Newly Diagnosed & Thank You, Thank You

[stitch'smama]

Hi everyone, this is my first time posting to a thread ever. My name is Annette and my furry boy, Stitch, a chihuahua mix was diagnosed on 7/3/12. I have been pouring over the invaluable information on your site since he was diagnosed. I felt compelled to write to thank you all. Because of you all, I became aware that for the first month I had the incorrect insulin, Humulin R, due to both whoever typed the prescription and to whoever filled it at the local CVS pharmacy. I read the thread on insulin and diet and instead of concentrating on diet, I looked at insulin everyone was using and noticed Humulin R wasn't used often or if it was it was used along with another type insulin. I learned Humulin R was short acting and my discharge papers from the vet said they were putting Stitch on a long acting insulin.

I called my vet first thing in the morning and questioned why the Humulin R. I was told he should be on Humulin N, to bring the bottle in, and told that he could have died. He had had 2 glucose curves during that month at the vet's and each time he was increased 1 unit. Started on 3, then 4, then 5 units. They never saw the insulin as per their instructions I fed and administered the insulin at home and then took him to the office for the curve.

I questioned vet's office what the prescription was written for and they said Humulin-no R, no N but that that "means" Humulin N. Apparently that's not what it meant to the pharmacy but they should have called the vet's office for clarification since the prescription was not specific.

So I wasted a month of trying to get him regulated, and he is now on 4 units of Humulin N. I felt so bad for my little guy. Words can't express my gratitude to you all. I have more questions, but this is already long so I'll save them for another post. My vet doesn't recommend home testing, but I'm going to order probably the Alpha Trak 2 and give it a try anyway. Do I stay on the same thread when I have questions? Many thanks!

[Judi]

Re: Newly Diagnosed & Thank You, Thank You

welcome and thank goodness you noticed the difference in the insulin! we like long posts and pictures!

let us know how the curve goes. Judi

[Abby's Mom]

Re: Newly Diagnosed & Thank You, Thank You

Oh my! What a horrible mistake for the pharmacy and/or vet to get that sort of mix up, and go unnotice for over a month!!

As you read, we do like home testing. This is invaluable information when changing diets, increasing food, when finding out that perhaps something else is going on. If not home testing... it is like shooting in the dark (or at least that is my opinion).

Looking forward to learning more about Stitch... let us know what he is eating, and post some curves when you get them.

Yes, we do like to see all postings in the same thread, that way all the history is in one spot.

Welcome!
Barb

[Cebe]

Re: Newly Diagnosed & Thank You, Thank You

Yes, please post in the same thread as you will have an invaluable history of your dog's illness to review later, if needed.

so glad you were perceptive enough to catch that mistake! You know you can get your insulin at Walmart, right? Most states don't require a prescription either.

And home testing is a great resource. My vets discouraged it at first, but I just don't have the money to go in for curves all the time. Plus I had some hypoglycemic incidents with Zoe that convinced me I needed to test at home. And my vets are ok with me testing now. It's given them great info, too.

I have an alphatrak (the original) and a Nova Max. I'm using the nova now while I look for a deal or two on the alpha strips.

Welcome and good work!

[CraigM]

Re: Newly Diagnosed & Thank You, Thank You

Welcome!
Cebe beat me to mentioning Walmart. Humulin-N is $24.99 there, probably about 1/3 the price of CVS! Exact same insulin, they have a contract with Lily to sell it under Walmart's RELION branding (a very little icon on the box). Syringes are probably a lot less expensive there also.

[jesse girl]

Re: Newly Diagnosed & Thank You, Thank You

hi and welcome to both of you how much does your baby weigh

a starting dose is based on weight

it really is amazing how the body can help to prevent a low blood sugar event (hypoglycemia ) with 4 units of r my jesse may get a quarter unit of r at times and that can drop her 50 points lower and she is a 26 pound beagle

with such a high dose of r your pup maybe out of whack just trying to preserve life so you may see elevated numbers from this experience so be very careful raising the dose the clues i look for if a curve at a lower dose is better than a higher dose then you maybe going in the wrong direction

you do want to do a a curve at the vet which amounts to a test of blood sugar at mealtime and shot(fasting) and every 2 hours till the vet closes and you evaluate the curve based on the lowest number not the highest or average on dose adjustments

people doing testing at home will perform the curve in this environment just because of cost stability and for the most part a more realistic outcome also doing curves at home we take it to a minimum to next fasting and some do 24 hours to get a complete picture

[stitch'smama]

Re: Newly Diagnosed & Thank You, Thank You

Thank you all for the welcome. Hopefully I'm posting this right, clicking on reply to thread. Stitch was abandoned and came into our home in June of 2002. My vet at the time, since retired, thought he was around 3 years old. (Seems like they always say 3) So I'd say he's at least 11, maybe as old as 15. Stitch was usually a picky eater and always preferred wet food and has never been overweight. He currently weighs 10.2 down over a pound from when he was at the vets in October of last year. Doesn't sound like a lot, but he looks very thin. Previous to his diabetes diagnosis, his diet was California Natural wet lamb and brown rice and Orijen dry to munch on during the day. My vet who is an internist at a 24hr emergency clinic, wanted me to switch to dry food only and gave a prescription for Purina OM, or Hill's W/D, or Hill's RD. I've never been a fan of prescription diets, and I was concerned because these seem to be for overweight dogs. After some research, I am feeding 1/3 cup of Nutrisca dry mixed with about 3-3 1/2 tablespoons of Merricks wet low glycemic flavors 2x a day. I have to grind the dry food so he can't eat around it. I'm thinking about Honest Kitchen Thrive but don't want to make any diet changes till I give home testing a try.

I first brought Stitch to the vet July 2nd, after 3 or 4 days of excessive drinking and pee pee accidents overnight. Instead of being a picky eater, he was eating eagerly for about a month-but I thought that was good. His glucose was 489 and he had ketones. He had an ultrasound and both adrenal glands were enlarged-possibly Cushings which I suspect or they said it could be due to stress from the diabetes. My poor little guy was acting fine so they didn't keep him. Started him on 3 units, was instructed to urine test with glucose and ketone strips.

He had his 1st BG curve done July 11 while on the Humulin R-3 units. They have me feed him and give him his shot at home which is at about 8:15am/pm. His readings were:

9am 529
10am 428
12pm 403
2 pm 449

After this curve he was increased to 4 units.

July 31st BG curve on 4 units of Humulin R:

9am 456
11am 313
1 pm 290
3 pm 335

After this curve he was increased to 5 units. He also had ACTH test and tested negative.

August 6th started on 4 units of Humulin N and they had me bring him for a curve on August 9th (kind of soon?) I thought maybe they should have started him on 3 units. Like they did originally (with the wrong insulin) but when I questioned that, they said no 4 units. They had a lot going on so I didn't get a record of his curves but it was in the 300 to 400 range. They decided to keep him on 4 units and bring him back for a curve in 3 weeks (kind of long?) I wonder why he didn't have a significant drop at least once on his curves while on the Humulin R?

Sorry I'm trying to cover alot and may have bounced around a bit. Some of his other numbers were out of range on his bloodwork, but I'll cover that on another post. Sorry this one is so long. Thank you for all the support and the Walmart tip. I'm paying over 80 dollars at CVS in CA. What is the insulin called that is the same as Humulin N? Next step is to get the glucose monitor. Thanks again.

[Rubytuesday]

Re: Newly Diagnosed & Thank You, Thank You

Hello and welcome. What a horrible mistake the pharmacy made, they should know better...R insulin Good catch on your part. This may not be the first time something like this happens in dealing with your dog's condition. There seem to be a great many approaches to diabetes out there, some of them scary. With the help of this group though you will do great. You also have good instincts. I wouldn't wait three weeks to do a curve. Often times the dose will settle in further, bring numbers lower, after three days. I wouldn't want to wait three weeks to find out the dog was dropping too low.

Never feel you need to apologize for too much info. Around here the more the better.

[SandyL]

Re: Newly Diagnosed & Thank You, Thank You

Welcome to you and Stitch!!!

The supplies at Walmart are the Relion brand. So just ask for a bottle of Relion Humulin N.... Can't beat the price!! I also get the Relion syringes.... 30u, 5/16 needle length, 30 or 31 guage needle.....12.97 for a box of 100!

I agree with Tara.... Wouldn't wait the three weeks

Sandy

[jesse girl]

Re: Newly Diagnosed & Thank You, Thank You

interesting curve on 3 and 4 uniits of r almost a similar profile as you would see on n it actually looks pretty good for early in th dx maybe your seeing that longer duration that you would not normally see do to the volume of r which is allot for a 10 pound dog

it does appear the 4 units seem to be ok to start compared with r which would probably mean that the dose will more than likely go up with the n. i do understand waiting a bit to do a curve do to the use of r but i think a week would probably be appropriate to do another curve a reevaluate. dose adjustments up should probably go no more than half unit adjustments for such a small pup

i think thats a great idea to test the needs for insulin can change do to your baby's health improving and you will catch it before it becomes a problem and will help with diet change also as you mentioned

actually im surprised the r did not have a big impact it may show there maybe something else going on the enlarged glands may point to that and like i said when that improves the need for insulin may decrease

[Shellie]

Re: Newly Diagnosed & Thank You, Thank You

Hi and welcome to you and to Stitch! SO glad you found us and found out the insulin was the wrong one! Whew, that was a close call! Sounds like you have been doing a lot of research and while the learning curve on this disease is a steep one...it's well worth the effort to get educated. YOU are the one thing that will keep your dog alive!

Home testing is one thing I just can't figure out with a lot of vets! I wonder why so many are against home testing when it can only help them help their patients. Only thing I can figure is they thing we'll start doing our own dosing changes....which we do! lol But only AFTER we learn how to do it. lol

I would encourage you and I know that every one else here will encourage you as well, to home test. It will not only save you a lot of money but will give you the information you need to keep your Stitch safe. I don't test often but it is one of the things that I rely on whenever I have any question or inkling something might not be right. Most folks do test at least two to three times a day and it really does help. We can certainly help you with ideas and information on what to do and how to do it.

One thing...you did mention the Alpha Trak....you can also use a human meter which works very well for most dogs. I think a lot of us use the OneTouchUltra which has very good comparisons to the Alpha and is about a quarter the price.

Welcome again!

[stitch'smama]

Re: Newly Diagnosed & Thank You, Thank You

Thank you so much for all your advice. I don't cry easily, but reading all your replies brought tears to my eyes. I have already ordered the alphatrak 2 and its on its way.

Stitch had been testing negative for both ketone and glucose around 7am for 3 mornings in a row, aug. 14, 15, 16th. I put a call in to the vet yesterday the 16th 1st thing. They didn't return my call before feeding time, so I fed him, gave him the usual 4 units. Insulin was given at 8:40 am. Vet tech returned my call, and advised me to bring Stitch in for a BG reading. It was 316 @ 10:05am. I was advised if urine tested negative again today to bring him in before eating. I also told them, he was more his old self the day (Aug. 6) I realized the mistake in insulin so it was skipped in the morning, started on Humulin N that evening. He was more perky the following day too, but the longer he's been on the 4 units, he seems more lethargic.

So last night when I administered the the 4 units @ 8:25 pm, he turned his head around, he jumped off my lap, the needle came out, some squirted out in the air and there was about 1 1/2 units left. I didn't give him any more. I figure I got maybe 2 units in. So this morning I was expecting he would not be negative for glucose, on the urine strips, but he was. So no food or insulin and off to the vets office. My regular vet and her assistant are off on fridays so I saw a different internist. His BG was 192. They wanted me to feed him, (I had brought his food.) so they could take it again, but even though he eats fine at home, he wouldn't eat there. They advised they could keep him today and do another curve, he could be getting too much and mentioned the somogyi effect (which I already knew about, thanks to you all!) or decrease his dose to 3 units and see my vet next week. Since he wouldn't eat for me there, I chose to take him home. I fed him and gave him 3 units at 10:05am.

I want to get him back to feeding at the regular 8:15ish time, so is it ok to feed him earlier in 15 minute increments, each day till I get him back to normal time? Also since I saw a different vet, I asked her thoughts on home testing. Same response, it may "interfere" with the owner and dog's relation ship. I don't get, don't know till you try.

[jesse girl]

Re: Newly Diagnosed & Thank You, Thank You

yes you do need to home test with maybe 2 units and still saw negative and 192 reading with half the amount coupled being a bit more lethargic the clues do point to that 4 units maybe to high

good job being proactive sometimes it can be difficult to tell if you are giving to much insulin but home testing will help with that

[SandyL]

Re: Newly Diagnosed & Thank You, Thank You

My Tiggy was started on 4 units and the 2nd day all she wanted to do was sleep. Because of the people here I halfed her dose to 2.... Probably saved her life at the time because it appears she was " honeymooning" and still producing a bit of insulin on her own!!

With home testing and doing curves at home where she isn't stresse, we got her regulated in a reasonable time frame. And contrary to your vets belief about putting a strain on the pets and owners relationship, she still likes me!!! Lol
In fact with the constant care we give our pets actually makes the relationship closer!!!

Sandy

[Cebe]

Re: Newly Diagnosed & Thank You, Thank You

Zoe is a big dog, so it's a little different, but I would say that home testing has done nothing but improve my relationship with her. It makes me truly her caretaker. I don't baby my dog. I treat her more like a 2-3 year old child. She gets scolded if she does something bad, and praised when she's good, and cuddles when she's willing. Testing her gives me the control over her care, which is my job as a doggie mom, and I refuse to substitute the vet's care for my care.

My resources are limited, too, so I have to limit how much I use the vet anyway.

Home testing, if your dog will tolerate it, is more control for you. This disease is a long-term proposition and you need to be able to pivot when the need presents itself and your vet might not be open. Home testing allows for that.