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Soaphie & Sydney's Mom
11-13-2008, 05:18 PM
Hi there!

This is my first post.

I have an 8 year old bernese mountain dog / border collie mix that was diagnosed with diabetes at the end of July (2008). Up until this time Soaphie lived a healthier lifestyle than the majority of the people I know. She would run with me 3-4 times a week (including a long run of 9 miles....sometimes a little more), healthy food and snacks were veggies and fruits. Healthy weight etc.

So....

We have been on Vetsulin since July and have had an EXTREMELY difficult time getting regulated on this insulin....HIGHS...LOWS (including the horrific experience of a seizure).

Has anyone else gone through this with Vetsulin? Help! Thank you!

We Hope
11-13-2008, 05:31 PM
Hi and welcome, Soaphie's Mom! :)

Please tell us more about Soaphie. Know Bernese are not small dogs, but since insulin goes according to body weight, how much does Soaphie weigh? Are you working with one shot a day or two and how many units is she getting? What are you feeding Soaphie and when?

The more you can tell us about Soaphie, the easier it will be for us to try to help you. There can be many causes for highs and lows with insulin--in order for us to talk with you about what might be causing Soaphie's problems, we need you to tell us as much as you can.

Kathy

BestBuddy
11-13-2008, 05:36 PM
Hi and welcome.
Kathy has already started the questions and we do ask a lot. The advice given really will depend on your answers. Soaphie's weight, food and insulin amount and how often will all make a big difference.
Jenny & Buddy

Soaphie & Sydney's Mom
11-13-2008, 05:39 PM
Fast response! Thank yo

Soaphie currently weighs 59 pounds (down from a healthy weight of 68....but up from a low of 49...my poor baby). She eats twice daily - Wellness Venison and Rice (didn't switch to WD because she has some food allergies we are dealing with as well that FINALLY cleared up with the Wellness food). VERY limited snacks - maybe a couple cherry tomatoes - but we try to be incredibly consistent with her food since we are having such a tough time getting her regulated).

As far as treatment: Glucose curves....boy oh boy have we done glucose curves. I couldn't even begin to count. She has spent so many days at the vet - I've asked them to post her name on one of the exam room doors "This room sponsored by Soaphie".

Soaphie had a seizure a few weeks back at which time we took a big step back on the units given to her and then built up. As of last Friday's curve - I believe the 8:00 a.m. was 250 after fasting about 14 hours (I was ok with this number) - then gave her 11 units - I can't recall the draws during the day, but the final draw at 5:30ish was 330 (too high in my opinion as then she would have dinner and another shot and her blood sugar would climb even higher for a few hours).

SO - today we did a fructosamine test (results tomorrow) as well as a blood glucose test. She was in the low 300's again this morning. The vet mentioned today the possibility of switching insulins. I asked what she was thinking of switching to and she was possibily PZI.

Everyone at the vet's office said in all their years of working there they have never seen a case as difficult as Soaphie's.

So - current is 11 units twice a day. I'm very anxious to get her fructosimine test results back tomorrow...

Debbie & Apollo
11-13-2008, 05:42 PM
Hi and welcome

I know there are definite opinions about the kind of insulin.

Apollo has been on Vetsulin from day one (we are starting his 3rd year in December)
anyhow -- I am super picky about his schedule - when he eats, gets his insulin etc.... not sure if that has helped but... so far pretty good.

others will be along to give input. good luck

Debbie

BestBuddy
11-13-2008, 05:48 PM
Hi,
You are very welcome. 11 units isn't a great lot for Soaphie's size but all our dogs are certainly different. Buddy is only a little over 11lbs (5 kilos) and he gets 5 units of Humulin N twice a day. We started with Caninsulin (Australia's version of Vetsulin) and had great success for nearly 4 years so I know it is a good insulin but sometimes a bit pricey especially for the larger dogs. Your numbers are not so bad, a lot of us struggled with much worse numbers early on. How long has Soaphie been on insulin? Food plays a bit part of regulating and sometimes the type of food and insulin just don't match. A lot of us home blood test so it can be much cheaper and convenient, that is something you can investigate later. When you say seizure are you meaning a Hypo?
Jenny & Buddy

eyelostit
11-13-2008, 05:51 PM
Hi and Welcome,:)

My dog is Border Collie/Aussie maybe some Heeler in her.

I had a hard time getting her regulated, I think it's her breed, she in her 7th year now as a diabetic. She was really bad off before she got diag.

You'll get lots of help and info here, without the board I don't know what I would have done, I was frantic for answers with my baby.

The vet had me coming every week $$$$$ and was not helping and made matters worse, found a new vet.

Anyway, welcome again and here is my link here to Niki's story, anxious to see a picture of your dog. :)
http://www.k9diabetes.com/storynikid.html (http://www.k9diabetes.com/storynikid.html)

Soaphie & Sydney's Mom
11-13-2008, 05:54 PM
Yes - hypo on the seizure. At that time she was on 14/12. A couple weeks ago we were at 12/12 and a blood test one morning was 115 which I thought was too low considering it had been 14 hours since she had eaten. Ugh. The struggle continues.

Soaphie is pretty much "sedentary" now as well - no longer running since I don't want to throw off her blood sugar. It breaks my heart as I would do ANYTHING to run with her again.

Soaphie & Sydney's Mom
11-13-2008, 05:57 PM
Test post to see if Soaphie's picture shows up...

eyelostit
11-13-2008, 06:01 PM
LOL I guess we all were posting at the same time :)

We Hope
11-13-2008, 06:47 PM
Soaphie's Mom,

If we look at a modest starting dose of insulin--regardless of strength or species, it would be from 0.25-0.50 units per kilogram (2.2 lb) of body weight. Soaphie weighs close to 27 kg.

Getting 11 units twice a day, Soaphie is getting less than 0.50 units per kg of weight at present. She's nowhere near the resistance point with her present dose. She's also resposive to the insulin, because if she wasn't, you would not have gotten a fasting reading of 115, so there doesn't appear to be immune-mediated insulin resistance problems.

Regarding PZI, the IDEXX PZIVet, which was U 40 strength insulin 10% pork insulin, 90% beef insulin, was discontinued earlier this year. This leaves you with compounded beef PZI only, unless you want to import Hypurin Bovine PZI from Wockhardt in the UK.

http://petdiabetes.wikia.com/wiki/PZIVet#Obtaining_PZI_Vet

Compounded insulin can vary from batch to batch unlike manufactured insulins.

Rarely do dogs do well with PZI insulin, but they are helpful for many cats.

http://veterinarymedicine.dvm360.com/vetmed/article/articleDetail.jsp?id=325511

What Insulin Should I Choose Now that My Options Have Dwindled?
David Bruyette--Veterinary Medicine 2006

"PZI insulin: This long-acting, protamine zinc, beef-pork-origin insulin has, in my experience, not been more effective in controlling clinical signs in dogs than intermediate-acting insulins."

http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/40302.htm

"The normal fasting value for blood glucose in dogs and cats is 75-120 mg/dL."

"The renal threshold for glucose is ~180 mg/dL in dogs and ~240 mg/dL in cats."

When you exceed the renal threshold for a period of time, glucose will begin to spill into the urine.

http://www.thepetcenter.com/exa/nv.html

GLUCOSE 67 - 125 mg/dL --normal for dogs. Below that would be sliding into low blood sugar, or hypoglycemia.

Have conditions such as hypothyroid or Addison's been ruled out? Either of them can mean more sensitivity to insulin, thus more tendency toward hypos if they're not under control.

Are you certain the seizure was caused by Soaphie's blood glucose being too low?

Kathy

k9diabetes
11-13-2008, 09:46 PM
Thanks for filling us in some on Soaphie's story. I do have some concerns from what you've said...

First, PZI rarely is a good insulin for a dog. So it concerns me that your vet is considering it unless you already tried NPH and that didn't work.

Has Soaphie ever been on NPH insulin?

It would help immensely if you could get the records from your vet showing the curves that have been done and post them here - what time the blood draws were done and what the readings were plus what the insulin dose was at the time. I'd be happy to go through them and give some impressions. Can also chart them, which, for me at least, helps make sense of the trends.

The other possibility is that Soaphie's BG elevates some from stress at the vet and she may actually have lower blood sugar at home.

Have you ever considered home blood glucose testing?

It would save Soaphie a lot of time at the vet if nothing else.

We did all of Chris' curves at home starting in 2004 so for the vast majority of his time as a diabetic. You can see a video of him being tested at www.k9diabetes.com/bgtestvideos.html (http://www.k9diabetes.com/bgtestvideos.html). It's kind of a large file so give it time to download.

We used a OneTouch Ultra, which seems to work well with larger dogs like Soaphie (I have a MAJOR soft spot for Bernese mtn dogs by the way!) and the lip would be a great spot to test on her. You will see how bored Chris looked while being tested.

Chris weighed between 58 pounds and 65 pounds at various times and he never needed more than 11-12 units of NPH. Some dogs are just more sensitive.

I'm really curious to see Soaphie's profile on Vetsulin. If you take a look at Chris' case study (www.k9diabetes.com/k9diabetes.pdf (http://www.k9diabetes.com/k9diabetes.pdf)), you will see that Humulin L, which is a preparation very similar to Vetsulin but with human insulin, had Chris' BG all over the map - highs and lows during a 12-hour period - while NPH and even Regular worked much much better for him.

I think you would find home blood glucose testing literally a lifesaver for Soaphie... it's the only way to get a really really good handle on what's happening with their food and insulin. And you could use the information from curves you do yourself to time her exercise so that she can get out and get more active again. Without it, we would never have been able to regulate Chris. His BG the last time it was tested at the vet was in the normal range for a nondiabetic!

Best wishes,

Natalie

bgdavis
11-14-2008, 05:41 AM
Hi and welcome,

One question I don't see asked: is Soaphie taking insulin twice a day or only once? Some vets start dogs on Vetsulin on a single dose.

Bonnie and Crissy

Soaphie & Sydney's Mom
11-14-2008, 02:45 PM
Soaphie is on twice daily insulin shots. Started off with once daily and that wasn't working so we went to twice daily.

Soaphie & Sydney's Mom
11-14-2008, 02:52 PM
Hi there - I'll try to address all of your questions (hope I don't miss any :)).

1) Soaphie hasn't been on NPH
2) I have considered the stress level elevation factor at the vets office - but I do notice her drinking more water at home so I know she's a bit high.
3) We will look into the at-home testing
4) The recommended starting dosage for vetsulin is .5 per KG which would be 13 units once a day....going to twice a day you make adjustments which equates to about 10 units twice a day. This is a "starting" range. Vetsulin has changed their recommended dosages a couple times to my knowledge. At 10/10 her blood sugar is too high....11/11 it's too high - so as of today we are trying 12/11 (knowing that 14/12 made her hypo in the middle of the night).

Soaphie & Sydney's Mom
11-14-2008, 03:48 PM
In regards to the blood glucose meters that everyone is using - can you tell me the pros and cons of each? Ease of use? Amount of blood? etc etc etc?

k9diabetes
11-14-2008, 04:00 PM
Ah, she's gorgeous, as I knew she would be!

I don't know what it is about Bernese mountain dogs. I've never had one but there is something about them that really appeals to me.

I got the impression from some of the numbers you listed that the curves on Vetsulin might not be all that bad.

In general, most of us get in a habit of asking for copies of all test results. Its invaluable information that builds a very detailed picture over time. I could sit down and compare, for example, Chris' blood panels from a year ago or two years ago, across several veterinarians, to see how things were changing in those results. And a HI on a blood panel can mean a lot of things... I always wanted to know if it was a lot high or a little. My vet is good about concentrating on ones that are more than just a point or two off the reference range, but I always felt better having the data in front of me so I could see for myself.

I remain a bit concerned about the PZI comment... especially since she's never tried NPH. You can see that even in the Merck Manual, the two insulins that vets now routinely use are NPH and Vetsulin/Caninsulin:

Most dogs require 2 doses of insulin a day. In general NPH or lente is the initial insulin of choice at a dose of 0.5 U/kg bid.

http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/40302.htm.

Depending on how serious she was about PZI being her next choice, that could suggest that she's not very experienced with diabetes, which is not all that unusual. It seems quite a few vets latch onto a single insulin and don't know much about alternatives.

I'm glad there's no rush to do anything drastic right now. I'm hoping we can get a look at her curves and see if we can offer some additional insight.

Natalie

We Hope
11-14-2008, 04:11 PM
Hi there - I'll try to address all of your questions (hope I don't miss any :)).

1) Soaphie hasn't been on NPH
2) I have considered the stress level elevation factor at the vets office - but I do notice her drinking more water at home so I know she's a bit high.
3) We will look into the at-home testing
4) The recommended starting dosage for vetsulin is .5 per KG which would be 13 units once a day....going to twice a day you make adjustments which equates to about 10 units twice a day. This is a "starting" range. Vetsulin has changed their recommended dosages a couple times to my knowledge. At 10/10 her blood sugar is too high....11/11 it's too high - so as of today we are trying 12/11 (knowing that 14/12 made her hypo in the middle of the night).

http://www.vin.com/VINDBPub/SearchPB/Proceedings/Pr05000/pr00105.htm

Diabetes Mellitus: Treatment Options David Bruyette United States
World Small Animal Veterinary Association-Vancouver, 2001

"The intermediate acting insulins are classified as either NPH or Lente"

"In dogs we like to start with Humulin-N at 0.5 units/kg q12h."

0.5 units per kilo of body weight every 12 hours.

http://www.intervet.com.au/binaries/82_103335.pdf

Caninsulin page 5--once daily was 1 unit per kg of body weight plus additional weight-dependent unit(s). This is how the insulin was recommended to be used in Australia, the UK and other countries before it came here as Vetsulin.

Page 6-Twice-Daily Caninsulin Regimen-"The starting dose of insulin is 0.25-0.5 units per kilogram of body weight, twice-daily, rounded down to the nearest whole unit."

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

Vetsulin Tech bulletin page 2--this is how the insulin was originally introduced in the US--the same as above, with a notation that the majority of dogs would require not once-daily, but twice daily dosing.

Mine was the first Caninsulin/Vetsulin patient in the US who'd not been part of an earlier trial; he was using it before Vetsulin was on the US market. He was using Lilly Iletin II Lente--U 100 strength pork Lente insulin until Lilly discontinued it and was using 2 shots a day, continuing on to Caninsulin/Vetsulin with two shots a day. Both insulins were used as X amount of unit(s) per kg of body weight for initial dosing. 4 units twice a day kept him in the 85-100 bg range; he never had a hypo.

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

Vetsulin "Dear Doctor" letter from circa March-April 2008--the starting dosage recommended is now 0.5 units per kg of body weight. Until this, the original starting doses were as above.

Is there any reason stepping up or down by half-unit hasn't been tried? Marion, who's here as Cara's Mom, had some problems with using 15 units twice daily with Cara. Reducing slightly to 14.5 units twice a day has made things work out well. Marion does home testing and does give Cara a snack before bed to make sure there are no lows; this is just like many people with diabetes do.

Learning how to test Soaphie's blood glucose at home would be very helpful in trying to discover when her high and low periods are.

Marion was having trouble with Cara's post-meal spike; home testing was able to uncover this. She did need slightly more insulin to keep her bg's from skyrocketing after meals. You'd be able to see how the insulin and food work with Soaphie by doing home testing and could make any needed adjustments to either much easier.

Think that regulating and monitoring Soaphie would be much easier if you thought seriously about doing blood glucose testing at home.

Kathy

k9diabetes
11-14-2008, 04:23 PM
We mainly used OneTouch Ultra, which uses a small to medium sized drop of blood. The Freestyle meters use less blood but with Chris they were not as accurate as the OneTouch Ultra.

Over the years, it has seemed to me like Freestyles tend to work best with small dogs - they sometimes get lab-quality readings. But it seemed to be less so with larger dogs.

There's a lot of variation and ultimately you just have to try the meter with your dog and see what you get.

We started with an Accuchek Advantage, which was as accurate for Chris as the OneTouch but needed a lot more blood - more than I really wanted to draw on a daily basis.

We also did some trial work with the AlphaTrak, which is an animal-adjusted meter meant for diabetic cats and dogs. It was very accurate for Chris but it was too expensive for us to use routinely when I could get good results with the OneTouch, which ran a pretty consistent 30-40 points lower than lab values. I always just added 30 to his readings above 80 and 20 to his readings below 80.

We also did some trial runs with Ulticare's iPet animal meter and I was sad to say that the testing did not go well. In our case, the readings were erratic and often seemed to be excessively high. Based on our experience, I can't recommend that meter.

Generally, I suggest going with a higher quality meter - don't get the cheapest meter you can find - since you usually can get the meter free or nearly free. Over the long haul, it's the strips that are the real cost. And you can often buy them at better prices online. We purchased ours from www.hocks.com (http://www.hocks.com) - they specialize somewhat in diabetes supplies. There are cheaper places too... I bought them from Hocks as I felt like I could feel comfortable they weren't outdated or knockoffs and still get a better price than off the shelf at the pharmacy.

And I suggest starting with a regular meter meant for human diabetics - cheaper to practice and is often all you will need. Once you're proficient, if you want to go to an animal-adjusted meter, you will know what you're doing at that point.

It's also important to know that animal-adjusted meters like the AlphaTrak don't actually measure the blood sugar more accurately. They measure it the same way the regular meters do and then, through the meters coding, those readings are adjusted to an average that comes from testing the meters on animal blood and taking a lab analysis reading of the same blood. They take the average difference over some numbers of tests and use that average to adjust the reading you see displayed. It often works great but it doesn't always. Some worked well for Chris, others didn't.

Probably more than you wanted to know! :)

There's some links to each manufacturer's pages at the monitoring page on the website: www.k9diabetes.com/monitoring.html (http://www.k9diabetes.com/monitoring.html).

Natalie

Soaphie & Sydney's Mom
11-14-2008, 04:40 PM
I'm definitely going to look into home testing - thank you for the recommendation for the glucose meter.

Also - I have been meaning to ask for a copy of Soaphie's file as I'm big into data. But each time I get to the vet we start discussing the case and I forget to ask - I will make a note for my visit on Monday :) I also want a copy in case we ever have an emergency happen on a weekend and have to go to the animal ER...

I do have the utmost confidence in Soaphie's vet. The "possibility" of PZI was just that - sometime to consider but of course we'd have more discussions around it. I mentioned "N" to her today and we have a couple more steps to go through before we do any switching.

I will be getting copies of her file and do some graphing of my own (I love data - so this is right up my alley).

rhodesian46
11-19-2008, 04:46 PM
Hi Welcome to the forum
I see that you are wanting to home test. I have some brand new One touch ultra meters if you need one. Pm me please.

Soaphie & Sydney's Mom
11-21-2008, 04:08 PM
Hi all!

Just joined here a week-or-so ago. There is an "overview" posted in a separate thread.

Soaphie went in for another curve today. We started at 12/12 this week and were getting readings in the 300's all week (home testing - thank you for the recommendations).

So - here are the readings from today - testing with both my home tester and the vet's machine:

my machine vets machine
8:00 a.m. 365 416 then given 13 units
10:00 a.m. 314 394
12:00 p.m. 176 (has to be incorrect) 319
2:00 p.m. 327 371
5:00 p.m. 347 461

So we are now doing 13/13 for the Soapher dog and going back to the vet on Tuesday. I will continue testing at home until then.

eyelostit
11-21-2008, 05:06 PM
Your food sounds ok, Those figures seem to high, but I do not use vetsulin, your doggie weighs about same as mine? 45-50 lbs? part border collie? Niki was hard to regulate also, i think its the border collie in her, it took awhile but I did it with the help of the people here.

My suggestion is to start using the NPH insulin, if you are going to think about doing this, we are here to help you, alot of members do the switch because of the constant highs. Plus once you see the BG go down a bit it really eases up your mind from worry, I was a wreck those first 6 months.

Awhile back I was helping a gal who was using the wellness food and had switched foods, the wellness was not enough carbs to match the insulin, but your food has rice in it, so that should help as far as the carbs.

Remember sometimes I hate to say this, but not all vets are very knowledgeable on diabetes, they go by their normal guidelines and use this for all pets, they don't want owners to switch foods or insulin and they will keep you coming back, thats what my 1st vet did, I'm glad I found a better vet

I think Nat or Kathy will be online shortly

Take care

Soaphie & Sydney's Mom
11-21-2008, 05:53 PM
oh yes - they are high. But this is the first day back to 13/13 (when she had the seizure she was 14/12 and then we took some steps back and starting buildling up again). We go back on Tuesday for another curve. Want to try this to ensure we are covering all bases before switching with the goal of A) hopefully getting her regulated and B) if we do have to switch, then we did all we could on vetsulin and won't have to switch back - which I imagine would really mess her up.

The venison rice wellness is 48.2% carbs....is this a good level?

Thank you!!!!

Soaphie & Sydney's Mom
11-21-2008, 06:01 PM
One more question....if both Vetsulin and NPH are intermediate acting insulins - any ideas on why they are processed differently in the dogs system? Does it have to do with the suspension (one being isophane and one being zinc)?

Thanks!

Cara's Mom
11-21-2008, 06:03 PM
Welcome:)! Glad you're here! Cannot add anything to all the advice you have received, but I would strongly recomment you start hometesting!!
Cara, my 8 1/2 yrs old English setter was diagnosed Aug. 1. Has been a rough ride. She would not settle down at the clinic, so curves were out of the question...had no choice but start doing it at home. And I am glad I did, both for my sanity as well as Cara's! If I see something is not right, a quick test will tell what's going on and something can be done about it!
Believe me, I know what you are going through! Was there myself not all that long ago:eek::eek:

Keep up the good work!

eyelostit
11-21-2008, 07:38 PM
This link will help you out abit, Nat and Kathy are the experts here describing insulin action, types etc. hope this helps

http://k9diabetes.com/forum/showthread.php?t=124 (http://k9diabetes.com/forum/showthread.php?t=124)

take care:)

We Hope
11-21-2008, 08:14 PM
There are some differences in these insulins. One is made from pork which is a perfect amino acid match to canine insulin, one is r-DNA human insulin which is one amino acid away from being a perfect match to canine insulin.

One is U 100 strength and one is U 40 strength and one is protamine or isophane suspension and the other is zinc suspension.

The insulin that's a perfect amino acid match to your own insulin will begin to work faster, peak faster, and have less duration than one that is not. A more dilute insulin (U 40) will also begin working faster, peak faster, and have less duration than one that's less dilute. And then we get into NPH and Lente having some profile differences in action but still qualifying as intermediate acting insulins.

When human insulin was first introduced, most people were using either beef, pork, or a combination beef/pork insulin to manage their diabetes. Because when you look at the amino acid differences between a person's own insulin and beef insulin, there are three amino acid differences (two between beef and canine insulin) between them and one between pork (perfect canine match) and a person's.

The exact match of the r-DNA insulin to that of a person caused a lot of problems for some people with diabetes because it meant that the insulin they had now switched to worked quicker, peaked quicker, and didn't last as long as beef, pork or the beef/pork combination did. Some had problems with hypos and I personally know some people who are not able to treat their diabetes with human insulin. The more amino acid differences between what you're injecting and the insulin your pancreas originally made, the slower the insulin starts working, peaks, and the longer it lasts for you. While beef ultralente insulin is no longer made by anyone, it had more duration for people than Lantus does--because of the 3 amino acid differences between beef insulin and native human insulin.

When we get into the strength of the insulin, the more dilute the insulin is, the faster it will break down from hexamer form to dimer and monomer form, and that's when the body can begin using it--after it breaks down into dimers and monomers. Less dilute insulin tends to stay in hexamer form longer, so it doesn't start working as quickly as a more dilute one does.

There are some PubMed studies where they compared U 100 strength r-DNA human R insulin, U 40 r-DNA strength human R insulin and Humalog with people. Their findings were that the U 40 r-DNA strength human R was only slightly slower in action than the rapid-acting insulin analog Humalog; slowest to act of all 3 was the U 100 strength human R insulin. The difference between the two non-analog insulins was in their strength only.

A couple of years ago, the German government did some serious study of insulins and their costs because the German health plans are government based. Their aim was to try to save some health care costs while not compromising treatment. They took these studies into consideration regarding the differences in insulin strengths and made the decision that newly-diagnosed type 2 persons with diabetes who required a fast-acting insulin would not be able to have their health insurance pay for a rapid-acting insulin (Novolog, Humalog, Apidra) unless a specialist had certified that there was a medical reason they cannot use a more dilute form of R human insulin.

A while back we had someone with similar problems on another board. They were in the UK, where beef insulin called Insuvet is available and the dog was initially started on Insuvet beef Lente insulin twice daily (U 100).

The amino acid differences between the beef insulin and canine insulin made the Insuvet beef act too slowly for him. So the vet switched him to Caninsulin (Vetsulin). The combination of the perfect match to canine insulin and the faster acting U 40 strength insulin made the dog use the insulin too rapidly.

At the time, both Lilly and Novo Nordisk were phasing out their r-DNA human Lente insulins, so it would not have made sense to try to get him started on either of those. The thought was to try r-DNA NPH/isophane insulin for him. The UK trade name for the Novo brand is Insulatard--here we know it as Novolin N.

Having some resistance by the insulin being one amino acid away from being a perfect match to canine insulin was finally the right match for him and he was no longer using the insulin too slowly or too rapidly.

So while there are differences in the way insulin is suspended and preserved, there are also differences in species and in the strength of the insulin formula. Any or all of them can be a factor--it depends on the person or dog who's using the insulin.

Kathy

Ricksma
11-22-2008, 06:47 AM
Hi! So glad you found this board...these moderators are amazing!! I can't really add anything that they haven't covered, but I wanted to tell you about my personal experience with Vetsulin and Humulin N (and later Relion Novolin N) with my Ricky. We started off using Vetsulin, and after three months, it became clear to me that I was no closer to real regulation. There were dramatic swings in his readings, I'm sure because of the formulation of the Vetsulin with the 70/30 mix of intermediate with fast acting insulin. I decided to try the Humulin N, since I was home cooking, and the only carbs he was getting (by his choice, lol) were in the W/D patties I make him...I felt that the N would be a better fit. We haven't looked back. I have been very happy with the results, and switched to the even less expensive Relion Novolin N, without a hitch. So now after saying all this, I am touching wood and keeping my fingers crossed that I haven't jinxed anything....hehehe. But, for the most part, he is happy, feeling good, and we are cautiously optimistic about the future. Good luck!!

Love and hugs, Teresa and Ricky

We Hope
11-22-2008, 08:54 AM
Just gonna make a point here. Lente insulin is made by combining 30% semilente (fast-acting Lente-type) insulin with 70% slow|long-acting ultralente insulin. You put the slow and the fast together to end up with one that's intermediate, or in the "middle". :)

There's been a notion that the "fast" acting portion of Lente insulin is R insulin; that's not correct--it can't be chemically. When you combine R insulin with any of the insulins of the Lente family (semilente, lente, ultralente), the Lente-type insulin will bind (slow or hold back) the R insulin. This means that when you put the R together with them, the R loses its ability to act quickly--what you wanted it for in the first place; your purpose would be defeated. :D

The semilente insulin is a member of the Lente family, does act quickly, but does not bind when it's combined with an insulin of its own family, so it will be able to act fast in combination. You can get R insulin to work quickly if you give it as a separate shot, but if the R was in the same syringe, you could have the slowing, binding effect; nobody would even try putting it in the same insulin vial. ;)

Kathy

k9diabetes
11-22-2008, 10:23 PM
Kathy gave a good overview of all the reasons why Vetsulin/Caninsulin can result in some sharper drops in BG than NPH.

The combination of a lack of resistance because the insulin molecule is identical to a dog's natural insulin molecule and a more dilute solution gives a tendency at least for that to happen.

Our dog was a good example of one who processed zinc suspensions like Vetsulin and protamine suspensions like NPH very differently even though his zinc lente insulin was a U100 human-origin insulin -- Humulin L, which is no longer available. He got a pretty even supply of insulin from the NPH protamine version but took a long time to "break open" the zinc suspension of Humulin L (no longer available).

I'm just very glad we still have at least two choices of insulins. Every time an insulin type goes away, pets suffer. Humulin L was a really great insulin for a lot of dogs and Vetsulin/Caninsulin is not an exact substitute for it - a good thing for dogs who need something different, like Kathy's Lucky, but a bad thing for the dogs for whom Humulin L was the perfect insulin.

Soaphie & Sydney's Mom
12-19-2008, 01:08 PM
Ok - I think I have given it the 'ol college try with Vetsulin. Soaphie is low (again) this afternoon. I came home from work due to a big storm we are getting here in upstate NY and she wasn't acting quite right....I gave her some banana, and 20-30 minutes later she still wasn't acting right. So I tested her....52 (it's about 13% lower than at the vet). So I gave her some karo....waited 15 minutes and she still wasn't acting right so I gave her some rice and more karo. She's now sleeping by my feet. I called the vets office - and no vet is in the office right now.

So - my question - any advice on dosage after tonight's meal?

Argh. I will be in the vets office on Monday and we are done with Vetsulin - I feel like we've tried every dosage/food combination possible. My poor baby...

We Hope
12-19-2008, 02:14 PM
When you do get hold of your vet, ask him/her if he/she prefers to cut the dosage tonight by 30-50% or to omit tonight's shot. Some vets prefer to cut the dose, while others would rather skip a shot--it depends on what your vet prefers and what Soaphie's bg's look like as you continue to keep an eye on them.

Until you can go Monday, you'll need some type of "working" dose of insulin, so it would also be good to find out from your vet how many units Soaphie is to get starting tomorrow on a regular basis over the weekend.

Kathy

Soaphie & Sydney's Mom
12-19-2008, 02:42 PM
I won't be able to talk to anyone tonight - so I think my plan will be to cut in half tonight and talk to the vet in the morning. Ugh.

We Hope
12-19-2008, 02:54 PM
If you cut by half, you can be sure there will be no more hypos tonight. She will obviously be running high, but this can get straightened out after you are able to talk with your vet.

Kathy

rhodesian46
12-19-2008, 05:15 PM
Good choice to go 1/2 Better high than low. Are you planning on switching to Novolin N? I think it is a good idea besides the cost You get more insulin i than in the Vetsulin( 2 1/2 more times) Pebbles did well on Novolin N . ALso you need to have an emergency number or a contact # just in case you need to speak to someoneHope Sophie does well this evening

Soaphie & Sydney's Mom
12-19-2008, 06:10 PM
At 6:20 p.m. she was at 113 (this is 1/2 hour after eating her dinner and three hours after karo/rice). I gave her 8 units. We are just all over the board with Vetsulin. I have really really really tried - I didn't want to rush to change just to have to change back. But - I think it's time. A few weeks ago we were at 14/14 and her levels were high....then moved to 15/15 and I did a curve last weekend and she was low so I dropped her to 14.5/14.5 and here we are again - low. It absolutely breaks my heart to see her this way - up until this summer when she was diagnosed, she would run up to 10 miles with me - she was my training partner. Life isn't fair :(

I will be on the phone with the vet that is on duty tomorrow (not our normal vet - but she is familiar with Soaphie's case).

Thanks all!

k9diabetes
12-20-2008, 12:00 AM
Re: Insulin

NPH works so well for so many dogs - plus is easy to obtain and can be used with lots of different needle gauges... I think it would be great to try Soaphie on it and see how she does.

You may find, in the end, that it's her metabolism that's at the root of this variation rather than the insulin. But the only way to know is to try and you really don't have anything to lose by trying it either. At worst, you go back to Vetsulin and reduce the dose so you don't risk winding up in hypo territory.

I know one dog who did the same thing on Vetsulin and she was actually transitioned over to Regular four times a day, the same schedule Chris was on. I think that dog was allergic to NPH. Both she and Chris did very well on Regular faster-acting insulin as their only insulin!

Our dog is a good example of the world of difference the insulin preparation can make. His curves on the old Humulin L and NPH were like night and day in terms of how he absorbed the insulin. The endocrinologist was fine with the swings, but we were not and changing the type of insulin got rid of them.

Re: Exercise

I don't know that Soaphie will ever be able to run 10 miles at a stretch again BUT she certainly should be able to get to the point where she can get some good exercise!

It's a variable that's usually best left out of the equation when you're first working on regulation. But once you find an insulin / diet combination and know how she handles them, you can start to introduce exercise again and see what that does, starting with small amounts and working up to a level she can safely handle.

Most dogs will see their blood sugar drop during exercise, in which case you can give some carby snacks or even glucose prior to going out and while out to keep the blood sugar adequately high.

I believe some people actually see their BG go higher from exercise... if that's the case with Soaphie, it might not be enough to be a concern or it might be a matter of proper timing... there are ways to do it when you have a fair amount of home testing experience and can identify her particular patterns.

Chris was never a runner - his heart had always been compromised from his PDA and he never had much stamina - but he went on walks all through his diabetes. As he got sicker, the walks got shorter, not from the diabetes but from his heart problems. I would check his BG before we left and give him some glucose if I was concerned about the level of his BG starting out. And we tried to time the walks so they weren't at his lowest BG level.

Re: Emergencies

As for the vet availability issue, do you have any 24-hour options available in your area?

We have identified a 24-hour clinic that's near us and we call them after hours if we absolutely need help, which we have a few times. We are fortunate that we also have used their specialists a few times so they know us and had a file on Chris. In fact, the clinic owner was the one who helped us when we had to let Chris go - she had a special place in her heart for Chris.

Our original vet kept one doc on-call but hardly any clinics still do that - which is understandable. Now, since we have a half dozen 24-hour hospitals here, they pretty much all just ask clients to call the ER vet in the case of an emergency.

I know some vets don't bother with any options for overnight or weekend emergencies... I think that should be illegal! I hope that's not the case for you guys as it is scary going it alone and some situations just won't wait for office hours!!

Okay... I've written a book!!

Hope Soaphie and you are feeling more relaxed now!

Natalie

eyelostit
12-20-2008, 02:20 AM
I'm sorry about what you and Soaphie are going thru.
It was months and months of my 1st vet that kept uping the insulin until Niki went into shock, she was at 18 units of NPH at the time, now she is at 9 1/2 or 10 units for yrs now. I was so digusted with the vet, found this board and put Niki's life in my hands and never looked back.

This is no reflection on your vet, but the lows are scary, better highs than lows.

Hang in there.:)

Soaphie & Sydney's Mom
12-21-2008, 03:41 PM
Tomorrow morning I'm meeting with a new vet for Soaphie. The switch from Vetsulin to NPH will begin. In my brief call with the new vet on Saturday, she stated that NPH is the gold standard and that many have come to her to switch. Here's my question - she said that the switch would be gradual....part vetsulin / part NPH for a while until it all becomes NPH.

Has anyone else done a transition like this?

We Hope
12-21-2008, 04:31 PM
We switched species three times. Each time we did so, it was just begin using the new insulin, period. I know others who have made transitions to either human or pork insulin and they did the same thing--began the new insulin at a modest dose, leaving the old one behind. Don't know of anyone who made a change like the one proposed for Sophie.

Kathy

We Hope
12-21-2008, 04:47 PM
http://www.vetsulin.com/vet/DosingConverting.aspx

This is transitioning from human insulin to Vetsulin. There's no mention of the need for a mixture of the two insulins at all:

"When an insulin change is necessary, one must be very cautious. Due to the nature of the disease, it is difficult to have general guidelines; however, some recommendations can be made:

"If regulation is already adequate, it is suggested to start Vetsulin at 50−75% of the dosage used with the previous insulin.

"If ideal regulation has not been achieved, it is suggested to first investigate the cause of poor regulation: eg, owner administration issues, insulin storage issues, use of improper syringes, Somogyi overswing, etc. Once it has been determined that the dose of the previous insulin is inadequate, start Vetsulin at 75−100% of the dosage used with the previous insulin."

Jenny, who is a member of this board, needed to switch Buddy from Caninsulin/Vetsulin to NPH; AFAIK, she did no transition like the one your new vet detailed. There were also two others who were members of another diabetes board who needed to make the switch from Caninsulin to human insulin, and I know they only stopped using the Caninsulin/Vetsulin and started using the human product.

From a personal standpoint, when neither human nor beef insulin were doing anything for Lucky, we were eager to leave the old insulin behind with the hope that the new one would be what he needed.

Lucky's switches from human to beef to pork, were supervised by our vet, as were the transitions from pork Lente to pork NPH and back to pork Lente, made necesssary by Lilly's discontinuation of their pork Lente and his having issues with both the protamine suspension and different preservatives of pork NPH. Since he was intolerant of everything in the pork NPH except the pork insulin itself, we were only to happy to be able to stop using it for him.

Kathy

Adding here--one of the dogs from the other board was initially placed on Insuvet Lente-U 100 bovine Lente insulin available only in the UK. The insulin did not work quickly enough for him because of the two amino acid difference between bovine and canine insulin.

He was then switched from Insuvet Lente to Caninsulin/Vetsulin. That worked too quickly for him because more dilute insulin work faster than less dilute ones and the amino acid match between pork insulin and canine insulin is a perfect one.

He was finally switched to U 100 NPH insulin and the combination of the less dilute insulin and the one amino acid difference between human and canine insulin provided him with what he personally needed to manage his diabetes.

He wasn't switched by mixing any of these insulins any more than Lucky was.

Soaphie & Sydney's Mom
12-21-2008, 04:52 PM
After the lows we have been having - I want to be done with it and not look back.

Thanks for your advice!

k9diabetes
12-21-2008, 09:40 PM
Everyone one I know who has changed just switched immediately to the other insulin at a reduced dose and worked up to the right level of insulin units since it can definitely vary.

Which makes me wonder a bit about this vet's recommendation in terms of other advice she might give... she may not be used to people who home test blood glucose... ? I can't think of any reason really to do that.

BestBuddy
12-22-2008, 01:29 AM
Hi,
Buddy made the change from Caninsulin to Humulin N overnight. He had been well regulated on the Caninsulin for nearly 4 years before we struck trouble hence the change. He was on 4.8iu of Caninsulin at night and we made the change to 4iu of Humulin N the next morning. His numbers didn't change, meaning the highs and lows were the same number with each insulin just the timing of them changed. We had to increase a bit to 4.5iu but are now back to 4iu and doing great after a diet change. Caninsulin saved my boys life and gave us 4 more years so I have nothing but good things to say about it but I have noticed with the NPH that I am able to get a flatter curve which makes getting better numbers easier.
Jenny & Buddy

Soaphie & Sydney's Mom
12-23-2008, 05:08 AM
Yesterdays appt went very very well. We are starting at 10/10 NPH and will adjust from there. This morning her BG was 263.

Thank you everyone!

Tami

Dollydog
12-23-2008, 05:29 AM
Hi Tami,
I've really appreciated reading this part of your thread as I want to change Lady to a human insulin. (Will check with our pharmacist to see if NPH is available here before I discuss it further with the vet.)
Lady is approximately 15lbs and gets 16iu's of Caninsulin twice a day....haven't checked her in the last week so don't know if it's made much of a difference.
Wishing you all the best with the transition and I'll be checking back often to see how you make out,
Jo-Ann & Lady :)

k9diabetes
12-23-2008, 07:57 AM
Everything's crossed here in hopes that Soaphie gets nice level curves from the NPH!

Even just from the standpoint of working with a large dog, it's nice to use NPH instead.

Natalie

eyelostit
12-23-2008, 07:55 PM
I think it will all go well for you, seems most owners do the switch and have better results.

Take care all will be OK:)

k9diabetes
12-27-2008, 11:02 AM
I see from posts elsewhere that Soaphie seems tired despite good blood sugar levels. Keep an eye on this as Chris was allergic to the protamine in NPH and he showed it by being lethargic and tired, especially when walking. Once he was on all NPH, he couldn't walk to the end of the block.

Sounds, too, like Soaphie may be one of those dogs whose blood sugar bounces around regardless of the insulin. Time will tell. Chris was not all that stable on a dose of insulin and we varied his number of units periodically. His was kind of a wave of rolling changings.

Soaphie & Sydney's Mom
12-27-2008, 11:11 AM
Gosh - I sure hope she isn't allergic (although - it had crossed my mind). I'm hoping when we are back to our normal schedules next week that "all will be well". It's funny - our other dog (non-diabetic), sleeps more than Soaphie and I don't second guess any of her movements. Ugh.

k9diabetes
12-27-2008, 11:26 AM
I always think of it in terms of what's "normal" for Soaphie or for Chris.

Chris' sudden inability to walk to the end of the block came on fairly abruptly and at first we thought it was arthritis. But then I stumbled on some discussion of what's called "Stiff Man Syndrome" in people while researching his problems and several diabetic people posted that they resolved extreme stiffness and soreness instantly by getting off of NPH!

So we took Chris off the NPH and within about 48 hours he was back to normal.

If I hadn't read about Stiff Man Syndrome, I probably would never have figured it out.

Does Soaphie tend to be allergic to things?

Natalie

k9diabetes
12-27-2008, 11:33 AM
I see she does have allergy tendencies, at least toward food.

You can wait and see how she does - just wanted to put it out there as a possibility.

I still think Soaphie might wind up being one of those dogs whose blood sugar bounces around. (Sorry!) If she's not allergic to the NPH, you could settle on a sort of "basal" dose of NPH and then treat high blood sugars with a bit of Regular.

Judging from the numbers you've seen so far (posted elsewhere), the 10 units is keeping her in a good range overall - the low day only went into the low 100s and the higher readings in the 300s but most readings in the 200s. If Soaphie's gonna be a "bouncer", this is the kind of range you would aim for - where the low days aren't dangerously low. This would be good safe regulation for Soaphie if she continues this pattern of periodic unexpected low days.

Natalie

Soaphie & Sydney's Mom
12-28-2008, 08:02 AM
Natalie -

I've been reading and re-reading your case study on Chris throughout the weekend. What a great summary of "the story" - so very helpful.

Here is my question for the group:

Soaphie has been on NPH since last Monday night, we are doing a full curve today. She has been very lethargic. I'm unsure if it's due to high BG's or if she is allergic to NPH like Chris was. We'll give it more time of course, but play along with my scenario below - want your experienced opinions:

So for a moment - let's assume she is allergic to NPH and let's assume that we aren't able to do 4 shots of R throughout the day due to work schedules etc......any thoughts as to what our other options would be? Knowing that Vetsulin gave us way too many lows and it not an option?

Thank you all!!!!

Tami & Soapher

We Hope
12-28-2008, 08:05 AM
Soaphie has just started with NPH, so it will take more time than this to try to find her "right" dose, so it's sort of borrowing trouble right now to be assuming she has problems with either the protamine suspension or the different preservatives of the NPH.

You probably will be seeing some higher numbers right now until you learn what the right number of units for Soaphie are.

You'd be better off assuming that you're not at the correct dosage of the NPH at this point, rather than that Soaphie can't tolerate it.

When we were forced to take Lucky from pork Lente to pork NPH because Lilly had discontinued the pork Lente and we were in the process of waiting for our IND (Investigational New Drug)-Personal Use paperwork to be approved by FDA, he used the pork NPH for a bit more than 2 months.

Lucky was happy, healthy, active, and doing very well with all aspects while he was using the Lilly pork Lente insulin. Even though both were made from pork, we found that it took more insulin to control his blood glucose with the pork NPH than it did with the pork Lente.

Protamine is a protein, just as insulin is, and this means there is a possibility when you have immune-mediated reactions (as we did to both human and beef insulins), the same thing can happen with the protamine suspension--that the body begins attacking that, just as it did the insulins other than pork.

Lucky's system was going after the salmon-based protamine too. The only thing he liked about pork NPH insulin was that the insulin itself was made from pork. This meant that his bg's were not out of control, but it was taking more pork NPH insulin to keep them in control than it was of the pork Lente, which has no protamine in its suspension.

After a little more than 2 months on it, this was beginning to interfere with his blood glucose control even more.

He had other issues with the phenol and metacresol preservatives of the NPH; Lente insulins have only one preservative in them and that's methylparaben. The preservatives which are used in both NPH and R insulin cannot be used in the production of Lente as they will destroy the Lente type insulin.

Lucky was extremely lethargic, sleeping most of the time while using pork NPH. He never had neuropathy, no matter how high his blood glucose was before we got control of it, but he developed neuropathy while on the pork NPH.

His skin and coat were extremely dry--his fur looked dull, dry and lifeless; the coat was also very thin. He also began having a problem with his eyes becoming constantly irritated and watery. None of this was happening while he was on pork Lente insulin.

I could see him begin to improve with all of this from the first shot of Caninsulin/Vetsulin. Within two weeks of switching to it, all of his complications were gone. He even decided to re-grow the winter coat he'd grown while using NPH insulin, and he shed every last hair of it. The new fur was as it always was--thick, shiny, and healthy. His neuropathy resolved, his eyes were no longer irritated and he was his normal, happy active self once again.

So let's not go any further ahead with the thought that Soaphie may not be doing well with the NPH for now--give it a chance.

Kathy

Soaphie & Sydney's Mom
12-28-2008, 08:10 AM
So is it "normal" (per se - whatever "normal" is) to see the lethargy when switching insulins?

I agree with you that it's too soon to tell - but I want to do the research so we don't go another 5 months (like we did with Vetsulin) before making a switch.

She just has no energy at all...

Soaphie & Sydney's Mom
12-28-2008, 08:12 AM
So far today:

8:00 a.m. 352
10:00 a.m. 272
11:00 a.m. 286
12:10 p.m. 326
1:21 p.m. 330

We Hope
12-28-2008, 08:36 AM
Sorry--my computer decided I was finished posting before I really was. :D

What needs to be sorted out here and it's still too early in the NPH game to do that is whether Soaphie's lethargy stems from not yet having her bg's controlled by the right amount of units of NPH or whether this comes from something in the insulin itself.

We knew it was the insulin suspension and preservatives with Lucky because we had gotten his bg's under control with it. We also know it wasn't the insulin itself because pork insulin was the only one he responded to.

Lucky was also just the opposite when he had high bg's--they made him hyperactive instead of lethargic--like a little kid on a "sugar buzz" who's had way too much candy. So for Lucky, he didn't become languid at all when we tried the human and beef insulins--his immune system simply destroyed them before they could do anything about controlling his blood glucose and he went around on his "sugar buzz". He only became lethargic after going onto the pork NPH and that disappeared rapidly once he was back on pork Lente insulin.

Natalie's Chris had no problems with the human insulin itself, and no problems with the preservative metacresol, which is also in R insulin. His problems stemmed from the protamine suspension of the NPH and likely from the addition of the phenol that is also used to preserve NPH.

Soaphie most likely will need to have her NPH increased--it's very rare that you hit on the right dose the first time when you start an insulin. ;)

Kathy

We Hope
12-28-2008, 09:17 AM
Not sure this is helpful, but FWIW--

The U 100 insulins will take somewhat longer with onset, peak and last longer than U 40 ones do; the NPH you're using is a U 100 insulin while Vetsulin is a U 40 one.

There is one amino acid difference between human insulin and pork/canine insulin--the difference is that of the B-30 position of that chain.

http://images2.wikia.nocookie.net/petdiabetes/images/f/fb/Canineinsulin8.png

When you have amino acid differences between the insulin you're using and the one your pancreas made when it was working properly, this creates some insulin resistance. The resistance doesn't always have to be the type that interferes with diabetes control--what it can do is to make the insulin's onset and peak slower, as well as increase its duration.

People who used bovine ultralente insulin as their basal, or body's basic needs, not considering food, found all of this to be positives for them; there are 3 amino acid differences between bovine and human insulin as you can see on the graphic above. Bovine ultralente used in a human being lasts longer than Lantus.

Not long after Lucky was diagnosed with diabetes, he had a cyst near his tail open up. We treated it and there was no infection, but when the fur in that area grew back, it looked slightly different than the rest of him. The only people who would notice something like this would be John and myself--others wouldn't have seen the difference.

Even after Lucky got onto U 100 pork Lente insulin from Lilly, that spot didn't change--when he shed, it still looked slightly different. After going onto the U 40 pork Lente from Intervet and shedding the terrible winter coat he'd grown when using pork NPH, that funny spot was gone forever. I couldn't find it no matter how hard I looked and neither could the professional eyes of John.

When using U 100 pork Lente, Lucky's bg's were in the low 100 range--very nice, steady and would be considered in the normal blood glucose range for someone without diabetes. After regulating on Caninsulin/Vetsulin, he was in the 85 range and just as nice and steady. So for Lucky, having the U 40 insulin with a faster onset than the same U 100 was a plus, as his body was using the insulin better than it was the Lily pork Lente.

Kathy

k9diabetes
12-28-2008, 09:54 AM
I am concerned because Soaphie's BG has been mostly in the 200s while on NPH, which is really pretty good - I'm doubtful that the lethargic behavior is a result of high blood sugar, especially since its onset coincides exactly with introduction of NPH.

Chris went on to NPH gradually so the stiffness came on gradually as well.

I wouldn't want to up the dose much right now given that she had a the better part of a day in the low 100s. Here's her numbers collected from your posts at the CDMB:


NPH was started on Monday 22nd evening dose.

"Officially" was on 15/15 Vetsulin (but I had decreased it over the last week or so) and are now on 10/10 NPH.

12.23 - first day of 10/10 NPH - mid-200s on 3-4 readings, 263 at breakfast

12.25 - Every BG I have taken has been right around the mid 200's

12.26 - 360 before eating breakfast and 380 5.5 hours later.
12.26 - 11.5 hours 132 predinner
12.26 - 4 hours after insulin shot - 121 BG. Fed her a snack.

12.27 - This morning she was at 271 so that's good.



What you can do to sort out if it is the NPH is to, temporarily, go back to the Vetsulin. That's the most straightforward way to find out if NPH is a problem for Soaphie.

If she perks up quickly by switching back to Vetsulin, then I'd say you have your answer. If not, then you know it's something else bothering her and you can go back to NPH.

Chris had the same response to a food allergy by the way.

In terms of what other insulins you can use, there are not a lot of other choices. Regular can sometimes be used three times a day rather than four. Lantus is another possibility. Levemir is likely out if NPH is a problem because Levemir also has protamine in it.

I'd suggest doing a quick switch back to Vetsulin at the same number of units you were giving of it or even a little less - not necessarily aiming for perfect blood sugar control, just for the NPH to clear her system - give it 48 hours and see what you get.

If you're "lucky" the lethargy won't change... and I say "lucky" only in that your insulin alternatives are limited. Because if switching back to Vetsulin doesn't change her lethargic behavior, you will have to look for something else as the cause and that's scarier than an insulin preparation allergy.

Have there been any other changes at the same time?

Food, supplements, meds, etc.?

Any other change made at the same time could be at the root of the problem.

Natalie

We Hope
12-28-2008, 10:25 AM
Just want to add here that if the protamine and/or its preservatives appear to be the problem, any PZI--Protamine Zinc Insulin--would not be an alternative because PZI is basically NPH with more protamine added to it to extend its duration.

Some compounding pharmacies offer beef PZI and offer human PZI.

Kathy

Soaphie & Sydney's Mom
12-28-2008, 10:47 AM
GREAT INFORMATION! THANK YOU!!!! I appreciate all of your time!

I updated her BG's in the post below with her latest numbers....so today after 5 tests, she had two readings in the 200's (higher end of 200's) and is now back in the 300's.

I'm very hesitant to go back to Vetsulin as we had significant lows with her when using that product (ugh). I'm going to see what happens with the remaining readings from the curve and go from there. Also - will be calling the vet tomorrow to get her take on all of this.

Oh - in response to other changes to her schedule. No changes to diet or exercise have been made so she's stable there - we figure it's the only thing we can really "control" until we get everything else sorted out. When we get her regulated (or as close to "regulated" as she may get :)), we will then thrown in other variables if we are able.

k9diabetes
12-28-2008, 10:59 AM
That is a nice flat curve... I hope NPH is not the problem.

There are multiple possibilities behind an allergy, if there is an allergy here.

Protamine is one, human insulin is another, and the preservatives are a third. The NPH introduces all three of these factors.

In terms of dose, even though these numbers are bit higher than you would like, I'd stay with 10/10 units given Soaphie's history of variability and the significantly lower numbers from a few days ago.

With dogs who "bounce around" in their response, it takes longer to get an idea of what their range of blood glucose on a dose of insulin is going to be. You need to see what a "low day" looks like and it could be those readings in the low 100s were one of her low days.

Maybe Soaphie won't have those low days on NPH but I think it will take a more extended period of time to find out for sure.

One nice thing with NPH if it works is that you could set a baseline dose of NPH, sort of like basal insulin for people, and then give a little bit of Regular on her "high days" to bring the blood sugar down. The baseline NPH would be a dose that's safe on her low days.

I wonder if the Stiff Man Syndrome discussions are still available online... I may have old links to them.

We Hope
12-28-2008, 11:04 AM
Is it possible for you to go back on one of your previous Vetsulin curves and post them for us along with the results you get from Soaphie's curve today? By comparing them, we might be able to spot a trend.

Should it wind up that you need to go back to Vetsulin because of the protamine and/or preservatives problem, what may be possible for you to work out is some type of feeding schedule whereby Soaphie's meals are changed from two large ones directly before insulin to three or four smaller ones which equal the same amount of food, but "spread" it out over a longer length of time, thus perhaps avoiding the lows.

Some people schedule a bit or extra food as a snack prior to the times when they know their dog might be approaching a low--this is something else to think about.

Kathy

k9diabetes
12-28-2008, 11:09 AM
I couldn't find the links and a quick search did not turn up the forum-type discussion I looked at three plus years ago.

k9diabetes
12-28-2008, 11:10 AM
This is one of Soaphie's curves from 11.21

Soaphie went in for another curve today. We started at 12/12 this week and were getting readings in the 300's all week (home testing - thank you for the recommendations).

So - here are the readings from today - testing with both my home tester and the vet's machine:

my machine vets machine
8:00 a.m. 365 416 then given 13 units
10:00 a.m. 314 394
12:00 p.m. 176 (has to be incorrect) 319
2:00 p.m. 327 371
5:00 p.m. 347 461

So we are now doing 13/13 for the Soapher dog and going back to the vet on Tuesday. I will continue testing at home until then.

Here she went low on 12.19 - looks like she was on 14.5 units:

Soaphie is low (again) this afternoon. I came home from work due to a big storm we are getting here in upstate NY and she wasn't acting quite right....I gave her some banana, and 20-30 minutes later she still wasn't acting right. So I tested her....52 (it's about 13% lower than at the vet). So I gave her some karo....waited 15 minutes and she still wasn't acting right so I gave her some rice and more karo.

At 6:20 p.m. she was at 113 (this is 1/2 hour after eating her dinner and three hours after karo/rice). I gave her 8 units. We are just all over the board with Vetsulin. I have really really really tried - I didn't want to rush to change just to have to change back. But - I think it's time. A few weeks ago we were at 14/14 and her levels were high....then moved to 15/15 and I did a curve last weekend and she was low so I dropped her to 14.5/14.5 and here we are again - low.

Soaphie & Sydney's Mom
12-28-2008, 11:15 AM
Is there a way I can email you her excel spreadsheet? I'll look through your profile and see if I can send you both her spreadsheet....

k9diabetes
12-28-2008, 11:17 AM
Send it to me at k9diabetes@gmail.com.

Soaphie & Sydney's Mom
12-28-2008, 11:23 AM
Your "stiff man syndrome" comment has me curious - I'm going to go and read more about that.....

BestBuddy
12-28-2008, 11:23 AM
From what I can see you are getting pretty flat numbers which is great. Still a bit high but that can be worked on. I just wanted to say that when Buddy has an "episode" of high BG even when the BG comes back into a good range it takes several days for him to start feeling better. He gets so lethargic and sleepy so like everything it takes time to see the end result.
Jenny & Buddy

k9diabetes
12-28-2008, 11:32 AM
I think it's possible, after looking through your previous posts, that the problem with Vetsulin is a combination of Soaphie being a "bouncer" and in response she's being given too much Vetsulin.

If you do a curve and it's a "high day" and you then increase the insulin, you are likely to be giving too much insulin overall - great for a "high day" but dangerously overdosing a "low day."

You might go on the assumption (because it's still a guess on my part) that Soaphie is a "bouncer" and on the same dose of insulin she's going to have about 50% normal levels, 40% high days, and 10% low days and dose the insulin so that her low days are never too low.

From there, if she can use NPH, you *might be able to correct the high days with some R - though that's down the road after the true situation is sorted out instead of guessing/thinking out loud.

I think 14 units of Vetsulin was too much for Soaphie's low days.

If it was my dog, I would:

1) Do a two-day trial OFF the NPH - go back to Vetsulin at 12/12 or 13/13 - and determine immediately whether her lethargy is related to the insulin.

That way, you settle that question right away.

2a) If NPH is not the problem, leave her on 10/10 NPH and follow her blood sugar over at least another 10 days to see whether she is more stable on NPH or whether she is still "bouncing" with high days and low days.

2b) If NPH is the problem, go back to Vetsulin but at a lower dose such as 12/12 or 13/13 for now.

If she still bounces on NPH, then you know the insulin preparation is not the cause and you could use either Vetsulin or NPH. If NPH doesn't correct her uneven response, it's likely coming from Soaphie, not the insulin.

3) If she bounces around on NPH, whatever insulin you use will have to be dosed to prevent the low days from being dangerously low.

Which means many other days she will run higher than you'd like. But those lows create havoc of their own and the only way to get things stable would be to get rid of dangerously low blood sugar.
__________

Johanna's dog Killian over at the CDMB is what I've been calling a "bouncer." He goes along fine on a dose of insulin and then suddenly has a "low day" and that dose of insulin is too much. Since there seems to be no way to predict these low days for him (and you had a similar situation with Soaphie recently on NPH where in the evening she suddenly dipped into the hundreds), then you don't have much choice but to go to a lower dose of insulin.

Once you get all these questions answered, then we could work on the best plan for working with what Soaphie offers. But right now I think there are too many unanswered questions.

k9diabetes
12-28-2008, 11:35 AM
Here's one of Tami's curves on Soaphie done at home with Vetsulin 13 units:

11/22/2008 7:15 a.m.247 - 13 units
11/22/2008 10:20 a.m.339
11/22/2008 1:31 p.m.270
11/22/2008 6:15 p.m.273

This curve is nice.

k9diabetes
12-28-2008, 11:37 AM
11/25/2008 8:00 a.m.421 14 units
11/25/2008 10:00 a.m. 449
11/25/2008 12:00 p.m.528
11/25/2008 2:00 p.m.654
11/25/2008 4:00 p.m.502
11/25/2008 6:00 p.m.412

I can see why this moved you to raise the insulin, though that may not actually be a good idea with Soaphie.

I've got to go offline now... will email your Excel file to Kathy before I do.

Natalie

Soaphie & Sydney's Mom
12-28-2008, 11:41 AM
8:00 a.m. 352
10:00 a.m. 272
11:00 a.m. 286
12:10 p.m. 326
1:21 p.m. 330
2:35 p.m. 255
4:00 p.m. 261

Soaphie & Sydney's Mom
12-28-2008, 11:53 AM
Ok - so for the last reading, she just flopped down and laid on her side. She's so lethargic, I've never seen her like this. I will be going back to Vetsulin tonight and see what happens. I never thought that I'd say those words "go back to Vetsulin"....

We Hope
12-28-2008, 12:56 PM
Most of what I've collected here on stiff man syndrome had to be accessed via Google cache. The pages are running very slow for some reason, so when you do get them up, click for the text version only right away and you'll be able to read them.

http://74.125.95.132/search?q=cache:8hphqhhjs7UJ:http://emedicine.medscape.com/article/1172135-overview+stiff+man+syndrome+insulin&hl=en&strip=1

http://74.125.95.132/search?q=cache:zeG-28DSDQwJ:http://www.diagnose-me.com/cond/C550180.html+stiff+man+syndrome+insulin&hl=en&strip=1

http://www.gpnotebook.com/simplepage.cfm?ID=1483407407

More on protamine:

http://www.ncbi.nlm.nih.gov/pubmed/1879305?dopt=Abstract

Diabetes Research & Clinical Practice May 1991

A case of insulin allergy: the crystalline human insulin may mask its antigenicity.

We report an unusual case of insulin allergy. A 48-year-old man with non-insulin-dependent diabetes mellitus receiving biosynthetic isophane human insulin (Humulin N) developed itchy wheal-and-flare reactions at the sites of injection. When Humulin N was changed to a semi-synthetic crystalline human insulin zinc (Novolin U), the allergic reactions completely disappeared. Evaluation of his serum showed a high level of insulin-specific IgE. Skin testing with all commercially available insulins showed immediate local reactions to all agents tested except for Novolin U. In addition, decrystallized Novolin U prepared by lowering the pH with acetic acid also induced a positive reaction. These observations suggest that the crystallized structure of human insulin may mask its antigenicity for allergic reactions.

http://www.ncbi.nlm.nih.gov/pubmed/6196244?ordinalpos=9&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

Diabetologica October 1983

Circulating IgG antibody to protamine in patients treated with protamine-insulins

Sera from patients with different types of protamine-insulin were assayed for IgG antibody to protamine. A high prevalence of circulating antibody was found in patients treated with either bovine isophane insulin (26 out of 28 patients; 26 of whom also had antibodies to insulin), or bovine protamine zinc insulin (27 out of 30 patients; all 30 had antibodies to insulin). In sera from 24 patients treated with highly purified porcine isophane insulin, protamine antibody was detected in nine; circulating insulin-antibody was detected in 12 patients, eight of whom had protamine-antibody; in the 12 patients with no detectable antibody to insulin, antibody to protamine was detected in only one (x2 = 8.7, p less than 0.01). This relationship between insulin and protamine antigenicity is of interest as it suggests that the protamine-insulin complex is itself immunogenic.

http://www.fda.gov/medwatch/SAFETY/2004/jul_PI/NovoLog_PI.pdf

Page 8 Novolog

Localized reactions and generalized myalgias have been reported with the use of metacresol as an injectable excipient.

http://www.fda.gov/cder/foi/label/2002/21172s3lbl.pdf

Page 10 Novolog Mix

Reactions may be related to the insulin molecule, other components in the insulin preparation including protamine and cresol, components in skin cleansing agents, or injection technques.

Localized reactions and generalized myalgias have been reported with the use of phenol as an injectable excipient.

The insulin molecule, in this case, is insulin aspart, which is not "plain" human insulin, but an analog of it.

http://images2.wikia.nocookie.net/petdiabetes/images/b/bb/Figure2.gif

Position #28 in the human insulin B chain is altered--Proline is replaced by aspartic acid. Humalog, or insulin lispro, is made by altering the amino acids found in positions #28 and #29 in the human insulin B chain. Proline, normally found at #28, is replaced by Lysine, normally found at #29. The process then replaces Lysine, found normally at #29 with Lysine--the two are in effect, "swapped".

The mixed forms of these two analog insulins are suspended in the same fashion as NPH and NPH mixed insulins are--with protamine as a suspension and phenol and cresol as the preservatives.

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

"Antibodies may be directed either against the insulin or against other foreign proteins in the preparation."

Protamine is a protein.

My Lucky was doing just about the same thing on the pork NPH. What probably made it easier for us to see was that he was not like this at all until protamine suspended insulin came into the picture.

The first week of human insulin worked well--by the second one, it was like giving him no insulin at all--the immune mediated insulin resistance had started. Giving beef a try to see if the two amino acid differences between bovine and canine insulin would make for a longer-lasting insulin for him was the same as with human insulin. His immune system rejected it and destroyed it as it would an invading bacteria or virus. When we started with pork, it was with the old Lilly Iletin II Lente, which was U 100 Lente insulin--no protamine, phenol or cresol. We knew the insulin itself and this type of suspension and preservatives worked great for him.

The strange thing was that out of all of our dogs, Lucky was the one who seemed to have no allergies--no food allergies and never needed to be treated for any other allergies as all of our others did at some time or another. So we really had no "warning" that something like this might happen.

Kathy

Adding to this--

http://www.provet.co.uk/health/diseases/insulinineffectiveness.htm

Presentation given by Prof Richard Nelson DVM Diplomate ACVIM at the North American Veterinary Conference 2001.
INSULIN INEFFECTIVENESS IN DIABETICS

"Ineffectiveness of insulin should be considered when poor glycaemic control is present in patients that are given insulin at a dose rate of more than 1.5U/kg body weight twice daily and :

"They are still showing the clinical signs typical of diabetes - weight loss, polydipsia, polyuria, polyphagia, lethargy, poor hair coat, neuropathy
Their blood glucose concentrations exceed 300mg/dl (16.8 mmol/l)
Their blood fructosamine concentrations exceed 500 mmol/l"

This article was our "springboard" to connecting the NPH insulin to Lucky's problems. Though he didn't show weight loss, continued PU/PD, or have high bg's or fructosamine concentrations while on it, we identified with the lethargy, poor hair coat and neuropathy--none of which were present when he was using pork Lente insulin.

We then began the process with Intervet and the FDA to file for permission to import Caninsulin for his personal use, as it was still not approved for use in this country.

k9diabetes
12-28-2008, 02:35 PM
I do actually hope the NPH is the cause since that's easy to fix even if it means more difficult diabetes control.

If she doesn't improve markedly off the NPH, I'd take her back to the vet as she seems, from your description, to be getting worse.

Her blood sugar's not all that high but have you checked for ketones?

How's her appetite?

Natalie

Soaphie & Sydney's Mom
12-28-2008, 02:40 PM
She only ate breakfast today (no snacks since we are doing a curve). She's ate well at that time.

I haven't checked for ketones.

I will be calling the vet tomorrow for certain.

So....I think I will give 12 units tonight of Vetsulin (ugh).

k9diabetes
12-28-2008, 02:49 PM
It's a pretty dramatic change in her. Definitely worth testing to see if NPH is the source.

You may find that you can avoid the lows by ignoring the highs with Vetsulin.

If she's a bouncer, there are worse things. I know a handful of dogs like this. Dawn's Brandy is another one - they are both over at the CDMB and can share their experiences with you about how they went for months trying to find the right dose and finally just had to get used to the idea that their dogs' blood sugar levels were going to vary for no particular reason.

Really, this lethargicness scares me so I hope she feels better by tomorrow without the NPH.

Soaphie & Sydney's Mom
12-28-2008, 02:52 PM
8:00 a.m. 352
10:00 a.m. 272
11:00 a.m. 286
12:10 p.m. 326
1:21 p.m. 330
2:35 p.m. 255
4:00 p.m. 261
5:45 p.m. 260

Thank you for all your help today!!!!!!

k9diabetes
12-28-2008, 03:06 PM
By the way, how's the color of her gums and her capillary refill time?

To check capillary refill, put some pressure on her gums for a few seconds and release it and see how long it takes for the color to come back.

Soaphie & Sydney's Mom
12-28-2008, 03:21 PM
Light pink gums and it took about 1 second for the color to return.

I've been monitoring the inside of her ears today as well (not sure if that tells anything or not - but they had been light pink/whitish and slightly cool to the touch - now they feel a bit warmer).

She's pepping up a bit now and wanting me to feed her (she's here hitting me with her paw).

k9diabetes
12-28-2008, 03:24 PM
Good to hear she's perking up some. If the gums seem normally pink, that's a good sign.

Chris had a bad allergic reaction to something - we never knew what - one Labor Day and his gums went stark white and wouldn't refill. He couldn't stand up he was so weak and we had to take him to the ER. After that his face started to itch like crazy - all signs of an acute allergy attack in a dog. An injection of benedryl set him right again.

He also had pale gums and/or slow refill time with heart problems.

k9diabetes
12-28-2008, 03:42 PM
Tami,

There are some interesting comments on your spreadsheet. Mind if I post a PDF of it?

Natalie

Soaphie & Sydney's Mom
12-28-2008, 04:29 PM
Go for it :)

eyelostit
12-28-2008, 05:21 PM
Sorry Soaphie isn't her old self.
Something is going on with Niki, she's laying around too much, shes on NPH Novolin for years now, we are off to the vet hopefully tommorrow, did you vet check urine and blood?

Soaphie & Sydney's Mom
12-28-2008, 05:26 PM
Sorry Soaphie isn't her old self.
Something is going on with Niki, she's laying around too much, shes on NPH Novolin for years now, we are off to the vet hopefully tommorrow, did you vet check urine and blood?

I did a curve today:
8:00 a.m. 352
10:00 a.m. 272
11:00 a.m. 286
12:10 p.m. 326
1:21 p.m. 330
2:35 p.m. 255
4:00 p.m. 261
5:45 p.m. 260

She was pestering me around dinner time, ate, received 12 units of Vetsulin tonight to see if she peps up a bit. She's sleeping now. I'll be calling the vet tomorrow...

Sorry your baby instead feeling well too - did she eat? BG level?

eyelostit
12-28-2008, 05:55 PM
Your numbers were flat that was good I can see the insulin working and the food meeting the insulin.

Guess both of us will be going to the vet........:confused:I gotta go and post about Niki ;)

k9diabetes
12-28-2008, 08:57 PM
Here's a copy of the Excel records from Tami's file on Soaphie.

www.k9diabetes.com/userimages/Soaphie_Diabetes.pdf (http://www.k9diabetes.com/userimages/Soaphie_Diabetes.pdf)

I see quite a few references to her being lethargic prior to the switch to NPH, though not for days on end.

You actually had some pretty good readings at 13 units of Vetsulin - all in the 200s - toward the end of November.

It could be that just a slight increase in the Vetsulin from 13 to 13.5 or even 13.25 if you have syringes with half unit markings might have been enough to bring her into a better range.

Sometimes it doesn't take a lot to tip them way over into low blood sugar. Paul's Zip (fatdog55) is a good example of a dog for whom a half a unit (and as I recall this was with more than 20 units per injection) was the difference between too high and well regulated. Another half a unit was too much.

Or even just sticking with 13 units for a longer period of time. Soaphie was on 13 units on the 21st and up to 14 units on the 25th. It could be that over time she would have leveled out even more on 13 units.

If you wind up going back to Vetsulin for a while, I'd sit at 13 units for a week or ten days at least, maybe longer if the readings are decent and then increase, if needed, by the smallest amount possible. I think you can safely say that 15 units is way too much and 14 units looks to me to be too much also, at least on some days, which makes it too much in general.

How's she doing? I hope she's feeling better tonight. Will be anxious to hear what the vet says.

Natalie

Soaphie & Sydney's Mom
12-29-2008, 06:24 AM
I have a call into the vet and am hoping to hear back soon.

I gave her 12 units of vetsulin last night and again this morning. Her BG this morning was 334. She seems MUCH better. Gosh - I was so worried yesterday.

Yes - I think that the amount was increased too quickly - I'm hoping that we won't see that with our new vet.

Question - anyone have experience with insulin overlap? Meaning - that it might take a 2-3 weeks to get the insulin ball rolling and have a slight overlap affect with the dosages which helps it work better (or worse if the amount is too high). I have a feeling that might have been happening with Soaphie when on 14 and 15 etc....it might take a few weeks to build up and then there is too much overlap.....just a thought. Please let me know what you think of my hypothesis....

We Hope
12-29-2008, 10:43 AM
http://www.childrenwithdiabetes.com/download/hanas_insulin.pdf

I'm going to suggest that you might want to do a little reading of the chapter at the link above. While it was written for people, particularly children and young adults with diabetes, there's much we people with pets who have diabetes can learn from it. Pages 10 and 11 discuss what an Insulin Depot is.

Whether Soaphie was using Vetsulin or human NPH, she was using what's classed as an intermediate-acting insulin. While you can view profiles for both Lente and NPH insulins which show they are "around" for close to 24 hours, what's being measured is how long they can be found in the bloodstream when a blood test is done--not whether they are in the system in sufficient quantity do anything at all about reducing blood glucose.

http://petdiabetes.wikia.com/wiki/Insulin#Kinetics_.26_dynamics

"Insulin Kinetics refers to the time when an insulin can be measured in the bloodstream. It's important to understand that even though it's "officially" made its way there, the insulin has not yet done so in sufficient quantity to effectively begin to lower blood glucose.

"Insulin Dynamics is the point where it has an effect on blood glucose levels.

"A good illustration of kinetics and dynamics is having a headache and taking an aspirin for it. You will get relief after the aspirin's level in your system has reached the dynamic stage. While it is in the kinetic one, you are still waiting for headache relief."

http://www.diabetesnet.com/images/frombook/KinvsDyn.jpg

The dotted line shows insulin entering the bloodstream (kinetics).
The bold line (dynamics) illustrates the insulin at the point where
blood glucose is lowered by it.

Dr. Hanas writes that if you are using only intermediate or long acting insulin (which is what most are doing with pets--not adding any fast or rapid-acting insulin), the depot of insulin under one's skin will last for about 24 hours. She also speaks of there needing to be at least 2-5 days after making an insulin adjustment to be able to see the results of it.

http://k9diabetes.com/forum/showthread.php?t=372

This is a link to a thread we had on Insulin Depots a while ago.

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

Intervet suggests waiting 5-7 days unless hypoglycemia is seen, before increasing a dose.

Can personally say that we increased Lucky only by half units, because he was a small dog, but Marion's Cara, who is about the size of Soaphie, had her insulin adjusted in terms of half units also and has done very well with her regulation. There's nothing wrong with using caution, especially when you know the dog you are treating has a tendency toward having hypo episodes. I think, as Natalie indicated above, things may look a lot different for you and Soaphie if the increases were done cautiously and as half unit ones.

Can also say that when we were regulating Lucky each time on pork insulin, he had a tendency to "fall back", meaning that on our way up the insulin ladder by half units, we would get to the number of units which would eventually become his mantenance dose.

But when we first "arrived" at that number of units, they weren't doing the job we wanted them to, so we would increase by another half unit morning and evening. Lucky would then give us a lower than we'd like (but never a hypo) reading and we'd decrease the half unit both morning and evening. We knew that this meant he was fully regulated on that insulin and had settled into his daily maintenance dose. This was true for Lucky with both Lily pork Lente and pork NPH--also on Caninsulin/Vetsulin; he did it all three times. Marion's Cara is also using less daily insulin than she was when she regulated.

Soaphie may need more insulin units during the day and less of them in the evening--there are some dogs who need a schedule like this, some who need just the reverse--more at night and less during the day, and others whose insulin requirements are the same morning and evening.

The most important thing is that however it turns out regarding the number of units, that the dose is right for Soaphie. :)

Kathy

Soaphie & Sydney's Mom
12-29-2008, 10:48 AM
Thank you (again) for all the resources and sharing of knowledge - I have learned SO much!

I will read these articles this evening (I'm one of the unlucky ones - I had to go to work this week after having vacation last week)...

Soaphie & Sydney's Mom
12-29-2008, 04:04 PM
So - last night - switched back to Vetsulin 12/12. This morning she was at 335 and tonight 275....she was bouncing off the walls when I got home from work - so obvious that she felt better.

Talked to the vet - she said she has treated 300 dogs with NPH and has never heard of this happening. I told her even my husband noticed Soaphie's lethargy (and he's totally not "in tuned" to her like I am) so it's not in my head. Also - I explained that I cannot even go to the bathroom without Soaphie following me and yesterday she wasn't moving at all.

SO - she said to go back to the Vetsulin for a while and we can try again in a month or so.

So, basically, it looks like for now, I'm on my own (with the great support/advice of the forum, of course).

Tomorrow I plan on going to 13 units in the morning and staying at 12 at night and keep it here for a while and see what happens.

k9diabetes
12-29-2008, 04:09 PM
There were a lot of people who thought I was crazy when this happened to Chris but the difference in his behavior was so obvious that there was no question in my mind. We had taken him to the vet and even put him on pain meds for what we thought was arthritis before trying simply taking him off the NPH.

I think you can make Vetsulin work if that's what it needs to be. 13-13.5 units most likely.

I'm just so relieved that she feels better!

Natalie

We Hope
12-29-2008, 04:21 PM
We never thought anything like this was possible until we were forced to switch Lucky from pork Lente to pork NPH. We knew he was doing extremely well on the pork Lente insulin and hated to make the change but until we were able to get the Caninsulin/Vetsulin, he had to have some type of insulin made from pork because he didn't get any bg control from anything else.

Neither of us were prepared for the big changes going to pork NPH meant for Lucky. No matter how high his bg's were running before we got to the insulin that controlled them, he was always very active and had no neuropathy.

Switching to the pork NPH meant that he needed to use 1 1/2 units more insulin each day to keep his bg's under control.

He went from normal activity and no neuropathy to sleeping most of the time and having neuropathy during the little more than two months he was using pork NPH.

About the time we were faced with a question we were hoping to avoid--it appeared that he was going to need more pork NPH to keep his bg's under control, we got the Caninsulin/Vetsulin and switched him back to pork Lente.

When Lucky regulated on pork Lente, either Lilly's or Intervet's, after you found his maintenance dose, we didn't need to do insulin adjustments at all.

Neither of us had ever seen a dog who "hated" that suspension so much, he literally grew his second coat of the winter to be totally rid of it. :) What he shed was a thin, dry, lifeless winter coat and what replaced it was his normal, thick, healthy and shiny winter one.

His eyes stopped being always irritated and watery--the neuropathy disappeared and his legs were back to normal--he became happy and active once more.

Both of us, one being a vet, know what we saw with Lucky regarding radical changes for the worse after going on pork NPH insulin. And both of us know the happiness and joy we both felt when Lucky was once more well, having gotten his pork Lente once again.

Kathy

Soaphie & Sydney's Mom
12-31-2008, 04:41 AM
Anyone had a dog with a stye on their eye? Soaphie was diagnosed with dry eye a little over a month ago and is on a few medications for the condition.

She rubs her eyes at certain times of the day (in the morning before we get out of bed and before I can put meds in her eyes) and of course she probably rubs them some when we aren't here. Once we get the various drops put in her eyes, the rubbing stops.

Now a stye has developed on her upper right eyelid. Anyone have any experience with this? Will it just go away or burst? I put a warm compress on it this morning and will continue to do so throughout the day as I'm working from home today...

Thanks!

Tami

Ginny Dudek
12-31-2008, 07:35 AM
Sounds like you're doing all the right stuff. Warm compresses sounds soothing, and will promote healing.
Ginny

k9diabetes
12-31-2008, 02:21 PM
I haven't dealt with a sty, sounds like you're doing well with that since Ginny, who is a nurse, approves! :)

What is she taking for dry eye?

Natalie

k9diabetes
12-31-2008, 02:56 PM
How is Soaphie now that she's back on Vetsulin?

Soaphie & Sydney's Mom
12-31-2008, 03:57 PM
Thanks for asking.

Here are a couple BG readings - no full curve - won't do that for a little while until she adjusts again:

12/29 6:45 a.m. before eating = 334
12/29 5:45 p.m. before eating = 275 = extremely playful tonight - bouncing around, playing with her toys, chewing her bones - so nice to see this.
12/30 - no testing and switched to 13/12 (from 12/12)
12/31 1:13 p.m. 287
12/31 5:20 p.m. (about 1 hour before feeding and 2 hours after playing in the fresh snow) = 183

General demeanor has been great!

Sty has developed on her right eye - using warm compresses and continuing her dry eye medication.

She was just outside about 10 minutes ago and I thought I saw her pee in two different places so I'm HOPING AND PRAYING AND CROSSING EVERY FINGER AND TOE that she doesn't have or iisn't developing a UTI. We need to catch a break here.... I hope I wasn't seeing right as it is dark and there are tons of shadows etc. :)

eyelostit
12-31-2008, 05:54 PM
I hope things get better for you, the 183 was good and it was almost time to eat again, just check her like you have been, its just gonna take a few days, ya I know, I'm goin thru the diet & insulin change and some other things now. Maybe the cyst will open a bit and start to drain, I think thats what they do, my dogs always got the warts but they never seemed to affect them.

Hoping we have a better year !! ;)

k9diabetes
01-01-2009, 09:30 AM
Those numbers look great! Nice and level and even the playing in the snow didn't take her down too far. Glad to see things settling down.

Natalie

Soaphie & Sydney's Mom
01-01-2009, 07:11 PM
I'm at a total loss here.

I tested Soaphie's blood 3.5 hours after eating dinner (3.5 hours after getting her shot 12 units Vetsulin).

She was at 46! My husband and I re-tested her and it was 52!

Why can't I get this figured out! This is much lower dose and you can see the other numbers I posted form the last couple days.

We tried the NPH only to have a horrible reaction (lethargy - see prior posts).

My God. I just don't know what to do.

We Hope
01-01-2009, 07:35 PM
What I am wondering here is whether Soaphie may not have some beta cells in her pancreas which are still able to function but only work sporadically.

If this is so, they don't put out insulin on a regular basis but do every so often. When they do, the insulin Soaphie's getting via injection and whatever the beta cells might be creating put together equal too much insulin.

I'm going to suggest a consult with an ACVIM Internal Medicine specialist in your area. You can arrange for this without needing to be referred.

http://www.acvim.org/Specialist/Search.aspx

On the Species drop down menu, select Small Animal--Large Animals are considered to be cows, etc. Then select your state from the State drop down menu.

From everything you've posted, you seem to be doing everything right. Things go along smoothly for a bit and then Soaphie hits an unexpected low. I think seeing a specialist to find out what's causing this is the way you need to go at this point to get to the bottom of these sudden lows.

Please keep us posted!

Kathy

Soaphie & Sydney's Mom
01-01-2009, 07:37 PM
Thanks! I was actually in the process of doing this as well.....there are two in the area - one that is here full time and one that is here part time. I'm calling tomorrow. This has to be figured out. :(

Thanks for responding!

eyelostit
01-01-2009, 10:32 PM
Tami, I hope you are OK, I know how worried you must be, Kathy could be right about the pancreas, I wish there was something I could do to help you.

I'll be anxious to hear what the specialist said, there gotta be an answer.

I'm at a loss for words as I am dumbfounded as how this could be happening.

I hope you can get some rest, tho I know you will be watching Soaphie tonite.

I tried to message you here but you must add me to your allowed list. I'll be up for awhile.

Soaphie & Sydney's Mom
01-02-2009, 03:45 AM
This morning she was at 338. She slept fine - no pacing, no hitting me with her paws to get up (she's done this in the past when she's gone low in the middle of the night - smart gal).

I will be calling the internist today to see if they can help me. Something else has to be going on.

Thank you all for caring!!!

Tami

Ricksma
01-02-2009, 04:40 AM
Tami...we are hoping that you can get this figured out, so you can stop being on pins and needles all the time. Soaphie....knock it off, you are scaring your mom....lol..we are keeping good thoughts going from our house to you.

Love and hugs, Teresa and Ricky

k9diabetes
01-02-2009, 10:26 AM
Hi Tami,

I may have the information in the Excel file you sent me - will take a look later... is this when Soaphie typically goes low on Vetsulin?

Could be the faster acting component of Vetsulin is just too much for her if there is a pattern to the lows being more or less at the same time.

In which case a quick acting snack - even some pure glucose - could be given a couple hours after injection.

Looking for patterns will help you best sort out what the issue is. If the drops occur at all different times in the 12-hour injection cycle, something like insulin from the pancreas is more likely. But...

Exercise, unless it's always about the same amount at the same time of day, will be a complicating factor as it could induce a drop in BG by itself and likely will muddy the picture.

It might help, if you can, to spend a week on a restricted activity schedule with a reduction in the Vetsulin and look for trends under as few variables as possible to sort out whether the 30% semilente is acting too quickly or if there's something else going on.

Natalie

Soaphie & Sydney's Mom
01-02-2009, 10:37 AM
I'm suspecting a potential overlap.

Here are her readings from today:

6:22 a.m. = 338
11:09 a.m. 208 (she had a snack at 8:30 a.m.)
1:30 p.m. = 151

I was thinking I test again at 3:30 and probably 6:00ish before she eats again.....but maybe I should just keep testing until she starts to come back up and if that happens to be at 6:00 - that's great - but if it's 8:00 tonight, then I could see the overlap....thoughts?

k9diabetes
01-02-2009, 10:47 AM
If you can, test her frequently until she reverses the drop and starts to climb. That would be good information - the snack does color things a bit as there might be food released in the next few hours.

I take it she ate breakfast at 6:30.

Did you take her BG at 8:30 when you gave her the snack?

Natalie

k9diabetes
01-02-2009, 10:54 AM
Ideally, to check for overlap, you would need to do a detailed curve without any snacks between meals and no exercise, run for 24 hours or more. And no low the night before.

It can be very difficult to distinguish overlap from too sharp a drop from the semi-lente insulin. And you really can't do it today because of the low last night and the food given in response - that skews everything.

If you had overlap, I'd expect to see a low fasting blood sugar that gets even lower during the first four to six hours after injection with another dose.

That isn't what you had yesterday so I'm personally leaning more toward too strong a response to the semilente portion of the insulin. But I haven't had a chance to look at your Excel file and probably won't until later today.

It's difficult to methodically test when things are unstable. I'd cut her insulin back to 11 units and see if you can get her BG completely out of lows - forget about the high numbers for now. Once she's been in a stable place for five days or so, you could do a very detailed 24-36 hour curve with no exercise or intervening snacks and get a clean snapshot of what she's doing.

Natalie

Soaphie & Sydney's Mom
01-02-2009, 11:02 AM
Natalie - do you think 11/11 in other words - for both injections? Thanks.

k9diabetes
01-02-2009, 11:07 AM
Yes.

She might run high on that but I want to see the lows completely gone.

They set off all the counter regulatory system responses and then glucose or food is given, as it should be, to counteract them so you don't have a clean slate to work with - can't tell who's doing what to who! :)

Until she never goes low for five or six days, your BG tests help you monitor her for safety but they don't tell you much more than that.

Natalie

Soaphie & Sydney's Mom
01-02-2009, 11:10 AM
Great - that's what we'll do. Thank you!!!!

k9diabetes
01-02-2009, 11:16 AM
If she still goes low (below 80, say, cuz at that level there's the possibility she will go lower still later), even on 11 units, drop it another unit until the lows disappear.

Soaphie & Sydney's Mom
01-02-2009, 02:57 PM
Here's another question for you....we feed Soapher then give her the insulin right away....should we be waiting?

k9diabetes
01-02-2009, 04:01 PM
I would leave everything as is for now until you can eliminate some variables. Then do some testing to see what her response is under stable conditions.

There are times when waiting helps but I don't think you have enough information on what's happening with her blood sugar yet to know if it would help. She might drop really really hard after injection if you waited very long.

Her readings today reflect a hypo yesterday and glucose and snacks yesterday and a snack today so I really can't say much of anything about her insulin use from today's numbers. If you identify the point at which her BG starts rising, that will give you some idea of where the nadir is, tho it's still skewed by the snacks and what was perhaps an artificially high number this morning.

There are times when some people have actually - and I'm NOT recommending you do this, just mentioning it as an illustration - done a foodless curve so they could see the profile of the insulin alone to gauge exactly how quickly the insulin starts to lower the blood sugar and when it gives out when there is no food to go along with it - working on basal glucose levels only and a reduced number of units of insulin.

Because even when the only variables are food and insulin, it's hard to know how much of each is contributing to a particular blood glucose curve.

Say her BG is 330 now.

Is that because the insulin has been mostly used up and so no longer affects the basal blood glucose?

Or is it that she digests her food very slowly so she got a big jolt of glucose late in the day and there was insulin still around but it was not enough to handle the glut of glucose from a slow digestive process?

There's no way to know which it is or even whether it's a bit of both.

Any snapshot of blood glucose reflects both food digestion and insulin absorption and it's difficult to tease them out.

Anyway... all of this, to me, is kind of academic until she's stabilized on food and insulin every 12 hours with no lows and snacks.

Natalie

Soaphie & Sydney's Mom
01-02-2009, 04:43 PM
Natalie - again thank you for all of the "mind dumps" you have provide to me - truly invaluable...

here is her BG's today:

6:22 a.m. = 338
8:30 a.m. snack
11:09 a.m. = 208
1:30 p.m. 151
6:15 p.m. = 275
7:40 p.m. = 177 (wow - 1 hour after eating - is this "normal" per se?)
8:30 p.m. snack
10:00 p.m. = 177
snack again before bed

Breakfast / shot at 6:30 a.m.
Snack at 8:30 a.m.
Dinner/shot at 6:30 p.m.

The reason we give her a snack at 8:30 a.m. is this is when my husband leaves for work and we started doing this to cover some of the insulin. This, right now, is a normal part of our routine (for fear of hypo's during the day when we are at work). Same goes for night time - snack before bed to cover insulin for fear of hypo's.

Thoughts on the BG's above?

Tami

eyelostit
01-02-2009, 10:37 PM
Hi Tami

6:22 a.m. = 338
8:30 a.m. snack
11:09 a.m. = 208
1:30 p.m. 151
6:15 p.m. = 275
7:40 p.m. = 177 (wow - 1 hour after eating - is this "normal" per se?)
8:30 p.m. snack
10:00 p.m. = 177
snack again before bed

I think some of the vetsulin is still working, from what I have learned it has two peaks, but you are not seeing those lows, thats good.

See how its goes tommorrow, and if you get any lows decrease the insulin as Nat had mentioned.

I'm so glad you did not get any of those lows, it just takes awhile for her system to settle down and for the new dose to take effect, I think you will see some different results next few days.

I'm glad this was a better day for you :) No hits from the paws.;)

BestBuddy
01-03-2009, 02:43 AM
Hi Tami,

As I have mentioned before Buddy was on Caninsulin and did well for 4 years. Caninsulin has been available in Australia since 1988 and it is the only insulin vets seem to start with. Buddy was dx in 2002 and the flyer given to me by the vet (I assume from the manufacturers) said strictly no food between the 12 hour feeding and injections. I followed this religiously and it worked for us but I have noticed that those instructions are now not on the website so things have changed.

We used canned WD and then changed to Science Diet Light so obviously both those foods matched the insulin and Buddy. You are going through the hardest part at the moment trying to find the insulin, dose and food that will work so just hang in there because once you can get those variables worked out it gets so much easier.

Jenny & Buddy

Soaphie & Sydney's Mom
01-06-2009, 12:23 PM
I'm in the process of doing a curve on Soaphie today....this is on 11 units a.m. and 11 units p.m. per our conversations last week:

Here are the readings thus far:

7:00 a.m. = 306
9:00 a.m. = 378
11:00 a.m. = 270
1:00 p.m. = 228
3:00 p.m. = 127
5:00 p.m. = to be determined
7:00 p.m. = to be determined

My question is this....if she continues to go down at 5:00 and 7:00....do I not feed her / skip her shot and monitor her at 8:00, 9:00 etc until she starts going back up again? Or feed/give shot normally but still do a couple tests at 9:00 and 11:00?

Thanks!

Tami

BestBuddy
01-06-2009, 12:42 PM
Hi Tami,
Personally I wouldn't be giving a snack, mainly because the drop is slow (so far) and the next reading at 5 would help me make a decision on what to do. If she starts to climb again at the next reading all is well but if she has dropped lower maybe a snack would be in order. Depending what the number at 7 is I would consider dropping the insulin if needed. It's so hard trying to guess what will happen and when but you are really on the right track, the curve so far seems to be smooth so all I can do is wish you luck with the next testing and fingers crossed it will be fine.
Jenny & Buddy

Soaphie & Sydney's Mom
01-06-2009, 12:45 PM
Hi there,

I haven't given a snack - just her breakfast this morning along with her insulin. I just wanted to throw out the question now in case no one was online when I get the actual readings....

I am very happy with the numbers thus far (knock on wood - knock on wood - lots of wood :)).

Thanks!
Tami

BestBuddy
01-06-2009, 01:01 PM
Hi Tami,
I think it really helps to know how food and insulin are working over the 12 hours without snacks "clouding" the picture. I know they are needed sometimes but I think you get more info and how it is all working without them. Most of the time I know how Buddy is going to react so I have my own formula on when to drop insulin or give something extra to eat but it really took a long time (years) before I work this out without panicking. You really should be proud of the way you are handling this because I am in awe of all those starting out as I was so slow to learn or even home BG test (took years). Buddy is nearing 7 years with diabetes and I certainly didn't know what you know starting out.
Jenny & Buddy

Soaphie & Sydney's Mom
01-06-2009, 02:05 PM
updated with 5:00 BG reading...

7:00 a.m. = 306
9:00 a.m. = 378
11:00 a.m. = 270
1:00 p.m. = 228
3:00 p.m. = 127
5:00 p.m. = 166
7:00 p.m. = to be determined

k9diabetes
01-06-2009, 03:01 PM
Oh good... things have turned upward. This curve will be very helpful. I like that the lowest number was above 100.

Soaphie & Sydney's Mom
01-06-2009, 04:20 PM
Update for full 12 hour curve...

7:00 a.m. = 306
9:00 a.m. = 378
11:00 a.m. = 270
1:00 p.m. = 228
3:00 p.m. = 127
5:00 p.m. = 166
7:00 p.m. = 270

k9diabetes
01-06-2009, 04:25 PM
So was this without a snack at 8:30am?

Soaphie & Sydney's Mom
01-06-2009, 04:26 PM
Nope - nothing after her breakfast this morning. nada - nothing :)

k9diabetes
01-06-2009, 04:41 PM
Breakfast / shot at 6:30 a.m.
Dinner/shot at 6:30 p.m.
______________________________

January 2nd - with snacks
6:22 a.m. = 338
8:30 a.m. snack
11:09 a.m. = 208
1:30 p.m. 151
6:15 p.m. = 275
7:40 p.m. = 177
8:30 p.m. snack
10:00 p.m. = 177
snack again before bed

January 3rd - no snack
7:00 a.m. = 306
9:00 a.m. = 378
11:00 a.m. = 270
1:00 p.m. = 228
3:00 p.m. = 127
5:00 p.m. = 166
7:00 p.m. = 270
_____________________

With this curve without the snacks, you do not have a lack of duration - the BG returned to just below it's starting point in 12 hours.

This is actually really nice... her nadir is sometime between about 7-8 hours here.

Where a small snack might be useful is around lunchtime. And I would make it a small one. Just to tide her BG through the lowest point. Too much of a snack and I think you'll burn up too much insulin, resulting in higher numbers when the BG starts to rise again.

In fact, rather than "adding" a snack, you might deduct it from her meal so that she gets slightly less food in the morning and gets the rest of it at lunch time. Because right now in terms of calories you have a pretty good match to the insulin. Adding more food would potentially shove the insulin over into lack of duration.

It's a lot easier to make minute adjustments in food than it is in insulin.

I would stay at 11/11 obviously since the lows are down into the low hundreds. Maybe try a small snack at lunchtime if you want/can. And then reassess things in 3-5 days.

It's good at a point like this to be patient and allow the body to adjust to a stable blood sugar situation. Sometimes that stability changes things when they have been unstable for a long time. Plus with Soaphie's tendency to wobble in terms of the overall level of her blood sugar, you need to see if this is her "low wobble" or her "high wobble". Ideally it's somewhere in between.

Nicely done Tami!

Natalie

Soaphie & Sydney's Mom
01-06-2009, 04:46 PM
Thank you!

I am pretty excited about these numbers.

I plan on testing her one or two more times this evening to see where she's at...

Giving a snack at lunch time will be difficult as both my husband and I work....BUT - on days we can get home, we will adjust her breakfast and give her a snack.



Thanks again!

Soaphie & Sydney's Mom
01-06-2009, 05:23 PM
7:00 a.m. = 306
9:00 a.m. = 378
11:00 a.m. = 270
1:00 p.m. = 228
3:00 p.m. = 127
5:00 p.m. = 166
7:00 p.m. = 270
8:15 p.m. = 196

k9diabetes
01-06-2009, 05:38 PM
I don't think you need to give a snack as long as the insulin dose keeps her out of hypoglycemic range.

Especially right now while you're observing her food and insulin trends. How about seeing if she can just go without it.

If that snack is a ritual for them and it means a lot to her and/or him, I think you could still give the 8:30 snack, just keep it small and deduct it from breakfast.

Soaphie & Sydney's Mom
01-06-2009, 07:12 PM
7:00 a.m. = 306
9:00 a.m. = 378
11:00 a.m. = 270
1:00 p.m. = 228
3:00 p.m. = 127
5:00 p.m. = 166
7:00 p.m. = 270
8:15 p.m. = 196
10:00 p.m. = 184

I'll be giving a snack tonight as she didn't "rise" after eating like she did this morning...

eyelostit
01-06-2009, 09:59 PM
Good Job !! ;)

peggy0
01-08-2009, 06:28 AM
Are you giving Sophie brown or white rice with her wellness?

Soaphie & Sydney's Mom
01-08-2009, 07:03 AM
Brown rice

Soaphie & Sydney's Mom
01-08-2009, 04:10 PM
I did a random BG on Soaphie this evening....69, 11 hours after her shot. I fed her, then re-tested 45 minutes later....126, gave her a little more food and her 11 units.

I just wanted to confirm my "methodology"...once I got her above 100 I felt better about giving her a shot - then just gave her a little extra food. I'll test again before bed...

Tami

eyelostit
01-08-2009, 04:21 PM
Yep, what you are doing is correct, how much extra food? I just want to make sure we will cover any low.

Soaphie & Sydney's Mom
01-08-2009, 05:08 PM
1/2 cup.....I'll test her before bed and probably give her a snack at that time. Right now she's snoozing.

k9diabetes
01-08-2009, 09:13 PM
It really does make me wonder if Soaphie might still be producing some insulin...

The other possibility is that she's broken through some insulin resistance from long-term high blood sugar so now needs less insulin to get the same effect. Looks like you could down to 10.5 units.

Soaphie & Sydney's Mom
01-09-2009, 05:40 AM
It's just so bizarre. This morning she was 320 - but I had given her extra food.

peggy0
01-09-2009, 05:59 AM
Isn't this just a fun puzzle to solve :)

eyelostit
01-09-2009, 08:52 PM
Soaphies mom, did you try the 10.5 units today? I'm wondering what BG readings you got today.

Soaphie & Sydney's Mom
01-09-2009, 08:53 PM
Here are her readings from today:

7:00 a.m. = 320
2:48 p.m. = 142
4:34 p.m. = 138 (gave her 2 baby carrots right after this reading)
6:30 p.m. = 230 then fed her / gave shot
7:51 p.m. = 136 (the gave her 1/2 cup food + some brown rice)
11:51 p.m. = 99 (gave her 1/2 cup brown rice)

Wow.

I'm thinking I will be dropping her to 10.5 units twice a day starting tomorrow. Seems like I'm managing her too much with food.

Thoughts?

Tami

eyelostit
01-09-2009, 09:01 PM
7:00 a.m. = 320
2:48 p.m. = 142
4:34 p.m. = 138 (gave her 2 baby carrots right after this reading)
6:30 p.m. = 230 then fed her / gave shot
7:51 p.m. = 136 (the gave her 1/2 cup food + some brown rice)
11:51 p.m. = 99 (gave her 1/2 cup brown rice)

Ok, i wanted to see all of her food: Wellness Venison&Rice 1.5 C w/ 1/2 C rice
Do you think you can start to add some vegetables to her diet? These will stay in her system longer and prevent some lows you are seeing and also that high of 320.
I don't know the carb content in the food as the labels never show it, with Niki the dogfood get digested faster than vegetables.

See what you get for BG in AM, I am thinking you need to add some green vegetables at this time, I use the NPH insulin and my curves would look different than yours, with Niki being so hard to regulate in the beginning, only thing that helped was adding the vegetables, this helps alot with the lows and the highs being they take longer to digest. It would not hurt to try this, green beans or brocolli, I buy frozen thaw it to semi frozen and chop it up, and give Niki 1/2 c of this with her food.

for now I'd do the 10.5 units also, hang in there, you are almost there.;)

Soaphie & Sydney's Mom
01-09-2009, 09:29 PM
Thank you!!!! We are "almost there" it appears...we'll see.

On the list of items that Soapher is allergic to is green pea....without thinking, about a month ago, I tried giving her green beans as a snack, within a day she was licking etc - all the signs of when she is allergic to something. Pumpkin - same thing - I thought it was ok with her - but then she started licking her behind. Any other ideas on veggies that I could add that could help her?

Has any added Fiber Sure to their dogs food? Would that help?

Thanks again -

Tami

Soaphie & Sydney's Mom
01-09-2009, 09:30 PM
Oh - one more thing - I have the nutritional make up of the Venison and Rice - I'll post it tomorrow morning....

eyelostit
01-09-2009, 09:30 PM
Oh, I do the whole bag of the veggies, and have the rest for for a few day, I didn't want you think to have to chop vegetables every night.:rolleyes:

eyelostit
01-09-2009, 09:31 PM
Ok, post tommorrow, don't worry about any highs right now, i think the veg's may help alot.:)

eyelostit
01-09-2009, 09:33 PM
Your mean she is licking all over or urine area?

eyelostit
01-09-2009, 09:37 PM
Other Veg's
Brocolli, Zucchini, Squash (not the butternut), celery, gr. peppers.

I never used the gr. peppers as they give me indigestion, so in my mind i think NIki will get it, LOL

I think Nat has a list of low carb veg's
The green peas, you would not want as to the sugar in them

eyelostit
01-09-2009, 09:39 PM
sorry, she is just licking her behind? but adding the carrot no problems correct?

BestBuddy
01-09-2009, 10:54 PM
I'm sure Buddy thinks he is too manly to eat vegies.;) We use Benfiber and although I have no evidence it seems to even out his BG. I just sprinkle a teaspoon on his food and he doesn't even know it is there.:D
Jenny & Buddy

Soaphie & Sydney's Mom
01-10-2009, 05:12 AM
The Wellness Venison & Rice contains 13.71% fat, 23.00% protein and 48.20% carbohydrates.

When her allergies kick in she licks a combination of her butt and urine area.

When people talk about the bottom part of the insulin bottle - I can't remember - do they say "weaker" or "stronger"? We are at the bottom 1/4 of the bottle right now.

Here are a couple more BG readings:

2:20 a.m. = 216
7:40 a.m. = 302

I have her 10.5 units this morning.

Thanks for the list of veggie possibilities and the benefiber suggestion!

Tami

We Hope
01-10-2009, 06:38 AM
Tami,

If the insulin is being re-suspended properly before you draw from the vial, it should still be in the right fractions--70% ultralente and 30% semilente.

With a "cloudy" insulin (Lente and NPH), if you don't re-mix it properly, you'll get more suspension and other excipients, rather than enough of the insulin (the white stuff you see in insulin vials is the insulin itself).

Some of what else is in an insulin vial is purified water, so not remixing insulin well can mean there's too much water and not enough insulin when a shot is drawn. This means you won't get the full benefit from a shot drawn from a poorly remixed vial.

Opened insulin starts losing its potency from the time you open it--take the first draw from the vial. The other factors in keeping your opened insulin well are whether it's kept in the fridge when not being used (this extends the life of the vial) or kept outside of it at room temperature (this shortens the life of the vial). Some people do keep their insulin outside of the fridge.

http://care.diabetesjournals.org/cgi/reprint/26/9/2665.pdf

Diabetes Care-September 2003-Dr. Martin M. Grajower
How Long Should Insulin Be Used Once a Vial Is Started?

When he wrote this, you got plenty of responses from the human pharmas who make insulin--most of them pooh-poohing the idea that a vial could last more than 30 days.

http://care.diabetesjournals.org/cgi/content/full/26/9/2665?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=humalog+and+timing&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT

Diabetes Care 2003

http://care.diabetesjournals.org/cgi/content/full/27/5/1225

Diabetes Care 2004

What I always did was to write the date we took the first draw on the front of the carton. This was a reminder to me twice a day as to how long the insulin was in use, and also a help in identifying any possibly slightly lower or higher than usuals with Lucky.

Slight lows can happen when you first use the newly opened insulin--it was never anything to worry about re: going too low, but it was helpful to have it on record why we were seeing slighly lower bg levels. They never needed treatment and once the insulin wasn't so "new", we didn't see this.

I always kept the insulin in the fridge in the butter dish area. This keeps it cool, but makes sure that it's nowhere near any of the coils and so on which might accidently get it too cold or possibly freeze. Frozen insulin is good for nothing.

Kept it standing straight up in its carton--Intervet has indicated that if you have it lying on its side, it's possible that some of the insulin might stick to the rubber stopper where you take your draws from, and that means you are losing insulin to the rubber stopper.

We could use a vial of Lilly pork Lente for close to 3 months before it started losing potency; there would be 1/3-/1/4 left in the vial at that time because Lucky used a very small amount.

With Caninsulin/Vetsulin, I could keep a vial until it was gone--just short of 6 weeks.

HTH!

Kathy

Soaphie & Sydney's Mom
01-10-2009, 09:43 AM
Ok - I think I'm right on with the insulin then....we just started this vial during Christmas week, I mix it well before using (not shaking), and we keep it in the butter thing on the fridge door in an upright position still in it's box :)

Without wanting to change more than one variable at once....today I gave her 10.5 units (dropped from 11). Does anyone have thoughts on keeping her at that and doing a curve mid next week or going back to 11 units and adding fiber sure to her food? Or other thoughts?

Thank you!!!

We Hope
01-10-2009, 10:02 AM
With Soaphie having these periodic, unexplained lows, I believe I would try sticking with the 10.5 units and keep monitoring her. If you see that she's getting too high, you can always go back to the 11 units, but it would be nice if you could see what she does on the 10.5 for at least 3 days or better.

Since you monitor her regularly, I think that in itself will let you spot either trend--higher or sliding toward another low.

When you start adding fiber, this can reduce insulin needs, so I think I would hold off on that for a little longer. If you add the fiber right now, I think it would be hard to say if Soaphie does have another low, whether it was because of the fiber or too much insulin for her. Think it would confuse all of us even more. :)

When we went to the higher fiber W/D canned with Lucky, we hadn't changed the insulin as yet. So when he started having a lot less drinking and urinating, we knew it was due to the higher fiber in that W/D rather than an insulin he had been getting in resistance doses and was not doing anything about controlling his bg's. Basically, the insulin wasn't doing anything to make this happen, the W/D was.

We made sure that there could not be any possibility of his having a hypo and reduced the insulin dose. Kept everything like that until we got the Iletin II Lente from the pharmacy's order of it. Had we changed them both at the same time, I'm sure he would have had the only hypo of his life.

The added fiber has a tendency to reduce insulin needs, no matter what insulin you're using. The little one who'd been switched to the W/D canned and who had a hypo from it, was well-regulated on human NPH when it happened; Lucky was still waiting for regulation.

I wish Soaphie could talk--it might make this easier! :D

Kathy

k9diabetes
01-10-2009, 11:21 AM
I too would stay at 10.5 units (or drop more as needed) and not change anything else. Stay at whatever dose brings NO low blood sugar and no need to give her additional food to bring the blood sugar up - the dose that she gets 2 meals and injections and only a scheduled snack and her blood sugar never goes too low.

Whatever dose that is, stay at that dose for a week to give Soaphie time to "wobble" so you know that even on a low day she's not going too low and for her to be on a stable, low-free regimen for a whole week and then we can evaluate her curve and see what you've got at that point. That will be a "genuine" curve - without any other influences from lows or extra food given for lows and will have been in place a while so she can adjust to that.

Not that one curve will ever tell Soaphie's whole story but I would be interested in it's overall shape more than the highest and lowest blood sugar levels.

If her low times occur fairly predictably, you could test fewer times per day while working this out. I don't want her to be too much of a pin cushion!

This does take time but it's worth it.

Natalie

eyelostit
01-11-2009, 01:50 PM
Just checking in on Soaphie :)

Soaphie & Sydney's Mom
01-11-2009, 02:29 PM
Hi there,

Last night at dinner time she was at 210....three hours later 115, gave her some rice and 2 baby carrots (knowing she'd be going lower and knowing it was bed time...). At 11:20 p.m. tested her again and she was at 99. Gave her 1/2 cup dog food and went to bed. This morning she was at 271. Gave her 10 units this morning and no snacks. I'll test her again tonight before dinner. I'm hoping hoping hoping that she has a good number at dinner time - not to high, not to low....poor thing. She's a little pin cushion (hence the reason why I didn't test her over and over throughout the day today).

One item - last night she was MANIC - every time I moved - she would jump up and try to get me into the kitchen to give her more food. We went to bed and after 10 minutes.....almost sleeping - she pounces and is jumping all over - again - FOOD. That's when we went downstairs, tested her and then fed her (11:20 p.m.)

I thought dogs just got super hungry when their blood suger was high? This was totally annoying last night.

Any thoughts on this?

Thank you!!!!

tami

k9diabetes
01-11-2009, 02:35 PM
I think she's experimenting to see what works! :) This seems to work!

Soaphie & Sydney's Mom
01-11-2009, 04:06 PM
I know! She's a smart one and I fell for it - mostly out of frustration. I know I shouldn't cave - hence the testing of her blood....when I saw it was 99, I figured she should eat. She then immediately fell asleep and looked like the angel dog that I know and love so much (not the devil dog that was on a mission for food).

Before feeding tonight she was 251...

Soaphie & Sydney's Mom
01-15-2009, 05:54 PM
Went to the canine opthamologist for what I thought was a stye on Soaphie's eye. The vet isn't certain, but the course of treatment we are taking is animax ointment and rimadyl pills - thinking it's an infection. I need to contact the vet on Tuesday and let her know how Soaphie's doing. If her eye isn't improving, they will do a biopsy to see if it's a mast cell tumor.

It will never end....

I was planning on doing a curve on her this weekend since we switched to 10 units BID and wanted to check her progress. I'm guessing that I shouldn't bother since she's on the additional meds? The canine opthamologist seemed to think that the meds should affect her, but said it wouldn't hurt to wait.

Thoughts?

peggy0
01-16-2009, 04:42 AM
i'd be careful of the rimadyl. It can cause vomiting and diarrhea. Did he give that to her for pain? I never heard of using rimadyl for anything but arthritis. I'd stick with the ointment.

Soaphie & Sydney's Mom
01-16-2009, 08:10 AM
She said in case there was an internal infection as well - Rimadyl should help with it.

Ugh.

k9diabetes
01-16-2009, 09:40 AM
It is an NSAID I believe so it would be anti-inflammatory... still, I'm not sure I would give it for this type of problem.

Some dogs do fine with it, some have problems. You should know pretty quickly if it's a problem. I was gonna say "watch her carefully" but that goes without saying!

Natalie

Soaphie & Sydney's Mom
01-16-2009, 10:29 AM
So far so good, she's had two pills so far (one last night and one this morning). Last night she slept like a log as she spent the day in the office with me - she was SSSOOOOOO TIRED.

Thoughts on doing a curve while on this medicine?

eyelostit
01-16-2009, 12:34 PM
Can't help you there with the rimadyl and a curve:o, my Chief (not diabetic) took rimadyl for his hips it helped, then we went to meloxicam.

k9diabetes
01-16-2009, 02:29 PM
I wouldn't expect it to have much effect on a curve. As an anti-inflammatory, it is possible that it could reduce the blood sugar as any kind of inflammation tends to raise blood sugar.

I meant to say earlier that if you're getting any readings on 10 units that cause you to feed to stave off potential lows, then the insulin dose is still too high to accomplish what you're aiming for, which is no corrections with food and all numbers 100 and above.

She dipped just under 100 the other night even with an additional snack so I that tells me that the insulin should be reduced further. To get to the point where that fear of a low doesn't happen. That will give you a set point of insulin that's a safe amount.

I think I'd drop her insulin to 9 units in hopes that 9 units is a small enough dose to eliminate potential lows. Once you've gone a whole week with no intervention food, I'd say you've found that set point.

Ideally the other night was her low wobble but I don't think we can say that for sure yet. Especially with an infection potentially present and antibiotics therefore potentially dropping her need for insulin still further.

Natalie

Soaphie & Sydney's Mom
01-16-2009, 02:53 PM
hhhmmmm - I think the post you saw that was below 100 was on 10.5 units which was on 1/10/09....on 1/11/09 I switched her to 10 units and have been doing random draws since then (not too many - just a few spot checks - nothing low).

I'll try a curve tomorrow and see how she's doing.

Thanks!

Tami

k9diabetes
01-16-2009, 03:18 PM
Oh good... that's cool.

Natalie

eyelostit
01-16-2009, 07:58 PM
Here's to a good curve Madame ;)

Soaphie & Sydney's Mom
01-17-2009, 04:52 AM
Thank you!!!!

So far she's "high"

6:00 a.m. = 416 (then was drinking some water - more than "normal")
8:00 a.m. = 397
10:00 a.m. = 406
12:00 p.m. = 407
2:40 p.m. = 290
4:20 p.m. = 316
5:45 p.m. = 250

I gave her 10.5 units tonight (up from 10).

k9diabetes
01-18-2009, 05:55 PM
I would not have increased her insulin...

This is the thing you will have to avoid - responding to higher numbers by immediately upping the amount of insulin since 10.5 units put her under 100 recently.

I'm hoping we can identify a dose at which she is NEVER too low, even on her low wobble days and let her stay at that dose for a week or more to look at what kind of variation in blood sugar levels she has on that dose.

She will inevitably have days on that dose when she is higher than you would like. But with a "wobbly" dog that sometimes is necessary and I see this as a learning period where you are taking the time to read Soaphie's "book" from first chapter to last, metaphorically, rather than skipping around and reading excerpts here and there. To sit back and watch her blood sugar over a span of time on a stable, unchanging dose of insulin.

I would be shocked, under this plan, if she didn't have high days. That would be uncharacteristic of her! ;) So I'd recommend resisting the temptation to adjust her insulin right now and just watch what happens.

There could come a point where she would have a standard dosage of insulin and then could be "corrected" with small doses of Regular insulin when her blood sugar exceeds a certain level... something like that. But we need to know more about her before any plan like that. Maybe she will wind up going high and staying high on 10 units but the only way to find out is to leave her at that dose.

I'm not saying this is the route you have to go! :) Just filling in my thinking for the reason for doing this particular regimen and what you could gain from it. I understand it's really hard to live with the higher BGs and how difficult it can be with a "wobbly" dog...

In Chris' case, he didn't do a sudden unexpected low day as Soaphie has. But his insulin needs weren't static either and we rolled through a range of about a unit and a half. His was fairly predictable.

Natalie

eyelostit
01-18-2009, 09:48 PM
Sometimes it justs takes awhile, i know how worrisome it gets with the highs, i don't like them either, but its hard on us humans to wait for results, and its been hard for me now with changing Niki's diet, I've been thru this before, but still its like starting at the beginning and finding the right dose and food etc. its nerve wracking, and Niki just looks at me :confused:

All will be OK.;)

Soaphie & Sydney's Mom
01-19-2009, 08:21 AM
Here's another question for you..... :)

Before dropping her down to 10 units BID, she was only on 10.5 for 1 day....here were her readings for that day:

1/10/2009 =
7:40 a.m. 306
6:20 p.m. 210
9:15 p.m. 115
11:21 p.m. 99

Then the next day I went to 10 units.....was it too soon to go to 10 units? Should I have given her a few days on 10.5?

Another question - thoughts on 10.5 for the morning shot, 10 units at night?

k9diabetes
01-19-2009, 08:52 AM
My concern with that 99 is that it was after additional food was given... at least that was how I understood it. So potentially it could have been a lot lower than that if you hadn't given more food.

Am I confused?

I personally would go with 10 units morning and night since that may be a dose you can stick with for a while. You only gain information if you can settle on one dose and stick with it for a week or more with no correcting food and no dose changes.

Soaphie & Sydney's Mom
01-19-2009, 10:02 AM
Thank you!

We have been on 10 units BID from the 1/11 until the evening of 1/17. Here are her random readings from that week (full curve on 1/17):

Sunday 1/11/2009 7:36 p.m. 271
Sunday 1/11/2009 6:24 p.m. 251
Sunday 1/11/2009 10:06 p.m. 193
Monday 1/12/2009 9:00 p.m. 206
Tuesday 1/13/2009 5:07 p.m. 204
Tuesday 1/13/2009 1:41 p.m. 320
Thursday 1/15/2009 1:27 p.m. 306
Saturday 1/17/2009 5:55 a.m. 416
Saturday 1/17/2009 8:00 a.m. 397
Saturday 1/17/2009 9:52 a.m. 406
Saturday 1/17/2009 11:54 a.m. 407
Saturday 1/17/2009 2:39 p.m. 290
Saturday 1/17/2009 4:20 p.m. 316

Still think 10 BID? If so - I will go back down - and try another curve in a week or so...

Thanks!

Patty
01-19-2009, 10:29 AM
Hi Tami,
Not to confuse things further, but a thought...

I've not used the U40 syringes. Are you able to guage a 1/4u on them?

Ali was on 9 3/4u for a while. I was able to consistently measure this by placing the bottom of the lip of the plunger at 10 instead of the top of the plunger. It gave me a half way point between 9 1/2 and 10 that I could consistently measure. I know some people are not comfortable measuring in between - too much guess work. Finding a reference point was key to consistent measuring for us.

If it looks like over time 10 is not enough and 10 1/2 too much, it might be something to consider. Ali is very sensitive to the slightest change and a 1/4u makes a big difference with her. I've been saying I wish the syringe companies would make 1/8u markings for us! LOL
Patty

peggy0
01-19-2009, 11:13 AM
Hi TAmi

Forbins curve was exactly like this the first 1/2 week they lowered his dosage, then it normalized. Its still too high, we're going today to see what the new one is after 10 days, but the curve went flat after a week.

k9diabetes
01-19-2009, 08:48 PM
I went back through your posts and actually... it looks to me like the 99 that you fed to correct was on 11 units of insulin, not 10.5.

Does your log confirm that?

January 2nd - with snacks - 11 units
6:22 a.m. = 338
8:30 a.m. snack
11:09 a.m. = 208
1:30 p.m. 151
6:15 p.m. = 275
7:40 p.m. = 177
8:30 p.m. snack
10:00 p.m. = 177
snack again before bed

January 3rd - no snack - 11 units
7:00 a.m. = 306
9:00 a.m. = 378
11:00 a.m. = 270
1:00 p.m. = 228
3:00 p.m. = 127
5:00 p.m. = 166
7:00 p.m. = 270

January 6th - 11 units
7:00 a.m. = 306
9:00 a.m. = 378
11:00 a.m. = 270
1:00 p.m. = 228
3:00 p.m. = 127
5:00 p.m. = 166
7:00 p.m. = 270
8:15 p.m. = 196


January 9th - 11 units
7:00 a.m. = 320
2:48 p.m. = 142
4:34 p.m. = 138 (gave her 2 baby carrots right after this reading)
6:30 p.m. = 230 then fed her / gave shot
7:51 p.m. = 136 (the gave her 1/2 cup food + some brown rice)
11:51 p.m. = 99 (gave her 1/2 cup brown rice)
2:20 a.m. = 216
7:40 a.m. = 302

"Wow. I'm thinking I will be dropping her to 10.5 units twice a day starting tomorrow."

January 17th - 10 units
6:00 a.m. = 416 (then was drinking some water - more than "normal")
8:00 a.m. = 397
10:00 a.m. = 406
12:00 p.m. = 407
2:40 p.m. = 290
4:20 p.m. = 316
5:45 p.m. = 250
_______________________

If that 99 was on 11 units, 10.5 units might be okay.

She seems to typically hit the lowest blood sugar around 3 am/pm and it's the sharpness of the drop on Vetsulin that is an important part of what we are analyzing right now.

Comparing approximate times in these curves, it seems it's not uncommon for her blood sugar to drop anywhere from 150 - 200 points between injection and nadir around 3pm - looks to usually be about 180 points (fairly consistent actually).

So assuming that it could drop 200 points, you would need the premeal reading to be at least 280.

The day it dropped to 99, she started out at only 230 at meal time. If she did her typical thing and dropped about 180 points, she'd have been down to 50 if you hadn't fed her so I think you read the trend correctly.

So, now that I think that occurred on 11 units, 10.5 units might work well.

You could change to 10.5 and monitor that for at least a week to 10 days before making any further changes unless she goes too low on that. Still want to be sure to catch the low end of the wobble on a dose to see "how low it goes."

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

Natalie

Soaphie & Sydney's Mom
01-20-2009, 12:36 PM
This does make sense - thanks for analyzing! Really appreciate it.

She did drop to 99 on 10.5 units - the day after it happened on 11 units....then she only stayed on 10.5 for one day.

I'll try 10.5 again and keep a close eye on her and see how she does for a week to 10 days.

Good news is - last week when she went for her eye appt, she gained a few pounds (sorry Dolly - I know you've been trying hard to put weight on Nikki).

eyelostit
01-22-2009, 12:03 AM
Sounds like you are just about there, you are doing great, give yourself a pat on the back.

"Good news is - last week when she went for her eye appt, she gained a few pounds (sorry Dolly - I know you've been trying hard to put weight on Nikki).

LOL we will get their eventually;)

eyelostit
01-27-2009, 04:51 PM
Hows lil Soaphie ?:)

Soaphie & Sydney's Mom
01-27-2009, 04:57 PM
Hi there!

I have been here - lurking and reading :)

Soaphie seems to be doing pretty well. I've done some random checks. I plan on a full curve tomorrow - she's been on 10.5 units twice a day since Jan. 19th. If I were to guess - I'd say we will be going 11 in the a.m. and 10.5 in the p.m.? But - that's just a guess and tomorrow will tell me the answer (along with the forum's necessary guidance) :)

She still have the issue with her eye - swollen....checked in with the vet last week (at that time I'm guessing the swelling had gone down 50%). It's still the same this week - I have a call into the vet to see next steps. Not sure if she will do a biopsy or what....guess I'll find out soon.

She seems in good spirits.

Thanks for asking!

eyelostit
01-27-2009, 05:14 PM
Glad she is doing well, Niki is on the same 10.5 units now, how much does Soaphie weigh, Niki is at 41-42 lbs, i should weigh her, but I picked her up other day to put in car (too much snow) and hurt my knee.:rolleyes:

Soaphie & Sydney's Mom
01-27-2009, 05:51 PM
She's about 64 pounds now. Her "fightin' weight" is 68 pounds....lowest weight was 48 pounds (scary!).

k9diabetes
01-27-2009, 10:07 PM
Poor girl... I'll bet she did look rugged at 48 pounds!

Soaphie & Sydney's Mom
01-28-2009, 12:41 PM
Soaphie's curve so far today:

6:43 a.m. = 185
8:55 a.m. = 317
11:00 a.m. = 290
1:00 p.m. = 283
3:10 p.m. = 121
4:10 p.m. = 124
5:00 p.m. = TBD

Soaphie & Sydney's Mom
01-29-2009, 08:11 AM
Soaphie's curve yesterday....
6:43 a.m. = 185
8:55 a.m. = 317
11:00 a.m. = 290
1:00 p.m. = 283
3:10 p.m. = 121
4:10 p.m. = 124
5:20 p.m. = 147

peggy0
01-29-2009, 08:26 AM
nice curve mam:)

Cara's Mom
01-29-2009, 08:59 AM
Nice curve:)
Doing excellent job! Keep it up, Mom!

We Hope
01-29-2009, 09:15 AM
Since everything looks so good here, tell Soaphie to keep "printing out" ones just like this! :)

Kathy

k9diabetes
01-29-2009, 10:05 PM
That is beautiful!!! Congratulations! :)

Soaphie & Sydney's Mom
01-30-2009, 07:38 AM
THANK YOU!!!!! It's nice to see her rolling around on her back and throwing her toys in the air.

She goes next Tuesday for a biopsy of that bump on her right eyelid....fingers crossed....

eyelostit
01-30-2009, 09:35 PM
Beautiful curve !!:)

BaileyBear
01-30-2009, 09:58 PM
Congratulations on the nice curve! :D

I hope Soaphie's bump turns out to be nothing more than, well...just a bump. :)

pgcor
01-31-2009, 09:02 AM
Wow! How wonderful - Soaphie's got her groove back! Congratulations!

eyelostit
02-03-2009, 02:18 PM
Guess you're at the vet today, I hope everything is ok.:)

Soaphie & Sydney's Mom
02-03-2009, 02:43 PM
Soaphie had a busy day. Was at the vet from about 11:15 - 1:45. They did a skin scrap and a punch biopsy. She has a couple stitches on her eyelid now.

Will find out in a little over a week what the results are....

Right now she's snoozing with her "patience hat" on....can't remember who called it that - but it cracks me up. Soaphie's tired... :)

We Hope
02-03-2009, 03:10 PM
Before you and Soaphie joined the board, Marion was dealing with a vet for Cara who kept telling her to "have patience" as Cara was not getting her insulin increased enough.

Somehow this evolved into whether she was wearing her "patience hat". When she decided she had no more, she switched vets and "burned" the "patience hat". :D

Hope that Soaphie will get a good report when the waiting's over!

Kathy

Patty
02-03-2009, 03:45 PM
Love the patience hat story...

Hoping Soaphie has good results from the biopsy!

eyelostit
02-03-2009, 05:51 PM
I'm afraid to ask what a Punch biopsy is !!;)

BaileyBear
02-03-2009, 09:38 PM
Ugh, waiting is always the hardest part. Hoping you & Soaphie get good news soon. :)

k9diabetes
02-04-2009, 10:33 PM
Is Soaphie feeling okay? Hope the biopsy was a tiny little bit so they didn't leave much of a wound.

The waiting is definitely the worst...

Natalie

eyelostit
02-05-2009, 06:59 PM
How's Soaphie ?:)

eyelostit
02-10-2009, 11:59 PM
Hows Soaphie? Where are you?

peggy0
02-12-2009, 03:03 PM
I'm very worried about sophie. has anyone heard anything?

k9diabetes
02-12-2009, 10:07 PM
Haven't heard a word so sent her an email to tell her we are worried....

Natalie

Soaphie & Sydney's Mom
02-13-2009, 08:36 AM
Sorry! I've been in MEXICO! :)

Annual "girls only trip" to veg on the beach. Just got home at 1:00 a.m. My husband appeared to do fine with the dogs and Soapher (and Sydney) were especially happy to see me...."FINALLY - SHE'S HOME"!!!

I'll post more later...

We Hope
02-13-2009, 08:39 AM
I'm gonna believe DH handled everything like a champ--we didn't have any "Soaphie's Dad" posts from him! :D

Kathy

eyelostit
02-17-2009, 03:06 AM
Glad to see you, was wondering where you were, its good to get away isn't it. ;)

Soaphie & Sydney's Mom
02-18-2009, 04:36 PM
The results of Soaphie's biopsy came back today (the one they did on her eyelid). Not cancer - whew. Bottom line after going through a bunch of medical jargon is that it was/is an abcess. The vet did a great job "cleaning it out" when she did the biopsy and it's looking really good right now.

KNOCK ON WOOD!

She goes in for a check of her eye(s) on Monday.

peggy0
02-18-2009, 05:01 PM
That's great news! Glad Sophie is well

eyelostit
02-19-2009, 06:05 AM
Glad to hear that, 3rd good news I've heard today ! :)

Cara's Mom
02-19-2009, 02:51 PM
Ohhh.. so good to hear that!!! I'll be "knocking-on-wood" for you and Sophie:D:D!

k9diabetes
02-20-2009, 12:55 PM
Yes! Yes! Yes! I'm so happy for you guys!!!

Natalie

BaileyBear
02-21-2009, 11:34 PM
Fantastic news!! :D

Hope you had a blast in Mexico - sounds wonderful! :D

Soaphie & Sydney's Mom
02-24-2009, 08:45 AM
Soaphie had a check-up yesterday on her eye where they took the biopsy. There were still a couple stitches left so the vet removed those. She also took a look at her eyes and her cataracts are still "immature" so that's great news. The vet (she's a canine opthamologist) said that typically once the cataracts start they quickly progress, but no so in Soaphie's case (knock on wood). The vet was so excited to see Soaphie - she said she needed a "calm dog" as all other dogs that she had appts with yesterday were wild. Soaphie just laid there :D

Soaphie is now up to 65 pounds and I'd like to keep her right here - not gain any more. I have started to trim back the dog food portion of her meals.....she was getting 1.5 cups dog food + .5 cups brown rice twice a day. A couple of days ago I reduced to 1.25 cups dog food + .5 cups brown rice twice a day....does anyone have any thoughts on this? Too much of a reduction? Too little? Insulin effect (or affect?)? I plan on doing a curve next week.

Fishslayer
02-24-2009, 09:30 AM
I avoid any sudden diet changes even in my healthy dogs. Sudden changes can upset their systems.

I'm sort of doing the same with Lucy as you are right now. She has been getting pretty huge amounts of food trying to get her weight up for her spay.

Now that she's spayed, I've backed off the higher fat dog food about an eighth cup (she was getting a full cup twice a day) while keeping the same amount of low fat food. I'll keep her there for about a week, reduce some more, etc.

With a healthy dog I would just start feeding to the target weight right away, but with Lucy that would be almost a 50% reduction! YIKES! :D And she's still a bit underweight at 31#, but looks MUCH better.

Eventually I will be feeding her the recommended amount for about a 33-35# dog.

Rick

peggy0
02-24-2009, 12:00 PM
I would not make changes until you can do a curve. 1/4 of a cup changed forbins numbers. I typically feed my dogs in between the recommended amounts so if they say 2-3 cups, I do 21/2 and see what happens. With Forbin, who had lost 8 pounds initially, I feed him at the top of the recommended and added 1/4 cup of boiled chicken and he has gained 5 pounds back.

Soaphie & Sydney's Mom
02-24-2009, 12:15 PM
Peggy - here is the curve from 1/29/09

6:43 a.m. = 185
8:55 a.m. = 317
11:00 a.m. = 290
1:00 p.m. = 283
3:10 p.m. = 121
4:10 p.m. = 124
5:20 p.m. = 147

eyelostit
02-24-2009, 12:30 PM
Hi lady,

You went down 1/4 c of the dry, I would just keep an eye on Soap's bg at the 3:10 4:10 times and in AM fast PM fast or if you want do a mini curve over the day, you may need to go down a 1/2 U with the insulin, if you are doing readings today your curve will show that. As long as you are there to keep an eye on her I think she will be ok. Her bg may show some changes today, some dogs don't.

Hope this helps:)
Dolly

peggy0
02-24-2009, 05:41 PM
I too would just be a little nervous about the 3-4 reading, given I'm at work at that time. I'd want to make sure it didn't dip it much if any :) Soaphie is really doing great! Congratulations

Soaphie & Sydney's Mom
02-25-2009, 04:20 AM
I tested her this morning and she was at 89. I did give her the reduced amount of food as outlined below, and reduced insulin to 10. I will be home this afternoon to do some testing and keeping an eye on her.

Thank you all!

Tami

Soaphie & Sydney's Mom
02-25-2009, 12:58 PM
Ok - here are some readings from today:

6:19 a.m. = 89 (reduced her to 10 units at this time vs. 10.5)
11:35 a.m. = 165
1:26 p.m. = 125
3:00 = 76
3:38 p.m. = 60 (she wasn't acting funny, but I gave her some rice, 2 baby carrots and a little bit of karo)

I'll be dropping her to 9 units tonight (pending her BG reading at dinner time).

I'm just amazed at her sensitivity to any change.

Tami

peggy0
02-25-2009, 02:15 PM
She is just like Forbin. I was shocked. It was almost like starting over trying to balance it again

Soaphie & Sydney's Mom
02-25-2009, 02:21 PM
Peggy - I don't recall....how many units of Vetsulin is Forbin on? I think it's the crazy border collie in them that makes them tough to regulate....always keeping us on our toes!
:)

Tami

peggy0
02-25-2009, 03:34 PM
He's on 18 right now. His BGs still go into the 300's at times during the day, but if i increase him above this, he gets some pretty big lows, 60s, 70s, so I'm trying to adjust his food but I'm doing it slowly just like insulin. Any change for him needs a week to sink in :) he weighs 83 pounds so its not alot

eyelostit
02-25-2009, 11:41 PM
Tami,:)

Yep its the border collie in them !!, I think it was wise to go down to 9 units and see how she settles with that after 3 + days, it takes a little time for the insulin thats in her system to work its way down some, after the 3+ days you may get a slight rise, but you're keeping a good eye on her.

With Niki she seems to digest the food very fast, I had one H of a time after dx with getting her to being regulated.:eek:

peggy0
02-27-2009, 04:57 AM
Hows sophie today?

Soaphie & Sydney's Mom
02-27-2009, 08:18 AM
Here are some readings from 2-26-09 (yesterday)...this is on 9 units:

7:07 a.m. = 146
1:57 p.m. = 84
3:00 p.m. = 76 (didn't want her to go lower, she wasn't acting funny, gave her 1/2 cup dog food and 2 baby carrots)
6:25 p.m. = 276 (gave 9 units)

Today (2/27/09) =
6:30 a.m. = 187

This morning I gave her 8 units hoping that she won't drop so much....I'll test her this afternoon.

Thanks for asking!

Tami

eyelostit
03-02-2009, 07:00 PM
Tami,

How's it going? ;)

Soaphie & Sydney's Mom
03-03-2009, 12:25 PM
I've been playing around with her dose a bit to get her on the straight and narrow (ya, right)....

Seemed like 8 units kept her in the 200's so a couple days ago I tried 8.5 and last night at fasting she was 103......2 hours later, 102. I would have expected her BG number to have risen. I was afraid that since we were going to bed within the hour she'd end up going low so I gave her 1/2 cup food. She woke me up in the middle of the night, we came downstairs, she drank a TON of water and went outside to pee - I then tested her (3:40 a.m.) and she was at 371. Yeouch. This morning I gave her 8.25 units and at 2:00 she was at 176. So that's better. I'll keep on testing! :)

eyelostit
03-03-2009, 08:03 PM
I go thru this at times, sometimes that lil 1/4 unit you can hardly see on the syringe will do the trick.

Soaphie & Sydney's Mom
03-04-2009, 08:16 AM
This post doesn't have anything to do with Soaphie....but it concerns her sister, Sydney. Sydney is an aussie mix that has been displaying what I believe to be the beginnings of arthritis...

I had an appt with the vet scheduled for Friday but she appeared worse this morning, wouldn't get up, I put a blanket over her to cover her up and under normal conditions, she wouldn't have tolerated being covered up and she just laid there. When she did get up she wouldn't put her back right leg down. I know both of her back legs are sore. She was also drinking alot of water this morning.

So we got into the vet today. They took her temp....106! I immediately burst into tears and am still crying. They told me "normal" was 101. She is staying there for the day - they are giving her fluids, taking xrays and doing blood work.

I'm a total wreck.

Patty
03-04-2009, 08:23 AM
Tami,
I'm so sorry to hear about Sydney! Will be praying her today. Keep us posted.
Patty

k9diabetes
03-04-2009, 08:26 AM
Oh Tami... I'm so sorry that Sydney is not well. We have everything here crossed for a quick recovery and will be checking in often for news. I know you are worried sick.

Natalie

Cara's Mom
03-04-2009, 09:38 AM
Tami, I am so sorry that Sydney is doing poorly! You are both in my thoughts and everything here is crossed too for speedy recovery!

Hugs,

peggy0
03-04-2009, 10:06 AM
Oh Tami

I'm so sorry. Hopefully some antibiotics will cure the fever and then they can find some answers to the arthritis. My last springer had a fever like that and it was a tooth abcess!! So try to stay positive. There is some good medicine out there for arthritis as well. My springer would not put her back leg down because she had a deposit on her hip that was rubbing every time she took a step. They got rid of it and she was much better. how old is Syd?

We Hope
03-04-2009, 10:35 AM
Tami,

Hope that Sidney will be on her way both to being better and coming home soon!

Kathy

Soaphie & Sydney's Mom
03-04-2009, 12:47 PM
Hi all,

Regarding Sydney:

The vet called me about 1:00 and said that nothing usual turned up in the blood work of the xray they did of her chest and back leg (besides the inflammation of the back leg) - no mass etc in the chest xray. At this point they had given her some rimadyl and some IV fluids but her temp wasn't coming down (106.5). They took a few other blood samples to send to another lab to test for lyme disease and an ANA test to see if it was autoimmune related (lupus possibility). They wanted me to go see a specialist. So we did.

Went to the specialist. He took another look at the xrays (both chest and leg) and noted that the inflammation in her back leg was tissue related, not joint related. He took her pulse in numerous places and said her pulse was very weak. We talked somemore and then he took her pulses a second time and confirmed again, weak pulse. He said depending on the results of the ANA and lyme test, he thinks we might end up having to see a cardiologist. She needs to stay at the vet overnight to continue fluids and have her temperature monitored throughout the night (they have overnight care thankfully). I told them she panics when in crates (frothy mouth, panting - NOT good), they said they'd keep her in an x-pen instead so I'm hopeful that is what they do with her.

Ugh.

It was so incredible sad to say good bye to her. I just hope the results of the tests come back quickly.

Thanks for listening.

k9diabetes
03-04-2009, 01:52 PM
Did they run a strip (ECG) to check her heart rhythm?

And a blood cell count was normal?

http://www.dogchannel.com/dog-health/dog-medical-conditions/fever-in-dogs.aspx

We are beaming our strongest get-well wishes to Sydney and checking back frequently!

Natalie

Soaphie & Sydney's Mom
03-04-2009, 02:46 PM
Hi Natalie,

I'm assuming under the hematology report WBC = white blood cell count....if so it was 13.49k/uL and it looks like the normal range is 5.5 to 16.9. The "regular" vet said nothing was out of whack with her blood tests....just waiting for the results of the other blood tests that were sent to another lab...

I don't think they ran a strip....(I've never heard of that term)...perhaps that's what the canine cardiologist would do?

Ugh.

Tami

Soaphie & Sydney's Mom
03-04-2009, 02:47 PM
oh - one more thing

on her blood test - her PLT was 140 which states that it is low (norm 175-500) - but I need to read up on this to see what it means....

ladysmom06
03-04-2009, 03:48 PM
Tami,

So sorry to hear about Sydney. Sending prayers and positive thoughts that she's better and home soon. Hugs to all of you.

Luv,
Lynne and Lady

Patty
03-04-2009, 03:56 PM
Tami,
Hoping they will be able to identify the problem and she will be back home soon.
Patty

We Hope
03-04-2009, 04:05 PM
Tami,

A "strip" comes from taking an electrocardiogram (EKG/ECG).

http://www.basinc.com/products/vetronics.html

PLT is platelet count:

http://home.gci.net/~divs/disease/lab_tests.html

http://home.gci.net/~divs/disease/lab_tests.html#Platelets

"Platelets (PLT) - Play an important role in blood clotting. Decrease in number occurs in bone marrow depression, autoimmune hemolytic anemia, systemic lupus, severe hemorrhage or intravascular coagulation. Increased number may occurs with fracture or blood vessel injury, or cancer."

HTH!

Kathy