dosing

[jnklein13]

my 8 y/o rott mix was just diagnosed with diabetes today-her glucose was 682 when she was tested this morning! she was prescribed 55 units of insulin bid and she weighs 115 lbs--i dont mean to second guess my vet but that sounds like an awful big dose and im kind of leery to give it to her! anyone else have to start off with such a big dose?

[CraigM]

Re: dosing

Welcome to the forum.

Yes, that seems much more than normal to start with! A common starting dosage is frequently .2 unit per pound, so about 23 units twice a day. Of course this would be a starting dosage and over time the pup could require much more. I would suggest you contact your vet with your concern, it might have been a misunderstanding?

What brand of insulin is she on? Has she been spayed?

Craig

[jnklein13]

Re: dosing

she is spayed and Novolin was prescribed! i just dont want to bottom her out-today has been awful enough for her and I-we also discovered today she has a slightly bulged disc that was not causing her much discomfort til she was poked and prodded and irritated getting in and out of vehicle!

[amydunn19]

Re: dosing

Could it have been 55 total - if that is two doses 12 hours apart, then it would be 22.5 per shot? I think that 55 units twice a day is too aggressive to start.

[CraigM]

Re: dosing

If your vet clinic is already closed, I might go with 23 units tonight and in the morning. Then contact the clinic for clarification. Or, you might contact an urgent care clinic and discuss with their vet?

Will you be feeding twice a day? Identical meals? Have you read about home blood testing? Home blood testing is done by most on this forum.

Btw, Novolin-N is $25/vial at Walmart. Syringes are low cost there also.

Craig

[jnklein13]

Re: dosing

she said being a big dog it would take A LOT! she figured that amount and told me that itd be 55 units bid, and thats what was called to Walmart! :-( i reluctantly gave her 50 units, its been about an hour since, and I have karo syrup on stand by! she gets fed twice a day, its weight management food for about the past year. Have had a really hard time getting her to eat past two weeks now tho, so ive been mixing a few tablespoons of wet weight management food with it (checked it tonight to make sure no sugary stuff in it)

[momofdecker]

Re: dosing

Welcome to the forum. Do you know if a curve was done to determine the 55u bid starting dose? Did the vet keep her overnight or at least all day to check her blood glucose (bg) every two hours?

I'm asking because I had a 97 pound dog who was started on 35u of humulin N and then raised to 40u the next day. He was sent home with instructions to give him 40u BID. We never asked for his records but thankfully were checking his bg at home. By day 2 we knew something was wrong. It happened to be a Thursday and the vet office was closed on Thursdays. My dog's bg prior to morning insulin was only in the 80's. We didn't dare give him 40u of insulin so we skipped the dose. We carried on for 7 days as instructed and skipped the dose when we felt his bg was too low. The vet never explained what a curve was nor did he explain to us that the dosing was based off the lowest reading in a curve.

Long story short - we overdosed him pretty significantly. When we reduced his insulin we dropped back to 20u, which was still too much, then back to 15u and started over. Several months later we asked for a copy of his records. What we saw was that one dose of 40u dropped his bg to LO. It was the last recorded reading in his records, with no sign of the LO being treated. Yet we were still told to give him 40u BID.

We were also never told that exercise could lower bg in diabetic dogs. We had a high energy boy and had it not been winter in NY he could have been in serious trouble.

There is a chance your pup could end up needing 55u BID - but unless a few curves were done to determine that starting dose - I think it's quite irresponsible of your vet to start your dog on that dose. I agree with Craig & Amy and would recommend you reduce the dose.

There are ketone strips which you can purchase at most local drug stores. Ask the pharmacist to point you in the right direction if you can't find them. You can test your gals urine for ketones at home. If she shows anything more than trace it can become life threatening - a condition known as DKA or Diabetic ketoacidosis - and you should seek emergency veterinary care for her. That is the major risk of her bg running high. The risk of it running too low is death.

You have great instincts to question the 55u BID. Way to follow those instincts. Welcome aboard!

Holli

[amydunn19]

Re: dosing

There are really not different rules for big dogs versus little dogs. Insulin is figured by weight and dogs are typically started conservatively at 1/5 unit per pound. If a vet is more aggressive they might start at 1/4 unit per pound. Please reconsider this dosage. Holli lived this with her dog, Decker. Your dog may need 55 units but he might only need 25 units. Scary the difference in those two - curves need to be done to establish some patterns and you have to be slow and steady with raises. Too little insulin can be raised, too much can be deadly.

[jnklein13]

Re: dosing

nothing was mentioned about a curve, but i started crying like a baby when i was told she had diabetes and it was something alot of people choose not to treat, but instead have them euthanized, so i dont know, and didnt know what all to ask, other than her diet! they did not keep her either, just sent her lab results with me and said to bring her back in two weeks! It sounds like i need to make a list of questions for them and make a call in the morning!

[jnklein13]

Re: dosing

I have a feeling I'm going to have a long night ahead! I'm afraid to not keep an eye on her tonight now! If I've read correctly it starts acting in 1-2 hrs and peaks anywhere from 4-12, right??

[PupsterNYC]

Re: dosing

I was also told that many people choose euthanasia over treating diabetes. I think it's reprehensible to paint that kind of picture just when you've dropped this kind of health bomb and devastated the dear parent(s) of the pet.

I am only one month into our diabetes diagnosis, but I do want you to know that it gets better, even from where I'm sitting. This forum is amazing. I was afraid to write here for fear of hearing that I should euthanize, but it's been the opposite, and now I feel like I could say anything and be helped.

Your dog is lucky to have you. Have faith, things will get easier (I'm telling myself that as much as you, but things are much better for me than they were three weeks ago already).

Hugs.

[Jamie_DeBree]

Re: dosing

You know, the more I read through these posts, the more I think vets overdose more often than not when dogs are first brought in. Scary, but it seems like they just follow the insulin manufacturer's instructions blindly instead of being more conservative/safer.

It really is overwhelming - Lucy was just diagnosed last week, so I hear ya on way, way too much info at once. And how horrible that they mentioned euthanasia right away! I'd be looking for a new vet after that, personally.

You have great advice from people who have done this far longer than I for tomorrow regarding her dosage and such, so try to breathe, and just keep an eye out tonight. And if you don't like what the vet tells you tomorrow, don't hesitate to call around and find another vet.

Hang in there!

[amydunn19]

Re: dosing

Sadly, that is the way some vets view things. My vet said he didn't push home testing before he had Maggie as a patient because people are very overwhelmed and some would choose euthanasia if he threw testing into the mix. I have opened his eyes to the value of home testing but it has been a struggle. Now, he at least mentions how well Maggie has done if people seem to be open to it.

Many vets don't have much diabetes knowledge beyond the "book" but a general vet doesn't really get a ton of experience especially in testing and curves in their every day practice. It seems to be a trend that vets no longer do many curves - they think every dog has their low point at the same time. We have found that every dog is different in their response to insulin. That is why many of us home test and have taken on the management of this disease.

I would just watch him - if he starts to look shaky or stumbling or anything hypoglycemic, give some Karo and something carby. If you are really worried, you could give him some food and start over tomorrow.

Most of us keep a notebook and write down questions and any observations you might make and your schedule (what time and how much you feed, insulin) to keep it all straight. Don't worry - this forum is a great source of information and there is always someone to answer questions or help.

[momofdecker]

Re: dosing

http://www.caninediabetes.org/pdorg/..._questions.htm

Here is a link to a site with good questions. A member here shared this with me when I realized we needed a more skilled vet.

The insulin peak for every dog is different and the only true way to know when it is would be by testing and multiple curves. Let us know if you are interested in learning how to monitor bg at home. It can be overwhelming at first but over time becomes routine. The information it provides can let you know how well balanced your gals food/insulin are, can help you understand how her insulin dose is working and if it needs adjustment, and it can save you a lot of money vs paying a vet to do it.