Diabetes in Dogs: The k9diabetes.com Forum

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oliversparents 09-29-2016 01:01 PM

Ollie's journey
 
Our dog Ollie was diagnosed with diabetes a month ago. He's a 66 lb lab mix. Our vet started him out on 10 units Novolin.

We wasted time with the first bottle by not handling it properly, so his blood sugar was still testing high 600's to low 700's midway between meals. Took the Alphatrak to the vet to compare with his two meters, and yes, it reads a bit high, but not so high to be defective.

Tried a new bottled of Novolin, handled properly this time, and waited a week. Still no change. Then I went online, found out by weight, his dose should have started at 15 units! Went up to 12, then 14, and today he's still testing at 702 midway between meals.

We are boosting it to 15 tonight. I am wondering if it's normal to see no incremental decrease in blood sugar as you increase the insulin? Is there a threshold or something?

It's possible that for some reason he's resistant to the Novolin. When should I try something else? How long can we keep increasing the Novolin before we know it isn't working?

He drinks and pees more than usual, is lethargic, but comfortable. Also we are 2 hrs from the nearest vet.

Thanks...we need some experienced advice. It's so frustrating not knowing what is causing the insulin to be ineffective.

CraigM 09-29-2016 01:27 PM

Re: New and needing advice
 
Welcome to the forum. Sorry to hear you are having a little trouble with Ollie.

Many of us feel .2 units per pound is a good STARTING dosage (twice a day injections). So, a 66 pounder might be started around 13 units. The key word is STARTED at 13 units. A few may do OK on the starting dose, but many (most?) will require more. Just as an example, my 18 pound dog would be started at 4 units, but she has been getting 9 units for the past several years. Every dog / situation is different.

Sounds like you are doing things right. Monitor, small increase, and then monitor for about a week before possibly another increase.

Craig

CraigM 09-29-2016 01:30 PM

Re: New and needing advice
 
Before I forget. Are you getting your Novolin-N from Walmart? Walmart sells Novolin-N for $25/bottle, MUCH less expensive than other pharmacies! Syringes are pretty low cost there also.

oliversparents 09-29-2016 02:29 PM

Re: New and needing advice
 
Craig,

Thanks for your quick reply.

Yes, we've been getting the insulin from Walmart. It's good to know that dosages can be quite a bit higher than the starting dose once they start working. I had no idea.

Would it be normal to see a gradual reduction in blood sugar as the dose increases? I am hoping he doesn't have a uti on top of things, making the insulin less effective, or non-effective. In the past few days, he's urinated on his bed while sleeping. Before that, if he had an accident, he would get up and do it somewhere away from his bed.

Plus I have a vet tech friend of a friend who says Novolin does not work. I have a hard time believing that, since it's sold as a human insulin as well. And there can be so much human error in administration (speaking from experience!).

But the hardest thing is knowing what high blood sugar can do to our little guy, and standing by helplessly trying to help with no change yet.

Mary

CraigM 09-29-2016 02:50 PM

Re: New and needing advice
 
Quote:

Originally Posted by oliversparents (Post 157485)
Craig,

Thanks for your quick reply.

Yes, we've been getting the insulin from Walmart. It's good to know that dosages can be quite a bit higher than the starting dose once they start working. I had no idea.

Would it be normal to see a gradual reduction in blood sugar as the dose increases? I am hoping he doesn't have a uti on top of things, making the insulin less effective, or non-effective. In the past few days, he's urinated on his bed while sleeping. Before that, if he had an accident, he would get up and do it somewhere away from his bed.

Plus I have a vet tech friend of a friend who says Novolin does not work. I have a hard time believing that, since it's sold as a human insulin as well. And there can be so much human error in administration (speaking from experience!).

But the hardest thing is knowing what high blood sugar can do to our little guy, and standing by helplessly trying to help with no change yet.

Mary

Uncontrolled urination is a byproduct of high blood glucose. The body tries to rid itself of glucose through the urine. Guess it can sneak up on the pup.

I can't remember if I saw a gradual lowering in numbers, it's been over 8 years. I do remember I had big swings in readings the first year or so, but things finally stabilized.

Are you feeding two similar meals per day? No, or highly restricted, between meal snacks? Any other medications?

Craig

oliversparents 09-29-2016 03:17 PM

Re: New and needing advice
 
We are feeding 2 meals, the same amount and type of dry kibble, 12 hrs apart. He doesn't get anything in between. He's a good eater, and has been lethargic enough that we are pretty sure he's not sneaking a cat poo in between meals! He's not on any other meds, and so far isn't displaying any of the other signs of a uti.

About the urine, that's good news. It was just a change from him trying to pee discreetly somewhere else when he had to at night. We've put towels down on his bed and the cleanup is actually easier that way. I'm hoping that goes away when he becomes regulated.

amydunn19 09-29-2016 05:52 PM

Re: New and needing advice
 
Vets have their bias sometimes regarding insulin. They sell vetsulin so naturally, nothing else works as good in their mind. What they don't mention is that Vetsulin was off the market for several years and dogs used human N insulin because vetsulin was not stable. Some vets really push Humulin N(same type as Novolin n) but Eli Lilly has reps that visit the vets like the doctor's offices and I guess that is where that comes from. Maggie used both Humulin and Novolin and even though I saw very little difference, I noticed two things that made me favor Novolin. For Maggie, the duration was longer - she seemed to run out of Humulin at about the 9th hour of the day, Novolin would last 11-12 hours usually for her. Also, the bottle of Novolin stayed potent for at least 30 days - my Humulin never lasted a full thirty days without her numbers creeping up. Others get more time out of their bottle and I don't know if living in a humid climate made any difference but there was something, a preservative, in Novolin that caused it to last longer for us.

jesse girl 09-29-2016 08:08 PM

Re: New and needing advice
 
Walmarts relion n insulin has saved me about $4200 in jesses 6 year run of diabetes ( thanks walmart ) . Now i don't know if vetsulin was better choice as it was coming off the market 2 weeks into jesse's diagnosis so i cant give much of an opinion but when jesse did make the change her pattern remained the same . She used both humulin and novolin she also dabbled in lantus and has used novolog and r insulin

After all that we ended with nph or n insulin and has worked well for jesse . I do think the insulin for dogs that we do have is not optimum for a dogs metabolism but its adequate for a dog to live a happy dogs life with normal lifespans

Now of coarse i would not celebrate the savings for jesse to suffer as far as less than adequate regulation . So if i thought there was something better i would probably move to that even if its more money

oliversparents 09-30-2016 09:49 AM

How fast should I increase doses to avoid ketoacidosis
 
Here's a related question regarding Ollie, who was diagnosed 1 month ago, and whom we're still trying to regulate. His blood sugar has been in the high 600's to low 700's midway between meals since diagnosis, as far as I can tell.

His keytones have increased to a trace (5). We are continuing to increase his dose of insulin (novolin n): he started at 10, and now we're at 16.

How long to wait between increases? Both vets I've spoken to say a day or two, but here I've read a week or two.

Seems like we don't have a lot of time, and the faster increases would be more prudent in this case, to avoid ketoacidosis. But I don't know.

Any thoughts?

Mary

jesse girl 09-30-2016 10:45 AM

Re: How fast should I increase doses to avoid ketoacidosis
 
that's a difficult question to answer . usually takes about a week for a dose to settle and know its true colors. some could take 2 weeks .there are times that 3 days maybe ok but to make a change every day or 2 is really pushing it When resistance is broken it can be dramatic and all of a sudden and a dogs body may not have enough sugar to slow down the strength of insulin do to building to much insulin in the body to fast

What is the weight of your pup ?

CraigM 09-30-2016 12:30 PM

Re: How fast should I increase doses to avoid ketoacidosis
 
Although giving a dose about a week to settle seems to be the general consensus, I might be a little more aggressive until I see any reading in the 300/400s. I'd then slow down once seeing any 300. Just my thought!

By the way, are you also testing just prior to meals/injection, or only around the +6 hour point? Text books might indicate the +6 hour should yield the lowest number, but MOST PUPS DONT READ THE TEXT BOOKS.;). My Annie has her lowest reading at around the +10 to +12 (just prior to the next meal). In fact, my Annie generally has her highest number around the +5 to +6 hour.

Craig

CraigM 09-30-2016 12:37 PM

Re: New and needing advice
 
I combined your threads to make it easier for folks to look at your history. Don't worry about folks not seeing any new question / comment because most of us read every new post. Generally, we like to keep one thread for each pup:)

Craig

oliversparents 09-30-2016 03:15 PM

Re: New and needing advice
 
He weighs 66 lbs, and has been losing weight. His ideal weight is more like 60.

CraigM 09-30-2016 05:57 PM

Re: New and needing advice
 
Now that you've been on the forum for awhile, would you like a moderator change the title of your thread from "new and needing advice" to something more personal? Maybe something like "Ollie the Lab Mix" or ??? Just write what you would like, and a moderator can change it for you.

Craig

oliversparents 10-01-2016 11:20 AM

Re: New and needing advice
 
Yes, please retitle the thread "Ollie's Journey".

Thanks for mentioning that about the ideal time to test. I was wondering why we don't look for the lowest point to be just prior to meals/insulin injection.

So, the testing we've been doing is 6 hrs after his morning meal.

CraigM 10-01-2016 01:37 PM

Re: Ollie's journey
 
Every pup / situation is different. A few might have their lowest number at the mid point (+6 hours), a few might get the insulin working quickly and have their lowest reading within 3-4 hours, others take longer and don't have their lowest reading until just before the next meal / injection.

I guess it's a combination of factors. How fast each pup gets the insulin working, how fast their metabolism is getting their food digested, and general activity.

For years I've given slightly more insulin with Annie's dinner because (I think) she is much less active in the evening, basically sleeping from shortly after dinner until the next breakfast! So for Annie, less activity seems to require a little more insulin. Of course every dog is different, and this is something you can test for yourself later when Ollie finally gets to better numbers.

Craig

oliversparents 10-02-2016 08:17 AM

Re: Ollie's journey
 
An update:

Yesterday Ollie tested at 592. Still real high, but finally there is some progress here. He's at 17 units now. I'll retest in a few days and see where he's at.

amydunn19 10-02-2016 09:11 AM

Re: Ollie's journey
 
Do you have other numbers from tests during the same day? One numbers can't really gauge where he is at - if you can do a few more tests during different times of the day, that might say more. You don't have to do curves but it will give you a better idea of how he is really doing in context.

oliversparents 10-05-2016 05:22 PM

Re: Ollie's journey
 
OK, we tested Ollie's blood 3 times today, here's the results:

(he gets fed at 7:30 am and 7:30 pm)

10 am: 511

2pm: 643

6pm: 568

He was getting 17 units, and we'll increase it to 18 tonight.


At least the numbers are going down. About two weeks ago, we got these:

8:30am: 720

11:00am: 676

2:00pm: 743

He also seems peppier, and went a whole night without any accidents last two nights. Any advice/comments?

Thanks,

Mary

CraigM 10-05-2016 05:54 PM

Re: Ollie's journey
 
I'd probably go for 19. Still plenty high.

oliversparents 10-10-2016 01:16 PM

Re: Ollie's journey
 
OK, Ollie tested like this yesterday (we've been giving him 19 units for a few days):

9:25 am: 671

1:15 pm: 611

6:50 pm: 539

So we increased to 21 units today. Hopefully we'll see some significant change soon.

Mary

oliversparents 10-13-2016 04:08 PM

meter advice
 
So, we are in limbo for a few days at 21 units because I am waiting for more strips in the mail. Ollie is spunky! Good to see him wagging his tail a lot and barking.

I am wondering if I should get an additional meter. Both for the less expensive strips and for an additional reading when in doubt.

My Alphatrak tested high in comparison with my vet's Alphatrak on the same blood sample. I'm thinking if we ever get Ollie's levels down, this could be dangerous. I think it was 50-100 higher than my vet's meter. Control test checks out fine.

I've just done some research, and although human meters seem to work, I guess dogs have smaller blood cells and their glucose is found more in the plasma than in human blood. This all makes human meters read lower, which was my experience at the vet...who also tested the same blood sample with a human meter.

I don't seem to be able to regularly get a decent sized drop of blood, so would prefer a meter that doesn't need much blood. Or maybe I should use a different gauge lance? I'm testing on the elbow callous and carpal pad. Can't get up the nerve to try ear or mouth yet.

Am I right in thinking that any meter reading is an approximation, and there is no way to really get an accurate number outside of a vet's office? And for the most part, this works for most dogs (and people)?

Thanks for the advice...this forum has been a godsend. Thanks for all those who maintain and contribute!

Mary

jesse girl 10-13-2016 04:30 PM

Re: Ollie's journey
 
Jesse has used a human meter for he 6.5 years being diabetic

I did do a comparison early on with a vets lab analyzer ( not another handheld ) and that particular meter read higher at the higher range and was quite close at a lower range . I dont use that meter anymore It was a bit expensive

I cant recommend jesses meter because what works for jesse may not work for others . You just have to experiment and find a meter your comfortable with . the one touch ultra has a good track record but needs a larger blood sample . I have used it and has compared well with jesses meter

High sugar tested you have to take with a grain of salt it could be off by a 100 points or more and usually i think with very high numbers with insulin given the meter maybe reading higher but thats my opinion

As long as jesse shows no symptoms of the disease and pretty much normal and her meter reads within 100 to 250 points i am very happy taking the numbers as is from her human meter

amydunn19 10-13-2016 06:24 PM

The thing with meters and getting exact numbers is this: when you use a meter, you are getting an approximation. I always felt it was much more beneficial to use that number for what it was and think of the numbers as they fell into a range. You get a feel for how your dog reacts with certain numbers. Maggie had a hypoglycemic seizure and measured in the 20's on my human meter. Luckily, she survived it but it gave me a rather definite reference point. I also learned that all meters are more accurate in lower ranges.

Blood sugar is changing constantly - if you checked it every five minutes, you would get different numbers. I had to learn that as much as it is frustrating and you try to control it, there is a limit to what you can do. You have to learn to be comfortable with a situation that you may not grasp fully. If our dogs could tell us when they felt terrible, then it would be easy. So, you just use the meter to learn tendencies and observe. I think the object is to make the connection.

oliversparents 10-16-2016 02:05 PM

Re: Ollie's journey
 
Ok, here are Ollie's numbers from yesterday (21 units):

9 am: 443

11:15 am: 481

1pm: 456

4:15: 392

It's good to see these numbers still going down. We are 2 doses away from emptying the current insulin bottle. I was thinking we should wait to increase his dose until we open a new bottle and retest. It seems the potency of the insulin can decrease in your fridge, and it's been 5 weeks or so since we opened this bottle.

So should we increase by 1 unit at this point, or continue with 2?

Thanks for the advice.

jesse girl 10-16-2016 02:33 PM

Re: Ollie's journey
 
well if you are seeing higher stable sugar within a curve raising the dose maybe prudent

sometimes you can correlate physical symptoms with dose adjustments if raising sees a more perkier feeling good kind a pup over lethargic which may point that you are going in a positive direction

oliversparents 10-23-2016 06:54 AM

Re: Ollie's journey
 
We tested Ollie again yesterday. He's at 23 units. Unfortunately, the numbers are higher than the last time:

9:45 am: 397

2:15 pm: 520

6:30 pm: 593

We'll increase another unit, but I have a few questions I hope some of you can answer.

Is there a point at which you are giving so many units that you assume the insulin is not working? I noticed the syringe only goes up to 30.

Why does his curve seem to be higher right before feeding time (7:30pm)?

He weighs about 60-65 lbs. He seems to be getting better: he's increasingly spunky, his neuropathy is decreasing (he even jumped on the bed last two days!) and his appetite is good. He's lost a lot of abdominal fat, and is even looking better.


Thanks for the help.

Mary

jesse girl 10-23-2016 07:29 AM

Re: Ollie's journey
 
A 65 pound dog could get up to 65 units if still have elevated numbers would be resistant to that insulin

Are you doing complete curves to determine dose adjustments? the numbers you posted are helpful but not complete for dose adjustments my jesse started from 500 at fasting dropped to 70 in 3 hours and back up to 500 at hour 6

so if we only tested at fasting and at hour 6 we would have continued to raise the dose and actually we would have been going in the wrong direction

If you get to 30 units that's not a huge dose . if you go past that dose then your just have to get syringes with higher capacity .

Some forum members have switched to levemir who were on large doses of other insulins with not good results . its 4 times as potent so you need allot less insulin with levemir . I dont think your at that point but its nice to have options .

glad he seems to be feeling better thats positive

oliversparents 10-23-2016 08:42 AM

Re: Ollie's journey
 
Thanks so much for that information. I had no idea doses could get that big.

So, what would be a complete curve?

Mary

tonyr 10-23-2016 08:57 AM

Re: Ollie's journey
 
Check out post 161 under Angus the Westie for an example.
Check blood before meals then every 2hrs till the next injection,
Include all times of exercise and treats if any given to give a full picture.

jesse girl 10-23-2016 09:45 AM

Re: Ollie's journey
 
Quote:

Originally Posted by oliversparents (Post 157796)
Thanks so much for that information. I had no idea doses could get that big.

So, what would be a complete curve?

Mary

yes they can but its rare and i think there are other medical issues that maybe the need for a higher dose

the key is not going past a dose thats needed if that happens it can create allot problems thats why we do complete curves and dose adjustments are based on the lowest number in that curve

Tonyr gives a good explanation of what a curve is . some even do 24 hour curves

MikeMurphy 10-23-2016 10:00 AM

Re: Ollie's journey
 
Hi Mary,

Here's another example of what a curve looks like. You test before breakfast and then every 2 hours for 12 hours, right up to dinner.

This is what many would consider to be an ideal curve...

http://www.k9diabetes.com/IdealCurve2011.jpg

amydunn19 10-23-2016 12:28 PM

He is higher right before dinner because he has likely run out of insulin. That's a guess but is typically the case. You will know more when u do a curve.

CraigM 10-23-2016 12:28 PM

Re: Ollie's journey
 
Quote:

Originally Posted by MikeMurphy (Post 157803)
Hi Mary,

Here's another example of what a curve looks like. You test before breakfast and then every 2 hours for 12 hours, right up to dinner.

This is what many would consider to be an ideal curve...

http://www.k9diabetes.com/IdealCurve2011.jpg

Keep in mind the shown curve is just one example. Curves aren't always the perfect "saucer shape" where the lowest number is at the mid-point.

My Annie's curve would CLIMB for a couple of hours after a meal and injection of Novolin-N. It would then level out, getting the HIGHEST number around the mid-point. After about 6 hours, her numbers would start to decrease (insulin finally working) and her numbers would be the lowest at, or just prior to the next meal / injection.

My thought is that a good curve would be testing about every 2-3 hours where the lowest reading is in the low-mid 100s, while the highest reading generally stays below the low-mid 200s. The actual shape of the curve can vary from situation to situation.

Craig

oliversparents 10-29-2016 11:51 AM

Re: Ollie's journey
 
An update on Ollie:

Yesterday we did a more complete curve. Note that his feeding/insulin shot time is 7:30 am and 7:30 pm. He was at 24 units. Here's the numbers, still high, unfortunately:

6:30 am: 437

9:30 am: 619

12:30 pm: 445

3:30 pm 557

6:30 pm: 497

So we increased to 25.5 units last night. Right now he is trying to eat a lot of grass outside. I haven't seen him vomit, but that's what he's trying to do. I know that's bad, maybe ketoacidosis. I will do a urine test asap. We are 2 hours away from vet, so it's not an easy decision to go or not.

We have started giving him Cranberry Relief as a preventative for uti. He doesn't appear to have any symptoms of that yet as far as I can tell (no abdominal tenderness, or discharge).

Will keep you posted, and thanks again for all the advice. He remains peppy, and weight loss has slacked off.

I forgot to mention that he rarely has urination accidents anymore, and has stopped drinking large amounts of water. AND a reminder that my monitor tested high against two others at the vet, one human, one the same model, Alphatrak.

CraigM 10-29-2016 12:56 PM

Re: Ollie's journey
 
Although we agree with small insulin increases, going from 24 to 25.5 units is a tiny 6.25% increase. Possibly a 10 to 15 percent increase would show an improvement without being too much?

Craig

oliversparents 10-29-2016 02:19 PM

Re: Ollie's journey
 
GOOD NEWS! Ollie's keytones are negative! He's acting fine as well. His urine test said his glucose was at 1+++.

Thanks Craig. I do have trouble knowing how much to increase it by. I think my husband did go ahead and do 26 units this morning, though that's not much different. I guess I'm scared of going too far. I mean, the incremental overall lowering of his blood sugar seems linear, to be progressing at a steady rate. However, I realize the decrease in blood sugar could be non-linear, and the change might come quite dramatically. I imagine it's different for every dog.

Anyway, therein lies my caution and resulting incremental dose increases. But I do appreciate the advice. So, if I did increase by 2 units or more, what kind of numbers would you then slow down at?

Also, I haven't been exercising him much at all, not even short walks. Now that his hind end is working better, what can I expect a short walk to do to his blood sugar? I would think it would increase his metabolism, and use up the insulin faster. Is that right? Or is the insulin pretty stable regardless?

Mary

CraigM 10-29-2016 03:16 PM

Re: Ollie's journey
 
Just my personal idea would be to increase by 10 to 15% until the lowest number breaks into the 200s, then make smaller changes to get into the 100s.

Craig

oliversparents 11-06-2016 07:15 AM

Re: Ollie's journey
 
Ollie is not doing so good today.

We now have him at 29 units. We did a curve yesterday, and he's still in the high 300's-400's. He actually did have a reading of 291 this week, though. Keytones are negative.

He's been having trouble with one eye lately, trying to keep it closed. It looks a little swollen. Last night he was very restless, so we let him outside to pee and then got him on the bed. He was shivering for a long time, even after we had him under a blanket. Now this morning both eyes are looking swollen and are maybe photophobic. He's not shivering anymore. He's trying to keep his eyes closed, and seems to be in discomfort.

He didn't want to eat this morning, but we did manage to entice him with an egg on top of his food. So he's had his insulin this morning.

Has anyone had a dog with this kind of eye trouble? It may not be related to the diabetes, I guess. Doing a search on photophobia, it could be anything.

Worried for him. Also...the vet is 2 hrs away, so that is why we aren't rushing to get him to a doc. He's not suffering horribly.

I never mentioned it before, but Ollie has a huge lump on his neck. Two vets have seen it. One thinks it's cancer and will eventually block off his airway. The other did not know and said we could biopsy or do surgery or both. Ollie is a lumpy dog anyway, so it could well be benign. However, the first vet thinks it's cancer because it changes size.

We have a very limited income, and I don't want to have Ollie in a stressful environment like the vet. He really turns to jello there. So I guess we're in a wait-and-see mode.

jesse girl 11-06-2016 08:21 AM

Re: Ollie's journey
 
eye complications from diabetes is not unusual and can be serious

now you have to determine if its an eye condition where there is discomfort and pain or something else

my jeeses eyes may close if blood sugar is spiking or dropping thats maybe more of a lethargic feeling causing the eyes to close

are the eyes red maybe swollen does there appear to be pain .

of course the big problem for diabetics is cataracts . they can give discomfort and can lead to other problems

probably the best thing is to get the eyes checked if unsure .


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