Newly Diagnosed, having issues

[Neirracul]

Re: Newly Diagnosed, having issues

I think we will keep her at 14 for a few more days and do another curve this weekend before making a decision about her dose. She just might not have good reaction to changes in dose. If she skips another meal I will try the 1/4 dose and see what effect that has. We typically do top her food with something, so far we have used frozen green beans, broccoli, cauliflower, and apple. She loves frozen veggies was excited for those for a while but she gets used to it and then no longer wants them. Currently we are using 1/6 cup of beef broth drizzled on top and 1/6 cup of hot water to simulate a cooked meal. It’s been reasonably successful so far but I don’t know for how long ha ha. She doesn’t like cheese or eggs, but I will try some fish when she starts getting tired of the beef broth. Originally she was nuts for the kibble and ate it plain but all good things must come to an end it seems.

I’ll update y’all after the curve we do this weekend and see where pups numbers are.

[Neirracul]

Re: Newly Diagnosed, having issues

We did another curve yesterday and got:

445
453
527
523
451
458

The spot checks we did during the week were all super high too. Wondering if she maybe is experiencing a honey moon and that’s why normal insulin doses seem to be too much for her. Im wondering if we should maybe start over again with a .25 dose of NPH per kg. Of all the doses she’s been on so far, she seemed to do best on around 11 units of Vetsulin. We had numbers from 275 - 400 on the 11 and she seemed to be doing a lot better and might benefit from a lower dose with half unit increases every week or so. What do you guys think? I’m afraid to give her too much because of how hard she was rebounding in the beginning on the 20 units of Vetsulin. If this reasoning is totally off please let me know. She’s not doing as good now, very tired and isn’t able to do her normal walk without getting run down. We started using a little chunk of cooked beef to get her to eat her food and that’s been going well.

[Riliey and Mo]

Re: Newly Diagnosed, having issues

great youve got her eating and that curve is flattening out well.

you doing great . lets see a curve on the weekend and go up one unit at a time from now on.

shes under dosed at 14 units as 65lbs x .25 is 16 units for her weight.

[Neirracul]

Re: Newly Diagnosed, having issues

Doesn’t a 16 units starting dose seem high, especially since she was in rebound at 20 units? I’m a bit confused. I’ve been reading some journal articles about Vetsulin and NPH use in dogs and all of their dosing schedules are listed in units per KG. This includes the starting doses which are listed as .25 to .50 units per kg. Maura is around 65 lbs which equals about 29 kg.

So in theory her recommended starting dose should be .25 x 29kg = 7.25 units to .50 x 29 kg = 14.5 units as a high starting dose. This sounds kind of low, but I can’t find any sources using units per pound either. The one article I read found that most dogs average around .63 units per kg when fully regulated.

[jesse girl]

Re: Newly Diagnosed, having issues

You can try the lower dose to see if it makes a difference . You do have some history with better numbers and physical symptoms

My jesse at 26 pounds cant have more than 3 units at one time and that led me to giving her 3 shots a day to accomplish that

Now her numbers dont go low they go high with a higher dose . Maybe its a reaction to injected insulin as it is a foreign substance to the body but who knows for sure . When she runs higher on occasion and I have tried to raise the dose she goes higher .

My jesse early in her diagnosis was at 1 unit for a brief time which I believe a honeymoon period and I guess it ended but her dose remained lower than most

[Riliey and Mo]

Re: Newly Diagnosed, having issues

the initial recommended dose is 0.5 iu kg insulin body weight
0.5 x 29.48 kg dog is 14.74 twice a day

the initial start dose in .lbs is .25 iu lb insulin per body weight
.25 x 65 .lbs dog is 16.25 twice a day.

i always converted kg to lbs and used the
.25iu as my vet weighed Riles in kg

the important thing is not to follow numbers as every dog is different.

looking forward to Maura.s next curve

[Raysaint]

Re: Newly Diagnosed, having issues

All my vets told me 0.5 units per kg NPH is the start dose, which is usually conservative.
I believe the AVMA diabetes guideline is the same.

My dog is just over 12 kg, start dose was 6 units, now he's at 9 units of nph.

[Neirracul]

Re: Newly Diagnosed, having issues

Hi all,

Finally got to do another curve so we did the full 12 hours and then two more tests after that. Still at 14 units of Novolin N.

Numbers:
474 - fasting, fed breakfast right after
401
469
459
397
471
372 - fasting, then dinner right after
499

She’s been eating perfectly, 2.5 cups of chicken Ketona per day with four cubes of beef, 1/3 cup of beef broth, and some hot water added. Split between two meals. No complaints yet.
Her energy level is still low; she can barely get through her normal walk anymore. She gets two leisurely 30 min walks per day after her meals.
The curve today was interesting to me since most of her spot tests during the week have been in the 500s.
This curve seems kind of flat to me, though I’m not sure what the after dinner spike was from or the weird undulations during the day.
Is this where we should increase by another unit?

[jesse girl]

Re: Newly Diagnosed, having issues

Yes you do have the opportunity to raise the dose

Nice and flat which makes raising the dose a bit easier . Remember a dose adjustment is based on the lowest number in a curve

I would not place much interpretation on the highest number as meters appear to become less accurate at higher levels

well done

[sibhus]

Re: Newly Diagnosed, having issues

I can tell you my husky like yours was very sluggish when hovering in the 400s. They feel a lot more comfortable when you can get them below 300. Since your nadir or bottom line number is 397, one unit won't make any difference on the larger dogs. You may want to start by increasing 2 units but I have a feeling you'll be closer to giving 20 units to get her nadir closer to 100.

I read a vet article that insulin can be increased no more than 10 percent every 4 days.

How does your husky like the ketona?

[Neirracul]

Re: Newly Diagnosed, having issues

Okay, we will move up to 15 later this week. I don’t want to do more than one unit at a time because she doesn’t seem to react well to the changes. It took like two weeks for her numbers to stabilize in the 400s.... if that makes sense. We will wait a day or so, so my partner will be home all day to spot test and then probably do another curve next weekend.

Sibhus- that’s good to know, I’m hoping we can get her numbers back down again. They seemed the best around 11 units but still too high. She was actually started on 20 units by the vet and it put her in hyperglycemia rebound pretty hard. Her BG wouldn’t stop going up and up - to the high 600s before we realized what was happening (not sure how accurate this was with an alpha trak though). She seems to like the ketona enough, haha. It’s hard to get her to eat any food for long periods of time - she’s a picky dog.

Also, a side note: before my mom was taking care of her, at age 5 she weighed about 45 pounds and had for a few years. At 65 pounds, she still seems kind of overweight to me. The vet didn’t have any comment on her weight at all which seemed kind of weird to me, but is weight loss even something we should be considering right now as well?

[jesse girl]

Re: Newly Diagnosed, having issues

With weight gain has your dog been checked for thyroid problems ?Not sure if that has already been sugested . If the thyroid is out of whack it can make regulating blood sugar more challenging .

[sibhus]

Re: Newly Diagnosed, having issues

I can tell you from owning several Siberians, that they are prone to diabetes and obesity. They love to eat and well its gets the better of them and leads to diabetes. A typical female should weigh 35-50lbs and male about 55-65 but then again there are variations in heights of these dogs. Ive noticed Siberian females put on weight easily after being spayed.

As Jessegirl mentioned I also feared a thyroid problem but his T4 was ok and in my case I was able to get him to shed off a few lbs in a month with extra walks and cutting his intake by 400 calories. But a T4 test on the CBC will identify a thyroid issue.

[Neirracul]

Re: Newly Diagnosed, having issues

I looked through the CBC one of the vets did and it doesn't look like they included the T4 test or anything thyroid-related. I looked at the bill from the other vet and it doesn't look like they did any bloodwork at all really. We are going to have to take her back sometime soon, but most of our money was eaten up by the hospitalization so we are waiting until we have enough for a return visit.

She has teeth issues and a skin infection that they noted and told me they addressed, but I'm pretty sure they did not because there's nothing on the bill about it and the issues are still there, especially the skin problem/infection.

We did another curve with no changes to diet or exercise times. She is currently at 15 units twice daily. Her BG is averaging higher and higher every time we do a curve it seems. The mid to low 300s and low 400s we were seeing around 10-12 units haven't reappeared yet. Her daily energy levels are lower and lower so we've had to shorten her walks because she just gets too tired.

486 - fasting
521
515
590
552
488

[jesse girl]

Re: Newly Diagnosed, having issues

yeah it sounds like you maybe seeing other issues affecting regulation . Skin issues can be another sign of thyroid problems . could be some kind of infection. There could be some resistance to insulin for whatever reason

Maybe the insulin isnt agreeable .

The other situation you may have seen is a honeymoon period ( the body still producing some insulin on its own ) and that ended

Now with numbers going higher with a higher dose the body may consider its to much and you can temporarily drop the dose and see if numbers and energy improve . You will need at least a few days at the lower dose to get and idea if its helpful and it could take up to a week to get results with no guarantees but thats how the disease works . Trial and error .