Soaphie the sophisticated is an angel October 29, 2015

[Soaphie & Sydney's Mom]

Re: Your dog's diet, insulin, and meter used

In regards to the blood glucose meters that everyone is using - can you tell me the pros and cons of each? Ease of use? Amount of blood? etc etc etc?

[k9diabetes]

Re: Soaphie

Ah, she's gorgeous, as I knew she would be!

I don't know what it is about Bernese mountain dogs. I've never had one but there is something about them that really appeals to me.

I got the impression from some of the numbers you listed that the curves on Vetsulin might not be all that bad.

In general, most of us get in a habit of asking for copies of all test results. Its invaluable information that builds a very detailed picture over time. I could sit down and compare, for example, Chris' blood panels from a year ago or two years ago, across several veterinarians, to see how things were changing in those results. And a HI on a blood panel can mean a lot of things... I always wanted to know if it was a lot high or a little. My vet is good about concentrating on ones that are more than just a point or two off the reference range, but I always felt better having the data in front of me so I could see for myself.

I remain a bit concerned about the PZI comment... especially since she's never tried NPH. You can see that even in the Merck Manual, the two insulins that vets now routinely use are NPH and Vetsulin/Caninsulin:

Most dogs require 2 doses of insulin a day. In general NPH or lente is the initial insulin of choice at a dose of 0.5 U/kg bid.

http://www.merckvetmanual.com/mvm/in...m/bc/40302.htm.

Depending on how serious she was about PZI being her next choice, that could suggest that she's not very experienced with diabetes, which is not all that unusual. It seems quite a few vets latch onto a single insulin and don't know much about alternatives.

I'm glad there's no rush to do anything drastic right now. I'm hoping we can get a look at her curves and see if we can offer some additional insight.

Natalie

[We Hope]

Re: Soaphie

Hi there - I'll try to address all of your questions (hope I don't miss any ).

1) Soaphie hasn't been on NPH
2) I have considered the stress level elevation factor at the vets office - but I do notice her drinking more water at home so I know she's a bit high.
3) We will look into the at-home testing
4) The recommended starting dosage for vetsulin is .5 per KG which would be 13 units once a day....going to twice a day you make adjustments which equates to about 10 units twice a day. This is a "starting" range. Vetsulin has changed their recommended dosages a couple times to my knowledge. At 10/10 her blood sugar is too high....11/11 it's too high - so as of today we are trying 12/11 (knowing that 14/12 made her hypo in the middle of the night).

http://www.vin.com/VINDBPub/SearchPB...00/pr00105.htm

Diabetes Mellitus: Treatment Options David Bruyette United States
World Small Animal Veterinary Association-Vancouver, 2001

"The intermediate acting insulins are classified as either NPH or Lente"

"In dogs we like to start with Humulin-N at 0.5 units/kg q12h."

0.5 units per kilo of body weight every 12 hours.

http://www.intervet.com.au/binaries/82_103335.pdf

Caninsulin page 5--once daily was 1 unit per kg of body weight plus additional weight-dependent unit(s). This is how the insulin was recommended to be used in Australia, the UK and other countries before it came here as Vetsulin.

Page 6-Twice-Daily Caninsulin Regimen-"The starting dose of insulin is 0.25-0.5 units per kilogram of body weight, twice-daily, rounded down to the nearest whole unit."

http://www.vetsulin.com/PDF/Vetsulin_Tech_Bulletin.pdf

Vetsulin Tech bulletin page 2--this is how the insulin was originally introduced in the US--the same as above, with a notation that the majority of dogs would require not once-daily, but twice daily dosing.

Mine was the first Caninsulin/Vetsulin patient in the US who'd not been part of an earlier trial; he was using it before Vetsulin was on the US market. He was using Lilly Iletin II Lente--U 100 strength pork Lente insulin until Lilly discontinued it and was using 2 shots a day, continuing on to Caninsulin/Vetsulin with two shots a day. Both insulins were used as X amount of unit(s) per kg of body weight for initial dosing. 4 units twice a day kept him in the 85-100 bg range; he never had a hypo.

http://www.vetsulin.com/PDF/Vetsulin...tor_Letter.pdf

Vetsulin "Dear Doctor" letter from circa March-April 2008--the starting dosage recommended is now 0.5 units per kg of body weight. Until this, the original starting doses were as above.

Is there any reason stepping up or down by half-unit hasn't been tried? Marion, who's here as Cara's Mom, had some problems with using 15 units twice daily with Cara. Reducing slightly to 14.5 units twice a day has made things work out well. Marion does home testing and does give Cara a snack before bed to make sure there are no lows; this is just like many people with diabetes do.

Learning how to test Soaphie's blood glucose at home would be very helpful in trying to discover when her high and low periods are.

Marion was having trouble with Cara's post-meal spike; home testing was able to uncover this. She did need slightly more insulin to keep her bg's from skyrocketing after meals. You'd be able to see how the insulin and food work with Soaphie by doing home testing and could make any needed adjustments to either much easier.

Think that regulating and monitoring Soaphie would be much easier if you thought seriously about doing blood glucose testing at home.

Kathy

[k9diabetes]

Re: Soaphie

We mainly used OneTouch Ultra, which uses a small to medium sized drop of blood. The Freestyle meters use less blood but with Chris they were not as accurate as the OneTouch Ultra.

Over the years, it has seemed to me like Freestyles tend to work best with small dogs - they sometimes get lab-quality readings. But it seemed to be less so with larger dogs.

There's a lot of variation and ultimately you just have to try the meter with your dog and see what you get.

We started with an Accuchek Advantage, which was as accurate for Chris as the OneTouch but needed a lot more blood - more than I really wanted to draw on a daily basis.

We also did some trial work with the AlphaTrak, which is an animal-adjusted meter meant for diabetic cats and dogs. It was very accurate for Chris but it was too expensive for us to use routinely when I could get good results with the OneTouch, which ran a pretty consistent 30-40 points lower than lab values. I always just added 30 to his readings above 80 and 20 to his readings below 80.

We also did some trial runs with Ulticare's iPet animal meter and I was sad to say that the testing did not go well. In our case, the readings were erratic and often seemed to be excessively high. Based on our experience, I can't recommend that meter.

Generally, I suggest going with a higher quality meter - don't get the cheapest meter you can find - since you usually can get the meter free or nearly free. Over the long haul, it's the strips that are the real cost. And you can often buy them at better prices online. We purchased ours from www.hocks.com - they specialize somewhat in diabetes supplies. There are cheaper places too... I bought them from Hocks as I felt like I could feel comfortable they weren't outdated or knockoffs and still get a better price than off the shelf at the pharmacy.

And I suggest starting with a regular meter meant for human diabetics - cheaper to practice and is often all you will need. Once you're proficient, if you want to go to an animal-adjusted meter, you will know what you're doing at that point.

It's also important to know that animal-adjusted meters like the AlphaTrak don't actually measure the blood sugar more accurately. They measure it the same way the regular meters do and then, through the meters coding, those readings are adjusted to an average that comes from testing the meters on animal blood and taking a lab analysis reading of the same blood. They take the average difference over some numbers of tests and use that average to adjust the reading you see displayed. It often works great but it doesn't always. Some worked well for Chris, others didn't.

Probably more than you wanted to know!

There's some links to each manufacturer's pages at the monitoring page on the website: www.k9diabetes.com/monitoring.html.

Natalie

[Soaphie & Sydney's Mom]

Re: Soaphie

I'm definitely going to look into home testing - thank you for the recommendation for the glucose meter.

Also - I have been meaning to ask for a copy of Soaphie's file as I'm big into data. But each time I get to the vet we start discussing the case and I forget to ask - I will make a note for my visit on Monday I also want a copy in case we ever have an emergency happen on a weekend and have to go to the animal ER...

I do have the utmost confidence in Soaphie's vet. The "possibility" of PZI was just that - sometime to consider but of course we'd have more discussions around it. I mentioned "N" to her today and we have a couple more steps to go through before we do any switching.

I will be getting copies of her file and do some graphing of my own (I love data - so this is right up my alley).

[rhodesian46]

Re: Soaphie

Hi Welcome to the forum
I see that you are wanting to home test. I have some brand new One touch ultra meters if you need one. Pm me please.

[Soaphie & Sydney's Mom]

Soaphie - new curve today

Hi all!

Just joined here a week-or-so ago. There is an "overview" posted in a separate thread.

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.

[eyelostit]

Re: Soaphie

Your food sounds ok, Those figures seem to high, but I do not use vetsulin, your doggie weighs about same as mine? 45-50 lbs? part border collie? Niki was hard to regulate also, i think its the border collie in her, it took awhile but I did it with the help of the people here.

My suggestion is to start using the NPH insulin, if you are going to think about doing this, we are here to help you, alot of members do the switch because of the constant highs. Plus once you see the BG go down a bit it really eases up your mind from worry, I was a wreck those first 6 months.

Awhile back I was helping a gal who was using the wellness food and had switched foods, the wellness was not enough carbs to match the insulin, but your food has rice in it, so that should help as far as the carbs.

Remember sometimes I hate to say this, but not all vets are very knowledgeable on diabetes, they go by their normal guidelines and use this for all pets, they don't want owners to switch foods or insulin and they will keep you coming back, thats what my 1st vet did, I'm glad I found a better vet

I think Nat or Kathy will be online shortly

Take care

[Soaphie & Sydney's Mom]

Re: Soaphie

oh yes - they are high. But this is the first day back to 13/13 (when she had the seizure she was 14/12 and then we took some steps back and starting buildling up again). We go back on Tuesday for another curve. Want to try this to ensure we are covering all bases before switching with the goal of A) hopefully getting her regulated and B) if we do have to switch, then we did all we could on vetsulin and won't have to switch back - which I imagine would really mess her up.

The venison rice wellness is 48.2% carbs....is this a good level?

Thank you!!!!

[Soaphie & Sydney's Mom]

Re: Soaphie

One more question....if both Vetsulin and NPH are intermediate acting insulins - any ideas on why they are processed differently in the dogs system? Does it have to do with the suspension (one being isophane and one being zinc)?

Thanks!

[Cara's Mom]

Re: Soaphie

Welcome! Glad you're here! Cannot add anything to all the advice you have received, but I would strongly recomment you start hometesting!!
Cara, my 8 1/2 yrs old English setter was diagnosed Aug. 1. Has been a rough ride. She would not settle down at the clinic, so curves were out of the question...had no choice but start doing it at home. And I am glad I did, both for my sanity as well as Cara's! If I see something is not right, a quick test will tell what's going on and something can be done about it!
Believe me, I know what you are going through! Was there myself not all that long ago

Keep up the good work!

[eyelostit]

Re: Soaphie

This link will help you out abit, Nat and Kathy are the experts here describing insulin action, types etc. hope this helps

http://k9diabetes.com/forum/showthread.php?t=124

take care

[We Hope]

Re: Soaphie

There are some differences in these insulins. One is made from pork which is a perfect amino acid match to canine insulin, one is r-DNA human insulin which is one amino acid away from being a perfect match to canine insulin.

One is U 100 strength and one is U 40 strength and one is protamine or isophane suspension and the other is zinc suspension.

The insulin that's a perfect amino acid match to your own insulin will begin to work faster, peak faster, and have less duration than one that is not. A more dilute insulin (U 40) will also begin working faster, peak faster, and have less duration than one that's less dilute. And then we get into NPH and Lente having some profile differences in action but still qualifying as intermediate acting insulins.

When human insulin was first introduced, most people were using either beef, pork, or a combination beef/pork insulin to manage their diabetes. Because when you look at the amino acid differences between a person's own insulin and beef insulin, there are three amino acid differences (two between beef and canine insulin) between them and one between pork (perfect canine match) and a person's.

The exact match of the r-DNA insulin to that of a person caused a lot of problems for some people with diabetes because it meant that the insulin they had now switched to worked quicker, peaked quicker, and didn't last as long as beef, pork or the beef/pork combination did. Some had problems with hypos and I personally know some people who are not able to treat their diabetes with human insulin. The more amino acid differences between what you're injecting and the insulin your pancreas originally made, the slower the insulin starts working, peaks, and the longer it lasts for you. While beef ultralente insulin is no longer made by anyone, it had more duration for people than Lantus does--because of the 3 amino acid differences between beef insulin and native human insulin.

When we get into the strength of the insulin, the more dilute the insulin is, the faster it will break down from hexamer form to dimer and monomer form, and that's when the body can begin using it--after it breaks down into dimers and monomers. Less dilute insulin tends to stay in hexamer form longer, so it doesn't start working as quickly as a more dilute one does.

There are some PubMed studies where they compared U 100 strength r-DNA human R insulin, U 40 r-DNA strength human R insulin and Humalog with people. Their findings were that the U 40 r-DNA strength human R was only slightly slower in action than the rapid-acting insulin analog Humalog; slowest to act of all 3 was the U 100 strength human R insulin. The difference between the two non-analog insulins was in their strength only.

A couple of years ago, the German government did some serious study of insulins and their costs because the German health plans are government based. Their aim was to try to save some health care costs while not compromising treatment. They took these studies into consideration regarding the differences in insulin strengths and made the decision that newly-diagnosed type 2 persons with diabetes who required a fast-acting insulin would not be able to have their health insurance pay for a rapid-acting insulin (Novolog, Humalog, Apidra) unless a specialist had certified that there was a medical reason they cannot use a more dilute form of R human insulin.

A while back we had someone with similar problems on another board. They were in the UK, where beef insulin called Insuvet is available and the dog was initially started on Insuvet beef Lente insulin twice daily (U 100).

The amino acid differences between the beef insulin and canine insulin made the Insuvet beef act too slowly for him. So the vet switched him to Caninsulin (Vetsulin). The combination of the perfect match to canine insulin and the faster acting U 40 strength insulin made the dog use the insulin too rapidly.

At the time, both Lilly and Novo Nordisk were phasing out their r-DNA human Lente insulins, so it would not have made sense to try to get him started on either of those. The thought was to try r-DNA NPH/isophane insulin for him. The UK trade name for the Novo brand is Insulatard--here we know it as Novolin N.

Having some resistance by the insulin being one amino acid away from being a perfect match to canine insulin was finally the right match for him and he was no longer using the insulin too slowly or too rapidly.

So while there are differences in the way insulin is suspended and preserved, there are also differences in species and in the strength of the insulin formula. Any or all of them can be a factor--it depends on the person or dog who's using the insulin.

Kathy

[Ricksma]

Re: Soaphie

Hi! So glad you found this board...these moderators are amazing!! I can't really add anything that they haven't covered, but I wanted to tell you about my personal experience with Vetsulin and Humulin N (and later Relion Novolin N) with my Ricky. We started off using Vetsulin, and after three months, it became clear to me that I was no closer to real regulation. There were dramatic swings in his readings, I'm sure because of the formulation of the Vetsulin with the 70/30 mix of intermediate with fast acting insulin. I decided to try the Humulin N, since I was home cooking, and the only carbs he was getting (by his choice, lol) were in the W/D patties I make him...I felt that the N would be a better fit. We haven't looked back. I have been very happy with the results, and switched to the even less expensive Relion Novolin N, without a hitch. So now after saying all this, I am touching wood and keeping my fingers crossed that I haven't jinxed anything....hehehe. But, for the most part, he is happy, feeling good, and we are cautiously optimistic about the future. Good luck!!

Love and hugs, Teresa and Ricky

[We Hope]

Re: Soaphie

Just gonna make a point here. Lente insulin is made by combining 30% semilente (fast-acting Lente-type) insulin with 70% slow|long-acting ultralente insulin. You put the slow and the fast together to end up with one that's intermediate, or in the "middle".

There's been a notion that the "fast" acting portion of Lente insulin is R insulin; that's not correct--it can't be chemically. When you combine R insulin with any of the insulins of the Lente family (semilente, lente, ultralente), the Lente-type insulin will bind (slow or hold back) the R insulin. This means that when you put the R together with them, the R loses its ability to act quickly--what you wanted it for in the first place; your purpose would be defeated.

The semilente insulin is a member of the Lente family, does act quickly, but does not bind when it's combined with an insulin of its own family, so it will be able to act fast in combination. You can get R insulin to work quickly if you give it as a separate shot, but if the R was in the same syringe, you could have the slowing, binding effect; nobody would even try putting it in the same insulin vial.

Kathy