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-   -   Annie & Craig - Getting too smart! (http://k9diabetes.com/forum/showthread.php?t=1637)

CraigM 09-27-2009 09:12 PM

Annie & Craig - Getting too smart!
 
Our Annie has been diabetic for about a year and I've reading this forum for about two months. Thought it was time to join and share our experiences.

Pets name: Annie
Breed: Lhasa Apso
Age: 8
Weight: 16 pounds
Diabetic since: June 2008
Insulin: Vetsulin - usually 6 units, twice a day
BG meter: AlphaTrak
Food: currently mix of 2 tablespoons of NATURE's RECIPE (Venison & rice) and 1.5 ounces (use a scale) of NATURE's RECIPE (Venison & Rice) dry. Have tried homemade and other commercial brands.

I'll add more info after I see if this post makes it.

Craig, Annie's dad

CraigM 09-27-2009 09:39 PM

Re: Annie needs help
 
OK, looks I know how to make a post, so I'll continue.

We check Annie's BG, feed and inject twice a day at 8AM & 8PM. There are periods of 4 - 5 days where she stays in what I consider a good range of 100 - 225 (TELL ME IF THIS ISN'T A GOOD GOAL!). Then there are days like yesterday and today!

9-26-09 8AM = 68
9-26-09 8PM = 465
9-27-09 8AM = 61
9-27-09 8pm = 414

I was VERY surprised with the AM readings, but she was active and seemed to be doing OK. The PM readings were about 200 higher than I expected, but again she looked to be doing fine.

As I mentioned in my earlier post, I measure her food fairly closely. We don't THINK she has been finding food on her own, but would eating a little grass (she has access to the back yard) possibly cause the PM readings?

Craig

k9diabetes 09-27-2009 10:00 PM

Re: Annie needs help
 
That looks like rebound to me. You may not have caught the lowest her blood sugar has been going. And blood sugar in the 60s would be enough to set off the counterregulatory response. I get extremely shaky when my blood sugar drops that low.

So I would reduce her insulin right away and see if that settles it all.

With such a small amount of insulin, dropping 1 unit may be enough to get all blood sugars back into a safe range.

Natalie

k9diabetes 09-27-2009 10:01 PM

Re: Annie needs help
 
Your goal is good but I do think it likely that she wobbles and somedays that regulation is too tight. You'd want her blood sugar to never go below about 90 and she has definitely dropped lower than that.

And welcome!!! :) She's adorable!

Natalie

k9diabetes 09-27-2009 10:02 PM

Re: Annie needs help
 
One more thing... those lows are in the morning. Have you ever had them in the evening? It could be only the night time dose is too high or it could be both.

CarolW 09-28-2009 12:24 AM

Re: Annie needs help
 
Craig - welcome to you and Annie. I'm glad you joined us.

Indeed, I think those numbers you show suggest the possibility of rebound, as Natalie suggested.

I notice you take readings at fasting-time - just before feeding. What about BG curves? - taking readings every couple of hours, for at least 12 hours (some do 24-hours, but I don't bother, as my dog, Kumbi, seems okay overnight).

Does your vet, or do you, at times, take curves?

I have a bunch of charts on my web site, some of which show rebound, or rebound-like, effects. If you start here, you can go through various charts by using the NEXT buttons above the main pictures on each page.

http://www.coherentdog.org/vek/bgcharts1.php

There are other charts on the web, also.

I think charts help to show what's going on, especially for visually-oriented humans! (me, for instance; haha!)

Another thought I had, though this would really take some work, is that, Annie, being fairly small at 16 pounds, might do well on NPH insulin, which has only one peak (time of most-intense working), rather than the two that Vetsulin has. The first, and heaviest, Vetsulin peak occurs so-many-hours (perhaps 4 to 6) after injection; it's the faster-acting component of Vetsuilin that does that; then a second peak comes along maybe, say, 11 to 14 hours after injection. This second peak would be a gentler one than the first. (My indication of timing is from memory, and may not be perfectly accurate; also, timing of the peaks varies with individual dogs.)

But without curve data, we can't really see anything about how BG levels are varying throughout the day (nor, of course, the night).

If you or your vet does curves fairly regularly, perhaps you could post some curve-numbers? And if not, I would certainly do a curve as soon as you conveniently can. If you do it, of course, you'd need to be home to do it! A curve, though, would help reveal whether rebound is in fact occurring.

Changing insulins is a job and a half, not to be undertaken lightly, and I wouldn't even raise the issue if Annie were going along really smoothly.

But if you think you might like to change, the aim would be to flatten the response to the insulin, between injections. Once a dog is well-stabilized on NPH insulin, too, the need for constant testing seems to be reduced, as long as there aren't other underlying conditions besides diabetes.

I always defer to the observations of Natalie and Kathy on this forum, so I'd certainly attend to what either has to say about Annie.

So many dogs (by no means all) do well on the human (NPH) insulins.

Vetsulin, or its counterpart elsewhere, Caninsulin), seems to do a really good job for a lot of dogs - but then, so does Novolin-NPH, or Humulin-NPH (or similar insulins) - for many dogs.

My Kumbi, who weighs about 20 pounds (right now, 19 pounds), does really well on Novolin-NPH, and he's been on that from the time of his diagnosis, 1 September, 2006.

Welcome! I'll be following Annie's story.

Mon, 28 Sep 2009 00:24:34 (PDT)

We Hope 09-28-2009 07:29 AM

Re: Annie needs help
 
Quote:

Originally Posted by CarolW (Post 19721)
Once a dog is well-stabilized on NPH insulin, too, the need for constant testing seems to be reduced, as long as there aren't other underlying conditions besides diabetes.

I'm not able to see how the use of NPH appears to mean that there's less need for testing. Can you provide any references?

Kathy

CarolW 09-28-2009 08:00 AM

Re: Annie needs help
 
Hi Kathy,

Thanks for catching that. It's a fairly complex consideration, according to all I read in various places - essentially, two other forums.

Quote:

Originally Posted by We Hope (Post 19725)
I'm not able to see how the use of NPH appears to mean that there's less need for testing. Can you provide any references?

Kathy

Not specifically, but in general. This comes from long series, multiple posts, on other forums; I don't remember seeing such remarks here, though they may exist.

What appears to happen with people who change from Vetsulin (or Caninsulin) to NPH insulin is that, in general, they stop feeling very concerned about that first peak that occurs with the 30% amorphous component of Vetsulin. So, where once, they might have tested halfway through the day (or 4, 6, 8, whatever, hours after injection), people who have changed seem sometimes to omit that midday test.

I notice here, practically everyone seems to learn to test BG levels at home. I think that's a great safety measure, as well as keeping stress levels down for the dog, and it also helps keep costs down.

On the other forums I frequent, or read regularly, there are numbers of people who choose not to learn to test, some who do learn, but avoid testing much, and some who work to maintain tight glycemic control, and so, test at least at fasting-time (usually that's twice a day, before dog-meals), and sometimes "midday" (estimated insulin-peak-time, especially Vetsulin's [Caninsulin's] first peak).

That's all providing there's no particular indication of conditions other than diabetes.

Mon, 28 Sep 2009 07:56:32 (PDT)

We Hope 09-28-2009 08:04 AM

Re: Annie needs help
 
Like Natalie, I also see some rebound here, which would mean an insulin reduction.

Let's look at Lente insulin, which is what Vetsulin is. Whether it's made from pork, beef or r-DNA, all Lente insulins work the same way.

Quote:

Originally Posted by We Hope (Post 3332)
Marion,

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

http://www.ncbi.nlm.nih.gov/pubmed/9...gdbfrom=pubmed

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

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

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

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

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

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

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


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

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

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

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

Kathy

So it's not a must to have two peaks from Lente; some do and some don't. My Lucky had just one at 6 hours after food and insulin.

Here's a look at the old Time Action Profiles when Lilly was still producing an r-DNA Lente insulin, Humulin L:


Note also there are two non-analog mixed insulins' Time Action profiles shown here-Humulin 70/30 (30% fast acting R insulin and 70% intermediate acting NPH insulin) and Humulin 50/50 (50% fast-acting R insulin and 50% intermediate-acting NPH insulin). Theoretically, there should be two peaks for them also--one for the fast-acting R and one for the slower-acting NPH, but we see a "smoothed out" graph for both of them and also for the Lente insulin, Humulin L.

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

"An insulin dose that is too high may bring about the Somogyi effect or rebound hyperglycemia. This is produced because blood glucose concentrations fall too rapidly. The moment that the Somogyi effect is triggered is very individual it is a life-saving response."

Years ago on another board, we had a dog who was very well-regulated on NPH insulin. However, every time his bg's approached 85 mg/dl, he would have all the symptoms of a hypo. The answer was to slightly reduce his insulin to keep him from nearing the 85 mark.

Lucky on the other hand, would be going along at 85 8-10 hours after his Caninsulin/Vetsulin shot and feeling fine.

Like Natalie, I think Annie needs the insulin reduction because the lows and highs sure look like they're rebound-related.

Kathy

We Hope 09-28-2009 08:14 AM

Re: Annie needs help
 
Quote:

Originally Posted by CarolW (Post 19727)
Hi Kathy,

Thanks for catching that. It's a fairly complex consideration, according to all I read in various places - essentially, two other forums.



Not specifically, but in general. This comes from long series, multiple posts, on other forums; I don't remember seeing such remarks here, though they may exist.

What appears to happen with people who change from Vetsulin (or Caninsulin) to NPH insulin is that, in general, they stop feeling very concerned about that first peak that occurs with the 30% amorphous component of Vetsulin. So, where once, they might have tested halfway through the day (or 4, 6, 8, whatever, hours after injection), people who have changed seem sometimes to omit that midday test.

I notice here, practically everyone seems to learn to test BG levels at home. I think that's a great safety measure, as well as keeping stress levels down for the dog, and it also helps keep costs down.

On the other forums I frequent, or read regularly, there are numbers of people who choose not to learn to test, some who do learn, but avoid testing much, and some who work to maintain tight glycemic control, and so, test at least at fasting-time (usually that's twice a day, before dog-meals), and sometimes "midday" (estimated insulin-peak-time, especially Vetsulin's [Caninsulin's] first peak).

That's all providing there's no particular indication of conditions other than diabetes.

Mon, 28 Sep 2009 07:56:32 (PDT)

Then this is strictly anecdotal.

Kathy


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