't start working until 1-4 hours after it's been given.

We give insulin after meals for safety's sake to prevent hypos. Most people, though, use their fast acting insulin BEFORE they eat. They've determined how much fast-acting insulin they'll need by what they're planning to have as a meal.

Some people have found that delaying the after-meal insulin works best for their dog--it depends on the dog and the food, and the way the dog uses insulin. Most of us have always given the insulin directly after the meal.

Does this help or do you feel like running from the computer as fast as you can? :)

Kathy

[Cara's Mom]

It helped, but I still felt like running from the computer!!! But I didn't:)
I asked, because often Cara does a lot of panting after her meal and insulin Kind of scares me, when I watch her do it!! But when I check Bg's they are Hi (and in my heart I expected them to be too low!!!)
However, this was explained on the link to petdiabetes/Post-prandial ! And if I read it right could be because insulin given was not enough!!!! Is that right?
But it could also be a matter of timing regarding insulin and food!?:(:(

[We Hope]

Marion,

At one time, we got weak vials of the old Lilly Iletin II Lente insulin (pork Lente insulin U100 strength). They were only about 45-50% potent. Lucky's bg's soared and this was before Caninsulin, where one could get another vial at the vet. The pharmacies didn't stock it--they needed to order it for you.

He had visible panting from his post-meal spiking when that happened--because he wasn't getting enough insulin since it was weak. This happened over a weekend and the earliest one could place an order for a new vial would be Monday morning--it began on a Friday night.

All we had was the old vial of insulin which we knew was no longer 100% potent--the brand-new vial of insulin was meant to replace it. We didn't know exactly how much potency was left in the old vial, so we couldn't run the risk of hypo by increasing Lucky's dose of it. So all we could do was to stay at his normal dosage and keep at it until we could get a new vial.

It took the weekend to get his bg's back into a decent range where he was no longer panting 2 hours after eating. We did it with the old vial, because that had more potency to it than the new one did. Every time I'd give Lucky his shot, we would see the panting time decrease until it was gone--we'd finally gotten his bg's down. This was because of not enough insulin.

As Natalie said in her post, Cara is still not yet in the range with insulin dosage where she's getting about 0.25 units per kg of her body weight. The new Vetsulin starting dosage calls for 0.5 units per kg of body weight. My thought would be like Natalie's--that you will see more progress with post meal spikes and with those high bg numbers when you get nearer the 0.25-0.5 units per kg with Cara. As things stand right now, it's very likely that it's just not enough insulin for her yet.

You're right in that it could be a food/insulin timing problem, but you need to get closer to the "right" insulin dose for Cara before we can rule that in and work on that, if necessary.

I think Cara's next insulin increase will tell us a lot more about whether it's not enough insulin or a food/insulin timing problem. If it's not enough insulin, both the numbers and the post-meal panting should be on the decrease.

Glad I didn't scare you off! :D

Kathy

[Cara's Mom]

As always...thanks Kathy!
I feel better again. We should have an insulin increase by Monday and hopefully see less (maybe none) of those panting episodes.
Well, it's 10 PM here and the girls are wondering what I am still doing at the computer!!!
They feel left out!!!

[Cara's Mom]

After 3 weeks on the same food, Miss Cara is not eating everything anymore!!! Deep down, I cannot blame her. She has been eating very big meals, way bigger than before DM. If you add it all up, comes to about 3 cups/meal, that's 6 cups/day!! Before DM the most she ate was 3 cups/day! Should I be concerned? Should I cut her back a little? Will this influence her insulin dose for better? Or worse?
Or should I just wait and see:(:(:(?

[k9diabetes]

I went back through your thread... looks like the amount of food was to try to get some weight back on Cara?

Weight gain will be hard to accomplish until she gets enough insulin to move all of what she eats into her cells to use. With a diabetic you can feed them a lot of food and without enough insulin all the glucose that food produces just washes away into the blood and then the urine, giving them very high blood sugar but no more useful calories.

If you cut back the volume of food, the insulin dose she's currently on should go a bit farther.

If the old amount of calories worked well for her prediabetes and her activity level is basically the same as prediagnosis, you can feed her somewhat more than that until she regains her weight back and adjust the insulin accordingly. And then when her weight is where you want it, cut back to a maintenance number of calories. Recognizing that her weight won't come back until she has enough insulin to go with the food...

If you want to cut back her meals, consider cutting back slowly in small increments... maybe cut back about the amount she leaves behind... so you can see how her insulin dose matches the reduction.

Her tummy's been through a lot so this could be a temporary thing.

But it also wouldn't hurt to cut back to what she will eat so you can keep her on a predictable amount of food and match the insulin.

I think I'm rambling... does any of that make sense? :)

Natalie

[Cara's Mom]

No, you're not rambling!!! :)
OK, so I'll cut back by what she leaves of her food and see if that "helps" insulin do a little better job!
She just leaves rice and veggies!!! The meat is all gone!
Thanks Natalie!

[k9diabetes]

Will be interesting to see if she still picks out the meat and leaves the rice and veggies.

We used to use cottage cheese with the rice to mix it all up cuz Chris wouldn't eat rice by itself. But when it was mixed with the cottage cheese, he couldn't separate it out and would eat both.

[Cara's Mom]

She does get some cottage cheese in there to.
But heh, I do see some minor improvements! Early morning Bg's are still unacceptable, by 11 she starts slowly dropping 24.5 - 25.1 - 23.1 - 20.9 and by 7 PM 26. So we have more movement than we ever had!!!! We heading in the right direction!:D:D:D
To-morrow is "Curve day". Let's keep our fingers crossed!

[We Hope]

Marion,

Never turn down any improvements! :)

Here's hoping we all see more improvement when you post tomorrow's curve!

Kathy

[Ricksma]

Ricky and I are keeping everything crossed here for you guys to get a good curve, and maybe some helpful information. Keep the faith!!

Love and hugs, Teresa and Ricky

[Cara's Mom]

Thanks Kathy and Teresa for your encouragements!! Both Cara and I can sure use them!We need all the help we can get!!!

Cara is still loosing weight..down to 21.05 KG (46.3 lbs?!?)Have to get back to 50 lbs!

[We Hope]

Marion,

Cara will stop losing and start re-gaining when the dose of insulin she's getting is a better fit to her needs. Right now her body's not able to use the glucose from her food properly yet. So it's using some of the fat to burn for its energy needs instead of the glucose it's meant to burn for that.

Once she starts using "all the right stuff"--burning glucose instead of fat for this--she will start picking up the lost weight.

Refresh my memory, please--when does Cara have the chance to get her insulin increased if need be?

We'll get some "meat" back on Cara's bones yet! ;)

Kathy

[Cara's Mom]

Hi Kathy,
You know the song titled TO- MORROW? Well, that's what I am singing to-day:)!!!
Running a curve right now and will be talking to vet to-morrow!! The last time I talked to him, he was suggesting maybe going up by 2 units!

[We Hope]

Marion,

I hope he does just that because that will bring Cara up to 10 units twice daily. I think we determined not long ago that Cara would be at about the 0.25 IU per kg if she got to 11 units twice daily.

Once that happens, while we probably won't see perfect yet, we should see more signs that we're closer to where we need to go with the insulin dose--better bg's for starters! ;)

Remember, in the musical, Annie sang that the sun would come out then! :D

Kathy

[Cara's Mom]

Kathy, she is now on 9 units/twice day! Could go up to 11 by to-morrow:D:D:D!

[We Hope]

Marion,

I like hearing that even BETTER! :)

Kathy

[Cara's Mom]

Kathy,

" You're darn tootin":D:D:D:D:D!

[Cara's Mom]

We did it! We're up to 11 UI!
Her curve yesterday looked like a curve, a very small one, but a curve:
hi - hi - 25.1 - 21.4 -20.2 - 22.4 - hi
So, I was warned to watch her closely and her Hi should be about 17 (300),
low about 11 (200) Boy, would be nice to see numbers like that!!!! Believe it when I see it! Have to call in to morrow afternoon to let them know what's going on:):)
Who cares.........my baby might feel a lot better by to morrow.:D:D:D

[CarolW]

We did it! We're up to 11 UI!
Her curve yesterday looked like a curve, a very small one, but a curve:
hi - hi - 25.1 - 21.4 -20.2 - 22.4 - hi
So, I was warned to watch her closely and her Hi should be about 17 (300),
low about 11 (200) Boy, would be nice to see numbers like that!!!! Believe it when I see it! Have to call in to morrow afternoon to let them know what's going on:):)
Who cares.........my baby might feel a lot better by to morrow.:D:D:D

Hi Marion - I read your entire thread, beginning to end. What a time you and Cara have been having - and reading the whole thread is very educational, thanks to the knowledge represented here!

Remember it could take a few days before you see the full effect of the increased dose of insulin! - I gather, even up to a week before numbers stabilize. LOOKS as though your vet is properly cautious, even though the raise was two units; I don't think you'll likely see a hypo in there anywhere! My vet is similarly cautious!

I'll be watching for Cara's numbers!

Love and hugs,
Mon, 22 Sep 2008 18:01:39 (PDT)

[We Hope]

Marion,

I think you did get some good information from the curve--you are seeing Cara respond to the insulin, so that means it's working--but there wasn't enough of it to get the job done properly.

When we initially started Lucky, it was on human Lente type insulin. He responded nicely the first week. By week #2, it was like he'd been getting no insulin at all. Then we went to beef, with the thought that he might be using the insulin too rapidly; human insulin is only 1 amino acid's match from canine insulin--beef is two away from it. You can extend the duration of insulin in this way; when it was still on the market, beef Ultralente insulin had more duration in people than Lantus does--it was virtually peakless too.

We went just about as far with the beef as we did with the human insulin--an insulin meant to work about 12 hours would be ineffectve for him in about 2-4 hours, even at resistance level doses.

What we were seeing was an almost flat, high line that would only dip slightly then go back up. He had immune-related insulin resistance, meaning that his body recognized the insulins as not his own and destroyed them like a virus or germ before they could do anything about controlling his blood glucose.

We went to pork Lente insulin as it's a perfect match to a dog's own insulin. Within a week's time, his bg's came down about 400 points on the mg/dl; he was in the low 200's on that scale and now it was a matter of finding his dose.

http://www.vin.com/ImageDBPub/TN20000/TN_IMC16199_550X0Y.jpg

This is an animal (species not stated) receiving Lente insulin (species not stated) twice daily. You see only very slight drops after the insulin takes effect and then back into the same high ranges. This was what Lucky was doing.

http://www.vin.com/ImageDBPub/TN20000/TN_IMC16197_550X0Y.jpg

This is a graph of a cat receiving beef Lente insulin once a day. You see the cat respond to the insulin, but that he/she should be getting insulin twice a day, because there's not enough duration to that one shot.

This is somewhat like Cara, because you are seeing those bg's come down in response to the insulin. The cat above's problem is a need for two insulin shots a day--Cara's is for more insulin each time she uses it.

Once Cara gets into the 17-high and 11-low area your vet spoke of, you will be getting close to where the "treasure" (regulation) is hidden. :)

Lucky spent most of his time before pork Lente insulin in that "HI" zone. On the number of units of Caninsulin right for him, checking him 8-10 hours after breakfast and morning insulin, he would be at 4.72 mmol/L.

Something tells me that when you post tomorrow, what you'll be telling us you're seeing will be worth "hootin" and "tootin" about, because you've seen those numbers at least start to go down and stay down.

It takes about 2-3 days, minimum, for you to see the full effect of an insulin increase, so please don't think it's not working if you don't see the numbers your vet gave you tomorrow. Good downward movement will get "hoots" and "toots" from all of us! :D

Kathy (who returns to the "reconstruction" task of her desktop computer :eek: )

[Cara's Mom]

Thanks Carol :),
No I do not believe there will be a hypo either in there! But my vet did make me a little nervous when he asked if I had any honey or so in the house!!!!!!
Her last dose increase took 6 days to see a little better results. I would love to see us get somewhere with this latest increase, like no more "of the meter" numbers (Hi). Maybe it's our turn:D:D:D

[Cara's Mom]

Kathy,
Girl, you got a way to explain things!! Your sure you are not a vet :D! Well, you should be. I have had more and better info form you than I ever got from any vet!!!
Do not expect any signs for next couple of days, but let me tell you, I am very anxiuos to see any result!!! And so is Cara!!
Thanks again for your support!
Cara loves you and Polly agrees with that:D:D

[Cara's Mom]

Anybody noticed Cara's new picture?

[CarolW]

Thanks Carol :),
No I do not believe there will be a hypo either in there! But my vet did make me a little nervous when he asked if I had any honey or so in the house!!!!!!
Her last dose increase took 6 days to see a little better results. I would love to see us get somewhere with this latest increase, like no more "of the meter" numbers (Hi). Maybe it's our turn:D:D:D

Marion - Yes; I think it's your turn! You and Cara! About the honey - I keep corn syrup here. I even carry some in my fanny pack when we go out for walks. I've never needed any, in more than two years now! The nearest we got to a hypo was a reading of 3.8 mmol/L (68 mg/dL) and a minute later, 3.9 mmol/L (70 mg/dL). At the time, Kumbi was on 4.5 units of Novolin NPH insulin; I cut his evening dose by a quarter unit (being a U-100 insulin, it's more concentrated than Vetsulin), and phoned my vet. My vet returned my call the next morning; said I was right to cut the dose just as I did, and said I should stay on that slightly lowered dose, which we did for some time thereafter, till the next curve, when Kumbi's numbers were a bit high, and we went back up in dose. (He weighs 20 pounds.)

Since then, we've gradually increased, to where now, Kumbi is on 6.5 units of Novolin NPH insulin twice daily, and he's been stable on this dose for about half a year now. That could change, but it seems not to change FAST. I personally think weather conditions affect BGs to some extent, possibly partly because of change in events - such as exercise - amount and type.

But keeping Karo - or corn syrup (which is what Karo is) - or honey - on hand seems to me something everyone with a diabetic dog should do as a matter of course! If for some completely unknown and unexpected reason the dog goes into hypo, you NEED that suff right on hand, for immediate application to gums or under tongue!

So I don't think you need to worry about your vet asking that!

I love Cara's new picture. She is one gorgeous dog!

Mon, 22 Sep 2008 20:36:20

[Cara's Mom]

Carol, whenever we go for our walk, I do carry a tube with glucose in my fanny-pack. When my vet asked me if I had honey in the house(and I do!)my first thought was: He is expecting trouble!!! And that worried me:eek:!
You know, when I "talk" with all of you here on the forum, it's always comforting knowing you've all had the experiences I am going thru right now. And you all came thru it with flying colors. So there is hope for us too!! And after a month and half, I am a different person. Never thought I would be giving shots....never liked shots!! And poking for blood! Feel like a vampire at times!!! But we are all doing it, because those furbabies deserve it!

P.S Cara says: Thanks, she likes the picture too!

[eyelostit]

Just wanted to say you a doing a great job, you have come a long way.:)

The decrease in food was a good suggestion, but you don't want to do that now with the insulin increase.

I think your insulin increase will help.

If you still get the high readings, take away some of the food and add veggies like brocolli.

hang in there, take care;)

[k9diabetes]

Hi Marion,

Sorry to be slow to get here... kind of a crazy day here that I'll explain in the Everything Else forum.

Dolly makes a good point about the food - a 2 unit increase in insulin AND a reduction in food carries some risk of lower than desired numbers...

Was the curve done on the reduced amount of food?

If so, you should be okay.

Also if the amount of food you cut (because she wasn't eating it anyway) wasn't much in terms of her overall meal volume, then it's also not much to worry about.

With her blood sugar still mostly in the 500 or 600 range, depending on where your meter goes to HI, and just now reaching 1/4 unit per pound I don't think you have much to worry about anyway. You have a long way to go before you have to worry about low blood sugar. And I know you'll watch her carefully.

Natalie

[Cara's Mom]

Hi Natalie,
Yes the food reduction was made before the curve was done! So I should be OK! And it was not much, just the amount she would not eat..... rice with vegies not more than 1/4 c total and she still get some veggies for lunch and for 2 treats/day.

[Cara's Mom]

Hi Dolly,
The food reduction was done before the curve. The vet was still talking about putting her back on WD. Cara does not like that....so that's out. Besides, like you said, increasing dosage and fooling around with food at same time....not a good idea!
Everything is staying the way it is! We want lower Bg's!!
She has had two shot by now of the increased dosages, her pm last nite and am this morning! (and I survived!!!)She is doing just fine!
Thanks for your concern!

[Cara's Mom]

Did some spot checks!!
10:30 20.7 / 1.00 15.9
Is not this going a little fast?

[We Hope]

Marion,

Check for a PM from me.

Kathy

[k9diabetes]

I'm not worried. Those convert to U.S. readings of 373 and 286, which is still a long way from worrisome. :)

After having high BG for so long, I could see how that would seem scary. But that was the point of making the bigger increase in insulin... to start getting those horrible high blood sugars :o down into a more manageable range.

Just keep checking and posting the numbers. I'm thrilled personally. :cool: Cara deserves to get down into a healthy range.

She might actually be hungrier if her blood sugar gets into a better range.

Natalie

[BestBuddy]

Hi Marion,
I am laughing but not at you, with you. All we want is good BG numbers and when we start to get them we panic and it's like OMG what is going on. You are still a long way from danger lows and really it looks like you are getting there. It's just so hard that it has to take so long.
Jenny & Buddy

[Cara's Mom]

Well, ended up at vet's office:o:o Better safe than sorry!!!!
Right now we are down to 11.6 and my stomach is still turning:o:o!!
Waited so long for nice Bg's and when you get them....they scare the breath out of you!!!! Vet has been very supportive! Have to call him every hour with the numbers and keeps telling me "she's OK". I can see Cara is OK, but my stomach does not believe it!!!
Have to do an other check!!!
Thanks guys :o:o:o

[Cara's Mom]

We are slowing down!!! 11.3
Boy, what a ride!

[k9diabetes]

Kathy says she dropped further, to 11.1 / 200?

I assume you're coming up on her next injection so you might want to cut it by 1/2 a unit just to be safe and not worry tonight. What does the vet think?

I also hear that the vet's being great about keeping up with how things are going and giving you advice! That's wonderful!

What Jenny said is very true. I've seen plenty of people feel really panicky when their dogs' blood sugar finally gets close to good numbers!

And just so you know, lots of dogs do not rebound just because the blood sugar comes down rapidly. It's very individual. Chris wasn't much of a rebounder at all in fact. I wonder if Chris and Cara have kind of the same approach since both of them did/do not need a lot of insulin for their size...

Try as much as you can to just watch and see what happens and then adjust the next injection. This is all a learning process and as long as you're there to keep an eye on things you don't have to worry. Plus you have my phone number. If something really scary happens, you can always call me if the vet is not immediately available and I can help you sort out if there's any danger, whether it would be wise to give some syrup just as a precaution.

I'm very excited for Cara! She should feel so much better at these numbers! :)

Natalie

[k9diabetes]

We were posting at the same time. This looks really good!! You can see the nadir hitting here - the lowest point in the blood glucose level.

I'm so happy that the vet is helping you with this.

Natalie

[Cara's Mom]

Yes, he's been very supportive!!!! As have all of you!!!! Even when you are laughing (with me)!!I can laugh now when I read over the post........a real newbie!!! That's what I am and proud of it!!!
Have to phone in the next Bg to the vet in a hour. He says up to now everything is within range, does not believe we have to go down on insulin. Wants AM fasting Bg's to morrow.
Will keep you informed!
Cara is having a good day and I should get used to that:D:D:D!!

[We Hope]

Marion,

Who needs skydiving for adventure? Just have a dog who's been diagnosed with diabetes! :D

Tell Cara we're all SO glad she finally pulled the "parachute" hook! ;)

Boy, when I said yesterday I though you'd have something to "hoot and toot" about, I wasn't kidding! Too bad I don't know any lottery numbers--for anyone's lottery! :)

Kathy

[Cara's Mom]

Who needs a lottery, while we all have the" FIRST PRIZE" at home already! However.....
it might cover some vet bills!
Cara is busy!!!! Playing Tug-of-war with Polly! But when she comes in, I'll give her the message!!!
I have seen the old Cara this afternoon!!!! And boy, did she have me worried!

[We Hope]

Marion,

When she's finished, you might suggest to her that yelling "GERONOMO!" would be a good idea next time she's going to do this! :D

Kathy

[Cara's Mom]

Or at least WHOOPIE!!!!!

[We Hope]

Marion,

You're right--it should be WHOOPIE! That's what we're all saying--now! ;)

Kathy

[Cara's Mom]

We're up to 17.8!! I can breath again.....WOOPHIE!!!!

[k9diabetes]

Hahahaha... Woophie!! I love it.

[Ricksma]

Jenny, I am laughing at your post!! That is so true. It seems we get so used to seeing the really high numbers at first that when they start to get down more into a "normal" range, we start to freak!! Cara is going to be just fine. I wouldn't worry too much about rebounding right now...Natalie is right about that. Ricky has had some pretty big drops without any rebound. I am just so happy that Cara is doing better. She will feel so much more like herself when she has better numbers...and mom will feel better too!!

Love and hugs, Teresa and Ricky

[Cara's Mom]

Teresa, I sure did not expect those "normal" range numbers to show up so fast! They came after her 2nd shot and that freaked me out!! To-day is a new day, so let's see if we have an other "woopie" day!!! I am ready for it now!! (I hope!?)

[Cara's Mom]

It looks an other rollercoaster ride again:)
Bg's before meal 12.3, after meal Hi, 8:30 - 25.4, 10:30 - 16.7.
Now the last one is 1 hour after our 1/2 hr walk. That should have some effect on it!?!
I don't understand the first two readings...(I did the first one twice becase I did not believe it!)!? Any explanation for that?:o:o

[We Hope]

Marion,

Everything you read about diabetes in people talks about the need for regular exercise to keep the bg's low and steady. A lot of people are told by their doctors very plainly that their control would be a lot better if they did this.

http://petdiabetes.wikia.com/wiki/Overweight#Exercise_and_active_play

"Dr. Harkin of Kansas State University is a believer in exercise for all his patients--canine and feline. Active play can be a fun way to "work out".

"Note: Exercise will often noticeably affect a cat or dog's insulin requirements and blood sugar levels. Informal polls on the FDMB show that the effect differs considerably from animal to animal, and may either raise or lower blood glucose levels depending on the individual. This is something you should find out about your pet and keep in mind when increasing exercise. Exercise should be avoided at or near the peak time of the pet's insulin, as the action can result in hypoglycemia."

The same is true for people--for most, exercise does reduce their blood sugar levels and this is why the doctors and various diabetes organzations keep talking about it.

Glucose is body fuel. Many athletes believe in what's called "carbo loading" before a big athletic event. They make a point of eating foods high in carbohydrates which turn into glucose. The extra glucose is extra energy for them during the match or game.

With the right amount of insulin, the body is able to use the glucose as fuel--without it is why you see abnormal amounts of glucose in both blood and urine--uncontrolled or poorly controlled diabetes.

When you and Cara took your walk, the exercise made her able to use the glucose for energy, so it didn't show up on your meter. :)

Cara's fasting is good--you can see when her body starts working on the meal, and that's when she starts climbing. There may need to be some "bumps" worked out re: insulin timing and food, but I think you'd be best off to just concentrate on getting lower levels than Cara was giving us before her insulin increase for now. As Cara continues working her way toward regulation, these "bumps" could become a non issue.

I think she's doing GREAT!!!!!!!! :D

Kathy

[Cara's Mom]

Thanks Kathy! I just could not figure out those first to readings!
Heh, we go every day between 9 and 10 for a 40 minutes walk, never miss a morning. Used to be 1 hour. But Polly is getting up there so we cut it back. This morning Polly could not keep up and we stopped a little earlier! It's was one of the first frosty mornings of this fall!!
Well, I'll just plow on:D:D...stomach feels fine, this far!!! And Cara looks bright and alert!

:):):):) YES, WE HAVE SOMETHING TO SMILE ABOUT:):):):)

[rhodesian46]

Hi Marion,
I have learned that I don't boast too much about Pebbles Bgs" Because when I do she throws me a curveball and goes up a bit. So SHHHHHH!!( HA) ALso it me Pebbles over a year to get numbers below 120 or so. Glad Cara is doing well!!:D:D

[ladysmom06]

Hi Marion,

Happy:D:D to hear that Cara is doing better. Your doing a great job with her. For months Lady had really high bg's and when I finally start getting good numbers I was so worried she was going to go too low - but she was fine and Cara will be too. Hugs to you, Cara and Polly too.

Luv,
Lynne and Lady

[k9diabetes]

Bg's before meal 12.3 / 221
after meal Hi, / over 500? or is it 600?
8:30 - 25.4 / 457
10:30 - 16.7 / 300


How much time elapsed between the 12.3 and the HI?

Which reading did you recheck?

Depending on how much time elapsed, one could be a false test.

Not sure if I mentioned to you previously... it's quite common for the blood sugar readings to be nice and level when they are all too high and for you to start to see sharper ups and downs as they come closer to normal readings.

Could be that the carbs you give... I'm thinking it's rice but haven't taken time to go back and check... are getting digested pretty fast, before the insulin catches up, and you are just starting to see that show up now that there's room for the readings to vary.

I agree with Kathy - don't worry about doing anything right now except watching what she does with this diet and this dose of insulin.

Plus, she may need at least some of the carbs to cover her walk in the morning.

Chris' BG always plunged sharply with exercise. So you will need to, as you settle into a long term food and insulin plan, include the amount and timing of exercise in that mix.

For now, just keep track of everything, including what time you walk and for how long and the blood sugar readings if you take them before and after and after she's been in this spot for a week you can spread it all out and evaluate how it's going and see what might need some tweaking.

Natalie

[Cara's Mom]

Hi Natalie,
There was about 25- 30 min. between first to readings. Right before eating and right after. I redid the first reading (12.3).
She has been dropping faster to-day and lower to-day.
After morning Hi we got
8:30 - 25.4, 10:30 - 16.7, 12:40 - 12.7, 2:30 - 6.8, 3:30 - 6.7
and I'll do her again within 20 min (4:30) that 'swhen she should be climbing back up hopefully!
I read that both lows are still within range, but I sure like her to come up a little . Did give her some carbs after 6.8. She seems fine. Just barked her head off, when neighbor rang the bell!

[Cara's Mom]

4:30 - 8.5 coming back up!

[We Hope]

Marion,

What you're seeing now is the insulin at work. When you see Cara going to 6.8 at 2:30 and 6.7 at 3:30--this is the "peak" time for the insulin--when it's working hardest.

http://www.bddiabetes.com/us/main.aspx?cat=1&id=402

BD Diabetes--Blood Glucose Curves

"An ideal blood glucose curve looks like a bowl. The lowest spot in the curve, called the nadir, appears halfway between insulin injections. If the dog’s blood glucose does not go lower than 100 mg/dL or higher than 300 mg/dL during the observation period, it means that the insulin doses and duration are working well."

http://www.bddiabetes.com/resource.aspx?IDX=2495

Before the addition of those 2 more units morning and evening, Cara's curve looked like this because she needed more insulin.

http://www.bddiabetes.com/resource.aspx?IDX=2496

Although Cara may still need to have some insulin increases along the regulation route, now her bg's look more like the first picture than the second.

So what you're looking at are the "peaks and valleys" made by how hard the insulin's working at a particular time. As you and your vet work more at finding the right dose for Cara, you will see that the "bowl" made by the insulin's effect will become more "shallow"--meaning that Cara's highs won't be as high any more.

Gosh--yesterday we got into "WHOOPIE!" and today we're into bowls. If someone read only the last two days of Cara's thread, they might wonder what it has to do with diabetes. :D

You're darn tootin' it sounds like that girl of yours is getting back to her old self! :)

Kathy

[Cara's Mom]

Well, I rather yell WHOOPIE than BOWLS!!
Those "6" readings were scary! But now I know what to look for, the time I mean.
The time right between the two shots should read the lowest reading. So that's around 6 1/2 hours in!?! Got you!

[We Hope]

Marion,

Peak or nadir times vary according to the duration (short/fast, intermediate--this is Caninsulin, an intermediate, like NPH), and even the type of insulin.

Both Caninsulin/Vetsulin and NPH are considered intermediate-acting insulins; NPH is suspended with isophane/protamine and it goes to peak or nadir faster than Lente, which is suspended by the size of the insulin crystals.

On top of that, every person or pet has a different peak or nadir time. This has to do with the way that particular body processes the insulin. Most people and pets are decently within the range shown by the insulin time activity profiles. So from what we've seen today, Cara peaks or hits her nadir 6 1/2 hours after having her shot--and that would be in keeping with the Lente time activity profile.

If we both get them filled with ice cream, I'm willing to yell "BOWLS!"--what about you? :D

Kathy

[Cara's Mom]

As long as there is whipped cream on top!!!!!!!
Just fed my girls....Cara was starving!!! Do we have to do something about that or let it be for next couple days!?! And give her a few more veggy snacks in between!?!
I am glad Cara is finally doing something she is supposed to be doing!!!!

[Cara's Mom]

Recalculation: She eats and gets shot 6:30 AM - peaks around 2:30......that's 8 hours!!!!!!!

[We Hope]

Marion,

Have a look at the Lente insulin time activity profile graph. Though it's not a bowl, but a "bump", it shows you when the insulin's working the hardest by where the "bump" is the tallest:

http://images3.wikia.nocookie.net/petdiabetes/images/7/7f/Lentetap.gif

You see that it's tallest at the point between 8 and 10 hours after a shot.

She has that on the money!! :)

Cara's feeling better from not having those awfully high bg's and this is what's making her hungry--many don't care to eat and you have a hard time with that when they have high bg's.

Going with some veggie snacks should fill her up some without being "hard" on the bg's. With the way things are going, I'd try to keep as much to the way you've been going along as you can for now.

I'm shaking the aerosol can to top our "BOWLS!" :D

Kathy

[Cara's Mom]

Sure happy she knows what she is doing!!! And doing it right!!

Here's to you, Kathy, while I lick out my BOWL!!!!

Cara sents her love:)

[Cara's Mom]

Just a quick update:
This was day 5 on 11 UI and we are still alive!
These are todays numbers:
6:30 - Hi
8:30 - Hi Just before excercise (over 500)
9:30 -21.7 Just after excercise (390)
12:30 - 15.7 (282)
2:30 - 9.2 (165)
4:30 - 7.1 (128)
6:00 - 21.7 (first time no Hi after PM meal)(390)
What do you think? It's a start of something good to Cara and me:D:D:D!!!!
She is again just as hungry as those weeks, when everything started! Poor thing! But otherwise, she's happy, playfull and very active!

[We Hope]

Marion,

It looks like Cara's post-meal spikes are beginning to lessen from the insulin increase. I'd believe that since this is the first time Cara wasn't high after dinner, tomorrow morning's fasting will also be lower--the "bowl" is getting "shallower". :)

I think that once the morning fasting is lower, the rest of the day and evening will come into line better also. She might still need some sort of increase, but this is real progress! :D

When we had the weak Iletin, it took about 3 days for Lucky's physical signs (panting) of his post meal spike to disappear. We were after them with less than 100% potent insulin and because of not knowing the true potency left in it, we had to stay with his normal dose and not increase it. (The quest for Caninsulin was born with this incident. :D )

Before getting to pork Lente insulin, Lucky was always hungry also--he was looking for dinner when it was hours away. He always had a healthy appetite, but this was just "driven". On top of that, he was hyperactive from the high bg's; he was like a small child who'd had too much sugar.

John and I called it a "sugar buzz". Seeing him stop coming into the kitchen after meals for his shot and starting the "sugar buzz", led us to look into the insulin--we found it was weak.

Cara's telling us that she feels much better now that her bg's are getting down. ;)

Since that bowl is getting shallower, I think it's a "soup night"! :D

Kathy

[Cara's Mom]

Kathy,
Cara has not done any panting lately, just a little heavier breathing. But that passes in no time.
I am so glad there is improvement! This little girl deserves it. She is so patient and comes and waits for her shot after each meal. Could be she wants the treat and tolerates the shot:)

What the "soup" concerns.....No thanks, ate already!

As always, thanks for the encouragement:D:D:D

[CarolW]

Kathy,
Cara has not done any panting lately, just a little heavier breathing. But that passes in no time.
I am so glad there is improvement! This little girl deserves it. She is so patient and comes and waits for her shot after each meal. Could be she wants the treat and tolerates the shot:)

What the "soup" concerns.....No thanks, ate already!

As always, thanks for the encouragement:D:D:D

Marion - I had three pages to read to catch up with you and Cara; Great job! I know what you mean about how scary it is to see those numbers lowering, when you weren't used to it! Kumbi tends to run high, so readings in the 6 area (mmol/L) would probably scare me - at least; I'd have to watch closely.

Exercise has so much to do with how the BG levels go! Kumbi's BG levels drop after exercise. I do believe, though, that there's a rise in BG levels from the stress (excitement), and a drop when the body uses the glucose as fuel, so a lot of how we figure this out probably has to do with TIMING of our readings! A useful book is, _Why Zebras Don't Get Ulcers_ (3d edtion, 2004) by Robert M. Sapolsky. Pretty technical, but entertaining, and you can just read through it, not try to learn, just get the idea - and learn a lot that way!

Fri, 26 Sep 2008 19:37:54

[Cara's Mom]

Hi Carol,
Have to agree with you...stress brings those pesty little Bg's or should I say big Bg's! Right now, do'nt think she has any stress....she's sound asleep, with a nice full tummy:D!
That book sounds interesting. I'll see if I can borrow it at the Library tomorrow.

[k9diabetes]

Just a quick update:
This was day 5 on 11 UI and we are still alive!
These are todays numbers:
6:30 - Hi
8:30 - Hi Just before excercise (over 500)
9:30 -21.7 Just after excercise (390)
12:30 - 15.7 (282)
2:30 - 9.2 (165)
4:30 - 7.1 (128)
6:00 - 21.7 (first time no Hi after PM meal)(390)
What do you think? It's a start of something good to Cara and me:D:D:D!!!!
She is again just as hungry as those weeks, when everything started! Poor thing! But otherwise, she's happy, playfull and very active!


I will be curious to see how she does the next couple of days. If this seems to be where she stays, I'd want to work on the high readings in the morning - assuming they are still occurring.

The trick is that she could need either more or less insulin at night.

If she was getting too much insulin at night, she could be going into low blood sugar and then rebounding. Given that she's dropping all the way from over 500 down to 128, that is a possibility.

The other possibility is that because she doesn't exercise at night she needs more insulin to cover the glucose that, during the day, is being eaten up by exercise.

If you're lucky, the curve will flatten out on its own as she continues to adjust to the new dose. I hope that's the case. But if not, some tweaking can help even things out.

It's such a joy to see those numbers coming down!! :)

Natalie

[Cara's Mom]

Natalie,
I love those lower Bg's, as scared as I was when the first appeared!
I have to turn in a curve again Monday, so I was going to give her a day-off from Mom, the Vampire!! Will just watch her as a hawk and when I get uncomfortable I will play Vampire again! Would that be OK?
The only thing different she gets in the morning is 2 Vi-Sorbits and 1 capsule codliver oil. Could that be a cause for higher Bg's?
It would be very nice, if that curve would flatten out by it self, but I will not hold my breath! Would be toooooo easy!!!!!!!:D:D:D

[We Hope]

Marion,

It doesn't look like Cara will drop into the low/hypo range, so don't see why you couldn't give her a day of rest from "poking". ;)

Here's the link to what's in the Vi-Sorbits:

http://www.pfizerah.com/PAHimages/compliance_pdfs/US_EN_VO_compliance.pdf

You do see corn syrup there under ingredients but I'd believe there's not enough in the vitamins that it should be a problem with driving Cara's bg's up. Would also think it's the same for the cod liver oil capsules.

Now--if today's to be an "off" day for both of you, hope you all get to do some enjoying somewhere! :)

Kathy

[k9diabetes]

I'm assuming that first reading in the morning is before food, insulin, vitamins etc. If so, the 500+ reflects something that's happening at night.

If it doesn't go away, you might want to set the alarm and run a few spot checks during the night to see if she's higher all night or potentially dropping low and adjust from there.

Enjoy your day off! You two definitely deserve it!

Natalie

[Cara's Mom]

Thanks ladies!!!!
We will spent the day in the yard......beautiful day here!
I was thinking of checking her during the nite, but never did anything about it:o:o:o!!! So, to nite I will do it!!
Have a good week-end and we'll talk on Monday about weekly vet report!

[CarolW]

Marion - have a great day off. Of course, you'll wreck it by poking half the night; ha! How about taking ONE night off as well? Just a thought. If you're doing a curve Monday, you could take tonight off. Maybe. Maybe I'm not understanding right.

I first learned to test early in December, 2006, a few months after Kumbi was diagnosed as diabetic. One of the vet techs had told me I'd need two people. That was her only mistake. But it kept me from doing the testing at home for at least a couple of months.

Kumbi stressed SO badly, being at the vet's all day for testing, that finally I decided I HAD to test, even with only one person (me). To my delight, Kumbi cooperated. It wasn't that hard to learn to test, because my vets use the Lip-Stick, which is apparently one of the painless kinds of testing - I'd find Ears difficult. I use the inside of the upper lip.

But when I first learned, I did a fair bit of extra testing, such as, every hour (when not really needed); once, every half hour for the first few hours after the morning injection (but my vet did suggest that, to catch the onset time). I kept that up - extra testing - for a few months - then, one of my vets remarked, saying (gently) - that's a lot of stress to lay on Kumbi.

Of course, Kumbi isn't in the same situation as Cara - his numbers didn't run HI on the meter. So we don't need all those tests. You might well need as many as you do. Still, it IS stressful for the dog; just thought I'd remark on that. (As though you didn't already KNOW that! - silly me!)

Anyway, if/when you CAN take a break, why not do that? (I'm considering, someday, doing tests at night also, but probably won't do that till Kumbi starts showing signs of discomfort at night. I should do it once, though, to get a baseline!)

Sat, 27 Sep 2008 12:12:54

[Cara's Mom]

Hi Carol,
With the Bg's going so low (for the first time in a month and 1/2) I have to know what's going on!!!
Was a wreck when I first started.....wasted lots of test strips!!!!! But you have to keep going, without showing Cara that I was way too nervous!! Now it's almost routine :). However the test strips for the AlphaTrak have gone up by $ 6.00 for 50 of them!!!!Found a coupon for a Free OneTouch Ultra and found out that their test strips are in the same price range.....but you get 100!!!!!! So I bought a box and got the meter!! Was on a webside that compared the AlphaTrak to human meters and the OneTouchUltra scored very good!!

http://felinediabetes.com/glucometer.htm

Now I have to check how much or little the difference really is.
I am still on my day off.....so no checking it today and tomorrow is the curve day and have to use the AlphaTrak for that. So maybe can check than.
Talk to you later:D:D

[k9diabetes]

Hi Marion! :) [Cara],

We used a OneTouch Ultra most of Chris' diabetes years and we loved it. For him it was a consistent 30-40 points lower than lab values. We bought the strips through www.hocks.com (http://www.hocks.com) - perhaps not a bargain basement price but a lot better than buying them at the drugstore.

Carol asked me for a link to the comparison I did with my OneTouch Ultra and AlphaTrak meters so I'll post it here so you can see how they compared for us.

It's all individual of course. The only way to know how you and Cara will do with the meter is to try it. But it seems to work well with larger dogs like Cara and a 30-40 point difference from labs seems to be fairly common.

Natalie

http://www.randomfierce.com/canines/OTandATfinal.jpg

[k9diabetes]

As far as frequency of testing goes, I agree that right now you need to know what's going on with her.

I am of two somewhat conflicting opinions on testing in general...

As far as stress, that just really depends on the dog. Chris couldn't care less about having his blood sugar tested and didn't find it stressful at all. Anyone who's seen the video of him can see how basically bored he looked about the whole thing.

So if your dog stresses, you definitely want to try to limit testing to only as needed.

And it certainly is possible to go overboard and fret over every individual number every day. You will get to a point where constant hovering over individual readings isn't at all necessary. But it can sometimes be a hard habit to break.

My experience over the years tells me that a lot of dogs don't mind it a bit and if you have a need to test, test. Veterinarians too often scare people, telling them the testing will stress the dog. It might... it might not. And the stuff they do at the vet is inherently more stressful than anything done at home. Heck, just being at the vet is stressful for a lot of dogs.

Once Cara's on a generally unchanging amount of insulin, the need to test her will decrease. The nice thing is you can take a day off and still test her if she gives you some cues that she's in trouble.

In Chris' case, with him getting four injections a day, I tested a minimum of three times a day because his blood sugar was so variable. I'd skip testing for one of his meals, usually the early morning one, unless I had some reason to be concerned. And if I was concerned, I tested.

If I had to be gone and I was worried, I'd test him and give sugar if need be to make me comfortable with leaving him unattended. If he was acting off, I'd check to see if it was high or low blood sugar (they can look a lot alike!) to find out if that was the problem.

You and Cara will find what works best for you. Obviously you won't be doing curves or even mini curves every day for the rest of her life. You'll find out how consistent she is and how much testing will be needed to monitor her. I'm hoping that over the next four or five days her curve will flatten out.

Natalie

[Cara's Mom]

Hi Natalie!
Now you got me very curious!! But the price difference was too tempting. AlphaTrak cost me $1.34 and OneTouchUltra cost $0.75 per test strip. That's a big difference!
Your comparison and the one I mentioned are different. Did you try the link I sent? But anyway, as long as I find out the difference between them by doing a comparison myself, I should be alright!

P.S. I am the two legged one (Marion) Cara is the four-legged girl:D:D:D( her reading is not up to par!!!)

[k9diabetes]

I totally agree with you on the price. Personally, I always used the OneTouch and simply added 30 points to each reading. At the very low end I added only 20 points just to be safe.

I got the AlphaTrak mainly just to see what it was like and then kept it around to double check a reading if the OneTouch reading didn't seem right. It was just too expensive to use!

I will pass a long a tip via personal message too - it's something I can't put in a public forum.

Natalie

[Cara's Mom]

We were posting at the same time, I guess!!
No, I have no intentions on testing her so much for much longer. But like I said before...those low Bg's are still a little scary!!! It's all so new and I cannot read 100% yet! But it's getting better. To-day was a good day, did not bother her at all!

[Cara's Mom]

Update:
Yesterdays curve:
6:00 - Hi before meal
8:30 - 25 (450)
10:30 - 15.4 (277) after excercise
12:30 - 15.5 (279)
2:30 - 14.3 (257)
4:30 - 25.2 (454)
6:00 - Hi before meal
8:00 - 26.5 (477)
10.00 - 23.6 (425)
This AM:
6:00 - 14.9 (263) before meal Best one yet!

Vet was pleased!! She probably still needs higher dose, but wants to wait till next curve. Wants her in 200 range for most of day and that might be coming

So what do you think? Some food manipulations?
Vet suggested increase kibble (now 1/2 cup science diet adult lite) and maybe reduce rice (now 1/2 cup). She still get 1 oz of senior canned, and 3 oz WD canned. Could be changed to all WD!?

[We Hope]

Marion,

I LOVE this morning's fasting!!!!!!!!!! :D

You might try increasing the Science Diet and reducing the rice as your vet suggested--some people with diabetes say they can't even look at rice or pasta without their bg's rising. Others say they're fine with it in moderation.

Changing to W/D canned depends on one VERY important thing--will Cara eat it willingly? :)

Can tell you from personal experience that W/D does wonders with bg's. We switched to W/D canned with Lucky about a week before we were able to get the Iletin insulin to make the switch to pork insulin.

I made a total switch to 100% W/D canned the evening I brought it home from the hospital. Had asked John at the time, when we might expect to see some results from the food change and he said in about 5 days.

Within 24 hours of starting the W/D, Lucky's drinking and urinating had improved quite a bit. It was so much of an improvement, I called John to ask if, in light of this, we should decrease the amount of insulin to be safe. The insulin was ineffective for Lucky up to resistance level, so we knew the improvement was not from anything but the W/D. We decreased his insulin for safety's sake; if we had changed both the food and the insulin at the same time, I believe Lucky would have had a hypo!

Have seen a lot of other people who feed W/D say they've seen their dog's insulin needs decrease as a result of switching to the food.

It still looks to me that Cara may need a bit more insulin--this could change, though, depending on if you increase the Science Diet and decrease the rice or change to W/D. We'll need to see how Cara deals with the changes you decide to make against her current 11 units twice daily insulin dose.

Cara, keep that progress coming, dear! :)

Kathy

[Cara's Mom]

Morning Kathy!!
Cara is currently eating 3 oz of WD canned! What she won't eat is the dry!
Do not want to make to many changes at once....so what would you suggest? Reduce the rice or take it out all together? And increase the WD canned to 4 oz? Whit that she get 4 oz cooked chickenbreast.
Oh, she gained some weight, almost back at 21 kg (still long way to her former 23-24 Kg) and her urine glucose is down too!!!!
Yes, she is doing a vey good job! I think.....I will keep her;);)

[We Hope]

Marion,

You are absolutely right--make only 1 change at a time so you can see what's been successful or what hasn't been.

Since your vet suggested the increase of Science Diet and the decrease of rice, I'd go to that first and see what kind of effect it has on Cara's bg's. The chicken has no carbs or sugars in it so I don't think that needs to change at all. It's also low-fat, so that's an added plus! ;)

We didn't consider the W/D dry for Lucky at all because back then, the extra fiber in the dry formula was being provided by peanut shells. Lucky had a large bladder stone removed about 4 years before he had diabetes and peanut products can cause additional stones to form. W/D dry no longer has any peanut products in it.

I believe as you continue coming closer to regulation, you'll see Cara picking up the lost weight. As we talked about earlier, she's now doing a better job at burning the glucose, not the fat, for her energy.

I think you should not only keep Cara, but that she should get a "raise"! :D

Kathy

[Cara's Mom]

Are you affilliated with the "Union of the DM Canines"!?! Talking about raises!!! Don't let Cara hear you, she might think Bg's:D:D:D
So to-nite we'll reduce the rice to just a table spoon and increase kibble from 1/2 c to 3/4 c or should I go higher, say 1c?

[We Hope]

Marion,

I believe I would try going to 3/4 cup of the Science Diet and only the tablespoon of the rice. This should let you know whether it's the rice that makes for higher bg's.

Quite a few people do feed that Science Diet as a less expensive alternative to W/D or other prescription diabetes diets and it's worked well for them. We started out with W/D canned and because it did so well for Lucky, we wanted to stay with it.

Then starting this evening, you can see if this results in getting Cara's bg's lower.

I am a Union Organizer for this poor, under-represented group of Sugar Dogs, who need a no/low carb, no sugar pay hike ASAP! :D

Kathy

[Cara's Mom]

Thanks Kathy,
Will do!!!

PS. This Sugar Dog will get a raise:D:D:D!!

[rhodesian46]

Hi Marion,
Hope Cara does better Am watching or your posts These doggies and the stress they give us mommies:D

[Cara's Mom]

Hi Marianne,
It's nice to see these changes....waited long time for them!!
These problem babies do not only give stress...they cause weight loss!!!! And I am not talking about Cara loosing weight, I have dropped some lbs too:D:D:D!! But that's not a bad thing!

[k9diabetes]

What a beautiful premeal reading this morning!! :) Natalie

[Cara's Mom]

Thanks Natalie, I think I'll frame that one:D:D:D:D!

[eyelostit]

Have you tried some veggies like chopped raw brocolli or green beans? Really helps lower the BG

[Cara's Mom]

Morning Dolly,
Yes, she is getting chopped veggies and loving them! I believe I just have to be a little more patient...it all takes time, doesn't it:):)

[k9diabetes]

In going through your thread, it seems to me that this curve you did on the 26th is looking fairly typical.

6:30 - Hi (500+)
8:30 - Hi Just before excercise (over 500)
9:30 -21.7 Just after excercise (390)
12:30 - 15.7 (282)
2:30 - 9.2 (165)
4:30 - 7.1 (128)
6:00 - 21.7 (390)

It looks like most of the insulin's effect is finished at about 10 hours - that's why her premeal readings tend to be high.

Tweaking the diet could potentially flatten out the curve - her BG takes a big drop late in the 12 hours, going from 500+ at 8:30am down to 128 at 10 hours. And then it climbs back up quickly during the last hour and a half.

Exercise could have a lot to do with that drop. IF that's the case, then the same sharp drop in BG isn't necessarily occurring at night.

The next curve was on the 28th.

6:00 - Hi (500+) before meal
8:30 - 25 (450)
10:30 - 15.4 (277) after excercise
12:30 - 15.5 (279)
2:30 - 14.3 (257)
4:30 - 25.2 (454)
6:00 - Hi before meal
8:00 - 26.5 (477)
10.00 - 23.6 (425)
This AM:
6:00 - 14.9 (263) before meal Best one yet!

This curve is flatter, which I like.

With a curve that's flatter, like this one, you would be able to increase the insulin to take all the numbers down to a better level.

Then today...

5:15am threw up some bile. Bg 26.9 (484)
7:30am (1 hr after meal) Bg 25.3 (455)

These numbers aren't much different than the curve above so I'd consider them part of the trend and not focus too much on what the throwing up might have meant.

I don't think there's any way to know what's happening at night without doing some spot checks. Because it could be either she's not getting enough insulin so her BG is high all night OR she's dropping too far at night and rebounding. They will look exactly the same in the morning's reading.

The factors you've got mixing together include:
- insulin dose
- diet
- exercise (when and how much)
- general activity level (more in daytime than night time)

All of those things affect her blood sugar and it could be that her nighttime numbers are quite a bit different from her daytime ones.

Suggestions!

Curve her today or tomorrow during the day with the food change and see what changing her food has done to the overall shape of the curve.

Hold this dose of food and insulin for a few days to get her long-term response.

Do some night time tests - ideally, 8:30pm, 10:30pm, 2:30am and 4:30am as those are the points during the day when her BG is lowest. Keep your routine the way you normally do - so if she doesn't exercise at night, don't exercise her when doing these tests.

Let us know what you get and we will give you some input on what we think is happening.

Natalie

[Cara's Mom]

Thanks Natalie!
I believe I am not focussing on the big picture....too much on what is happening right now!!! Good thing we have you to point that out:o!
I am curving her to-day and it does not look as nice as yesterday's:
After excercise she was 18.4 (331)
12:30 16.5 (297)
2:20 18.6 (335)
Will do the rest of the readings you suggested and let you know to-morrow!

[k9diabetes]

I put Cara's two curves into a chart and that helps show how similar they are with the one on the 28th being flatter - a very good thing.


http://www.randomfierce.com/canines/carabg093008.jpg

[k9diabetes]

Actually, I think these readings today look good. Here's why...

If she kept the curve you did on the 26th, you could not increase her insulin as she was bottoming out in the 100s but also spending time at over 500. Any more insulin under that curve and she would have gone hypoglycemic.

With the curve slowly flattening out as you see it doing today - that is a goal, to have the flattest curve you can get - you will be able to increase her insulin and get ALL of her numbers down into a good range.

A dog that can achieve a perfectly flat curve (very rare) can have essentially perfect, very very tight blood sugar control. The flatter the curve, the tighter the control can be.

It is easy to get lost and not see the forest for the trees. It's trends you want to look at and how the BG is doing over the course of several days. Try not to pay too much attention to any single reading.

I think this is a great development!!! If she stays consistent with this on her new diet with less rice, you will be able to up the dose of insulin and bring all of her blood sugar levels into a better range.

You didn't know this was good news, huh?

I'm really excited about this and hope it continues.

Natalie

[Cara's Mom]

These curves gives you a whole different perspective!
I am looking at numbers when they happen without counting them in the whole picture!!!
So you still want the same dose insulin for to-nite, to find out what is happening during the nite! OK!

[k9diabetes]

I added your numbers quickly so this is a little less pretty image but you can see that actually she's trending pretty predictably between the 28th and today.


http://www.randomfierce.com/canines/carabg093008x1.jpg

[Cara's Mom]

And all this, because she threw up at 5:15! And I still do not know why!?

No...did not know this was good:o:o:o!! Just have to believe you and those curves you made!

Cara likes your curves too:D:D:D:D!!!

[k9diabetes]

Sometimes a chart is the only way for me to accurately spot trends, especially over a number of days.

[Cara's Mom]

We posted at the same time..again! Please check bottom of previous page!

[We Hope]

Marion,

If you'd like to try graphing this out yourself and don't mind "fiddling" with converting mmoL to mg/dl, Intervet has a curve generator on its Vetsulin site. Nothing goes back to Intervet re: anything you enter, BTW.

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

The tool has a built-in kg/lb, lb/kg converter that pops up as a mini window for weight.

http://www.childrenwithdiabetes.com/bs_conv.htm

This page has the mmoL-mg/dl (and vice versa :) ) blood glucose values converter.

The Vetsulin page will generate a curve graph that you can print out.

Kathy

[k9diabetes]

LOL... We were pretty well synchronized there for a while! :p

Looking forward to seeing the rest of her numbers.

Do you have Excel?

I can send you a copy of the spreadsheet I used to create the chart if you want to follow up with the numbers yourself that way.

Natalie

[k9diabetes]

Now I was posting the same time as Kathy... I think this means I should go do some paying work! ;)

[Cara's Mom]

I think you all should start doing some paying work!!!
No I do not have Excel, sorry Natalie! Quess have to check Vetsulin's website and see what I can accomplice there!
Thanks Ladies!!!
Back to-morrow whit some more numbers!!

[Cara's Mom]

Well...here goes. Bg;s for yesterday and last nite!
AM
5:00 - 484
8:45 - 455 (pre walk)
10:00 - 331
PM
12:30 - 297
2:30 - 335
4:30 - 340
6:00 - 482 (after meal/shot))
8:30 - 344
10:30 - 248
OCT 1 AM
2:30 - 466
4:30 - 455
6:00 - 464 (pre meal/shots)
6:30 - Hi (after meal)
And that was our story of a long, long day:eek::eek:!!!
Cara is not talking to me anymore!!

[We Hope]

Marion,

What jumps out at me first of all is the 10:30 PM 248 reading contrasted with the 2:30 AM rise to 466, and then gradually on to "HI" this morning after breakfast and insulin.

It looks to me like Cara still does need more insulin to get things under control--she's at roughly 0.25 units per kg of her weight--still 0.25 units away from what's now the suggested intial dose of 0.50 units per kg of body weight. The insulin "on board" tries to do the job, but there's just not enough of it to do it.

People with diabetes who are having "numbers problems" in the morning do about the same thing you did with Cara--they check their bg's about 2-3 AM to see what they are; if they find they've gotten markedly higher at that time, they increase their evening insulin if overnight/morning is the only place they have a problem.

Increasing Cara just at night wouldn't be the total answer--she needs to be increased morning and night. An overall increase should bring these numbers down to better levels. Is there any way you could speak to Cara's vet and ask if he would consider increasing her insulin every 5 days, if it appears she needs it?

Cara says, "I didn't think vampires were found in Canada!" :D

Kathy

[Cara's Mom]

Hi Kathy,
We can get Cara's insulin increased every week! After I turn in a curve, ofcourse:(:(:(
On our last visit on monday he mentioned bringing her up a unit, but wanted her meals a little changed. Never liked the rice in there, always wanted her on kibble! So that's why those diet changes first. He is a nice guy, so I like to give him his way once in a while;););) But I am positive we will have an increase on monday ( if I play vampire on sunday!!)

Vampires are not from Canada, but do you realy know where I am from???? I might be the first imported vampire:D:D:D Sure feel like one, after yesterday:D:D:D

[We Hope]

Marion,

The only way he can see what's going on with Cara's bg's is via the curve. Any chance he'd review your findings from yesterday and today, so he can also see what we're seeing?

With the rice now gone, we see that wasn't causing the high bg's.

Looking back a couple of days to the 29th, I see he was pleased with those results. I didn't see that Cara got any increase on Monday; if not, he might have different ideas if he saw what you have for yesterday and today. Also see that he wanted to wait until next curve to do an increase--to me, yesterday and today would surely fit the bill as the next one. ;)

The sooner you can move Cara safely along, the sooner she will get to being regulated.

He got his way with the diet, and now it might be your turn to get yours re: increasing Cara's insulin. :D

So, are you saying you're really the Countess Aculard in disguise? :):D;)

Kathy

[Cara's Mom]

Now why didn't I think of that:o:o:o!! Not enough sleep last nite!
He is getting yesterday's curve and we should have an increase to-morrow, maybe tonite!!!!
Have to go:D:D:D!!!
The "Countess" has to negotiate an increase:D:D:D!

[ladysmom06]

Hi Marion,

Your doing a GREAT JOB:D:D with Cara and getting great advise from Kathy and Natalie. Hang in there - it will get better - I promise. Hugs to all of you.

Luv,
Lynne and Lady

[Dollydog]

You are doing an awesome job and a great encouragement to anyone starting out on this journey. Your ability to do curves is the greatest asset to the successful treatment of Cara's diabetes.
I only wish I had been so successful with Lady's treatment!
We would increase her insulin every 5-7 days after a few draws at the clinic. It took us months as we were trying to get the Cushings regulated too.
But Lady would never have stood for so many pricks from me...there were 2 of them at the clinic to do the draws from her neck! ;)
Keep up the good work,
Jo-Ann & Lady :)

[Cara's Mom]

Thanks Lynne,
I feel a little better lately and a little more confident, thanks to all of you here on the forum. And now I do believe that it will get better:D!

[Cara's Mom]

Hi Jo-anne, thanks for the vote of confidence! I HAD to start curving her myself, she was a wreck (and still is) everytime she walked through that door at the clinic!!!! They would never get any good reading at all!!!
Did you hear back from that lady, who needed help in Ont.? Oh, I can so understand her panic and angst!!! Been there and still doing it, now and then:o:o

[Cara's Mom]

WE ARE UP 1 UNIT!!!!
That makes it 12 UI/twice day! Starting tonite.
Thanks Kathy:D:D:D:D

[We Hope]

:D :) ;) :D :) ;)

Kathy

[Cara's Mom]

Cara had her Urine test today......looks like an other infection could be lurking!!!!!:(:(:(Sent away for sensitivity and culture. Probably won't be back till Friday!!!! Back on antibiotics in the meantime: Amoxil This is supposed to be little milder than Clavamox. Sure hope so..that was 2 wks of diarrhrea:(:(:(
Ofcourse this has to happen when she was picking-up so nicely!
Well. that's live..two steps forward, one step back!!!!
Does not seem to bother her (yet)....happy, active and has gained 1/2 lbs :) And everything else is normal: eating, drinking, peeing. Bg's little wacky, but has only been on new dosage for 3 days, need a little more time and/or infection looming?

[We Hope]

Marion,

When there's an infection in the picture, most often the bg's do go up. The previous one may have been in the picture for a while, as sometimes the infections are there, but there's no evidence of them until you take a urine cuture.

I would venture an opinion here that if Cara does have a UTI, it's not as bad as the previous one. If there is, this one has been spotted and treated early. Last time, Cara was initially taking an antibiotic which had no effect on the bacteria causing the infection. That was when she had the urine culture done and it took Clavamox to make it leave. The chances are that if there's something there, the Amoxil may be working on it.

You might get a clue if you see the bg's start going down--that usually means the antibiotic has had some effect on the UTI. But you really aren't going to have a good test of how the insulin's doing until the question about the UTI has been sorted out.

When people with diabetes get an infection, their bg's most often rise too. And that means for many that they will temporarily need an increase in their fast-acting insulin; the need for extra insulin disappears once the infection is gone.

Those with diabetes do tend to have more infections, UTIs among them. They seem to thrive and grow in the bladder because of the additional sugar in the hyperglycemic urine.

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

Am also going to suppose out loud that because Cara HAS has some improvement with the bg's--they are no longer the constant "meter scorchers" they once were--that if she does have an infection, the less "sugary" urine may have helped her cause there.

Cara may not be troubled with UTIs so much once her bg's get under control and her urine has less sugar in it, as there's less for the bacteria to establish itself with.

And now, another thing to look forward to with regulation--putting these problems to rest too! :D

Kathy

[Cara's Mom]

Bg's are not that high, they are just "wacky". AM fasting Bg 's are now on the meter, usual around 18-19. PM are Hi -19. But she peaks at 10 AM, goes gently up and peaks again around 4!? They usually peak at 14 - 15.:(:(

[Cara's Mom]

does that mean her fast acting part of the insulin cannot handle it at the moment....so...indications of infection?

[We Hope]

Marion,

Right now, what you may be seeing is the point where the fast-acting semilente insulin peaks--around 10 AM--and the second peak at about 4 PM is that of the long-acting ultralente.

http://www.ncbi.nlm.nih.gov/pubmed/9358402?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=3&log$=relatedarticles&logdbfrom=pubmed

Pharmacokinetics of a porcine insulin zinc suspension in diabetic dogs.
Journal of Small Animal Practice-1997

"Ten dogs with naturally occurring diabetes mellitus were injected with a highly purified porcine insulin zinc suspension at a dose according to their expected requirement. Plasma insulin and glucose concentrations were measured at two-hourly intervals over 24 hours following injection. There were either one or two peaks in plasma insulin concentration: one at about four hours (mean 4.3 +/- 1.3 [SD]) and another at about 11 hours (mean 11 +/- 1.85) after the injection. The second insulin peak was seen in only eight dogs. Persistence of elevated plasma insulin concentrations ranged from 14 to 24 hours (mean 17.4 +/- 3.65). These results compare favourably with those published for other intermediate-acting insulin preparations used to treat canine diabetes mellitus and suggest that this preparation has useful properties for the successful management of many canine diabetics."

Taking this apart a bit, they say that the first peak at about 4 hours after insulin is plus or minus 1.3 hours. That means it could be 1.3 hours sooner or 1.3 hours later. Then you see them talk about the second peak at 11 hours--plus or minus 1.85 hours later. Meaning that it could be close to 2 hours earlier or later than 11 hours.

These numbers are an average of the times noted for the 10 dogs tested, with 8 of the 10 showing evidence of the second, later peak.

All Lente insulins "operate" like this, in the respect that there are two Lente family insulins combined to produce the insulin--30% fast-acting semilente and 70% slow-acting ultralente.

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

But what's shown as a time activity profile is all of this nicely "smoothed" out:

http://images3.wikia.nocookie.net/petdiabetes/images/7/7f/Lentetap.gif

People who continue to use Lente insulin (beef only now--imported from the UK) and those who formerly used it when it was more widely available would have also had the possibility for the two peaks because no matter what one makes or made the insulin from, it still works in the same fashion.

It may be that you will continue to see two peaks from Cara. When her bg's were so high, it would have been difficult to impossible to have seen it.

Lucky did not show two peaks but just the one later in the day, so he was still keeping with his tradition of not going by the book. :)

Does this help any--sure hope so! :)

Kathy

[Cara's Mom]

Hi Kathy, so again she is doing what she's supposed to be doing!!!!! Smart doggie:D:D!
I believed it to be an indication of an infection. Never realized there could be 2 peaks ( Twin Peaks :D). Just got my head around "nadir" or "peak" and doing my own curves on Vetsulins webside. Boy, still got a lot to learn:o:o
The urine test at the Vet was called "inconclusive" (don't like that word !), little to "murky"( scientific word?!?) and that's why it was sent out. There were no ketones, but Bg's were present, ofcourse.

Thanks Kathy, you are the bestes:D:D!

[We Hope]

Marion,

If you look at this (another "grab" via Google cache from caninsulin.com), noting the blue lines for insulin, you'll see the faster semilente peaking at about 10:00 in the example. Then you see the slow ultralente peaking between 14:00 and 16:00--

http://www.caninsulin.com/images/insulinactivitydog.jpg

Keep in mind that the higher the blue line goes, the harder the insulin is working--the red line is the blood glucose.

Now--let's have a look at another fast-acting insulin--this is R, Regular, or Neutral. This is used to cover meals and to bring down high bg's; it has roughly the same time activity profile as semilente.

http://images2.wikia.nocookie.net/petdiabetes/images/9/98/Rtap.gif

See how much that looks like the semilente blue line from about 8:00 to 12:00 on the Caninsulin example?

And now, we take a look at ultralente:

http://images2.wikia.nocookie.net/petdiabetes/images/0/01/Ultralentetap.gif

Have a look at this one at about 12 to 14 hours after injection; the "bump" is the tallest--this is the peak of ultralente. Now look back at the Caninsulin example at about 14:00 to 16:00--this is where the ultralente starts working hardest.

I used to watch that show, "Twin Peaks". :D I agree with you re: inconclusive, but there are times when it's really the only way to describe where we are at this point--what we've done up to now hasn't ruled in anything or ruled it out either.

Nice to know that something that looked worrisome really isn't, right? :)

Kathy

[Cara's Mom]

:D:D:DRIGHT!:D:D:D

[Cara's Mom]

Have other question: Re: those "Twin Peaks":)
With the first peak being at 10 AM, around the same time of our walk, will it not be more benificial to change walktime? Let's say more towards the "Valley" time? As a boost for the insulin?
Just thinking:)

[We Hope]

Marion,

I think this is worth a try! :)

http://www.bddiabetes.com/us/main.aspx?cat=1&id=389

"Managing your dog’s diabetes also means managing its activity level. Exercise ‘burns up’ blood glucose the same way that insulin does."

http://www.bddiabetes.com/resource.aspx?IDX=2493

You may find that in changing the time of your walk, the exercise could be more helpful at keeping those bg's down after the 10 AM insulin peak is over.

Boy, still got a lot to learn

I think you're doing GREAT at this! ;)

Kathy

[Cara's Mom]

Just came back from our walk.....so will try this to-morrow !
I do have lot to learn yet, but with things slowing down a little....my brain starts working again and I seem to able to "reason" better:D:D:D
Thanks Kathy

[We Hope]

You're darn tootin' you're learnin' those ropes! :D

Kathy

[eyelostit]

Sounds like you are taking good care of Cara.

Re: UTI's, Niki has never had this problem, but earlier in her diag she was constantly high and I notices by her PP little crystals hanging from her hair, the doc said it was from the sugar in the urine, so I gave her a wash with my summers eve, went over the area with a tucks pad.

So I wash her PP once a week, sometimes I forget, but I think from the urine with the sugar in it and then sometimes they are laying on the floor leaking the urine that is how they get a UTI, thats just my thought on it.

Niki does seem relieved when I do this, especially when I wash the area behind her PP where the urine would drip on, on the fur.

Maybe I'm just nuts, but she hasn't had a UTI yet.

[Cara's Mom]

Hi Dolly,
Yes, Marianne gave me the same advice...so because she is long haired, I shaved the area around her PP and like you, I now wash her once a week...But she does not like it:):)
However, things are not clear yet re: Uti. Vet called the lab, yesterday morning and there was nothing "growing" yet:D:D:D. But they want to wait 72 hours to be sure. So, please keep your fingers crossed!!!

[Cara's Mom]

Update:
Today's curve:
AM
6:00 - 14.6 (263) before meal
6:30 - 18.9 (340) after meal
8:30 - 24.3 ( Faulty strip - other story!!!)(437)
10:30 - 15.9 (286)
PM
12:30 - 9.2 (166) after walk
2:30 - 14.9 (268)
4:30 - 14.6 (263)
5:45 - 15.1 (272 before meal
6:00 - 18.8 (338)
I would say: Pretty Good! Vet wanted her between 300 and 200. And she almost did it all day:) Think I will put walk back to 9:30, this is second day she is below 200 after walk at that time!
The 8:30 reading was a faulty strip. Had several that were stuck together and none of them did a proper job, either way to low or way to highor Er code!!! And these cost me $ 1.34/each!!! Just had 7 left for this curve
so could not use an other!!! Called the vet and bitched!!! All they had left were same lot number I have. Don't want to waste my money on those:mad::mad:
So of to the vet we go to-morrow with this curve!!! See what we can find out about urine culture and talk about dosage!?!

[We Hope]

Marion,

I say pretty good too! :) I think you need to call the maker of your meter and strips and tell them what's happened to some of them. They're usually good about sending you either a reimbursement or some free coupons for a vial or two of them.

They don't so much make their $ on the meters, but on the fact that as long as you have it and use it, the strips are where they make it. This is why you see so many "free meter" deals going around.

Give them a call tomorrow and tell them that you're unhappy--I think they'll come up with something to "soothe" you. :D

Keep up the good work!

Kathy

[Cara's Mom]

Hi Kathy, this meter is the AlphTrak and I bitched already to the vet, who sold it to me. They pulled two more vials of their shelf, with the same problem. So they said they would contact them for reimbursement for theirs and mine!!! Only use the AlphaTrak for curves, too expensive! However, would not hurt to give them a call myself, would it now!?;)

[We Hope]

Marion,

Here's how :) :

http://www.abbott.com/content/en_US/10.40.278:278/general_content/Global_Location_Profile_0051.htm

Abbott Animal Health
P.O. Box 6150, Station Centre -Ville
Montréal, Québec, Canada H3C 3K6
Telephone:
(514) 832-7233 or
(800) 361-7852, ext. 7233

Facsimile: (800) 513-7337

Nice they have a toll-free 800 number too. ;)

If you're an unhappy customer, you just might decide to drop their meter in favor of a human blood glucose meter and it might be someone else's brand. That would mean no more $ from you to them for strips. :)

Let us know how your talk with them tomorrow goes, OK? :D

Kathy

[Cara's Mom]

I'll keep you informed!!!!

[We Hope]

Go get 'em! :D

Kathy

[CarolW]

Update:
....
The 8:30 reading was a faulty strip. Had several that were stuck together and none of them did a proper job, either way to low or way to highor Er code!!! And these cost me $ 1.34/each!!! Just had 7 left for this curve
so could not use an other!!! Called the vet and bitched!!! All they had left were same lot number I have. Don't want to waste my money on those:mad::mad:


Hey, Marion! That was one absolutely FABULOUS curve on Cara! Great job, Cara! Great job, Marion!

What meter are you using? What test strips cost $1.34 each? Yikes! Scary! Would that be an AlphaTrak or something?

What a pest, though! I am wildly tempted to test Kumbi more often than I do, but my vet doesn't like me to, as he stresses quite a bit with the testing, especially now when I'm comparing two meters in the field, using a double-prick to do it.

Cara seems to be a champ with your testing! anyway, that was a wonderful curve!

Wed, 8 Oct 2008 07:43:59

[Cara's Mom]

Thanks Carol!
Yes I have an AlphaTrak meter,made by same co. that makes Freestyle, but this meter is for pets only! Am pleased with it, however latest batches of testing strips were horrible! And on top of that, it's very expensive in use. That's why I only use it on the curves that my Vet wants! I have an One Touch Ultra too, which I like very much. It's out few points either way. You have to keep that in mind when you do the readings. But works good for spot checks (and lot cheaper in use!!)

[Cara's Mom]

Called Abbott (re: AlphaTrak test strips)!!!!!
Canada could do nothing for me. But they were sorry:rolleyes:
So ended up phoning your side of the border. Talked to very pleasant guy called David! He is sending me a new vial and will make sure that it's not the same lot number!!
Cara is up by 1 unit to 13 (:eek: unlucky number!?!)Vet was very pleased with her progress, but did not like her weight. Now we are increasing her kibble by 1/4 cup/meal. So there will probably be not too much difference this week. She'll hopefully will stay the same. She probably needs an other increase next week.
No news from lab yet (re:Urine culture)

And that's all folks:)