Mini-Me's diabetes

[alan]

Having trouble getting our recently diagnosed 80lb Lab/Pointer mix BG stabilized. After 6 weeks and 70 units total per day still showing numbers of 300AM , 450 mid PM , and 500 Late PM.
Vet wants to switch to Vetsulin but I thought this was discontinued or pulled from market.
New to this so bear with me and thanks in advance for any comments and help.
Alan

[Cebe]

Re: Humilin N vs. Vetsulin

Hi! you may want to review Decker's thread. You may want to consider a different human insulin over all, but there are other things you need to check. Thyroid especially.

[CraigM]

Re: Humilin N vs. Vetsulin

Vet wants to switch to Vetsulin but I thought this was discontinued or pulled from market.
New to this so bear with me and thanks in advance for any comments and help.
Alan

Welcome to the forum. Sorry to hear you are having problems.

I'll let others discuss the possible reasons your dosage of Humulin (Humulin-N?) isn't reducing his numbers. Here are a few questions that might help us:

What is he eating? 12 hours apart?
ANYTHING given between meals?
Any other medical conditions? Medications?
Do you home blood test?

You are correct that Vetsulin has been removed from sale in the U.S. There is/was a special program that would allow Vetsulin be provided in SPECIAL cases, but I think this program was hard to get into. Besides, Vetsulin would likely be VERY expensive for your dog. Vetsulin was a U-40 insulin, compared to Humulin-N which is a U-100 insulin. Basically this means you would inject 2.5 times more liquid, and the Vetsulin vial only contained 400 units!

Craig

[Patty]

Re: Humilin N vs. Vetsulin

Hi Alan and welcome to you!

Vetsulin has been pulled from the market in the US. There are a few exceptions like dogs that are allergic to NPH. Those pups have been getting Caninsulin imported from the UK usually.

Has your pup had a CBC and full Chem panel done recently?
Full Thyroid panel (includes more than just T4 such as those listed here: http://hemopet.org/index.php?option=...d=24&Itemid=39)
Any outward signs of Cushing's Disease, such as hair loss, pot belly?

What NPH dose was your pup started on?
Do you have any full curves (where blood sugar is measured before food/insulin then every 2 hours after until next shot time) you could post?
What is your dog currently eating?

A lot of questions but hopefully will help us better help you.
Glad to have you here,
Patty

[momofdecker]

Re: Humilin N vs. Vetsulin

Having trouble getting our recently diagnosed 80lb Lab/Pointer mix BG stabilized. After 6 weeks and 70 units total per day still showing numbers of 300AM , 450 mid PM , and 500 Late PM.
Vet wants to switch to Vetsulin but I thought this was discontinued or pulled from market.
New to this so bear with me and thanks in advance for any comments and help.
Alan

Hi Alan, welcome to you and your pup! I'm Decker's mom. Decker was around 97pounds when he was diagnosed. The day he was taken in to be regulated his blood glucose (bg) was 263 after eating. His diagnosing vet started him at 35u of humulin N insulin, presumably twice a day. The next morning his bg was 470 and the vet increased his dosage to 40u of humulin. Unfortunately, his diagnosing vet didn't recognize that by increasing Decker's dose he was further overdosing him. We were sent home with instructions to give him 40u twice a day. Having no prior experience with diabetes, my husband & I didn't know any better either so the overdosing continued for nearly six weeks before we found this forum. Folks here recommended we drop him back to 20u, which we did and found it was still too much. We then dropped him back to 15u and started over, including finding a new vet. For many reasons we were unable to regulate Decker on humulin N and in May 2012 switched to levemir insulin, which is four times as potent and doesn't have the long standing history NPH insulin does in dogs. The levemir has worked wonders for Decker but there are others on this forum that have had their share of challenges with it. You'll find that a lot of diabetes management is very dog specific and will likely hear the phrase, 'every dog is different' quite a lot around here.

A few questions for you, if you don't mind...

Did your vet run a complete blood count (CBC) on your pup at time of diagnosis? If yes, I would recommend asking for a copy and posting any values that are high or low on the CBC. If no, I would recommend that you request that a CBC be run. A CBC may help identify if anything else may be going on.

Does your pup have any other medical conditions? Are additional vitamins or other medications given?

How is your pup's weight? Was there a loss of weight prior to diagnosis? Has there been further loss as you try to obtain regulation? Is the 80 pounds a good weight for your pup?

What does your pup eat, how often is your pup fed and how much is your pup fed? Are there any challenges with eating?

How is you pup's overall mood and symptoms? Is there still a lot of drinking and urinating? Does your pup seem as active as prior to diagnosis?

Did your vet mention that exercise can impact regulation. Some dogs have drops in bg with exercise. Others, will see a rise with elevated bg. The best way to learn how exercise impacts your pup is to test bg prior to and after exercise.

Are you home testing? Or do you have a desire to learn how to home test?

Has your vet mentioned testing for ketones while the bg is elevated?

How much insulin was your pup started on and how often were increases made? Were the increases based on curves, where the bg reading is taken prior to morning food/injection and tested again ever two hours through evening feeding/injection. If you have copies of curves and are able to post them there are many experienced folks on here that could offer you feedback as to how things such as food and insulin are balancing.

There are a lot of vets that believe a dog's bg should peak around the six hour mark. Only problem is that not all dogs know that. There are many dogs on this forum that have various peaks. Some peak twice a day (known as a double hump curve). Others peak around the 12 hour mark (known as a mountain curve). Others follow the expected protocol and peak around the six hour mark (known as a bowl curve).

Probably enough questions for now. I know early on I found the whole process to be very overwhelming. I also found that I've never encountered something that could test my patience the way trying to regulate Decker did.

So please hang in there. Lots of great information on this site available. Lots of great folks on this forum available to help out. Don't hesitate to ask questions or provide long posts. Often the more information you can provide the better folks can assist.

Again, welcome to you! Holli

[Soaphie & Sydney's Mom]

Re: Humilin N vs. Vetsulin

Vetsulin isn't available in the US anymore - not even in special circumstances - that program was discontinued a while ago.

I was getting Caninsulin from Canada (and in some cases they were getting it from the UK). Right now there isn't any online pharmacy that is selling Caninsulin either - and I haven't been able to find an online UK pharmacy that sells it either. I have called vets in Canada - and they won't sell it to me unless they see the dog first. (Caninsulin is the Vetsulin equivalent outside the US).

I have about 3 months remaining in our supply - I will probably end up having to switch to levemir.

Bottom line is - you can't use Vetsulin/ Caninsulin...it's not even an option.

Tami, Soaphie and Sydney

[CarolW]

Re: Humilin N vs. Vetsulin

Tami - I am SO sorry about the complications of being on Caninsulin. Our dear, dear Soaphie. (And Sydney, I'm not forgetting you, but glad you don't need Caninsulin.)

I understand about an individual vet saying s/he won't provide Caninsulin without seeing the dog first, but this is a different situation from the normal, and I'd think professional courtesy could play a part across national borders, allowing the shipment of Caninsulin from a Canadian vet to a U.S. one.

Sheesh!

I could hope, if things get worse, that Levemir would help.

Big hugs, licks and wags to you, Miss Soaphie, and Miss Sydney.
Sat, 22 Dec 2012 14:06:41 (PST)

[alan]

Re: Humilin N vs. Vetsulin

Thank you for your response MomofDecker!

Our situation is very similar. We also believe we could be over dosing. Just today our Vet suggested we may want to switch to Levemir as Humilin N is not working.

Had recent CBC all okay except elevated ALKP which has had for several years as a result of low dose steroid treatment. T4 & T3 okay. A-Typical Cushings referred to by some as adrenal exhaustion is what requires the steroid treatment. We are aware that makes B/G level raise.

She currently is taking fish oil, CoQ-10, L-Glutamine, B-12, Ocuvite, Soloxine .4 mg twice a day, Natural Hydrocortizone 10 mg in am & 10 mg in pm.

80 to 85 pounds is ideal. Yes she lost before diagnosis & during treatment.

We feed (do not like either)W/D & I/D canned & kibble along with baked chicken breast, green beans and cottage cheese. We feed approximately 2 cups in am & same in pm. Per Vets suggestion.

Lots of drinking & peeing - not as active.

Yes we are home testing & giving insulin injections ourselves. We also home test for ketones with ketostix.

She originally started on 20 units a day on Humilin N. Now at 25/25/20 units, this afternoon the Vet suggested 30 units due to high B/G reading of 657. And he said if this doesn't work to switch to Levemir or start over giving 10 units 3 times a day.

Today is the first time we have tested for a curve; readings started at 9:00 am & have been taken every 2 hours since (345, 491, 520, 657, 615 and now is 553
at 7:00 pm).

Thank you,
Al

[jesse girl]

Re: Humilin N vs. Vetsulin

i think holli makes some very good points

it is possible overdosing maybe going on we went through that with my jesse it took 6 months just to figure where her dose might be the overdosing i believe created chronic rebounding even with the lower doses we still had problems

the 3 shots a day can be challenging in itself we do 3 shots but it took quite a bit of time to figure

levemir seems to do well in larger breeds where smaller not so good and more than likely for smaller breeds have to use such a small amount which makes it very difficult to dose for larger breeds in most cases they use a larger dose which makes them more appropriate for this type of insulin

it would give the opportunity for a reset start a lower dose and see how it goes just a thought

[momofdecker]

Re: Humilin N vs. Vetsulin

Great information, Alan. Thanks for sharing.

From what you've posted, I would recommend staying with the NPH but to consider a moving to two shots a day, 12 hours apart. One change you may want to think about is going from humulin N to novolin N. Most folks on here find that they are similar. Wal-Mart carries their "relion" version of novolin N for around $25.00. Likely a lot less than what you'd pay for humulin N.

Most folks also find that feeding and injecting 12 hours apart is the best balance for their pups. Of course, there are exceptions but that comes from those that have done lots of testing to determine what will work best for their pup.

I have to defer to some more experienced folks to comment on what the best starting dose of NPH for a 12 hour, two shot a day schedule should be for your pup. I also have to defer to the experienced folks to comment on your list of supplements/meds.

Should you decide to make the switch to levemir I would recommend two shots a day, 12 hours apart, otherwise you would risk dealing with overlap. If you go that route, I would also recommend starting conservatively and working your way up. Decker was at 37u of NPH when he was switched to levemir. We started him at 5u of levemir (equal to 20u of NPH). Given his history of overdosing combined with the potency of levemir we played things cautiously.

[Rubytuesday]

Re: Humilin N vs. Vetsulin

Hi Alan, You have gotten a lot of good info and given a lot of good info. I just wanted to add my welcome and thoughts.

Dogs are usually started at 1/4-1/2 unit per pound. So a good starting dose for him would have been 20 units, but that would have been twice daily. Why does the doctor have you giving it 3x daily? Sometimes different approaches need to be taken, but that is arrived at by studying the dog's trends through curves after starting with the usual approach.

If curves weren't done periodically before increases were made it may be hard to tell if he is being overdosed without starting over.

You have mentioned some things that may make him resistant to the insulin; the atypical cushings, the steroids, and the hypothyroidism which I assume is what he is taking the soloxine for?

For the hypothyroidism you might look at Dr Jean Dodds website as she is the go to Dr. for this condition in dogs. Where as other approaches only look at the surface of the disease she looks at the disease and the individual animal.
I wonder if your pups values could be looking okay with the standard test, but if Dr. Dodds insight and testing procedures could be beneficial.

I will have to defer to others with more experience regarding the cushings and steroid use. It has been a long time since I have had an animal on steroids and I'm not sure what a large dose would be, but 20 mg. a day dose sounds like a fair amount to me as it is such a powerful drug.

I am curious to hear more and also confused as my quick googling says that hydrocortisone at the dose you are using is used for dogs with addison's disease. I believe that is the opposite of cushings???

With the numbers you posted was the 9:00 reading before food and insulin? When was the midday shot given?

A small discrepancy in amount of food can make a difference in the numbers. A fair amount of folks weigh the food, even weighing the different componets to be sure the food value is always the same.

Again welcome!

Tara

[alan]

Re: Humilin N vs. Vetsulin

Vetsulin isn't available in the US anymore - not even in special circumstances - that program was discontinued a while ago.

I was getting Caninsulin from Canada (and in some cases they were getting it from the UK). Right not there isn't any online pharmacy that is selling Caninsulin either - and I haven't been able to find an online UK pharmacy that sells it either. I have called vets in Canada - and they won't sell it to me unless they see the dog first. (Caninsulin is the Vetsulin equivalent outside the US).

I have about 3 months remaining in our supply - I will probably end up having to switch to levemir.

Bottom line is - you can't use Vetsulin/ Caninsulin...it's not even an option.

Tami, Soaphie and Sydney

I was told by a vet at a teaching hospital that Caninsulin would be available in US in January. No details so consider it a rumor until it appears.

[alan]

Re: Humilin N vs. Vetsulin

Craig and Annie,
Yes,you are exactly right about Vetsulin.My vet says it's coming in Jan. We'll see.
We feed every 12 hrs.Chicken,green beans,and Prescription W/D canned and kibble per vet.Don't like that stuff.
She also has Atypical Cushings which some call adrenal exhaustion which is treated with small doses of steroids. I accepted this diagnosis 4 yrs ago but now I wonder as I know the steroids interfere with stabilizing the insulin.Contacting a new endocrinologist next week.
Many Thanks for response.
AL and Mini

[alan]

Re: Humilin N vs. Vetsulin

Hi Patty and Ali,
Before I respond in more detail, I note you are a moderator of site.
My computer skills are limited and I am struggling to reply in correct format.Anyplace on site you can direct me to so my wife and I can get sorted out and respond to all the great members?
Thanks,
AL and Jeanne and Mini

[Soaphie & Sydney's Mom]

Re: Humilin N vs. Vetsulin

I was told by a vet at a teaching hospital that Caninsulin would be available in US in January. No details so consider it a rumor until it appears.

Wow! I will be on the look out! Thanks for the information!