Soaphie the sophisticated is an angel October 29, 2015

[Soaphie & Sydney's Mom]

Hi there!

This is my first post.

I have an 8 year old bernese mountain dog / border collie mix that was diagnosed with diabetes at the end of July (2008). Up until this time Soaphie lived a healthier lifestyle than the majority of the people I know. She would run with me 3-4 times a week (including a long run of 9 miles....sometimes a little more), healthy food and snacks were veggies and fruits. Healthy weight etc.

So....

We have been on Vetsulin since July and have had an EXTREMELY difficult time getting regulated on this insulin....HIGHS...LOWS (including the horrific experience of a seizure).

Has anyone else gone through this with Vetsulin? Help! Thank you!

[We Hope]

Re: Soaphie

Hi and welcome, Soaphie's Mom!

Please tell us more about Soaphie. Know Bernese are not small dogs, but since insulin goes according to body weight, how much does Soaphie weigh? Are you working with one shot a day or two and how many units is she getting? What are you feeding Soaphie and when?

The more you can tell us about Soaphie, the easier it will be for us to try to help you. There can be many causes for highs and lows with insulin--in order for us to talk with you about what might be causing Soaphie's problems, we need you to tell us as much as you can.

Kathy

[BestBuddy]

Re: Soaphie

Hi and welcome.
Kathy has already started the questions and we do ask a lot. The advice given really will depend on your answers. Soaphie's weight, food and insulin amount and how often will all make a big difference.
Jenny & Buddy

[Soaphie & Sydney's Mom]

Re: Soaphie

Fast response! Thank yo

Soaphie currently weighs 59 pounds (down from a healthy weight of 68....but up from a low of 49...my poor baby). She eats twice daily - Wellness Venison and Rice (didn't switch to WD because she has some food allergies we are dealing with as well that FINALLY cleared up with the Wellness food). VERY limited snacks - maybe a couple cherry tomatoes - but we try to be incredibly consistent with her food since we are having such a tough time getting her regulated).

As far as treatment: Glucose curves....boy oh boy have we done glucose curves. I couldn't even begin to count. She has spent so many days at the vet - I've asked them to post her name on one of the exam room doors "This room sponsored by Soaphie".

Soaphie had a seizure a few weeks back at which time we took a big step back on the units given to her and then built up. As of last Friday's curve - I believe the 8:00 a.m. was 250 after fasting about 14 hours (I was ok with this number) - then gave her 11 units - I can't recall the draws during the day, but the final draw at 5:30ish was 330 (too high in my opinion as then she would have dinner and another shot and her blood sugar would climb even higher for a few hours).

SO - today we did a fructosamine test (results tomorrow) as well as a blood glucose test. She was in the low 300's again this morning. The vet mentioned today the possibility of switching insulins. I asked what she was thinking of switching to and she was possibily PZI.

Everyone at the vet's office said in all their years of working there they have never seen a case as difficult as Soaphie's.

So - current is 11 units twice a day. I'm very anxious to get her fructosimine test results back tomorrow...

[Debbie & Apollo]

Re: Soaphie

Hi and welcome

I know there are definite opinions about the kind of insulin.

Apollo has been on Vetsulin from day one (we are starting his 3rd year in December)
anyhow -- I am super picky about his schedule - when he eats, gets his insulin etc.... not sure if that has helped but... so far pretty good.

others will be along to give input. good luck

Debbie

[BestBuddy]

Re: Soaphie

Hi,
You are very welcome. 11 units isn't a great lot for Soaphie's size but all our dogs are certainly different. Buddy is only a little over 11lbs (5 kilos) and he gets 5 units of Humulin N twice a day. We started with Caninsulin (Australia's version of Vetsulin) and had great success for nearly 4 years so I know it is a good insulin but sometimes a bit pricey especially for the larger dogs. Your numbers are not so bad, a lot of us struggled with much worse numbers early on. How long has Soaphie been on insulin? Food plays a bit part of regulating and sometimes the type of food and insulin just don't match. A lot of us home blood test so it can be much cheaper and convenient, that is something you can investigate later. When you say seizure are you meaning a Hypo?
Jenny & Buddy

[eyelostit]

Re: Soaphie

Hi and Welcome,

My dog is Border Collie/Aussie maybe some Heeler in her.

I had a hard time getting her regulated, I think it's her breed, she in her 7th year now as a diabetic. She was really bad off before she got diag.

You'll get lots of help and info here, without the board I don't know what I would have done, I was frantic for answers with my baby.

The vet had me coming every week $$$$$ and was not helping and made matters worse, found a new vet.

Anyway, welcome again and here is my link here to Niki's story, anxious to see a picture of your dog.
http://www.k9diabetes.com/storynikid.html

[Soaphie & Sydney's Mom]

Re: Soaphie

Yes - hypo on the seizure. At that time she was on 14/12. A couple weeks ago we were at 12/12 and a blood test one morning was 115 which I thought was too low considering it had been 14 hours since she had eaten. Ugh. The struggle continues.

Soaphie is pretty much "sedentary" now as well - no longer running since I don't want to throw off her blood sugar. It breaks my heart as I would do ANYTHING to run with her again.

[Soaphie & Sydney's Mom]

Re: Soaphie

Test post to see if Soaphie's picture shows up...

[eyelostit]

Re: Soaphie

LOL I guess we all were posting at the same time

[We Hope]

Re: Soaphie

Soaphie's Mom,

If we look at a modest starting dose of insulin--regardless of strength or species, it would be from 0.25-0.50 units per kilogram (2.2 lb) of body weight. Soaphie weighs close to 27 kg.

Getting 11 units twice a day, Soaphie is getting less than 0.50 units per kg of weight at present. She's nowhere near the resistance point with her present dose. She's also resposive to the insulin, because if she wasn't, you would not have gotten a fasting reading of 115, so there doesn't appear to be immune-mediated insulin resistance problems.

Regarding PZI, the IDEXX PZIVet, which was U 40 strength insulin 10% pork insulin, 90% beef insulin, was discontinued earlier this year. This leaves you with compounded beef PZI only, unless you want to import Hypurin Bovine PZI from Wockhardt in the UK.

http://petdiabetes.wikia.com/wiki/PZ...aining_PZI_Vet

Compounded insulin can vary from batch to batch unlike manufactured insulins.

Rarely do dogs do well with PZI insulin, but they are helpful for many cats.

http://veterinarymedicine.dvm360.com....jsp?id=325511

What Insulin Should I Choose Now that My Options Have Dwindled?
David Bruyette--Veterinary Medicine 2006

"PZI insulin: This long-acting, protamine zinc, beef-pork-origin insulin has, in my experience, not been more effective in controlling clinical signs in dogs than intermediate-acting insulins."

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

"The normal fasting value for blood glucose in dogs and cats is 75-120 mg/dL."

"The renal threshold for glucose is ~180 mg/dL in dogs and ~240 mg/dL in cats."

When you exceed the renal threshold for a period of time, glucose will begin to spill into the urine.

http://www.thepetcenter.com/exa/nv.html

GLUCOSE 67 - 125 mg/dL --normal for dogs. Below that would be sliding into low blood sugar, or hypoglycemia.

Have conditions such as hypothyroid or Addison's been ruled out? Either of them can mean more sensitivity to insulin, thus more tendency toward hypos if they're not under control.

Are you certain the seizure was caused by Soaphie's blood glucose being too low?

Kathy

[k9diabetes]

Re: Soaphie

Thanks for filling us in some on Soaphie's story. I do have some concerns from what you've said...

First, PZI rarely is a good insulin for a dog. So it concerns me that your vet is considering it unless you already tried NPH and that didn't work.

Has Soaphie ever been on NPH insulin?

It would help immensely if you could get the records from your vet showing the curves that have been done and post them here - what time the blood draws were done and what the readings were plus what the insulin dose was at the time. I'd be happy to go through them and give some impressions. Can also chart them, which, for me at least, helps make sense of the trends.

The other possibility is that Soaphie's BG elevates some from stress at the vet and she may actually have lower blood sugar at home.

Have you ever considered home blood glucose testing?

It would save Soaphie a lot of time at the vet if nothing else.

We did all of Chris' curves at home starting in 2004 so for the vast majority of his time as a diabetic. You can see a video of him being tested at www.k9diabetes.com/bgtestvideos.html. It's kind of a large file so give it time to download.

We used a OneTouch Ultra, which seems to work well with larger dogs like Soaphie (I have a MAJOR soft spot for Bernese mtn dogs by the way!) and the lip would be a great spot to test on her. You will see how bored Chris looked while being tested.

Chris weighed between 58 pounds and 65 pounds at various times and he never needed more than 11-12 units of NPH. Some dogs are just more sensitive.

I'm really curious to see Soaphie's profile on Vetsulin. If you take a look at Chris' case study (www.k9diabetes.com/k9diabetes.pdf), you will see that Humulin L, which is a preparation very similar to Vetsulin but with human insulin, had Chris' BG all over the map - highs and lows during a 12-hour period - while NPH and even Regular worked much much better for him.

I think you would find home blood glucose testing literally a lifesaver for Soaphie... it's the only way to get a really really good handle on what's happening with their food and insulin. And you could use the information from curves you do yourself to time her exercise so that she can get out and get more active again. Without it, we would never have been able to regulate Chris. His BG the last time it was tested at the vet was in the normal range for a nondiabetic!

Best wishes,

Natalie

[bgdavis]

Re: Soaphie

Hi and welcome,

One question I don't see asked: is Soaphie taking insulin twice a day or only once? Some vets start dogs on Vetsulin on a single dose.

Bonnie and Crissy

[Soaphie & Sydney's Mom]

Re: Soaphie

Soaphie is on twice daily insulin shots. Started off with once daily and that wasn't working so we went to twice daily.

[Soaphie & Sydney's Mom]

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).