Question on dose adjustment

[mr.G]

Hello, Leo is some variation of cocker spaniel(11 yrs old). I don't have enough words to describe of how healthy he seemed to be until 1 month ago, when he was diagnosed with diabetes.

Now, we are in the phase of finding the proper dosage of insulin and we're having a hard time. (Will attach some curves)

We started the treatment on Saturday, 26 April on 10 units caninsulin only in the morning.

As you can see, we've hit 2.5 mmol/L from 17 in several hours, and amazingly after 24 hours he was at 3.8 so we skipped the dose on Sunday.
I did follow most of the guidelines, timing of food and the like... Since he was diagnosed, I am literally doing constant research over the internet and the like on Leo's situation.

On Monday, the vet instructed me to give 10 again and we get a seemingly but not so abrupt curve. A red vertical line means feeding with insulin, a green one means feeding without insulin.

After this, the vet put me on hold for too days since he was working at another clinic and also due to the fact that he did not know what to do(he told me not to give Leo any insulin for these 2 days). Leo's bg level rose to 20s on Tuesday(no insulin) so on Wednesday I decided by myself to give him 8 units. This time he drops ~6 mmol from 20s to ~15.

The vet comes back on Thursday noon with the idea of doing abdominal ultrasound and blood testing but in the meantime I must only give Leo 8 units. But earlier that day I gave Leo 10 units. He insists a lot on giving Leo only 8 units for another whole week.

At this point, I could already see the cataracts evolving and when I told this to the vet he replied to me : "That's fine! It is worse if he goes hypoglycemic!".So on Friday and Saturday I give Leo 10 units and still the nadir is around 15 each day(as in Wed, Thur).

Today, Sunday, I've decided to give him 12 units and now we get something very similar to the first day of treatment. He smoothly drops from 5 a.m.(time of injection, 17.1 mmol/L) to 1 p.m.(6 hours later, 13 mmol/L). By 4 pm his at 5 mmol/L and by 7 p.m. he is at 17 mmol/L(one hour after finishing his meal). A possibility could be the Somogy effect.

There's much more to say about Leo, but right now I have to find a vet, an endocrinologist or someone that could help me, so I will come back with more information later. I will also upload a better quality version of the bgs and some more bgs.

Does someone have any idea of what's going on just by looking at these values?

Thank you for sparing some of your time to read this!

Picture of curves

http://postimg.org/image/f41xvd0y5/

http://postimg.org/image/hvl7lyzgt/

http://postimg.org/image/ic6f8en7x/

http://postimg.org/image/t97qx69zh/

[mr.G]

Re: Question on dose adjustment

I had some problems posting... this message is just a test to see whether I can post or not.

[jesse girl]

Re: Question on dose adjustment

hi and welcome .

you would think the single dose of 10 units maybe to much . from the lower numbers you posted .

most dogs need 2 doses a day 12 hours apart . the problem with giving one large dose can be problematic if food and the body cant provide enough glucose to keep up with that large single dose which is needed to attain a 24 hour duration

another thought you cant keep going from giving insulin to none because of lower reading .

you could try 4 units twice a day depending on the weight of your pup and if you see relatively flat numbers with no big swings . dont worry about how high the numbers are so to build a foundation on where to start .

this way you giving a continuous action of insulin working and hopefully evenly though that 24 hour period

[Riliey and Mo]

Re: Question on dose adjustment

Hello and welcome

Firstly can u give us more info on your dog

What food is he eating and how much?

Do you have a recent curve you can post. This will give you more data on your pup.

Whats his weight thanks?

What glucose meter are you using. ??

3.8 bg could be higher compared to the gets lab meter or the animal alphtrack meter. Then there would be no need to intervene and skip an injection. Lets us know the answers kk!!

Mr Gee. Its good not too chase numbers but c the overall picture of your dogs habits. Insulin, what kind, how much twice a day over a 12 hour period. How much he, s fed, what he, s fed. What exercise he gets.

I got a cockerspaniel mix cockapoo. 20 lbs, gets 5 1/2 units nph insulin right after his 1/2 cup of fromm surf and turf food. Just a sample, every dog is different Mr Gee

[mr.G]

Re: Question on dose adjustment

Thanks to all for the welcomes.

Firstly can u give us more info on your dog

I apologize for this, but there are so many things to say and I'm very busy since I'm monitoring him almost all the time. I'm mostly alone in this.
Leo is most likely not purebred. I know for sure his mom was closer to an english cocker spaniel than he is. I'm guessing that his father was a labrador or something like that since he has a much sturdier built than a cocker. I've seen his mom, but not his dad. Hence he's always weighed more but I can assure you that he's never been fat.

What food is he eating and how much?

Right now he is eating 2 cups Royal Canin Diabetics diet.

Do you have a recent curve you can post. This will give you more data on your pup.

I don't have a scanner with me, I will upload once I get myself to a scanner.

Whats his weight thanks?

now around 21 kg and up until 1 year and several months before he weighed around 24 kg.

What glucose meter are you using. ??

Bayer Counter next EZ

[Rubytuesday]

Re: Question on dose adjustment

I don't have a scanner with me, I will upload once I get myself to a scanner.

Hi Mr. G and welcome.

Most of us just write the curve out such as:

6am 220 food and 5u insulin
8am 250
10am 180
and so on until
6pm 200 food and 5u insulin

The above numbers are just to give you an example. I think you are in Canada so the numbers will look different.

Tara

[k9diabetes]

Re: Question on dose adjustment

Are you still giving insulin only once a day?

Caninsulin really must be given twice a day to work. I honestly don't know why it was marketed as a once daily insulin - it is constructed exactly like other insulins that were always given twice a day.

In ten years and roughly a thousand dogs, I've seen, at most, five dogs who could by on once daily injection of NPH or Caninsulin.

And, at least at times, 10 units at a time has been too much for him.

I would drop to... maybe 6 units... twice a day if you are still on once daily injections of 10-12 units.

When you are close to the right amount, even half a unit can make a big difference. Our dog was on about 7-8 units and I adjusted his insulin by a quarter of a unit at a time using a syringe with half unit marks.

As far as the cataracts are concerned, given how quickly they became apparent after treatment, the process had likely already begun before that and there isn't anything you could have done to prevent them.

Yes, hypoglycemia is dangerous but it's not such a worry for someone testing blood sugar at home. You have already started gathering data about how his body responds and can come to a point where he can be on a stable dose of insulin and you will have a good idea of how consistent he is, when his blood sugar is lowest during the day, and how low it usually goes. Which is all you need to manage his diabetes safely.

Try to get on a stable dose of the same number of units of insulin with a meal every 12 hours, a dose at which his blood sugar never ever goes below 150 (and could be higher than that, just not lower). Then stay at that dose for at least a week before conducting a blood glucose curve.

Tell us the results of the curve and we can give you an idea of how things are going with that dose.

Slow, methodical steps are the fastest way to the right dose of insulin. Once it's overshot, the blood sugar is erratic and you don't know what is working and what isn't. So you start with less insulin than you think you will need, give it consistently for at least a week, measure the results with a curve, and adjust in small increments.

The only exception to waiting a week is low blood sugar. If the blood sugar goes low, immediately drop all future doses of insulin until you get no low blood sugar and then start the week-long-wait over again.

Natalie

started the treatment on Saturday, 26 April on 10 units caninsulin only in the morning. and hit 2.5 mmol/L from 17 in several hours, and amazingly after 24 hours he was at 3.8

The vet comes back but in the meantime I must only give Leo 8 units. But earlier that day I gave Leo 10 units. He insists a lot on giving Leo only 8 units for another whole week.

Other than the once a day part, the above advice is good advice.

At this point, I could already see the cataracts evolving and when I told this to the vet he replied to me : "That's fine! It is worse if he goes hypoglycemic!".So on Friday and Saturday I give Leo 10 units and still the nadir is around 15 each day(as in Wed, Thur).

Today, Sunday, I've decided to give him 12 units and now we get something very similar to the first day of treatment. He smoothly drops from 5 a.m.(time of injection, 17.1 mmol/L) to 1 p.m.(6 hours later, 13 mmol/L). By 4 pm his at 5 mmol/L and by 7 p.m. he is at 17 mmol/L(one hour after finishing his meal). A possibility could be the Somogy effect.

[mr.G]

Re: Question on dose adjustment

Hi Tara and thanks,

I have around ~100 data points since I've started the treatment. It would take some time.

@k9diabetes

Caninsulin really must be given twice a day to work. I honestly don't know why it was marketed as a once daily insulin - it is constructed exactly like other insulins that were always given twice a day.

Yeah, I have the same reasoning, you should have listened to my vet repeating three times to me that I should keep him on 8 in the morning, "cuz otherwise we have to start all over"(him saying). Also, he charges 39 $ just for looking at one curve, so I've kind of lost faith in him.(he may have the intention of lenghtening the treatment on purpose).

As far as the cataracts are concerned, given how quickly they became apparent after treatment, the process had likely already begun before that and there isn't anything you could have done to prevent them.

As long as I could regulate his bg, they should stop.

So you start with less insulin than you think you will need, give it consistently for at least a week

I'm trying a bit faster, I'll change it at three days apart. I'm having someone near him almost all the time.

Are you still giving insulin only once a day?

No, more on this below.

I'll try to add some information about Leo.

He started urinating and drinking water excessively around 13 April. Shortly after, I went to a vet with him. His blood glucose was 23 mmol/L and he had a urinary tract infection. Just after these 2 tests the vet gave a certain diagnostic of diabetes(no repeats of the tests).

The links to the pics I have put above denote the curves between 25 April - 2 May(the name of the pics give the date of curve). For 2-3 May and 3-4 May i have almost identical results to 1-2 May. Therefore, on Saturday I have given him one dose of 12 units in the morning and had very similar effect to the first day of treatment. He goes very steep, 5 a.m. administration of insulin(at 18 mmol/L) and by 4 p.m. he's at 5 mmol/L.

Now, I was sure I should give him twice dosing, so I gave him 8 units in the morning and 9 units in the evening. We start at 17 mmol/L at 5 a.m. and throughout the day I get very little variation(about 1-2 mmol/L) for the first 12 hours(glucose goes up and down) and something similar for the other half of the day, except now we have a larger variation(6 mmol/L). Next day, I give him same dosage, even less variation throughout the day except now we started at 14 mmol/L.

Next day, I gave him 10 in the morning, 12 in the evening. Now something wierd happens. For the 1-2 hours after meal and administration his BG rises(instead of dropping).

Next day, which is yesterday, same dosage, but now we stay in the range 10-15 mmol/L all the time. And same thing is valid for today.

I see a pattern, the higher dosage we give Leo, the more abruptly his bg goes up for the first few hours(2-3)(probably the part of intermediate insulin of caninsulin ~30 % is disolved harder, or some kind of alergic reaction, or resistance to it). The other, 70% lente, does its work and Leo goes fairly smoothly down. I'm thinking we might need to change the insulin to faster acting one (Humulin R, maybe).

If someone knows a good vet in the Kitchener-Waterloo region of Ontario, please let me know.

[amydunn19]

Re: Question on dose adjustment

Hi and welcome to the forum. I am trying to follow along what is happening with your dog and it is a tad confusing. I have always been able to just read numbers - sometimes a chart or graph makes my eyes glaze over. You really have been busy - there is a great deal of info and though I can appreciate your hard work, I think you may be trying to draw conclusions a little too early in the process about some of the things you are seeing.

I can see why you were not thrilled with the vet's advice of once daily dosing. He rightfully should do better on two doses a day. The vet had him on 8 units once a day and now is he getting about twice that amount, right when you add both his doses together? The vet's dose was probably a little low starting out. I am just wondering if starting a little lower twice a day would have made a difference.

The part I am not understanding is the speed at which you are changing doses. This process should be a slower one if done correctly. Doses should be given a minimum of 5-7 days with no changes of any kind, then do a 12 hour curve, and re-evaluate your dose. By changing so quickly, you are not giving his body enough time to adjust to the dose. Dogs need more time for their bodies to adjust to a new dose - we call it settling. When you rush the process too much, getting his blood sugar under control becomes much harder and you may actually go past the proper dose. Being reactive with this type of insulin is not effective in lowering blood sugar.

It is hard to make a judgement about insulin and if caninsulin is not appropriate because there just isn't enough time yet to determine that. I would like to see him on a stable dose without changing anything for 5-7 days. Then do your curve again.

I know you want to get this under control but it kind of has its own time table. The cataracts are part of it all and may develop despite your best effort. You can always have them surgically fixed if they do develop. Blindness is not the worst thing that could happen and many dogs adapt well to it.