Daygo - Switching to NPH

[k9diabetes]

Re: Switching to NPH

Vetsulin in its materials regarding switching the opposite direction - from NPH to Vetsulin - has recommended a 25% reduction in the insulin dose.

I like the 25% and would not want to start with less than 50% of the amount of Vetsulin you have been giving because in all likelihood the doses will end up being similar. Eric's Sable is a good example.

How much risk there is depends on how well regulated your dog is on Vetsulin. If the regulation on, just for example, 6 units of Vetsulin is really really good and tight - blood sugar all in the 100s - then I'd be more cautious with the dose of NPH to start out because there's less leeway for low blood sugar from a strong response to the new insulin. If the regulation on Vetsulin is not very tight, you could start with more.

Long answer short - I'd do between half and three quarters of the Vetsulin dose.

Low end of the scale if there's more risk, high end of the scale if there isn't.

If you're giving 6 units, something between 3 and 4 units would be a good place to start.

[k9diabetes]

Re: Switching to NPH

I think sometimes things get confused because of why you are switching insulins at this point.

Usually, a vet would choose to switch insulins because your dog isn't responding to the one you're currently giving. For example, you're giving a 10 pound dog 10 units of insulin per injection and his blood sugar is still high so you know that he's not putting the insulin to use.

If you were to switch a dog under those circumstances to a new insulin, I would drastically cut the dose to start the new insulin on.

Because the whole point of switching is that you hope the new insulin will have an effect that the old one did not. And if it succeeds, a unit per pound is probably way too much.

But these circumstances are different. In most cases Vetsulin is working so you have a ballpark idea of how many units of insulin your dogs needs. The dose should be reduced some just because the response to a different insulin may be different. But it's not likely to be astonishingly different the way it would be if the insulin you were dropping wasn't working.

Hope that makes sense!

Natalie

[minpinlover]

Re: Switching to NPH

Thanks for all the help. I do home test him so I will keep an eye on him during the switch. His last weight at the vet a few weeks ago was 16.6 lbs.
I'm thinking that I will probably start the NPH this weekend so I have a few shots of vetsulin for back-up if needed and start him at 3 units and go from there. Will I be able to see the activity of the NPH right away or will it take a while for his body to adjust to the new insulin to get an accurate picture of the dose? I'm planning on another curve in 2-3 weeks after the switch. Thanks again to everyone for your help!

[ravenecw]

Re: Switching to NPH

Thanks for all the help. I do home test him so I will keep an eye on him during the switch. His last weight at the vet a few weeks ago was 16.6 lbs.
I'm thinking that I will probably start the NPH this weekend so I have a few shots of vetsulin for back-up if needed and start him at 3 units and go from there. Will I be able to see the activity of the NPH right away or will it take a while for his body to adjust to the new insulin to get an accurate picture of the dose? I'm planning on another curve in 2-3 weeks after the switch. Thanks again to everyone for your help!

When I started Sable on NPH I started at (again I would have to look back but...) 4 units I believe. I was up to 6 and 7 units rather quickly, I home test too and she ran high until I started to get the units closer to what I was using on Vetsulin. Now I am in tweek mode but I don't adjust for a week at a time and there are 2 reasons for that. One is that I like to give the insulin a chance to settle in for Sable and two, I'm not home "all day" during the week.

Every dog is different though, but that was my experience. I'm betting it will go great and I hope it does, I'll be checking in to see.

[amberiu99]

Re: Switching to NPH

Here is my recommendation and it's what I am doing with my MinPin now, he is 17-18 lbs. he was on 6.4 units of Vetsulin. When I switched him to Humulin N, the vet said to start him at 2 units. I balked because I knew that would not be enough and I was not willing to risk him suffering long-term effects of being with a high Bg over the couple of months it would take to increase him. I will be moving him nearer to his vetsulin levels with careful monitoring. The vet said it could take time to see results and not to bump him too fast, but I am also focused on not having him develop ketoacidosis because that will just bring on a whole new set of problems.

I switched him over on Tuesday night and gave him 3 units, then 3 again on Wednesday morning. We saw an internist vet who did her masters in Diabetes on Wednesday and I got the ok to go to 4 units. We stayed at 4 units and I did a 10 hour curve on Saturday (was supposed to be 12, but I had to go to work and my boyfriend couldn't get the glucometer to work properly) with readings from 359-463 at every interval. I will be spot checking him because I am going to move him to 5 units and leave him at that until at least Friday. I will do another curve and contact the vet with results. I suspect at this point we will end up at 6 units at about the 2.5 to 3 week mark. I'll keep you posted.

Out of curiosity, when you check at home, do you use ear, lip, or do you draw blood? With Jory the least painful way was to draw his blood, so I am curious about others with dogs that are little and spry like Jory.

Thanks for all the help. I do home test him so I will keep an eye on him during the switch. His last weight at the vet a few weeks ago was 16.6 lbs.
I'm thinking that I will probably start the NPH this weekend so I have a few shots of vetsulin for back-up if needed and start him at 3 units and go from there. Will I be able to see the activity of the NPH right away or will it take a while for his body to adjust to the new insulin to get an accurate picture of the dose? I'm planning on another curve in 2-3 weeks after the switch. Thanks again to everyone for your help!

[minpinlover]

Re: Switching to NPH

I started swithching Daygo yesterday for his morning dose. I've just been checking a fasting and 5-6 hour on him. This is what I have so far-
11-15: fasting 181 (he was on 6U Vetsulin)
gave him 2.5 U NPH at 8AM
BG at 1240PM - 305
BG at 730PM (before feeding) - 321
Today: fasting 447
gave him 3.5U at 805AM
BG at 115PM - 293
Wondering if I should leave him on the 3.5 for a while to let him adjust or increase him to 4U tomorrow? It sound like Jory and Daygo are within about a pound of each other in size. My biggest question right now is how long to wait before I decide to increase the dose. I do his testing on his carpal pad(which he hates) because he doesn't like his mouth messed with. I never even thought about drawing a venous sample until you mentioned it. That's
what I did for a living on humans before I retired, so I thing I could do that
on Daygo too. Do you use an insulin syringe to draw? Keep us posted on Jory's progress. Linda

[minpinlover]

Re: Switching to NPH

Forgot to mention that I checked my meter with testing at the vet the last time and my meter was 43 mg/dl lower than their blood draw. I got 80 on my meter and their result was 123. I have been documenting all of my testing and doses as I go so I can share with my vet since she's new with using NPH. Sometimes I feel that she gets a little offended when I ask too many questions or share what I've learned from others on this forum. But since Daygo can't speak for himself, I guess she'll just need to put up with me!
Linda

[Patty]

Re: Switching to NPH

Linda,
Remind me what meter you're using.
Curious...

Patty

[minpinlover]

Re: Switching to NPH

Hi Patty!
I'm using a ReliOn Ultima (Walmart).
Linda

[amberiu99]

Re: Switching to NPH

This is my third time typing this message...1st time forgot to click on keep me logged in, 2nd time battery died...sooo I'm giving it one more shot.

I do use an insulin needle to draw his blood, but it's one gauge smaller than what I inject with. The 31 gauge short needle is what I inject with, but I draw with the 30 gauge short needle. I have a much easier time drawing with the slightly larger needle, but then again Jory has been my only patient

When I draw, I use his back leg, I grab around the bend in his leg pretty tightly so that the vein pops, which makes it pretty easy. I am going to video and post it, even though you probably don't need it, hopefully it will help someone

With the numbers you have so far, it seems that you would be ok to go up a half unit or a whole unit, but only you are qualified to make that call...the blessing and the curse.

With Jory, his numbers were so high even on 4 units, I moved him up to 4.5 and in a few days I will likely move him to 5. I think from everything else I have read we will likely end up where we were with vetsulin. I'll probably slow down the adjustment at 5. I'll give him a solid week there before adjusting him again unless he stays in the 400s.

Best of luck with Daygo, I'll keep you posted. You are already getting better numbers than us!

BTW I am also using the ReliOn meter.

I started swithching Daygo yesterday for his morning dose. I've just been checking a fasting and 5-6 hour on him. This is what I have so far-
11-15: fasting 181 (he was on 6U Vetsulin)
gave him 2.5 U NPH at 8AM
BG at 1240PM - 305
BG at 730PM (before feeding) - 321
Today: fasting 447
gave him 3.5U at 805AM
BG at 115PM - 293
Wondering if I should leave him on the 3.5 for a while to let him adjust or increase him to 4U tomorrow? It sound like Jory and Daygo are within about a pound of each other in size. My biggest question right now is how long to wait before I decide to increase the dose. I do his testing on his carpal pad(which he hates) because he doesn't like his mouth messed with. I never even thought about drawing a venous sample until you mentioned it. That's
what I did for a living on humans before I retired, so I thing I could do that
on Daygo too. Do you use an insulin syringe to draw? Keep us posted on Jory's progress. Linda

[minpinlover]

Re: Switching to NPH

Last night I increased the insulin to 4U because his BG was still 419 before feeding. This morning his fasting at 730AM was >500, at 1PM he was 160 and before feeding tonight at 730PM he was >500. I talked to our vet this morning and she said to go ahead and give him 4.5U for today and keep monitoring him. I really thought we were on the right track with that 160. I don't want him this high for very long, but how long before things begin to stabilize? If the NPH wasn't working at all for him would I be seeing any drop in his sugars at the 5 hour testing? I'm going to leave him on the 4.5U for tonight and I guess we'll see what tomorrow brings.

[k9diabetes]

Re: Daygo - Switching to NPH

Hi Linda,

Had you done any curves lately on the Vetsulin?

Did you take any other readings on the NPH today?

Diet: Science diet adult light with a small amount of canned light mixed in

From the three readings today, it looks like the insulin's being metabolized very quickly so dropping the blood sugar hard and then running out.

That's why I was curious if the Vetsulin curve was similar or if this is specific to NPH.

If only the NPH is doing this, you might be able to adjust Daygo's diet and make things balance better.

Are you home with him during the day?

Natalie

[minpinlover]

Re: Daygo - Switching to NPH

Hi Natalie! I did a curve on him on Oct. 11 while he was still on Vetsulin 7U.
Fasting - 275
2 hour - 105
4 hour - 48
6 hour - 70
8 hour - 219
10 hour - 346
12 hour - 312
My meter is about 40 lower than the testing at the vet. From the results of this curve we lowered him to 6U. I'm still feeding him 3/4 cup of Science Diet light and 1-2 T. of canned (usually Alpo) mixed in. He gets about 1/4 cup of green beans after his shot for a treat. I am home almost all day with him so I'm keeping a close eye on him. I'm eager for any suggestions!
Linda

[k9diabetes]

Re: Daygo - Switching to NPH

From the readings you had today...

This morning his fasting at 730AM was >500,
at 1PM he was 160 and
before feeding tonight at 730PM he was >500.

There's a really sharp drop in BG occurring and it will prevent you from giving much if any more insulin. Definitely not ideal.

I was wondering if you would be able to consistently give him a snack mid-day.

We would need some readings between about 10am and 2pm to find out when his blood sugar hits that low point and then you would give a snack an hour or so before that low point so there is some food to go with the insulin.

But it has to be something you can give every day because the goal is to flatten out the curve and then be able to up the insulin to bring the blood sugar down to a good level.

If you could not do it consistently, once you established that it works, you could give less insulin on the days you can't give a snack...

The Vetsulin curve was a lot better for Daygo. If he has trouble with NPH, once Vetsulin is back on the market reliably he could switch back. But in the meantime, if you could give him some lunch, you might be able to improve this curve and make it work better for him.

Natalie

[minpinlover]

Re: Daygo - Switching to NPH

I'll try giving him the snack and see if that helps. I'm wondering if he's still hitting that low about 4 hours after his shot and I'll do some checks around that time to see where he is. Most days it won't be a problem to give him a snack. If I can just get him evened out I can adjust for the days I can't. Thanks Natalie!
Linda and Daygo