Max has earned his wings

[jaimeed]

Hi Everyone,
I'm new to the forum and having a rough morning after my dog Max's shot. He's had diabetes for 3 months now and the shots aren't getting any easier for me. I am being as gentle as I can be and I rub the area for a minute to try and desensitize it before the shot. This morning he really yiped and it made me cry afterwards. I hate hurting something that I love not once but twice a day. It's hard on me. It's not always bad but I it seems worse when my husband isn't here to help rub his ears while I do it. Ugh. Anyway, Max is around 47lbs and receiving 15 units twice a day. Does anyone else out there have a dog that weight and if so, how many units are they receiving? I realize that it depends on the dog but I was wondering if I'm way under the average. I am monitoring with both a monitor and urine strips but the insulin units seem to keep going up. He is on Blue Buffalo dry dog food mixed with my homemade wet food of boiled chicken thighs, carrots, celery, pumpkin, flaxseed. Then once that is cooked I mix it with raw green beans and carrots that I've chopped in the blender. For treats he gets homemade... beef baby food, wheat flour and eggs, baked in the oven.
Thanks for the input,
Jaimee

[peggy0]

Re: 47lb Dog - Average Amount of Insulin?

Hi jaimee

What type of insulin is Max on? and do you monitor him at home? The experts here are really going to have to see results of a curve before they can determine what his results are given insulin and food. What time do you give them to them as compared to when you feed? Also are you letting the insulin warm up a bit from the fridge? It only takes about 15 minutes. Cold insulin stings. I feel my dog buffalo blue but moved to the weight control. It brought his BG down a bit, but I only modified his food once I had a pretty consistent curve to play with.

[k9diabetes]

Re: 47lb Dog - Average Amount of Insulin?

Hi Jaimee,

Welcome to the forum!

I have LOTS of questions...

What insulin are you giving - NPH? Vetsulin?

Where are you injecting Max?

Do you rotate the injection site?

What gauge is the needle in the syringes you are using?

Do you warm in the insulin in the syringe before injecting?

What breed is Max?

Has he had a curve done on his current dose of insulin? If so, please post the results.

What kinds of results have you been getting with the monitor and what kind of blood glucose monitor is it?

In other words, is Max "regulated" now or still working on it?

Does he bounce back up every time he gets an insulin increase?
____________

Okay... enough questions! For now...

15 units is a pretty average dose in a 47 pound dog. The dose could go quite a bit higher and be considered normal.

As far as the comfort of the injections, some things that potentially could help include:

- Be sure to warm the insulin to room temperature before injecting

- Put the bevel of the syringe facing up when you inject

- If you are using a fairly large needle, get syringes with a finer needle

- If you are using a long needle, try a syringe with a short needle

- try injecting somewhere else - diagram of where you can inject: http://www.bddiabetes.com/us/main.aspx?cat=1&id=395

- skip the rubbing and see if this actually makes it easier - maybe just make it a quick experience without time for anticipation

- reward afterward with a treat Max likes

- inject while he's finishing his food so he's distracted

- work on your own mental approach to the injections - be as calm and nonchalant about it as you can be so that you convey that energy rather than fear and anxiety to Max.

With more information, we can offer some additional advice. Hang in there. It does get easier.

Natalie

[fatdog55]

Re: 47lb Dog - Average Amount of Insulin?

Jaimee
I am going to assume that by your saying that the insulin keeps going up – you mean his numbers are high and you are trying to combat the increasing bgs with more insulin.
One thing you may want to back off on regarding his food is the carrots – both raw and cooked; they are high in sugar content… not sure about the wheat flour, but I am about the carrots.
Also, as Natalie suggests above – a thin needle works wonders.
Paul

[jaimeed]

Re: 47lb Dog - Average Amount of Insulin?

Wow this is THE most supportive forum I've ever been involved with. I feel better already just knowing how many caring folks there are out there. I will try to answer all of the questions...Max is a 12 year old Lab/Dach. mix (the only Dachshund you see is in the face a little :>) I make sure that the insulin is warm first by holding it in my hand or under the arm pit which is know to have the most heat. Am I over heating it? He is on Vetsulin and we are using the 1/2cc 29 guage 1/2" Ulticare needles. I am ordering BD needles in the morning because I read that there are problems getting rid of the air bubble and that's just whats happening to me. I have tried all of the tricks but I tap the needle and it's there at the top, I eject some insulin out but it's still there. We feed at 8am and 8pm with the injection coming right after each meal. We inject him anywhere we can find fat but mostly the scruff on the top of the back and down, sides of the neck where there is a lot of loose skin and fat. We rotate the injection sites too. I always give him a treat afterwards and make a big deal..."good boy good boy" in our little language. Then he gets kisses to "take the boo boo away" I'm a little nutty about my doggies. They're our best friends. We didn' t have a curve done when Max was first diagnosed as my vet did not suggest it. I am just learning to use the monitor at home (One Touch Ultra) and it seems to work well on the upper lip. I try to do it at 2:00pm since my vet said that is the peak time. Once was 269 and the next was 346. He is not drinking a ton and peeing like before being on the insulin. He is always the one to pick play fights with our other dog so I know he feels good but what are the risks of not regulating your dog to be in the 100's?? Is it ABSOLUTELY necessary to use the monitor every day once we get the numbers a little lower? It's hard to give two injections plus stick him in the mouth every day. But if that's what you have to do then that's what you have to do. Thank you again for your help, I appreciate it so much!
Jaimee

[We Hope]

Re: 47lb Dog - Average Amount of Insulin?

Hi Jaimee!

I don't believe BD sells U 40 syringes in the US, so if you were ordering those, you would need to convert the dosage of the insulin to the U 100 syringe by multiplying it by 2.5. The only other U 40 insulin syringes on the market here that I am aware of besides UltiCare are the Vetsulin ones.

If you're determined to use the U 100 BD syringes, since Max's current insulin dose is 15 units of U 40 insulin, you would need to fill a U 100 syringe to 37.5 units. It means that you would need 1/2 cc U 100 syringes which hold up to 50 units--the 3/10 U 100 syringes hold only up to 30 units. If you don't multiply the number of U 40 insulin units by 2.5 for use in a U 100 syringe, you would be underdosing with the insulin.

You won't do the insulin any harm if you re-inject it into the vial and re-draw it, if that might help. You're warming the insulin the right way--by putting the syringe unfer your arm or warming it with your hands.

Am going to suggest that you try not to use the scruff of Max's neck because the absorption there is not so good:

http://web.archive.org/web/200702081..._diabetes.html

Dr. Greco:

"Is the client injecting in the proper place? (Armpit or flank instead of in the scruff; the scruff is a poorly vascularized area with slow absorption.)"

Am going to suggest that you have a curve done for Max because this is the only way you can tell how he's using the insulin at various times of the day; unless you've done that, you don't know when Max's insulin peaks. The peak time is when the insulin is working hardest, so that would correspond to the time when bg's are at their lowest, or nadir point.

When you see the time activity profiles for any insulin, they are an average. They're compiled by giving insulin to healthy people or pets and taking blood samples every hour and testing them for the presence of insulin. Some people and pets use insulin faster, and some use it slower--it depends on the person or pet.

Getting a curve done will also show you how Max's food and insulin work with each other. With the information a curve provides, you can learn how to make diet changes which will have a positive effect on the insulin--it's very hard to do that without the knowledge you gain from a curve.

You can do a curve at home or you can have your vet do one, but I think you do need this information to be able to get Max's bg's regulated.

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

There are risks to having bg's that stay too high. Dogs in particular are prone to losing their sight from high glucose levels, as diabetic cataracts form faster from them. Some vets want their patients to be under 200 at all times.

When you get to the 180 and above area and stay there for a while, the renal threshold has been crossed and this means the glucose spills into the urine; you can't measure it with a urine glucose test stick if it's 180 or below. Poor regulation can mean more prone to infections, especially urinary tract ones, since bacteria thrives in the sugary urine; it can also make for more serious renal problems too.

A lot to think about, I know, but I think the key to doing better for Max is to have a curve done--either by you at home or at the vet's.

Kathy

[k9diabetes]

Re: 47lb Dog - Average Amount of Insulin?

It sounds like you are doing lots of things right!! That's great!!

Thinner needles might be more comfortable for him. And to get thinner needles, you do have to go to the U100 syringes and make the conversion that Kathy described, filling the U100 syringe to the 37.5 mark with Vetsulin in order to deliver 15 units of insulin.

In U40 syinges the thinnest needle is the 29 gauge. In U100 syringes you can get 30 gauge and 31 gauge, with 31 gauge being the finest needle.

What is your sense of why Max is reacting?

Do you think it actually hurts him or is he reacting to being held / restrained, anxiety, etc.?

You might try faking an injection using a syringe with the cap on and touching it to his skin the same way you would if you were actually injecting him. If he still reacts, then you know it's anticipatory / emotional rather than necessarily that the injections are actually uncomfortable and you could work on some training with the cap on to get him used to being restrained, tented, injected, etc.

I'm guessing he might not like the neck area so I'd avoid that...

We injected Chris along the rib cage just behind his front leg about midway vertically. (Looks like BD reoganized their website... will have to update the links)

From BD slide show how to inject your dog




We injected where this diagram labels it as "Side of Chest."

We had started with the scruff but he got thick skin there very quickly. The side worked much better for us.

We didn't look for a fatty area - just used the area that worked best for Chris.

If they really are uncomfortable - he reacts only when the needle is put in, you can experiment with different positions to have him in, different places to inject, and different angles or approaches to the injection.

For example, some dogs don't like having the tent of skin pulled up and if you skip that they do better.

Some dogs don't like a particular spot or they prefer one side of their body to the other.

Some do better if you put the syring straight down into a tent instead of coming in from the side. Of they prefer a 45 degree angle.

No one can tell you what might work for Max so you just have to experiment and see if you can find something that works better.

This is getting long so I'll respond to other questions in another thread.

I know you'll get there! We have had a couple of people for whom injections were a major challenge. I'll pull up one of the threads so you can see it. They got it sorted out and I know you will too!

Natalie

[k9diabetes]

Re: 47lb Dog - Average Amount of Insulin?

What are the risks of not regulating your dog to be in the 100's??

Is it ABSOLUTELY necessary to use the monitor every day once we get the numbers a little lower?

The primary problem that comes from not getting blood sugar into the 100s is cataracts, which are very very common in diabetic dogs.

Not every dog can be regulated that tightly anyway - you want to regulate Max as best he safely can be to avoid hypoglycemia. The thing with the cataracts, too, is that once they start to form that cannot necessarily be stopped.

There's time yet to see what Max will be capable of. For now, it's okay to concentrate on trying to make injections a dull, uneventful process for everyone!

As far as home testing goes, some people never home test. Some test quarterly or monthly. Some test weekly or daily. It all depends on how well Max responds to food and insulin and how tightly you want to regulate him.

I tested Chris routinely before 3 of his 4 meals a day and then other times when I wanted to know what it was or was doing a curve. His insulin needs varied from week to week on kind of an undulating wave up and down through a unit or a unit and a half's difference and a single dose every day would not have worked well for him. Plus he couldn't care less about being tested or injected. He was Mr. Mellow that way. Not try to clip a nail...

You will work all of this out over time after you know more about Max's idea of diabetes regulation.

Natalie

[eyelostit]

Re: 47lb Dog - Average Amount of Insulin?

Hi jamieed,

Niki didn't like her shots at first but after awhile somehow she knew she needed the shot and would come to me after food for her shot, I think in awhile your dog may start coming to you (tho I know it seems not posssible right now )

I would ease off the carrots and use green beans or a piece of brocolli for a treat. I have found the timing of the treat makes a big difference also with bg. I like to give Niki her treat right before she goes into her peak insulin time.

Hang in there, it'll get better.

[jaimeed]

Re: 47lb Dog - Average Amount of Insulin?

What is your sense of why Max is reacting?

Do you think it actually hurts him or is he reacting to being held / restrained, anxiety, etc.?

Probably through my own fault...Max is a bit of a "mommas boy". I got him from a local shelter as a pup so he didn't have much time to become frightened of things but he gets upset quite easily. Loud noises, thunder, etc. He will want to sit on my lap until he feels better. Even if our other dog makes a gagging noise, you know, when they have a hair in their throat or whatever, Max gets up and leaves the room. He doesn't like when the cat throws up either..hahaha which is a pleasant noise in itself. So I guess I'd have to say that he is extra sensitive, he doesn't give the vet trouble with yipes when he gets his shots there and he seems that way too when my husband gives the shot. Maybe he tends to be more of a baby when I'm there. This morning's shot went well. I made sure the bevel was up too.

When you get the bg's that low eventually....and the insulin peak, my vet tells me, hits at 2:00pm...6 hours from the shot.....if you are at work during the day...how can you be sure your dog isn't at home having an episode of hypoglycemia??

[jaimeed]

Re: 47lb Dog - Average Amount of Insulin?

Ok just checking back in to tell you Max's bg results. I used the monitor at 2:00pm which is when my vet told me his nadir would be with the Vetsulin. He is at 306 and the urine strips show 1/2% and no ketones. Should I increase to 16 units? He's been at 15 now for a while. Also, what types of foods can I add that help counter the glucose?

[k9diabetes]

Re: 47lb Dog - Average Amount of Insulin?

Max is SOOOOOO handsome!!

Has he ever had a curve done?

There's no guarantee without a curve that his nadir is at 6 hours. We have a handful of dogs here on the forum whose lowest blood sugar is at meal time and the highest is at about six hours.

I would want more information before making any changes in dose.

How about a mini-curve?

Check the BG...

before food and insulin
3 hours later
6 hours later
9 hours later
just before next food and insulin

That would give you enough information to have a basic idea of the "shape" of his curve so you would know when he actually has the lowest blood sugar between injections.

Natalie

[jaimeed]

Re: 47lb Dog - Average Amount of Insulin?

He IS handsome! My little sweetie pie he is....always such a good boy. I haven't done a curve but I like the sounds of your mini curve. I can handle that. I'd sure hate to drop him off at the vets for 24hours. He had TPLO surgery last May and I cried every day until he came home. I'm waaaaayyyyy too emotional about my animals. Anyway I seem to have an easier time doing the prick on his upper lip for the monitor than I do giving the shot. I am so glad you guys are here for help!!!

[k9diabetes]

Re: 47lb Dog - Average Amount of Insulin?

So is he built like a miniature labrador - long legs in lab proportions?

[jaimeed]

Re: 47lb Dog - Average Amount of Insulin?

Yep, he's got real long legs. I saw his mom at the shelter and she was more Dachsund so I guess he took after dad.