Remy Newly diagnosed Diabetes

[jesse girl]

With all that is going on with remey the chances for consistency maybe difficult . It is possible you are giving to much insulin but a try at a lower dose and what that dose could be is a coin flip . Also if that's the case of to much the body can be so out of whack it can take sometime to get things to settle which may result remey in higher ranges . Just to give some perspective 30 pound Jesse got 6 units total for a day of nph which usually would be same dosing with vetsulin .

[RemysMom]

I think when we started three years ago he was getting 2U twice a day. We have slowly worked our way up depending on how it was working. Last week we had several very nice days but now we’re back to dwindling response. Here is is 4:30 in the afternoon and he’s up to 400 + already. I was doing 5 - 5.5 U twice a day for quite a while but got into this rut of little response. I’ve tried splitting the dose 2.5 early evening and 3.5 with his 10 PM dinner.that doesn’t do much either. There’s no way for me to know why he has a good day/s vs. bad ones. Maybe NPH is a stronger drug than Vetsulin. Typically we have found Vetsulin to have a slow onset of effect and it doesn’t last long enough. But with all the ups and downs of his cortisol plus the newly diagnosed bladder tumor I think we’re all hesitant to make too many changes at once. I’ve got the Humulin R in the event he is miserable later on. I’m saving it for ‘emergency situations’ so far.

[jesse girl]

It's difficult to really dive into this . So many factors at play that can have a impact . Now I believe vetsulin has a fast acting component built into the insulin . Now it's just a fleeting memory so don't take as gold . So basically it should have a early onset to start . Nph does not have this component and why R is provided. Now when Jesse was briefly on vetsulin ( maybe a couple weeks ) and then switched to nph the action seemed relatively the same but it was such a short time that I can't be absolute . Most dogs who have made the switch did see similar results . Some saw improved consistency . Most made the change for price and just easier to work with . I don't remember any switching back to vetsulin after going to nph . So as I suggested I would not expect a game changer but could give you a reset .

[Riliey and Mo]

yes i agreei asked earlier if you ever dropped Remys insulin back to see if he levelled out.
now hes rising again after an increase is signs of overdosing

i wouldnt be raising his insulin any higher giving your seeing higher and higher numbers

for starters i would try dropping insulin then change food then change injecting after he eats

i would drop down the dose 1 unit and drop 1/2 unit after that till you see some levelling off low 300,s
thats how overdosing works the numbers go higher as your seeing.
the other problem is the sensor does not show high numbers

changing food is another alternative but then you need to solve the issue with rising blood sugar

its tricky to change foods, find the right consistency he likes oof course, then find the right amount to meet up with the insulin

also injecting 30 minutes after food can be the problem with higher numbers as the insulin and food arent meeting up

it takes half hour to see in the blood sugar what numbers are showing?
if there high the food could be the problem. too much?
it takes 1 1/2 hours for insulin to show in bg. what are his numbers at this point

[RemysMom]

Let me clarify. We went up to 6 U on the advice of the internist because we were not getting much response to 5-5.5 anymore. We have the cortisol situation that may or may not be affecting things. I usually give his insulin about 30 minutes before his dinner. We spoon feed him so it takes 20-30 minutes for him to have his meal. It’s a slow process, not like most dogs who happily gulp down their dinners. He eats the same amount of food every meal. His weight has been consistent for about 18 months and is perfect for his size at 14#. We are now being faced with the manufacturer of his food discontinuing all but three flavors. Remy doesn’t like to eat the same thing for dinner as he had for breakfast. He tends to spit it right back at us. So we either have to find a different food or he’ll have to get used to three rotating flavors. His stomach is rather sensitive and we have limited his diet to what agrees with him (canned pate wet food by SImply Nourish) He hasn’t been in the hospital for pancreatitis in two years now. He does not get snacks or treats unless he’s going low glucose. Vetsulin takes hours to kick in. Today it was 7-1/2 hours before he started to drop below 400. Now, 3-1/2 hours later he’s headed back up again and he didn’t get below 200. It’s frustrating to say the least. The endocrinologist suggested we try Degludec but none of his other doctors are familiar with it and are concerned if we run into problems late at night or over the weekend nobody will be around who understands this insulin to help us. I know humans will use a fast/short acting insulin before meals to help prevent postprandial spikes. I have also heard of people doing this with their pets and reducing the dose of intermediate or long lasting insulin. His internists aren’t in favor of this. And I’m afraid to ‘go rogue’. Remy has never had a consistent curve. In fact, the only consistent thing about him is that he’s inconsistent. He’s always been that way. Whether its related to his cortisol situation I don’t really know. You are correct, sensor doesn’t show above 400 but I can usually tell by his behavior if he’s around 400 or much higher. We do have the AlphaTrak and can stick him to verify numbers but I need my husband to help me do that. Remy fights like a wild thing when I have to do a stick. The good thing is even though he’s hanging around 400 much of the time, he’s not uncomfortable and he’s not drinking excessively. I do have the Humulin R if he becomes uncomfortably high. I appreciate the information and I’m trying my best. I hung in there at 5 to 5.5U for weeks before I went up to 6. It seemed great for a few days but now we’re back to the same slow response and limited time of action.

[jesse girl]

I think the key word in your comments is comfortable and that's what your are doing for remey . Rouge is all I did with Jesse as she was to complex for her regular vet as he read out of the medical journal on how to proceed . At the time that was the best thing I could do .
now you could give some fast acting after remey has ate . Half unit . I would probably back down to 5.5 units of vetsulin to start and see if you can get maybe in the 300s and maybe 200s .

If at a lower level of blood sugar on the next shot don't give the fast acting .

You are really not giving more insulin . Your just giving more insulin action upfront with food which is normal for humans .

You stick to the protocols when to give and how much .

It's not difficult and isn't involved . It's just dosing . You can even hold off the vetsulin a bit to see how the r interacts by itself . Probably would have to wait up to an hour .

Lots of dosing possibilities that may benefit Remy .

[Riliey and Mo]

i agree dropping back the insulin and also agree injecting half a unit after he eats . that should drop 50 points. but also eating and injecting right after food should work.

Remy looks sooo nice and comfy in his bed. thankyou for sharing his picture

[RemysMom]

Last night I dropped Vetsulin to 5.5U injected at 9:25 PM. Fed dinner at 10. He was 400+ when I started and it was close to 3 AM before he dropped below 400. Got down to 160 but by 9 AM he was back up to 400. Gave 5.5U again and breakfast at 10 AM. It is now 6 PM and he has finally gotten down to 300. Started to drop around 4:30 but it was minimal response until around 5:30. The one time he was given an injection of Humulin R it was I believe 1U and it dropped him a couple of hundred points and lasted about 2-1/2 hours. (This was administered by his primary care) I could try .5U and see what it does. But since he’s been relatively comfortable I haven’t wanted to rock the boat. I think if I’m going to try it I would be wise to do it at breakfast instead of at night where we would have to make an ER run if things went wrong. I do have 50% dextrose which the internist gave me if I need to boost his glucose fast. But I would feel more comfortable trying it in the morning. There’s nothing worse than having to rush to the ER in the middle of the night. I think maybe try it Saturday when we will be with him all day and don’t have to go anywhere so we can watch his response. My plan would be not to use it unless he was over 400+ though. With him he can suddenly go in the opposite direction for no apparent reason and wind up down in the 60s. So I admit to being nervous about using the fast acting except when I know he is over 500 and obviously uncomfortable.

[Riliey and Mo]

i dont understand why your injecting first then waiting 30 minutes to feed. it can be dangerous if for some reason Remy doesnt eat.

where do you inject?
most common place is top leg mid back and rotate evening and night

whats his curve like injecting right after he eats?

feeding then checking his bg is over 200 then inject insulin is the prodocal for regulation.

might be a better plan to start over feed then inject insulin according to his weight right after meals

your getting results dropping down. its good if you can get him down to 4 units then feed and inject 4 units right after food

[Riliey and Mo]

goodafternoon,
thinking of you and Remy. i apologize for my questions and suggestions as sometimes i find it frustrating not knowing or having data posted.
how is he doing? eating okay, good fecals

[RemysMom]

I’ve been having some problems getting onto this site. Don’t know if it’s software or our internet here which has been horribly slow lately. Remy is doing OK. Not responding much at all to Vetsulin I think it’s probably time to make a change to something else. He’s pretty much in the upper 300s to “high (which means over 400 on the sensor). It’s totally different from the pattern he was in for the past several years. So either he is becoming resistant to Vetsulin or it could also be his cortisol levels which have been erratic the past few months. I do wish I old post the libre graph on line but it is never clear no matter how I do it. Yesterday he was in the 400 range most of the day. I might as well give him injections of water. Late afternoon he’ll drop for a couple of hours to around 250 and then right back up. Same in the morning. He went down to 350 around 7:30 this morning and down to 319 and back up to 350 at 10 AM. Remy is never consistent and has not been for the past 3 years. None of his various doctors seems to know what to do with him so they tell me I know him best and as long as he’s comfortable to keep doing what I’m doing. To answer your question he is eating. We always spoon feed and he always eats it all. Good fecals, no diarrhea. Drinking fine, seems OK. He was happy and playful last night. Most of the time he sleeps. 22 hrs out of the day he sleeps. We just started meloxicam Saturday for the bladder cancer so I’m watching for potential GI upset. I’m going to try a photo upload from LibreLinkUp and see if it’s clear IMG_7617.png Still not the best but maybe you can read it. This is typical of what I’m getting now. Very brief drops and then right ack up. This was from midnight until now.

[Riliey and Mo]

glad your getting logged in Claire and thanks for the sensor pic but looks the same as the previous post.
i.ve been re reading your k9cushings and k9dbs posts regarding the vetinsulin. seems it hasnt worked to regulate since the beginning.
i agree with you its time to switch insulin and suggest the novolin or humulin nph.
what you need to know its very important to drop Remy's dose back down. nph is more concentrated needs less. change syringes from u40 to u 100

checkout the insulin section on k9 websight

heres an example

0.25 u/kg of weight is starting dose twice a day after food
14 lbs = 6.35 kgs
6.35 x .25 equals 1.58 iu nph starting dose

nph U 100 syringes

i would start at 1 1/2 or 2 units after food inject and monitor the sensor after 30 minutes to 1 1/2 hours
continue for 4 or 5 days
checking his sensor right after food if hes under 200 wait 30 minutes check again

[RemysMom]

He got down around 200 for a bit but then headed back up to 400. I have both U40 and U100 syringes. I really don’t understand why his doctors haven’t wanted to try NPH or Humulin. I used Humulin for another dog many years ago. I’ve asked about it a number of times. We did try PZI a couple of years ago but it didn’t work any better than Vetsulin. The situation with Vetsulin has changed considerably since the change in cortisol levels late fall and thru this winter. He’s never been consistent or had a nice glucose curve but it wasn’t like this where it hardly works at all. He can have crazy unexplained low glucose at times but never clinical symptoms. His alarm always goes off if he starts going low. I’m going to check and see if I need a Rx for NPH. I have to talk to his internist anyway and set up appointment for monitoring his bladder tumor. Endocrinologist really wanted us to try Degludec but it scares me a bit. It can last quite a long time in the body.Thanks for the advice!

[Riliey and Mo]

thanks for letting us no
keep Remys updates coming
big hugs to Remy

[Riliey and Mo]

yes good to wait longer for the meloxicam to settle in before more changes
hope your going to revisit changing to nph insulin at a low starting point for his weight see previous post