Soaphie the sophisticated is an angel October 29, 2015

[We Hope]

Re: Soaphie

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]

Re: Soaphie

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]

Re: Soaphie

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]

Re: Soaphie

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]

Re: Soaphie

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]

Re: Soaphie

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]

Re: Soaphie

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]

Re: Soaphie

Send it to me at k9diabetes@gmail.com.

[Soaphie & Sydney's Mom]

Re: Soaphie

Your "stiff man syndrome" comment has me curious - I'm going to go and read more about that.....

[BestBuddy]

Re: Soaphie

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]

Re: Soaphie

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]

Re: Soaphie

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]

Re: Soaphie

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]

Re: Soaphie

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]

Re: Soaphie

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"....