WSAVA Diabetes Mgmt Excerpts

[k9diabetes]

WSAVA (World Small Animal Veterinary Association) has put up proceedings from their 2011 annual conference and I pulled up the one for diabetes. The presentation is by Dr. Johan Schoeman of South Africa so the presentation gives European names for insulin products and European guidelines.

Wasn't thrilled to see Caninsulin (Vetsulin in U.S.) still being introduced as a once-daily insulin product. But the dosing guidelines for all insulins, including Caninsulin, are much better than the one initially provided by Intervet for Caninsulin.

Initial insulin treatment of the diabetic dog:

Intermediate insulins are the initial insulin of choice (Monotarde, Protrophane, Caninsulin). These are given twice daily (12 hrly with feeding at each injection) in the case of Monotard and Protophane and once daily in the case of Caninsulin (with twice daily feeding). The starting dose is usually around 0.35 to 0.5 IU / kg per dose. This dose is kept up for a period of around a week and glycaemic control is then assessed.

Good news is strong admonitions to hold the dose steady to allow the long-term response to develop and to only initiate dose changes after performing a full curve, never on a couple of spot readings (Yay!):

Initial adjustment of insulin therapy:

The goal after the first visit (during which diagnostic evaluation occurs and the insulin treatment is initiated) is not to establish the ideal insulin dose. This will take anything from 4-8 weeks. . . . The patient needs time equilibrate to the insulin given and the metabolic derangements will slowly begin to reverse. Insulin dose should not be adjusted without a blood glucose curve.

You never get the information you need to properly adjust insulin dose on only one or two blood glucose levels in a day and even less so on urine dipstick information.

Yikes....

Hand-held blood glucose machines are useful for these determinations. Keep in mind that they are programmed to read blood glucose lower than it actually is, at the low end of the scale (to prevent missing hypoglycaemia in human patients).

I have heard this repeatedly and have never been provided with any evidence that this assertion is true and some strong denials by meter manufacturers that this is the case.

Natalie

[Patty]

Re: WSAVA Diabetes Mgmt Excerpts

Insulin dose should not be adjusted without a blood glucose curve.

You never get the information you need to properly adjust insulin dose on only one or two blood glucose levels in a day and even less so on urine dipstick information.

Love these statements.

[Cebe]

Re: WSAVA Diabetes Mgmt Excerpts

"metabolic derangement" is my new favorite phrase. Sounds downright evil, and I hope Zoe is over it.

thanks for posting.

I went to a fair that my vet clinic put on and talked with one of the doctors who consulted on Zoe's initial diagnosis. She said she'd been to a convention and that diabetes was a big topic. I think vets are starting to catch up.

[CarolW]

Re: WSAVA Diabetes Mgmt Excerpts

Natalie - is Monotard the same as NPH insulin? I have a vague memory that it might be. Oh; they spelled it with an e - Monotarde.

Haven't heard of the other one (besides Caninsulin) mentioned (Protrophane).

I really WONDER why they said once daily for Caninsulin, unless maybe there's some Intervet influence operating there. I've NEVER heard of a dog doing well on one injection a day of Caninsulin, though I suppose it's theoretically possible, but the numbers of those dogs must be extremely limited. I find it hard to imagine the insulin could hold for 24 hours.

Very relieved to see the suggestion of 0.35 to 0.5 units per Kilogram (emphasizing, Kilogram, not pound) per dose, for the suggested starting dose. (A Kg [Kilogram] is about 2.2 pounds.)

And I agree with Cebe -the term "metabolic derangements" is just FABULOUS! Love the explanation that these derangements will slowly begin to reverse. I will emphasize; SLOWLY.

Bet you anything that LifeScan, makers of OneTouch Ultra and Ultra2 meters (as well as some others), would fervently deny programming them to read lower than actual. I talked to OneTouch Customer Care 8 to 10 times, and found them extremely instructive and helpful (though as soon as I mentioned I was using the meter on a dog, they shut their mouths and wouldn't help at all - undoubtedly, a potential liability problem, so if anybody here is using OneTouch meters, and wants to talk to Customer Care, do NOT mention you're using them on a dog, or they won't help you at all.

Anyway, I was very, VERY impressed with OneTouch Customer Care. And by the way, they told me that their meters work to the industry standard, which is, a margin for error of 20% plus or minus (either direction).

Cebe, I hope you're right that vets will start to catch on. I think our dogs deserve that. (Cats too.)

Thu, 9 Feb 2012 15:34:35 (PST)

[Shellie]

Re: WSAVA Diabetes Mgmt Excerpts

Oh, we're metabolically deranged over here most definitely! Mentally deranged as well which I'm pretty sure won't be reversing any time soon! LOL

[k9diabetes]

Re: WSAVA Diabetes Mgmt Excerpts

I loved that term too... am considering all the situations I might be able to apply it! It would make a great online identity, wouldn't it?

Natalie

[CarolW]

Re: WSAVA Diabetes Mgmt Excerpts

I loved that term too... am considering all the situations I might be able to apply it! It would make a great online identity, wouldn't it?

Natalie

How the heck did I miss this till now! Well, I've been a bit busy. But wow; GREAT idea for an online identity!

Since you posted the information from the conference, Natalie, I've used the term "metabolic derangement" I think at least three times. To me, it seems to help people, including me, understand the nature of the beast! And the suggestion of slow reversal makes so much sense, too.

I think this should help newcomers to canine diabetes feel at least a little less hasty, hoping for immediate regulation, when immediate regulation really isn't possible.

I subscribe to one other forum on canine diabetes besides this one, and it's a kind of mail-bomb forum, where hands are constantly held - so much so that a couple of nights ago there were at least 50 messages overnight, when a member was having difficulty with her dog, and two others (one of them being me) were hand-holding. Normally, I'd give up on a forum like that; it's too much.

But it does seem to help the ones who are so overwhelmed and new that they can't, yet, take in the CONCEPTS that underlie managing the care of a diabetic dog. The woman being assisted had a particularly difficult situation, with an Alzheimers patient to care for, i believe children as well, with a full-time day job, and so forth. The Alzheimers patient would feed the dog in the wee hours of morning - anything that was at hand.

Talk about metabolic derangement! And to complicate matters, the dog also had a persistent UTI, and was on antibiotics.

The dog was running low BGs, and the two of us others were talking her through giving syrup and snacks. She was testing every 15 minutes, and FINALLY the dog's numbers rose enough so all three of us could go to bed.

Any of us, too, can get a bit metabolically deranged by losing a lot of sleep all at once; ha! So I've been concentrating, partly for my own sake, and partly, for Camellia's - on slowly reversing that loss-of-sleep metabolic derangement.

I'll have to check the thread Camellia Camelo, in Everything else, to find out if I reported HER metabolic derangement just under a week ago, caused by big dogs rushing her, two days in a row. It was so bad that Camellia expressed her anal glands, and was far too stressed to be able to take her bath (for atopy). Managed the bath the NEXT day, after Camellia had had a little rest and relaxation.

So, anyway, it seems to me that understanding the notion of "metabolic derangement" is key, both for dogs and for humans. And, of course, for cats, too.

And also, that reversal is necessarily a bit slow. I think that's always true.
Mon, 13 Feb 2012 19:50:37 (PST)

[k9diabetes]

Re: WSAVA Diabetes Mgmt Excerpts

You can get additional information on the various names for insulins at Kathy's Canine Diabetes Wiki:

http://diabetesindogs.wikia.com/wiki/Monotard

http://diabetesindogs.wikia.com/wiki/ReliOn/Novolin_NPH

Monotard isn't around anymore - it was similar to Humulin L.

Natalie